NURS 5434 Family III HTN Quiz UTA 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
──────────────────────────────
SECTION 1: PATHOPHYSIOLOGY & DIAGNOSIS (Q1–Q8)
──────────────────────────────
Question 1
A 52-year-old patient has clinic blood pressures of 138/86 mmHg and 142/88 mmHg on
two separate visits. Home BP monitoring shows an average of 128/78 mmHg over one
week. According to ACC/AHA 2017 and 2026 update guidance, what is the most
accurate classification?
A. Stage 1 hypertension based on clinic readings
B. White coat hypertension
C. Masked hypertension
D. Normal blood pressure
Correct Answer: B
Rationale:
White coat hypertension is diagnosed when clinic BP is ≥130/80 mmHg but out-of-office
BP (home or ambulatory) is <130/80 mmHg. The patient's home average of 128/78
mmHg confirms this pattern. Masked hypertension is the inverse (normal clinic,
elevated out-of-office). ACC/AHA 2017 and 2026 updates emphasize out-of-office
monitoring to avoid misclassification and overtreatment.
Question 2
,A 45-year-old patient with newly diagnosed hypertension has no comorbidities. Which
pathophysiological mechanism primarily drives the sustained elevation in essential
hypertension?
A. Increased cardiac output due to sympathetic overactivity
B. Increased systemic vascular resistance from arteriolar remodeling and endothelial
dysfunction
C. Decreased renal sodium excretion due to primary aldosteronism
D. Increased plasma volume from excessive antidiuretic hormone secretion
Correct Answer: B
Rationale:
Essential (primary) hypertension is characterized by increased total peripheral
resistance from structural arteriolar remodeling, endothelial dysfunction, and vascular
smooth muscle hypertrophy. While early hypertension may show increased cardiac
output, sustained essential hypertension is predominantly a low-renin, high-resistance
state. Primary aldosteronism and ADH excess are secondary causes, not mechanisms
of essential hypertension.
Question 3
A 38-year-old patient presents with BP 172/108 mmHg, hypokalemia (K⁺ 3.1 mEq/L),
and metabolic alkalosis. Plasma renin activity is suppressed, and aldosterone is
elevated. Which diagnostic finding would confirm the most likely secondary cause?
A. Elevated urinary metanephrines
B. Abdominal CT showing an adrenal adenoma
C. Renal artery Doppler showing >70% stenosis
D. Elevated plasma free metanephrines
Correct Answer: B
Rationale:
,The triad of hypertension, hypokalemia, and metabolic alkalosis with suppressed renin
and elevated aldosterone is classic for primary aldosteronism (Conn syndrome). CT
imaging of the adrenal glands identifies adenomas (aldosterone-producing adenoma) or
bilateral hyperplasia. Elevated metanephrines suggest pheochromocytoma; renal artery
stenosis would show elevated renin, not suppression.
Question 4
A 61-year-old patient with long-standing uncontrolled hypertension develops left
ventricular hypertrophy on echocardiography. Which hemodynamic parameter is most
directly responsible for this structural adaptation?
A. Increased pulse pressure
B. Sustained elevation in afterload (systemic vascular resistance)
C. Increased preload from volume expansion
D. Reduced coronary perfusion pressure
Correct Answer: B
Rationale:
Left ventricular hypertrophy is a compensatory response to chronic pressure overload
from increased afterload (systemic vascular resistance). The LV wall thickens to
normalize wall stress according to Laplace's law (wall stress = pressure × radius / 2 ×
wall thickness). While pulse pressure and preload contribute to cardiac workload,
sustained afterload is the primary driver of concentric LVH in hypertension.
Question 5
A 29-year-old woman presents with severe headache, BP 186/118 mmHg, and
papilledema on fundoscopic exam. Urinalysis shows 3+ proteinuria. Which target-organ
finding distinguishes malignant hypertension from severe uncomplicated hypertension?
A. The absolute BP elevation alone
, B. The presence of acute hypertensive retinopathy (papilledema, flame hemorrhages)
C. The presence of proteinuria
D. The patient's age and gender
Correct Answer: B
Rationale:
Malignant hypertension is defined by severely elevated BP accompanied by acute
target-organ damage, specifically grade III-IV hypertensive retinopathy (papilledema,
flame hemorrhages, cotton-wool spots) or acute kidney injury. Severe uncomplicated
hypertension lacks acute target-organ damage despite similarly elevated pressures.
Proteinuria can occur in both; papilledema is the distinguishing feature per ACC/AHA
guidelines.
Question 6
A 55-year-old patient has ambulatory blood pressure monitoring showing daytime
average 136/84 mmHg and nighttime average 125/76 mmHg. Which pattern carries
independent cardiovascular risk beyond clinic BP alone?
A. Isolated daytime hypertension
B. Non-dipping pattern (reduced nocturnal BP decline <10%)
C. White coat hypertension
D. Morning surge phenomenon only
Correct Answer: B
Rationale:
A non-dipping pattern (failure of nocturnal BP to decline by ≥10% from daytime values)
is associated with increased cardiovascular and cerebrovascular risk independent of
24-hour mean BP. Non-dipping correlates with autonomic dysfunction, CKD, diabetes,
and obstructive sleep apnea. ACC/AHA guidelines recognize abnormal circadian
patterns as prognostically significant.
Exam-Style Questions with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
──────────────────────────────
SECTION 1: PATHOPHYSIOLOGY & DIAGNOSIS (Q1–Q8)
──────────────────────────────
Question 1
A 52-year-old patient has clinic blood pressures of 138/86 mmHg and 142/88 mmHg on
two separate visits. Home BP monitoring shows an average of 128/78 mmHg over one
week. According to ACC/AHA 2017 and 2026 update guidance, what is the most
accurate classification?
A. Stage 1 hypertension based on clinic readings
B. White coat hypertension
C. Masked hypertension
D. Normal blood pressure
Correct Answer: B
Rationale:
White coat hypertension is diagnosed when clinic BP is ≥130/80 mmHg but out-of-office
BP (home or ambulatory) is <130/80 mmHg. The patient's home average of 128/78
mmHg confirms this pattern. Masked hypertension is the inverse (normal clinic,
elevated out-of-office). ACC/AHA 2017 and 2026 updates emphasize out-of-office
monitoring to avoid misclassification and overtreatment.
Question 2
,A 45-year-old patient with newly diagnosed hypertension has no comorbidities. Which
pathophysiological mechanism primarily drives the sustained elevation in essential
hypertension?
A. Increased cardiac output due to sympathetic overactivity
B. Increased systemic vascular resistance from arteriolar remodeling and endothelial
dysfunction
C. Decreased renal sodium excretion due to primary aldosteronism
D. Increased plasma volume from excessive antidiuretic hormone secretion
Correct Answer: B
Rationale:
Essential (primary) hypertension is characterized by increased total peripheral
resistance from structural arteriolar remodeling, endothelial dysfunction, and vascular
smooth muscle hypertrophy. While early hypertension may show increased cardiac
output, sustained essential hypertension is predominantly a low-renin, high-resistance
state. Primary aldosteronism and ADH excess are secondary causes, not mechanisms
of essential hypertension.
Question 3
A 38-year-old patient presents with BP 172/108 mmHg, hypokalemia (K⁺ 3.1 mEq/L),
and metabolic alkalosis. Plasma renin activity is suppressed, and aldosterone is
elevated. Which diagnostic finding would confirm the most likely secondary cause?
A. Elevated urinary metanephrines
B. Abdominal CT showing an adrenal adenoma
C. Renal artery Doppler showing >70% stenosis
D. Elevated plasma free metanephrines
Correct Answer: B
Rationale:
,The triad of hypertension, hypokalemia, and metabolic alkalosis with suppressed renin
and elevated aldosterone is classic for primary aldosteronism (Conn syndrome). CT
imaging of the adrenal glands identifies adenomas (aldosterone-producing adenoma) or
bilateral hyperplasia. Elevated metanephrines suggest pheochromocytoma; renal artery
stenosis would show elevated renin, not suppression.
Question 4
A 61-year-old patient with long-standing uncontrolled hypertension develops left
ventricular hypertrophy on echocardiography. Which hemodynamic parameter is most
directly responsible for this structural adaptation?
A. Increased pulse pressure
B. Sustained elevation in afterload (systemic vascular resistance)
C. Increased preload from volume expansion
D. Reduced coronary perfusion pressure
Correct Answer: B
Rationale:
Left ventricular hypertrophy is a compensatory response to chronic pressure overload
from increased afterload (systemic vascular resistance). The LV wall thickens to
normalize wall stress according to Laplace's law (wall stress = pressure × radius / 2 ×
wall thickness). While pulse pressure and preload contribute to cardiac workload,
sustained afterload is the primary driver of concentric LVH in hypertension.
Question 5
A 29-year-old woman presents with severe headache, BP 186/118 mmHg, and
papilledema on fundoscopic exam. Urinalysis shows 3+ proteinuria. Which target-organ
finding distinguishes malignant hypertension from severe uncomplicated hypertension?
A. The absolute BP elevation alone
, B. The presence of acute hypertensive retinopathy (papilledema, flame hemorrhages)
C. The presence of proteinuria
D. The patient's age and gender
Correct Answer: B
Rationale:
Malignant hypertension is defined by severely elevated BP accompanied by acute
target-organ damage, specifically grade III-IV hypertensive retinopathy (papilledema,
flame hemorrhages, cotton-wool spots) or acute kidney injury. Severe uncomplicated
hypertension lacks acute target-organ damage despite similarly elevated pressures.
Proteinuria can occur in both; papilledema is the distinguishing feature per ACC/AHA
guidelines.
Question 6
A 55-year-old patient has ambulatory blood pressure monitoring showing daytime
average 136/84 mmHg and nighttime average 125/76 mmHg. Which pattern carries
independent cardiovascular risk beyond clinic BP alone?
A. Isolated daytime hypertension
B. Non-dipping pattern (reduced nocturnal BP decline <10%)
C. White coat hypertension
D. Morning surge phenomenon only
Correct Answer: B
Rationale:
A non-dipping pattern (failure of nocturnal BP to decline by ≥10% from daytime values)
is associated with increased cardiovascular and cerebrovascular risk independent of
24-hour mean BP. Non-dipping correlates with autonomic dysfunction, CKD, diabetes,
and obstructive sleep apnea. ACC/AHA guidelines recognize abnormal circadian
patterns as prognostically significant.
