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A 60-year-old patient with a history of hypertension presents to the clinic for a routine check-up. Which of the following findings would indicate poor management of hypertension?
(Select All that Apply.)

Frequent headaches

Blood pressure consistently at goal

Normal renal function tests

Steady weight with no recent gain

Proteinuria on urinalysis

Left ventricular hypertrophy on echocardiogram

Absence of retinal changes on fundoscopic exam

Answer and Explanation

Correct Answer : E,F

A.   Frequent headaches can be a symptom of hypertension but are not specific to poorly managed hypertension.
B.   Blood pressure consistently at goal indicates good management of hypertension.
C.   Normal renal function tests suggest that there has been no damage to the kidneys, a common consequence of poorly controlled hypertension.
D.   Steady weight with no recent gain suggests good management of overall health, which can contribute to better blood pressure control.
E.   Proteinuria indicates kidney damage, often a result of uncontrolled hypertension.
F.   Left ventricular hypertrophy (LVH) is a sign of chronic hypertension and indicates poor management, as it results from the heart working harder to pump blood against increased pressure.
G.   Absence of retinal changes on fundoscopic exam indicates that there is no evidence of hypertensive retinopathy, suggesting good hypertension management.

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Correct Answer is ["B","E","F","G"]

Explanation

A. Positioning the patient supine can increase the risk of aspiration and should be avoided during feeding. The head of the bed should be elevated instead.
B. Monitoring gastric residual volumes is important to assess the tolerance of the feeding and prevent aspiration.
C. Feedings should be given slowly to avoid complications like gastric distention, not rapidly.
D. Using sterile gloves when handling a feeding tube is not necessary unless there is a risk for infection, but clean gloves are generally adequate.
E. Flushing the tube with water before and after medication administration helps to maintain patency and prevent clogging.
F. The head of the bed should be elevated at least 30 degrees during feeding to reduce the risk of aspiration.
G. Verifying tube placement before starting the feeding ensures that the feeding is going into the stomach and not the lungs.

A. Presence of anti-cyclic citrullinated peptide (anti-CCP) antibodies B. Elevated rheumatoid factor (RF) levels C. Decreased erythrocyte sedimentation rate (ESR) D. Elevated C-reactive protein (CRP) levels

Correct Answer is D

Explanation

A. Anti-cyclic citrullinated peptide (anti-CCP) antibodies are specific for rheumatoid arthritis but are not necessarily linked to disease activity.
B. Elevated rheumatoid factor (RF) levels are common in rheumatoid arthritis but not always indicative of disease activity.
C. A decreased erythrocyte sedimentation rate (ESR) is typically a sign of less inflammation, not more.
D. Elevated C-reactive protein (CRP) levels are a direct marker of inflammation and are often correlated with increased disease activity in rheumatoid arthritis.

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A 60-year-old patient with a history of hypertension presents to the clinic for a routine check-up. Which of the following findings would indicate poor management of hypertension? (Select All that Apply.)

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Explanation

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A 60-year-old patient with a history of hypertension presents to the clinic for a routine check-up. Which of the following findings would indicate poor management of hypertension?
(Select All that Apply.)