The nurse is caring for a client who has been diagnosed with primary hypertension. Which pathophysiological mechanism does the nurse recognize as the cause of primary hypertension?

Failure of angiotensin I to convert to angiotensin II.

Increased levels of angiotensin in the bloodstream.

The release of excess sodium and water.

Juxtaglomerular cells’ systemic effect after renin release.

Answer and Explanation

The Correct Answer is B

Choice A reason: Failure of angiotensin I to convert to angiotensin II would reduce blood pressure, as angiotensin II is a potent vasoconstrictor. Primary hypertension involves increased angiotensin II, driving vasoconstriction and sodium retention. This failure is not a cause, making it incorrect for the mechanism of hypertension.

Choice B reason: Increased angiotensin II levels in the bloodstream cause vasoconstriction and aldosterone-mediated sodium retention, elevating blood pressure in primary hypertension. This is a key mechanism in the renin-angiotensin-aldosterone system (RAAS), driving chronic hypertension. This aligns with cardiovascular pathophysiology, making it the correct mechanism for the nurse to recognize.

Choice C reason: Excess sodium and water retention is a consequence of RAAS activation in hypertension, not the primary cause. Angiotensin II drives this retention via aldosterone. While important, sodium/water release is secondary to angiotensin’s vasoconstrictive effects, making this less precise than increased angiotensin levels.

Choice D reason: Juxtaglomerular cells release renin, initiating RAAS, but the systemic effect is mediated by angiotensin II, not renin alone. Hypertension results from angiotensin’s vasoconstriction and sodium retention. This choice is less specific, as angiotensin II’s actions are the direct cause, making it incorrect.

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Correct Answer is D

Explanation

Choice A reason: Loss of metatarsal arch indicates flat feet, a musculoskeletal issue unrelated to osteoporosis. Osteoporosis involves reduced bone density, causing fractures and spinal deformities like kyphosis. Arch loss does not reflect bone loss or fragility, making it incorrect for osteoporosis’s pathophysiological process.

Choice B reason: An S-shaped curve to the back suggests scoliosis, a lateral spinal deformity unrelated to osteoporosis. Osteoporosis causes vertebral compression fractures, leading to kyphosis. Scoliosis is structural, not a result of bone density loss, making this incorrect for osteoporosis’s pathophysiological manifestation.

Choice C reason: Obesity is a risk factor for many conditions but not a direct indicator of osteoporosis. In fact, higher body weight may protect against bone loss. Osteoporosis involves bone density reduction, leading to kyphosis from fractures. Obesity does not reflect this process, making it incorrect.

Choice D reason: Severe kyphosis, a forward spinal curvature, results from vertebral compression fractures due to osteoporosis’s reduced bone density. This pathophysiological process weakens bones, causing fractures and spinal deformity, aligning with osteoporosis’s clinical presentation in older adults, per orthopedic and endocrinology evidence.

A. Loop of Henle. B. Glomerulus. C. Distal convoluted tubule. D. Bowman’s capsule.

Correct Answer is B

Explanation

Choice A reason: The loop of Henle regulates water and electrolyte reabsorption, not protein filtration. Proteinuria results from glomerular damage, allowing proteins to leak into urine. The loop’s role in concentration does not involve protein handling, making it incorrect for the structure impaired in CKD-related proteinuria.

Choice B reason: The glomerulus filters blood, normally preventing large proteins from entering urine. In CKD, glomerular damage (e.g., from hypertension or diabetes) increases permeability, causing proteinuria. This is a hallmark of glomerular injury, aligning with CKD’s pathophysiology, making the glomerulus the correct structure responsible for proteinuria.

Choice C reason: The distal convoluted tubule regulates electrolytes and acid-base balance, not protein filtration. Proteinuria stems from glomerular dysfunction, not tubular issues. The distal tubule’s role in reabsorption does not involve proteins, making it incorrect for the structure causing proteinuria in chronic kidney disease.

Choice D reason: Bowman’s capsule collects glomerular filtrate but does not filter proteins itself. Proteinuria occurs due to glomerular barrier damage, allowing proteins to pass into the capsule. While adjacent, the capsule is not the primary impaired structure, making the glomerulus the correct choice for CKD-related proteinuria.

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The nurse is caring for a client who has been diagnosed with primary hypertension. Which pathophysiological mechanism does the nurse recognize as the cause of primary hypertension?

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