| Course | NUR-7071 Adult Primary Care Part I |
|---|---|
| Module | Module 1 |
| Paper type | Case paper: hypertension in primary care |
| Length | About 1,135 words, 7 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7071 Module 1
Numbers at Home, Numbers in the Clinic: Confirming and Treating Stage 2 Hypertension
Student Name
M.S. in Nursing, Family Nurse Practitioner, Thomas Edison State University
NUR-7071: Adult Primary Care Part I
Mentor Name
Month Day, Year
Numbers at Home, Numbers in the Clinic: Confirming and Treating Stage 2 Hypertension
The Patient
Daniel Brooks, an invented 54-year-old Black man who works rotating shifts as a truck dispatcher, came in for a physical his employer requires. At that visit his blood pressure was 152/96 and 156/98 two weeks later, each figure averaging two seated measurements, after he had rested five minutes, using a cuff that fit his arm. He has no chest pain, headaches or vision changes. He smokes no cigarettes, drinks four or five beers on weekends, eats most meals from a truck stop diner and walks little. His father had a stroke at 63. At a body mass index of 31 he is obese, but the examination is otherwise unremarkable, with no carotid bruits, edema or abnormal heart sounds.
Screening and Confirmation
Office screening for high blood pressure is advised for every adult from age 18, yearly from age 40 or earlier when risk is raised (US Preventive Services Task Force, 2021). The same statement asks that high clinic values be confirmed with measurements outside the clinic before treatment begins, because white coat effects can inflate office values and lead to unnecessary medication. Ambulatory monitoring over 24 hours is the reference standard; home monitoring with a validated upper-arm device is an accepted alternative. Mr. Brooks was lent a validated home cuff and taught to take two measurements every morning and every evening for a week, seated, with his arm supported at heart level. His home average was 154/96, confirming that the office numbers were not nerves.
Staging and Evaluation
Whelton et al. (2018) define normal blood pressure as below 120/80, elevated pressure as a systolic value of 120 to 129 with a diastolic value under 80, stage 1 hypertension as systolic values in the 130s or diastolic values in the 80s and stage 2 hypertension as 140 or higher systolic or 90 or higher diastolic. Mr. Brooks has stage 2 hypertension. The guideline recommends a basic workup for every newly diagnosed adult: fasting glucose, complete blood count, lipid profile, serum creatinine with estimated glomerular filtration rate, sodium, potassium and calcium, thyroid-stimulating hormone, urinalysis and an electrocardiogram, with a urine albumin-to-creatinine ratio as an optional test. The guideline also asks clinicians to estimate 10-year atherosclerotic cardiovascular risk, which guides how intensively to treat. His results showed normal kidney function and electrolytes, a fasting glucose of 104, LDL cholesterol of 138 and a normal electrocardiogram. His 10-year risk was estimated at about 14 percent.
How Low to Aim
The SPRINT trial randomly assigned 9,361 adults aged 50 and older with systolic pressure between 130 and 180 and increased cardiovascular risk, but without diabetes or prior stroke, to a systolic goal of under 120 or of under 140 (SPRINT Research Group, 2015). The trial was stopped early, after a median of about three years, because the intensive group had a 25 percent lower rate of the primary composite of heart attack, other acute coronary syndromes, stroke, heart failure and cardiovascular death, and lower all-cause mortality. Intensive treatment also brought more hypotension, fainting, electrolyte abnormalities and acute kidney injury. Its results shaped the 2017 guideline's general goal of under 130/80.
| Source | Key point | Application to Mr. Brooks |
|---|---|---|
| Screening statement (US Preventive Services Task Force, 2021) | Confirm office readings outside the clinic before treating | Seven days of home readings confirmed the diagnosis |
| Whelton et al. (2018) | Stage 2 at 140/90; basic workup; two drugs when far above goal | Workup completed; two-drug start chosen |
| Intensive target trial (SPRINT Research Group, 2015) | Lower systolic targets cut events but raised side effects | Target below 130/80 with monitoring |
Choosing Medication
Whelton and colleagues recommend medication alongside lifestyle change for stage 2 hypertension, and they advise a two-drug start, using agents from separate first-line classes, once the average exceeds the goal by over 20/10. At 154/96, Mr. Brooks is 24/16 above the 130/80 goal. The first-line choices are thiazide-type diuretics, calcium channel blockers and drugs that block the renin-angiotensin system, either ACE inhibitors or ARBs; for Black adults without heart failure or chronic kidney disease, the guideline prefers starting with either a calcium channel blocker or a thiazide-type diuretic. After discussing options, Mr. Brooks and I chose chlorthalidone 12.5 mg and amlodipine 5 mg once daily, with a plan to move to a single combined tablet if one becomes affordable through his pharmacy plan. A basic metabolic panel will be repeated in two to four weeks to check potassium, sodium and creatinine.
Lifestyle Changes That Fit His Life
The guideline lists the expected systolic reductions for each change: roughly 1 mm Hg for each kilogram lost, around 11 for a DASH-style diet in people with hypertension, 5 to 6 for cutting sodium, 4 to 5 for more dietary potassium, 5 to 8 for regular aerobic activity and about 4 for limiting alcohol. Rather than handing Mr. Brooks a list, I asked which changes seemed realistic. He chose three: packing two meals from home on work nights, walking 20 minutes before each shift and keeping weekend drinking to two beers a day. We agreed to revisit the plan, not to judge it, at each visit.
Shift Work and Adherence
Rotating shifts make a fixed medication schedule hard. We linked his pills to waking up, whatever the clock said, and set a phone reminder. He worried that the diuretic would send him to the bathroom during long dispatch stretches; taking it on waking rather than before a shift addresses that concern.
Equity and Access
Hypertension develops earlier and causes more heart failure, stroke and kidney disease in Black adults than in white adults, differences rooted in social and structural conditions as well as biology. Low-cost generic drugs, a free home cuff from the clinic's loan program and evening appointment slots remove some of the barriers Mr. Brooks faces.
Follow-Up
The guideline recommends monthly visits after starting or changing therapy until the goal is reached. Mr. Brooks will return in four weeks with his home log and laboratory results. If he is above goal, the amlodipine dose can be raised to 10 mg before adding a third drug. Once controlled, visits can move to every three to six months.
Limits
The 2017 guideline's lower thresholds remain debated, and SPRINT did not enroll anyone with diabetes or a past stroke. Home cuffs vary in accuracy unless validated. The patient and clinic are invented.
Conclusion
The screening statement asked me to confirm Mr. Brooks's office readings at home before treating, Whelton and colleagues provided the staging, workup and rationale for a two-drug start and SPRINT showed why a lower target can prevent heart attacks and strokes at the cost of more side effects. Confirmation, a workup, two first-line drugs, lifestyle changes he chose himself and monthly follow-up give him a plan that fits a night-shift life.
References
SPRINT Research Group. (2015). A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine, 373(22), 2103-2116. https://doi.org/10.1056/NEJMoa1511939
US Preventive Services Task Force. (2021). Screening for hypertension in adults: US Preventive Services Task Force reaffirmation recommendation statement. JAMA, 325(16), 1650-1656. https://doi.org/10.1001/jama.2021.4987
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., . . . Wright, J. T. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension, 71(6), e13-e115. https://doi.org/10.1161/HYP.0000000000000065
NUR 7071 Module 1 instructions, in plain terms
Cardiovascular care is named first among the body systems in TESU's catalog description of NUR-7071, and with its course outline available only to enrolled students, the first paper here is modeled as a hypertension case. Present an adult patient with history, examination and measured readings, then explain how the diagnosis was confirmed outside the office, how the stage was assigned and which tests were ordered. Justify the drug choice with guideline thresholds, set a blood pressure target supported by trial evidence and describe lifestyle changes the patient chose. Plan follow-up with specific timing and laboratory checks. Address barriers such as cost, work schedule and access. Some sections require a SOAP note format instead of an essay. Ask whether calculated cardiovascular risk scores should be shown.
Inside the NUR 7071 Module 1 example
Daniel Brooks, an invented 54-year-old dispatcher seen by an FNP student in Vineland, has office readings of 152/96 and 156/98. Seven days of home readings confirm stage 2 hypertension, and a guideline workup with an electrocardiogram and laboratory tests follows. The screening statement, Whelton and colleagues' guideline and the SPRINT trial are linked to decisions in a table. Chlorthalidone and amlodipine are started because his average is more than 20/10 above goal. Lifestyle changes he chose, a section on shift work and adherence, equity and access, monthly follow-up, limits and a conclusion complete the paper. Taking the diuretic on waking, rather than before a shift, is also explained.
NUR 7071 Module 1 rubric: what earns full marks
Hypertension case papers earn high marks when the diagnosis is confirmed outside the office, the stage is assigned with correct cutoffs and the workup matches the guideline. Readers look for a drug choice tied to a stated threshold, such as a two-drug start once readings sit over 20/10 above goal, and for first-line classes chosen with the patient's characteristics in mind. A target supported by trial evidence, with its trade-offs named, shows judgment. Lifestyle changes the patient selected, a plan for laboratory monitoring and follow-up at defined intervals show complete primary care management rather than a prescription alone. Explaining the diuretic's timing around shift work shows attention to adherence.
NUR 7071 Module 1 help from the desk
Hypertension papers often start medication on a single office reading; show how you confirmed the diagnosis with home or ambulatory readings. Use the guideline's stage cutoffs, list the baseline tests and tie your drug choice to a threshold and to the patient's characteristics. Explain the target and what the evidence says about its benefits and risks. Ask the patient which lifestyle changes are realistic, plan a laboratory check after starting a diuretic and schedule monthly visits until control is reached. Send us the prompt with your patient's readings and history to get a free first draft written to your instructions. If your case uses a different guideline, such as one for older adults, explain why it applies.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 7071 Module 1 questions, answered
Where can I find a free NUR 7071 Module 1 sample paper?
The stage 2 hypertension case paper, from home readings to a two-drug start, is on this page.
When should hypertension be confirmed outside the office?
The USPSTF recommends out-of-office readings, by ambulatory or home monitoring, before starting treatment.
What blood pressure defines stage 2 hypertension?
Under the 2017 guideline, 140 or higher systolic or 90 or higher diastolic.
When should two antihypertensive drugs be started?
When the average reading sits over 20/10 above goal, per Whelton and colleagues.
What did the SPRINT trial show?
A systolic target below 120 cut cardiovascular events and deaths but raised side effects such as hypotension and kidney injury.