FNP 2 HTN | Questions and Complete Verified
Answers
Primary HTN - ANSWER most commonly linked to obesity, or family hx of HTN or CVD.
secondary HTN - ANSWER is related to another medical condition (renal, endocrine,
heart disease).
prehypertension - ANSWER SBP/DBP from the 90-<95th percentile - this group of
children needs to mainly focus on lifestyle modifications; adolescents are considered
pre-hypertensive with a BP of 120/80.
*White coat HTN is a known phenomenon in children who have an elevated BP only in
the clinic/doctors office.
*An initial elevated BP is not enough for a diagnosis, need 3 consecutive elevated
readings within one week.
When does screening for HTN start for peds? - ANSWER age 3 and screen at every sick
and well visit.
For those under 3, screen if: premature, very low birth weight, congenital heart disease,
recurrent UTIs, hematuria, proteinuria, renal disease, family hx of congenital renal
disease; if they've had an organ transplant, malignancy/bone marrow transplant,
elevated ICP.
How to take BP for peds? - ANSWER Korotkoff sounds, use right arm if possible, child
should be seated/resting for several minutes
causes of HTN in peds - ANSWER familial link (family obesity), childhood obesity,
increased BMI, sedentary lifestyle, stress, maternal smoking
Children with a BMI >95%, are at an increased risk
,Breastfeeding is thought to have a protective factor against HTN
concerning signs and symptoms for HTN - ANSWER headache, fatigue, blurred vision,
epistaxis, bell's palsy.
Peds elevated BP - ANSWER History: neonatal history, diet, activities, medications,
smoking/drinking, sleep problems
Assessment: s/s of renal dysfunction, heart disease, chronic diseases, UTIs, DM,
headaches, dyspnea, abd pain, family history of MI/BM/HLP/Obesity; height and weight
percentiles, plot BMI, use appropriate size BP cuff! Look at skin for striae, fundus in
eyes, quality of pulses, head/neck for moon face or webbed neck, chest, abdomen,
genitals, extremities.
Concerning signs and symptoms are headache, fatigue, blurred vision, epistaxis, bell's
palsy.
Red flags in neonates:
red flags in neonates - ANSWER irritability, lethargy, congestive heart failure, respiratory
distress, failure to thrive, seizure.
peds exams and labs - ANSWER abdominal girth, triglycerides (usually elevated), HDL
(usually low), glucose (usually have some form of insulin resistance), cardiac/ECHO
(common to see left ventricular hypertrophy), UA, ESR, electrolytes, CBC, renal sono,
lipid panel, fasting glucose, drug screen, assess for sleep disorders, assess for retinal
disorders.
Further evaluation = plasma renin determination: identifies low renin related to
mineralocorticoid-related disease
peds: tx HTN - ANSWER DASH diet (low-fat, high fiber, more fruits and vegetables),
avoid sodium and salt, no sugary beverages, increase physical fitness, stress
management in children is very important and often looked over, start with a single
drug
, Peds HTN stages - ANSWER Stage 1 HTN: 95-99th percentile - recheck in 1-2 weeks, if
elevated two more times refer or initiate treatment.
Stage 2 HTN: >99th percentile - refer to specialty within one week or initiate therapy,
continue to reevaluate
Adult: types of HTN - ANSWER Primary = idiopathic or essential HTN
Secondary = needs to be a known identified cause; common causes are CKD, OSA (dx
with 10 or more episodes in a night), thyroid disorders (can be hypo or hyper); less
common causes are renovascular, primary hyperaldosteronism, pheochromocytoma,
cushing's disease, coarctation of aorta
White coat
Isolated systolic = normal DBP, usually occurs with increased age and changes in
vasculature
Resistant = treated but is still not controlled when on 3 or more medications
Severe = very high BP with immediate or near-immediate risk of acute cardiac event
according to USPSTF how often should we check P <120/80 - ANSWER only need to be
check Q2y, but Dr. Bull says just check at every visit!
risk factors for adult HTN - ANSWER Risk factors: obesity (increase activation of
renin/angiotensin system, and SNS), tobacco, physical inactivity, medications, ethnicity
(AA typically have worse outcomes, caucasians have more CV outcomes), family history.
Other factors to consider are: NSAIDs (can increase to as much as 5mg of SBP/DBP), OCP
(there's no evidence of postmenopausal estrogen causing HTN), corticosteroids,
decongestants, antidepressants (Effexor, wellbutrin), methylxanthines, nicotine
adult HTN assessment - ANSWER History: ask about PMH, FMH, risk factors, lifestyle,
diet (24h recall), exercise, sleep
Answers
Primary HTN - ANSWER most commonly linked to obesity, or family hx of HTN or CVD.
secondary HTN - ANSWER is related to another medical condition (renal, endocrine,
heart disease).
prehypertension - ANSWER SBP/DBP from the 90-<95th percentile - this group of
children needs to mainly focus on lifestyle modifications; adolescents are considered
pre-hypertensive with a BP of 120/80.
*White coat HTN is a known phenomenon in children who have an elevated BP only in
the clinic/doctors office.
*An initial elevated BP is not enough for a diagnosis, need 3 consecutive elevated
readings within one week.
When does screening for HTN start for peds? - ANSWER age 3 and screen at every sick
and well visit.
For those under 3, screen if: premature, very low birth weight, congenital heart disease,
recurrent UTIs, hematuria, proteinuria, renal disease, family hx of congenital renal
disease; if they've had an organ transplant, malignancy/bone marrow transplant,
elevated ICP.
How to take BP for peds? - ANSWER Korotkoff sounds, use right arm if possible, child
should be seated/resting for several minutes
causes of HTN in peds - ANSWER familial link (family obesity), childhood obesity,
increased BMI, sedentary lifestyle, stress, maternal smoking
Children with a BMI >95%, are at an increased risk
,Breastfeeding is thought to have a protective factor against HTN
concerning signs and symptoms for HTN - ANSWER headache, fatigue, blurred vision,
epistaxis, bell's palsy.
Peds elevated BP - ANSWER History: neonatal history, diet, activities, medications,
smoking/drinking, sleep problems
Assessment: s/s of renal dysfunction, heart disease, chronic diseases, UTIs, DM,
headaches, dyspnea, abd pain, family history of MI/BM/HLP/Obesity; height and weight
percentiles, plot BMI, use appropriate size BP cuff! Look at skin for striae, fundus in
eyes, quality of pulses, head/neck for moon face or webbed neck, chest, abdomen,
genitals, extremities.
Concerning signs and symptoms are headache, fatigue, blurred vision, epistaxis, bell's
palsy.
Red flags in neonates:
red flags in neonates - ANSWER irritability, lethargy, congestive heart failure, respiratory
distress, failure to thrive, seizure.
peds exams and labs - ANSWER abdominal girth, triglycerides (usually elevated), HDL
(usually low), glucose (usually have some form of insulin resistance), cardiac/ECHO
(common to see left ventricular hypertrophy), UA, ESR, electrolytes, CBC, renal sono,
lipid panel, fasting glucose, drug screen, assess for sleep disorders, assess for retinal
disorders.
Further evaluation = plasma renin determination: identifies low renin related to
mineralocorticoid-related disease
peds: tx HTN - ANSWER DASH diet (low-fat, high fiber, more fruits and vegetables),
avoid sodium and salt, no sugary beverages, increase physical fitness, stress
management in children is very important and often looked over, start with a single
drug
, Peds HTN stages - ANSWER Stage 1 HTN: 95-99th percentile - recheck in 1-2 weeks, if
elevated two more times refer or initiate treatment.
Stage 2 HTN: >99th percentile - refer to specialty within one week or initiate therapy,
continue to reevaluate
Adult: types of HTN - ANSWER Primary = idiopathic or essential HTN
Secondary = needs to be a known identified cause; common causes are CKD, OSA (dx
with 10 or more episodes in a night), thyroid disorders (can be hypo or hyper); less
common causes are renovascular, primary hyperaldosteronism, pheochromocytoma,
cushing's disease, coarctation of aorta
White coat
Isolated systolic = normal DBP, usually occurs with increased age and changes in
vasculature
Resistant = treated but is still not controlled when on 3 or more medications
Severe = very high BP with immediate or near-immediate risk of acute cardiac event
according to USPSTF how often should we check P <120/80 - ANSWER only need to be
check Q2y, but Dr. Bull says just check at every visit!
risk factors for adult HTN - ANSWER Risk factors: obesity (increase activation of
renin/angiotensin system, and SNS), tobacco, physical inactivity, medications, ethnicity
(AA typically have worse outcomes, caucasians have more CV outcomes), family history.
Other factors to consider are: NSAIDs (can increase to as much as 5mg of SBP/DBP), OCP
(there's no evidence of postmenopausal estrogen causing HTN), corticosteroids,
decongestants, antidepressants (Effexor, wellbutrin), methylxanthines, nicotine
adult HTN assessment - ANSWER History: ask about PMH, FMH, risk factors, lifestyle,
diet (24h recall), exercise, sleep
