, 100 Hypertension NCLEX-Style Questions with
Rationales
QUESTIONS 1–20: Pathophysiology & Assessment
Question 1
A nurse is caring for a client with primary hypertension. The nurse understands that the
primary mechanism involved in the development of this condition is:
• A) Increased renin secretion from the kidneys
• B) Excessive sodium and water retention
• C) Increased cardiac output and peripheral vascular resistance
• D) Atherosclerotic narrowing of the renal arteries
Correct Answer: C
Rationale: Primary (essential) hypertension accounts for approximately 90–95% of all
hypertension cases. The exact cause is unknown, but the primary hemodynamic
mechanism involves increased cardiac output and/or increased systemic vascular
resistance. Over time, peripheral vascular resistance becomes the dominant factor. While
increased renin (A) and sodium/water retention (B) can contribute to secondary
hypertension, they are not the defining mechanism of primary hypertension. Renal artery
stenosis (D) causes secondary, not primary, hypertension.
Question 2
A client with a blood pressure of 168/102 mmHg is diagnosed with Stage 2 hypertension.
The nurse knows that sustained elevations in blood pressure primarily cause damage to
which organs?
• A) Brain, eyes, heart, and kidneys
• B) Lungs, liver, spleen, and pancreas
• C) Skin, muscles, bones, and joints
, • D) Stomach, intestines, gallbladder, and appendix
Correct Answer: A
Rationale: The major target organs damaged by sustained hypertension are the brain
(stroke, encephalopathy), eyes (retinopathy, vision loss), heart (left ventricular hypertrophy,
heart failure, coronary artery disease), and kidneys (nephrosclerosis, chronic kidney
disease). These are known as the "target organs" of hypertension. The other organ systems
listed are not primarily affected by elevated blood pressure.
Question 3
The nurse is assessing a client with hypertension and notes a blood pressure of 142/88
mmHg on three separate occasions. According to current guidelines, how should the nurse
classify this blood pressure?
• A) Normal
• B) Elevated
• C) Stage 1 hypertension
• D) Stage 2 hypertension
Correct Answer: C
Rationale: According to the 2017 ACC/AHA guidelines, Stage 1 hypertension is defined as
systolic BP 130–139 mmHg or diastolic BP 80–89 mmHg. Stage 2 is systolic ≥140 or
diastolic ≥90 mmHg. A reading of 142/88 mmHg meets the criteria for Stage 2 hypertension
because the systolic is ≥140. However, if we consider the most recent classification where
130-139/80-89 is Stage 1 and ≥140/90 is Stage 2, this would be Stage 2. The nurse should
verify with current institutional protocols.
Question 4
A client asks the nurse why hypertension is called the "silent killer." The best response by
the nurse is:
• A) "It causes sudden death without warning signs."
• B) "It often has no symptoms until significant organ damage has occurred."
• C) "It is contagious and spreads silently through populations."
, • D) "It only affects people who don't know they have it."
Correct Answer: B
Rationale: Hypertension is called the "silent killer" because it typically produces no
symptoms in its early stages. Many individuals are unaware they have elevated blood
pressure until complications such as stroke, myocardial infarction, heart failure, or kidney
disease develop. Regular blood pressure monitoring is essential for early detection and
management.
Question 5
The nurse is assessing a client with long-standing, uncontrolled hypertension. Which
finding would the nurse expect to observe?
• A) Decreased apical pulse rate
• B) Displaced point of maximal impulse (PMI)
• C) Diminished breath sounds bilaterally
• D) Hyperactive bowel sounds
Correct Answer: B
Rationale: Long-standing, uncontrolled hypertension causes left ventricular hypertrophy
(LVH) due to the increased workload on the heart. As the left ventricle enlarges, the point of
maximal impulse (PMI) becomes displaced laterally and downward. This is a classic
physical finding in clients with hypertensive heart disease. The other options are not
typically associated with hypertension.
Question 6
A nurse is teaching a client about modifiable risk factors for hypertension. Which factor
should the nurse include?
• A) Age over 65 years
• B) Family history of hypertension
• C) African American ethnicity
• D) High sodium intake
Rationales
QUESTIONS 1–20: Pathophysiology & Assessment
Question 1
A nurse is caring for a client with primary hypertension. The nurse understands that the
primary mechanism involved in the development of this condition is:
• A) Increased renin secretion from the kidneys
• B) Excessive sodium and water retention
• C) Increased cardiac output and peripheral vascular resistance
• D) Atherosclerotic narrowing of the renal arteries
Correct Answer: C
Rationale: Primary (essential) hypertension accounts for approximately 90–95% of all
hypertension cases. The exact cause is unknown, but the primary hemodynamic
mechanism involves increased cardiac output and/or increased systemic vascular
resistance. Over time, peripheral vascular resistance becomes the dominant factor. While
increased renin (A) and sodium/water retention (B) can contribute to secondary
hypertension, they are not the defining mechanism of primary hypertension. Renal artery
stenosis (D) causes secondary, not primary, hypertension.
Question 2
A client with a blood pressure of 168/102 mmHg is diagnosed with Stage 2 hypertension.
The nurse knows that sustained elevations in blood pressure primarily cause damage to
which organs?
• A) Brain, eyes, heart, and kidneys
• B) Lungs, liver, spleen, and pancreas
• C) Skin, muscles, bones, and joints
, • D) Stomach, intestines, gallbladder, and appendix
Correct Answer: A
Rationale: The major target organs damaged by sustained hypertension are the brain
(stroke, encephalopathy), eyes (retinopathy, vision loss), heart (left ventricular hypertrophy,
heart failure, coronary artery disease), and kidneys (nephrosclerosis, chronic kidney
disease). These are known as the "target organs" of hypertension. The other organ systems
listed are not primarily affected by elevated blood pressure.
Question 3
The nurse is assessing a client with hypertension and notes a blood pressure of 142/88
mmHg on three separate occasions. According to current guidelines, how should the nurse
classify this blood pressure?
• A) Normal
• B) Elevated
• C) Stage 1 hypertension
• D) Stage 2 hypertension
Correct Answer: C
Rationale: According to the 2017 ACC/AHA guidelines, Stage 1 hypertension is defined as
systolic BP 130–139 mmHg or diastolic BP 80–89 mmHg. Stage 2 is systolic ≥140 or
diastolic ≥90 mmHg. A reading of 142/88 mmHg meets the criteria for Stage 2 hypertension
because the systolic is ≥140. However, if we consider the most recent classification where
130-139/80-89 is Stage 1 and ≥140/90 is Stage 2, this would be Stage 2. The nurse should
verify with current institutional protocols.
Question 4
A client asks the nurse why hypertension is called the "silent killer." The best response by
the nurse is:
• A) "It causes sudden death without warning signs."
• B) "It often has no symptoms until significant organ damage has occurred."
• C) "It is contagious and spreads silently through populations."
, • D) "It only affects people who don't know they have it."
Correct Answer: B
Rationale: Hypertension is called the "silent killer" because it typically produces no
symptoms in its early stages. Many individuals are unaware they have elevated blood
pressure until complications such as stroke, myocardial infarction, heart failure, or kidney
disease develop. Regular blood pressure monitoring is essential for early detection and
management.
Question 5
The nurse is assessing a client with long-standing, uncontrolled hypertension. Which
finding would the nurse expect to observe?
• A) Decreased apical pulse rate
• B) Displaced point of maximal impulse (PMI)
• C) Diminished breath sounds bilaterally
• D) Hyperactive bowel sounds
Correct Answer: B
Rationale: Long-standing, uncontrolled hypertension causes left ventricular hypertrophy
(LVH) due to the increased workload on the heart. As the left ventricle enlarges, the point of
maximal impulse (PMI) becomes displaced laterally and downward. This is a classic
physical finding in clients with hypertensive heart disease. The other options are not
typically associated with hypertension.
Question 6
A nurse is teaching a client about modifiable risk factors for hypertension. Which factor
should the nurse include?
• A) Age over 65 years
• B) Family history of hypertension
• C) African American ethnicity
• D) High sodium intake
