NR 661 VISE EXAM QUESTIONS AND
DETAILED ANSWERS. EXPERT
VERIFIED FOR GUARANTEED PASS.
Hypertension - presentation - ANS Most are not symptomatic, Occipital Headaches,
headache on awakening in am, blurry vision
hypertension - assessment - ANS · Asymptomatic
· Occipital headache
· Blurry vision
· Headache upon wakening
· Look for AV nicking
· LVH (left vent hypertrophy - sob, fatigue, cp, dizzy)
Hypertension - Diagnostic Studies - ANS to look for secondary causes of HTN like target organ
damage and establish ASCVD risk: EKG, fasting lipid profile, fasting blood glucose, CBC, CMP
(electrolyte, creatinine, & calcium levels), and urinalysis (checking for proteinuria).
hypertension - diagnosis - ANS Measure BP 5 minutes apart. Average of 2 or more BP
readings on two different visits at > 140/90 mm Hg start then can be diagnosed with HTN.
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,Hypertension - staging - ANS Stage 1 (ASCVD <10%) then non-pharmacologic management
only:
· First: Lifestyle modifications: diet and exercise 30 minutes aerobic exercise 5 days per week.
· Limit alcohol
· stop smoking
· stress management.
· DASH
· Medication compliance
· Reduce sodium intake
· Measure BP daily
If Stage 2 (ASCVD >10% and known CAD) initiate lifestyle + Pharmacologic
Hypertension pharmacological management - ANS · Alone: hydrochlorothiazide (HCTZ) 25
mg/day (chlorthalidone is preferred over HCTZ)
· Alone: lisinopril 10mg/day complicated HTN first line
· Combo: thiazide + ACE or ARB
· Alternative CB (especially in isolated HTN seen mainly in older adults)
· Black population: thiazide + CCB is recommended first line
hypertension f/u - ANS 2-4 weeks
hypertension referral - ANS cardiology if ekg abnormal
hypertension differential - ANS · Secondary hypertension
· Pregnant
· Pregnancy induced hypertension
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,acute maxillary sinusitis - etiology - ANS inflammation of the maxillary sinus due to viral,
bacterial, or fungal infection or allergic reaction
acute sinusitis - ANS symptoms last < 12 weeks
· Common bacterial causes: strep pneumoniae, haemophilus influenzae, Moraxella catarrhalis
· Common viral causes: rhonovirus, coronavirus, flu A and B, parainfluenza, RSV
recurrent acute sinusitis - ANS at least 3 episodes of acute bacterial sinusitis in a year
chronic sinusitis - ANS symptoms of varying severity > 12 weeks; further classified with or
without nasal polyps, abnormal findings on CT scan or nasal endoscopy
· Gram negative is more likely
· Staph aureus
· Pseudomonas aeruginosa
· Anaerobic organisms
sinusitis - presentations - ANS · Fever may or may not be present
· Persistent symptoms of URI (> 10-14 days)
· Congestion, purulent nasal discharge
· headache, sore throat,
· Pain and pressure over cheeks and upper teeth suggest maxillary
· Pain and pressure over eyebrows suggest frontal
· Pain and pressure/tenderness behind and between eyes suggests ethmoid
· cough, anosmia, halitosis, postnasal discharge, periorbital edema
Symptoms > 10 days that worsen after initial improvement, persistent purulent nasal discharge,
fever, unilateral face or tooth pain is more likely a bacterial infection
sinusitis - diagnostics - ANS CBC (elevated WBC),
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
, sinus x-rays for recurrent disease
transillumination: opacification with air-fluid levels if sinus cavity is infected
CT scan for recurrent disease
Consider c and s for treatment resistant infections
sinusitis -- nonpharmacological - ANS Avoid environmental irritants,
Humidified air
treat otitis media,
sleep with HOB elevated to aid with drainage,
Good hand hygiene
blowing nose, not sniffing.
sinusitis -- pharmacological - ANS First line- Augmentin 875 mg/125 mg PO BID for 5 days,
Allergic to Penicillin then Doxycycline 100mg BID for 5-7 days OR 200mg PO daily for 5-7 days
Levofloxacin 500mg PO daily for 10-14 days Monifloxacin 400mg PO daily for 5-7 days
Macrolides no longer recommended due to high resistance
Analgesics for headache and fever
Saline irrigation
sinusitis - f/u, referral - ANS Follow up:
1 week or until clinically free of infection
Referral:
May refer to ENT for recurrent infections or resistance to tx
Consider immediate referral if periorbital cellulitis
ER if meningitis suspected
hyperlipidemia - etilogy - ANS may be familial, dietary, obesity, hypothyroid, renal disorders,
thiazide or beta blocker use, alcohol and/or caffeine intake
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
DETAILED ANSWERS. EXPERT
VERIFIED FOR GUARANTEED PASS.
Hypertension - presentation - ANS Most are not symptomatic, Occipital Headaches,
headache on awakening in am, blurry vision
hypertension - assessment - ANS · Asymptomatic
· Occipital headache
· Blurry vision
· Headache upon wakening
· Look for AV nicking
· LVH (left vent hypertrophy - sob, fatigue, cp, dizzy)
Hypertension - Diagnostic Studies - ANS to look for secondary causes of HTN like target organ
damage and establish ASCVD risk: EKG, fasting lipid profile, fasting blood glucose, CBC, CMP
(electrolyte, creatinine, & calcium levels), and urinalysis (checking for proteinuria).
hypertension - diagnosis - ANS Measure BP 5 minutes apart. Average of 2 or more BP
readings on two different visits at > 140/90 mm Hg start then can be diagnosed with HTN.
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,Hypertension - staging - ANS Stage 1 (ASCVD <10%) then non-pharmacologic management
only:
· First: Lifestyle modifications: diet and exercise 30 minutes aerobic exercise 5 days per week.
· Limit alcohol
· stop smoking
· stress management.
· DASH
· Medication compliance
· Reduce sodium intake
· Measure BP daily
If Stage 2 (ASCVD >10% and known CAD) initiate lifestyle + Pharmacologic
Hypertension pharmacological management - ANS · Alone: hydrochlorothiazide (HCTZ) 25
mg/day (chlorthalidone is preferred over HCTZ)
· Alone: lisinopril 10mg/day complicated HTN first line
· Combo: thiazide + ACE or ARB
· Alternative CB (especially in isolated HTN seen mainly in older adults)
· Black population: thiazide + CCB is recommended first line
hypertension f/u - ANS 2-4 weeks
hypertension referral - ANS cardiology if ekg abnormal
hypertension differential - ANS · Secondary hypertension
· Pregnant
· Pregnancy induced hypertension
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,acute maxillary sinusitis - etiology - ANS inflammation of the maxillary sinus due to viral,
bacterial, or fungal infection or allergic reaction
acute sinusitis - ANS symptoms last < 12 weeks
· Common bacterial causes: strep pneumoniae, haemophilus influenzae, Moraxella catarrhalis
· Common viral causes: rhonovirus, coronavirus, flu A and B, parainfluenza, RSV
recurrent acute sinusitis - ANS at least 3 episodes of acute bacterial sinusitis in a year
chronic sinusitis - ANS symptoms of varying severity > 12 weeks; further classified with or
without nasal polyps, abnormal findings on CT scan or nasal endoscopy
· Gram negative is more likely
· Staph aureus
· Pseudomonas aeruginosa
· Anaerobic organisms
sinusitis - presentations - ANS · Fever may or may not be present
· Persistent symptoms of URI (> 10-14 days)
· Congestion, purulent nasal discharge
· headache, sore throat,
· Pain and pressure over cheeks and upper teeth suggest maxillary
· Pain and pressure over eyebrows suggest frontal
· Pain and pressure/tenderness behind and between eyes suggests ethmoid
· cough, anosmia, halitosis, postnasal discharge, periorbital edema
Symptoms > 10 days that worsen after initial improvement, persistent purulent nasal discharge,
fever, unilateral face or tooth pain is more likely a bacterial infection
sinusitis - diagnostics - ANS CBC (elevated WBC),
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
, sinus x-rays for recurrent disease
transillumination: opacification with air-fluid levels if sinus cavity is infected
CT scan for recurrent disease
Consider c and s for treatment resistant infections
sinusitis -- nonpharmacological - ANS Avoid environmental irritants,
Humidified air
treat otitis media,
sleep with HOB elevated to aid with drainage,
Good hand hygiene
blowing nose, not sniffing.
sinusitis -- pharmacological - ANS First line- Augmentin 875 mg/125 mg PO BID for 5 days,
Allergic to Penicillin then Doxycycline 100mg BID for 5-7 days OR 200mg PO daily for 5-7 days
Levofloxacin 500mg PO daily for 10-14 days Monifloxacin 400mg PO daily for 5-7 days
Macrolides no longer recommended due to high resistance
Analgesics for headache and fever
Saline irrigation
sinusitis - f/u, referral - ANS Follow up:
1 week or until clinically free of infection
Referral:
May refer to ENT for recurrent infections or resistance to tx
Consider immediate referral if periorbital cellulitis
ER if meningitis suspected
hyperlipidemia - etilogy - ANS may be familial, dietary, obesity, hypothyroid, renal disorders,
thiazide or beta blocker use, alcohol and/or caffeine intake
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
