NURS 251 Pharmacology Module 7 - Cardiovascular | Portage Learning (2026/2027) Page 1
NURS 251 - Pharmacology Module 7 Examination
Cardiovascular Pharmacology | Portage Learning (2026/2027) Actual Questions & Answers with
Rationales
Total Questions: 90 | Cognitive Distribution: 35% Recall - 45% Application - 20% Analysis
Format: 70% Scenario-Based, 30% Direct Recall | Item Type: Multiple Choice (4 options, single best answer)
Coverage: CV foundations, antihypertensives, heart failure, antiarrhythmics, antianginals, lipid-lowering agents,
anticoagulants/antiplatelets, and CV medication safety.
Apply cardiovascular pharmacology principles, hold parameters, therapeutic monitoring, and patient safety standards to select
the single best answer for each item.
Section 1: Cardiovascular Pharmacology Foundations (Hemodynamics, Cardiac Function,
& Drug Principles) - Q1-Q12
Q1. A nursing student is studying cardiac output. Which formula correctly represents the relationship
between cardiac output (CO), stroke volume (SV), and heart rate (HR)?
A. CO = SV × HR [CORRECT]
B. CO = SV / HR
C. CO = HR / SV
D. CO = SV + HR
Correct Answer: A
Rationale: Cardiac output (CO) equals stroke volume (SV) multiplied by heart rate (HR): CO = SV × HR. A normal resting
CO is approximately 4-8 L/min. The other formulas misrepresent the physiologic relationship. Study note: CO = SV × HR; SV
is determined by preload, afterload, and contractility - the three determinants targeted by many CV drugs.
Q2. A patient with heart failure has increased venous return to the heart. The nurse understands that this
increased volume stretching the ventricular muscle fibers prior to contraction represents:
A. Afterload
B. Preload [CORRECT]
C. Contractility
D. Cardiac output
Correct Answer: B
Rationale: Preload is the volume and pressure stretching the ventricular muscle fibers at end-diastole - directly related to
venous return. Afterload is the resistance against which the ventricle must eject; contractility is the inherent squeezing strength
of the myocardium; cardiac output is the total volume pumped per minute. Study note: preload = "stretch" (volume coming
in); afterload = "resistance" (pressure pushing against ejection); contractility = "squeeze."
Q3. A nurse is caring for a patient with hypertension and high systemic vascular resistance. The nurse
understands that the resistance the left ventricle must overcome to eject blood represents:
A. Preload
B. Afterload [CORRECT]
C. Contractility
D. Heart rate
Correct Answer: B
Rationale: Afterload is the resistance the ventricle must overcome to open the semilunar valve and eject blood - largely
determined by systemic vascular resistance (SVR) for the left ventricle. Vasodilators reduce afterload; conditions like
hypertension and aortic stenosis increase it. Study note: afterload = "push-back" against ejection - reduced by vasodilators
Verified Answers + Detailed Rationales - Actual Questions & Answers NURS 251 Module 7 - 90 Items
,NURS 251 Pharmacology Module 7 - Cardiovascular | Portage Learning (2026/2027) Page 2
(ACE inhibitors, ARBs, hydralazine, nitroprusside).
Q4. A patient receives a medication that increases the force of myocardial contraction without changing
preload or afterload. The nurse recognizes this medication has a positive inotropic effect, which is best
defined as:
A. Increased heart rate
B. Increased force of myocardial contraction [CORRECT]
C. Decreased myocardial oxygen demand
D. Decreased peripheral resistance
Correct Answer: B
Rationale: Positive inotropy refers to increased force of myocardial contraction. Examples include digoxin, dobutamine, and
milrinone. Chronotropy refers to heart rate; dromotropy refers to conduction velocity. Study note: "inotrope" = force of
contraction; "chronotrope" = HR; "dromotrope" = conduction velocity - positive = increase, negative = decrease.
Q5. A nurse is preparing to administer a medication that affects the renin-angiotensin-aldosterone system
(RAAS). The nurse understands that angiotensin II primarily causes:
A. Vasodilation and sodium excretion
B. Vasoconstriction and aldosterone release, increasing blood pressure and volume [CORRECT]
C. Decreased sympathetic nervous system activity
D. Increased renal blood flow
Correct Answer: B
Rationale: Angiotensin II is a potent vasoconstrictor that also stimulates aldosterone release from the adrenal cortex, causing
sodium and water retention and potassium excretion - all of which increase blood pressure and circulating volume. ACE
inhibitors and ARBs target this pathway. Study note: Ang II = vasoconstriction + aldosterone + sympathetic activation; ACE
inhibitors block Ang II formation; ARBs block Ang II receptors.
Q6. A patient is prescribed a medication with a narrow therapeutic index. The nurse understands that this
means the medication:
A. Has a wide margin of safety
B. Has a small difference between therapeutic and toxic doses, requiring close monitoring [CORRECT]
C. Does not require monitoring
D. Can be administered safely at any dose
Correct Answer: B
Rationale: A narrow therapeutic index (or narrow therapeutic window) means the difference between the dose that produces
a therapeutic effect and the dose that causes toxicity is small. Examples include digoxin, warfarin, lithium, and heparin. These
drugs require close monitoring of drug levels and patient response. Study note: narrow TI = high-risk drug = monitor levels
(digoxin, warfarin INR, aPTT, etc.).
Q7. A patient receives a medication that stimulates beta-1 receptors in the heart. The nurse anticipates which
physiologic response?
A. Decreased heart rate and contractility
B. Increased heart rate and contractility [CORRECT]
C. Bronchoconstriction
D. Increased gastrointestinal motility
Correct Answer: B
Rationale: Beta-1 receptors are primarily located in the heart; stimulation increases heart rate (positive chronotropy),
contractility (positive inotropy), and conduction velocity (positive dromotropy). Beta-2 receptors in the lungs cause
bronchodilation when stimulated. Study note: Beta-1 = Heart (HR, contractility); Beta-2 = Lungs (bronchodilation);
Beta-blockers that are cardioselective target Beta-1.
Verified Answers + Detailed Rationales - Actual Questions & Answers NURS 251 Module 7 - 90 Items
, NURS 251 Pharmacology Module 7 - Cardiovascular | Portage Learning (2026/2027) Page 3
Q8. A patient receives a medication that blocks alpha-1 receptors. The nurse anticipates which physiologic
effect?
A. Vasoconstriction and increased blood pressure
B. Vasodilation and decreased blood pressure [CORRECT]
C. Increased heart rate and contractility
D. Bronchoconstriction
Correct Answer: B
Rationale: Alpha-1 receptor blockade causes vasodilation and decreased blood pressure, as alpha-1 stimulation normally
causes vasoconstriction. Examples of alpha-1 blockers include prazosin, doxazosin, and tamsulosin. Study note: Alpha-1 =
vasoconstriction (so blocking causes vasodilation); non-selective alpha/beta blockers like carvedilol and labetalol also block
alpha-1, contributing to BP lowering.
Q9. A nurse is caring for a patient receiving a medication with a half-life of 12 hours. The nurse understands
that approximately how long it will take for the medication to reach steady state?
A. 12 hours
B. 24 hours
C. 48 hours
D. 60 hours (approximately 5 half-lives) [CORRECT]
Correct Answer: D
Rationale: Steady state is reached in approximately 4-5 half-lives. For a drug with a 12-hour half-life, steady state would be
reached in 48-60 hours (about 2-2.5 days). This principle is important for timing drug level monitoring and evaluating
therapeutic effect. Study note: 4-5 half-lives to steady state; 4-5 half-lives to elimination after the last dose.
Q10. A patient with cirrhosis has decreased albumin levels. The nurse anticipates that medications that are
highly protein-bound will have:
A. Increased free (active) drug levels, potentially increasing toxicity [CORRECT]
B. Decreased free drug levels
C. No change in drug effect
D. Increased drug clearance
Correct Answer: A
Rationale: With hypoalbuminemia, fewer protein-binding sites are available, leaving more free (active) drug in circulation.
This increases the risk of toxicity, especially for highly protein-bound drugs like warfarin, phenytoin, and digoxin. Study note:
low albumin = more free drug = higher risk of toxicity; check albumin and total protein before administering highly bound
drugs in liver disease.
Q11. A nurse is administering a medication that undergoes first-pass hepatic metabolism. The nurse
understands that this means the medication:
A. Is fully active before reaching the liver
B. Is partially inactivated by the liver before reaching systemic circulation when given orally
[CORRECT]
C. Cannot be given by mouth
D. Bypasses the liver entirely
Correct Answer: B
Rationale: First-pass (presystemic) metabolism occurs when oral medications are absorbed through the gut and transported
via the portal vein to the liver, where a portion is metabolized before reaching systemic circulation. This reduces
bioavailability; some drugs (like nitroglycerin) are given sublingually to bypass first-pass metabolism. Study note: first-pass =
liver metabolizes drug before systemic effect; sublingual, IV, and transdermal routes bypass this.
Verified Answers + Detailed Rationales - Actual Questions & Answers NURS 251 Module 7 - 90 Items
NURS 251 - Pharmacology Module 7 Examination
Cardiovascular Pharmacology | Portage Learning (2026/2027) Actual Questions & Answers with
Rationales
Total Questions: 90 | Cognitive Distribution: 35% Recall - 45% Application - 20% Analysis
Format: 70% Scenario-Based, 30% Direct Recall | Item Type: Multiple Choice (4 options, single best answer)
Coverage: CV foundations, antihypertensives, heart failure, antiarrhythmics, antianginals, lipid-lowering agents,
anticoagulants/antiplatelets, and CV medication safety.
Apply cardiovascular pharmacology principles, hold parameters, therapeutic monitoring, and patient safety standards to select
the single best answer for each item.
Section 1: Cardiovascular Pharmacology Foundations (Hemodynamics, Cardiac Function,
& Drug Principles) - Q1-Q12
Q1. A nursing student is studying cardiac output. Which formula correctly represents the relationship
between cardiac output (CO), stroke volume (SV), and heart rate (HR)?
A. CO = SV × HR [CORRECT]
B. CO = SV / HR
C. CO = HR / SV
D. CO = SV + HR
Correct Answer: A
Rationale: Cardiac output (CO) equals stroke volume (SV) multiplied by heart rate (HR): CO = SV × HR. A normal resting
CO is approximately 4-8 L/min. The other formulas misrepresent the physiologic relationship. Study note: CO = SV × HR; SV
is determined by preload, afterload, and contractility - the three determinants targeted by many CV drugs.
Q2. A patient with heart failure has increased venous return to the heart. The nurse understands that this
increased volume stretching the ventricular muscle fibers prior to contraction represents:
A. Afterload
B. Preload [CORRECT]
C. Contractility
D. Cardiac output
Correct Answer: B
Rationale: Preload is the volume and pressure stretching the ventricular muscle fibers at end-diastole - directly related to
venous return. Afterload is the resistance against which the ventricle must eject; contractility is the inherent squeezing strength
of the myocardium; cardiac output is the total volume pumped per minute. Study note: preload = "stretch" (volume coming
in); afterload = "resistance" (pressure pushing against ejection); contractility = "squeeze."
Q3. A nurse is caring for a patient with hypertension and high systemic vascular resistance. The nurse
understands that the resistance the left ventricle must overcome to eject blood represents:
A. Preload
B. Afterload [CORRECT]
C. Contractility
D. Heart rate
Correct Answer: B
Rationale: Afterload is the resistance the ventricle must overcome to open the semilunar valve and eject blood - largely
determined by systemic vascular resistance (SVR) for the left ventricle. Vasodilators reduce afterload; conditions like
hypertension and aortic stenosis increase it. Study note: afterload = "push-back" against ejection - reduced by vasodilators
Verified Answers + Detailed Rationales - Actual Questions & Answers NURS 251 Module 7 - 90 Items
,NURS 251 Pharmacology Module 7 - Cardiovascular | Portage Learning (2026/2027) Page 2
(ACE inhibitors, ARBs, hydralazine, nitroprusside).
Q4. A patient receives a medication that increases the force of myocardial contraction without changing
preload or afterload. The nurse recognizes this medication has a positive inotropic effect, which is best
defined as:
A. Increased heart rate
B. Increased force of myocardial contraction [CORRECT]
C. Decreased myocardial oxygen demand
D. Decreased peripheral resistance
Correct Answer: B
Rationale: Positive inotropy refers to increased force of myocardial contraction. Examples include digoxin, dobutamine, and
milrinone. Chronotropy refers to heart rate; dromotropy refers to conduction velocity. Study note: "inotrope" = force of
contraction; "chronotrope" = HR; "dromotrope" = conduction velocity - positive = increase, negative = decrease.
Q5. A nurse is preparing to administer a medication that affects the renin-angiotensin-aldosterone system
(RAAS). The nurse understands that angiotensin II primarily causes:
A. Vasodilation and sodium excretion
B. Vasoconstriction and aldosterone release, increasing blood pressure and volume [CORRECT]
C. Decreased sympathetic nervous system activity
D. Increased renal blood flow
Correct Answer: B
Rationale: Angiotensin II is a potent vasoconstrictor that also stimulates aldosterone release from the adrenal cortex, causing
sodium and water retention and potassium excretion - all of which increase blood pressure and circulating volume. ACE
inhibitors and ARBs target this pathway. Study note: Ang II = vasoconstriction + aldosterone + sympathetic activation; ACE
inhibitors block Ang II formation; ARBs block Ang II receptors.
Q6. A patient is prescribed a medication with a narrow therapeutic index. The nurse understands that this
means the medication:
A. Has a wide margin of safety
B. Has a small difference between therapeutic and toxic doses, requiring close monitoring [CORRECT]
C. Does not require monitoring
D. Can be administered safely at any dose
Correct Answer: B
Rationale: A narrow therapeutic index (or narrow therapeutic window) means the difference between the dose that produces
a therapeutic effect and the dose that causes toxicity is small. Examples include digoxin, warfarin, lithium, and heparin. These
drugs require close monitoring of drug levels and patient response. Study note: narrow TI = high-risk drug = monitor levels
(digoxin, warfarin INR, aPTT, etc.).
Q7. A patient receives a medication that stimulates beta-1 receptors in the heart. The nurse anticipates which
physiologic response?
A. Decreased heart rate and contractility
B. Increased heart rate and contractility [CORRECT]
C. Bronchoconstriction
D. Increased gastrointestinal motility
Correct Answer: B
Rationale: Beta-1 receptors are primarily located in the heart; stimulation increases heart rate (positive chronotropy),
contractility (positive inotropy), and conduction velocity (positive dromotropy). Beta-2 receptors in the lungs cause
bronchodilation when stimulated. Study note: Beta-1 = Heart (HR, contractility); Beta-2 = Lungs (bronchodilation);
Beta-blockers that are cardioselective target Beta-1.
Verified Answers + Detailed Rationales - Actual Questions & Answers NURS 251 Module 7 - 90 Items
, NURS 251 Pharmacology Module 7 - Cardiovascular | Portage Learning (2026/2027) Page 3
Q8. A patient receives a medication that blocks alpha-1 receptors. The nurse anticipates which physiologic
effect?
A. Vasoconstriction and increased blood pressure
B. Vasodilation and decreased blood pressure [CORRECT]
C. Increased heart rate and contractility
D. Bronchoconstriction
Correct Answer: B
Rationale: Alpha-1 receptor blockade causes vasodilation and decreased blood pressure, as alpha-1 stimulation normally
causes vasoconstriction. Examples of alpha-1 blockers include prazosin, doxazosin, and tamsulosin. Study note: Alpha-1 =
vasoconstriction (so blocking causes vasodilation); non-selective alpha/beta blockers like carvedilol and labetalol also block
alpha-1, contributing to BP lowering.
Q9. A nurse is caring for a patient receiving a medication with a half-life of 12 hours. The nurse understands
that approximately how long it will take for the medication to reach steady state?
A. 12 hours
B. 24 hours
C. 48 hours
D. 60 hours (approximately 5 half-lives) [CORRECT]
Correct Answer: D
Rationale: Steady state is reached in approximately 4-5 half-lives. For a drug with a 12-hour half-life, steady state would be
reached in 48-60 hours (about 2-2.5 days). This principle is important for timing drug level monitoring and evaluating
therapeutic effect. Study note: 4-5 half-lives to steady state; 4-5 half-lives to elimination after the last dose.
Q10. A patient with cirrhosis has decreased albumin levels. The nurse anticipates that medications that are
highly protein-bound will have:
A. Increased free (active) drug levels, potentially increasing toxicity [CORRECT]
B. Decreased free drug levels
C. No change in drug effect
D. Increased drug clearance
Correct Answer: A
Rationale: With hypoalbuminemia, fewer protein-binding sites are available, leaving more free (active) drug in circulation.
This increases the risk of toxicity, especially for highly protein-bound drugs like warfarin, phenytoin, and digoxin. Study note:
low albumin = more free drug = higher risk of toxicity; check albumin and total protein before administering highly bound
drugs in liver disease.
Q11. A nurse is administering a medication that undergoes first-pass hepatic metabolism. The nurse
understands that this means the medication:
A. Is fully active before reaching the liver
B. Is partially inactivated by the liver before reaching systemic circulation when given orally
[CORRECT]
C. Cannot be given by mouth
D. Bypasses the liver entirely
Correct Answer: B
Rationale: First-pass (presystemic) metabolism occurs when oral medications are absorbed through the gut and transported
via the portal vein to the liver, where a portion is metabolized before reaching systemic circulation. This reduces
bioavailability; some drugs (like nitroglycerin) are given sublingually to bypass first-pass metabolism. Study note: first-pass =
liver metabolizes drug before systemic effect; sublingual, IV, and transdermal routes bypass this.
Verified Answers + Detailed Rationales - Actual Questions & Answers NURS 251 Module 7 - 90 Items
