NUR 2474 Pharmacology Exam 2 Rasmussen
University 2026/2027 | Complete Study
Guide | Graded A+
Question 1: A patient with hypertension is started on lisinopril. The nurse knows that
ACE inhibitors are particularly beneficial for hypertensive patients with which
comorbidity?
A) Asthma
B) Diabetes mellitus with proteinuria
C) Gout
D) Peripheral artery disease
Answer: B
Rationale: ACE inhibitors reduce intraglomerular pressure and slow the progression of
diabetic nephropathy, making them especially beneficial for patients with diabetes and
proteinuria. They provide renal protection beyond their antihypertensive effects.
Question 2: A patient taking lisinopril reports a persistent dry cough. The nurse
recognizes this as:
A) An anaphylactic reaction requiring immediate epinephrine
B) A common side effect of ACE inhibitors due to bradykinin accumulation
C) A sign of heart failure exacerbation
D) A psychosomatic response unrelated to the medication
Answer: B
Rationale: ACE inhibitors cause a dry, non-productive cough in 5-20% of patients due
to increased bradykinin levels. ARBs do not cause this cough and are a suitable
alternative. The cough is not a sign of anaphylaxis or heart failure.
,Question 3: A patient prescribed metoprolol for hypertension and heart failure makes
which statement indicating a need for further teaching?
A) "I should not stop this medication suddenly."
B) "I will check my heart rate before taking it."
C) "I can stop this medication if I feel tired."
D) "This medication may make me feel tired at first."
Answer: C
Rationale: Abrupt withdrawal of beta-blockers can cause rebound hypertension,
tachycardia, and increased risk of myocardial infarction. Metoprolol must be tapered
gradually under medical supervision. Fatigue is a common initial side effect but does not
warrant abrupt discontinuation.
Question 4: A patient with hypertension and chronic kidney disease is prescribed
lisinopril. Which laboratory value should be monitored closely?
A) Hemoglobin
B) Serum potassium and creatinine
C) Blood glucose
D) Liver function tests
Answer: B
Rationale: ACE inhibitors can cause hyperkalemia and a reversible increase in creatinine
(up to 30%). Monitoring renal function and potassium is essential, especially in patients
with CKD. The patient should be educated to report signs of hyperkalemia (muscle
weakness, palpitations).
Question 5: A patient taking losartan asks the nurse how this medication differs from
lisinopril. The nurse's best response is:
A) "Losartan is more effective at lowering blood pressure."
B) "Losartan does not cause the dry cough that lisinopril can cause."
C) "Losartan works immediately, while lisinopril takes weeks."
D) "Losartan has more side effects than lisinopril."
,Answer: B
Rationale: ARBs do not inhibit bradykinin breakdown and therefore do not cause the
characteristic ACE inhibitor cough. Both are similarly effective. ARBs are preferred when
patients cannot tolerate ACE inhibitors due to cough.
Question 6: A patient is prescribed hydralazine for hypertension. The nurse should
teach the patient to report which potential adverse effect?
A) Dry cough
B) Lupus-like syndrome (fever, joint pain, rash)
C) Peripheral edema
D) Bradycardia
Answer: B
Rationale: Hydralazine can cause a drug-induced lupus erythematosus, especially in
slow acetylators. Symptoms include fever, arthralgia, and rash. Patients should be
monitored for these symptoms, and the medication may need to be discontinued.
Question 7: A patient is prescribed clonidine for hypertension. Which instruction is most
important?
A) "Take this medication with a full glass of milk."
B) "Do not stop this medication abruptly; it can cause rebound hypertension."
C) "This medication may cause hyperkalemia."
D) "Take this medication only when your blood pressure is elevated."
Answer: B
Rationale: Abrupt clonidine withdrawal can cause severe rebound hypertension,
tachycardia, and sympathetic overactivity. The dose must be tapered gradually over 2-4
days to prevent this life-threatening complication.
Question 8: A patient is prescribed doxazosin for benign prostatic hyperplasia and
hypertension. The nurse should instruct the patient to take the first dose:
, A) In the morning with breakfast
B) At bedtime to prevent orthostatic hypotension
C) With a full glass of grapefruit juice
D) Only when experiencing urinary symptoms
Answer: B
Rationale: Alpha-1 blockers (doxazosin, terazosin) can cause significant first-dose
orthostatic hypotension due to sudden vasodilation. Taking the first dose at bedtime
reduces the risk of falls and syncope.
Question 9: A patient with hypertension and asthma is prescribed a beta-blocker.
Which beta-blocker would be safest for this patient?
A) Propranolol
B) Metoprolol
C) Nadolol
D) Timolol
Answer: B
Rationale: Metoprolol is a cardioselective beta-1 blocker with less effect on beta-2
receptors in the lungs. Propranolol, nadolol, and timolol are non-selective and can cause
bronchospasm in patients with asthma or COPD.
Question 10: A nurse administers an ACE inhibitor to a patient taking it for the first
time. What must the nurse include in the client's education?
A) "Take this medication with potassium supplements."
B) "Do not get up without assistance; you may feel dizzy."
C) "Report any muscle pain immediately."
D) "This medication works within 30 minutes."
Answer: B
Rationale: First-dose hypotension can occur with ACE inhibitors, causing dizziness and
lightheadedness. The patient should be instructed to rise slowly and request assistance
University 2026/2027 | Complete Study
Guide | Graded A+
Question 1: A patient with hypertension is started on lisinopril. The nurse knows that
ACE inhibitors are particularly beneficial for hypertensive patients with which
comorbidity?
A) Asthma
B) Diabetes mellitus with proteinuria
C) Gout
D) Peripheral artery disease
Answer: B
Rationale: ACE inhibitors reduce intraglomerular pressure and slow the progression of
diabetic nephropathy, making them especially beneficial for patients with diabetes and
proteinuria. They provide renal protection beyond their antihypertensive effects.
Question 2: A patient taking lisinopril reports a persistent dry cough. The nurse
recognizes this as:
A) An anaphylactic reaction requiring immediate epinephrine
B) A common side effect of ACE inhibitors due to bradykinin accumulation
C) A sign of heart failure exacerbation
D) A psychosomatic response unrelated to the medication
Answer: B
Rationale: ACE inhibitors cause a dry, non-productive cough in 5-20% of patients due
to increased bradykinin levels. ARBs do not cause this cough and are a suitable
alternative. The cough is not a sign of anaphylaxis or heart failure.
,Question 3: A patient prescribed metoprolol for hypertension and heart failure makes
which statement indicating a need for further teaching?
A) "I should not stop this medication suddenly."
B) "I will check my heart rate before taking it."
C) "I can stop this medication if I feel tired."
D) "This medication may make me feel tired at first."
Answer: C
Rationale: Abrupt withdrawal of beta-blockers can cause rebound hypertension,
tachycardia, and increased risk of myocardial infarction. Metoprolol must be tapered
gradually under medical supervision. Fatigue is a common initial side effect but does not
warrant abrupt discontinuation.
Question 4: A patient with hypertension and chronic kidney disease is prescribed
lisinopril. Which laboratory value should be monitored closely?
A) Hemoglobin
B) Serum potassium and creatinine
C) Blood glucose
D) Liver function tests
Answer: B
Rationale: ACE inhibitors can cause hyperkalemia and a reversible increase in creatinine
(up to 30%). Monitoring renal function and potassium is essential, especially in patients
with CKD. The patient should be educated to report signs of hyperkalemia (muscle
weakness, palpitations).
Question 5: A patient taking losartan asks the nurse how this medication differs from
lisinopril. The nurse's best response is:
A) "Losartan is more effective at lowering blood pressure."
B) "Losartan does not cause the dry cough that lisinopril can cause."
C) "Losartan works immediately, while lisinopril takes weeks."
D) "Losartan has more side effects than lisinopril."
,Answer: B
Rationale: ARBs do not inhibit bradykinin breakdown and therefore do not cause the
characteristic ACE inhibitor cough. Both are similarly effective. ARBs are preferred when
patients cannot tolerate ACE inhibitors due to cough.
Question 6: A patient is prescribed hydralazine for hypertension. The nurse should
teach the patient to report which potential adverse effect?
A) Dry cough
B) Lupus-like syndrome (fever, joint pain, rash)
C) Peripheral edema
D) Bradycardia
Answer: B
Rationale: Hydralazine can cause a drug-induced lupus erythematosus, especially in
slow acetylators. Symptoms include fever, arthralgia, and rash. Patients should be
monitored for these symptoms, and the medication may need to be discontinued.
Question 7: A patient is prescribed clonidine for hypertension. Which instruction is most
important?
A) "Take this medication with a full glass of milk."
B) "Do not stop this medication abruptly; it can cause rebound hypertension."
C) "This medication may cause hyperkalemia."
D) "Take this medication only when your blood pressure is elevated."
Answer: B
Rationale: Abrupt clonidine withdrawal can cause severe rebound hypertension,
tachycardia, and sympathetic overactivity. The dose must be tapered gradually over 2-4
days to prevent this life-threatening complication.
Question 8: A patient is prescribed doxazosin for benign prostatic hyperplasia and
hypertension. The nurse should instruct the patient to take the first dose:
, A) In the morning with breakfast
B) At bedtime to prevent orthostatic hypotension
C) With a full glass of grapefruit juice
D) Only when experiencing urinary symptoms
Answer: B
Rationale: Alpha-1 blockers (doxazosin, terazosin) can cause significant first-dose
orthostatic hypotension due to sudden vasodilation. Taking the first dose at bedtime
reduces the risk of falls and syncope.
Question 9: A patient with hypertension and asthma is prescribed a beta-blocker.
Which beta-blocker would be safest for this patient?
A) Propranolol
B) Metoprolol
C) Nadolol
D) Timolol
Answer: B
Rationale: Metoprolol is a cardioselective beta-1 blocker with less effect on beta-2
receptors in the lungs. Propranolol, nadolol, and timolol are non-selective and can cause
bronchospasm in patients with asthma or COPD.
Question 10: A nurse administers an ACE inhibitor to a patient taking it for the first
time. What must the nurse include in the client's education?
A) "Take this medication with potassium supplements."
B) "Do not get up without assistance; you may feel dizzy."
C) "Report any muscle pain immediately."
D) "This medication works within 30 minutes."
Answer: B
Rationale: First-dose hypotension can occur with ACE inhibitors, causing dizziness and
lightheadedness. The patient should be instructed to rise slowly and request assistance
