FNP Theory 1 Flashcards
Exam 3
1
Q
What are modifiable risk factors for cardiovascular disease?
A
Smoking
Hypertension
Dyslipidemia
Diabetes
Obesity
Physical Activity
Diet
Alcohol Use
2
Q
How does smoking affect CVD?
A
Increases sympathetic activity
Chemicals in cigarettes cause inflammation
Damages vessel wall
Microvascular constriction
3
Q
What is the increase in CVD risk if you smoke according to gender?
A
In females, you are at a 6 x increase in risk and in males you are at 3 x increase in risk
4
Q
What lab can you order to assess inflammation?
A
CRP
5
Q
What is the BMI goal for patients?
A
18.2 to 24.9
6
Q
What waist circumferences increases risk of CVD?
A
40 in men and 35 in women
7
Q
What is the goal for physical activity?
A
150 minutes a week (30 minutes a day for 5 days)
8
Q
What is the goal for hypertension to reduce risk for CVD?
A
Less than140/90
9
Q
What is the goal A1C to reduce risk for CVD?
A
Less than 7%
10
Q
What are nonmodifiable risk factors for CVD?
A
Age
Family History
Gender
11
Q
What labs do you test for assessing risk for ASCVD?
A
CRP
CBC
Lipids
Blood Pressure screening
A1C
12
Q
What is considered low risk for ASCVD?
A
Less than 5%
13
Q
What is borderline risk for ASCVD?
A
5-7.5%
14
Q
What is intermediate risk for ASCVD?
A
7.5-20%
15
Q
What is high risk for ASCVD?
A
Greater than 20%
16
Q
What is the screening recommendations for AAA?
A
Men who smoke that are between the ages of 65 to 74
17
Q
What is considered overweight?
A
25-29.9
17
Q
What are the recommendations for nutrition to reduce your risk for CVD?
A
Eat more vegetables and fruits
Decrease saturated and trans fat
Reduce alcohol consumption
Decrease sugary sweetened beverages and red meat
Eat more a plant/Mediterranean diet
18
Q
What is considered obese?
A
Greater than 30
19
Q
What is a common risk factor for resistant hypertension?
A
OSA
20
Q
How can you treat OSA?
A
CPAP
21
Q
What are the cardiovascular risk factors predisposing females to cardiovascular disease (CVD)?
A
A. Absence of estrogen adversely affects lipoprotein metabolism.
22
Q
Hypertension is a major contributing factor to
A
MI
Heart Failure
Stroke
CKD
PAD
Retinopathy
23
Q
How should you screen someone for hypertension for someone who is greater than 40?
A
Annually
24
How should you screen someone for hypertension between the ages of 18-39?
Every 3 to 5 years
25
How does the JNC-8 define hypertension?
Someone who has a blood pressure greater than 140/90 on two separate occasions separated by one week less than 60 years old
26
When should you start pharmacological treatment for someone who is greater than 60?
150/90
27
When should you start pharmacological treatment for someone who is greater than 60 with diabetes?
140/90
28
What is first-line treatment for someone who is diagnosed with hypertension in the general nonblack population?
Thiazide, ARB, ACE, or CCB
29
What is the first line treatment for someone who is diagnosed with hypertension in the black population?
Thiazide or CCB
30
If the target blood pressure is not reached within one month of treatment, what should you do as a provider?
Either increase the dose of the antihypertensive or add an additional hypertensive
31
What are the guidelines for ANC?
Normal: Less than 120 Less than 80
Elevated BP: 120-129, Less than 80
Stage 1: 130-139; 80-89
Stage 2: Greater than 140 Greater than 90
32
What are the guidelines for JCN-8
Normal: Less than 120, Less than 80
Pre hypertension: 120-129, 80-89
Stage 1: 130-159, 90-99
Stage 2: Greater than 160, Greater than 100
33
What is the proper technique to measure BP?
Appropriate cuff size (cuff encompassing at least 80% of arm circumference)
Applied 1 cm above the AC
Patient arm positioned level of the heart
Patient seated with feet on the floor
34
What is white coat hypertension?
Blood pressure that is elevated only in the office but normal at home
35
What are short term factors that effect blood pressure?
Stress
Emotions
Pain
Physical Activity
Drugs such as nicotine or caffeine
36
Which of the following is an appropriate blood pressure (BP) goal for a 65-year-old male with no comorbidities?
150/90
37
What is the main complications of hypertensions?
Left ventricular hypertrophy
38
What are signs and symptoms of left ventricular hypertrophy?
Shortness of breath
Fatigue
Chest pain after exercising
Rapid fluttering or pounding heart beat
Dizziness or fainting
39
What are some other complications of hypertension?
Heart failure
Ischemic stroke
Intracerebral hemorrhage
Ischemic heart disease
Chronic kidney disease
Ocular disease
40
How does alcohol increase your blood pressure?
It activates renin which causes the blood vessels to constrict.
41
What is the recommendation for alcohol use to reduce risk for hypertension?
2 drinks for men or 1 drink for women
42
Once the diagnosis of hypertension, evaluation should be performed to ascertain what?
end organ damage
43
What labs should be performed on all patients who have been newly diagnosed with hypertension?
CBC
CMP/BMP
Urinalysis
Lipids
A1C
EKG
Thyroid
Fasting glucose
44
On what basis should the diagnosis of hypertension (HTN) be established?
An average of two or more readings taken during at least two separate clinic visits.
45
A patient has a 2-year history of hypertensive heart disease. What major pathophysiologic changes should the family nurse practitioner expect?
Left ventricular hypertrophy
46
The family nurse practitioner is planning the treatment of an older adult patient newly diagnosed with hypertension (HTN). What parameters are most important in determining the appropriate pharmacologic therapy?
Determine other medical conditions for which the patient is being treated.
47
When should you suspect secondary hypertension?
Patient with resistant hypertension
OSA-Snoring
If patient develops specific symptoms native to various disorders
Medications
Arterial bruit--abdomen, femoral, carotid
Cocaine use-tachycardia, fine tremors, sweating
Primary aldosteronism
Caffeine intake
48
What is the gold standard for diagnosing renal artery stenosis?
Renal arteriography
49
What are symptoms of pheochromocytoma?
Headache, hyperhidrosis, and palpitations
50
What is primary hyperaldosteroism?
Adrenal gland makes too much aldosterone leading to hypertension and hypokalemia
51
What are signs and symptoms of coarctation of the aorta?
Presence of claudication
Delayed femoral pulses
Notching of ribs on CXR
52
What is the cause of Cushing's syndrome?
It is caused by hypersecretion of glucocordicosteroids by the adrenal cortex.
53
What are some medications that can cause hypertension?
Oral contraceptives
Corticosteroids
NSAIDs
Atypical antipsychotics
Decongestants
Antidepressants
Some weight loss medications
Stimulants
Erythropoietin
54
What pharmacological treatments are recommended for someone with CKD?
ACE or ARBs
55
What is the first line therapy of a thiazide diuretic?
Chlorthalidone
Indapamide
56
What are common side effects of Ace Inhibitors?
Cough
Angeoedema
57
What is a common side effect of CCB?
Peripheral edema
58
What should you use in caution in the elderly?
Beta Blockers
59
A family nurse practitioner is reviewing a female patient’s medication profile during her annual wellness examination. The patient’s past medical history includes recent treatment for hypertension, which began 8 months ago, with a prescribed lisinopril (Prinivil) dosage of 10 mg daily. The patient now states that she may be considering having a child. Which action should be taken by the family nurse practitioner at this time?
Discontinue lisinopril (Prinivil).
60
The family nurse practitioner is prescribing antihypertensive drug therapy for older adult patients. Which class of antihypertensive agents should be used with great caution in the older adult?
Beta blockers.
61
A patient with a history of hypertension is started on spironolactone (Aldactone) 50 mg by mouth daily. The family nurse practitioner instructs the patient to call the clinic if which symptoms are experienced?
Muscle twitching, numbness, tingling, burning sensations of the limbs, and diarrhea.
62
The family nurse practitioner has prescribed losartan (Cozaar) 50 mg by mouth daily. This medication promotes vasodilation by:
Blocking the action of angiotensin II.
63
The family nurse practitioner initiates antihypertensive therapy for a middle-aged nonsmoking male. One week later, the patient returns for a follow-up visit and complains of a recurrent dry cough since initiating the medications. This is most likely a side effect of:
Angiotensin-converting enzyme (ACE) inhibitor.
64
The family nurse practitioner has been treating an older patient’s hypertension successfully with diet, exercise, and hydrochlorothiazide (HydroDIURIL) 25 mg by mouth daily for 5 months. During today’s clinic visit, the patient’s blood pressure was 154/90 mm Hg and temperature was 99.9°F (37.7°C). The patient’s physical exam revealed clear breath sounds; S1 and S2 with no murmurs, gallops, or rubs; and no JVD. The patient denied syncope, headaches, or visual changes but exhibited a tender and edematous right ankle. Which laboratory values would be most appropriate for evaluation?
Serum uric acid and CBC.
65
An older adult white male with a long history of chronic obstructive pulmonary disease has recently developed hypertension. Which class of antihypertensive agents should the family nurse practitioner avoid for this patient?
Beta Blocker
66
A male patient who is mildly hypertensive and takes hydrochlorothiazide presents with red, painful swelling of the great toe. In addition to treating the gout, the family nurse practitioner also knows to:
Change his thiazide antihypertensive medication.
67
A patient’s blood pressure (BP) is within 4 mm Hg of the treatment goal after follow-ups at 1 and 4 weeks. What is the most appropriate strategy to take?
Discuss the risks and benefits of adding another medication with the patient.
68
A 54-year-old patient with type 2 diabetes has been diagnosed with hypertension (HTN). Which antihypertensive drug is the recommended choice to treat HTN in patients with diabetes?
Angiotensin-converting enzyme (ACE) inhibitor.
69
Which of the following antihypertensive medications classes may cause ankle edema in older adults?
A calcium channel blocker.
70
