Leigh
NUR 445 EXAM 2 HYPERTENSION (HTN) – 40 NCLEX-STYLE QUESTIONS,
HIGHLIGHTED ANSWERS & FULL RATIONALES
1. A client diagnosed with hypertension asks what caused their condition. The
nurse explains that primary hypertension is defined as:
A. Hypertension caused by kidney damage
B. Hypertension with an unknown direct cause
C. Hypertension due to endocrine dysfunction
D. Hypertension caused by medication side effects
✔ Correct Answer: B. Hypertension with an unknown direct cause
Rationale:
Primary (essential) hypertension has no single identifiable cause. It is related to
genetics, environment, lifestyle, and vascular resistance changes. Secondary HTN
has a specific reversible cause.
2. The nurse identifies which factor as a contributor to secondary hypertension?
A. Family history
B. Stress
C. Medication side effects
D. Obesity
✔ Correct Answer: C. Medication side effects
Rationale:
Secondary HTN has a known cause, such as medications (steroids, oral
contraceptives), renal disease, endocrine disorders. Obesity and stress contribute
to primary HTN.
,Leigh
3. A patient’s BP readings taken two weeks apart are 150/92 and 148/94. These
readings indicate:
A. Normal BP
B. Prehypertension
C. Stage 1 hypertension
D. Stage 2 hypertension
✔ Correct Answer: C. Stage 1 hypertension
Rationale:
Stage 1 HTN = 140–159 systolic OR 90–99 diastolic on two separate occasions by
a healthcare provider.
4. The nurse teaches a client with newly diagnosed hypertension that early
symptoms often include:
A. Severe chest pain
B. Retinal hemorrhages
C. Persistent cough
D. Hyperreflexia
✔ Correct Answer: B. Retinal hemorrhages
Rationale:
HTN is called the "silent killer" but may cause vision changes, retinal hemorrhage,
flushing, dizziness, headaches as it progresses.
5. A client has a BP of 165/102 on two consecutive visits. How is this classified?
A. Elevated
B. Stage 1
,Leigh
C. Stage 2
D. Crisis
✔ Correct Answer: C. Stage 2
Rationale:
Stage 2 HTN: ≥160 systolic OR ≥100 diastolic.
6. Which lifestyle modification is FIRST-LINE management for newly diagnosed
hypertension?
A. Starting ACE inhibitors
B. Weight reduction and low-sodium diet
C. Immediate diuretic therapy
D. Beta-blocker therapy
✔ Correct Answer: B. Weight reduction and low-sodium diet
Rationale:
All guidelines recommend lifestyle changes BEFORE medication unless levels are
severe. This includes sodium restriction, stress reduction, exercise, weight
management, and smoking cessation.
7. The nurse identifies which BP range as prehypertension?
A. 110/70
B. 118/72
C. 128/84
D. 140/96
✔ Correct Answer: C. 128/84
Rationale:
, Leigh
Pre-hypertension: 120––89.
8. A client asks how ACE inhibitors lower blood pressure. The nurse responds:
A. They block adrenaline release
B. They constrict peripheral arteries
C. They prevent conversion of angiotensin I to angiotensin II
D. They increase heart rate
✔ Correct Answer: C. They prevent conversion of angiotensin I to angiotensin II
Rationale:
ACE inhibitors ↓ BP by preventing formation of angiotensin II, a potent
vasoconstrictor.
9. Which finding should the nurse monitor for when administering ACE
inhibitors?
A. Hypoglycemia
B. Persistent dry cough
C. Hyperreflexia
D. Increased libido
✔ Correct Answer: B. Persistent dry cough
Rationale:
ACE inhibitors cause bradykinin accumulation, leading to a dry, persistent cough
and possible angioedema.
10. A patient taking ARBs (-sartan) should be monitored for:
NUR 445 EXAM 2 HYPERTENSION (HTN) – 40 NCLEX-STYLE QUESTIONS,
HIGHLIGHTED ANSWERS & FULL RATIONALES
1. A client diagnosed with hypertension asks what caused their condition. The
nurse explains that primary hypertension is defined as:
A. Hypertension caused by kidney damage
B. Hypertension with an unknown direct cause
C. Hypertension due to endocrine dysfunction
D. Hypertension caused by medication side effects
✔ Correct Answer: B. Hypertension with an unknown direct cause
Rationale:
Primary (essential) hypertension has no single identifiable cause. It is related to
genetics, environment, lifestyle, and vascular resistance changes. Secondary HTN
has a specific reversible cause.
2. The nurse identifies which factor as a contributor to secondary hypertension?
A. Family history
B. Stress
C. Medication side effects
D. Obesity
✔ Correct Answer: C. Medication side effects
Rationale:
Secondary HTN has a known cause, such as medications (steroids, oral
contraceptives), renal disease, endocrine disorders. Obesity and stress contribute
to primary HTN.
,Leigh
3. A patient’s BP readings taken two weeks apart are 150/92 and 148/94. These
readings indicate:
A. Normal BP
B. Prehypertension
C. Stage 1 hypertension
D. Stage 2 hypertension
✔ Correct Answer: C. Stage 1 hypertension
Rationale:
Stage 1 HTN = 140–159 systolic OR 90–99 diastolic on two separate occasions by
a healthcare provider.
4. The nurse teaches a client with newly diagnosed hypertension that early
symptoms often include:
A. Severe chest pain
B. Retinal hemorrhages
C. Persistent cough
D. Hyperreflexia
✔ Correct Answer: B. Retinal hemorrhages
Rationale:
HTN is called the "silent killer" but may cause vision changes, retinal hemorrhage,
flushing, dizziness, headaches as it progresses.
5. A client has a BP of 165/102 on two consecutive visits. How is this classified?
A. Elevated
B. Stage 1
,Leigh
C. Stage 2
D. Crisis
✔ Correct Answer: C. Stage 2
Rationale:
Stage 2 HTN: ≥160 systolic OR ≥100 diastolic.
6. Which lifestyle modification is FIRST-LINE management for newly diagnosed
hypertension?
A. Starting ACE inhibitors
B. Weight reduction and low-sodium diet
C. Immediate diuretic therapy
D. Beta-blocker therapy
✔ Correct Answer: B. Weight reduction and low-sodium diet
Rationale:
All guidelines recommend lifestyle changes BEFORE medication unless levels are
severe. This includes sodium restriction, stress reduction, exercise, weight
management, and smoking cessation.
7. The nurse identifies which BP range as prehypertension?
A. 110/70
B. 118/72
C. 128/84
D. 140/96
✔ Correct Answer: C. 128/84
Rationale:
, Leigh
Pre-hypertension: 120––89.
8. A client asks how ACE inhibitors lower blood pressure. The nurse responds:
A. They block adrenaline release
B. They constrict peripheral arteries
C. They prevent conversion of angiotensin I to angiotensin II
D. They increase heart rate
✔ Correct Answer: C. They prevent conversion of angiotensin I to angiotensin II
Rationale:
ACE inhibitors ↓ BP by preventing formation of angiotensin II, a potent
vasoconstrictor.
9. Which finding should the nurse monitor for when administering ACE
inhibitors?
A. Hypoglycemia
B. Persistent dry cough
C. Hyperreflexia
D. Increased libido
✔ Correct Answer: B. Persistent dry cough
Rationale:
ACE inhibitors cause bradykinin accumulation, leading to a dry, persistent cough
and possible angioedema.
10. A patient taking ARBs (-sartan) should be monitored for:
