RATIONALES
You cexamine ca c38-year-old cwoman cwho chas cpresented
for can cinitial cexamination cand cPapanicolaou ctest. cShe chas
no ccomplaint. cHer cblood cpressure c(BP) cis c154/98 cmm cHg
bilaterally cand cher cbody cmass cindex c(BMI) cis c31 ckg/m2.
The crest cof cher cphysical cexamination cis cunremarkable.
Your cnext cbest caction cis cto:
A. cinitiate cantihypertensive ctherapy.
B. carrange cfor cat cleast ctwo cadditional cBP cmeasurements
during cthe cnext c2 cweeks.
C. corder cblood curea cnitrogen, ccreatinine, cand cpotassium
ion cmeasurements cand curinalysis.
D. cadvise cher cto creduce cher csodium cintake. c- cCORRECT cANS✔✔B
You csee ca c68-year-old cwoman cas ca cpatient cwho cis ctransferring
care cinto cyour cpractice. cShe chas ca c10-year chistory
of chypertension, cdiabetes cmellitus, cand chyperlipidemia.
Current cmedications cinclude chydrochlorothiazide
(HCTZ), cglipizide, cmetformin, csimvastatin, cand cdaily
low-dose caspirin. cToday's cBP creading cis c158/92 cmm cHg,
and cthe crest cof cher chistory cand cexamination care cunremarkable.
Documentation cfrom cher cformer chealthcare
provider cindicates cthat cher cBP chas cbeen cin cthe crange cfor
the cpast c12 cmonths. cYour cnext cbest caction cis cto:
A. cprescribe can cangiotensin-converting cenzyme cinhibitor
(ACEI).
B. chave cher creturn cfor ca cBP ccheck cin c1 cweek.
C. cadvise cthat cher ccurrent ctherapy cis cadequate.
D. cadd ctherapy cwith can caldosterone cantagonist. c- cCORRECT cANS✔✔A
You cexamine ca c78-year-old cwoman cwith clong-standing,
poorly ccontrolled chypertension. cWhen cevaluating cher
for chypertensive ctarget corgan cdamage, cyou clook cfor
evidence cof:
A. clipid cabnormalities.
B. cinsulin cresistance.
C. cleft cventricular chypertrophy.
D. cclotting cdisorders. c- cCORRECT cANS✔✔C
Diagnostic ctesting cfor ca cpatient cwith cnewly cdiagnosed
primary chypertension cshould cinclude call cof cthe cfollowing
except:
A. chematocrit.
B. curic cacid.
C. ccreatinine.
D. cpotassium. c- cCORRECT cANS✔✔B
In cthe cperson cwith chypertension, cthe cnurse cpractitioner
(NP) crecommends call cof cthe cfollowing cto cpotentially
reduce cBP cin ca cpatient cwith ca cBMI cof c30 ckg/m2 cexcept:
A. c10-kg c(22-lb) cweight closs.
B. cdietary csodium crestriction cto c2.4 cg c(6 cg cNaCl) cper cday.
C. cregular caerobic cphysical cactivity, csuch cas c30-40 cminutes
of cbrisk cwalking cmost cdays cof cthe cweek.
D. cconsuming cat cleast c1-2 cservings cof calcohol. c- cCORRECT cANS✔✔D
,Match cthe cantihypertension cmedication cwith cits
appropriate cclass.
_______6. camlodipine
_______7. cdiltiazem
_______8. ctrandolapril
_______9. ctelmisartan
_______10. cpindolol
A. cbeta-adrenergic creceptor
antagonist
B. cnondihydropyridine
calcium cchannel cblocker
C. cdihydropyridine ccalcium
channel cblocker
D. cangiotensin creceptor
antagonist
E. cACEI c- cCORRECT cANS✔✔6. cC.
7. cB.
8. cE.
9. cD.
10. cA.
You csee ca c38-year-old cAfrican cAmerican cmale cwith
hypertension cwho cis ccurrently cbeing ctreated cwith
thiazide-type cdiuretic. cHis ccurrent cblood cpressure
reading cis c156/94 cmm cHg cand che chas cno chistory cof
diabetes cmellitus cor cchronic ckidney cdisease. cFollowing
current cbest cevidence, cyou cconsider cadding cwhich cof
the cfollowing cmedications?
A. cACEI
B. cangiotensin creceptor cblocker c(ARBs)
C. cbeta-adrenergic creceptor cantagonist
D. ccalcium cchannel cblocker c- cCORRECT cANS✔✔D
Nondihydropyridine ccalcium cchannel cblockers care ccontraindicated
in cpatients cwith:
A. ctype c1 cdiabetes cmellitus.
B. ca chistory cof cvenous cthromboembolism.
C. csevere cleft cventricular cdysfunction.
D. cconcomitant ctreatment cwith can cACEI. c- cCORRECT cANS✔✔C
In cobtaining can coffice cBP cmeasurement, cwhich cof cthe
following cis cmost creflective cof cthe cbest cpractice?
A. cThe cpatient cshould csit cin ca cchair cwith cfeet cflat con cthe
floor cfor cat cleast c5 cminutes cbefore cobtaining cthe
reading.
B. cThe cBP ccuff cshould cnot ccover cmore cthan c50% cof cthe
upper carm.
C. cThe cpatient cshould csit con cthe cedge cof cthe cexamination
table cwithout carm csupport cto cenhance creading
accuracy.
D. cObtaining cthe cBP creading cimmediately cafter cthe
patient cwalks cinto cthe cexamination croom cis
recommended. c- cCORRECT cANS✔✔A
A cBP celevation cnoted conly cat can coffice cvisit cis ccommonly
known cas chypertension.
A. cprovider-induced
B. cclinical
C. cwhite ccoat
D. cpseudo c- cCORRECT cANS✔✔C
The cmost cimportant clong-term cgoal cof ctreating
hypertension cis cto:
A. cstrive cto creach crecommended cnumeric
BP cmeasurement.
B. cavoid cdisease-related ctarget corgan cdamage.
C. cdevelop ca cplan cof ccare cwith cminimal cadverse ceffects.
D. ctreat cconcomitant chealth cproblems coften cnoted cin
the cperson cwith cthis ccondition. c- cCORRECT cANS✔✔B
You cstart ca cpatient cwith chypertension cwho cis calready
receiving can cACEI con cspironolactone. cYou cadvise cthe
,patient cto creturn cin c4 cweeks cto ccheck cwhich cof cthe
following claboratory cparameters?
A. csodium
B. ccalcium
C. cpotassium
D. cchloride c- cCORRECT cANS✔✔C
A c68-year-old cwoman cpresents cwith chypertension cand cBP
of c152-158/92-96 cmm cHg cdocumented cover c2 cmonths con
three cdifferent coccasions. cElectrocardiogram c(ECG) cand
creatinine care cnormal, cand cshe chas cno cproteinuria. cClinical
findings cinclude cthe cfollowing: cBMI c26.4 ckg/m2; cno cS3,
S4, cor cmurmur; cand cpoint cof cmaximal cimpulse cat cfifth
intercostal cspace, cmid-clavicular cline. cWhich cof cthe
following crepresents cthe cbest cintervention?
A. cInitiate ctherapy cwith cmetoprolol.
B. cInitiate ctherapy cwith chydrochlorothiazide.
C. cInitiate ctherapy cwith cmethyldopa.
D. cContinue cto cmonitor cBP, cand cstart cdrug ctherapy cif
evidence cof ctarget corgan cdamage. c- cCORRECT cANS✔✔B
Which cof cthe cfollowing ccan chave ca cfavorable ceffect
on ca ccomorbid ccondition cin ca cperson cwith
hypertension?
A. cchlorthalidone cin cgout
B. cpropranolol cwith cairway cdisease
C. caldosterone cantagonist cin cheart cfailure
D. cmethyldopa cin can colder cadult c- cCORRECT cANS✔✔C
According cto cJNC-8 cguidelines, call cof cthe cfollowing
medications care cfirst-line cagents cfor cuse cin ca
middle-aged cwhite cman cwithout cdiabetes
mellitus cexcept:
A. clisinopril.
B. chydrochlorothiazide.
C. cmetoprolol.
D. camlodipine. c- cCORRECT cANS✔✔C
You csee ca c59-year-old cman cwith cpoorly ccontrolled
hypertension. cOn cphysical cexamination, cyou cnote
grade c1 chypertensive cretinopathy. cYou canticipate call
of cthe cfollowing cwill cbe cpresent cexcept:
A. cpatient creport cof cacute cvisual cchange.
B. cnarrowing cof cthe cterminal carterioles.
C. csharp coptic cdisc cborders.
D. cabsence cof cretinal chemorrhage. c- cCORRECT cANS✔✔A
According cto cJNC-8, ca c52-year-old cwell cwoman
with ca chealthy cBMI cwhose cblood cpressure cis
consistently c130-135/82-86 cmm cHg cis cconsidered
to chave:
A. cnormal cblood cpressure.
B. chypertension crequiring ctherapy cwith ca ccalcium
channel cblocker c(CCB).
C. chypertension crequiring ctherapy cwith can calpha
blocker.
D. chypertension crequiring ctherapy cwith ca cthiazide-type
diuretic. c- cCORRECT cANS✔✔A
Which cof cthe cfollowing cis cassociated cwith cthe chighest
risk cof cischemic cheart cdisease?
A. cpresence cof cmicroalbuminuria cplus cheavy calcohol
intake
B. cabsence cof cmicroalbuminuria cplus cuse cof ca
thiazolidinedione
C. cabsence cof cmicroalbuminuria cplus cchronic cphysical
inactivity
D. cpresence cof cmicroalbuminuria cplus ccigarette
smoking c- cCORRECT cANS✔✔D
When ccompared cwith cCaucasians, cAfrican cAmericans
tend cto chave ca creduced ceffect cwith cmonotherapy
with call cof cthe cfollowing cblood cpressure cmedications
except:
A. cACEIs.
, B. cARBs.
C. cCCB.
D. cbeta cblockers. c- cCORRECT cANS✔✔C
Match cthe crecommended cblood cpressure cgoal cfor
each cpatient caccording cto cJNC-8 cguidelines. c(An
answer ccan cbe cused cmore cthan conce.)
A. c<130/80 cmm cHg
B. c<140/80 cmm cHg
C. c<140/90 cmm cHg
D. c<150/90 cmm
_______24. ca c57-year-old cwhite
male cwith cno chistory
of cdiabetes cmellitus
(DM) cor cchronic
kidney cdisease c(CKD)
_______25. ca c62-year-old cAfrican
American cmale cwith
diabetes cmellitus
_______26. ca c67-year-old cfemale
with cCKD
_______27. ca c62-year-old cfemale
with cno chistory
of cDM cor cCKD
_______28. can c82-year-old cmale
with cno chistory
of cDM cor cCKD
_______29. ca c72-year-old cfemale
with cDM cand cCKD c- cCORRECT cANS✔✔24. cC.
25. cC.
26. cC.
27. cD.
28. cD.
29. cC.
You csee ca c62-year-old cman cwithout cchronic ckidney
disease cor cdiabetes cmellitus cwho cis ccurrently cbeing
treated cwith clow-dose cHCTZ cand closartan. cHis cblood
pressure cis ccurrently c162/88 cmm cHg. cAll cof cthe cfollowing
are cappropriate cnext ccourses cof caction cexcept:
A. cincreasing cthe cdose cof closartan.
B. cadding ca cbeta-adrenergic creceptor cantagonist.
C. cadding ca ccalcium cchannel cblocker.
D. cincreasing cthe cdose cof cHCTZ. c- cCORRECT cANS✔✔B
Which cof cthe cfollowing cstatements cconcerning cpostural
hypotension cin cthe celderly cis cfalse?
A. cIt cincreases cthe crisk cof cfalls cand csyncope.
B. cIt cis ccharacterized cby ca cdrop cin cblood cpressure cwhen
going cfrom ca cstanding cto ca csitting cposition.
C. cIt cincreases cthe crisk cof ccardiovascular cevents.
D. cIt cis cassociated cwith cthe cuse cof cvasodilating
medications. c- cCORRECT cANS✔✔B
According cto cAmerican cCollege cof cCardiology
Foundation/American cHeart cAssociation
(ACCF/AHA) cguidelines, cwhen ctreating celderly
patients cwith chypertension, cwhich cof cthe cfollowing
medications chave ca ccompelling cindication cfor cuse cin cthe cfollowing cpatient cconditions? c(The cmedications
listed ccan cbe cused cmore cthan conce. cA cgiven ccondition
can chave cmore cthan cone cmedication cindicated.)
A. cthiazide cdiuretic
B. cbeta cblocker
C. cACEI
D. cARB
E. caldosterone
antagonist
F. ccalcium cchannel