Walden University NURS 6521 Advanced
Pharmacology – Cardiovascular Pharmacotherapy
Practice Questions (docx) | 2026/2027 | Nursing
1. An adult with uncomplicated stage 2 hypertension is starting treatment. Which initial strategy follows current
guidance?
A) Two complementary first-line antihypertensives, preferably in one pill
B) A beta blocker alone
C) An ACE inhibitor plus an ARB
D) A loop diuretic alone
Correct Answer: Two complementary first-line antihypertensives, preferably in one pill
Rationale: Using two complementary first-line classes usually achieves faster blood pressure control and
improves adherence when supplied as one pill. This distinction supports safe prescribing and monitoring in
cardiovascular pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment
strategies, or effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific
risks helps clinicians select treatment and recognize when reassessment is necessary.
2. A person with stage 1 hypertension and low predicted cardiovascular risk has no symptoms. What initial
approach is appropriate?
A) Immediate triple-drug therapy
B) Lifestyle intervention followed by reassessment over three to six months
C) Routine intravenous labetalol
D) Permanent avoidance of all exercise
Correct Answer: Lifestyle intervention followed by reassessment over three to six months
Rationale: In lower-risk stage 1 hypertension, lifestyle modification can precede medication, with subsequent
reassessment of blood pressure. This distinction supports safe prescribing and monitoring in cardiovascular
pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment strategies, or
effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific risks helps
clinicians select treatment and recognize when reassessment is necessary.
3. A clinician selects lisinopril for hypertension. Which process does this drug inhibit?
A) Aldosterone binding to its receptor
B) Calcium influx through L-type channels
C) Conversion of angiotensin I to angiotensin II
D) Sodium reabsorption in the thick ascending limb
Correct Answer: Conversion of angiotensin I to angiotensin II
Rationale: ACE inhibition decreases angiotensin II formation and reduces aldosterone stimulation, lowering
vascular resistance and sodium retention. This distinction supports safe prescribing and monitoring in
cardiovascular pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment
strategies, or effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific
risks helps clinicians select treatment and recognize when reassessment is necessary.
,4. Dry cough develops after initiation of enalapril. Which mechanism best explains this effect?
A) Direct stimulation of beta-2 receptors
B) Excessive calcium-channel blockade
C) Increased uric acid excretion
D) Reduced breakdown of bradykinin
Correct Answer: Reduced breakdown of bradykinin
Rationale: ACE normally contributes to bradykinin degradation, so inhibition can increase bradykinin and
provoke a persistent dry cough. This distinction supports safe prescribing and monitoring in cardiovascular
pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment strategies, or
effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific risks helps
clinicians select treatment and recognize when reassessment is necessary.
5. A patient develops angioedema while taking ramipril. What is the appropriate response?
A) Stop the ACE inhibitor and urgently assess the airway
B) Continue at half the dose
C) Add another ACE inhibitor
D) Treat solely with a cough suppressant
Correct Answer: Stop the ACE inhibitor and urgently assess the airway
Rationale: ACE inhibitor–associated angioedema can compromise the airway and warrants immediate
discontinuation and urgent evaluation. This distinction supports safe prescribing and monitoring in
cardiovascular pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment
strategies, or effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific
risks helps clinicians select treatment and recognize when reassessment is necessary.
6. An individual taking losartan asks how it works. Which target does losartan block?
A) Angiotensin-converting enzyme
B) Angiotensin II type 1 receptors
C) Beta-1 adrenergic receptors
D) Mineralocorticoid receptors
Correct Answer: Angiotensin II type 1 receptors
Rationale: ARBs selectively block AT1 receptor signaling, decreasing vasoconstriction and aldosterone-
mediated effects without directly inhibiting ACE. This distinction supports safe prescribing and monitoring in
cardiovascular pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment
strategies, or effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific
risks helps clinicians select treatment and recognize when reassessment is necessary.
7. Serum potassium rises after valsartan is started. What explains this laboratory change?
A) Increased potassium secretion by the collecting duct
B) Increased intestinal potassium loss
C) Reduced aldosterone-mediated potassium excretion
, D) Inhibition of dietary potassium absorption
Correct Answer: Reduced aldosterone-mediated potassium excretion
Rationale: Blocking angiotensin II decreases aldosterone signaling, which can reduce renal potassium excretion
and produce hyperkalemia. This distinction supports safe prescribing and monitoring in cardiovascular
pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment strategies, or
effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific risks helps
clinicians select treatment and recognize when reassessment is necessary.
8. A patient taking an ACE inhibitor becomes pregnant. Which medication concern takes priority?
A) Expected harmless fetal exposure
B) Protection against fetal renal injury
C) Prevention of maternal hyperkalemia
D) Potential fetal toxicity requiring prompt treatment review
Correct Answer: Potential fetal toxicity requiring prompt treatment review
Rationale: Drugs that inhibit the renin–angiotensin system can injure the developing fetus and should not be
continued during pregnancy. This distinction supports safe prescribing and monitoring in cardiovascular
pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment strategies, or
effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific risks helps
clinicians select treatment and recognize when reassessment is necessary.
9. Which drug is a long-acting dihydropyridine calcium-channel blocker used for hypertension?
A) Amlodipine
B) Verapamil
C) Diltiazem
D) Digoxin
Correct Answer: Amlodipine
Rationale: Amlodipine preferentially relaxes vascular smooth muscle, lowering peripheral resistance and blood
pressure with comparatively limited direct AV-node effects. This distinction supports safe prescribing and
monitoring in cardiovascular pharmacotherapy. Alternative choices describe different drug targets,
inappropriate treatment strategies, or effects that do not explain the clinical finding. Applying the mechanism
alongside patient-specific risks helps clinicians select treatment and recognize when reassessment is
necessary.
10. Bilateral ankle swelling follows initiation of amlodipine. Which explanation is most likely?
A) Severe potassium depletion is inevitable
B) Precapillary arteriolar dilation increases capillary hydrostatic pressure
C) Increased venous constriction prevents edema
D) Direct injury to the glomerulus is the usual mechanism
Correct Answer: Precapillary arteriolar dilation increases capillary hydrostatic pressure
Rationale: Dihydropyridine calcium-channel blockers can cause dependent edema through unequal arteriolar
and venous dilation rather than generalized fluid overload. This distinction supports safe prescribing and
monitoring in cardiovascular pharmacotherapy. Alternative choices describe different drug targets,
Pharmacology – Cardiovascular Pharmacotherapy
Practice Questions (docx) | 2026/2027 | Nursing
1. An adult with uncomplicated stage 2 hypertension is starting treatment. Which initial strategy follows current
guidance?
A) Two complementary first-line antihypertensives, preferably in one pill
B) A beta blocker alone
C) An ACE inhibitor plus an ARB
D) A loop diuretic alone
Correct Answer: Two complementary first-line antihypertensives, preferably in one pill
Rationale: Using two complementary first-line classes usually achieves faster blood pressure control and
improves adherence when supplied as one pill. This distinction supports safe prescribing and monitoring in
cardiovascular pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment
strategies, or effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific
risks helps clinicians select treatment and recognize when reassessment is necessary.
2. A person with stage 1 hypertension and low predicted cardiovascular risk has no symptoms. What initial
approach is appropriate?
A) Immediate triple-drug therapy
B) Lifestyle intervention followed by reassessment over three to six months
C) Routine intravenous labetalol
D) Permanent avoidance of all exercise
Correct Answer: Lifestyle intervention followed by reassessment over three to six months
Rationale: In lower-risk stage 1 hypertension, lifestyle modification can precede medication, with subsequent
reassessment of blood pressure. This distinction supports safe prescribing and monitoring in cardiovascular
pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment strategies, or
effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific risks helps
clinicians select treatment and recognize when reassessment is necessary.
3. A clinician selects lisinopril for hypertension. Which process does this drug inhibit?
A) Aldosterone binding to its receptor
B) Calcium influx through L-type channels
C) Conversion of angiotensin I to angiotensin II
D) Sodium reabsorption in the thick ascending limb
Correct Answer: Conversion of angiotensin I to angiotensin II
Rationale: ACE inhibition decreases angiotensin II formation and reduces aldosterone stimulation, lowering
vascular resistance and sodium retention. This distinction supports safe prescribing and monitoring in
cardiovascular pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment
strategies, or effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific
risks helps clinicians select treatment and recognize when reassessment is necessary.
,4. Dry cough develops after initiation of enalapril. Which mechanism best explains this effect?
A) Direct stimulation of beta-2 receptors
B) Excessive calcium-channel blockade
C) Increased uric acid excretion
D) Reduced breakdown of bradykinin
Correct Answer: Reduced breakdown of bradykinin
Rationale: ACE normally contributes to bradykinin degradation, so inhibition can increase bradykinin and
provoke a persistent dry cough. This distinction supports safe prescribing and monitoring in cardiovascular
pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment strategies, or
effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific risks helps
clinicians select treatment and recognize when reassessment is necessary.
5. A patient develops angioedema while taking ramipril. What is the appropriate response?
A) Stop the ACE inhibitor and urgently assess the airway
B) Continue at half the dose
C) Add another ACE inhibitor
D) Treat solely with a cough suppressant
Correct Answer: Stop the ACE inhibitor and urgently assess the airway
Rationale: ACE inhibitor–associated angioedema can compromise the airway and warrants immediate
discontinuation and urgent evaluation. This distinction supports safe prescribing and monitoring in
cardiovascular pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment
strategies, or effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific
risks helps clinicians select treatment and recognize when reassessment is necessary.
6. An individual taking losartan asks how it works. Which target does losartan block?
A) Angiotensin-converting enzyme
B) Angiotensin II type 1 receptors
C) Beta-1 adrenergic receptors
D) Mineralocorticoid receptors
Correct Answer: Angiotensin II type 1 receptors
Rationale: ARBs selectively block AT1 receptor signaling, decreasing vasoconstriction and aldosterone-
mediated effects without directly inhibiting ACE. This distinction supports safe prescribing and monitoring in
cardiovascular pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment
strategies, or effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific
risks helps clinicians select treatment and recognize when reassessment is necessary.
7. Serum potassium rises after valsartan is started. What explains this laboratory change?
A) Increased potassium secretion by the collecting duct
B) Increased intestinal potassium loss
C) Reduced aldosterone-mediated potassium excretion
, D) Inhibition of dietary potassium absorption
Correct Answer: Reduced aldosterone-mediated potassium excretion
Rationale: Blocking angiotensin II decreases aldosterone signaling, which can reduce renal potassium excretion
and produce hyperkalemia. This distinction supports safe prescribing and monitoring in cardiovascular
pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment strategies, or
effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific risks helps
clinicians select treatment and recognize when reassessment is necessary.
8. A patient taking an ACE inhibitor becomes pregnant. Which medication concern takes priority?
A) Expected harmless fetal exposure
B) Protection against fetal renal injury
C) Prevention of maternal hyperkalemia
D) Potential fetal toxicity requiring prompt treatment review
Correct Answer: Potential fetal toxicity requiring prompt treatment review
Rationale: Drugs that inhibit the renin–angiotensin system can injure the developing fetus and should not be
continued during pregnancy. This distinction supports safe prescribing and monitoring in cardiovascular
pharmacotherapy. Alternative choices describe different drug targets, inappropriate treatment strategies, or
effects that do not explain the clinical finding. Applying the mechanism alongside patient-specific risks helps
clinicians select treatment and recognize when reassessment is necessary.
9. Which drug is a long-acting dihydropyridine calcium-channel blocker used for hypertension?
A) Amlodipine
B) Verapamil
C) Diltiazem
D) Digoxin
Correct Answer: Amlodipine
Rationale: Amlodipine preferentially relaxes vascular smooth muscle, lowering peripheral resistance and blood
pressure with comparatively limited direct AV-node effects. This distinction supports safe prescribing and
monitoring in cardiovascular pharmacotherapy. Alternative choices describe different drug targets,
inappropriate treatment strategies, or effects that do not explain the clinical finding. Applying the mechanism
alongside patient-specific risks helps clinicians select treatment and recognize when reassessment is
necessary.
10. Bilateral ankle swelling follows initiation of amlodipine. Which explanation is most likely?
A) Severe potassium depletion is inevitable
B) Precapillary arteriolar dilation increases capillary hydrostatic pressure
C) Increased venous constriction prevents edema
D) Direct injury to the glomerulus is the usual mechanism
Correct Answer: Precapillary arteriolar dilation increases capillary hydrostatic pressure
Rationale: Dihydropyridine calcium-channel blockers can cause dependent edema through unequal arteriolar
and venous dilation rather than generalized fluid overload. This distinction supports safe prescribing and
monitoring in cardiovascular pharmacotherapy. Alternative choices describe different drug targets,
