NR 566 FINAL EXAM Questions with 100% verified Answers Latest Versions 2024 GRADED A+, Exams of Nursing

Download NR 566 FINAL EXAM Questions with 100% verified Answers Latest Versions 2024 GRADED A+ and more Exams Nursing in PDF only on Docsity! NR 566 FINAL EXAM Questions with 100% verified Answers Latest Versions 2024 GRADED A+ Week 3 Quiz Question 1 1 / 1 pts Diagnosis of heart failure cannot be made by symptoms alone because many disorders share the same symptoms. The most specific and sensitive diagnostic test for heart failure is: Complete blood count, blood urea nitrogen, and serum electrolytes that facilitate staging for end- organ damage. Chest x-rays that show cephalization and measure heart size. Correct! Two-dimensional echocardiograms that identify structural anomalies and cardiac dysfunction. Measurement of brain natriuretic peptide to distinguish between systolic and diastolic dysfunction. Question 2 1 / 1 pts Because primary hypertension has no identifiable cause, treatment is based on interfering with the physiological mechanisms that regulate blood pressure. Thiazide diuretics treat hypertension because they do which of the following? Correct! oF Deplete body sodium and reduce fluid volume.  Inadequate relaxation and loss of muscle fiber secondary to valvular dysfunction. Increased demands of the heart beyond its ability to adapt secondary to anemia. Slower filling rate and elevated systolic pressures secondary to uncontrolled hypertension. Question 6 1 / 1 pts Which of the following medications require monitoring of pulmonary and thyroid function tests every 6 months? Procainamide (Pronestyl). Correct! Amiodarone (Cordarone). Mexilitine (Mexitil). Flecainide (Tambocor). Question 7 1 / 1 pts A 59-year-old male has poorly controlled hypertension. He is currently taking furosemide (Lasix) 40mg daily for congestive heart failure. When choosing to add another antihypertensive, which of the following should the clinician avoid due to its strong negative inotropic effect? Losartan (Cozaar). Carvedilol (Coreg). Amlodipine (Norvasc). Correct! Verapamil (Calan). Question 8 1 / 1 pts The clinician has decided to prescribe an angiotensin-converting enzyme inhibitor (ACEI) for a patient with hypertension. The patient informs the clinician that she is "really bad at taking medication more than once per day". Which of the following medications requires more than once daily dosing and therefore should be avoided? Correct! Captopril (Captoten). Benazapril (Lotensin). Lisinopril (Zestril). Enalapril (Vasotec). Question 9 1 / 1 pts Omega 3 fatty acids are best used to help treat which of the following? High total cholesterol. Elevated HDL. Correct! High triglycerides. Reduced LDL. detection, evaluation, and management of high blood pressure in adults. Journal of the American College of Cardiology, 71(19), e127–e248. https://doi.org/10.1016/j.jacc.2017.11.006 Woo, T.M. & Robinson, M.V. (2016). Pharmacotherapeutics for Advanced Practice Nurse Prescribers (4th ed.). F.A. Davis Company. Hello Professor and class, Define different hypertension classes (normal, elevated, stage 1 & stage 2) according to each guideline. The American College of Cardiology’s and the American Heart Association’s recommendations (ACC/AHA) for hypertension guidelines and BP categories are classified as follows: 1) normal (<120 systolic and <80 mm Hg diastolic), 2) elevated (120–129 systolic and <80 mm Hg diastolic), 3) stage 1 hypertension (130–139 systolic or 80–89 mm Hg diastolic) and stage 2 hypertension (≥140 systolic or ≥90 mm Hg diastolic). These categories should not be based on BP readings at a single point in time, but rather should be confirmed by two or more readings (averaged) made on at least two separate occasions (Flack & Adekola, 2020). Individuals are classified according to their highest systolic or diastolic BP category with out of office BP readings (home or ambulatory BP monitoring) obtained for comparison with office BP readings. The BP category of pre-hypertension is no longer used (Flack & Adekola, 2020). According to the Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the JNC8 guidelines and criteria for hypertension state that elevated hypertension is defined as having a blood pressure of ≥140/90 mmHg (Gaidhane et al., 2020). The testing recommendations for the initial diagnosis of HTN of the JNC-7, listed below, were not altered (James et al., 2014). The guidelines built on systematic methods to evaluate and classify evidence offer a cornerstone for quality cardiovascular care (Gaidhane et al., 2020). The categorization differed from the previous recommendation in the JNC 7 report, with stage 1 hypertension now specified as an SBP of 130–139 or a DBP of 80–89 mm Hg, and with the stage 2 hypertension in the present document corresponding to stages 1 and 2 in the JNC 7 report (Gaidhane et al., 2020). Stage JNC-8 ACC/AHA Normal <120/<80 <120/<80 Elevated SBP 120-139 DBP 80-89 SBP 120-129 DBP <80 Stage 1 SBP 140-159 DBP 90-99 SBP 130-139 DBP 80-89 Stage 2 >160/>100 >140/>90 The table shows the BP readings that fall into each of these categories per ACC/AHA and the JNC-7 standards, which were not altered by the JNC-8, and this classification is based on the average of two or more properly measured seated BP readings on each of two or more office visits (Woo & Robinson, 2016). What are the thresholds for initiating treatment? With the 8th JNC, the thresholds set for starting the treatment regimen includes any individual above the age of 60 with systolic blood pressure over 150 and diastolic over 90, and patients with other existing comorbidities such as diabetes or chronic kidney disease with blood pressure over 140 systolic and 90 diastolic (Hernandez-Vila, 2015). Based on the American College of Cardiology/American Heart Association (ACC/AHA), guidelines for beginning treatment are intended for patients with systolic blood pressure over 130 or diastolic pressure over 90 if they have a known existing risk of cardiovascular disease, or if there exists a 10 percent greater risk of atherosclerotic CVD (Gaidhane et al., 2020) What are the treatment goals? (Hint: there may be multiple treatment goals based on certain populations such as diabetics) 8th JNC The treatment goal is to keep blood pressure controlled less than 140/90 if the patient is under 60 years of age or has other comorbid existing illnesses identified like diabetes or chronic kidney disease (Hernandez-Vila, 2015). If the patient is elderly above the age of 60, the treatment goal is to retain the blood pressure under 150/90 (Hernandez-Vila, 2015). ACC/AHA The treatment goal is to maintain blood pressure under 130/80 (Muntner et al., 2018). However, certain populations have may different treatment goals, as follows: ▪ Diabetes: for patients who have diabetes, and are the ages between 18 and 65, the target goals are 130 mmHg or less (systolic) and 70-80 mmHg (diastolic) (AHA, 2017a). ▪ Chronic Kidney Disease (CKD): for patients between the ages of 18-65 with CKD, treatment target goal is between 130-140 mmHg (systolic) and 70-80 mmHg (diastolic) (ACC, 2017). ▪ Age related: for patients who are 65 years old and above, the target goal is between 140 to 130 mmHg (systolic) and 70-80 mmHg (diastolic) (ACC, 2017). When the patient has an elevated blood pressure the treatment regimen begins with the recommendation of lifestyle and diet therapy, and then reassessment of the patient's blood pressure should be done in three to six months (Muntner et al., 2018). In the case that the patient has cardiovascular risk factors identified greater than ten percent or has other existing comorbidities, the patient should be put on a blood pressure-lowering medication and should be reassessed in one month to determine effectiveness (Gaidhane et al., 2020). What medications are recommended to treat hypertension in the African American population? The 8th Joint National Committee (JNC 8) and the American Heart Association guidelines recommend that African Americans with high blood pressure be prescribed with a calcium channel blocker or a thiazide diuretic as initial drug therapy (Hernandez- Vila, 2015). The ACC/AHA guidelines recommended thiazide diuretics as one of four acceptable first-line drug therapies, with no preference between thiazide and thiazide- like diuretics in patients without selected comorbidities that would alter this recommendation (Flack & Adekola, 2020). The only race-specific recommendation in the ACC/AHA guideline was for African Americans. Accordingly, those without heart failure or CKD who do not meet two-drug therapy criteria should be initially treated with either a thiazide-type diuretic or calcium antagonist (Flack & Adekola, 2020). The monotherapy recommendation is RAS blocker drugs and should be initially prescribed to African Americans with hypertension with these comorbidities (CKD and HF). Another recommendation was to encourage two- drug combination therapy in most African Americans (Flack & Adekola, 2020). Discuss why one set of guidelines might be used over the other (i.e., is one superior to the other?) The American Heart Association, the American College of Cardiology, and nine other professional organizations issued a new hypertension clinical practice guideline (CPG) in November 2017, which has lowered the hypertension threshold to 130/80 mmHg (Miyazaki, 2018). The American Academy of Family Medicine has opted not to endorse this new CPG for various reasons, including flaws in the CPG development process, and a limited additional benefit for lower treatment targets (Miyazaki, 2018). The major concern was an intellectual conflict of interest (COI) regarding why one set of guidelines might be used over the other (Miyazaki, 2018). Neither the JNC-8 guidelines nor the ACC/AHA guidelines are better or worse. Both are substantiated guidelines that help guide clinical decisions based on evidence-based practice. As providers, the guidelines set by the Centers for Medicare and Medicaid Services (CMS) should also be taken into consideration. The CMS has measure specifications focusing on patients age 18 and older with a diagnosis of hypertension whose blood pressure is adequately controlled at a level of 140/90 or less (CMS, 2019). The United States Preventive Services Task Force recommends screening for high blood pressure in adults age 18 years and older (CMS, 2019). The Joint National Committee on