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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/m 2. 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. - ANSWER B. arrange for at least
two additional BP measurements during the next 2 weeks.
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. - ANSWER A. prescribe an
angiotensin-converting enzyme inhibitor (ACEI).
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. - ANSWER C. left ventricular hypertrophy.
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. - ANSWER B. uric acid.
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. - ANSWER D. consuming at least
1-2 servings of alcohol.
Match the antihypertension medication with its appropriate class:
amlodipine
diltiazem
trandolapril
telmisartan
pindolol
A. beta-adrenergic receptor antagonist
B. nondihydropyridine calcium channel blocker