NSG 533 Advanced Pharm Exam 3 Comprehensive
Questions and Correct Answers plus Rationale | New
Update 2026-2027 (Already Graded A+) Wilkes
Question 1
Benazepril should be discontinued immediately if:
A. dry cough occurs
B. pregnancy occurs
C. potassium levels decrease
D. gout develops
Correct Answer: B. pregnancy occurs
Rationale: Benazepril is an ACE inhibitor, and this class of drugs is contraindicated
during pregnancy because of teratogenic effects on the renal system of the
developing fetus. Dry cough is an aggravating side effect that occurs in some
patients who take ACE inhibitors, but discontinuation is elective. ACE inhibitor use
is associated with increased potassium levels, not decreased levels. Gout is not
exacerbated by ACE inhibitor use.
Question 2
A characteristic of an ACE inhibitor-induced cough is that it:
A. is mildly productive
B. is worse at nighttime
C. usually begins within 2 weeks of starting therapy
D. is more common in men
Correct Answer: C. usually begins within 2 weeks of starting therapy
Rationale: ACE inhibitor-induced cough typically begins within 2 weeks of starting
therapy. It is characteristically a dry, nonproductive cough (not mildly productive),
,can occur at any time (not specifically worse at nighttime), and is more common in
women, not men. The mechanism involves increased bradykinin levels.
Question 3
A patient taking atorvastatin for newly diagnosed dyslipidemia complains of
fatigue, weakness, and muscle aches in his lower back, arms, and legs for the
past three days. It has not improved with rest. How should this be evaluated?
A. Stop the atorvastatin immediately
B. Check liver enzymes first
C. Order a CPK level
D. Ask about nighttime muscle cramps
Correct Answer: A. Stop the atorvastatin immediately
Rationale: This patient has complaints highly suggestive of rhabdomyolysis. The
atorvastatin should be stopped immediately and a CPK should be ordered. Liver
enzymes would not assess for the etiology of myalgias; they assess tolerance of
statins in the liver. Nighttime muscle cramps are not usually associated with statin
use. Myalgias are common but are not typically associated with an elevated CPK.
Rhabdomyolysis is a rare side effect of the statins.
Question 4
Which patient could be expected to have the highest systolic BP?
A. A 21-year-old male
B. A 50-year-old perimenopausal female
C. A 35-year-old with T2DM
D. A 75-year-old male
Correct Answer: D. A 75-year-old male
Rationale: Nearly 25% of the US population has hypertension. The greatest
incidence is in older adults because of changes in the intima of vessels as aging
and calcium deposition occur. Males of any age are more likely than females, with
African American adults having the highest incidence.
,Question 5
A 50-year-old patient with hypertension has taken hydrochlorothiazide 25 mg
daily for the past 4 weeks. Her BP has decreased from 155/95 to 145/90. How
should the NP proceed?
A. Wait another 4 weeks before making a dosage change
B. Increase the HCTZ to 50 mg daily
C. Add a drug from another class to the daily 25 mg HCTZ
D. Stop the HCTZ and start a drug from a different class
Correct Answer: C. Add a drug from another class to the daily 25 mg HCTZ
Rationale: The recommended target BP is <140/90. The current plan has not
allowed this patient to meet this goal, so it is not acceptable to continue this
current dose. Increasing the HCTZ to 50 mg daily will not result in a decrease in BP,
only an increase in potassium loss. Adding a drug from a different medication class
is a good choice because the combined effects of antihypertensive medications
nearly always produce a decrease in BP and both drugs can be maintained in low
doses.
Question 6
Which of the following hypertension medications should not be used in
pregnant women?
A. CCBs
B. TZDs
C. ARBs and ACEIs
D. BBs
Correct Answer: C. ARBs and ACEIs
Rationale: ARBs and ACEIs are contraindicated in pregnancy due to teratogenic
effects on the developing fetus, particularly affecting renal development. CCBs,
beta blockers, and other antihypertensives may be used with caution in pregnancy
when indicated.
, Question 7
A 52-year-old man presents to your office for a health maintenance exam, and
initial vital signs show a BP of 154/94. Previous BP measurements were normal.
What is the next step in management?
A. Start an antihypertensive medication
B. Repeat the BP measurement
C. Look for causes of secondary hypertension
D. Perform a urine drug screen
Correct Answer: B. Repeat the BP measurement
Rationale: A single elevated BP reading should be confirmed with repeat
measurements before initiating treatment. Hypertension diagnosis requires
elevated readings on multiple occasions. Looking for secondary causes or starting
medication would be premature based on a single reading.
Question 8
Which of the following statements is correct regarding BP evaluation?
A. The patient should be lying quietly on the exam table for 5 minutes prior to
obtaining a BP
B. Arm should be below heart level during BP measurement
C. The bladder of the BP cuff should encircle 80% of the forearm
D. Hypertension can be diagnosed by the average of 2 elevated BP readings on a
single occasion
Correct Answer: C. The bladder of the BP cuff should encircle 80% of the
forearm
Rationale: The bladder of the BP cuff should encircle 80% of the upper arm (not
forearm) for accurate measurement. The patient should be seated quietly for 5
minutes (not lying on exam table). The arm should be at heart level. Hypertension
diagnosis requires elevated readings on multiple occasions, not just a single
occasion.
Questions and Correct Answers plus Rationale | New
Update 2026-2027 (Already Graded A+) Wilkes
Question 1
Benazepril should be discontinued immediately if:
A. dry cough occurs
B. pregnancy occurs
C. potassium levels decrease
D. gout develops
Correct Answer: B. pregnancy occurs
Rationale: Benazepril is an ACE inhibitor, and this class of drugs is contraindicated
during pregnancy because of teratogenic effects on the renal system of the
developing fetus. Dry cough is an aggravating side effect that occurs in some
patients who take ACE inhibitors, but discontinuation is elective. ACE inhibitor use
is associated with increased potassium levels, not decreased levels. Gout is not
exacerbated by ACE inhibitor use.
Question 2
A characteristic of an ACE inhibitor-induced cough is that it:
A. is mildly productive
B. is worse at nighttime
C. usually begins within 2 weeks of starting therapy
D. is more common in men
Correct Answer: C. usually begins within 2 weeks of starting therapy
Rationale: ACE inhibitor-induced cough typically begins within 2 weeks of starting
therapy. It is characteristically a dry, nonproductive cough (not mildly productive),
,can occur at any time (not specifically worse at nighttime), and is more common in
women, not men. The mechanism involves increased bradykinin levels.
Question 3
A patient taking atorvastatin for newly diagnosed dyslipidemia complains of
fatigue, weakness, and muscle aches in his lower back, arms, and legs for the
past three days. It has not improved with rest. How should this be evaluated?
A. Stop the atorvastatin immediately
B. Check liver enzymes first
C. Order a CPK level
D. Ask about nighttime muscle cramps
Correct Answer: A. Stop the atorvastatin immediately
Rationale: This patient has complaints highly suggestive of rhabdomyolysis. The
atorvastatin should be stopped immediately and a CPK should be ordered. Liver
enzymes would not assess for the etiology of myalgias; they assess tolerance of
statins in the liver. Nighttime muscle cramps are not usually associated with statin
use. Myalgias are common but are not typically associated with an elevated CPK.
Rhabdomyolysis is a rare side effect of the statins.
Question 4
Which patient could be expected to have the highest systolic BP?
A. A 21-year-old male
B. A 50-year-old perimenopausal female
C. A 35-year-old with T2DM
D. A 75-year-old male
Correct Answer: D. A 75-year-old male
Rationale: Nearly 25% of the US population has hypertension. The greatest
incidence is in older adults because of changes in the intima of vessels as aging
and calcium deposition occur. Males of any age are more likely than females, with
African American adults having the highest incidence.
,Question 5
A 50-year-old patient with hypertension has taken hydrochlorothiazide 25 mg
daily for the past 4 weeks. Her BP has decreased from 155/95 to 145/90. How
should the NP proceed?
A. Wait another 4 weeks before making a dosage change
B. Increase the HCTZ to 50 mg daily
C. Add a drug from another class to the daily 25 mg HCTZ
D. Stop the HCTZ and start a drug from a different class
Correct Answer: C. Add a drug from another class to the daily 25 mg HCTZ
Rationale: The recommended target BP is <140/90. The current plan has not
allowed this patient to meet this goal, so it is not acceptable to continue this
current dose. Increasing the HCTZ to 50 mg daily will not result in a decrease in BP,
only an increase in potassium loss. Adding a drug from a different medication class
is a good choice because the combined effects of antihypertensive medications
nearly always produce a decrease in BP and both drugs can be maintained in low
doses.
Question 6
Which of the following hypertension medications should not be used in
pregnant women?
A. CCBs
B. TZDs
C. ARBs and ACEIs
D. BBs
Correct Answer: C. ARBs and ACEIs
Rationale: ARBs and ACEIs are contraindicated in pregnancy due to teratogenic
effects on the developing fetus, particularly affecting renal development. CCBs,
beta blockers, and other antihypertensives may be used with caution in pregnancy
when indicated.
, Question 7
A 52-year-old man presents to your office for a health maintenance exam, and
initial vital signs show a BP of 154/94. Previous BP measurements were normal.
What is the next step in management?
A. Start an antihypertensive medication
B. Repeat the BP measurement
C. Look for causes of secondary hypertension
D. Perform a urine drug screen
Correct Answer: B. Repeat the BP measurement
Rationale: A single elevated BP reading should be confirmed with repeat
measurements before initiating treatment. Hypertension diagnosis requires
elevated readings on multiple occasions. Looking for secondary causes or starting
medication would be premature based on a single reading.
Question 8
Which of the following statements is correct regarding BP evaluation?
A. The patient should be lying quietly on the exam table for 5 minutes prior to
obtaining a BP
B. Arm should be below heart level during BP measurement
C. The bladder of the BP cuff should encircle 80% of the forearm
D. Hypertension can be diagnosed by the average of 2 elevated BP readings on a
single occasion
Correct Answer: C. The bladder of the BP cuff should encircle 80% of the
forearm
Rationale: The bladder of the BP cuff should encircle 80% of the upper arm (not
forearm) for accurate measurement. The patient should be seated quietly for 5
minutes (not lying on exam table). The arm should be at heart level. Hypertension
diagnosis requires elevated readings on multiple occasions, not just a single
occasion.
