NR 509 Case: Primary Hypertension 57-Year-Old Overweight
Hispanic Male, Construction Worker And Smoker, Presents
After An Elevated BP Of 170/92 Was Noted At A Health Fair
130+Questions Updated with verified Answer.
Section 1: History of Present Illness (HPI)
1. What is the most appropriate next question after learning the BP is 170/92?
a) “Do you have a headache?”
b) “Have you ever been told you have high blood pressure before?”
c) “Do you take aspirin?”
d) “Are you allergic to any medications?”
Answer: b
Rationale: First determine if this is new or known hypertension. Previous diagnosis changes
management (e.g., possible medication non-adherence vs. new diagnosis).
2. He denies prior HTN diagnosis. How long ago was his last BP check?
a) “Within the last year”
b) “5 years ago at a physical”
c) “Never had it checked”
d) “Last month at work”
Answer: c (if patient says never) – but answer depends on case. Most realistic: b.
Rationale: Many men in this demographic lack regular checkups. Long interval suggests
possible undiagnosed chronic HTN.
3–5. (Fill-in)
3. Ask about symptoms of hypertensive emergency: He denies ______, ______, or ______.
,Answer: chest pain, shortness of breath, neurological deficits (e.g., vision changes,
weakness).
Rationale: Asymptomatic elevated BP ≠ hypertensive emergency; allows outpatient workup.
4. Review of systems for secondary HTN clues: He denies episodic ______, ______, or
______.
Answer: headaches, palpitations, sweating (pheochromocytoma).
5. Medication review: He takes no prescription meds but admits to occasional ______
for muscle pain.
Answer: ibuprofen or NSAID.
Rationale: NSAIDs can raise BP.
6–10. (Multiple choice – timing & context)
6. Was the 170/92 measured after rest?
a) Yes, 5 min seated
b) No, immediately after walking to booth
Answer: b (likely at health fair).
Rationale: Improper measurement technique can cause falsely high reading.
7. What was the cuff size used?
a) Standard adult
b) Large adult
c) Thigh cuff
Answer: b – his arm circumference likely >33 cm (overweight).
Rationale: Small cuff overestimates BP.
8. He smokes. Last cigarette before BP reading?
a) 30 min ago
b) 2 hours ago
c) 12 hours ago
Answer: a.
Rationale: Nicotine raises BP acutely.
, 9. Did he have caffeine before the fair?
a) Yes, coffee 1 hour prior
b) No
Answer: a.
Rationale: Caffeine can transiently increase BP.
10. Bladder status?
a) Full bladder
b) Just voided
Answer: a (common at health fairs).
Rationale: Full bladder ↑ SBP by 10–15 mmHg.
11–15. (Select all that apply – associated symptoms)
11. Which symptoms suggest possible secondary hypertension?
□ Headaches (occipital, morning)
□ Muscle weakness
□ Weight loss
□ Sweating/palpitations
□ Constipation
Answer: All except weight loss (though weight loss more linked to hyperthyroidism, but
hyperaldosteronism can have weakness, pheochromocytoma sweating/palpitations,
hypothyroidism constipation, Cushing’s weight gain – actually weight loss not typical for
primary hyperaldosteronism). Better answer: Headaches (pheo or malignant HTN), weakness
(hypokalemia from hyperaldosteronism), sweating/palpitations (pheo), constipation
(hypothyroidism or hypercalcemia).
Rationale: Screen for endocrine causes.
16–20. (Short answer)
16. He reports no dyspnea, orthopnea, or PND. What does this rule out?
Answer: Heart failure with volume overload.
Rationale: Longstanding uncontrolled HTN can lead to HF.
Hispanic Male, Construction Worker And Smoker, Presents
After An Elevated BP Of 170/92 Was Noted At A Health Fair
130+Questions Updated with verified Answer.
Section 1: History of Present Illness (HPI)
1. What is the most appropriate next question after learning the BP is 170/92?
a) “Do you have a headache?”
b) “Have you ever been told you have high blood pressure before?”
c) “Do you take aspirin?”
d) “Are you allergic to any medications?”
Answer: b
Rationale: First determine if this is new or known hypertension. Previous diagnosis changes
management (e.g., possible medication non-adherence vs. new diagnosis).
2. He denies prior HTN diagnosis. How long ago was his last BP check?
a) “Within the last year”
b) “5 years ago at a physical”
c) “Never had it checked”
d) “Last month at work”
Answer: c (if patient says never) – but answer depends on case. Most realistic: b.
Rationale: Many men in this demographic lack regular checkups. Long interval suggests
possible undiagnosed chronic HTN.
3–5. (Fill-in)
3. Ask about symptoms of hypertensive emergency: He denies ______, ______, or ______.
,Answer: chest pain, shortness of breath, neurological deficits (e.g., vision changes,
weakness).
Rationale: Asymptomatic elevated BP ≠ hypertensive emergency; allows outpatient workup.
4. Review of systems for secondary HTN clues: He denies episodic ______, ______, or
______.
Answer: headaches, palpitations, sweating (pheochromocytoma).
5. Medication review: He takes no prescription meds but admits to occasional ______
for muscle pain.
Answer: ibuprofen or NSAID.
Rationale: NSAIDs can raise BP.
6–10. (Multiple choice – timing & context)
6. Was the 170/92 measured after rest?
a) Yes, 5 min seated
b) No, immediately after walking to booth
Answer: b (likely at health fair).
Rationale: Improper measurement technique can cause falsely high reading.
7. What was the cuff size used?
a) Standard adult
b) Large adult
c) Thigh cuff
Answer: b – his arm circumference likely >33 cm (overweight).
Rationale: Small cuff overestimates BP.
8. He smokes. Last cigarette before BP reading?
a) 30 min ago
b) 2 hours ago
c) 12 hours ago
Answer: a.
Rationale: Nicotine raises BP acutely.
, 9. Did he have caffeine before the fair?
a) Yes, coffee 1 hour prior
b) No
Answer: a.
Rationale: Caffeine can transiently increase BP.
10. Bladder status?
a) Full bladder
b) Just voided
Answer: a (common at health fairs).
Rationale: Full bladder ↑ SBP by 10–15 mmHg.
11–15. (Select all that apply – associated symptoms)
11. Which symptoms suggest possible secondary hypertension?
□ Headaches (occipital, morning)
□ Muscle weakness
□ Weight loss
□ Sweating/palpitations
□ Constipation
Answer: All except weight loss (though weight loss more linked to hyperthyroidism, but
hyperaldosteronism can have weakness, pheochromocytoma sweating/palpitations,
hypothyroidism constipation, Cushing’s weight gain – actually weight loss not typical for
primary hyperaldosteronism). Better answer: Headaches (pheo or malignant HTN), weakness
(hypokalemia from hyperaldosteronism), sweating/palpitations (pheo), constipation
(hypothyroidism or hypercalcemia).
Rationale: Screen for endocrine causes.
16–20. (Short answer)
16. He reports no dyspnea, orthopnea, or PND. What does this rule out?
Answer: Heart failure with volume overload.
Rationale: Longstanding uncontrolled HTN can lead to HF.
