Chapter 15: Hyperlipidemia and Hypertension ATI

Question 1 of 5 When discussing cholesterol levels with a patient, which of the following is desirable? High cholesterol, low HDL High LDL, low cholesterol High cholesterol, high LDL High HDL, low LDL High HDL, High LDL

High HDL, low LDL

Question 4 of 14 In addition to the laboratory values, a physical examination of Ms. West is conducted. Which of the following are associated with hyperlipidemia? Select all that apply. Wheezing Xanthoma Clubbing of fingers Skin ulcers Xanthelasma Cyanosis

Xanthoma xanthelasma Xanthoma and xanthelasma are yellowish deposits under the skin and near the eye.

Question 2 of 5 Statins ________________. Select all that apply. are used to treat hypertension. decrease bile reabsorption. reduce liver synthesis of cholesterol. cause vasodilation. help to control hyperlipidemia.

reduce liver synthesis of cholesterol. help to control hyperlipidemia.

Question 4 of 5 Secondary hypertension ____________________. Select all that apply. has no known cause. is a blood pressure < 120/80 mm Hg. has no negative effect on the heart. is also known as essential hypertension. accounts for 5- to 10-percent of all hypertension cases.

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Question 5 of 5 Hypertension may cause ___________________. Select all that apply. atherosclerosis. left ventricular hypertrophy. increased cholesterol. increased coronary circulation need. vessels to burst.

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Question 14 of 14 Many medications are available to treat hypertension. Which of the following are you likely to discuss with Mr. Benson? Select all that apply. Corticosteroids ACE inhibitors Diuretics Aspirin Statins Calcium antagonists

ACE inhibitors Diuretics Calcium antagonists Corticosteroids may increase blood pressure, not decrease it. ACE inhibitors block the activation of angiotensin II which reduces vasoconstriction and blood pressure. Diuretics reduce blood volume and thus blood pressure. Calcium antagonists also reduce vasoconstriction and blood pressure. Statins lower cholesterol and aspirins decrease platelet adherence.

Question 10 of 14 Mr. Benson is surprised to hear he has hypertension, because overall he feels fine.You tell Mr. Benson that many patients with hypertension have no symptoms and that he has a number of risk factors that increase his risk for hypertension. Which of the following are risk factors for hypertension? Select all that apply. Age 20 to 40 years Excess sodium in diet Regular aerobic exercise History of autoimmune disease Obesity African American ethnicity Family history

Excess sodium in diet Obesity African American ethnicity Family history Excess sodium, obesity, African American ethnicity and a family history of hypertension are known risk factors for hypertension. Mr. Benson has all of these risk factors. The risk of hypertension increases with age, while regular aerobic exercise reduces the risk for hypertension. Autoimmune diseases are not a known risk for hypertension.

Question 3 of 5 Which of the following are recommendations regarding cholesterol? Select all that apply. Total cholesterol should be > 200 mg/dL. Exercise should occur daily for 30 minutes. Dietary saturated fat intake should be increased. HDL levels should be > 40 mg/dL.

Exercise should occur daily for 30 minutes. HDL levels should be > 40 mg/dL.

Question 7 of 14 Many medications are used to treat hyperlipidemia. Which of the following statements is true? Statins block cholesterol absorption in the intestines. Fibrates treat high triglyceride levels. Niacin raises LDL level and raises HDL levels. Hyperlipidemia medications can be combined Statin treatment cannot reduce atherosclerotic plaques already present

Fibrates treat high triglyceride levels. Hyperlipidemia medications can be combined Fibrates are used as first-line treatment for elevated triglyceride concentrations. Cholesterol-lowering medications are commonly used in combination. Statins work by reducing cholesterol synthesis by the liver and have been shown to reduce existing atherosclerotic plaques.

Question 1 of 5 The "good" cholesterol, thought to provide a cardioprotective effect, is known as____________. Chylomicrons Total cholesterol VLDL LDL HDL

HDL

Question 2 of 14 For cardiac health, which of the following should Ms. West work to elevate? Select all that apply. Total cholesterol LDL HDL Triglycerides

HDL HDL, high-density lipoprotein, is considered to the "good cholesterol," as it transports cholesterol from the bloodstream to the liver. A regular exercise program has been shown to increase HDL levels.

Question 11 of 14 You speak to Mr. Benson about lifestyle modifications and medication options to treat hypertension. Mr. Benson doesn't understand your concern about hypertension, because he does not notice "anything really wrong." You explain to Mr. Benson that many tissues can be damaged by hypertension. Which of the following tissues are most likely to be damaged by hypertension? Select all that apply. Heart Bladder Kidneys Retina Brain Stomach GI tract

Heart Kidneys Retina Brain High blood pressure can result in left ventricular hypertrophy of the heart. The kidneys can be damaged by hypertension, resulting in loss of protein in the urine and reduced filtering of waste products. The arterioles in the retina may be damaged resulting in blindness. Vessel damage in the brain due to hypertension increases the risk for aneurysms.

Question 3 of 5 If a patient presents with hypertension and no known cause exists, what type of hypertension does the patient have? Renovascular Nonessential Tertiary Secondary Primary

Primary

Question 6 of 14 Which of the following lifestyle modifications would you recommend to reduce Ms. West's hyperlipidemia? Select all that apply. Increase trans-fatty acid intake Keep dietary cholesterol intake < 300 mg per day Increase intake of fish oils Increase intake of dietary fiber 30 minutes of aerobic exercise daily

Keep dietary cholesterol intake < 300 mg per day Increase intake of fish oils Increase intake of dietary fiber 30 minutes of aerobic exercise daily Cholesterol intake should be less than 300 mg per day. Aerobic exercise has been shown to reduce LDL cholesterol and raise HDL cholesterol. Dietary fiber and fish oil are shown to have a favorable effect on cholesterol levels. Trans-fatty acids have been shown to increase LDL cholesterol.

Question 1 of 14 Ms. Karen West, age 58 years, is a retired librarian. She admits to leading a sedentary lifestyle, especially now that she has stopped working. Her only self-reported activity is working in her garden. She reports she has gained "about 15 pounds" in the last several years. At 5 feet, 4 inches, Ms. West weighs 192 pounds. Ms. West has not been see a physician in the past 4 years and her last blood laboratory tests were done 8 years ago. Among other tests, the primary care provider orders a lipid profile be completed for Ms. West. The results return with the following values: Total cholesterol: 238 mg/dL LDL cholesterol: 160 mg/dL HDL cholesterol: 35 mg/dL Triglycerides: 210 mg/dL Which of these values are considered high? Select all that apply. Total cholesterol LDL HDL Triglycerides

LDL Triglycerides Total Cholesterol High LDL is 160 to 189 mg/dL and high triglycerides is 200 to 499 mg/dL. Total cholesterol is high (> 240 mg/dL) and HDL is low.

Question 5 of 14 Ms. West requests further information about hyperlipidemia and its effects on the body. Which of the following statements regarding lipids are correct? Select all that apply. LDL lipoproteins and triglycerides play a role in atherosclerosis. Foam cells that result in plaque formation arise from neutrophils. The only source of cholesterol in the body is dietary intake. Atherosclerotic plaques disintegrate into foam cells. High levels of LDL cholesterol and low levels of HDL cholesterol increase risk for cardiovascular disease.

LDL lipoproteins and triglycerides play a role in atherosclerosis. High levels of LDL cholesterol and low levels of HDL cholesterol increase risk for cardiovascular disease. Both LDL lipoproteins and triglycerides are associated with atherosclerosis. The inverse relationship between elevated LDL cholesterol levels and reduced HDL cholesterol levels has been shown to be related to an increase risk of cardiovascular disease. Foam cells are formed from macrophages, not neutrophils. In addition to dietary intake of cholesterol, the liver also synthesizes cholesterol. Atherosclerotic plaques do not disintegrate into foam cells. Foam cells form fatty streaks which lead to atherosclerotic plaques.

Question 12 of 14 You tell Mr. Benson that there are many assessments available to determine if any organs are damaged by hypertension. Which of the following assessment results may be associated with hypertensive damage of body tissues? Select all that apply. Increase stomach acid Left ventricular hypertrophy Reduced TSH Microalbuminuria Cerebral hemorrhage Arteriovenous nicking in retina Barrel-chested appearance S4 sound Shift of point of maximal impulse of heart

Left ventricular hypertrophy Microalbuminuria Cerebral hemorrhage Arteriovenous nicking in retina S4 sound Shift of point of maximal impulse of heart As the heart pumps against increased pressure, left ventricular hypertrophy may develop. This may shift the point of maximal impulse. In addition, as blood enters a less compliant left ventricle, a S4 sound may be heard. Damage to retinal vessels may results in appearance of "AV nicking" where arteries and veins cross. Hypertension may damage the filtration membrane of the glomerulus resulting in the appearance of albumin in the urine (microalbuminuria). Damage to vessels of the brain increases the risk for cerebral hemorrhage.

Question 13 of 14 Before discussing treatments for Mr. Benson, it must be established if Mr. Benson is suffering from primary or secondary hypertension. Which of the following statements are true concerning these categories? Select all that apply. Primary hypertension accounts for 10 to 15% of hypertension. Primary hypertension has no known cause. Secondary hypertension has no known cause. Secondary hypertension may result from oral contraceptive usage. Renal disorders can results in primary hypertension.

Primary hypertension has no known cause. Secondary hypertension may result from oral contraceptive usage. Primary hypertension accounts for 90 to 95% of the cases of hypertension and has no known cause. Secondary hypertension is due to another systemic disorder (i.e. renal , medication, endocrine), so the cause can be determined. Oral contraceptives can result in elevated blood pressure in some women. Disorders of the kidney can lead to hypertension with activation of RAAS.

Question 8 of 14 Mr. Benson, a 45-year-old African American male, arrived in the clinic for his "annual" check-up. He is worried about his health, as his sister, age 52, recently suffered a heart attack. Mr. Benson realizes his lifestyle may increase his risk for cardiovascular disease. He tells you he "likes to eat whatever he wants" and he "loves to use the salt shaker." He enrolled in a fitness class near his home but has only attended a couple times. Calculating Mr. Benson's BMI, you note he falls within the "obese" category. Mr. Benson's resting heart rate is 86 bpm and he appears to have shortness of breath upon exertion. The last time Mr. Benson was in the clinic was 3 years ago. At that time, his blood pressure readings were 138/80 mm Hg and 134/82 mm Hg. He was told to return in 6 months for further evaluation. Mr. Benson's blood pressure readings placed him in which category? Normal Elevated Stage 1 HTN Stage 2 HTN

Stage 1 HTN Normal BP: < 120 mm Hg systolic and < 80 mm Hg diastolic Elevated: 120 to 129 mm Hg systolic and < 80 mm Hg diastolic Stage 1 HTN: 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic Stage 2 HTN: ≥ 140 mm Hg systolic or ≥ 90 mm Hg diastolic

Question 5 of 5 A patient has blood pressure readings of 142/92 mm Hg and 140/94 mm Hg. Which hypertension category would apply to this patient? Normal Elevated Stage 1 hypertension Stage 2 hypertension

Stage 2 HTN

Question 9 of 14 At this appointment, Mr. Benson's BP readings are 146/92 mm Hg and 142/90 mm Hg. What is the classification for Mr. Benson now? Normal Elevated Stage 1 HTN Stage 2 HTN

Stage 2 HTN Normal BP: < 120 mm Hg systolic and < 80 mm Hg diastolic Elevated: 120 to 129 mm Hg systolic and < 80 mm Hg diastolic Stage 1 HTN: 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic Stage 2 HTN: ≥ 140 mm Hg systolic or ≥ 90 mm Hg diastolic

Question 2 of 5 Which of the following medications work to lower cholesterol? Select all that apply. ACE inhibitors Nitroglycerin Diuretics Statins Bile acid sequestrants

Statins Bile acid sequestrants

Question 3 of 14 Other laboratory results indicate fasting plasma glucose of 120 mg/dL, an elevated TSH, and reduced thyroxine level. Based on these results and her patient data, which additional risk factors for hyperlipidemia may Ms. West have? Select all that apply. Hyperthyroidism Type 2 diabetes mellitus Hypothyroidism Obesity Pre-menopausal

Type 2 diabetes mellitus Hypothyroidism Obesity Type 2 diabetes mellitus, hypothyroidism, and obesity are all risk factors for hyperlipidemia. Given the laboratory results, Ms. West should have further evaluations for hypothyroidism and type 2 diabetes mellitus. Her BMI currently places her in the "obese" category.

Question 4 of 5 Which of the following is a potential complication of hypertension? Atrial fibrillation Ventricular hypertrophy Atrial atrophy AV block Ventricular tachycardia

Ventricular Hypertrophy