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NephSAP Module 1 Hypertension Pre toets

Nephsap

NephSAP Module 1 Hypertension Pre toets

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NephSAP is mede mogelijk gemaakt door financiële ondersteuning van
Sanofi-Aventis en Bristol Myers Squibb

1. A 47-year-old African American woman has a BP of 152/94 mmHg, a body mass index (BMI) of 26 kg/m2, and a serum creatinine level of 1.0 mg/dl. She walks approximately 20 minutes three times weekly. She states that she is trying to comply with this program but is under stress at home and plans to move. She consumes a diet high in sodium and low in potassium.

She could benefit from which ONE of the following approaches?

A. Starting a low-salt diet and changing her exercise program to include weight lifting
B. Starting a high-potassium, 100-mEq/d [Na+] diet and increasing exercise to five times weekly using 30-minute sessions
C. Starting a 1200-cal weight loss diet and adding an angiotensin-converting enzyme inhibitor (ACEI) to her regimen
D. Reevaluation in 6 months after her move
E. Vigorous 1-hour exercise for 6 d/wk and a high-potassium diet alone

2. A 35-year-old Caucasian man who is receiving dialysis treatment (BMI 31 kg/m2) is noted to have fluctuating BP such that he has severe hypertension 220/90 mmHg at the beginning of dialysis. Systolic BP drops to 130 mmHg during therapy, but he is always asleep when this happens. He is currently on four antihypertensive medications including minoxidil. When awakened, his systolic BP increases by at least 20 mmHg.

Which ONE of the following would be the MOST appropriate treatment for this patient?

A. Continuous positive airway pressure mask
B. Nocturnal O2
C. Adding guanethidine
D. Benzodiazepines for sleep
E. Weight loss and benzodiazepines

3. A 67-year-old African American woman has been hospitalized twice in the past year with symptoms of congestive heart failure. You are asked to review her clinical situation after a magnetic resonance angiogram showed complete occlusion of the right renal artery. Current medications are ramipril 10 mg/d, furosemide 40 mg/d, aspirin 325 mg/d, and carvedilol 12.5 mg twice daily. Physical examination revealed the following: BP of 155/80 mmHg, pulse of 64 bpm, height of 58 (168 cm), weight of 186 lb (84 kg), and BMI of 26 kg/m2. Lungs have occasional rhonchi, a third heart sound is appreciated, and 2+ peripheral edema is noted. Laboratory studies revealed the following: Hemoglobin level of 12 g/dl, serum creatinine level of 1.6 mg/dl, sodium level of 139 mEq/L, potassium level of 3.9 mEq/L, and normal urine. Magnetic resonance angiography showed complete occlusion of the right renal artery and high-grade stenosis (>95% narrowing) of the left renal artery.

Which ONE of the following recommendations would be MOST appropriate for this patient's care?

A. Stenting of the left renal artery
B. Laparoscopic nephrectomy of the right kidney
C. Coronary artery catheterization
D. Withdrawal of ACEI
E. Improvement BP control to 120/80 mmHg before any surgical procedure

4. A 36-year-old African American woman is admitted to the hospital with confusion and BP readings of 185/112 mmHg. She had no previous medical conditions with the exception of preeclampsia during her first two pregnancies. There is no history of trauma or drug use. Medications include enalapril 20 mg/d and hydrochlorothiazide 25 mg/d.

On physical examination, she was arousable but unable to converse. No focal neurologic deficits were noted. BP was 172/118 mmHg, pulse was 100 bpm, and BMI was 28 kg/m2. In the chest, coarse rhonchi were noted; trace peripheral edema also was noted. Laboratory studies revealed normal complete blood count, serum creatinine level of 1.6 mg/dl, sodium level of 139 mEq/L, and potassium level of 4.8 mEq/L; urinalysis revealed 2+ protein.

Which ONE of the choices offers the MOST appropriate therapeutic goal for this patient?

A. Controlled BP reduction to <130/80 mmHg
B. Pulse rate reduction to <60 bpm
C. Controlled BP reduction to 150/90 mmHg
D. Combined ACE inhibition/angiotensin receptor blockade
E. Combined ACE inhibition with nondihydropyridine calcium antagonist therapy to lower proteinuria and BP to <120/80 mmHg

5. A 62-year-old Caucasian patient with ESRD undergoes dialysis on the morning shift, at which time his systolic BP is consistently between 150 and 170 mmHg. After each treatment, his final BP remains >140 mmHg. A 24-hour BP monitor demonstrated that his average BP during the day is 148/72 mmHg and at night averages 144/78 mmHg. He currently takes all of his medications (ACEI, calcium antagonist, and β blocker) in the morning but does not take them on the morning of dialysis.

Which ONE of the following choices MOST accurately describes his cardiovascular risk?

A. He is at the same risk as the average patient with ESRD.
B. He is at higher risk than patients who have ESRD and whose BP manifests a nighttime "dip" (a nocturnal decline in BP).
C. His most likely time to have a cardiovascular event is in the late evening.
D. His prognosis will not improve if he is converted to a "dipper."
E. There is no known therapy that will convert him to a "dipping" status.