AGACNP 1 Exam 1
How do you manage a pt with hyperthyroidism?
1. Consult an endocrinologist. 2. Address symptoms: 10 mg of propanolol daily QID
Metoprolol 25 mg q 6-8 hrs
3. Start antithyroid meds
Tapazole, a methimazole, Initial: three doses of 30-60 mg per day Maintenance: 5 to 15 mg
per day If you are unable to tolerate methimazole and are not a surgical or radioactive iodine
candidate, try Propylthiouracil
Initial: four divided doses of 300-600 mg daily Maintain: three doses of 100-150 milligrams
per day Who ought to get the hepatitis B vaccine? Individuals who are at risk of contracting it
sexually or through IV drug use should take it. Additionally recommended for liver and
dialysis patients. Who is recommended to receive hepatitis A vaccine?
Gay men, people who take clotting concentrates, people who inject drugs, people who have
chronic liver disease, and lab workers who work with hepatitis A-infected primates When
should you start screening for prostate cancer?
40
When should you start screening for colorectal cancer?
Average risk patients: start at 50
Start at 40 for patients at high risk (hx of polyps, IBD, and heritable risk factors). What grade
murmur do you first hear a thrill?
4/6
Which murmurs are thought to be pathological? late systolic, diastolic, and continuous
systolic What murmur is this?
The decrecendo-crescendo, which is best heard at the peak, is low-pitched and does not
radiate. possesses diastolic rumble and opening snap. stenosis of the heart Operating
System by MicroSoft Snap of Mitral Stenosis Opening What kind of hum is this? Harsh,
crescendo-decrescendo, radiates to the carotids, heard best over aortic area
Stenosis of the aorta What murmur is this?
Holosystolic, high-pitched blowing sound, heard at apex, radiates to the axilla. Lateral
position can intensify sound. An S3 may accompany it if it is severe enough. Reflux of mitral
fluid What kind of sound is MVP (Mitral Valve Prolapse) characterized by? Midsystolic click
It's a systolic click with a musical "whoop" or "honk" in the middle to late systolic range.
What click is associated with stenosis, occurs early in systole, and heard at both apex and
base of heart?
Aortic ejection click
What click is associated with stenosis, is heard only at the base of the heart, and occurs
early in systole? Click of pulmonic ejection What is the definition of hypertension?
on each of the two office visits, sustained elevation of SBP of 130 or DBP of 80 taken in a
seated position. What is normal blood pressure?
120/80
What is the definition of elevated blood pressure (prehypertension)?
SBP 120-129 AND DBP <80
What is stage 1 hypertension?
, 130-139/80-89
What is stage 2 hypertension?
140/90 or greater
How would you handle a patient with a normal blood pressure of less than 120/80? Evaluate
yearly and encourage healthy lifestyle changes
What should you do if your patient has prehypertension? In three to six months, reevaluate
and encourage changes to a healthy lifestyle. When you learn that your patient has stage 1
hypertension, what should you do first? Assess the 10 year atherosclerotic cardiovascular
disease risk
(ASCVD)
You calculate your patient's ASCVD and their risk is <10%, what do you do?
Make healthy lifestyle changes now, and then reevaluate in three to six months. You
calculate your patient's ASCVD and their risk is >10% with a hx of CVD, DM, or CKD, what
do you do?
Recommend healthy lifestyle changes and start a BP lowering medication. In one month,
reevaluate. What is the BP goal for your patient you are treating?
130/80
Your patient comes back in a month and they are not at goal, what do you do?
Titrate the current medication or consider a different medication
How often should you see your patient until their BP goal of 130/80 is met?
each month Your patient has stage 2 hypertension (>140/90), what do you plan to do?
Changes to one's lifestyle should be recommended, and BP-lowering medications should be
started (two different medications from different classes). In one month, reevaluate. Your
patient with stage 2 HTN has met their goal, when do you now want to reassess?
They should return in three to six months. Your patient with stage 2 HTN has not met their
goal, what do you do?
Titrate their meds or pick a different medication. Continue monthly F/U until the 130/80
target is reached. What are the parameters of hypertensive urgency?
SBP >180 and/or DBP>120
Many of these patients are noncompliant with their meds. Restart or increase
antihypertensive treatment. What is the definition of hypertensive emergency?
SBP>180 and damage to the target organ DBP > 120 plus damage to the target organ What
is primary hypertension?
Essential or idiopathic hypertension
Unknown reason covers 95% of cases. Age of onset: 22-55 years old The cause of primary
hypertension is unknown. -genetic and environmental factors
-elevated intracellular calcium and sodium levels -sympathetic nervous system hyperactivity
-high renin-angiotensin activity causing vascular dysfunction
What is secondary hypertension?
HTN related to other known causes or disease processes.
Represents 5% of all HTN cases
What is the etiology of secondary HTN?
-renal disease (most common secondary cause) -estrogen use (via oral contraceptives or
hormone replacement therapy
-pregnancy
-endocrine disorders (i.e., pheochromocytoma)
What is isolated systolic hypertension?
How do you manage a pt with hyperthyroidism?
1. Consult an endocrinologist. 2. Address symptoms: 10 mg of propanolol daily QID
Metoprolol 25 mg q 6-8 hrs
3. Start antithyroid meds
Tapazole, a methimazole, Initial: three doses of 30-60 mg per day Maintenance: 5 to 15 mg
per day If you are unable to tolerate methimazole and are not a surgical or radioactive iodine
candidate, try Propylthiouracil
Initial: four divided doses of 300-600 mg daily Maintain: three doses of 100-150 milligrams
per day Who ought to get the hepatitis B vaccine? Individuals who are at risk of contracting it
sexually or through IV drug use should take it. Additionally recommended for liver and
dialysis patients. Who is recommended to receive hepatitis A vaccine?
Gay men, people who take clotting concentrates, people who inject drugs, people who have
chronic liver disease, and lab workers who work with hepatitis A-infected primates When
should you start screening for prostate cancer?
40
When should you start screening for colorectal cancer?
Average risk patients: start at 50
Start at 40 for patients at high risk (hx of polyps, IBD, and heritable risk factors). What grade
murmur do you first hear a thrill?
4/6
Which murmurs are thought to be pathological? late systolic, diastolic, and continuous
systolic What murmur is this?
The decrecendo-crescendo, which is best heard at the peak, is low-pitched and does not
radiate. possesses diastolic rumble and opening snap. stenosis of the heart Operating
System by MicroSoft Snap of Mitral Stenosis Opening What kind of hum is this? Harsh,
crescendo-decrescendo, radiates to the carotids, heard best over aortic area
Stenosis of the aorta What murmur is this?
Holosystolic, high-pitched blowing sound, heard at apex, radiates to the axilla. Lateral
position can intensify sound. An S3 may accompany it if it is severe enough. Reflux of mitral
fluid What kind of sound is MVP (Mitral Valve Prolapse) characterized by? Midsystolic click
It's a systolic click with a musical "whoop" or "honk" in the middle to late systolic range.
What click is associated with stenosis, occurs early in systole, and heard at both apex and
base of heart?
Aortic ejection click
What click is associated with stenosis, is heard only at the base of the heart, and occurs
early in systole? Click of pulmonic ejection What is the definition of hypertension?
on each of the two office visits, sustained elevation of SBP of 130 or DBP of 80 taken in a
seated position. What is normal blood pressure?
120/80
What is the definition of elevated blood pressure (prehypertension)?
SBP 120-129 AND DBP <80
What is stage 1 hypertension?
, 130-139/80-89
What is stage 2 hypertension?
140/90 or greater
How would you handle a patient with a normal blood pressure of less than 120/80? Evaluate
yearly and encourage healthy lifestyle changes
What should you do if your patient has prehypertension? In three to six months, reevaluate
and encourage changes to a healthy lifestyle. When you learn that your patient has stage 1
hypertension, what should you do first? Assess the 10 year atherosclerotic cardiovascular
disease risk
(ASCVD)
You calculate your patient's ASCVD and their risk is <10%, what do you do?
Make healthy lifestyle changes now, and then reevaluate in three to six months. You
calculate your patient's ASCVD and their risk is >10% with a hx of CVD, DM, or CKD, what
do you do?
Recommend healthy lifestyle changes and start a BP lowering medication. In one month,
reevaluate. What is the BP goal for your patient you are treating?
130/80
Your patient comes back in a month and they are not at goal, what do you do?
Titrate the current medication or consider a different medication
How often should you see your patient until their BP goal of 130/80 is met?
each month Your patient has stage 2 hypertension (>140/90), what do you plan to do?
Changes to one's lifestyle should be recommended, and BP-lowering medications should be
started (two different medications from different classes). In one month, reevaluate. Your
patient with stage 2 HTN has met their goal, when do you now want to reassess?
They should return in three to six months. Your patient with stage 2 HTN has not met their
goal, what do you do?
Titrate their meds or pick a different medication. Continue monthly F/U until the 130/80
target is reached. What are the parameters of hypertensive urgency?
SBP >180 and/or DBP>120
Many of these patients are noncompliant with their meds. Restart or increase
antihypertensive treatment. What is the definition of hypertensive emergency?
SBP>180 and damage to the target organ DBP > 120 plus damage to the target organ What
is primary hypertension?
Essential or idiopathic hypertension
Unknown reason covers 95% of cases. Age of onset: 22-55 years old The cause of primary
hypertension is unknown. -genetic and environmental factors
-elevated intracellular calcium and sodium levels -sympathetic nervous system hyperactivity
-high renin-angiotensin activity causing vascular dysfunction
What is secondary hypertension?
HTN related to other known causes or disease processes.
Represents 5% of all HTN cases
What is the etiology of secondary HTN?
-renal disease (most common secondary cause) -estrogen use (via oral contraceptives or
hormone replacement therapy
-pregnancy
-endocrine disorders (i.e., pheochromocytoma)
What is isolated systolic hypertension?
