NR 667 VISE Assignment| Ques ons and answers |
Updated New 2026
E ology: Hypertension
-No known cause in 90% of cases of primary HTN
-Secondary causes: renal failure, kidney disease, renal artery stenosis, Cushing syndrome,
hyper/hypo thyroidism, increased ICP, sleep apnea, oral contracep ves, steroids, cocaine,
NSAIDs, decongestants, sympathomime cs, alcohol, an depressants, caffeine
Risk Factors: Hypertension
-Modifiable: smoking, DM, high cholesterol, obesity (single most important factor in children),
physical inac vity, poor diet, excessive sodium intake, excessive alcohol consump on
-Non-modifiable: CKD, family hx, increased age (>55 men, > 65 women), low socioeconomic
status, low educa onal status, male sex, OSA, stress, pregnancy
Assessment: Hypertension
-Most are asymptoma c; occipital headache, headache upon waking, blurry vision, fundoscopic
exam (AV nicking, exudates, papilledema), le9 vent. hypertrophy, pregnancy w/HTN and
proteinuria, edema, and excessive weight gain
Differen al Diagnosis: Hypertension
-Secondary HTN, white coat HTN (ar ficial eleva on d/t medical environment anxiety)
Final Diagnosis: Hypertension
-Urinalysis = proteinuria
-Electrolytes, crea nine, calcium
-Fas ng lipid profile and BS
-ECG
-Measure BP twice, 5 mins apart
-Pa ent should be seated; use proper cuff size and applica on
Preven on: Hypertension
-Maintaining healthy weight and BMI
-Smoking cessa on
-Regular aerobic exercise
,-Alcohol in modera on (< 1 oz/day)
-Stress management
-Medica on compliance
-Assess for and treat OSA
Non-pharm management: Hypertension
-Stage 1: Risk score < 10% =lifestyle modifica on
-Stage 2: lifestyle + medica on
-DASH ea ng plan: high fruit, veggies, grains; low fat dairy, fish, poultry, beans, nuts
-Reduce dietary sodium to 2,300mg/day, increase K+
-Reduce sat. fat intake
-Body weight reduc on; 1kg of weight reduc on = 1 mm/hg bp reduc on
-150 mins of aerobic exercise and/or 3 sessions of isometric resistance per week
-Treat other underlying diseases
-Check bp 2x/week during pregnancy
Pharmacological management: Hypertension
-Start medica on for primary preven on of CVD if pt. has ASCVD risk ≥ 10% and stage 1 HTN or
if ASCVD is < 10% with bp >140/90
-Stage 2: start 2 bp-lowering medica ons
-African Americans: 2+ medica ons recommended; thiazide and CCBs are the most effec ve
*DO NOT use ACE and ARB concurrently
-Beta blockers are NOT first line
-Thiazides, CCBs, ACEIs, and ARBs can be used alone or in combo
Pregnancy considera ons: Hypertension
-Can use beta blockers (labetalol), methyldopa, CCBs (nifedipine)
-AVOID ARBs and ACEIs
Follow-up: Hypertension
-Inquire about adherence and any side effects
-Reassess monthly un l pa ent reaches goal, then every 3-6 months as needed
Expected course: Hypertension
-Only 54% of treated pa ents are at goal treatment; expect complica ons if under treated
-Most pa ents require more than one medica on to reach goal bp
Possible Complica ons: Hypertension
,-Stroke, CAD, MI, renal failure, heart failure, eclampsia (seizures), pulmonary edema,
hypertensive crisis, hypertensive re nopathy, ED
E ology: Hyperlipidemia
-Inherited disorder, high dietary intake, obesity, sedentary lifestyle, DM, hypothyroidism,
anabolic steroid use, hepa s, cirrhosis, uremia, nephro c syndrome, stress, drug-induced
(thiazide diure cs, beta blockers, cyclosporine), alcohol, caffeine, metabolic syndrome
Risk factors: Hyperlipidemia
-Family history, physical inac vity, smoking, age (men > 45, women > 55 or premature
menopause without estrogen replacement), obesity, diet high in sat. fat, DM
Assessment findings: Hyperlipidemia
-Few physical findings; xanthomata (fat deposits in the skin), xanthelasma (yellow plaques on
the eyelid), corneal arcus prior to age 50 (arc of cholesterol around the iris), bruits, angina
pectoris, MI, stroke
Differen al diagnosis: Hyperlipidemia
-Secondary causes: hypothyroidism, pregnancy, DM, non-fas ng state
Final diagnosis: Hyperlipidemia
-Fas ng lipid profile: 9-12 hours
-Glucose level
-Urinalysis, crea nine (for detec on of nephro c syndrome which can induce dyslipidemia)
-Baseline transaminases
-TSH for detec on of hypothyroidism (which can cause secondary dyslipidemia)
-Calculate ASCVD 10-year risk
Preven on: Hyperlipidemia
-Healthy lifestyle reduces ASCVD in all age groups
-Dietary interven ons: encourage mediterranean and DASH diet; limit saturated and trans fats;
limit sodium intake; increase fiber, vegetables, fruits, and other whole grains; eat lean meats
(poultry, fish); eggs, beans, nuts, low-fat dairy, avoid red meat, limit sugary drinks and sweets
-Mod to vigorous exercise of at least 40 mins 3-4x/week (sustained aerobic ac vity increases
HDL, decreases total cholesterol)
-Avoid tobacco
-Appropriately manage systemic diseases (DM, hypothyroidism, HTN)
Non-pharm management: Hyperlipidemia
, -Nutri on, weight reduc on, increased physical ac vity, pa ent educa on about risk factors
Pharmacological management: Hyperlipidemia
-Assign to a sta n treatment group using ASCVD 10-year risk calculator
-Primary lipid target it LDL
-Sta ns are 1st-line therapy
-Combo of sta n and non-sta n in some pa ents
-Consider adding non-sta n if unable to achieve LDL < 70mg/dl, but VERIFY adherence to sta ns
and lifestyle changes
-Non-sta ns: eze mibe (1st), bile acid sequestrant, vibrate, PCSK9 inhibitor
Pregnancy/lacta on considera on: Hyperlipidemia
-Cholesterol is usually elevated during pregnancy; measurement is not recommended and
treatment is contraindicated
Follow-up: Hyperlipidemia
-Check fas ng lipid panel 4-12 weeks a9er star ng or adjus ng a sta n or non-sta n
-Monitor for medica on compliance and lifestyle modifica on, especially if LDL drop is less than
expected
Expected course: Hyperlipidemia
-Depends on e ology and severity of disease
-1% decrease in LDL value decreases CHD risk by 2%
Possible complica ons: Hyperlipidemia
-CAD, cerebrovascular disease, PVD, arteriosclerosis
E ology: DM II
-Influences by gene cs and environmental factors
-High body mass and central obesity
-Drug or chemical-induced: glucocor coids, highly ac ve an retroviral therapy
Risk factors: DM II
-BMI > 25
-History of gesta onal DM and/or macrocosmic infant
-Family history of T2DM
-Condi ons associated with insulin resistance: PCOS, acanthosis nigricans)
-HDL-C < 35 and/or TG > 250
Updated New 2026
E ology: Hypertension
-No known cause in 90% of cases of primary HTN
-Secondary causes: renal failure, kidney disease, renal artery stenosis, Cushing syndrome,
hyper/hypo thyroidism, increased ICP, sleep apnea, oral contracep ves, steroids, cocaine,
NSAIDs, decongestants, sympathomime cs, alcohol, an depressants, caffeine
Risk Factors: Hypertension
-Modifiable: smoking, DM, high cholesterol, obesity (single most important factor in children),
physical inac vity, poor diet, excessive sodium intake, excessive alcohol consump on
-Non-modifiable: CKD, family hx, increased age (>55 men, > 65 women), low socioeconomic
status, low educa onal status, male sex, OSA, stress, pregnancy
Assessment: Hypertension
-Most are asymptoma c; occipital headache, headache upon waking, blurry vision, fundoscopic
exam (AV nicking, exudates, papilledema), le9 vent. hypertrophy, pregnancy w/HTN and
proteinuria, edema, and excessive weight gain
Differen al Diagnosis: Hypertension
-Secondary HTN, white coat HTN (ar ficial eleva on d/t medical environment anxiety)
Final Diagnosis: Hypertension
-Urinalysis = proteinuria
-Electrolytes, crea nine, calcium
-Fas ng lipid profile and BS
-ECG
-Measure BP twice, 5 mins apart
-Pa ent should be seated; use proper cuff size and applica on
Preven on: Hypertension
-Maintaining healthy weight and BMI
-Smoking cessa on
-Regular aerobic exercise
,-Alcohol in modera on (< 1 oz/day)
-Stress management
-Medica on compliance
-Assess for and treat OSA
Non-pharm management: Hypertension
-Stage 1: Risk score < 10% =lifestyle modifica on
-Stage 2: lifestyle + medica on
-DASH ea ng plan: high fruit, veggies, grains; low fat dairy, fish, poultry, beans, nuts
-Reduce dietary sodium to 2,300mg/day, increase K+
-Reduce sat. fat intake
-Body weight reduc on; 1kg of weight reduc on = 1 mm/hg bp reduc on
-150 mins of aerobic exercise and/or 3 sessions of isometric resistance per week
-Treat other underlying diseases
-Check bp 2x/week during pregnancy
Pharmacological management: Hypertension
-Start medica on for primary preven on of CVD if pt. has ASCVD risk ≥ 10% and stage 1 HTN or
if ASCVD is < 10% with bp >140/90
-Stage 2: start 2 bp-lowering medica ons
-African Americans: 2+ medica ons recommended; thiazide and CCBs are the most effec ve
*DO NOT use ACE and ARB concurrently
-Beta blockers are NOT first line
-Thiazides, CCBs, ACEIs, and ARBs can be used alone or in combo
Pregnancy considera ons: Hypertension
-Can use beta blockers (labetalol), methyldopa, CCBs (nifedipine)
-AVOID ARBs and ACEIs
Follow-up: Hypertension
-Inquire about adherence and any side effects
-Reassess monthly un l pa ent reaches goal, then every 3-6 months as needed
Expected course: Hypertension
-Only 54% of treated pa ents are at goal treatment; expect complica ons if under treated
-Most pa ents require more than one medica on to reach goal bp
Possible Complica ons: Hypertension
,-Stroke, CAD, MI, renal failure, heart failure, eclampsia (seizures), pulmonary edema,
hypertensive crisis, hypertensive re nopathy, ED
E ology: Hyperlipidemia
-Inherited disorder, high dietary intake, obesity, sedentary lifestyle, DM, hypothyroidism,
anabolic steroid use, hepa s, cirrhosis, uremia, nephro c syndrome, stress, drug-induced
(thiazide diure cs, beta blockers, cyclosporine), alcohol, caffeine, metabolic syndrome
Risk factors: Hyperlipidemia
-Family history, physical inac vity, smoking, age (men > 45, women > 55 or premature
menopause without estrogen replacement), obesity, diet high in sat. fat, DM
Assessment findings: Hyperlipidemia
-Few physical findings; xanthomata (fat deposits in the skin), xanthelasma (yellow plaques on
the eyelid), corneal arcus prior to age 50 (arc of cholesterol around the iris), bruits, angina
pectoris, MI, stroke
Differen al diagnosis: Hyperlipidemia
-Secondary causes: hypothyroidism, pregnancy, DM, non-fas ng state
Final diagnosis: Hyperlipidemia
-Fas ng lipid profile: 9-12 hours
-Glucose level
-Urinalysis, crea nine (for detec on of nephro c syndrome which can induce dyslipidemia)
-Baseline transaminases
-TSH for detec on of hypothyroidism (which can cause secondary dyslipidemia)
-Calculate ASCVD 10-year risk
Preven on: Hyperlipidemia
-Healthy lifestyle reduces ASCVD in all age groups
-Dietary interven ons: encourage mediterranean and DASH diet; limit saturated and trans fats;
limit sodium intake; increase fiber, vegetables, fruits, and other whole grains; eat lean meats
(poultry, fish); eggs, beans, nuts, low-fat dairy, avoid red meat, limit sugary drinks and sweets
-Mod to vigorous exercise of at least 40 mins 3-4x/week (sustained aerobic ac vity increases
HDL, decreases total cholesterol)
-Avoid tobacco
-Appropriately manage systemic diseases (DM, hypothyroidism, HTN)
Non-pharm management: Hyperlipidemia
, -Nutri on, weight reduc on, increased physical ac vity, pa ent educa on about risk factors
Pharmacological management: Hyperlipidemia
-Assign to a sta n treatment group using ASCVD 10-year risk calculator
-Primary lipid target it LDL
-Sta ns are 1st-line therapy
-Combo of sta n and non-sta n in some pa ents
-Consider adding non-sta n if unable to achieve LDL < 70mg/dl, but VERIFY adherence to sta ns
and lifestyle changes
-Non-sta ns: eze mibe (1st), bile acid sequestrant, vibrate, PCSK9 inhibitor
Pregnancy/lacta on considera on: Hyperlipidemia
-Cholesterol is usually elevated during pregnancy; measurement is not recommended and
treatment is contraindicated
Follow-up: Hyperlipidemia
-Check fas ng lipid panel 4-12 weeks a9er star ng or adjus ng a sta n or non-sta n
-Monitor for medica on compliance and lifestyle modifica on, especially if LDL drop is less than
expected
Expected course: Hyperlipidemia
-Depends on e ology and severity of disease
-1% decrease in LDL value decreases CHD risk by 2%
Possible complica ons: Hyperlipidemia
-CAD, cerebrovascular disease, PVD, arteriosclerosis
E ology: DM II
-Influences by gene cs and environmental factors
-High body mass and central obesity
-Drug or chemical-induced: glucocor coids, highly ac ve an retroviral therapy
Risk factors: DM II
-BMI > 25
-History of gesta onal DM and/or macrocosmic infant
-Family history of T2DM
-Condi ons associated with insulin resistance: PCOS, acanthosis nigricans)
-HDL-C < 35 and/or TG > 250
