Hypertension exam study questions with complete solutions graded A+ 2024, Exams of Nursing

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solutions graded A+ 2024

1. Target HBPM goal for treatment is:: <135/
2. Target HBPM goal for treatment in high risk patients is:: <130/
3. Above 115/75, for each increase of 20mmHg in SBP or 10mmHg in DBP, the risk of major CV and stroke events:: doubles
4. in 3 adults >18yrs have HTN.: 1
5. What percent of patients with HTN are under control?: 52.5%
6. What two populations have the worse BP control?: -Black males -Hispanic males
7. Why are black males more at risk for uncontrolled HTN?: -enhanced renal sodium absorption -3-5x more likely to whites to have stroke and kidney disease
8. Prevalence of HTN:: -higher in men until age 45 years -similar rate men and women 45-65 years -higher in women after 65 years
9. Is DBP or SBP more important CV risk factor until age 50.: -DBP
10. SBP or DBP is more important after age 50.: SBP
11. BP in Europeans:: -stroke risk assessed by both SBP and DBP until 62 years

solutions graded A+ 2024

12. Nocturnal BP dips how much at night:: 15%
13. Non dipper has what higher risk?: CVD and renal disease
14. What is the most common problem in primary care?: hypertension
15. Risk of HF in women with HTN:: increased 3x
16. HTN present in majority of:: -MI -1st strokes -CHF -PAD
17. Modifiable risk factors for HTN:: -obesity -metabolic syndrome -high dietary intake of fat -excessive sodium intake -physical inactivity -excessive alcohol intake -tobacco use
18. Non-modifiable risk factors for HTN:: -AA -advancing age -family history

solutions graded A+ 2024

-daytime avg >140/ -nighttime avg >125/

26. checking for orthostasis:: -have patient stand for one full minute before taking BP
27. Target organ damage to the brain:: -CVA -encephalopathy -dementia -multi-infarct -early cognitive decline
28. Target organ damage to the eye:: -can damage retina -hard exudates -flame hemorrhage -cotton wool spots
29. Target organ damage to the heart:: -LVH -CAD -MI -Rhythm disorders -aortic and PAD

solutions graded A+ 2024

-AAA

30. what drug is most effective for decreasing LVH?: ACEI
31. LVH is a risk factor for:: -stroke -CAD -PAD -HF
32. target organ damage to the kidney:: -CKD -GFR <
33. What is the new target organ to assess:: -erectile dysfunction -is independent CVD risk factor
34. Normal BP classification:: SBP <120 DBP <
35. Prehypertension classification:: -SBP 120- -DBP 80-
36. Stage I hypertension classification:: -SBP 140- -DBP 90-
37. Stage II hypertension classification:: -SBP >= 160 -DBP >= 100

solutions graded A+ 2024

42. Hypertensive emergency:: -hypertensive encephalopathy -dissecting AAA -unstable angina -acute HF -pulmonary edema -acute RF -eclampsia
43. Drugs used in clinic to lower BP in hypertensive urgency:: - furosemide 20mg -clonidine 0.2mg
44. Accelerated HTN:: -clinical evidence of severe arteriolosclerosis -Grade 2/4 hypertensive retinopathy -poor prognosis if untreated -renal insufficiency w/o apparent cause except HTN
45. Meds that can elevate BP:: -oral contraceptives -cyclosporine -tricyclic antidepressants -sympathomimetic decongestants

solutions graded A+ 2024

-corticosteroids -NSAIDS

46. Mnemonic for secondary HTN causes: ABCDE: -Accuracy, aldosteronism, apnea -Bruits, bad kidneys -catecholamines, cushings, coarct -drugs, diet -endocrine, erythropoeitin
47. Sleep apnea:: -CPAP
48. Coarctation of aorta:: -htn in young person -decreased BP in LE -diminished or absent femoral pulses -CXR: post-stenotic dilation of aorta
49. Pseudohypertension:: -wall of brachial artery is rigid from calcification -in office test: see if radial pulse obliterates when cuff is inflated. -suspect in patient with dizziness/weakness who has normal to high cuff reading on tx.
50. Renovascular HTN clinical findings increase probability: -unilateral

solutions graded A+ 2024

-LFT

54. Heart exam:: -louder S2 or systolic ejection murmur, split S2, high-pitched diastolic murmurs -LVH (heave or EKG) -echo
55. Kidney exam:: -UA -Cr -microalbumin -renal artery bruits -potassium (high can be renal, low aldosterone excess)
56. JNC8 BP goals:: -SBP <140mm (150 if >60 yrs old) -DBP <90mm -DM, HF, CRF: <140/90mm
57. BP goals in older adults:: -<140/90: 65- -140-145 for 80+
58. HTN lifestyle modifications:: -weight loss -DASH diet -decreased salt intake

solutions graded A+ 2024

-limit ETOH -tobacco cessation

59. Alternative tx options:: -Aerobic exercise: Level A -acupuncture: Level B -guided breathing: Level B 60. BP algorithm:
60. Potassium in HTN:: -increasing potassium lowers BP -low sodium diet is high in potassium -high sodium diet lowers potassium
61. Sodium recommendations:: -2,300 mg for avg adult -1500mg for persons with HTN, middle-aged+, blacks
62. Recommended amount of sodium intake per day:: 1500mg
63. Stage I HTN DOC in blacks:: CCB or Thiazide
64. Stage I HTN DOC nonblack <60 years old:: -ACEI or ARB
65. Stage I HTN DOC nonblack >60 years old:: CCB or Thiazide

solutions graded A+ 2024

-caution in gout/hyperlipidemia -may increase lipids -reduces urinary calcium; may prevent stones -NOT EFFECTIVE with high serum Cr/impaired RF

77. Loop diuretics:: -used in pts with renal insufficiency -not in gout -may increase calcium loss causing osteoporosis
78. Furosemide, bumetanide, torsemide:: loop diuretics
79. Non-thiazide diuretics:: -indapamide -increases glucose -prolong QT interval 80. Potassium sparing diuretics Mineralocorticoid antagonist:: -blocks aldosterone effects -caution if renal insufficiency -has anti-androgen effects -often 3rd or 4th drug add-on
80. Potassium sparing diuretics:: spironolactone
81. Epithelial sodium transport channel antagonist:: -amiloride and

solutions graded A+ 2024

triamterene -K+ retention

83. ACEI:: -blocks conversion of angiotensin I to II -lower peripheral vascular resistance and BP -no reflex stimulation of HR and contractility -preferred in DM, MI, HF -reduce morbidity and mortality in HF and MI -retard progression of diabetic renal disease and hypertensive nephrosclerosis
84. ACEI or ARB + diuretic + NSAID or ASA can:: -lead to acute RF
85. ACEI and serum Cr:: -can increase serum Cr by 30%; it reduces pressure w/in glomerulus and decreases filtration. -reversible
86. ARB:: -blocks action of angiotensin II -used in HF, DM -NOT in pregnancy
87. What drugs should you not combine?: ACEI with ARB or renin inhibitors
88. CCB:: -widely variable effects on heart

solutions graded A+ 2024

95. Alpha-adrenergic antagonist: -blocks alpha 1 adrenergic receptors causing vasodilation -increased incidence of HF -not first line agents
96. Centrally acting BP agents:: -clonidine -excessive sleepiness, fatigue, BP rebound -start dosing at bedtime
97. first line combo therapy:: -consider if >20/10mmHg above goal
98. orthostatic hypotension:: -at least 20mmHg fall in systolic -at least 10mmHg fall in diastolic -sx of cerebral hypoperfusion such as dizzines
99. ACEI + thiazide:: -preferred; good -decreases risk of hypokalemia
100. ACEI + dihydro CCB:: -ACEI reduces edema from dihydro CCB -use ARBS when unable to tolerate ACEI
101. Caution in lowering DBP to quickly:: -AHA recommends caution in lowering DBP quickly or below 60mmHG in those with occlusive CAD, myocardial ischemia,

solutions graded A+ 2024

60 years old, diabetics

102. African Americans:: -do not respond well to ACEI or BB; -do better with diuretics and CCB
103. Elders with isolated systolic HTN:: -low dose thiazide or log- ating CCB reduces mortality and morbidity
104. LVH:: -ACEI or ARB reduce ventricular mass and help with remodeling
105. diastolic dysfunction:: -CCB or BB may provide symptom relief and modest decrease in contractility
106. adverse effect of ACEI: -cough -angioedema -teratogenic
107. adverse effect ARB:: -angioedema -teratogenic
108. adverse effect CCB:: -ankle edema
109. adverse effect hydralazine:: -lupus like syndrome -peripheral sensory neuropathy
110. adverse effect of diuretics:: -gouty arthritis

solutions graded A+ 2024

117. JNC8 preferred agents:: -general population: thiazid e CCB ACEI ARB -black: CCB or thiazide -DM: thiazid e CCB ACEI ARB -CKD: ACE ARB
118. If goal BP not met after 1 month tx:: -increase dose of initial drug or -add second drug

solutions graded A+ 2024

119. If goal BP not met with 2 meds:: -add and titrate third med -do not use ACEI or ARB together
120. JNC8 three choices to dose meds:: 1. titrate to max dose, then add second drug. 2.Add second drug before achieving max dose of initial drug. 3.start with two drugs at some time if SBP >160 and/or DBP>100mmHG
121. Refractory HTN is usually due to:: -ETOH -non-adherence -hyperaldosterone
122. Resistant HTN defined as:: on 3 drugs w/o control and one must be diuretic.