NR 545 Exam 2 Advanced Practice Nursing:
Questions, Verified Answers, and Rationales
Bundle (Latest 2024/2025/2026)
Question 1
,A 62-year-old African American male presents to the clinic for a follow-up
blood pressure check. His blood pressure readings today average 152/94 mmHg,
and his previous reading two weeks ago was 150/92 mmHg. He has no history
of chronic kidney disease (CKD) or diabetes. According to evidence-based
guidelines (JNC 8), which of the following is the most appropriate initial
pharmacological treatment?
A) Lisinopril 10 mg daily
B) Losartan 50 mg daily
C) Amlodipine 5 mg daily
D) Metoprolol succinate 25 mg daily
Verified Answer: C) Amlodipine 5 mg daily
Explanation: According to the JNC 8 and AHA/ACC hypertension guidelines,
initial antihypertensive treatment for the general African American
population without chronic kidney disease (CKD) should include a thiazide-
type diuretic or a calcium channel blocker (CCB). Amlodipine is a
dihydropyridine calcium channel blocker that has been proven more effective
at lowering blood pressure and reducing cardiovascular outcomes in Black
patients compared to ACE inhibitors or angiotensin receptor blockers (ARBs)
when used as monotherapy. ACE inhibitors and ARBs (Options A and B) are
less effective as first-line monotherapy in this demographic due to a lower
baseline renin profile, unless a compelling indication like CKD or diabetic
nephropathy is present. Beta-blockers (Option D) are no longer recommended
as first-line agents for primary hypertension unless the patient has a
compelling cardiac indication such as heart failure or a recent myocardial
infarction.
,Question 2
A 55-year-old female patient with a history of hypertension and stable angina
presents with a dry, hacking, non-productive cough that has persisted for three
weeks. She was started on a new antihypertensive medication two months ago.
Which of the following mechanisms best explains this patient's medication-
induced adverse effect?
A) Blockade of angiotensin II type 1 receptors leading to pulmonary
vasoconstriction
B) Accumulation of bradykinin and substance P in the respiratory tract
C) Direct irritation of the pharyngeal mucosa by tablet excipients
D) Inhibition of cyclooxygenase-1 leading to increased leukotriene production
Verified Answer: B) Accumulation of bradykinin and substance P in the
respiratory tract
Explanation: The patient is experiencing a classic side effect of an
Angiotensin-Converting Enzyme (ACE) inhibitor, such as lisinopril or
enalapril. ACE is identical to kininase II, the enzyme responsible for breaking
down bradykinin and substance P. When an ACE inhibitor stops this
breakdown, bradykinin and substance P accumulate in the respiratory tract,
stimulating afferent C-fibers and causing a persistent, dry cough. This side
effect is a class effect and is not dose-dependent. Switching to an Angiotensin
Receptor Blocker (ARB) is the most appropriate step because ARBs block the
angiotensin receptor directly without affecting the breakdown of bradykinin,
avoiding this specific side effect.
Question 3
, A 68-year-old patient with New York Heart Association (NYHA) Class III
heart failure is prescribed spironolactone. Which of the following
pathophysiological mechanisms explains why this medication improves survival
rates in advanced heart failure patients?
A) It blocks the effects of aldosterone, preventing myocardial remodeling and
fibrosis.
B) It causes profound loop-of-Henle diuresis to significantly decrease cardiac
preload.
C) It acts as a direct arterial vasodilator to dramatically reduce cardiac afterload.
D) It exerts a positive inotropic effect by increasing intracellular calcium in
myocytes.
Verified Answer: A) It blocks the effects of aldosterone, preventing
myocardial remodeling and fibrosis.
Explanation: Spironolactone is an aldosterone antagonist (potassium-sparing
diuretic). In advanced heart failure, chronic activation of the renin-
angiotensin-aldosterone system (RAAS) leads to pathologically high levels of
aldosterone. Aldosterone promotes endothelial dysfunction, collagen
deposition, and progressive myocardial remodeling/fibrosis, which worsens
heart failure progression. While spironolactone has mild diuretic properties,
its primary survival benefit in heart failure (as demonstrated in the RALES
trial) stems from its ability to block aldosterone-mediated cardiac tissue
remodeling. Loop diuretics, not spironolactone, are responsible for profound
diuresis (Option B). It does not act as a direct vasodilator (Option C) or a
positive inotrope (Option D).
Question 4
Questions, Verified Answers, and Rationales
Bundle (Latest 2024/2025/2026)
Question 1
,A 62-year-old African American male presents to the clinic for a follow-up
blood pressure check. His blood pressure readings today average 152/94 mmHg,
and his previous reading two weeks ago was 150/92 mmHg. He has no history
of chronic kidney disease (CKD) or diabetes. According to evidence-based
guidelines (JNC 8), which of the following is the most appropriate initial
pharmacological treatment?
A) Lisinopril 10 mg daily
B) Losartan 50 mg daily
C) Amlodipine 5 mg daily
D) Metoprolol succinate 25 mg daily
Verified Answer: C) Amlodipine 5 mg daily
Explanation: According to the JNC 8 and AHA/ACC hypertension guidelines,
initial antihypertensive treatment for the general African American
population without chronic kidney disease (CKD) should include a thiazide-
type diuretic or a calcium channel blocker (CCB). Amlodipine is a
dihydropyridine calcium channel blocker that has been proven more effective
at lowering blood pressure and reducing cardiovascular outcomes in Black
patients compared to ACE inhibitors or angiotensin receptor blockers (ARBs)
when used as monotherapy. ACE inhibitors and ARBs (Options A and B) are
less effective as first-line monotherapy in this demographic due to a lower
baseline renin profile, unless a compelling indication like CKD or diabetic
nephropathy is present. Beta-blockers (Option D) are no longer recommended
as first-line agents for primary hypertension unless the patient has a
compelling cardiac indication such as heart failure or a recent myocardial
infarction.
,Question 2
A 55-year-old female patient with a history of hypertension and stable angina
presents with a dry, hacking, non-productive cough that has persisted for three
weeks. She was started on a new antihypertensive medication two months ago.
Which of the following mechanisms best explains this patient's medication-
induced adverse effect?
A) Blockade of angiotensin II type 1 receptors leading to pulmonary
vasoconstriction
B) Accumulation of bradykinin and substance P in the respiratory tract
C) Direct irritation of the pharyngeal mucosa by tablet excipients
D) Inhibition of cyclooxygenase-1 leading to increased leukotriene production
Verified Answer: B) Accumulation of bradykinin and substance P in the
respiratory tract
Explanation: The patient is experiencing a classic side effect of an
Angiotensin-Converting Enzyme (ACE) inhibitor, such as lisinopril or
enalapril. ACE is identical to kininase II, the enzyme responsible for breaking
down bradykinin and substance P. When an ACE inhibitor stops this
breakdown, bradykinin and substance P accumulate in the respiratory tract,
stimulating afferent C-fibers and causing a persistent, dry cough. This side
effect is a class effect and is not dose-dependent. Switching to an Angiotensin
Receptor Blocker (ARB) is the most appropriate step because ARBs block the
angiotensin receptor directly without affecting the breakdown of bradykinin,
avoiding this specific side effect.
Question 3
, A 68-year-old patient with New York Heart Association (NYHA) Class III
heart failure is prescribed spironolactone. Which of the following
pathophysiological mechanisms explains why this medication improves survival
rates in advanced heart failure patients?
A) It blocks the effects of aldosterone, preventing myocardial remodeling and
fibrosis.
B) It causes profound loop-of-Henle diuresis to significantly decrease cardiac
preload.
C) It acts as a direct arterial vasodilator to dramatically reduce cardiac afterload.
D) It exerts a positive inotropic effect by increasing intracellular calcium in
myocytes.
Verified Answer: A) It blocks the effects of aldosterone, preventing
myocardial remodeling and fibrosis.
Explanation: Spironolactone is an aldosterone antagonist (potassium-sparing
diuretic). In advanced heart failure, chronic activation of the renin-
angiotensin-aldosterone system (RAAS) leads to pathologically high levels of
aldosterone. Aldosterone promotes endothelial dysfunction, collagen
deposition, and progressive myocardial remodeling/fibrosis, which worsens
heart failure progression. While spironolactone has mild diuretic properties,
its primary survival benefit in heart failure (as demonstrated in the RALES
trial) stems from its ability to block aldosterone-mediated cardiac tissue
remodeling. Loop diuretics, not spironolactone, are responsible for profound
diuresis (Option B). It does not act as a direct vasodilator (Option C) or a
positive inotrope (Option D).
Question 4
