FNP 1 FINALS EXAMS QUESTIONS AND ANSWERS MARKED
A+
✔✔Findings in the FUNDOSCOPIC EXAM of pt with HYPERTENSION? - ✔✔1.
arteriolar narrowing
2. arteriolar/venous nicking
3. optic-disk swelling.
4. cotton wool spots (soft exudates)
cotton wool spot: caused by damage to retinal nerve fibers (d/t anything that occludes
retinal arteries)
✔✔How much can the DASH diet reduce SBP?
How much can weight loss reduce SBP?
What are other lifestyle modifications? - ✔✔DASH lowers 8 - 14 mm Hg
Weight loss lowers 5 - 20 mm Hg per 10 kg
Reduce dietary sodium (lowers 2-8 mmHg)
Physical activity most days/week (lowers 4-9 mmHg)
Moderate alcohol consumption, 2 drinks/day in men and 1 drink/day women (lowers 2-4
mmHg)
✔✔What medication(s) is appropriate for initiating hypertension treatment for an
African-American with no comorbidities?
What medication(s) is appropriate for initiating hypertension treatment for a non-Black
patient with no comorbidities? - ✔✔Black: thiazide or CCB (alone of in combination)
non-Black: thiazide, CCB, ACE or ARB
✔✔PER THE ADA = What medication(s) is appropriate for initiating hypertension
treatment for a DIABETIC?
PER JNC 8 - first line tx of HTN for DIABETICS - ✔✔ADA = ACE, ARB
JNC 8 = Thiazide or CCB (BLACK)
Thiazide, CCB, ACE or ARB (non-BLACK)
, ✔✔What are the pharmacological recommendations for treating HTN in a pt with
diabetes? - ✔✔1. give ACE or ARB (per ADA guidelines)
2. 2 agents will likely be needed to reach goals
3. give 1 agent at bedtime
4. monitor K+, Cr and GFR if using ACE, ARB or diuretic
✔✔What is the main goal of hypertension treatment? - ✔✔avoidance/reduction of target
organ damage (TOD)
✔✔What are the primary organs (=TARGET ORGANS) affected by hypertension? -
✔✔eyes, kidney, heart, brain
Microvascular (retinopathy, nephropathy, vascular dementia)
Macrovascular (stroke, MI, Left ventricular hypertrophy)
✔✔What medication should be included in the regimen of ALL hypertensive patients
with CKD regardless of race? - ✔✔ACE or ARB
1ST LINE MED FOR CKD PATIENTS
✔✔Microalbuminuria is an independent risk factor for what type of cardiovascular
disease (other than HTN)? - ✔✔ischemic heart disease
✔✔What are the primary side effects and contraindications of ACE inhibitors? -
✔✔HACK
Hyperkalemia
Angioedema
Cough
Kidney dx (contraindication)
✔✔What is the pathophysiologic mechanism underlying the ACE cough? - ✔✔Up
regulation of bradykinin receptors in the lungs
✔✔What type of diuretic is appropriate for Stage 4 - 5 CKD patients? - ✔✔Loop
diuretics
*thiazides not as effective when kidneys are not functioning well*
✔✔What are some negative effects of thiazide diuretics? - ✔✔1. Hyperglycemia (use
carefully in diabetics)
2. Hypokalemia
3. Increased Uric acid (can precipitate gout attacks)
A+
✔✔Findings in the FUNDOSCOPIC EXAM of pt with HYPERTENSION? - ✔✔1.
arteriolar narrowing
2. arteriolar/venous nicking
3. optic-disk swelling.
4. cotton wool spots (soft exudates)
cotton wool spot: caused by damage to retinal nerve fibers (d/t anything that occludes
retinal arteries)
✔✔How much can the DASH diet reduce SBP?
How much can weight loss reduce SBP?
What are other lifestyle modifications? - ✔✔DASH lowers 8 - 14 mm Hg
Weight loss lowers 5 - 20 mm Hg per 10 kg
Reduce dietary sodium (lowers 2-8 mmHg)
Physical activity most days/week (lowers 4-9 mmHg)
Moderate alcohol consumption, 2 drinks/day in men and 1 drink/day women (lowers 2-4
mmHg)
✔✔What medication(s) is appropriate for initiating hypertension treatment for an
African-American with no comorbidities?
What medication(s) is appropriate for initiating hypertension treatment for a non-Black
patient with no comorbidities? - ✔✔Black: thiazide or CCB (alone of in combination)
non-Black: thiazide, CCB, ACE or ARB
✔✔PER THE ADA = What medication(s) is appropriate for initiating hypertension
treatment for a DIABETIC?
PER JNC 8 - first line tx of HTN for DIABETICS - ✔✔ADA = ACE, ARB
JNC 8 = Thiazide or CCB (BLACK)
Thiazide, CCB, ACE or ARB (non-BLACK)
, ✔✔What are the pharmacological recommendations for treating HTN in a pt with
diabetes? - ✔✔1. give ACE or ARB (per ADA guidelines)
2. 2 agents will likely be needed to reach goals
3. give 1 agent at bedtime
4. monitor K+, Cr and GFR if using ACE, ARB or diuretic
✔✔What is the main goal of hypertension treatment? - ✔✔avoidance/reduction of target
organ damage (TOD)
✔✔What are the primary organs (=TARGET ORGANS) affected by hypertension? -
✔✔eyes, kidney, heart, brain
Microvascular (retinopathy, nephropathy, vascular dementia)
Macrovascular (stroke, MI, Left ventricular hypertrophy)
✔✔What medication should be included in the regimen of ALL hypertensive patients
with CKD regardless of race? - ✔✔ACE or ARB
1ST LINE MED FOR CKD PATIENTS
✔✔Microalbuminuria is an independent risk factor for what type of cardiovascular
disease (other than HTN)? - ✔✔ischemic heart disease
✔✔What are the primary side effects and contraindications of ACE inhibitors? -
✔✔HACK
Hyperkalemia
Angioedema
Cough
Kidney dx (contraindication)
✔✔What is the pathophysiologic mechanism underlying the ACE cough? - ✔✔Up
regulation of bradykinin receptors in the lungs
✔✔What type of diuretic is appropriate for Stage 4 - 5 CKD patients? - ✔✔Loop
diuretics
*thiazides not as effective when kidneys are not functioning well*
✔✔What are some negative effects of thiazide diuretics? - ✔✔1. Hyperglycemia (use
carefully in diabetics)
2. Hypokalemia
3. Increased Uric acid (can precipitate gout attacks)
