Nurs 620 Maryville Exam 2
Risk factors for hypertension - Answer: 1. age & sex- women older than 55 & men older than 45
2.Obesity
3.Excessive dietary intake of salt
4.cigarette smoking
5.chronic 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 - Answer: Healthy 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 - Answer: Weight 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: - Answer: -general population:
thiazide
,Nurs 620 Maryville Exam 2
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 - Answer: ACE and ARBS
HTN therapy for patients over 75years old with impaired kidney function - Answer: CCB
Thiazides
Classification of HTN per AHA - Answer: Normal 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+
,Nurs 620 Maryville Exam 2
Hypertensive crisis: 180+/120+
If goal not met for HTN in a month of treatment then what? - Answer: Increase 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 - Answer: 2-4
weeks, then once goal has achieved every 3-6 months.
Diagnostic workup for HTN - Answer: History- 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 - Answer: Cushings- 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 - Answer: failure 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
, Nurs 620 Maryville Exam 2
Causes of resistant HTN - Answer: 1) 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 - Answer: Left ventricular hypertrophy
Heart failure
Ischemic Stroke
Intracerebral hemmorage
Ischemic heart disease
CKD, ESRD
Signs of target organ damage in Hypertension - Answer: Headaches
vision changes
papillary edema
change in mental status
s/s heart failure
hematuria, proteinuria, elevated creatinine
Dyslipidemia-->
Desirable/optimal serum lipid levels ****** - Answer: Total cholesterol: less than 200mg/dl
Triglycerides: less than 150mg/dl
Risk factors for hypertension - Answer: 1. age & sex- women older than 55 & men older than 45
2.Obesity
3.Excessive dietary intake of salt
4.cigarette smoking
5.chronic 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 - Answer: Healthy 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 - Answer: Weight 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: - Answer: -general population:
thiazide
,Nurs 620 Maryville Exam 2
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 - Answer: ACE and ARBS
HTN therapy for patients over 75years old with impaired kidney function - Answer: CCB
Thiazides
Classification of HTN per AHA - Answer: Normal 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+
,Nurs 620 Maryville Exam 2
Hypertensive crisis: 180+/120+
If goal not met for HTN in a month of treatment then what? - Answer: Increase 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 - Answer: 2-4
weeks, then once goal has achieved every 3-6 months.
Diagnostic workup for HTN - Answer: History- 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 - Answer: Cushings- 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 - Answer: failure 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
, Nurs 620 Maryville Exam 2
Causes of resistant HTN - Answer: 1) 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 - Answer: Left ventricular hypertrophy
Heart failure
Ischemic Stroke
Intracerebral hemmorage
Ischemic heart disease
CKD, ESRD
Signs of target organ damage in Hypertension - Answer: Headaches
vision changes
papillary edema
change in mental status
s/s heart failure
hematuria, proteinuria, elevated creatinine
Dyslipidemia-->
Desirable/optimal serum lipid levels ****** - Answer: Total cholesterol: less than 200mg/dl
Triglycerides: less than 150mg/dl
