NR 667 VISE Assignment Exam Questions with Complete Solutions

NR 667 VISE Assignment Exam Questions with Complete Solutions Etiology: Hypertension - ANSWER -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 contraceptives, steroids, cocaine, NSAIDs, decongestants, sympathomimetics, alcohol, antidepressants, caffeine Risk Factors: Hypertension - ANSWER -Modifiable: smoking, DM, high cholesterol, obesity (single most important factor in children), physical inactivity, poor diet, excessive sodium intake, excessive alcohol consumption -Non-modifiable: CKD, family hx, increased age (55 men, 65 women), low socioeconomic status, low educational status, male sex, OSA, stress, pregnancy Assessment: Hypertension - ANSWER -Most are asymptomatic; occipital headache, headache upon waking, blurry vision, fundoscopic exam (AV nicking, exudates, papilledema), left vent. hypertrophy, pregnancy w/HTN and proteinuria, edema, and excessive weight gain Differential Diagnosis: Hypertension - ANSWER -Secondary HTN, white coat HTN (artificial elevation d/t medical environment anxiety) Final Diagnosis: Hypertension - ANSWER -Urinalysis = proteinuria -Electrolytes, creatinine, calcium -Fasting lipid profile and BS -ECG -Measure BP twice, 5 mins apart -Patient should be seated; use proper cuff size and application Prevention: Hypertension - ANSWER -Maintaining healthy weight and BMI -Smoking cessation -Regular aerobic exercise -Alcohol in moderation ( 1 oz/day) -Stress management -Medication compliance -Assess for and treat OSA Non-pharm management: Hypertension - ANSWER -Stage 1: Risk score 10% =lifestyle modification -Stage 2: lifestyle + medication -DASH eating 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 reduction; 1kg of weight reduction = 1 mm/hg bp reduction -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 - ANSWER -Start medication for primary prevention 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 medications -African Americans: 2+ medications recommended; thiazide and CCBs are the most effective *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 considerations: Hypertension - ANSWER -Can use beta blockers (labetalol), methyldopa, CCBs (nifedipine) -AVOID ARBs and ACEIs