Regis NU 650 Midterm Exam – 200+
Questions with Correct Answers
1. A 55-year-old patient with hypertension presents with a blood pressure of 168/98 mmHg
despite taking lisinopril 20 mg daily. The NP decides to add a second antihypertensive. Which
drug class is most appropriate to add due to its synergistic effect in reducing peripheral
vascular resistance?
a) Thiazide diuretic
b) Loop diuretic
c) Beta-blocker
d) Calcium channel blocker (non-dihydropyridine)
Answer: a) Thiazide diuretic
Rationale: The combination of an ACE inhibitor (like lisinopril) and a thiazide diuretic is a
common and effective strategy. The diuretic reduces plasma volume, while the ACE inhibitor
reduces vascular resistance, providing a synergistic effect.
2. In the RAAS system, which enzyme is responsible for converting Angiotensin I to
Angiotensin II?
a) Renin
b) ACE (Angiotensin-Converting Enzyme)
c) Aldosterone synthase
d) ACE 2
Answer: b) ACE (Angiotensin-Converting Enzyme)
Rationale: Renin converts angiotensinogen to Angiotensin I. ACE then converts Angiotensin I to
the potent vasoconstrictor Angiotensin II.
3. A patient with heart failure has an ejection fraction of 28%. Which neurohormonal system
is most maladaptively activated in this condition?
a) Natriuretic peptide system
b) Renin-Angiotensin-Aldosterone System (RAAS)
c) Parasympathetic nervous system
d) Dopaminergic system
Answer: b) Renin-Angiotensin-Aldosterone System (RAAS)
Rationale: In heart failure, reduced cardiac output activates the RAAS in a compensatory
,manner, leading to vasoconstriction, sodium/water retention, and remodeling, which ultimately
worsens the condition.
4. First-line pharmacotherapy for a newly diagnosed patient with uncomplicated hypertension
(African American male, 45 years old) is most likely:
a) ACE inhibitor
b) Thiazide diuretic
c) Beta-blocker
d) Calcium channel blocker (Dihydropyridine)
Answer: d) Calcium channel blocker (Dihydropyridine)
Rationale: JNC-8 guidelines recommend calcium channel blockers or thiazide diuretics as first-
line therapy for African American patients, as they often have a low-renin form of hypertension
and show a better response to these agents.
5. Which finding is a classic sign of left-sided heart failure?
a) Jugular venous distension
b) Hepatomegaly
c) Dependent edema
d) Crackles in the lung bases
Answer: d) Crackles in the lung bases
Rationale: Left-sided heart failure leads to pulmonary congestion and edema, manifesting as
crackles (rales) on auscultation. The other options are signs of right-sided heart failure.
6. The mechanism of action of statin drugs is:
a) Inhibition of HMG-CoA reductase
b) Binding bile acids in the intestine
c) Inhibition of cholesterol absorption in the jejunum
d) Activation of lipoprotein lipase
Answer: a) Inhibition of HMG-CoA reductase
Rationale: Statins work by competitively inhibiting HMG-CoA reductase, the rate-limiting
enzyme in the hepatic synthesis of cholesterol.
7. A patient presents with chest pain that is relieved by leaning forward. On exam, a triphasic
pericardial friction rub is heard. The most likely diagnosis is:
a) Unstable angina
b) Myocardial infarction
c) Acute pericarditis
d) Pulmonary embolism
Answer: c) Acute pericarditis
Rationale: The classic triad for pericarditis is pleuritic chest pain (worsened by lying down,
, improved by sitting up/leaning forward), pericardial friction rub, and diffuse ST-elevations on
ECG.
8. Which electrolyte imbalance is most commonly associated with digoxin toxicity?
a) Hyperkalemia
b) Hypokalemia
c) Hypercalcemia
d) Hypomagnesemia
Answer: b) Hypokalemia
Rationale: Hypokalemia potentiates digoxin toxicity by increasing the binding of digoxin to
cardiac cells, leading to an increased risk of life-threatening arrhythmias.
9. The preferred initial diagnostic test for confirming a diagnosis of heart failure with reduced
ejection fraction (HFrEF) is:
a) Chest X-ray
b) BNP level
c) Echocardiogram
d) ECG
Answer: c) Echocardiogram
Rationale: While BNP is a useful screening tool, an echocardiogram is the gold standard as it
directly assesses the ejection fraction, chamber size, and wall motion, confirming the diagnosis
and classifying the type of HF.
10. A major life-threatening adverse effect of ACE inhibitors is:
a) Persistent dry cough
b) Angioedema
c) Hyperkalemia
d) Both b and c
Answer: d) Both b and c
Rationale: While a dry cough is a common side effect, angioedema (which can cause airway
obstruction) and hyperkalemia (due to reduced aldosterone) are serious, life-threatening
adverse effects.
11. Which white blood cell is primarily responsible for the phagocytosis of bacteria in acute
inflammation?
a) Lymphocyte
b) Eosinophil
c) Neutrophil
d) Basophil
Answer: c) Neutrophil
Questions with Correct Answers
1. A 55-year-old patient with hypertension presents with a blood pressure of 168/98 mmHg
despite taking lisinopril 20 mg daily. The NP decides to add a second antihypertensive. Which
drug class is most appropriate to add due to its synergistic effect in reducing peripheral
vascular resistance?
a) Thiazide diuretic
b) Loop diuretic
c) Beta-blocker
d) Calcium channel blocker (non-dihydropyridine)
Answer: a) Thiazide diuretic
Rationale: The combination of an ACE inhibitor (like lisinopril) and a thiazide diuretic is a
common and effective strategy. The diuretic reduces plasma volume, while the ACE inhibitor
reduces vascular resistance, providing a synergistic effect.
2. In the RAAS system, which enzyme is responsible for converting Angiotensin I to
Angiotensin II?
a) Renin
b) ACE (Angiotensin-Converting Enzyme)
c) Aldosterone synthase
d) ACE 2
Answer: b) ACE (Angiotensin-Converting Enzyme)
Rationale: Renin converts angiotensinogen to Angiotensin I. ACE then converts Angiotensin I to
the potent vasoconstrictor Angiotensin II.
3. A patient with heart failure has an ejection fraction of 28%. Which neurohormonal system
is most maladaptively activated in this condition?
a) Natriuretic peptide system
b) Renin-Angiotensin-Aldosterone System (RAAS)
c) Parasympathetic nervous system
d) Dopaminergic system
Answer: b) Renin-Angiotensin-Aldosterone System (RAAS)
Rationale: In heart failure, reduced cardiac output activates the RAAS in a compensatory
,manner, leading to vasoconstriction, sodium/water retention, and remodeling, which ultimately
worsens the condition.
4. First-line pharmacotherapy for a newly diagnosed patient with uncomplicated hypertension
(African American male, 45 years old) is most likely:
a) ACE inhibitor
b) Thiazide diuretic
c) Beta-blocker
d) Calcium channel blocker (Dihydropyridine)
Answer: d) Calcium channel blocker (Dihydropyridine)
Rationale: JNC-8 guidelines recommend calcium channel blockers or thiazide diuretics as first-
line therapy for African American patients, as they often have a low-renin form of hypertension
and show a better response to these agents.
5. Which finding is a classic sign of left-sided heart failure?
a) Jugular venous distension
b) Hepatomegaly
c) Dependent edema
d) Crackles in the lung bases
Answer: d) Crackles in the lung bases
Rationale: Left-sided heart failure leads to pulmonary congestion and edema, manifesting as
crackles (rales) on auscultation. The other options are signs of right-sided heart failure.
6. The mechanism of action of statin drugs is:
a) Inhibition of HMG-CoA reductase
b) Binding bile acids in the intestine
c) Inhibition of cholesterol absorption in the jejunum
d) Activation of lipoprotein lipase
Answer: a) Inhibition of HMG-CoA reductase
Rationale: Statins work by competitively inhibiting HMG-CoA reductase, the rate-limiting
enzyme in the hepatic synthesis of cholesterol.
7. A patient presents with chest pain that is relieved by leaning forward. On exam, a triphasic
pericardial friction rub is heard. The most likely diagnosis is:
a) Unstable angina
b) Myocardial infarction
c) Acute pericarditis
d) Pulmonary embolism
Answer: c) Acute pericarditis
Rationale: The classic triad for pericarditis is pleuritic chest pain (worsened by lying down,
, improved by sitting up/leaning forward), pericardial friction rub, and diffuse ST-elevations on
ECG.
8. Which electrolyte imbalance is most commonly associated with digoxin toxicity?
a) Hyperkalemia
b) Hypokalemia
c) Hypercalcemia
d) Hypomagnesemia
Answer: b) Hypokalemia
Rationale: Hypokalemia potentiates digoxin toxicity by increasing the binding of digoxin to
cardiac cells, leading to an increased risk of life-threatening arrhythmias.
9. The preferred initial diagnostic test for confirming a diagnosis of heart failure with reduced
ejection fraction (HFrEF) is:
a) Chest X-ray
b) BNP level
c) Echocardiogram
d) ECG
Answer: c) Echocardiogram
Rationale: While BNP is a useful screening tool, an echocardiogram is the gold standard as it
directly assesses the ejection fraction, chamber size, and wall motion, confirming the diagnosis
and classifying the type of HF.
10. A major life-threatening adverse effect of ACE inhibitors is:
a) Persistent dry cough
b) Angioedema
c) Hyperkalemia
d) Both b and c
Answer: d) Both b and c
Rationale: While a dry cough is a common side effect, angioedema (which can cause airway
obstruction) and hyperkalemia (due to reduced aldosterone) are serious, life-threatening
adverse effects.
11. Which white blood cell is primarily responsible for the phagocytosis of bacteria in acute
inflammation?
a) Lymphocyte
b) Eosinophil
c) Neutrophil
d) Basophil
Answer: c) Neutrophil
