NR 509 Advanced Physical Assessment – Case Study Primary Hypertension
Patient.
History Taking & Risk Factors (1–25)
1. A 58-year-old male with hypertension reports waking up 3 times per night to
urinate. His morning BP is 145/92, evening BP 128/80. This pattern suggests:
A) Benign prostatic hyperplasia
B) Diabetes insipidus
C) Non-dipping hypertension
D) Primary hyperaldosteronism
Answer: C
Rationale: Loss of normal nocturnal BP dip (non-dipping) causes pressure
natriuresis, increasing nocturnal urine output. BPH causes nocturia but does not
explain the BP pattern.
2. Which dietary item, if consumed daily, would most exacerbate hypertension?
A) Grilled salmon
B) Low-fat yogurt
,C) Canned vegetable soup
D) Black coffee (1 cup)
Answer: C
Rationale: Canned soups are extremely high in sodium (often >800 mg/serving).
Daily intake significantly raises BP. Fish is beneficial, yogurt is neutral, coffee has
minimal effect at 1 cup.
3. A hypertensive patient reports using ibuprofen 600 mg three times daily for
knee pain. This likely causes:
A) Improved BP control via anti-inflammatory effect
B) Reduced efficacy of lisinopril
C) Increased risk of angioedema
D) Orthostatic hypotension
Answer: B
Rationale: NSAIDs inhibit renal prostaglandins, causing sodium retention and
vasoconstriction, blunting ACE inhibitor and diuretic efficacy, and can raise BP
directly.
, 4. A 45-year-old woman with hypertension reports heavy menstrual bleeding and
fatigue. Hemoglobin is 9.8 g/dL. The most likely cause of anemia is:
A) Chronic kidney disease
B) ACE inhibitor-induced anemia
C) Menorrhagia-related iron deficiency
D) Microangiopathic hemolysis
Answer: C
Rationale: Menorrhagia in perimenopausal women commonly causes iron
deficiency anemia. ACE inhibitors rarely cause anemia. CKD is less likely without
elevated creatinine.
5. Which symptom paroxysm suggests pheochromocytoma in a hypertensive
patient?
A) Dizziness and syncope
B) Headache, palpitations, sweating
C) Polyuria and polydipsia
D) Muscle cramps and weakness
Answer: B
Patient.
History Taking & Risk Factors (1–25)
1. A 58-year-old male with hypertension reports waking up 3 times per night to
urinate. His morning BP is 145/92, evening BP 128/80. This pattern suggests:
A) Benign prostatic hyperplasia
B) Diabetes insipidus
C) Non-dipping hypertension
D) Primary hyperaldosteronism
Answer: C
Rationale: Loss of normal nocturnal BP dip (non-dipping) causes pressure
natriuresis, increasing nocturnal urine output. BPH causes nocturia but does not
explain the BP pattern.
2. Which dietary item, if consumed daily, would most exacerbate hypertension?
A) Grilled salmon
B) Low-fat yogurt
,C) Canned vegetable soup
D) Black coffee (1 cup)
Answer: C
Rationale: Canned soups are extremely high in sodium (often >800 mg/serving).
Daily intake significantly raises BP. Fish is beneficial, yogurt is neutral, coffee has
minimal effect at 1 cup.
3. A hypertensive patient reports using ibuprofen 600 mg three times daily for
knee pain. This likely causes:
A) Improved BP control via anti-inflammatory effect
B) Reduced efficacy of lisinopril
C) Increased risk of angioedema
D) Orthostatic hypotension
Answer: B
Rationale: NSAIDs inhibit renal prostaglandins, causing sodium retention and
vasoconstriction, blunting ACE inhibitor and diuretic efficacy, and can raise BP
directly.
, 4. A 45-year-old woman with hypertension reports heavy menstrual bleeding and
fatigue. Hemoglobin is 9.8 g/dL. The most likely cause of anemia is:
A) Chronic kidney disease
B) ACE inhibitor-induced anemia
C) Menorrhagia-related iron deficiency
D) Microangiopathic hemolysis
Answer: C
Rationale: Menorrhagia in perimenopausal women commonly causes iron
deficiency anemia. ACE inhibitors rarely cause anemia. CKD is less likely without
elevated creatinine.
5. Which symptom paroxysm suggests pheochromocytoma in a hypertensive
patient?
A) Dizziness and syncope
B) Headache, palpitations, sweating
C) Polyuria and polydipsia
D) Muscle cramps and weakness
Answer: B
