Focused Exam – Hypertension and Type
2 Diabetes (Shadow Health) | 40 Clinical
Simulation Questions with Rationales |
2025 Edition
Question 1:
A 58-year-old patient with hypertension and type 2 diabetes presents for a follow-up visit. Their
blood pressure is 142/88 mmHg. According to the 2025 AHA/ACC guidelines, what is the
appropriate blood pressure target for this patient?
A. Less than 140/90 mmHg
B. Less than 130/80 mmHg
C. Less than 120/80 mmHg
D. Less than 150/90 mmHg
■ Correct Answer: B
Rationale: The 2025 AHA/ACC High Blood Pressure Guideline recommends a BP target of
<130/80 mmHg for adults with hypertension, including those with comorbidities like diabetes, to
reduce cardiovascular risk.
Question 2:
During the focused exam, the patient reports adherence to their metformin 1000 mg BID but
mentions occasional nausea. What is the nurse's best initial action for medication
management?
A. Discontinue metformin immediately.
B. Advise taking with food to reduce GI side effects.
C. Switch to insulin glargine.
D. Increase dose to 2000 mg daily.
■ Correct Answer: B
Rationale: Metformin commonly causes GI upset; administering with meals slows absorption
and minimizes nausea, a first-line strategy per ADA 2025 Standards of Care.
Question 3:
The patient's HbA1c is 8.2%. Based on the 2025 ADA Standards of Care, what is the
recommended HbA1c target for most adults with type 2 diabetes?
A. Less than 6.5%
, B. Less than 7.0%
C. Less than 8.0%
D. Less than 9.0%
■ Correct Answer: B
Rationale: The ADA 2025 guidelines recommend an HbA1c <7.0% for most non-pregnant adults
with type 2 diabetes to minimize microvascular complications, individualized based on risks.
Question 4:
In therapeutic communication, the patient expresses frustration about frequent blood glucose
monitoring. What is the most empathetic response?
A. "Many patients find it burdensome; let's discuss simplifying your regimen."
B. "You must monitor to avoid complications."
C. "It's only a few minutes a day."
D. "Focus on your diet instead."
■ Correct Answer: A
Rationale: Acknowledging feelings validates the patient, fostering trust and opening dialogue for
shared decision-making in chronic disease management.
Question 5:
The patient's lipid panel shows LDL 110 mg/dL. For a patient with diabetes and hypertension,
what is the target LDL per 2025 guidelines?
A. Less than 100 mg/dL
B. Less than 70 mg/dL
C. Less than 130 mg/dL
D. Less than 160 mg/dL
■ Correct Answer: B
Rationale: High-risk patients (e.g., with diabetes) should have LDL <70 mg/dL to reduce
atherosclerotic cardiovascular disease, as per integrated 2025 ADA/AHA recommendations.
Question 6:
Scenario: The patient is on lisinopril 20 mg daily for hypertension. Their serum creatinine rises to
1.8 mg/dL from baseline 1.2 mg/dL. What is the priority action?
A. Continue lisinopril and recheck in 3 months.
B. Hold lisinopril and notify the provider.
C. Add a diuretic.
D. Increase to 40 mg daily.
■ Correct Answer: B
Rationale: ACE inhibitors like lisinopril can cause acute kidney injury; a >30% creatinine rise
warrants discontinuation and provider notification for renal monitoring.
Question 7:
2 Diabetes (Shadow Health) | 40 Clinical
Simulation Questions with Rationales |
2025 Edition
Question 1:
A 58-year-old patient with hypertension and type 2 diabetes presents for a follow-up visit. Their
blood pressure is 142/88 mmHg. According to the 2025 AHA/ACC guidelines, what is the
appropriate blood pressure target for this patient?
A. Less than 140/90 mmHg
B. Less than 130/80 mmHg
C. Less than 120/80 mmHg
D. Less than 150/90 mmHg
■ Correct Answer: B
Rationale: The 2025 AHA/ACC High Blood Pressure Guideline recommends a BP target of
<130/80 mmHg for adults with hypertension, including those with comorbidities like diabetes, to
reduce cardiovascular risk.
Question 2:
During the focused exam, the patient reports adherence to their metformin 1000 mg BID but
mentions occasional nausea. What is the nurse's best initial action for medication
management?
A. Discontinue metformin immediately.
B. Advise taking with food to reduce GI side effects.
C. Switch to insulin glargine.
D. Increase dose to 2000 mg daily.
■ Correct Answer: B
Rationale: Metformin commonly causes GI upset; administering with meals slows absorption
and minimizes nausea, a first-line strategy per ADA 2025 Standards of Care.
Question 3:
The patient's HbA1c is 8.2%. Based on the 2025 ADA Standards of Care, what is the
recommended HbA1c target for most adults with type 2 diabetes?
A. Less than 6.5%
, B. Less than 7.0%
C. Less than 8.0%
D. Less than 9.0%
■ Correct Answer: B
Rationale: The ADA 2025 guidelines recommend an HbA1c <7.0% for most non-pregnant adults
with type 2 diabetes to minimize microvascular complications, individualized based on risks.
Question 4:
In therapeutic communication, the patient expresses frustration about frequent blood glucose
monitoring. What is the most empathetic response?
A. "Many patients find it burdensome; let's discuss simplifying your regimen."
B. "You must monitor to avoid complications."
C. "It's only a few minutes a day."
D. "Focus on your diet instead."
■ Correct Answer: A
Rationale: Acknowledging feelings validates the patient, fostering trust and opening dialogue for
shared decision-making in chronic disease management.
Question 5:
The patient's lipid panel shows LDL 110 mg/dL. For a patient with diabetes and hypertension,
what is the target LDL per 2025 guidelines?
A. Less than 100 mg/dL
B. Less than 70 mg/dL
C. Less than 130 mg/dL
D. Less than 160 mg/dL
■ Correct Answer: B
Rationale: High-risk patients (e.g., with diabetes) should have LDL <70 mg/dL to reduce
atherosclerotic cardiovascular disease, as per integrated 2025 ADA/AHA recommendations.
Question 6:
Scenario: The patient is on lisinopril 20 mg daily for hypertension. Their serum creatinine rises to
1.8 mg/dL from baseline 1.2 mg/dL. What is the priority action?
A. Continue lisinopril and recheck in 3 months.
B. Hold lisinopril and notify the provider.
C. Add a diuretic.
D. Increase to 40 mg daily.
■ Correct Answer: B
Rationale: ACE inhibitors like lisinopril can cause acute kidney injury; a >30% creatinine rise
warrants discontinuation and provider notification for renal monitoring.
Question 7:
