CEA Nursing Practice Exam

What condition is least suspicious for renal artery disease in a patient with hypertension?

1. Long-standing hypertension on two medications

2. Onset of hypertension before 30

3. Sudden or poorly controlled hypertension in a patient over 55

4. Small kidney size discrepancy

The correct answer is: Long-standing hypertension on two medications

The rationale for considering long-standing hypertension on two medications as the least suspicious condition for renal artery disease stems from the typical clinical presentation of this condition. Renal artery disease often leads to secondary hypertension, particularly when there is a significant stenosis in the renal arteries. This situation is more common in younger patients, those with sudden or poorly controlled hypertension, or in cases where kidney size discrepancies suggest asymmetrical blood flow or damage. In patients with long-standing hypertension, especially if it is effectively managed with two antihypertensive medications, it is more likely that the hypertension is primary (essential) rather than secondary to renal artery disease. Furthermore, the chronicity of hypertension indicates a longer-standing process that typically does not align with the acute nature often seen with renal artery stenosis. Additionally, individuals who have controlled their hypertension over time are less likely to have underlying renal artery issues, which are generally characterized by sudden changes or severe elevations in blood pressure. The other options reflect scenarios that are more synonymous with renal artery disease. For instance, the onset of hypertension before the age of 30 can suggest a secondary cause, including renal artery stenosis. Sudden or poorly controlled hypertension in someone over 55 raises concern for renovascular hypertension. Lastly, a small kidney