Unit 3, Part 1 Flashcards
A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches, palpitations, snoring, muscle weakness, and nocturia and does not take any medications. What will the provider do next to evaluate this patient?
a. Assess serum cortisol levels
b. Continue to monitor blood pressure at each health maintenance visit
c. Order urinalysis, CBC, BUN, and creatinine
d. Refer to a specialist for a sleep study
ANS: C
This patient has prehypertension levels and should be evaluated. UA, CBC, BUN, and creatinine help to evaluate renal function and are in the initial workup. Serum cortisol levels are performed if pheochromocytoma is suspected, which would cause headache. The patient does not have snoring, so a sleep study is not indicated at this time. It is not correct to continue to monitor without assessing possible causes of early hypertension.
An African-American patient who is being treated with a thiazide diuretic for chronic hypertension reports blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is the recommended action for this patient?
a. Add a beta blocker to the patient’s regimen.
b. Admit to the hospital for evaluation and treatment.
c. Increase the dose of the thiazide medication
d. Prescribe a calcium channel blocker.
ANS: B
Patients with a blood pressure >180/120 or those with signs of target organ symptoms should be admitted to inpatient treatment with specialist consultation. Changing the medications may be done with consultation, but a hospitalization and stabilization must be done initially.
Which are causes of secondary hypertension (HTN)? (Select all that apply.)
a. Increased salt intake
b. Isometric exercises
c. Nonsteroidal anti-inflammatory (NSAID) drugs
d. Oral contraceptives (OCPs)
e. Sleep apnea
ANS: C, D, E
NSAIDs and OCPs can both increase the risk of hypertension. Sleep apnea causes secondary hypertension. Increased salt intake does not cause HTN, but those with HTN are more sensitive to sale. Regular isometric exercise can decrease blood pressure.
An obese patient has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit?
a. C-peptide level
b. Hemoglobin A1C
c. Random serum glucose
d. Thyroid studies
ANS: B
HbA1C, along with fasting plasma glucose or a 2-hour plasma glucose during an oral glucose tolerance test (OGTT), is diagnostic of diabetes. This patient is probably not fasting, so a glucose level will not be helpful. C-peptide levels help to distinguish type 1 from type 2 diabetes and may be performed after a diagnosis of diabetes is made and if there is uncertainty about the cause. Thyroid studies are helpful in evaluating comorbidity.
A patient diagnosed with type 2 diabetes mellitus becomes insulin dependent after a year of therapy with oral diabetes medications. When explaining this change in therapy, the provider will tell the patient
a. it is necessary because the patient cannot comply with the previous regimen.
b. that strict diet and exercise measures may be relaxed with insulin therapy.
c. the use of insulin therapy may be temporary.
d. this is because of the natural progression of the disease.
ANS: D
Even after several years of therapy for type 2 DM well controlled with oral diabetic medications, diet, and exercise, the natural progression of the disease may require patients to become insulin dependent. Patients must understand that this does not represent failure on their part. Adding insulin may cause weight gain, so continuing lifestyle measures is essential. The addition of insulin is not temporary.
A patient diagnosed with diabetes has a blood pressure of 140/90 mm Hg and albuminuria. Which initial action by the primary care provider is indicated for management of this patient?
a. Consulting with a nephrologist
b. Limiting protein intake
c. Prescribing an antihypertensive medication
d. Referring to an ophthalmologist
ANS: A
Patients with diabetes who have elevated blood pressure and reduced renal function should be referred to a nephrologist. Limiting protein intake and giving an antihypertensive medication may be recommended, but evaluation by a nephrologist is essential. Ophthalmology referral will be made as well to assess concurrent ocular damage.
A patient recently diagnosed with type 1 diabetes mellitus is in clinic for a follow-up evaluation. The provider notes that the patient appears confused and irritable and is sweating and shaking. What intervention will the provider expect to perform once the point of care blood glucose level is known?
a. Dipstick urinalysis for ketones
b. Giving a rapid-acting carbohydrate
c. Injection of rapid-acting insulin
d. Performing a hemoglobin A1C
ANS: B
This patient has signs of hypoglycemia, so a rapid-acting carbohydrate should be given once this is confirmed. Assessing for ketones is done if the patient is hyperglycemic, as is insulin administration. Hemoglobin A1C gives information about long-term and not immediate glucose control.
