NR 667 VISE Assignment (2025) Actual
Exam Questions and Answers A+
Graded
.
Etiology: .Hypertension .- .CORRECT .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 .- .CORRECT .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 .- .CORRECT .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 .- .CORRECT .ANSWER--Secondary .HTN,
.white .coat .HTN .(artificial .elevation .d/t .medical .environment .anxiety)
Final .Diagnosis: .Hypertension .- .CORRECT .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 .- .CORRECT .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 .- .CORRECT .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 .- .CORRECT .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 .- .CORRECT .ANSWER--Can .use .beta
.blockers .(labetalol), .methyldopa, .CCBs .(nifedipine)
-AVOID .ARBs .and .ACEIs
Follow-up: .Hypertension .- .CORRECT .ANSWER--Inquire .about .adherence .and
.any .side .effects .
-Reassess .monthly .until .patient .reaches .goal, .then .every .3-6 .months .as .needed
Expected .course: .Hypertension .- .CORRECT .ANSWER--Only .54% .of .treated
.patients .are .at .goal .treatment; .expect .complications .if .under .treated
-Most .patients .require .more .than .one .medication .to .reach .goal .bp
Possible .Complications: .Hypertension .- .CORRECT .ANSWER--Stroke, .CAD, .MI,
.renal .failure, .heart .failure, .eclampsia .(seizures), .pulmonary .edema,
.hypertensive .crisis, .hypertensive .retinopathy, .ED
Etiology: .Hyperlipidemia .- .CORRECT .ANSWER--Inherited .disorder, .high .dietary
.intake, .obesity, .sedentary .lifestyle, .DM, .hypothyroidism, .anabolic .steroid .use,
.hepatitis, .cirrhosis, .uremia, .nephrotic .syndrome, .stress, .drug-induced .(thiazide
.diuretics, .beta .blockers, .cyclosporine), .alcohol, .caffeine, .metabolic .syndrome
Risk .factors: .Hyperlipidemia .- .CORRECT .ANSWER--Family .history, .physical
.inactivity, .smoking, .age .(men .> .45, .women .> .55 .or .premature .menopause
.without .estrogen .replacement), .obesity, .diet .high .in .sat. .fat, .DM
,Assessment .findings: .Hyperlipidemia .- .CORRECT .ANSWER--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
Differential .diagnosis: .Hyperlipidemia .- .CORRECT .ANSWER--Secondary .causes:
.hypothyroidism, .pregnancy, .DM, .non-fasting .state
Final .diagnosis: .Hyperlipidemia .- .CORRECT .ANSWER--Fasting .lipid .profile: .9-12
.hours
-Glucose .level
-Urinalysis, .creatinine .(for .detection .of .nephrotic .syndrome .which .can .induce
.dyslipidemia)
-Baseline .transaminases
-TSH .for .detection .of .hypothyroidism .(which .can .cause .secondary
.dyslipidemia)
-Calculate .ASCVD .10-year .risk
Prevention: .Hyperlipidemia .- .CORRECT .ANSWER--Healthy .lifestyle .reduces
.ASCVD .in .all .age .groups
-Dietary .interventions: .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
.activity .increases .HDL, .decreases .total .cholesterol)
-Avoid .tobacco
-Appropriately .manage .systemic .diseases .(DM, .hypothyroidism, .HTN)
Non-pharm .management: .Hyperlipidemia .- .CORRECT .ANSWER--Nutrition,
.weight .reduction, .increased .physical .activity, .patient .education .about .risk
.factors
Pharmacological .management: .Hyperlipidemia .- .CORRECT .ANSWER--Assign .to
.a .statin .treatment .group .using .ASCVD .10-year .risk .calculator
-Primary .lipid .target .it .LDL
-Statins .are .1st-line .therapy .
-Combo .of .statin .and .non-statin .in .some .patients
-Consider .adding .non-statin .if .unable .to .achieve .LDL .< .70mg/dl, .but .VERIFY
.adherence .to .statins .and .lifestyle .changes
-Non-statins: .ezetimibe .(1st), .bile .acid .sequestrant, .vibrate, .PCSK9 .inhibitor
Pregnancy/lactation .consideration: .Hyperlipidemia .- .CORRECT .ANSWER--
Cholesterol .is .usually .elevated .during .pregnancy; .measurement .is .not
.recommended .and .treatment .is .contraindicated
Follow-up: .Hyperlipidemia .- .CORRECT .ANSWER--Check .fasting .lipid .panel .4-12
.weeks .after .starting .or .adjusting .a .statin .or .non-statin
, -Monitor .for .medication .compliance .and .lifestyle .modification, .especially .if .LDL
.drop .is .less .than .expected
Expected .course: .Hyperlipidemia .- .CORRECT .ANSWER--Depends .on .etiology
.and .severity .of .disease
-1% .decrease .in .LDL .value .decreases .CHD .risk .by .2%
Possible .complications: .Hyperlipidemia .- .CORRECT .ANSWER--CAD,
.cerebrovascular .disease, .PVD, .arteriosclerosis
Etiology: .DM .II .- .CORRECT .ANSWER--Influences .by .genetics .and .environmental
.factors
-High .body .mass .and .central .obesity
-Drug .or .chemical-induced: .glucocorticoids, .highly .active .antiretroviral .therapy
Risk .factors: .DM .II .- .CORRECT .ANSWER--BMI .> .25
-History .of .gestational .DM .and/or .macrocosmic .infant
-Family .history .of .T2DM
-Conditions .associated .with .insulin .resistance: .PCOS, .acanthosis .nigricans)
-HDL-C .< .35 .and/or .TG .> .250
-HTN
-History .of .CVD
-Hemochromatosis
-Impaired .fasting .glucose
-Physically .active .< .3 .days/week
Assessment .findings: .DM .II .- .CORRECT .ANSWER--Usually .discovered .on
.routine .exam
-CMP .and .urinalysis: .glycosuria, .proteinuria, .hyperglycemia
-Obesity
-Acanthosis .nigricans
-Polydipsia, .polyuria, .polyphagia .
-Fatigue
-Blurred .vision
-Chronic .skin .infections
-Balanitis .in .men .> .65 .years
-Chronic .candidiasis .vulvovaginitis .
-Hyperosmolar .state .or .coma
Differential .diagnosis: .DM .II .- .CORRECT .ANSWER--TIDM
-Prediabetes
-Gestational .diabetes
-Cushing's .syndrome
-Pheochromocytoma
-Acromegaly
-Corticosteroid .use
-Pancreatic .insufficiency
Final .diagnosis: .DM .II .- .CORRECT .ANSWER--Fasting .plasma .glucose: .> .126
Exam Questions and Answers A+
Graded
.
Etiology: .Hypertension .- .CORRECT .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 .- .CORRECT .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 .- .CORRECT .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 .- .CORRECT .ANSWER--Secondary .HTN,
.white .coat .HTN .(artificial .elevation .d/t .medical .environment .anxiety)
Final .Diagnosis: .Hypertension .- .CORRECT .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 .- .CORRECT .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 .- .CORRECT .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 .- .CORRECT .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 .- .CORRECT .ANSWER--Can .use .beta
.blockers .(labetalol), .methyldopa, .CCBs .(nifedipine)
-AVOID .ARBs .and .ACEIs
Follow-up: .Hypertension .- .CORRECT .ANSWER--Inquire .about .adherence .and
.any .side .effects .
-Reassess .monthly .until .patient .reaches .goal, .then .every .3-6 .months .as .needed
Expected .course: .Hypertension .- .CORRECT .ANSWER--Only .54% .of .treated
.patients .are .at .goal .treatment; .expect .complications .if .under .treated
-Most .patients .require .more .than .one .medication .to .reach .goal .bp
Possible .Complications: .Hypertension .- .CORRECT .ANSWER--Stroke, .CAD, .MI,
.renal .failure, .heart .failure, .eclampsia .(seizures), .pulmonary .edema,
.hypertensive .crisis, .hypertensive .retinopathy, .ED
Etiology: .Hyperlipidemia .- .CORRECT .ANSWER--Inherited .disorder, .high .dietary
.intake, .obesity, .sedentary .lifestyle, .DM, .hypothyroidism, .anabolic .steroid .use,
.hepatitis, .cirrhosis, .uremia, .nephrotic .syndrome, .stress, .drug-induced .(thiazide
.diuretics, .beta .blockers, .cyclosporine), .alcohol, .caffeine, .metabolic .syndrome
Risk .factors: .Hyperlipidemia .- .CORRECT .ANSWER--Family .history, .physical
.inactivity, .smoking, .age .(men .> .45, .women .> .55 .or .premature .menopause
.without .estrogen .replacement), .obesity, .diet .high .in .sat. .fat, .DM
,Assessment .findings: .Hyperlipidemia .- .CORRECT .ANSWER--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
Differential .diagnosis: .Hyperlipidemia .- .CORRECT .ANSWER--Secondary .causes:
.hypothyroidism, .pregnancy, .DM, .non-fasting .state
Final .diagnosis: .Hyperlipidemia .- .CORRECT .ANSWER--Fasting .lipid .profile: .9-12
.hours
-Glucose .level
-Urinalysis, .creatinine .(for .detection .of .nephrotic .syndrome .which .can .induce
.dyslipidemia)
-Baseline .transaminases
-TSH .for .detection .of .hypothyroidism .(which .can .cause .secondary
.dyslipidemia)
-Calculate .ASCVD .10-year .risk
Prevention: .Hyperlipidemia .- .CORRECT .ANSWER--Healthy .lifestyle .reduces
.ASCVD .in .all .age .groups
-Dietary .interventions: .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
.activity .increases .HDL, .decreases .total .cholesterol)
-Avoid .tobacco
-Appropriately .manage .systemic .diseases .(DM, .hypothyroidism, .HTN)
Non-pharm .management: .Hyperlipidemia .- .CORRECT .ANSWER--Nutrition,
.weight .reduction, .increased .physical .activity, .patient .education .about .risk
.factors
Pharmacological .management: .Hyperlipidemia .- .CORRECT .ANSWER--Assign .to
.a .statin .treatment .group .using .ASCVD .10-year .risk .calculator
-Primary .lipid .target .it .LDL
-Statins .are .1st-line .therapy .
-Combo .of .statin .and .non-statin .in .some .patients
-Consider .adding .non-statin .if .unable .to .achieve .LDL .< .70mg/dl, .but .VERIFY
.adherence .to .statins .and .lifestyle .changes
-Non-statins: .ezetimibe .(1st), .bile .acid .sequestrant, .vibrate, .PCSK9 .inhibitor
Pregnancy/lactation .consideration: .Hyperlipidemia .- .CORRECT .ANSWER--
Cholesterol .is .usually .elevated .during .pregnancy; .measurement .is .not
.recommended .and .treatment .is .contraindicated
Follow-up: .Hyperlipidemia .- .CORRECT .ANSWER--Check .fasting .lipid .panel .4-12
.weeks .after .starting .or .adjusting .a .statin .or .non-statin
, -Monitor .for .medication .compliance .and .lifestyle .modification, .especially .if .LDL
.drop .is .less .than .expected
Expected .course: .Hyperlipidemia .- .CORRECT .ANSWER--Depends .on .etiology
.and .severity .of .disease
-1% .decrease .in .LDL .value .decreases .CHD .risk .by .2%
Possible .complications: .Hyperlipidemia .- .CORRECT .ANSWER--CAD,
.cerebrovascular .disease, .PVD, .arteriosclerosis
Etiology: .DM .II .- .CORRECT .ANSWER--Influences .by .genetics .and .environmental
.factors
-High .body .mass .and .central .obesity
-Drug .or .chemical-induced: .glucocorticoids, .highly .active .antiretroviral .therapy
Risk .factors: .DM .II .- .CORRECT .ANSWER--BMI .> .25
-History .of .gestational .DM .and/or .macrocosmic .infant
-Family .history .of .T2DM
-Conditions .associated .with .insulin .resistance: .PCOS, .acanthosis .nigricans)
-HDL-C .< .35 .and/or .TG .> .250
-HTN
-History .of .CVD
-Hemochromatosis
-Impaired .fasting .glucose
-Physically .active .< .3 .days/week
Assessment .findings: .DM .II .- .CORRECT .ANSWER--Usually .discovered .on
.routine .exam
-CMP .and .urinalysis: .glycosuria, .proteinuria, .hyperglycemia
-Obesity
-Acanthosis .nigricans
-Polydipsia, .polyuria, .polyphagia .
-Fatigue
-Blurred .vision
-Chronic .skin .infections
-Balanitis .in .men .> .65 .years
-Chronic .candidiasis .vulvovaginitis .
-Hyperosmolar .state .or .coma
Differential .diagnosis: .DM .II .- .CORRECT .ANSWER--TIDM
-Prediabetes
-Gestational .diabetes
-Cushing's .syndrome
-Pheochromocytoma
-Acromegaly
-Corticosteroid .use
-Pancreatic .insufficiency
Final .diagnosis: .DM .II .- .CORRECT .ANSWER--Fasting .plasma .glucose: .> .126
