HTN

Question 1

Risk factors

Answer 1

Modifiable-obesity, metabolic syndrome, high fat diet, high sodium intake, physical inactivity, excess alcohol, tobacco use
Non modifiable- AA, age, family hx, male

Question 2

Monitoring BP

Answer 2

Lower margin of cuff 2.5 cm above AC space
Middle bladder over brachial artery
80% arm circumference
Wait 5 minutes
Arm supported at heart levels
Measure both arms

Question 3

Initial screen for home

Answer 3

2-3 measures in early AM and PM for 7 days
Provider ignores all day 1 measures and 1st reading each set
Circle average
Home readings greater than 135/85 considered HTN

Question 4

TOD

Answer 4

Target organ damage

Question 5

Signs of TOD

Answer 5

CVA, encephalopathy, dementia, early cognitive decline, retinopathy, LVH, CAD, MI, rhythmic disorders, aortic and PAD, AAA, CKD, ED

Question 6

Diagnostic HTN

Answer 6

Based on BP measure on 2 or more occasions after initial detection
Exception >180/120

Question 7

Normal BP

Answer 7

Systolic less than 120
Diastolic less than 80

Question 8

Pre HTN

Answer 8

120-139 SBP
80-80 DBP

Question 9

Stage 1 HTN

Answer 9

140-159 SBP
90-99 DBP

Question 10

Stage 2 HTN

Answer 10

Greater than 160 SBP
Greater than 100 DBP

Question 11

HTN urgency

Answer 11

Greater than SBP 180 DBP 120
No TOD or SX
Not required rapid decrease
Start 2 drug combo check labs
Clonidine and furosemide if fluid overloaded

Question 12

HTN emergency

Answer 12

SBP greater than 180 DBP greater than 120 WITH TOD and/or SX
HTN encephalopathy-cerebral edema-confusion, HA, irritability
Dissecting AAA
Angina
CHF
Pulmonary edema
ARF
Eclampsia
MUST GO TO HOSPITAL

Question 13

Primary essential HTN

Answer 13

Multi cause
Increased peripheral arterial resistance
Increase endogenous presser activity

Question 14

Secondary HTN

Answer 14

Renal artery stenosis
Pheochromocytoma
OSA
hyper aldosteronism
Renal parenchyma disease
Coarctation of aorta
Substance abuse
ABCDE-accuracy, aldosteronism, apnea/bruits, bad kidneys/catecholamines, Cushing, coarc/drugs, diet/endocrine, erythropoietin

Question 15

Accelerated HTN

Answer 15

Clinical evidence of severe arteriosclerosis
Grade 3 or 4 HTN retinopathy
Renal insufficiency
Prognosis poor if untreated

Question 16

Meds that elevated BP

Answer 16

Contraceptive
Cyclosporine
TCA/MAOIs
Decongestant
Appetite suppressant
Steroids
NSAIDs
Erythropoietin
SRNI

Question 18

Pseudo HTN

Answer 18

Wall of brachial artery is rigid secondary to calcification
Correlate with radial pulse obliteration
Suspect in patients with dizziness/weakness who on tx has normal to high cuff reading

Question 19

Pheochromocytoma

Answer 19

Tachy, palps, sweating, HA paradoxical
24 urine to dx, urine catecholamine, metaphrines, vanillylmandelic acid
Plasma metaphrines
CT, MRI

Question 20

White coat syndrome

Answer 20

Home readings not above 135/85

Question 21

When to treat

Answer 21

-If no RD-several months if mild, life style modification, no CVD or RF
-several weeks if state 2 and no other RF
-if 1-2 RF trial several if stage 1
-if any TOD or greater than 2 RF CKD or DM drug 1st step
-stage 2 immediately with combo

Question 22

Pregnancy HTN

Answer 22

Methyldopa, Labetalol, hydrazine, diuretics are all ok
NO ACEO OR ARB-category X
CCB questionable

Question 23

A large cuff and a small armed individual show a blood pressure reading that is

Answer 23

Lower than expected

Question 24

Most patient was stage two high blood pressure due best with the following

Answer 24

Start two drugs to get a goal

Question 25

Eight guidelines for blood pressure control, and those with no indicator conditions include all the following drugs except

Answer 25

Beta blockers

Question 26

A 65-year-old male with a history of diabetes and high blood pressure which medication should you start first line?

Answer 26

ACEI

Question 27

What is the main goal for treatment of high blood pressure?

Answer 27

Prevent target organ damage

Question 28

What anti-hypertensive has been shown to be most effective in African-Americans as well as decreased stroke risk

Answer 28

Calcium channel blockers

Question 29

The nurse practitioner is working at an urgent care and sees a 37-year-old male who is complaining of feeling tired the nurse practitioner reviews vital signs and finds the blood pressure to be 182/102 after confirming the blood pressure is correct. The next course of action is

Answer 29

Ask the patient to return in two days for a recheck

Question 30

Current evidence suggested untreated or anally treated blood pressure is a factor related to

Answer 30

Early cognitive impairment Vascular dementia Encephalopathy Cerebral vascular disease