FNP 2 HTN | Questions and Complete
Verified Answers
according to USPSTF how often should we check P <120/80 - ANSWER only need to
be check Q2y, but Dr. Bull says just check at every visit!
risk factors for adult HTN - ANSWER Risk factors: obesity (increase activation of
renin/angiotensin system, and SNS), tobacco, physical inactivity, medications, ethnicity
(AA typically have worse outcomes, caucasians have more CV outcomes), family history.
Other factors to consider are: NSAIDs (can increase to as much as 5mg of SBP/DBP),
OCP (there's no evidence of postmenopausal estrogen causing HTN), corticosteroids,
decongestants, antidepressants (Effexor, wellbutrin), methylxanthines, nicotine
adult HTN assessment - ANSWER History: ask about PMH, FMH, risk factors,
lifestyle, diet (24h recall), exercise, sleep
Physical exam: Assess eyes (fundus exam, looking for retinopathy), heart (apical
pulses, carotid bruits, JVD, abd aorta bruits, peripheral extremities, edema, palpate for
heaves/thrills/lifts) inspect chest, kidney (changes in output, labs), general (fatigue,
headaches, dizziness, syncope)
diagnostics for adult HTN - ANSWER Need at least 3 abnormal BP readings in office or
a BP >180/110.
Compare home and office readings - ask the patient, who's taking the BP? What's
the patient's situation? When/How is it being taken?
24-hour ambulatory BP monitoring - BP usually declines 10-20% when sleeping, if it
doesn't go down like this then consider an abnormal finding; BP is also usually elevated
in the morning for most people but this can be related to hemorrhagic events in patient
with severe, uncontrolled HTN.
EKG
Urinalysis
,Labs - CBC (check for anemia, polycythemia), electrolytes, BUN/Creatinine, glucose
(DM/metabolic screen), Lipids, eGFR
management of adult HTN - ANSWER Recommend DASH diet, <2.4g of salt/day,
weight reduction, regular physical activity, limit alcohol consumption (will only see a
decrease in BP in patient was drinking >20 drinks/week), smoking cessation
complications of adult HTN - ANSWER Complications: Heart failure, MI, ischemic and
hemorrhagic stroke, aneurysms, dissections, nephrosclerosis/renal failure, retinopathy
clinical outcomes of control HTN - ANSWER only less than 50% meet BP goals
Decreased mortality
Decreased morbidity
HF reduced by 50%
CKD
Stroke reduced by 35%
MI reduced by 20%
JNC 8 guidelines - ANSWER HTN guidelines
JNC 8 guidelines- came out in 2013 (been out since 70s)- this is not end all be all-
other guidelines exist ex) american society of HTN
Others
American society of HTN
International society of HTN
goals of HTN treatment - ANSWER Cardiovascular risk and BP management ( JNC-8)
Adult management (pt under the age of 60)
SBP≥ 140 and DBP≥90
, Same goal for adults with DM or CKD
>60: Rx for SBP ≥ 150 or DBP ≥90 (SBP allowed to be higher, no evidence of benefits
of having it lower)
caveats of JNC 8 - ANSWER First line-thiazides, ACE inhibitor, ARBs,
CCB Beta blockers are no longer first line (JNC-8) -NEW Do not use ACE
inhibitors and ARBS together
ACE inhibitor or ARB plus thiazide, plus calcium channel before choosing other
classes before using other groups such as beta blockers
Compelling indications: ASH/ISH 2013 - ANSWER HF
-Beta blocker, ACEI, ARB, Aldosterone antagonist,
diuretic Coronary heart disease
Verified Answers
according to USPSTF how often should we check P <120/80 - ANSWER only need to
be check Q2y, but Dr. Bull says just check at every visit!
risk factors for adult HTN - ANSWER Risk factors: obesity (increase activation of
renin/angiotensin system, and SNS), tobacco, physical inactivity, medications, ethnicity
(AA typically have worse outcomes, caucasians have more CV outcomes), family history.
Other factors to consider are: NSAIDs (can increase to as much as 5mg of SBP/DBP),
OCP (there's no evidence of postmenopausal estrogen causing HTN), corticosteroids,
decongestants, antidepressants (Effexor, wellbutrin), methylxanthines, nicotine
adult HTN assessment - ANSWER History: ask about PMH, FMH, risk factors,
lifestyle, diet (24h recall), exercise, sleep
Physical exam: Assess eyes (fundus exam, looking for retinopathy), heart (apical
pulses, carotid bruits, JVD, abd aorta bruits, peripheral extremities, edema, palpate for
heaves/thrills/lifts) inspect chest, kidney (changes in output, labs), general (fatigue,
headaches, dizziness, syncope)
diagnostics for adult HTN - ANSWER Need at least 3 abnormal BP readings in office or
a BP >180/110.
Compare home and office readings - ask the patient, who's taking the BP? What's
the patient's situation? When/How is it being taken?
24-hour ambulatory BP monitoring - BP usually declines 10-20% when sleeping, if it
doesn't go down like this then consider an abnormal finding; BP is also usually elevated
in the morning for most people but this can be related to hemorrhagic events in patient
with severe, uncontrolled HTN.
EKG
Urinalysis
,Labs - CBC (check for anemia, polycythemia), electrolytes, BUN/Creatinine, glucose
(DM/metabolic screen), Lipids, eGFR
management of adult HTN - ANSWER Recommend DASH diet, <2.4g of salt/day,
weight reduction, regular physical activity, limit alcohol consumption (will only see a
decrease in BP in patient was drinking >20 drinks/week), smoking cessation
complications of adult HTN - ANSWER Complications: Heart failure, MI, ischemic and
hemorrhagic stroke, aneurysms, dissections, nephrosclerosis/renal failure, retinopathy
clinical outcomes of control HTN - ANSWER only less than 50% meet BP goals
Decreased mortality
Decreased morbidity
HF reduced by 50%
CKD
Stroke reduced by 35%
MI reduced by 20%
JNC 8 guidelines - ANSWER HTN guidelines
JNC 8 guidelines- came out in 2013 (been out since 70s)- this is not end all be all-
other guidelines exist ex) american society of HTN
Others
American society of HTN
International society of HTN
goals of HTN treatment - ANSWER Cardiovascular risk and BP management ( JNC-8)
Adult management (pt under the age of 60)
SBP≥ 140 and DBP≥90
, Same goal for adults with DM or CKD
>60: Rx for SBP ≥ 150 or DBP ≥90 (SBP allowed to be higher, no evidence of benefits
of having it lower)
caveats of JNC 8 - ANSWER First line-thiazides, ACE inhibitor, ARBs,
CCB Beta blockers are no longer first line (JNC-8) -NEW Do not use ACE
inhibitors and ARBS together
ACE inhibitor or ARB plus thiazide, plus calcium channel before choosing other
classes before using other groups such as beta blockers
Compelling indications: ASH/ISH 2013 - ANSWER HF
-Beta blocker, ACEI, ARB, Aldosterone antagonist,
diuretic Coronary heart disease
