HYPERTENSION RELIAS EXAM REVIEW: 2026/2027
UPDATED EDITION – ACC/AHA/WHO GUIDELINE
ALIGNED - Complete Clinical Scenarios with
Verified Solutions & Graded A+ Rationales
🩺 SECTION 1: BLOOD PRESSURE MEASUREMENT & CLASSIFICATION – 3
Items
Q1: A nurse is teaching a patient about proper technique for home blood pressure
monitoring. Which instruction should the nurse include?
A. "Take your blood pressure immediately after waking, while still in bed."
B. "Measure your blood pressure after drinking a cup of coffee to get your true reading."
C. "Sit quietly for 5 minutes with feet flat on the floor before measuring."
D. "Measure your blood pressure with a full bladder to ensure accuracy."
Correct Answer: C. Sit quietly for 5 minutes with feet flat on the floor before measuring.
Rationale: The 2025 ACC/AHA guidelines specify: patient should be seated in a chair
with back supported, feet flat on floor, legs uncrossed, arm supported at heart level, and
should rest quietly for 5 minutes before measurement. Empty bladder, no caffeine or
exercise for 30 minutes prior.
❌ A: Blood pressure should NOT be measured immediately upon waking while in bed;
❌ B: Caffeine elevates BP; should be avoided for 30 minutes prior.
patient should be seated in a chair.
,❌ D: Full bladder elevates BP; patient should void first.
Q2: According to the 2017 ACC/AHA hypertension guidelines (2025-2026 updates),
which blood pressure reading classifies as Stage 2 Hypertension?
A. 118/76
B. 128/82
C. 136/88
D. 148/92
Correct Answer: D. 148/92
Rationale: The 2017 ACC/AHA classification (reaffirmed in 2025-2026 updates):
● Normal: <120 and <80
● Elevated: 120-129 and <80
● Stage 1 HTN: 130-139 or 80-89
● Stage 2 HTN: ≥140 or ≥90
❌ A: Normal
❌ B: Elevated
❌ C: Stage 1 HTN
ATI/Relias Trap: Students often remember JNC 7 (140/90 threshold for diagnosis).
Current guidelines (since 2017, reaffirmed 2025) lower the threshold to 130/80 for
Stage 1. This is a high-yield test item.
Q3 (SATA): A patient's office blood pressure readings average 138/86. Home readings
average 128/78. Which of the following conditions should the nurse suspect? (Select all
that apply.)
A. White coat hypertension
B. Masked hypertension
C. Sustained hypertension
, D. White coat effect
E. Orthostatic hypotension
Correct Answers: A, D
✅
Rationale:
A. White coat hypertension — Defined as elevated office BP but normal out-of-office
BP (home or ambulatory monitoring). This patient has office BP in Stage 1 range but
✅
normal home readings.
D. White coat effect — Refers to the phenomenon of BP elevation in medical
settings; technically present in many patients even if they also have sustained HTN.
❌ B: Masked hypertension = normal office BP but elevated out-of-office BP (opposite
❌ C: Sustained hypertension = elevated both in and out of office.
of this patient).
❌ E: Orthostatic hypotension = drop in BP upon standing, unrelated.
📊 SECTION 2: PATHOPHYSIOLOGY OF HYPERTENSION – 3 Items
Q4: A nurse is explaining the pathophysiology of primary (essential) hypertension to a
patient. Which statement by the nurse is MOST accurate?
A. "Your hypertension is caused by a tumor in your adrenal gland."
B. "High blood pressure runs in families, but the exact cause is usually unknown."
C. "Your kidney disease has caused your blood pressure to increase."
D. "Narrowing of your aorta is the most likely cause of your hypertension."
Correct Answer: B. "High blood pressure runs in families, but the exact cause is usually
unknown."
Rationale: Primary (essential) hypertension accounts for 90-95% of cases and has no
identifiable single cause. It is multifactorial: genetics, sodium sensitivity,
UPDATED EDITION – ACC/AHA/WHO GUIDELINE
ALIGNED - Complete Clinical Scenarios with
Verified Solutions & Graded A+ Rationales
🩺 SECTION 1: BLOOD PRESSURE MEASUREMENT & CLASSIFICATION – 3
Items
Q1: A nurse is teaching a patient about proper technique for home blood pressure
monitoring. Which instruction should the nurse include?
A. "Take your blood pressure immediately after waking, while still in bed."
B. "Measure your blood pressure after drinking a cup of coffee to get your true reading."
C. "Sit quietly for 5 minutes with feet flat on the floor before measuring."
D. "Measure your blood pressure with a full bladder to ensure accuracy."
Correct Answer: C. Sit quietly for 5 minutes with feet flat on the floor before measuring.
Rationale: The 2025 ACC/AHA guidelines specify: patient should be seated in a chair
with back supported, feet flat on floor, legs uncrossed, arm supported at heart level, and
should rest quietly for 5 minutes before measurement. Empty bladder, no caffeine or
exercise for 30 minutes prior.
❌ A: Blood pressure should NOT be measured immediately upon waking while in bed;
❌ B: Caffeine elevates BP; should be avoided for 30 minutes prior.
patient should be seated in a chair.
,❌ D: Full bladder elevates BP; patient should void first.
Q2: According to the 2017 ACC/AHA hypertension guidelines (2025-2026 updates),
which blood pressure reading classifies as Stage 2 Hypertension?
A. 118/76
B. 128/82
C. 136/88
D. 148/92
Correct Answer: D. 148/92
Rationale: The 2017 ACC/AHA classification (reaffirmed in 2025-2026 updates):
● Normal: <120 and <80
● Elevated: 120-129 and <80
● Stage 1 HTN: 130-139 or 80-89
● Stage 2 HTN: ≥140 or ≥90
❌ A: Normal
❌ B: Elevated
❌ C: Stage 1 HTN
ATI/Relias Trap: Students often remember JNC 7 (140/90 threshold for diagnosis).
Current guidelines (since 2017, reaffirmed 2025) lower the threshold to 130/80 for
Stage 1. This is a high-yield test item.
Q3 (SATA): A patient's office blood pressure readings average 138/86. Home readings
average 128/78. Which of the following conditions should the nurse suspect? (Select all
that apply.)
A. White coat hypertension
B. Masked hypertension
C. Sustained hypertension
, D. White coat effect
E. Orthostatic hypotension
Correct Answers: A, D
✅
Rationale:
A. White coat hypertension — Defined as elevated office BP but normal out-of-office
BP (home or ambulatory monitoring). This patient has office BP in Stage 1 range but
✅
normal home readings.
D. White coat effect — Refers to the phenomenon of BP elevation in medical
settings; technically present in many patients even if they also have sustained HTN.
❌ B: Masked hypertension = normal office BP but elevated out-of-office BP (opposite
❌ C: Sustained hypertension = elevated both in and out of office.
of this patient).
❌ E: Orthostatic hypotension = drop in BP upon standing, unrelated.
📊 SECTION 2: PATHOPHYSIOLOGY OF HYPERTENSION – 3 Items
Q4: A nurse is explaining the pathophysiology of primary (essential) hypertension to a
patient. Which statement by the nurse is MOST accurate?
A. "Your hypertension is caused by a tumor in your adrenal gland."
B. "High blood pressure runs in families, but the exact cause is usually unknown."
C. "Your kidney disease has caused your blood pressure to increase."
D. "Narrowing of your aorta is the most likely cause of your hypertension."
Correct Answer: B. "High blood pressure runs in families, but the exact cause is usually
unknown."
Rationale: Primary (essential) hypertension accounts for 90-95% of cases and has no
identifiable single cause. It is multifactorial: genetics, sodium sensitivity,
