,NSG555/NSG 555 Exam 4 Nurse Practitioners in
Primary Care II | Wilkes | 26/27 Updated (PDF)
1. A 55-year-old Black patient has a blood pressure of 148/92 mmHg on two separate visits. The
patient has no comorbidities. According to JNC 8, what is the initial drug of choice?
A) Lisinopril
B) Amlodipine
C) Hydrochlorothiazide
D) Metoprolol
Correct Answer: Amlodipine
Rationale: A calcium channel blocker (amlodipine) or thiazide diuretic is recommended as first-line
therapy in Black patients without CKD or heart failure. ACE inhibitors (lisinopril) are less effective as
monotherapy in this population due to lower renin levels. JNC 8 guidelines support this
recommendation. Metoprolol is not recommended as initial therapy for hypertension without other
indications.
2. According to JNC 8 guidelines, what is the recommended blood pressure goal for a diabetic patient
under 60 years old?
A) <130/80 mmHg
B) <140/90 mmHg
C) <150/90 mmHg
D) <120/80 mmHg
Correct Answer: <140/90 mmHg
Rationale: JNC 8 recommends a blood pressure target of <140/90 mmHg for patients with diabetes or
chronic kidney disease, regardless of age. The ACC/AHA 2017 guidelines recommend <130/80 mmHg,
but NSG 555 tests strictly on JNC 8. Option C (<150/90 mmHg) is the target for patients ≥60 years
without diabetes or CKD. Option D is not a JNC 8 target.
3. A 72-year-old patient with hypertension and no comorbidities has a blood pressure of 152/88
mmHg. According to JNC 8, what is the target blood pressure for this patient?
A) <120/80 mmHg
B) <130/80 mmHg
,C) <140/90 mmHg
D) <150/90 mmHg
Correct Answer: <150/90 mmHg
Rationale: JNC 8 explicitly states that for adults ≥60 years of age without diabetes or CKD, the
treatment target is <150/90 mmHg. This is a key distinction from ACC/AHA 2017 guidelines, which
recommend <130/80 mmHg. Option D is the correct target for this age group without comorbidities.
4. A 45-year-old patient with hypertension and no other comorbidities has a blood pressure of 142/92
mmHg. What is the most appropriate initial management?
A) Start hydrochlorothiazide 12.5 mg daily
B) Start lisinopril 10 mg daily
C) Recommend lifestyle modifications and recheck in 3-6 months
D) Start amlodipine 5 mg daily
Correct Answer: Recommend lifestyle modifications and recheck in 3-6 months
Rationale: This patient has Stage 1 hypertension (130-139/80-89 mmHg) and is at low risk (no other
cardiovascular risk factors). According to ACC/AHA guidelines, patients with Stage 1 hypertension and
low risk should first receive lifestyle modifications with re-evaluation in 3-6 months. Pharmacologic
therapy is initiated if BP remains elevated after this period.
5. A 62-year-old female with hypertension and type 2 diabetes has a blood pressure of 148/88 mmHg
on lisinopril 20 mg daily. According to ACC/AHA guidelines, which medication should be added next?
A) Hydrochlorothiazide
B) Amlodipine
C) Metoprolol
D) Clonidine
Correct Answer: Amlodipine
Rationale: ACC/AHA guidelines recommend adding a calcium channel blocker (amlodipine) or a
thiazide diuretic if blood pressure remains above goal on an ACE inhibitor. Amlodipine is preferred in
patients with diabetes due to its neutral metabolic effects. Metoprolol and clonidine are not first-line
add-on therapies.
6. A 68-year-old male with CKD stage 3 has a blood pressure of 142/88 mmHg despite taking lisinopril
20 mg daily. According to JNC 8, which is the next appropriate step?
, A) Increase lisinopril to 40 mg
B) Add amlodipine
C) Add hydrochlorothiazide
D) Add metoprolol
Correct Answer: Add amlodipine
Rationale: JNC 8 recommends adding a thiazide diuretic or calcium channel blocker if blood pressure
remains above goal on a single agent. In patients with CKD, ACE inhibitors or ARBs are first-line, and
calcium channel blockers are preferred as add-on therapy due to additive effects and renal safety.
7. A 66-year-old female with a history of osteoporosis and hypertension presents with a blood
pressure of 165/95 mmHg. Which antihypertensive class should be avoided due to potential
exacerbation of her underlying condition?
A) Thiazide diuretic
B) ACE inhibitor
C) Calcium channel blocker
D) Beta-blocker
Correct Answer: Thiazide diuretic
Rationale: Thiazide diuretics increase urinary calcium excretion and can exacerbate bone loss in
patients with osteoporosis. ACE inhibitors, calcium channel blockers, and beta-blockers do not have
this adverse effect on bone mineral density. Thiazides should be used with caution or avoided in
patients with osteoporosis.
8. A 72-year-old male with hypertension and a history of gout has a blood pressure of 148/90 mmHg
on amlodipine 10 mg daily. Which medication should be avoided due to potential exacerbation of
gout?
A) Lisinopril
B) Hydrochlorothiazide
C) Metoprolol
D) Doxazosin
Correct Answer: Hydrochlorothiazide
Rationale: Thiazide diuretics can increase serum uric acid levels and exacerbate gout. ACE inhibitors,
beta-blockers, and alpha-blockers do not have this effect. In patients with gout, alternative
antihypertensive agents should be considered.
Primary Care II | Wilkes | 26/27 Updated (PDF)
1. A 55-year-old Black patient has a blood pressure of 148/92 mmHg on two separate visits. The
patient has no comorbidities. According to JNC 8, what is the initial drug of choice?
A) Lisinopril
B) Amlodipine
C) Hydrochlorothiazide
D) Metoprolol
Correct Answer: Amlodipine
Rationale: A calcium channel blocker (amlodipine) or thiazide diuretic is recommended as first-line
therapy in Black patients without CKD or heart failure. ACE inhibitors (lisinopril) are less effective as
monotherapy in this population due to lower renin levels. JNC 8 guidelines support this
recommendation. Metoprolol is not recommended as initial therapy for hypertension without other
indications.
2. According to JNC 8 guidelines, what is the recommended blood pressure goal for a diabetic patient
under 60 years old?
A) <130/80 mmHg
B) <140/90 mmHg
C) <150/90 mmHg
D) <120/80 mmHg
Correct Answer: <140/90 mmHg
Rationale: JNC 8 recommends a blood pressure target of <140/90 mmHg for patients with diabetes or
chronic kidney disease, regardless of age. The ACC/AHA 2017 guidelines recommend <130/80 mmHg,
but NSG 555 tests strictly on JNC 8. Option C (<150/90 mmHg) is the target for patients ≥60 years
without diabetes or CKD. Option D is not a JNC 8 target.
3. A 72-year-old patient with hypertension and no comorbidities has a blood pressure of 152/88
mmHg. According to JNC 8, what is the target blood pressure for this patient?
A) <120/80 mmHg
B) <130/80 mmHg
,C) <140/90 mmHg
D) <150/90 mmHg
Correct Answer: <150/90 mmHg
Rationale: JNC 8 explicitly states that for adults ≥60 years of age without diabetes or CKD, the
treatment target is <150/90 mmHg. This is a key distinction from ACC/AHA 2017 guidelines, which
recommend <130/80 mmHg. Option D is the correct target for this age group without comorbidities.
4. A 45-year-old patient with hypertension and no other comorbidities has a blood pressure of 142/92
mmHg. What is the most appropriate initial management?
A) Start hydrochlorothiazide 12.5 mg daily
B) Start lisinopril 10 mg daily
C) Recommend lifestyle modifications and recheck in 3-6 months
D) Start amlodipine 5 mg daily
Correct Answer: Recommend lifestyle modifications and recheck in 3-6 months
Rationale: This patient has Stage 1 hypertension (130-139/80-89 mmHg) and is at low risk (no other
cardiovascular risk factors). According to ACC/AHA guidelines, patients with Stage 1 hypertension and
low risk should first receive lifestyle modifications with re-evaluation in 3-6 months. Pharmacologic
therapy is initiated if BP remains elevated after this period.
5. A 62-year-old female with hypertension and type 2 diabetes has a blood pressure of 148/88 mmHg
on lisinopril 20 mg daily. According to ACC/AHA guidelines, which medication should be added next?
A) Hydrochlorothiazide
B) Amlodipine
C) Metoprolol
D) Clonidine
Correct Answer: Amlodipine
Rationale: ACC/AHA guidelines recommend adding a calcium channel blocker (amlodipine) or a
thiazide diuretic if blood pressure remains above goal on an ACE inhibitor. Amlodipine is preferred in
patients with diabetes due to its neutral metabolic effects. Metoprolol and clonidine are not first-line
add-on therapies.
6. A 68-year-old male with CKD stage 3 has a blood pressure of 142/88 mmHg despite taking lisinopril
20 mg daily. According to JNC 8, which is the next appropriate step?
, A) Increase lisinopril to 40 mg
B) Add amlodipine
C) Add hydrochlorothiazide
D) Add metoprolol
Correct Answer: Add amlodipine
Rationale: JNC 8 recommends adding a thiazide diuretic or calcium channel blocker if blood pressure
remains above goal on a single agent. In patients with CKD, ACE inhibitors or ARBs are first-line, and
calcium channel blockers are preferred as add-on therapy due to additive effects and renal safety.
7. A 66-year-old female with a history of osteoporosis and hypertension presents with a blood
pressure of 165/95 mmHg. Which antihypertensive class should be avoided due to potential
exacerbation of her underlying condition?
A) Thiazide diuretic
B) ACE inhibitor
C) Calcium channel blocker
D) Beta-blocker
Correct Answer: Thiazide diuretic
Rationale: Thiazide diuretics increase urinary calcium excretion and can exacerbate bone loss in
patients with osteoporosis. ACE inhibitors, calcium channel blockers, and beta-blockers do not have
this adverse effect on bone mineral density. Thiazides should be used with caution or avoided in
patients with osteoporosis.
8. A 72-year-old male with hypertension and a history of gout has a blood pressure of 148/90 mmHg
on amlodipine 10 mg daily. Which medication should be avoided due to potential exacerbation of
gout?
A) Lisinopril
B) Hydrochlorothiazide
C) Metoprolol
D) Doxazosin
Correct Answer: Hydrochlorothiazide
Rationale: Thiazide diuretics can increase serum uric acid levels and exacerbate gout. ACE inhibitors,
beta-blockers, and alpha-blockers do not have this effect. In patients with gout, alternative
antihypertensive agents should be considered.
