NRCME - National Registry of Certified Medical Examiners Hypertension Guidelines Questions and Answers — Questions and Answers
Question 1: A commercial driver presents for a recertification exam. His blood pressure is measured at 164/102 mmHg. He has a history of Stage 1 hypertension and has been on medication for the past year. According to FMCSA guidelines, what is the most appropriate action for the medical examiner to take?
- Disqualify the driver until his blood pressure is below 140/90 mmHg.
- Issue a 1-year certificate as he is already on medication.
- Issue a one-time 3-month certificate and advise him to follow up with his primary care provider. (Correct answer)
- Certify the driver for 6 months with a recommendation for lifestyle changes.
Correct answer: Issue a one-time 3-month certificate and advise him to follow up with his primary care provider.
The driver's blood pressure falls into the Stage 2 hypertension range (160-179/100-109 mmHg). For a driver with Stage 2 hypertension, the examiner should issue a one-time, 3-month certificate to allow the driver to seek treatment to lower their blood pressure to 140/90 mmHg or less.
Question 2: A 52-year-old driver is found to have a blood pressure of 182/114 mmHg during his initial DOT physical exam. Which of the following is the correct determination?
- Certify for 3 months with required treatment.
- Certify for 1 year, as long as he starts medication.
- Issue a 6-month certificate.
- Disqualify the driver. (Correct answer)
Correct answer: Disqualify the driver.
A blood pressure reading at or above 180/110 mmHg is considered Stage 3 hypertension. According to FMCSA guidelines, a driver with Stage 3 hypertension must be medically disqualified. The driver cannot be certified, even for a short period, until their blood pressure is reduced to 140/90 mmHg or less and the treatment is well-tolerated.
Question 3: A driver was disqualified for Stage 3 hypertension. He returns to your office two months later, and his blood pressure is now 138/88 mmHg with treatment. What is the maximum certification period for which this driver is now eligible?
- 3 months
- 6 months (Correct answer)
- 1 year
- 2 years
Correct answer: 6 months
After a driver has been disqualified for Stage 3 hypertension (BP ≥ 180/110 mmHg), once their blood pressure is reduced to 140/90 mmHg or less and treatment is well tolerated, they may be certified for a maximum of 6 months. Recertification is required every 6 months thereafter.
Question 4: A new applicant for a commercial driver's license has a blood pressure of 148/94 mmHg on their first examination. The driver is not on any antihypertensive medication. What is the appropriate certification period?
- 2 years
- 1 year (Correct answer)
- 6 months
- 3 months, one-time
Correct answer: 1 year
This blood pressure reading (140-159/90-99 mmHg) is classified as Stage 1 hypertension. For a first-time finding of Stage 1 hypertension, the driver may be certified for a maximum of one year.
Question 5: Which of the following blood pressure readings allows for a 2-year medical certification, assuming the driver has no other disqualifying conditions and is not on any antihypertensive medication?
- 142/88 mmHg
- 138/92 mmHg
- 136/84 mmHg (Correct answer)
- 140/90 mmHg
Correct answer: 136/84 mmHg
To qualify for a 2-year medical certificate, a driver must have a blood pressure reading of less than 140/90 mmHg and not be on medication for hypertension. A reading of 136/84 mmHg meets these criteria. The other readings are either at or above the 140/90 mmHg threshold.
Question 6: A driver with a history of treated hypertension presents for his annual recertification. His blood pressure is 152/96 mmHg. He was previously certified for one year. What is the appropriate next step for the medical examiner?
- Certify for another year, as his BP is only in Stage 1.
- Disqualify him immediately.
- Issue a one-time, 3-month certificate to allow for adjustment of his treatment. (Correct answer)
- Issue a 6-month certificate.
Correct answer: Issue a one-time, 3-month certificate to allow for adjustment of his treatment.
At a recertification exam for a driver with a history of hypertension, if the blood pressure is in the Stage 1 range (140-159/90-99 mmHg), the examiner can issue a one-time certificate for 3 months to allow the driver time to be evaluated and treated to bring their blood pressure back down to ≤ 140/90 mmHg.
