NURS 620 MARYVILLE EXAM 2 QUESTIONS AND ANSWERS 100%CORRECT! 2023 UPDATE

NURS 620 MARYVILLE EXAM 2 QUESTIONS AND ANSWERS 100%CORRECT! 2023 UPDATENURS 620 MARYVILLE EXAM 2 QUESTIONS AND ANSWERS 100%CORRECT! 2023 UPDATE Risk factors for hypertension - correct answers1. age & sex- women older than 55 & men older than 45 2.Obesity 3.Excessive dietary intake of salt ette smoking ic alcohol consumption 6.Family history of high blood pressure and/or cardiovascular disease 7.African American race 8.Stress 9.Sedentary lifestyle Blood pressure goals for JNC8 - correct answersHealthy patients over 60 years of age is okay if it is below 150/90 Healthy patients less than 60 years of age the blood pressure is okay if less than 140/90 Patients with dx of DM or CKD regardless of age, goal BP is less than 140/90 lifestyle modifications for - correct answersWeight reduction (BMI 18.5-24.9) DASH diet less than 2.4g a day of sodium Increase Pysical activity to 30min most days of the week Stop smoking Alcohol less than 2 drinks a day JNC8 preferred agents: - correct answers-general population: thiazide CCB ACEI ARB -black: (without CKD) CCB or thiazide -DM: thiazide CCB ACEI ARB -CKD: ACE ARB Which medications for HTN should not be used together - correct answersACE and ARBS HTN therapy for patients over 75years old with impaired kidney function - correct answersCCB Thiazides Classification of HTN per AHA - correct answersNormal BP: less than 120 Systolic, diastolic less than 80 Elevated: 120-129 systolic, less than 80 diastolic Stage 1 HTN: 130-139/80-89 Stage 2 HTN: 140+/90+ Hypertensive crisis: 180+/120+ If goal not met for HTN in a month of treatment then what? - correct answersIncrease the intital dose of drug or add a second agent, if goal not achieved with 2 agents consider a 3rd agent. When HTN treatment is initiated or dose changed when should patient follow up - correct answers2-4 weeks, then once goal has achieved every 3-6 months. Diagnostic workup for HTN - correct answersHistory- any symptoms? Physical examination What are their risk factors? - family history, smoking, drinking, sedentary lifestyle. Labs: BMP, CBC, UA, CMP, TSH, Lipid profile, ECG need to know kidney function, electrolytes, are they spilling protein in their urine. Work up for secondary causes of HTN - correct answersCushings- need a 24 hour urine Coarctation of the aorta- CXR Pheochromocytoma- 24 hour urine Primary hyperaldosteronism Renovascular hypertension- Renal arterogram, ultrasound of kidneys Resistant Hypertension - correct answersfailure to reach goal BP in patients who are taking full doses of an appropriate three-drug therapy regimen that includes a diuretic needs referral to cardiologist Causes of resistant HTN - correct answers1) Improper BP measurement 2) Excess Na+ intake 3) Inadequate diuretic Tx 4) Med issues such as inadequate doses, drug actions and interactions (e.g. NSAIDs, illicit drugs, sympathomimetics, OCPs), or OTC drugs and herbals 5) Excess EtOH intake 6) Underlying ID causes of HTN (2ndary) 7) White coat hypertension Complications of HTN - correct answersLeft ventricular hypertrophy Heart failure Ischemic Stroke Intracerebral hemmorage Ischemic heart disease CKD, ESRD Signs of target organ damage in Hypertension - correct answersHeadaches vision changes papillary edema change in mental status s/s heart failure hematuria, proteinuria, elevated creatinine Dyslipidemia--> Desirable/optimal serum lipid levels ****** - correct answersTotal cholesterol: less than 200mg/dl Triglycerides: less than 150mg/dl HDL: women greater than 45, men greater than 40, cardio protective is greater than 60 LDL: less than 100, DM 50-70 Screening for hyperlipidemia - correct answersHigh Risk- • More than 1 risk factor - HTN, Smoking, Family hx • Single risk factor that is severe - i.e. siblings w/ CAD at a young age - Very heavy smoking history • Start screening at age 25 for men, age 35 for women • Repeat screening every 3 years Low Risk- • In the general population, guidelines indicate screening based on sex and age • Males - age 35 • Females - age 45 • Rescreening recommended every 5 years symptoms of hyperlipidemia - correct answersA person with hyperlipidemia usually has no signs or symptoms. In familial, or inherited, hyperlipidemia, there may be yellowish fatty growths around the eyes or the joints. Hyperlipidemia is usually detected during a routine blood test, or following a cardiovascular event, such as a heart attack or stroke. How to manage hyperlipidemia - correct answers• Therapy should be initiated when a patient's 10-year risk for a first atherosclerotic cardiovascular disease (ASCVD) event is 7.5% • This calculator can be found at - When would you initiate drug therapy for high cholesterol according to lab results? - correct answers• Therapy should be initiated when a patient's 10-year risk for a first atherosclerotic cardiovascular disease (ASCVD) event is 7.5% Drug therapy for hyperlipidemia - correct answers• HMG-CoA reductase inhibitors - STATINS • Non-statin therapy - no longer recommended - Bile acid sequestrates - Niacin - Gemfibrozil - trigs - Fenofibrate - trigs - Fish oils - trigs - Ezetimibe (Zetia) Statins- • Rovastatin - Crestor • Atorvastatin - Lipitor • Simvastatin - Zocor • Pravastatin - Pravachol • Lovastatin • Fluvastatin Rechecking labs for hyperlipidemia - correct answers• LDL-C response at 6 weeks after initiating therapy • Every 6 to 12 months thereafter may be helpful in assessing medication adherence. • No need to monitor the LDL-C response to therapy other than to assess adherence, since we do not suggest intensifying the regimen for any particular level of LDL-C response Coranary Artery Disease (CAD) - correct answerscaused by plaque formation of cornary arteries, leads to restricted blood flow to the heart tissue. Angina vs MI - correct answersRestricted blood flow to the heart that causes chest pain