Leik hypertension Flashcards
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2. Which of the following findings is most likely in young primigravidas with
pregnancyinduced hypertension?
A) Abdominal cramping and constipation
B) Edema of the face and the upper extremities
C) Shortness of breath
D) Dysuria and frequency
- B) Edema of the face and the upper extremities
Common signs and symptoms of
pregnancy-induced hypertension include edema of the face and the upper
extremities, weight gain, blurred vision, elevated blood pressure, proteinuria, and
headaches.
- A 75-year-old woman has been on nifedipine (Procardia XL) 10-mg capsule for many years to control her stage II hypertension. Her blood pressure at this visit is 165/80 mmHg. She is currently complaining of pain at her right hip and in both knees. She has increased her dose of ibuprofen (Motrin) from 400 mg three times daily (TID) to 800 mg TID. She is still in pain and would like something stronger.
Which of the following statements is the best explanation of the effects of ibuprofen
(Motrin) on her disease?
A) It increases the chances of adverse effects to her health
B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic
C) It prolongs the therapeutic effects of hydrochlorothiazide and other diuretics
D) None of the statements are true
- B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic
Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid(ASA) inhibit the vasodilatory effects of prostaglandins, which predisposes the kidney to ischemia. NSAIDs can cause acute kidney injury by decreasing renal blood flow. Nonselective NSAIDs can adversely affect the kidneys, GI tract, liver, cardiovascular
system, and the lungs (bronchospasm).
- A 63-year-old patient with a 10-year history of poorly controlled hypertension
presents with a cluster of physical exam findings. Which of the following
clusters indicates the target organ damage commonly seen in hypertensive patients?
A) Pedal edema, hepatomegaly, and enlarged kidneys
B) Arteriovenous (AV) nicking, left ventricular hypertrophy, and stroke
C) Renal infection, S3 heart sound, neuromuscular abnormalities
D) Glaucoma, jugular vein atrophy, heart failure
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- B) Arteriovenous (AV) nicking, left ventricular hypertrophy, and stroke
AV nicking and copper wire/silver wire arterioles are signs of hypertensive retinopathy, left ventricular hypertrophy affects the heart, and stroke damages the
brain. These are all examples of target organ damage.
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49. All of the following are possible causes for secondary hypertension except: A) Acute pyelonephritis B) Pheochromocytoma C) Renovascular stenosis D) Coarctation of the aorta 640
- A) Acute pyelonephritis
Acute pyelonephritis does not involve any vascular
change; however, chronic pyelonephritis (reflux nephropathy) is a factor for secondary
hypertension. Pheochromocytoma is a rare tumor of the adrenal glands that results in
a release of too much epinephrine and norepinephrine, hormones that control heart
rate, metabolism, and blood pressure. Renovascular stenosis is a narrowing of one or
both arteries leading to the kidneys. It can cause severe hypertension and irreversible
kidney damage. Coarctation of the aorta is a congenital heart defect of the aorta; it is
a narrowing of the aorta that causes the heart to work harder to get blood to flow
through the narrow aortic passageway to other organs, which, in turn, causes an
increase in blood pressure.
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- You note the following result on a routine urinalysis of a 37-year-old primigravida
who is at 30 weeks gestation. Leukocyte = trace, nitrite = negative, protein = 2+,
blood = negative. Her weight has increased by 5 lbs during the past week. Which of
the following is most likely?
A) HELLP syndrome
B) Pregnancy-induced hypertension (preeclampsia)
C) Eclampsia of pregnancy
D) Primary hypertension
- B) Pregnancy-induced hypertension (preeclampsia) This patient is manifesting
the classic triad of symptoms of preeclampsia: hypertension, edema (weight gain),
and proteinuria.
225. What is the most common cause of left ventricular hypertrophy in the United States? A) Chronic atrial fibrillation B) Chronic hypertension C) Mitral valve prolapse D) Pulmonary hypertension
- B) Chronic hypertension
Left ventricular hypertrophy develops in response to
some factor, such as high blood pressure, that requires the left ventricle to work
harder. As the workload increases, the walls of the chamber grow thicker, lose
elasticity, and eventually may fail to pump with as much force as a healthy heart.
High blood pressure, a blood pressure reading greater than 140/90 mmHg, is the
greatest risk factor.
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- A 55-year-old woman with a history of migraine headaches has recently been
diagnosed with stage II hypertension. Her EKG strips reveal second-degree heart
block. The chest x-ray is normal. Which of the following drugs should this patient
avoid?
A) Angiotensin-converting enzyme (ACE) inhibitors
B) Angiotensin receptor blockers
C) Diuretics
D) Calcium channel blockers
- D) Calcium channel blockers
Common side effects of calcium channel blockers
include headaches, edema of the lower extremities, and heart block or bradycardia.
Contraindications for calcium channel blockers include second- or third-degree
atrioventricular (AV) block, bradycardia, and congestive heart failure.
- Lifestyle modifications are an important aspect in the treatment of hypertension. Which of the following statements is incorrect?
A) Reduce intake of sodium, potassium, and calcium
B) Reduce intake of sodium and saturated fats
C) Exercise at least three to four times per week
D) Maintain an adequate intake of potassium, magnesium, and calcium
- A) Reduce intake of sodium, potassium, and calcium
Lifestyle modifications
for hypertension include exercise three to four times a week, diet modifications of reduced intake of sodium and saturated fats, and adequate dietary intake of
potassium, magnesium, and calcium.
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- Which of the following classes of antihypertensive drugs should a patient be
weaned off slowly to avoid the risk of severe rebound hypertension?
A) Diuretics
B) Beta-blockers
C) ACE inhibitors
D) Calcium channel blockers
- B) Beta-blockers
Reverse rebound hypertension can occur if beta-blockers are abruptly stopped. Recommendations include weaning off the beta-blockers
when changing medications.
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- All of the following are clinical eye findings found in some patients with chronic
uncontrolled hypertension. Which is not associated with this disorder?
A) AV nicking
B) Copper wire arterioles
C) Flame-shaped hemorrhages
D) Microaneurysms
- D) Microaneurysms
Keith Wagener Barker (KWB) grades for uncontrolled
hypertension are as follows: Grade 1—generalized arteriolar constriction seen as
“silver wiring” and vascular tortuousities; grade 2—grade 1 plus irregularly located,
tight constrictions known as AV nicking or AV nipping; grade 3—grade 2 plus cotton
wool spots and flame-shaped hemorrhages; and grade 4—grade 3, but with swelling
of the optic disc (papilledema). Microaneurysms occur with diabetic retinopathy.
- A 40-year-old Black man with asthma and hypertension has been following a
lowfat, low-sodium diet and walking three times a week for the past 6 months.
His blood pressure readings from the past two visits were 160/95 and 170/100
mmHg. On this visit, it is 160/90. What is the most appropriate action for the nurse
practitioner to follow at this visit?
A) Continue the lifestyle modifications and recheck his blood pressure again in 4
weeks
B) Initiate a prescription of hydrochlorothiazide 12.5 mg PO daily
C) Initiate a prescription of atenolol (Tenormin) 25 mg PO daily
D) Refer the patient to a cardiologist for a stress EKG
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- B) Initiate a prescription of hydrochlorothiazide 12.5 mg PO daily
The Eighth Joint National Committee (JNC 8)-recommended pharmacological
treatment for Black adult hypertensive patients (without chronic kidney disease or
diabetes) is a thiazide-type diuretic or calcium channel blocker (CCB), used alone or
in combination.
For White adults, the JNC 8 recommends a thiazide-type diuretic or angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) or a CCB, used alone or in combination. Do not combine an ACE inhibitor with an ARB.
Although unusual, a serious adverse effect from these two drug classes is angioedema. Beta-blockers should be avoided in patients with chronic lung disease, such as asthma and chronic obstructive pulmonary disease (COPD), because they can cause bronchoconstriction.
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- Terazosin (Hytrin), an alpha-blocker, is used to treat which of the following
conditions?
A) Benign prostatic hypertrophy and hypertension
B) Chronic prostatitis and atrial fibrillation
C) Urinary tract infections and arrhythmias
D) Benign prostatic hypertrophy and chronic prostatitis
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- A) Benign prostatic hypertrophy (BPH) and hypertension
Terazosin (Hytrin)
is a treatment option for men with BPH and hypertension. Symptoms of BPH
include difficulty urinating (hesitation, dribbling, weak stream, and incomplete
bladder emptying), painful urination, and urinary frequency and urgency. Terazosin
is in a class of medications called alpha-blockers. It relieves the symptoms of BPH by
relaxing the muscles of the bladder and prostate. It lowers blood pressure by relaxing
the blood vessels so that blood can flow more easily through the body.
- A nurse practitioner is taking part in a community outreach program for a local
hospital. Most of her audience has a diagnosis of hypertension. They are all
interested in learning more about a proper diet. When discussing potential sources of
potassium and magnesium, which of the following are the best sources for these two
minerals?
A) Fruits, leafy greens, and nuts
B) Whole grains, red meat, and dairy
C) Bananas, beef, and yogurt
D) Mushrooms, fermented foods, and vegetables
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- A) Fruits, leafy greens, and nuts
The best sources of both potassium and
magnesium are fruits (bananas, cantaloupe, papaya, kiwi), leafy greens (spinach, kale,
chard), and nuts (cashews, almonds, walnuts, peanuts).
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- Which of the following conditions are possible causes of secondary hypertension?
A) Leukemia and thalassemia major
B) Hashimoto’s thyroiditis and polycystic ovaries
C) Renal stenosis and adrenal tumors
D) Myocardial infarction and coronary artery disease
- C) Renal stenosis and adrenal tumors
Secondary hypertension is most likely
seen following renal stenosis and adrenal tumors. Renal stenosis causes secondary
hypertension by plaque formation in the arteries, causing damage to coronary arteries
(atherosclerosis). Adrenal tumors initiate secondary hypertension by releasing a large
amount of aldosterone, which causes water and salt retention and loss of too much
potassium.
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- All of the following drug classes are approved for treating hypertension. Which of
the following antihypertensive drug classes is associated with the largest number of
research studies?
A) Angiotensin-converting enzyme (ACE) inhibitors
B) Angiotensin receptor blockers (ARBs)
C) Thiazide diuretics
D) Calcium channel blockers (CCBs)
- C) Thiazide diuretics
Thiazide diuretics have been used to treat hypertension for
many decades and numerous placebo-controlled studies have documented their
effectiveness as antihypertensive drugs.
