N5334 Advanced Pharmacology Test 2 Question and answers

You examine a 38-year-old woman who has presented for an initial examination and Papanicolaou test. She has no complaint. Her blood pressure (BP) is 154/98 mm Hg bilaterally and her body mass index (BMI) is 31 kg/m2. The rest of her physical examination is unremarkable. Your next best action is to: A. initiate antihypertensive therapy. B. arrange for at least two additional BP measurements during the next 2 weeks. C. order blood urea nitrogen, creatinine, and potassium ion measurements and urinalysis. D. advise her to reduce her sodium intake. - B You see a 68-year-old woman as a patient who is transferring care into your practice. She has a 10-year history of hypertension, diabetes mellitus, and hyperlipidemia. Current medications include hydrochlorothiazide (HCTZ), glipizide, metformin, simvastatin, and daily low-dose aspirin. Today's BP reading is 158/92 mm Hg, and the rest of her history and examination are unremarkable. Documentation from her former healthcare provider indicates that her BP has been in the range for the past 12 months. Your next best action is to: A. prescribe an angiotensin-converting enzyme inhibitor (ACEI). B. have her return for a BP check in 1 week. C. advise that her current therapy is adequate. D. add therapy with an aldosterone antagonist. - A You examine a 78-year-old woman with long-standing, poorly controlled hypertension. When evaluating her for hypertensive target organ damage, you look for evidence of: A. lipid abnormalities. B. insulin resistance. C. left ventricular hypertrophy. D. clotting disorders. - C Diagnostic testing for a patient with newly diagnosed primary hypertension should include all of the following except: A. hematocrit. B. uric acid. C. creatinine. D. potassium. - B In the person with hypertension, the nurse practitioner (NP) recommends all of the following to potentially reduce BP in a patient with a BMI of 30 kg/m2 except: A. 10-kg (22-lb) weight loss. B. dietary sodium restriction to 2.4 g (6 g NaCl) per day. C. regular aerobic physical activity, such as 30-40 minutes of brisk walking most days of the week. D. consuming at least 1-2 servings of alcohol. - D Match the antihypertension medication with its appropriate class. _______6. amlodipine _______7. diltiazem _______8. trandolapril _______9. telmisartan _______10. pindolol A. beta-adrenergic receptor antagonist B. nondihydropyridine calcium channel blocker C. dihydropyridine calcium channel blocker D. angiotensin receptor antagonist E. ACEI - 6. C. 7. B. 8. E. 9. D. 10. A. You see a 38-year-old African American male with hypertension who is currently being treated with thiazide-type diuretic. His current blood pressure reading is 156/94 mm Hg and he has no history of diabetes mellitus or chronic kidney disease. Following current best evidence, you consider adding which of the following medications? A. ACEI B. angiotensin receptor blocker (ARBs) C. beta-adrenergic receptor antagonist D. calcium channel blocker - D Nondihydropyridine calcium channel blockers are contraindicated in patients with: A. type 1 diabetes mellitus. B. a history of venous thromboembolism. C. severe left ventricular dysfunction. D. concomitant treatment with an ACEI. - C In obtaining an office BP measurement, which of the following is most reflective of the best practice? A. The patient should sit in a chair with feet flat on the floor for at least 5 minutes before obtaining the reading. B. The BP cuff should not cover more than 50% of the upper arm. C. The patient should sit on the edge of the examination table without arm support to enhance reading accuracy. D. Obtaining the BP reading immediately after the patient walks into the examination room is recommended. - A A BP elevation noted only at an office visit is commonly known as hypertension. A. provider-induced B. clinical C. white coat D. pseudo - C The most important long-term goal of treating hypertension is to: A. strive to reach recommended numeric BP measurement. B. avoid disease-related target organ damage. C. develop a plan of care with minimal adverse effects. D. treat concomitant health problems often noted in the person with this condition. - B You start a patient with hypertension who is already receiving an ACEI on spironolactone. You advise the patient to return in 4 weeks to check which of the following laboratory parameters? A. sodium B. calcium C. potassium D. chloride - C A 68-year-old woman presents with hypertension and BP of 152-158/92-96 mm Hg documented over 2 months on three different occasions. Electrocardiogram (ECG) and creatinine are normal, and she has no proteinuria. Clinical findings include the following: BMI 26.4 kg/m2; no S3, S4, or murmur; and point of maximal impulse at fifth intercostal space, mid-clavicular line. Which of the following represents the best intervention? A. Initiate therapy with metoprolol. B. Initiate therapy with hydrochlorothiazide. C. Initiate therapy with methyldopa. D. Continue to monitor BP, and start drug therapy if evidence of target organ damage. - B Which of the following can have a favorable effect on a comorbid condition in a person with hypertension? A. chlorthalidone in gout B. propranolol with airway disease C. aldosterone antagonist in heart failure D. methyldopa in an older adult - C According to JNC-8 guidelines, all of the following medications are first-line agents for use in a middle-aged white man without diabetes mellitus except: A. lisinopril. B. hydrochlorothiazide. C. metoprolol. D. amlodipine. - C You see a 59-year-old man with poorly controlled hypertension. On physical examination, you note grade 1 hypertensive retinopathy. You anticipate all of the following will be present except: A. patient report of acute visual change. B. narrowing of the terminal arterioles. C. sharp optic disc borders. D. absence of retinal hemorrhage. - A According to JNC-8, a 52-year-old well woman