NR 511 – FINAL EXAM STUDY GUIDE QUESTIONS WITH ANSWERS RATED A+ DOWNLOAD TO SCORE A.2023.Q, Exams of Nursing

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A.Qualified

HYPERTENSI ON

CLINICAL PRACTICE

A.Qualified

GUIDELINES NR511:

DIFFERENTIAL DX 2023.

CERITA SPEARS, RN

A.Qualified

INCIDENCE

& PREVALEN CE IN THE

US

➢

108M people in the United States

• 21M require lifestyle changes

• 87M require RX + lifestyle changes

• Most hypertensive adults are uncontrolled

➢

$131 Billion in costs were associated with HTN from 2003 to

➢

54% of the nation’s African Americans are hypertensive

➢

46.1% of the nation’s Caucasians are

hypertensive

➢

47M American between ages 45-65 are hypertensive

A.Qualified

➢

Men slight > Women

(Centers

Control

Prevention,

A.Qualified

HYPERTENS ION

Defined: Persistent high pressure exerted in

the arteries

Primary Hypertension (Unknown cause;

AKA essential / idiopathic) 95%

Secondary Hypertension (Caused

by known Underlying disorder) 5%

Systolic (mmHg) Diastolic

(mmHg)

STAGE 1 130 – 139 80 – 89

A.Qualified

STAGE 2 >/= 140 >/= 90

(McCance, Huether, Brashers & Rote,

2019)

A.Qualified

PATHOPHYSIOLOGY

Complex mechanism of interactions between the RAAS system, the

SNS, and natriuretic hormones

Dysfunction Insulin

Resistance SNS, RAA, NH

Inflammation

Vasoconstriction, Increased Na & H20 Retention

Increased Blood Volume & Increased Peripheral

Resistance

A.Qualified

(McCance, Huether, Brashers, & Rote, 2019)

Sustained HTN

A.Qualified

CLINICAL PRESENTATI

ON

➢

Usually asymptomatic— Silent

killer

➢

Severely elevated,

Somatic Complaints

Headache

Blurry vision

Nosebleeds

Fatigue, Dizzy

Palpitations

A.Qualified

Edema

(McCance, Huether, Brashers &

Rote, 2019)

A.Qualified

Guideline Publication(s)

Organization : American Medical Association

Original CPG : 2013 – 7

th

Joint National Committee (JNC7) Guidelines

Current CPG : 2014 – 8

th

Joint National Committee (JNC8) Guidelines

• Authors : Paul A. James, MD, Suzanne Oparil, MD, Barry L. Carter, PharmD, William C. Cushman, MD, Cheryl Dennison-Himmelfarb,

RN, ANP, PhD, Joel Handler, MD, Daniel T. Lackland, DrPH, Michael L. LeFevre, MD, MSPH, Thomas D. MacKenzie, MD, MSPH,

Olugbenga Ogedegbe, MD, MPH, MS, Sidney C. Smith Jr, MD, Laura P Svetkey, MD, MHS, Sandra J. Taler, MD, Raymond R. Townsend,

MD, Jackson T. Wright Jr., MD, PhD, Andrew S. Narva, MD, & Eduardo Ortiz, MD, MPH

PCP diagnose, treat, & manage HTN

A.Qualified

(James, Ortiz et al., 2014)

A.Qualified

Clinical Practice Guideline for Hypertension

Application in

Purpose

p of

r g

i u

m ide

a lin

r e

y to

a

c d

a dre

r s

e s & treat HTN in primary care

setting

Most common condition in primary

A.Qualified

care

Prevention of increased risk for additional

cardiovascular comorbidities that contribute

to economic burden

(James, Ortiz et al., 2014)

A.Qualified

A: strong recommendation – high certainty that net benefit is

substantial based on evidence

RECOMMENDATI ON

CATEGORIES

B: moderate recommendation – benefit is mod to substantial or

high certainty that the net benefit is moderate

C: weak recommendation – small net benefit with moderate

certainty based on evidence

D: recommendation against – moderate certainty based on

evidence that there is no benefit or risk > benefits

E: expert opinion (Not substantial evidence but committee

recommends)

A.Qualified

(James,

et al.,

A.Qualified

KEY ACTION STATEMENTS

• Recommendation #1 In the general population aged >/=60 years, initiate pharmacologic treatment to lower blood pressure (BP) at systolic

blood pressure (SBP) 150 mm Hg or diastolic blood pressure (DBP) 90 mm Hg and treat to a goal SBP

< 150 mmHg & Goal DBP < 90 mmHg. Strong Recommendation – Grade A

• Recommendation #2 In the general population <60 years, initiate pharmacologic treatment to lower BP at DBP 90mmHg and treat to a goal

DBP <90mmHg. (For ages 30-59 years, Strong Recommendation – Grade A; For ages 18-29 years, Expert Opinion – Grade E)

• Recommendation #6 In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include a

thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker

(ARB). (Moderate Recommendation – Grade B)

• Recommendation 7 In the general black population, including those with diabetes, initial antihypertensive treatment should include a thiazide-

type diuretic or CCB. (For general black population: Moderate Recommendation – Grade B; for black patients with diabetes: Weak

Recommendation – Grade C)

A.Qualified

• Recommendation 8 In the population aged >/=18 years with CKD, initial (or add-on) antihypertensive treatment should include an ACEI or

ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of

race or diabetes status. (Moderate Recommendation – Grade B) (James, Ortiz et al., 2014)

A.Qualified

A COMPARISION— CPG &

CLINICAL

• Pt: 67 y/o Caucasian male

PATIENT

• CC: Follow up to lab results & Medication from

previous visit

• PMHX: OBESITY, HTN, BPH

• VITALS: 77 HR, 136/74 BP

• Medications: Lisinopril 10mg PO QD
• DX: Persistent Primary Hypertension
• TX: Maintain current antihypertensive medication. F/U

6 mos

A.Qualified

• PT currently managed w/in JNC8 CPG for HTN

Continue to monitor patient’s BP on current

medication regimen unless there is a change

(increase/decrease) in BP—TX appropriately.

A.Qualified

REFERENCES

Centers for Disease Control and Prevention (CDC). (2019). Hypertension Cascade: Hypertension Prevalence, Treatment and Control

Estimates Among US Adults Aged 18 Years and Older Applying the Criteria from the American College of Cardiology and

American Heart Association’s 2017 Hypertension Guideline--NHANES 2013 – 2016.

Atlanta, GA: US Department of Health and Human Services; 2019. Retrieved from:

https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html

James, P.A., Ortiz, E, et al. (2014). Evidence-based Guideline for the Management of High Blood Pressure in Adults: (JNC8). Journal

of the American Medical Association, 311 (5), 507-20. Retrieved from: https://jamanetwork.com/ on 04/13/2020.

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2019). Pathophysiology (8th ed.). Retrieved from

https://online.vitalsource.com/#/books/9780323583473/epubcfi/6/2[;vnd.vst.idref=id_cover]!/4/4[pcover]/2[vst

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