NUR 521
Final Exam Information and Study Recommendations
Your final exam will contain 75 questions and you will have 2 hours to take it with an approved proctor. It is closed
book, closed notes/other resources. It will be offered as scheduled and posted in Blackboard. Your final is comprehensive,
and so you will have content from each module on the final. There will be an average of 8 questions from each
module, with more emphasis on antibiotics and drugs of choice for various diagnoses. The questions on your final
were provided by the lecturer on that content. So while it is comprehensive, and anything covered in the lectures or
required readings is fair game for the final, you should know the following content well.
Please Note: This study guide has been provided to you as a courtesy and is not group work. It is not to be shared in any
manner and it is NOT to be used while you are taking the final exam, as it is closed book and closed notes. The final
exam must be proctored.
1. DOCs for common diagnoses are always important to know. You will have multiple questions on your exam that
ask about DOCs for specific common diagnoses. Please use your primary care and psychiatric medication
assignments as study aids.
2. Classes of hypertension and hypertension emergency definitions. Pg.257,270
Essential Hypertension
Etiology & Classification A. Primary Essential Hypertension “Essential hypertension” is the term applied to the 95% of
hypertensive patients in which elevated blood pressure results from complex interactions between multiple genetic and
environmental factors. The proportion regarded as “essential” will diminish with improved detection of clearly defined
secondary causes and with better understanding of pathophysiology. Essential hypertension occurs in 10–15% of white adults
and 20–30% of black adults in the United States. The onset is usually between ages 25 and 50 years; it is uncommon before age
20 years. The best understood pathways underlying hypertension include overactivation of the sympathetic nervous and
NUR 521 Final Exam Information
Page 1 of 53
,renin-angiotensin-aldosterone systems (RAAS), blunting of the pressure-natriuresis relationship, variation in cardiovascular
and renal development, and elevated intracellular sodium and calcium levels.
Exacerbating factors include obesity, sleep apnea, increased salt intake, excessive alcohol use, cigarette smoking, polycythemia,
nonsteroidal anti-inflammatory drug (NSAID) therapy, and low potassium intake. Obesity is associated with an increase in
intravascular volume, elevated cardiac output, activation of the renin-angiotensin system, and, probably, increased
sympathetic outflow. Lifestyle-driven weight reduction lowers blood pressure modestly, but the dramatic weight reduction
following bariatric surgery results in improved blood pressure in most patients, and actual remission of hypertension in
20–40% of cases
Secondary Hypertension:
Secondary Hypertension Approximately 5% of patients have hypertension secondary to identifiable specific causes (Table
11–2). Secondary hypertension should be suspected in patients in whom hypertension develops at an early age or after the age
of 50 years, and in those previously well controlled who become refractory to treatment. Hypertension resistant to three
medications is another clue, although multiple medications are usually required to control hypertension in persons with
diabetes. Secondary causes include CKD,genetic syndromes; kidney disease; renal vascular disease; primary
hyperaldosteronism; Cushing syndrome; pheochromocytoma; coarctation of the aorta and hypertension associated with
pregnancy, estrogen use, hypercalcemia, and medications
· Stage1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic
pressure ranging from 80 to 89 mm Hg.
· Stage2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 140 mm Hg or
higher or a diastolic pressure of 90 mm Hg or higher.
NUR 521 Final Exam Information
Page 2 of 53
,Hypertensive Emergency/Urgency
Hypertensive crisis or malignant hypertension is defined as an extremely high SBP and/or DBP according to JNC-7.
Hypertensive was not addressed by JNC 8 guidelines.
Hypertensive crisis is further divided into two catagories based upon evidence of target organ damage. If end organg damage
is present, the condition is classified as hypertensive ermergency. Hypertensive crisis without evidence of organ damage is
classified as hypertensive urgency. In hypertensive emergencies, the therapeutic goal is to protect remaing end organ function,
reduce risk of complications, and improve outcomes.
3. Non-Black: Thiazide-type diuretic or ARB or ACE alone or in combo
Black: Thiazide-type diuretic or CCB or in combo
All Races with DM or CKD: ACE or ARB or combo with other
*(Do not mix ACE w. ARB)
Primary affect 95% of adults causes unknown contributing factors are environmental and genetic
Secondary 5% of all hypertension. Causes chronic kidney disease, renovascular hypertension,
hyperparathyroidism comma and primary aldosteronism.
Idiopathic has no identified cause
Pg.270
Hypertension crisis or malignant hypertension is defined as an extremely elevated systolic blood pressure and or
diastolic blood pressure.
Hypertensive emergency is when there is end organ damage present. Avoid dropping the blood pressure too fast it
may result in an increase in organ damage
NUR 521 Final Exam Information
Page 3 of 53
, rgan damage is a hypertensive urgency usually due to noncompliance or inadequate
Hypertensive crisis without o
treatment
3. DOC for hypertension based upon selected populations, including races, diabetics, specified medical diagnoses,
pregnancy, etc. pg.269-270
eriatrics if choosing a beta blocker for HTN than nebivolol and carvedilol are the most frequently used. If isolated
G
hypertension is present start with the diuretics and calcium channel blockers may be used.
Pregnancy methyldopa for pregnant woman with hypertension is most frequently used.
Black population chlorthalidone and amlodipine are drugs of choice, and more receptive to monotherapy diuretics. Alpha
blockers should not be used as initial treatment. Example; ace inhibitors causing angioedema.
Diabetics RAAs beta blockers, diuretics , calcium channel blockers, ace inhibitors, a ARBs are the recommended
treatment. ACE and ARBs are the cornerstone of therapy for diabetics
4. Know how grapefruit may interact with the CYP 450 system and how it may affect the potency of certain
medications such as antibiotics, calcium channel blockers and Alzheimer's drugs.
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller teresiagatere. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.19. You're not tied to anything after your purchase.
