AGNP exam 1 Questions and answers
2025
mechanisms .of .BP .control .- .ANS✓✓-
defects .in .excess .NA, .sympathetic .hyperactivity, .psychosocial .factors, .RAAS, .ni
tric .oxide .def., .inc. .insulin
Every .increase .of .20 .systolic .and .10 .diastolic= .- .ANS✓✓-
doubled .risk .for .CVD, .starting .at .115/75
HTN .most .prevalent .in .- .ANS✓✓-AA, .women .>50, .men .>45
RF .for .HTN .- .ANS✓✓-
age, .arterial .stiffness, .dec .baroreceptor .sensitivity, .inc .sympathetic .nervous .sys
tem .sensitivity, .endothelial .dysfunction, .decreased .Na .excretion, .decreased .plas
ma .renin .load, .genetics
obesity .BMI>30, .metabolic .syndrome, .DM, .high .fat .and .K .diets, .sedentary, .OSA,
.ETOH/tob
ETOH .and .HTN .- .ANS✓✓-
>2oz/d .= .linked .to .htn .due .to .increased .catecholamines
HTN .is .difficult .to .control .if .>4oz/d .or .binge .drinking
smoking .and .HTN .- .ANS✓✓-increases .BP .d/t .increased .plasma .norepinephrine
Meds .that .increase .BP .- .ANS✓✓-NSAIDS .(inc .by .5)
estrogen-progesterone .
(causes .mild .sustained .inc .in .bp .in .premenopausal .women)
glucocorticoids .(d/t .Na .retention)
Ephedrine .products
,History .taking .for .HTN .- .ANS✓✓-
prior .known .Hx, .Tx .for .htn, .response .to .therapy
prior .MI/CVA/PVD/CKD/DM
assess .for .ED/dyslipidemia/inflamm .disease/chronic .conditions
family .Hx
Meds
physical .activity .level, .diet, .ETOH/tob., .weight, .drugs, .psychosocial
PE .for .HTN .- .ANS✓✓-Weight .and .BMI, .BP
skin .for .hirsutism, .cushing's .findings, .neurofibromatosis
Thyroid .for .nodules, .goiter, .bruit
Optic .fundi .for .arterial .narrowing, .AV .knicking, .vasc. .tortuosity
Carotids .for .bruits, .diminuation .of .pulses
Renal, .Iliac, .Femoral, .Abd .bruits
Abd .aorta .pulsation
PVD
PMI .displaced .laterally
Loud .S1, .rapid .closure .of .aortic .valve
S4, .atrial .contraction .into .poorly .compliant .LV
Mitral/Atrial .regurgitation .murmur .common
pulmonary .for .crackles, .signs .of .HF
Abd .for .enlarged .kidneys, .masses, .distended .bladder
Measuring .BP .- .ANS✓✓-
sit .quiet, .feet .on .floor .for .5 .mins. .arm .supported .at .heart .level, .size .of .cuff .80%
.of .arm, .2-3 .measurements .1 .min .apart
Non-Dip .HTN .- .ANS✓✓-ABPM .detects .a .non-dip .pattern, .loss .of .nocturnal .dip .
(at .least .10% .during .sleep)...is .a .predictor .of .CV .risk, .inc .thrombotic .stroke .risk
, .accentuation .of .morning .BP .associated .with .increased .ICH .(wake .up .stroke).
Labile .HTN .- .ANS✓✓-
BP .intermittently .spikes .above .normal. .Often .progresses .into .sustained .htn.
White .coat .HTN .- .ANS✓✓-
persistently .high .140/90 .at .office .only. .Pt .needs .to .monitor .at .home .for .2 .weeks
.and .call .with .results
Masked .HTN .- .ANS✓✓-
normal .BP .in .office, .HTN .at .home .or .when .ambulating, .occurs .15-
20% .without .diagnosis.
, Isolated .Diastolic .HTN .- .ANS✓✓-DBP .>90, .sys<140. .
Common .in .elderly, .obese, .aortic .stenosis, .heavy .etoh/tob
Isolated .Systolic .HTN .- .ANS✓✓-SBP .>140, .common .in .elderly
Secondary .HTN .- .ANS✓✓-
BP .increase .d/
t .definable .etiology, .often .abrupt .and .severe. .suspect .if .it .develops .at .early .age
.or .if .those .prev. .controlled .become .refractory .or .if .htn .resistant .to .3 .medicatio
ns.
May .be .d/t .genetic .syndromes, .kidney .disease, .70-
80% .blocked .RAAS, .primary .hyperaldosteronism, .adrenal .adenoma, .cushings, .p
heochromocytoma, .coarc .of .aorta
Malignant .HTN .- .ANS✓✓-
rapid .increase .in .DBP .>130, .manifested .by .increased .ICP
s/s= .restlessness, .changed .LOC, .n/v, .blurred .vision, .CN .palsy, .HF .symptoms
HTN .urgency .- .ANS✓✓-SBP .>180, .DBP .>120
severe .elevation .with .NO .target .organ .damage
HTN .emergency .- .ANS✓
✓->180/>120 .WITH .new .or .worsening .target .organ .damage
TOD .examples .- .ANS✓✓-
ACS, .flash .pulmonary .edema, .ARF, .aortic .dissection, .CVA, .encephalopathy, .papi
lledema
JNC .8 .- .ANS✓✓-normal: .<120/<80
Prehtn: .120-139/80-89
stage .1: .140-159/90-99
stage .2: .>160/>100
ACC/AHA .- .ANS✓✓-normal: .<120/<80
Elevated: .120-129/<80
Stage .1: .130-139/80-89
Stage .2: .>140/>90
2025
mechanisms .of .BP .control .- .ANS✓✓-
defects .in .excess .NA, .sympathetic .hyperactivity, .psychosocial .factors, .RAAS, .ni
tric .oxide .def., .inc. .insulin
Every .increase .of .20 .systolic .and .10 .diastolic= .- .ANS✓✓-
doubled .risk .for .CVD, .starting .at .115/75
HTN .most .prevalent .in .- .ANS✓✓-AA, .women .>50, .men .>45
RF .for .HTN .- .ANS✓✓-
age, .arterial .stiffness, .dec .baroreceptor .sensitivity, .inc .sympathetic .nervous .sys
tem .sensitivity, .endothelial .dysfunction, .decreased .Na .excretion, .decreased .plas
ma .renin .load, .genetics
obesity .BMI>30, .metabolic .syndrome, .DM, .high .fat .and .K .diets, .sedentary, .OSA,
.ETOH/tob
ETOH .and .HTN .- .ANS✓✓-
>2oz/d .= .linked .to .htn .due .to .increased .catecholamines
HTN .is .difficult .to .control .if .>4oz/d .or .binge .drinking
smoking .and .HTN .- .ANS✓✓-increases .BP .d/t .increased .plasma .norepinephrine
Meds .that .increase .BP .- .ANS✓✓-NSAIDS .(inc .by .5)
estrogen-progesterone .
(causes .mild .sustained .inc .in .bp .in .premenopausal .women)
glucocorticoids .(d/t .Na .retention)
Ephedrine .products
,History .taking .for .HTN .- .ANS✓✓-
prior .known .Hx, .Tx .for .htn, .response .to .therapy
prior .MI/CVA/PVD/CKD/DM
assess .for .ED/dyslipidemia/inflamm .disease/chronic .conditions
family .Hx
Meds
physical .activity .level, .diet, .ETOH/tob., .weight, .drugs, .psychosocial
PE .for .HTN .- .ANS✓✓-Weight .and .BMI, .BP
skin .for .hirsutism, .cushing's .findings, .neurofibromatosis
Thyroid .for .nodules, .goiter, .bruit
Optic .fundi .for .arterial .narrowing, .AV .knicking, .vasc. .tortuosity
Carotids .for .bruits, .diminuation .of .pulses
Renal, .Iliac, .Femoral, .Abd .bruits
Abd .aorta .pulsation
PVD
PMI .displaced .laterally
Loud .S1, .rapid .closure .of .aortic .valve
S4, .atrial .contraction .into .poorly .compliant .LV
Mitral/Atrial .regurgitation .murmur .common
pulmonary .for .crackles, .signs .of .HF
Abd .for .enlarged .kidneys, .masses, .distended .bladder
Measuring .BP .- .ANS✓✓-
sit .quiet, .feet .on .floor .for .5 .mins. .arm .supported .at .heart .level, .size .of .cuff .80%
.of .arm, .2-3 .measurements .1 .min .apart
Non-Dip .HTN .- .ANS✓✓-ABPM .detects .a .non-dip .pattern, .loss .of .nocturnal .dip .
(at .least .10% .during .sleep)...is .a .predictor .of .CV .risk, .inc .thrombotic .stroke .risk
, .accentuation .of .morning .BP .associated .with .increased .ICH .(wake .up .stroke).
Labile .HTN .- .ANS✓✓-
BP .intermittently .spikes .above .normal. .Often .progresses .into .sustained .htn.
White .coat .HTN .- .ANS✓✓-
persistently .high .140/90 .at .office .only. .Pt .needs .to .monitor .at .home .for .2 .weeks
.and .call .with .results
Masked .HTN .- .ANS✓✓-
normal .BP .in .office, .HTN .at .home .or .when .ambulating, .occurs .15-
20% .without .diagnosis.
, Isolated .Diastolic .HTN .- .ANS✓✓-DBP .>90, .sys<140. .
Common .in .elderly, .obese, .aortic .stenosis, .heavy .etoh/tob
Isolated .Systolic .HTN .- .ANS✓✓-SBP .>140, .common .in .elderly
Secondary .HTN .- .ANS✓✓-
BP .increase .d/
t .definable .etiology, .often .abrupt .and .severe. .suspect .if .it .develops .at .early .age
.or .if .those .prev. .controlled .become .refractory .or .if .htn .resistant .to .3 .medicatio
ns.
May .be .d/t .genetic .syndromes, .kidney .disease, .70-
80% .blocked .RAAS, .primary .hyperaldosteronism, .adrenal .adenoma, .cushings, .p
heochromocytoma, .coarc .of .aorta
Malignant .HTN .- .ANS✓✓-
rapid .increase .in .DBP .>130, .manifested .by .increased .ICP
s/s= .restlessness, .changed .LOC, .n/v, .blurred .vision, .CN .palsy, .HF .symptoms
HTN .urgency .- .ANS✓✓-SBP .>180, .DBP .>120
severe .elevation .with .NO .target .organ .damage
HTN .emergency .- .ANS✓
✓->180/>120 .WITH .new .or .worsening .target .organ .damage
TOD .examples .- .ANS✓✓-
ACS, .flash .pulmonary .edema, .ARF, .aortic .dissection, .CVA, .encephalopathy, .papi
lledema
JNC .8 .- .ANS✓✓-normal: .<120/<80
Prehtn: .120-139/80-89
stage .1: .140-159/90-99
stage .2: .>160/>100
ACC/AHA .- .ANS✓✓-normal: .<120/<80
Elevated: .120-129/<80
Stage .1: .130-139/80-89
Stage .2: .>140/>90
