NURS 5434 HTN QUIZ FAMILY III FNP 3 REVIEW 2026 | UTA
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Section 1: Hypertension Pathophysiology & Diagnosis (Questions 1-15)
Q1: A 52-year-old patient presents with newly diagnosed hypertension. The FNP
understands that which of the following mechanisms is the primary driver of essential
(primary) hypertension?
A. Excessive renin release solely from renal ischemia
B. Complex interplay of genetic, environmental, and neurohormonal factors leading to
increased peripheral vascular resistance [CORRECT]
C. Overproduction of aldosterone from an adrenal adenoma
D. Autonomic hyperactivity caused by a pheochromocytoma
Correct Answer: B
Rationale: Per ACC/AHA guidelines, essential hypertension accounts for 90-95% of
cases and results from a complex interaction of genetic predisposition and
environmental factors (e.g., high sodium diet, obesity) that activate the sympathetic
nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS), causing
vascular remodeling and increased peripheral resistance. Options A, C, and D describe
specific secondary causes of hypertension.
Q2: A 28-year-old female presents with a blood pressure of 168/102 mmHg. She
reports episodic headaches, diaphoresis, and palpitations. Which secondary cause of
hypertension should the FNP suspect?
A. Primary hyperaldosteronism
B. Renal artery stenosis
C. Pheochromocytoma [CORRECT]
D. Obstructive sleep apnea
Correct Answer: C
Rationale: The classic triad of episodic headaches, sweating, and
tachycardia/palpitations in a young patient with severe hypertension is highly suggestive
of a pheochromocytoma, a catecholamine-secreting tumor. Primary hyperaldosteronism
presents with hypertension and hypokalemia without episodic catecholamine surges.
Renal artery stenosis presents with an abdominal bruit. Sleep apnea is associated with
daytime somnolence and snoring.
Q3: A 45-year-old patient is found to have a blood pressure of 150/95 mmHg and a
serum potassium of 3.1 mEq/L. The FNP suspects primary hyperaldosteronism (Conn's
syndrome). Which laboratory ratio is the most appropriate initial screening test?
,A. Plasma free metanephrines to creatinine ratio
B. Morning cortisol level
C. Thyroid stimulating hormone (TSH)
D. Aldosterone to renin ratio (ARR) [CORRECT]
Correct Answer: D
Rationale: The Endocrine Society and AHA guidelines recommend the
aldosterone-to-renin ratio (ARR) as the initial screening test for primary
hyperaldosteronism in patients with hypertension and spontaneous or diuretic-induced
hypokalemia. An elevated ARR suggests autonomous aldosterone production. Plasma
metanephrines screen for pheochromocytoma.
Q4: A 65-year-old patient with a history of smoking and dyslipidemia has an blood
pressure of 160/100 mmHg. On auscultation, a bruit is heard over the right flank area.
What is the most likely underlying etiology of this patient's secondary hypertension?
A. Coarctation of the aorta
B. Renal artery stenosis [CORRECT]
C. Cushing's syndrome
D. Thyroid storm
Correct Answer: B
Rationale: An abdominal or flank bruit, particularly in a patient with significant
cardiovascular risk factors (older age, smoking, dyslipidemia), is a classic clinical sign of
renal artery stenosis (RAS). Atherosclerotic RAS is the most common cause in this
demographic. Coarctation usually presents with arm-leg BP differential.
Q5: A patient with a body mass index (BMI) of 38 kg/m² reports loud snoring, witnessed
apneas, and excessive daytime sleepiness. The FNP recognizes this presentation as
which type of secondary hypertension?
A. Obesity-related hypertension
B. Obstructive sleep apnea (OSA) associated hypertension [CORRECT]
C. Cushing's syndrome
D. Metabolic syndrome
Correct Answer: B
Rationale: While obesity is a risk factor, the specific triad of loud snoring, witnessed
apneas, and daytime somnolence points directly to Obstructive Sleep Apnea (OSA), a
well-established secondary cause of hypertension due to chronic intermittent hypoxia
and sympathetic activation. Metabolic syndrome encompasses this but OSA is the
specific identifiable secondary cause here.
Q6: A 35-year-old woman presents with new-onset hypertension, central obesity, a
"moon facies," and purple striae on her abdomen. Which diagnostic test should the FNP
order to confirm the suspected secondary cause?
, A. 24-hour urine free cortisol or late-night salivary cortisol [CORRECT]
B. Plasma metanephrines
C. Aldosterone-to-renin ratio
D. Sleep study
Correct Answer: A
Rationale: The physical exam findings (central obesity, moon facies, purple striae) are
pathognomonic for Cushing's syndrome. The initial diagnostic test recommended by
Endocrine Society guidelines is a 24-hour urine free cortisol, late-night salivary cortisol,
or an overnight 1-mg dexamethasone suppression test.
Q7: During a routine physical exam on a 22-year-old male, the FNP notes a blood
pressure of 145/92 mmHg in the right arm and 110/70 mmHg in the left leg. Which
congenital condition should be evaluated?
A. Coarctation of the aorta [CORRECT]
B. Patent ductus arteriosus
C. Tetralogy of Fallot
D. Renal artery stenosis
Correct Answer: A
Rationale: Coarctation of the aorta typically presents with hypertension in the upper
extremities accompanied by diminished or delayed femoral pulses and lower blood
pressure in the lower extremities. A systolic BP difference of >20 mmHg between the
arms and legs is highly suspicious for coarctation.
Q8: The FNP is explaining the pathophysiology of long-standing essential hypertension
to a newly diagnosed patient. Which statement accurately describes the concept of
vascular remodeling?
A. The blood vessels dilate in response to high pressure to protect target organs.
B. Structural changes in the vessel wall, such as smooth muscle hypertrophy and
collagen deposition, lead to narrowed lumens and increased peripheral resistance.
[CORRECT]
C. The endothelium increases the production of nitric oxide to relax smooth muscle.
D. The renin-angiotensin system completely shuts down to prevent fluid overload.
Correct Answer: B
Rationale: Chronic hypertension causes structural adaptations in the arterioles known
as vascular remodeling. This includes hypertrophy of the vascular smooth muscle and
increased collagen deposition in the media, which reduces the lumen diameter and
perpetuates increased peripheral vascular resistance, creating a vicious cycle.
Q9: According to current pathophysiological models of essential hypertension, what is
the role of endothelial dysfunction?
Latest Update 100% Verified Questions & Answers | Grade A |
Pass Guaranteed
Section 1: Hypertension Pathophysiology & Diagnosis (Questions 1-15)
Q1: A 52-year-old patient presents with newly diagnosed hypertension. The FNP
understands that which of the following mechanisms is the primary driver of essential
(primary) hypertension?
A. Excessive renin release solely from renal ischemia
B. Complex interplay of genetic, environmental, and neurohormonal factors leading to
increased peripheral vascular resistance [CORRECT]
C. Overproduction of aldosterone from an adrenal adenoma
D. Autonomic hyperactivity caused by a pheochromocytoma
Correct Answer: B
Rationale: Per ACC/AHA guidelines, essential hypertension accounts for 90-95% of
cases and results from a complex interaction of genetic predisposition and
environmental factors (e.g., high sodium diet, obesity) that activate the sympathetic
nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS), causing
vascular remodeling and increased peripheral resistance. Options A, C, and D describe
specific secondary causes of hypertension.
Q2: A 28-year-old female presents with a blood pressure of 168/102 mmHg. She
reports episodic headaches, diaphoresis, and palpitations. Which secondary cause of
hypertension should the FNP suspect?
A. Primary hyperaldosteronism
B. Renal artery stenosis
C. Pheochromocytoma [CORRECT]
D. Obstructive sleep apnea
Correct Answer: C
Rationale: The classic triad of episodic headaches, sweating, and
tachycardia/palpitations in a young patient with severe hypertension is highly suggestive
of a pheochromocytoma, a catecholamine-secreting tumor. Primary hyperaldosteronism
presents with hypertension and hypokalemia without episodic catecholamine surges.
Renal artery stenosis presents with an abdominal bruit. Sleep apnea is associated with
daytime somnolence and snoring.
Q3: A 45-year-old patient is found to have a blood pressure of 150/95 mmHg and a
serum potassium of 3.1 mEq/L. The FNP suspects primary hyperaldosteronism (Conn's
syndrome). Which laboratory ratio is the most appropriate initial screening test?
,A. Plasma free metanephrines to creatinine ratio
B. Morning cortisol level
C. Thyroid stimulating hormone (TSH)
D. Aldosterone to renin ratio (ARR) [CORRECT]
Correct Answer: D
Rationale: The Endocrine Society and AHA guidelines recommend the
aldosterone-to-renin ratio (ARR) as the initial screening test for primary
hyperaldosteronism in patients with hypertension and spontaneous or diuretic-induced
hypokalemia. An elevated ARR suggests autonomous aldosterone production. Plasma
metanephrines screen for pheochromocytoma.
Q4: A 65-year-old patient with a history of smoking and dyslipidemia has an blood
pressure of 160/100 mmHg. On auscultation, a bruit is heard over the right flank area.
What is the most likely underlying etiology of this patient's secondary hypertension?
A. Coarctation of the aorta
B. Renal artery stenosis [CORRECT]
C. Cushing's syndrome
D. Thyroid storm
Correct Answer: B
Rationale: An abdominal or flank bruit, particularly in a patient with significant
cardiovascular risk factors (older age, smoking, dyslipidemia), is a classic clinical sign of
renal artery stenosis (RAS). Atherosclerotic RAS is the most common cause in this
demographic. Coarctation usually presents with arm-leg BP differential.
Q5: A patient with a body mass index (BMI) of 38 kg/m² reports loud snoring, witnessed
apneas, and excessive daytime sleepiness. The FNP recognizes this presentation as
which type of secondary hypertension?
A. Obesity-related hypertension
B. Obstructive sleep apnea (OSA) associated hypertension [CORRECT]
C. Cushing's syndrome
D. Metabolic syndrome
Correct Answer: B
Rationale: While obesity is a risk factor, the specific triad of loud snoring, witnessed
apneas, and daytime somnolence points directly to Obstructive Sleep Apnea (OSA), a
well-established secondary cause of hypertension due to chronic intermittent hypoxia
and sympathetic activation. Metabolic syndrome encompasses this but OSA is the
specific identifiable secondary cause here.
Q6: A 35-year-old woman presents with new-onset hypertension, central obesity, a
"moon facies," and purple striae on her abdomen. Which diagnostic test should the FNP
order to confirm the suspected secondary cause?
, A. 24-hour urine free cortisol or late-night salivary cortisol [CORRECT]
B. Plasma metanephrines
C. Aldosterone-to-renin ratio
D. Sleep study
Correct Answer: A
Rationale: The physical exam findings (central obesity, moon facies, purple striae) are
pathognomonic for Cushing's syndrome. The initial diagnostic test recommended by
Endocrine Society guidelines is a 24-hour urine free cortisol, late-night salivary cortisol,
or an overnight 1-mg dexamethasone suppression test.
Q7: During a routine physical exam on a 22-year-old male, the FNP notes a blood
pressure of 145/92 mmHg in the right arm and 110/70 mmHg in the left leg. Which
congenital condition should be evaluated?
A. Coarctation of the aorta [CORRECT]
B. Patent ductus arteriosus
C. Tetralogy of Fallot
D. Renal artery stenosis
Correct Answer: A
Rationale: Coarctation of the aorta typically presents with hypertension in the upper
extremities accompanied by diminished or delayed femoral pulses and lower blood
pressure in the lower extremities. A systolic BP difference of >20 mmHg between the
arms and legs is highly suspicious for coarctation.
Q8: The FNP is explaining the pathophysiology of long-standing essential hypertension
to a newly diagnosed patient. Which statement accurately describes the concept of
vascular remodeling?
A. The blood vessels dilate in response to high pressure to protect target organs.
B. Structural changes in the vessel wall, such as smooth muscle hypertrophy and
collagen deposition, lead to narrowed lumens and increased peripheral resistance.
[CORRECT]
C. The endothelium increases the production of nitric oxide to relax smooth muscle.
D. The renin-angiotensin system completely shuts down to prevent fluid overload.
Correct Answer: B
Rationale: Chronic hypertension causes structural adaptations in the arterioles known
as vascular remodeling. This includes hypertrophy of the vascular smooth muscle and
increased collagen deposition in the media, which reduces the lumen diameter and
perpetuates increased peripheral vascular resistance, creating a vicious cycle.
Q9: According to current pathophysiological models of essential hypertension, what is
the role of endothelial dysfunction?
