CMN 574 EXAM 1 STUDY GUIDE 2025/2026
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES
CARDIAC & HYPERTENSION
1. A 62yearold male with a history of hypertension presents with a blood
pressure of 168/102 mmHg on two separate occasions. He has no known drug
allergies. Which of the following is the most appropriate initial
antihypertensive agent for this patient?
A) Hydrochlorothiazide
B) Amlodipine
C) Lisinopril
D) Metoprolol
Answer: C) Lisinopril
Rationale: For a patient with stage 2 hypertension without compelling
indications, initial therapy can include an ACE inhibitor, ARB, CCB, or thiazide.
Lisinopril (ACE inhibitor) is a reasonable firstline agent. Hydrochlorothiazide
is also firstline but less preferred in patients with gout or metabolic
syndrome. Amlodipine is appropriate but can cause peripheral edema.
Metoprolol is not firstline for uncomplicated hypertension unless there is a
compelling indication like heart failure or angina.
,2. A 55yearold African American female with hypertension and no other
comorbidities has a BP of 152/96 mmHg. Which antihypertensive should be
avoided as monotherapy in this patient population?
A) Amlodipine
B) Chlorthalidone
C) Lisinopril
D) Metoprolol
Answer: C) Lisinopril
Rationale: ACE inhibitors (like lisinopril) and ARBs are less effective as
monotherapy in African American patients due to lower renin activity. CCBs
(amlodipine) and thiazide diuretics (chlorthalidone) are preferred as initial
monotherapy in this population. Betablockers (metoprolol) are not firstline
for uncomplicated hypertension.
3. A 70yearold male with a BP of 145/88 mmHg has a history of heart failure
with reduced ejection fraction (HFrEF). Which antihypertensive agent
provides both blood pressure control and mortality benefit in HFrEF?
A) Amlodipine
B) Carvedilol
C) Doxazosin
D) Clonidine
Answer: B) Carvedilol
Rationale: Carvedilol is a betablocker with proven mortality benefit in HFrEF.
Amlodipine is safe but does not reduce mortality in heart failure. Doxazosin
,(alphablocker) is not recommended for heart failure. Clonidine is a central
alphaagonist used for resistant hypertension but not for HFrEF.
4. A 48yearold female with hypertension and chronic kidney disease (CKD)
stage 3 has a BP of 142/90 mmHg. Her urine albumintocreatinine ratio is 300
mg/g. Which medication class is most renoprotective in this scenario?
A) Thiazide diuretic
B) ACE inhibitor
C) Dihydropyridine CCB
D) Betablocker
Answer: B) ACE inhibitor
Rationale: ACE inhibitors (or ARBs) are preferred in hypertensive patients
with CKD and albuminuria due to their renoprotective effects beyond blood
pressure lowering. Thiazides are less effective in CKD stage 3. CCBs and
betablockers do not provide the same degree of renoprotection.
5. A 60yearold male presents with a blood pressure of 180/110 mmHg. He is
asymptomatic. What is the most appropriate next step?
A) Admit to the hospital for intravenous antihypertensives
B) Start oral amlodipine and follow up in 1 week
C) Start two oral antihypertensives and follow up in 1 month
D) Recheck BP in 15 minutes and initiate oral therapy if sustained
, Answer: D) Recheck BP in 15 minutes and initiate oral therapy if sustained
Rationale: Asymptomatic severely elevated BP (≥180/120 mmHg) does not
require emergent treatment. The BP should be rechecked to confirm, and if
sustained, oral antihypertensive therapy can be initiated with close followup.
Intravenous therapy is reserved for hypertensive emergencies with endorgan
damage.
6. Which of the following blood pressure readings in an adult would be
classified as stage 1 hypertension according to the ACC/AHA guidelines?
A) 118/76 mmHg
B) 128/82 mmHg
C) 132/86 mmHg
D) 142/92 mmHg
Answer: C) 132/86 mmHg
Rationale: According to ACC/AHA guidelines, stage 1 hypertension is defined
as systolic BP 130139 mmHg or diastolic BP 8089 mmHg. 132/86 mmHg falls
into this category. 118/76 is normal; 128/82 is elevated; 142/92 is stage 2
hypertension.
7. A 45yearold male with resistant hypertension is on maximum doses of
lisinopril, amlodipine, and hydrochlorothiazide. His BP remains 158/96
mmHg. Which medication should be added next?
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES
CARDIAC & HYPERTENSION
1. A 62yearold male with a history of hypertension presents with a blood
pressure of 168/102 mmHg on two separate occasions. He has no known drug
allergies. Which of the following is the most appropriate initial
antihypertensive agent for this patient?
A) Hydrochlorothiazide
B) Amlodipine
C) Lisinopril
D) Metoprolol
Answer: C) Lisinopril
Rationale: For a patient with stage 2 hypertension without compelling
indications, initial therapy can include an ACE inhibitor, ARB, CCB, or thiazide.
Lisinopril (ACE inhibitor) is a reasonable firstline agent. Hydrochlorothiazide
is also firstline but less preferred in patients with gout or metabolic
syndrome. Amlodipine is appropriate but can cause peripheral edema.
Metoprolol is not firstline for uncomplicated hypertension unless there is a
compelling indication like heart failure or angina.
,2. A 55yearold African American female with hypertension and no other
comorbidities has a BP of 152/96 mmHg. Which antihypertensive should be
avoided as monotherapy in this patient population?
A) Amlodipine
B) Chlorthalidone
C) Lisinopril
D) Metoprolol
Answer: C) Lisinopril
Rationale: ACE inhibitors (like lisinopril) and ARBs are less effective as
monotherapy in African American patients due to lower renin activity. CCBs
(amlodipine) and thiazide diuretics (chlorthalidone) are preferred as initial
monotherapy in this population. Betablockers (metoprolol) are not firstline
for uncomplicated hypertension.
3. A 70yearold male with a BP of 145/88 mmHg has a history of heart failure
with reduced ejection fraction (HFrEF). Which antihypertensive agent
provides both blood pressure control and mortality benefit in HFrEF?
A) Amlodipine
B) Carvedilol
C) Doxazosin
D) Clonidine
Answer: B) Carvedilol
Rationale: Carvedilol is a betablocker with proven mortality benefit in HFrEF.
Amlodipine is safe but does not reduce mortality in heart failure. Doxazosin
,(alphablocker) is not recommended for heart failure. Clonidine is a central
alphaagonist used for resistant hypertension but not for HFrEF.
4. A 48yearold female with hypertension and chronic kidney disease (CKD)
stage 3 has a BP of 142/90 mmHg. Her urine albumintocreatinine ratio is 300
mg/g. Which medication class is most renoprotective in this scenario?
A) Thiazide diuretic
B) ACE inhibitor
C) Dihydropyridine CCB
D) Betablocker
Answer: B) ACE inhibitor
Rationale: ACE inhibitors (or ARBs) are preferred in hypertensive patients
with CKD and albuminuria due to their renoprotective effects beyond blood
pressure lowering. Thiazides are less effective in CKD stage 3. CCBs and
betablockers do not provide the same degree of renoprotection.
5. A 60yearold male presents with a blood pressure of 180/110 mmHg. He is
asymptomatic. What is the most appropriate next step?
A) Admit to the hospital for intravenous antihypertensives
B) Start oral amlodipine and follow up in 1 week
C) Start two oral antihypertensives and follow up in 1 month
D) Recheck BP in 15 minutes and initiate oral therapy if sustained
, Answer: D) Recheck BP in 15 minutes and initiate oral therapy if sustained
Rationale: Asymptomatic severely elevated BP (≥180/120 mmHg) does not
require emergent treatment. The BP should be rechecked to confirm, and if
sustained, oral antihypertensive therapy can be initiated with close followup.
Intravenous therapy is reserved for hypertensive emergencies with endorgan
damage.
6. Which of the following blood pressure readings in an adult would be
classified as stage 1 hypertension according to the ACC/AHA guidelines?
A) 118/76 mmHg
B) 128/82 mmHg
C) 132/86 mmHg
D) 142/92 mmHg
Answer: C) 132/86 mmHg
Rationale: According to ACC/AHA guidelines, stage 1 hypertension is defined
as systolic BP 130139 mmHg or diastolic BP 8089 mmHg. 132/86 mmHg falls
into this category. 118/76 is normal; 128/82 is elevated; 142/92 is stage 2
hypertension.
7. A 45yearold male with resistant hypertension is on maximum doses of
lisinopril, amlodipine, and hydrochlorothiazide. His BP remains 158/96
mmHg. Which medication should be added next?
