1. Clinical 2 (Primary Care of Adult/Gerontological Population)
Clinical Application Assignment #21) Hypertension (25 points)a. In non-black patients
without concurrent disease, the Hypertension Guideline Management Algorithm indicates
that first-line anti-hypertensive medication may include thiazide-type diuretics, OR ace
inhibitors, OR angiotensin receptor blockers, OR calcium channelblockers used alone or in
combination. (2.5 points)True / FalseIf false, correct the statement so it is true.b. In black
patients without concurrent disease, the Hypertension Guideline Management Algorithm
indicates that first-line anti-hypertensive medication may include thiazide-type diuretics,
OR beta blockers used alone or in combination. (2.5 points)True / FalseIf false, correct the
statement so it is true.c. JNC-8 recommendations regarding the use of Beta Blockers for the
primary management of HTN is (10 points):d. A 44 year old, Caucasian male has been
diagnosed with hypertension. Lifestyle modifications for one month did not bring his BP to
goal. Prescribe a medication for the patient utilizing JNC-8 guideline for Pharmacological
Therapy (10 points):Name: A.A.MaleDOB: 1-23-1971Date: May 27,
2015Medication:Sig:Quantity:Refills allowed:(continued)2) Dyslipidemia (25 points)a)
Counseling your patient with dyslipidemia about lifestyle modifications would include a
diet that is: (2.5 points)b) Routine monitoring of liver enzymes during statin therapy is
necessary. (2.5 points)True / FalseIf false, correct the statement so it is true.c) Your patient
has been diagnosed with dyslipidemia. Lifestyle modifications for 2 months have not altered
the patient’ s lipid panel. Describe the patient education you will provide your patient
regarding the need for pharmacological therapy: (10 points)d) A 54 year old, Caucasian
female has been diagnosed with dyslipidemia(non-diabetic; LDL 192) . Lifestyle
modifications for two months did not change her lipid panel. She is very concerned about
the cost of a medication for a chronic condition. Prescribe a medication for the patient (10
points):Name: A.A.FemaleDOB: 1-23-1961Date: May 27,
2015Medication:Sig:Quantity:Refills allowed:(continued)3) Acute Coronary Syndrome (25
points)a. A diagnostic test that should be done promptly for a patient with chest pain is: (2.5
points)a. 12-Lead Electrocardiogramb. Echocardiogramc. Lipid paneld. Nuclear Scanningb.
The best laboratory tests to rule out MI is / are: (2.5 points)a. ESRb. Chemistry Profilec.
Cardiac specific troponin / enzymesc. A 50 year old female patient presents with
“ heartburn” that she has had for one week. Identify 3 differential diagnosis of concern for
this patient and provide rationale for why it is a differential to consider: (10 points)d. Write

2. a prescription for a patient with stable angina for Nitroglycerin to use as needed: (10
points)Name: A.A.MaleDOB: 1-23-1951Date: May 27, 2015Medication:Sig:Quantity:Refills
allowed:(continued)4) Putting it all together (25 points)Patient:65 year old female with
complaints of “ Heartburn” and severe “ fatigue” for one week. Pain radiated to Right
posterior shoulder. No nausea, shortness of breath, or sweating.She was evaluated in the
primary care clinic and eventually admitted to the hospital with chest pain. It was
determined she did have a myocardial infarction. She was told her BP was consistently high
while in the hospital and that her cholesterol was “ too high” The patient is now being seen
by you in the primary care clinic.Today:BP: 160/96Pain freeIdentify the things you need to
assure are in place as she returns to your care:Medications (at least 3 things to consider;
more if you think of them):Lifestyle Education:HypertensionThe newest EBP guidelines
(JNC8) were released early in 2014. There are still many resources online that do not
contain these new guidelines.Dunphy (2015) 4th Edition: Chapter 10 Cardiovascular
Problems – pg 435 – 449 (Hypertension)Caboral-Stevens, M. F. & Rosario-Sim, M. (2014).
Review of the Joint National Committee’ s Recommendations in the Management of
Hypertension. The Journal of Nurse Practitioners, 10, pp. 325-330.2014 Evidence-Based
Guideline for the Management of High Blood Pressure in Adults. Report from the Panel
Members Appointed to the Eighth Joint National Committee (JNC8) [you do not need to read
this in its entirety but it is a good reference to have]DyslipidemiaThese are pretty new
guidelines as well – with some significant changes from previous guidelines. I will review
these in the lecture.Dunphy (2015) 4th Edition: Chapter 10 Cardiovascular Problems – pg
449-454 (Dylipidemia)Treatment of Blood Cholesterol to Reduce Atherosclerotic
Cardiovascular Disease Risk in Adults: Synopsis of the 2013 American College of
Cardiology/American Heart Association Cholesterol Guideline2013 ACC/AHA Guideline on
the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in
Adults: A Report of the American College of Cardiology / American Heart Association Task
Force on Practice Guidelines. (You do not need to read this article in its entirety but it is
available for you if you’ d like. I would like you to focus on pages: 13-15, 22-24, 27, 30, 42-
48)ASCVD Risk Calculator:https://myamericanheart.org/cvriskcalculator (Links to an
external site.)Coronary Heart Disease / Acute Coronary SyndromeDunphy (2015) 4th
Edition: Chapter 10 Cardiovascular Problems – pg 454-470 (Coronary Heart Disease
[Atherosclerotic Coronary Heart Disease] and Acute Coronary Syndrome)