NR 509 CASE PRIMARY HYPERTENSION – 57-YEAR-OLD HISPANIC MALE
QUESTIONS
Section 1: History & Risk Assessment (1–30)
1. A 57-year-old Hispanic male has a BP of 146/90 mm Hg on two separate visits.
He denies symptoms. What is the most appropriate diagnosis?
A) White coat hypertension
B) Stage 1 hypertension
C) Stage 2 hypertension
D) Hypertensive urgency
Answer: B
Rationale: Per ACC/AHA 2017, Stage 1 HTN = 130–139/80–89; Stage 2 = ≥140/≥90.
146/90 qualifies as Stage 2? Wait – 146 systolic is ≥140, so Stage 2. Correct
answer is C. Let me correct: 146/90 = Stage 2 (≥140 or ≥90). So answer is C.
2. Which question best assesses for secondary hypertension in this patient?
A) “Do you have frequent headaches?”
B) “Have you ever had muscle weakness or cramps?”
,C) “How much coffee do you drink?”
D) “Do you eat a lot of rice and beans?”
Answer: B
Rationale: Muscle weakness can indicate hypokalemia from hyperaldosteronism,
a common secondary cause.
3. The patient reports occasional epistaxis. This is:
A) Pathognomonic for malignant hypertension
B) A common but nonspecific finding in hypertension
C) Always indicates a bleeding disorder
D) Only seen in thrombocytopenia
Answer: B
Rationale: Epistaxis may occur with hypertension but is not diagnostic; many
hypertensives never have nosebleeds.
4. Family history reveals father had MI at age 55. This confers:
A) No additional risk
B) Increased cardiovascular risk
,C) Protection from hypertension
D) Risk only if mother was affected
Answer: B
Rationale: Premature CVD in a first-degree male relative (<55 years) is a major risk
factor.
5. The patient drinks 10 beers per week. What is your advice?
A) “Beer is safe; it has no effect on BP.”
B) “Reduce to no more than 14 drinks per week.”
C) “Limit to ≤2 drinks most days and no more than 14 per week.”
D) “Switch to wine – it lowers BP.”
Answer: C
Rationale: Current guidelines: ≤2 drinks/day for men (≤14/week). Reduction
lowers SBP by ~4 mmHg.
6. He smokes 1 pack/day for 30 years. Which statement is most accurate?
A) Smoking cessation will not affect BP
B) Smoking cessation reduces cardiovascular risk more than BP reduction alone
, C) Nicotine replacement is contraindicated in hypertension
D) Light smoking (<5 cigarettes/day) has no CVD risk
Answer: B
Rationale: Smoking cessation dramatically reduces overall CVD risk, even if BP
changes little.
7. The patient’s BMI is 32 kg/m². How much weight loss is needed to lower BP?
A) 1–2% of body weight
B) 5–10% of body weight
C) At least 20% of body weight
D) Weight loss does not affect BP
Answer: B
Rationale: Losing 5–10% body weight reduces SBP by ~5–10 mmHg.
8. He takes ibuprofen daily for knee osteoarthritis. This may:
A) Lower his BP due to analgesia
B) Raise his BP via sodium retention
QUESTIONS
Section 1: History & Risk Assessment (1–30)
1. A 57-year-old Hispanic male has a BP of 146/90 mm Hg on two separate visits.
He denies symptoms. What is the most appropriate diagnosis?
A) White coat hypertension
B) Stage 1 hypertension
C) Stage 2 hypertension
D) Hypertensive urgency
Answer: B
Rationale: Per ACC/AHA 2017, Stage 1 HTN = 130–139/80–89; Stage 2 = ≥140/≥90.
146/90 qualifies as Stage 2? Wait – 146 systolic is ≥140, so Stage 2. Correct
answer is C. Let me correct: 146/90 = Stage 2 (≥140 or ≥90). So answer is C.
2. Which question best assesses for secondary hypertension in this patient?
A) “Do you have frequent headaches?”
B) “Have you ever had muscle weakness or cramps?”
,C) “How much coffee do you drink?”
D) “Do you eat a lot of rice and beans?”
Answer: B
Rationale: Muscle weakness can indicate hypokalemia from hyperaldosteronism,
a common secondary cause.
3. The patient reports occasional epistaxis. This is:
A) Pathognomonic for malignant hypertension
B) A common but nonspecific finding in hypertension
C) Always indicates a bleeding disorder
D) Only seen in thrombocytopenia
Answer: B
Rationale: Epistaxis may occur with hypertension but is not diagnostic; many
hypertensives never have nosebleeds.
4. Family history reveals father had MI at age 55. This confers:
A) No additional risk
B) Increased cardiovascular risk
,C) Protection from hypertension
D) Risk only if mother was affected
Answer: B
Rationale: Premature CVD in a first-degree male relative (<55 years) is a major risk
factor.
5. The patient drinks 10 beers per week. What is your advice?
A) “Beer is safe; it has no effect on BP.”
B) “Reduce to no more than 14 drinks per week.”
C) “Limit to ≤2 drinks most days and no more than 14 per week.”
D) “Switch to wine – it lowers BP.”
Answer: C
Rationale: Current guidelines: ≤2 drinks/day for men (≤14/week). Reduction
lowers SBP by ~4 mmHg.
6. He smokes 1 pack/day for 30 years. Which statement is most accurate?
A) Smoking cessation will not affect BP
B) Smoking cessation reduces cardiovascular risk more than BP reduction alone
, C) Nicotine replacement is contraindicated in hypertension
D) Light smoking (<5 cigarettes/day) has no CVD risk
Answer: B
Rationale: Smoking cessation dramatically reduces overall CVD risk, even if BP
changes little.
7. The patient’s BMI is 32 kg/m². How much weight loss is needed to lower BP?
A) 1–2% of body weight
B) 5–10% of body weight
C) At least 20% of body weight
D) Weight loss does not affect BP
Answer: B
Rationale: Losing 5–10% body weight reduces SBP by ~5–10 mmHg.
8. He takes ibuprofen daily for knee osteoarthritis. This may:
A) Lower his BP due to analgesia
B) Raise his BP via sodium retention
