1
NURS 251 Pharmacology Module 8 Exam
Portage Learning Actual 2026/2027 with
Detailed Rationales | Complete Exam-
Style Questions | Pass Guaranteed – A+
Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular Pharmacology — Part 1 | Q1 – Q10
Section 2 | Cardiovascular Pharmacology — Part 2 | Q11 – Q20
Section 3 | Renal & Urinary Pharmacology | Q21 – Q30
Section 4 | Hematologic & Renal Adjuvant Pharmacology | Q31 – Q38
Section 5 | NGN-Style Clinical Judgment & Integrated Case Analysis |
Q39 – Q50
Instructions: Choose the single best answer. Pass: 40/50 in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR PHARMACOLOGY — PART 1
Q1 – Q10
══════════════════════════════════════
Question 1 of 50
,2
Mrs. Rodriguez, a 58-year-old woman with type 2 diabetes and newly
diagnosed hypertension (BP 152/96 mmHg), is prescribed lisinopril 10
mg daily. During medication teaching, she asks why this particular
medication was chosen for her. What explanation should the nurse
provide?
A. Lisinopril works by blocking beta-receptors in the heart to reduce
cardiac output, which is especially beneficial for diabetic patients who
often have elevated heart rates
B. Lisinopril inhibits angiotensin-converting enzyme, reducing
angiotensin II formation and providing renoprotective effects that slow
diabetic nephropathy progression ✓ CORRECT
C. Lisinopril blocks calcium channels in vascular smooth muscle,
causing vasodilation that is particularly effective in patients with glucose
intolerance
D. Lisinopril stimulates alpha-2 receptors in the brain stem, reducing
sympathetic outflow and improving insulin sensitivity in diabetic
patients
Correct Answer: B
Rationale: ACE inhibitors like lisinopril block conversion of angiotensin
I to angiotensin II, decreasing vasoconstriction and aldosterone secretion
while preserving renal blood flow—making them first-line for
hypertensive patients with diabetes due to documented renoprotective
benefits. Choice A describes beta-blocker mechanism, not ACE
inhibitors, which is a common classification error on nursing exams.
Clinical pearl: Always remember that ACE inhibitors and ARBs are
preferred antihypertensives in diabetic patients because they reduce
intraglomerular pressure and proteinuria.
,3
Question 2 of 50
Mr. Thompson, a 67-year-old man with hypertension and a history of
chronic dry cough, is being switched from lisinopril to losartan 50 mg
daily. He asks why he's changing medications when his blood pressure
was well-controlled. How should the nurse respond?
A. Losartan is an ARB that blocks angiotensin II receptors without
affecting bradykinin breakdown, eliminating the cough caused by ACE
inhibitor-induced bradykinin accumulation ✓ CORRECT
B. Losartan is a more potent antihypertensive than lisinopril and will
provide better blood pressure control as you age
C. Losartan works by a completely different mechanism that doesn't
affect the kidneys, making it safer for elderly patients
D. Losartan is a beta-blocker that won't cause respiratory side effects
like the cough you experienced with lisinopril
Correct Answer: A
Rationale: The characteristic dry cough occurs in up to 20% of patients
taking ACE inhibitors due to bradykinin accumulation in the lungs;
ARBs like losartan block angiotensin II receptors directly without
inhibiting bradykinin breakdown, effectively eliminating this side effect
while maintaining similar therapeutic benefits. Choice D incorrectly
classifies losartan as a beta-blocker when it's actually an angiotensin II
receptor blocker—a frequent drug classification mix-up. Clinical pearl:
If a patient develops an ACE inhibitor cough, switching to an ARB is
standard practice rather than discontinuing RAAS blockade entirely.
, 4
Question 3 of 50
A nurse is preparing to administer metoprolol succinate 50 mg PO daily
to Mr. Chen, a 54-year-old man with hypertension and a recent
myocardial infarction 3 weeks ago. Before giving the medication, which
assessment finding would cause the nurse to hold the dose and contact
the prescriber?
A. Blood pressure 128/82 mmHg, heart rate 58 bpm, no edema noted
B. Blood pressure 138/88 mmHg, heart rate 72 bpm, reports occasional
headache
C. Blood pressure 102/68 mmHg, heart rate 48 bpm, reports feeling
dizzy when standing ✓ CORRECT
D. Blood pressure 145/92 mmHg, heart rate 78 bpm, +1 ankle edema
bilaterally
Correct Answer: C
Rationale: Metoprolol is a selective beta-1 blocker that reduces heart
rate and contractility; a heart rate below 60 bpm combined with
hypotension and symptomatic bradycardia indicates excessive beta-
blockade requiring dose adjustment or holding. Choice A shows mild
bradycardia (58 bpm) but the patient is asymptomatic with adequate
blood pressure, so the medication can be safely administered with
monitoring. Clinical pearl: Beta-blockers should generally be held for
HR <60 bpm or SBP <100 mmHg, especially if the patient is
symptomatic.
NURS 251 Pharmacology Module 8 Exam
Portage Learning Actual 2026/2027 with
Detailed Rationales | Complete Exam-
Style Questions | Pass Guaranteed – A+
Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular Pharmacology — Part 1 | Q1 – Q10
Section 2 | Cardiovascular Pharmacology — Part 2 | Q11 – Q20
Section 3 | Renal & Urinary Pharmacology | Q21 – Q30
Section 4 | Hematologic & Renal Adjuvant Pharmacology | Q31 – Q38
Section 5 | NGN-Style Clinical Judgment & Integrated Case Analysis |
Q39 – Q50
Instructions: Choose the single best answer. Pass: 40/50 in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR PHARMACOLOGY — PART 1
Q1 – Q10
══════════════════════════════════════
Question 1 of 50
,2
Mrs. Rodriguez, a 58-year-old woman with type 2 diabetes and newly
diagnosed hypertension (BP 152/96 mmHg), is prescribed lisinopril 10
mg daily. During medication teaching, she asks why this particular
medication was chosen for her. What explanation should the nurse
provide?
A. Lisinopril works by blocking beta-receptors in the heart to reduce
cardiac output, which is especially beneficial for diabetic patients who
often have elevated heart rates
B. Lisinopril inhibits angiotensin-converting enzyme, reducing
angiotensin II formation and providing renoprotective effects that slow
diabetic nephropathy progression ✓ CORRECT
C. Lisinopril blocks calcium channels in vascular smooth muscle,
causing vasodilation that is particularly effective in patients with glucose
intolerance
D. Lisinopril stimulates alpha-2 receptors in the brain stem, reducing
sympathetic outflow and improving insulin sensitivity in diabetic
patients
Correct Answer: B
Rationale: ACE inhibitors like lisinopril block conversion of angiotensin
I to angiotensin II, decreasing vasoconstriction and aldosterone secretion
while preserving renal blood flow—making them first-line for
hypertensive patients with diabetes due to documented renoprotective
benefits. Choice A describes beta-blocker mechanism, not ACE
inhibitors, which is a common classification error on nursing exams.
Clinical pearl: Always remember that ACE inhibitors and ARBs are
preferred antihypertensives in diabetic patients because they reduce
intraglomerular pressure and proteinuria.
,3
Question 2 of 50
Mr. Thompson, a 67-year-old man with hypertension and a history of
chronic dry cough, is being switched from lisinopril to losartan 50 mg
daily. He asks why he's changing medications when his blood pressure
was well-controlled. How should the nurse respond?
A. Losartan is an ARB that blocks angiotensin II receptors without
affecting bradykinin breakdown, eliminating the cough caused by ACE
inhibitor-induced bradykinin accumulation ✓ CORRECT
B. Losartan is a more potent antihypertensive than lisinopril and will
provide better blood pressure control as you age
C. Losartan works by a completely different mechanism that doesn't
affect the kidneys, making it safer for elderly patients
D. Losartan is a beta-blocker that won't cause respiratory side effects
like the cough you experienced with lisinopril
Correct Answer: A
Rationale: The characteristic dry cough occurs in up to 20% of patients
taking ACE inhibitors due to bradykinin accumulation in the lungs;
ARBs like losartan block angiotensin II receptors directly without
inhibiting bradykinin breakdown, effectively eliminating this side effect
while maintaining similar therapeutic benefits. Choice D incorrectly
classifies losartan as a beta-blocker when it's actually an angiotensin II
receptor blocker—a frequent drug classification mix-up. Clinical pearl:
If a patient develops an ACE inhibitor cough, switching to an ARB is
standard practice rather than discontinuing RAAS blockade entirely.
, 4
Question 3 of 50
A nurse is preparing to administer metoprolol succinate 50 mg PO daily
to Mr. Chen, a 54-year-old man with hypertension and a recent
myocardial infarction 3 weeks ago. Before giving the medication, which
assessment finding would cause the nurse to hold the dose and contact
the prescriber?
A. Blood pressure 128/82 mmHg, heart rate 58 bpm, no edema noted
B. Blood pressure 138/88 mmHg, heart rate 72 bpm, reports occasional
headache
C. Blood pressure 102/68 mmHg, heart rate 48 bpm, reports feeling
dizzy when standing ✓ CORRECT
D. Blood pressure 145/92 mmHg, heart rate 78 bpm, +1 ankle edema
bilaterally
Correct Answer: C
Rationale: Metoprolol is a selective beta-1 blocker that reduces heart
rate and contractility; a heart rate below 60 bpm combined with
hypotension and symptomatic bradycardia indicates excessive beta-
blockade requiring dose adjustment or holding. Choice A shows mild
bradycardia (58 bpm) but the patient is asymptomatic with adequate
blood pressure, so the medication can be safely administered with
monitoring. Clinical pearl: Beta-blockers should generally be held for
HR <60 bpm or SBP <100 mmHg, especially if the patient is
symptomatic.
