CHAMBERLAIN NR 293 PHARMACOLOGY FOR NURSING
PRACTICEN EXAM 2 COMPREHENSIVE PRACTICE QUESTION BANK
(2026/2027) QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES |NURSING CONSIDERATIONS &
TEACHING POINTS
CONTENTS
Section 1 ..... Antihypertensives ......................... Q 1-40
Section 2 ..... Diuretics ................................. Q 41-65
Section 3 ..... Heart Failure Medications ................. Q 66-85
Section 4 ..... Antianginal Medications ................... Q 86-100
Section 5 ..... Antidysrhythmic Medications ............... Q 101-120
Section 6 ..... Anticoagulants ............................ Q 121-145
Section 7 ..... Antiplatelets & Thrombolytics ............ Q 146-160
Section 8 ..... Lipid-Lowering Agents .................... Q 161-175
Section 9 ..... Endocrine: Diabetes Medications .......... Q 176-200
SECTION 1: ANTIHYPERTENSIVES (Questions 1-40)
TOPIC 1A: ACE INHIBITORS
QUESTION 1
A patient is prescribed lisinopril for hypertension. Which common adverse
effect should the nurse monitor for?
A. Hyperkalemia and persistent dry cough
B. Tachycardia and weight gain
C. Hypokalemia and diarrhea
D. Bradycardia and constipation
CORRECT ANSWER: A. Hyperkalemia and persistent dry cough
RATIONALE: ACE inhibitors block the conversion of angiotensin I to angiotensin
II and also block the breakdown of bradykinin. Accumulation of bradykinin in
the airways produces the classic persistent, dry, nonproductive cough seen in
roughly 5-20% of patients. Because angiotensin II normally stimulates
aldosterone release, blocking it reduces aldosterone, which reduces sodium and
water retention but also reduces potassium excretion, producing hyperkalemia.
Other key effects are vasodilation (hypotension), reduced glomerular pressure,
1
,and angioedema. ACE inhibitors do not cause tachycardia (that is more typical
of direct vasodilators such as hydralazine), hypokalemia (that is diuretics),
or constipation (that is verapamil).
NURSING PRIORITY: Obtain a baseline potassium and creatinine before therapy
and
monitor periodically. Assess for cough at every visit.
PATIENT TEACHING: "A dry cough that will not go away is a common side effect.
Report it to your provider because you may need a different class of
medication, such as an ARB."
--------------------------------------------------------------------------------
QUESTION 2
A patient is prescribed lisinopril. Which assessment finding should the nurse
prioritize as a reason to WITHHOLD the medication and contact the provider
immediately?
A. A persistent dry, nonproductive cough
B. A serum potassium level of 4.2 mEq/L
C. Swelling of the lips, tongue, and face
D. Blood pressure of 118/76 mmHg
CORRECT ANSWER: C. Swelling of the lips, tongue, and face
RATIONALE: Swelling of the lips, tongue, and face indicates ANGIOEDEMA, a
life-threatening adverse effect of ACE inhibitors. It occurs because
bradykinin accumulation increases vascular permeability. Angioedema can
progress rapidly to laryngeal edema and airway obstruction. The drug must be
stopped immediately and emergency treatment (airway management,
antihistamines, epinephrine, corticosteroids) initiated. A dry cough is common
and annoying but not an emergency. Potassium 4.2 mEq/L is within normal limits
(3.5-5.0 mEq/L). BP 118/76 mmHg is acceptable.
NURSING PRIORITY: Teach patients to seek emergency care for any swelling of
the mouth, tongue, throat, or difficulty breathing. Angioedema can occur at any
time during therapy, including months after starting.
2
,--------------------------------------------------------------------------------
QUESTION 3
A client is prescribed losartan. The nurse understands that this medication is
classified as a(n):
A. Beta-blocker
B. ACE inhibitor
C. Angiotensin II receptor blocker (ARB)
D. Calcium channel blocker
CORRECT ANSWER: C. Angiotensin II receptor blocker (ARB)
RATIONALE: Losartan is an ARB (generic name ends in "-sartan"). ARBs block
angiotensin II at the AT1 receptor site, producing vasodilation and reduced
aldosterone release, similar to ACE inhibitors. However, ARBs do NOT inhibit
kininase II, so bradykinin does not accumulate, which is why ARBs have a much
lower incidence of dry cough and angioedema. ARBs are the preferred substitute
when a patient develops an intolerable ACE-inhibitor cough.
NURSING PRIORITY: Monitor potassium and renal function, since ARBs can also
cause hyperkalemia and renal impairment. ARBs are absolutely contraindicated
in pregnancy (pregnancy category D/X) because they cause fetal harm.
--------------------------------------------------------------------------------
QUESTION 4
Which instruction should the nurse include when teaching a patient about
captopril?
A. "Take this medication with a potassium supplement."
B. "Report a persistent dry cough to your provider."
C. "Increase your salt intake while taking this drug."
D. "This medication will increase your heart rate."
CORRECT ANSWER: B. "Report a persistent dry cough to your provider."
3
, RATIONALE: Captopril is a short-acting ACE inhibitor. The cough is caused by
bradykinin and prostaglandin accumulation in the lungs. Potassium supplements
should be avoided because ACE inhibitors retain potassium (risk of
hyperkalemia). Sodium intake should be restricted, not increased, in
hypertension management. ACE inhibitors do not increase heart rate; they tend
to lower BP without reflex tachycardia.
PATIENT TEACHING: Take captopril 1 hour before meals (food reduces
absorption).
Report cough, rash, swelling, or a sore throat with fever (possible
neutropenia). Rise slowly to prevent orthostatic hypotension.
--------------------------------------------------------------------------------
QUESTION 5
A patient taking enalapril develops a dry cough that is interfering with sleep.
The nurse anticipates the provider will:
A. Increase the dose of enalapril
B. Add a second ACE inhibitor
C. Discontinue enalapril and start an ARB such as valsartan
D. Add an over-the-counter cough suppressant and continue enalapril
CORRECT ANSWER: C. Discontinue enalapril and start an ARB such as valsartan
RATIONALE: The classic ACE-inhibitor cough does not respond to cough
suppressants because the cause is bradykinin accumulation, not a respiratory
infection. The standard clinical action is to switch to an ARB, which provides
similar blood-pressure lowering and organ protection without the cough
mechanism. Increasing the dose would worsen the cough. Adding a second ACE
inhibitor is never appropriate.
NURSING PRIORITY: Do not stop antihypertensives abruptly. Reinforce that the
new medication will be started as a direct replacement.
--------------------------------------------------------------------------------
QUESTION 6
4
PRACTICEN EXAM 2 COMPREHENSIVE PRACTICE QUESTION BANK
(2026/2027) QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES |NURSING CONSIDERATIONS &
TEACHING POINTS
CONTENTS
Section 1 ..... Antihypertensives ......................... Q 1-40
Section 2 ..... Diuretics ................................. Q 41-65
Section 3 ..... Heart Failure Medications ................. Q 66-85
Section 4 ..... Antianginal Medications ................... Q 86-100
Section 5 ..... Antidysrhythmic Medications ............... Q 101-120
Section 6 ..... Anticoagulants ............................ Q 121-145
Section 7 ..... Antiplatelets & Thrombolytics ............ Q 146-160
Section 8 ..... Lipid-Lowering Agents .................... Q 161-175
Section 9 ..... Endocrine: Diabetes Medications .......... Q 176-200
SECTION 1: ANTIHYPERTENSIVES (Questions 1-40)
TOPIC 1A: ACE INHIBITORS
QUESTION 1
A patient is prescribed lisinopril for hypertension. Which common adverse
effect should the nurse monitor for?
A. Hyperkalemia and persistent dry cough
B. Tachycardia and weight gain
C. Hypokalemia and diarrhea
D. Bradycardia and constipation
CORRECT ANSWER: A. Hyperkalemia and persistent dry cough
RATIONALE: ACE inhibitors block the conversion of angiotensin I to angiotensin
II and also block the breakdown of bradykinin. Accumulation of bradykinin in
the airways produces the classic persistent, dry, nonproductive cough seen in
roughly 5-20% of patients. Because angiotensin II normally stimulates
aldosterone release, blocking it reduces aldosterone, which reduces sodium and
water retention but also reduces potassium excretion, producing hyperkalemia.
Other key effects are vasodilation (hypotension), reduced glomerular pressure,
1
,and angioedema. ACE inhibitors do not cause tachycardia (that is more typical
of direct vasodilators such as hydralazine), hypokalemia (that is diuretics),
or constipation (that is verapamil).
NURSING PRIORITY: Obtain a baseline potassium and creatinine before therapy
and
monitor periodically. Assess for cough at every visit.
PATIENT TEACHING: "A dry cough that will not go away is a common side effect.
Report it to your provider because you may need a different class of
medication, such as an ARB."
--------------------------------------------------------------------------------
QUESTION 2
A patient is prescribed lisinopril. Which assessment finding should the nurse
prioritize as a reason to WITHHOLD the medication and contact the provider
immediately?
A. A persistent dry, nonproductive cough
B. A serum potassium level of 4.2 mEq/L
C. Swelling of the lips, tongue, and face
D. Blood pressure of 118/76 mmHg
CORRECT ANSWER: C. Swelling of the lips, tongue, and face
RATIONALE: Swelling of the lips, tongue, and face indicates ANGIOEDEMA, a
life-threatening adverse effect of ACE inhibitors. It occurs because
bradykinin accumulation increases vascular permeability. Angioedema can
progress rapidly to laryngeal edema and airway obstruction. The drug must be
stopped immediately and emergency treatment (airway management,
antihistamines, epinephrine, corticosteroids) initiated. A dry cough is common
and annoying but not an emergency. Potassium 4.2 mEq/L is within normal limits
(3.5-5.0 mEq/L). BP 118/76 mmHg is acceptable.
NURSING PRIORITY: Teach patients to seek emergency care for any swelling of
the mouth, tongue, throat, or difficulty breathing. Angioedema can occur at any
time during therapy, including months after starting.
2
,--------------------------------------------------------------------------------
QUESTION 3
A client is prescribed losartan. The nurse understands that this medication is
classified as a(n):
A. Beta-blocker
B. ACE inhibitor
C. Angiotensin II receptor blocker (ARB)
D. Calcium channel blocker
CORRECT ANSWER: C. Angiotensin II receptor blocker (ARB)
RATIONALE: Losartan is an ARB (generic name ends in "-sartan"). ARBs block
angiotensin II at the AT1 receptor site, producing vasodilation and reduced
aldosterone release, similar to ACE inhibitors. However, ARBs do NOT inhibit
kininase II, so bradykinin does not accumulate, which is why ARBs have a much
lower incidence of dry cough and angioedema. ARBs are the preferred substitute
when a patient develops an intolerable ACE-inhibitor cough.
NURSING PRIORITY: Monitor potassium and renal function, since ARBs can also
cause hyperkalemia and renal impairment. ARBs are absolutely contraindicated
in pregnancy (pregnancy category D/X) because they cause fetal harm.
--------------------------------------------------------------------------------
QUESTION 4
Which instruction should the nurse include when teaching a patient about
captopril?
A. "Take this medication with a potassium supplement."
B. "Report a persistent dry cough to your provider."
C. "Increase your salt intake while taking this drug."
D. "This medication will increase your heart rate."
CORRECT ANSWER: B. "Report a persistent dry cough to your provider."
3
, RATIONALE: Captopril is a short-acting ACE inhibitor. The cough is caused by
bradykinin and prostaglandin accumulation in the lungs. Potassium supplements
should be avoided because ACE inhibitors retain potassium (risk of
hyperkalemia). Sodium intake should be restricted, not increased, in
hypertension management. ACE inhibitors do not increase heart rate; they tend
to lower BP without reflex tachycardia.
PATIENT TEACHING: Take captopril 1 hour before meals (food reduces
absorption).
Report cough, rash, swelling, or a sore throat with fever (possible
neutropenia). Rise slowly to prevent orthostatic hypotension.
--------------------------------------------------------------------------------
QUESTION 5
A patient taking enalapril develops a dry cough that is interfering with sleep.
The nurse anticipates the provider will:
A. Increase the dose of enalapril
B. Add a second ACE inhibitor
C. Discontinue enalapril and start an ARB such as valsartan
D. Add an over-the-counter cough suppressant and continue enalapril
CORRECT ANSWER: C. Discontinue enalapril and start an ARB such as valsartan
RATIONALE: The classic ACE-inhibitor cough does not respond to cough
suppressants because the cause is bradykinin accumulation, not a respiratory
infection. The standard clinical action is to switch to an ARB, which provides
similar blood-pressure lowering and organ protection without the cough
mechanism. Increasing the dose would worsen the cough. Adding a second ACE
inhibitor is never appropriate.
NURSING PRIORITY: Do not stop antihypertensives abruptly. Reinforce that the
new medication will be started as a direct replacement.
--------------------------------------------------------------------------------
QUESTION 6
4
