NR 566 ADVANCED
PHARMACOLOGY FOR
CARE OF THE FAMILY
2026/2027 MIDTERM EXAM MASTERY
REVIEW
80 HIGH-LEVEL CLINICAL PRACTICE QUESTIONS
WITH CORRECT ANSWERS & DETAILED
RATIONALES
Questions 1–20
1. A 52-year-old patient with newly diagnosed hypertension has an average
BP of 154/96 mm Hg. The patient has no diabetes, chronic kidney disease, or
cardiovascular disease. Which initial pharmacologic approach is most
appropriate?
A. Begin propranolol monotherapy
B. Begin an appropriate first-line antihypertensive agent and reassess
C. Begin clonidine immediately
D. Begin hydralazine monotherapy
Answer: B
Rationale: First-line antihypertensive classes include thiazide-type diuretics, ACE inhibitors,
ARBs, and calcium channel blockers. Therapy should be individualized according to
comorbidities, BP severity, and patient factors. Clonidine and hydralazine are generally not
preferred initial agents for uncomplicated hypertension.
2. A patient taking lisinopril develops persistent dry cough. Which medication
is the most appropriate alternative?
A. Losartan
B. Propranolol
,C. Furosemide
D. Diltiazem
Answer: A
Rationale: ACE inhibitors can cause bradykinin-mediated cough. An ARB such as losartan
provides similar renin-angiotensin system blockade without the same frequency of cough.
3. Which adverse effect associated with ACE inhibitors requires immediate
evaluation?
A. Mild headache
B. Dry cough
C. Angioedema
D. Fatigue
Answer: C
Rationale: ACE inhibitor-associated angioedema can compromise the airway and is
potentially life-threatening. The ACE inhibitor should be discontinued, and emergency
treatment may be necessary.
4. A patient taking spironolactone is at greatest risk for which laboratory
abnormality?
A. Hypocalcemia
B. Hyperkalemia
C. Hypoglycemia
D. Hypernatremia
Answer: B
Rationale: Spironolactone is a potassium-sparing aldosterone antagonist. Reduced potassium
excretion can cause clinically significant hyperkalemia, particularly in patients with renal
impairment or those taking other medications that increase potassium.
5. Which patient would have the strongest indication for a beta blocker?
A. Patient with uncomplicated hypertension only
B. Patient with recent myocardial infarction
C. Patient with isolated mild hyperlipidemia
D. Patient with uncomplicated allergic rhinitis
, Answer: B
Rationale: Beta blockers have important indications following myocardial infarction and in
several cardiac conditions. They are not generally preferred solely for uncomplicated
hypertension when no compelling indication exists.
6. A patient taking metoprolol reports dizziness and has a heart rate of 48
beats/min. What should the clinician do first?
A. Increase the dose
B. Assess the patient and review the medication regimen
C. Add another beta blocker
D. Immediately discontinue every cardiovascular medication
Answer: B
Rationale: Bradycardia and symptomatic hypotension can occur with beta blockers. The
clinician should assess severity, symptoms, vital signs, and other medications before
determining whether dose reduction or discontinuation is appropriate.
7. Which medication is associated with a risk of lactic acidosis in susceptible
patients?
A. Metformin
B. Amoxicillin
C. Loratadine
D. Omeprazole
Answer: A
Rationale: Metformin-associated lactic acidosis is rare but serious. Risk increases with
significant renal impairment, hypoxia, severe acute illness, and certain other conditions.
8. Which instruction is most important for a patient beginning metformin?
A. Take it only when blood glucose is elevated
B. Take it with meals to reduce gastrointestinal adverse effects
C. Avoid all dietary carbohydrates
D. Stop the medication whenever glucose is normal
Answer: B
PHARMACOLOGY FOR
CARE OF THE FAMILY
2026/2027 MIDTERM EXAM MASTERY
REVIEW
80 HIGH-LEVEL CLINICAL PRACTICE QUESTIONS
WITH CORRECT ANSWERS & DETAILED
RATIONALES
Questions 1–20
1. A 52-year-old patient with newly diagnosed hypertension has an average
BP of 154/96 mm Hg. The patient has no diabetes, chronic kidney disease, or
cardiovascular disease. Which initial pharmacologic approach is most
appropriate?
A. Begin propranolol monotherapy
B. Begin an appropriate first-line antihypertensive agent and reassess
C. Begin clonidine immediately
D. Begin hydralazine monotherapy
Answer: B
Rationale: First-line antihypertensive classes include thiazide-type diuretics, ACE inhibitors,
ARBs, and calcium channel blockers. Therapy should be individualized according to
comorbidities, BP severity, and patient factors. Clonidine and hydralazine are generally not
preferred initial agents for uncomplicated hypertension.
2. A patient taking lisinopril develops persistent dry cough. Which medication
is the most appropriate alternative?
A. Losartan
B. Propranolol
,C. Furosemide
D. Diltiazem
Answer: A
Rationale: ACE inhibitors can cause bradykinin-mediated cough. An ARB such as losartan
provides similar renin-angiotensin system blockade without the same frequency of cough.
3. Which adverse effect associated with ACE inhibitors requires immediate
evaluation?
A. Mild headache
B. Dry cough
C. Angioedema
D. Fatigue
Answer: C
Rationale: ACE inhibitor-associated angioedema can compromise the airway and is
potentially life-threatening. The ACE inhibitor should be discontinued, and emergency
treatment may be necessary.
4. A patient taking spironolactone is at greatest risk for which laboratory
abnormality?
A. Hypocalcemia
B. Hyperkalemia
C. Hypoglycemia
D. Hypernatremia
Answer: B
Rationale: Spironolactone is a potassium-sparing aldosterone antagonist. Reduced potassium
excretion can cause clinically significant hyperkalemia, particularly in patients with renal
impairment or those taking other medications that increase potassium.
5. Which patient would have the strongest indication for a beta blocker?
A. Patient with uncomplicated hypertension only
B. Patient with recent myocardial infarction
C. Patient with isolated mild hyperlipidemia
D. Patient with uncomplicated allergic rhinitis
, Answer: B
Rationale: Beta blockers have important indications following myocardial infarction and in
several cardiac conditions. They are not generally preferred solely for uncomplicated
hypertension when no compelling indication exists.
6. A patient taking metoprolol reports dizziness and has a heart rate of 48
beats/min. What should the clinician do first?
A. Increase the dose
B. Assess the patient and review the medication regimen
C. Add another beta blocker
D. Immediately discontinue every cardiovascular medication
Answer: B
Rationale: Bradycardia and symptomatic hypotension can occur with beta blockers. The
clinician should assess severity, symptoms, vital signs, and other medications before
determining whether dose reduction or discontinuation is appropriate.
7. Which medication is associated with a risk of lactic acidosis in susceptible
patients?
A. Metformin
B. Amoxicillin
C. Loratadine
D. Omeprazole
Answer: A
Rationale: Metformin-associated lactic acidosis is rare but serious. Risk increases with
significant renal impairment, hypoxia, severe acute illness, and certain other conditions.
8. Which instruction is most important for a patient beginning metformin?
A. Take it only when blood glucose is elevated
B. Take it with meals to reduce gastrointestinal adverse effects
C. Avoid all dietary carbohydrates
D. Stop the medication whenever glucose is normal
Answer: B
