NR566 Midterm Exam Practice
Questions & [Verified Answers], Plus
Explained Rationales|2027 Latest
Update| Instant Download PDF
1. A patient with hypertension is prescribed lisinopril. Which
mechanism best explains the antihypertensive effect of this
medication?
A. Direct relaxation of vascular smooth muscle through calcium-channel
blockade
B. Inhibition of angiotensin-converting enzyme, reducing angiotensin
II formation
C. Increased sodium and water excretion through direct renal tubular
toxicity
D. Blockade of beta-1 receptors in the myocardium
Rationale: ACE inhibitors decrease conversion of angiotensin I to
angiotensin II. This reduces vasoconstriction and aldosterone
secretion, resulting in decreased blood pressure and reduced sodium
and water retention.
2. A patient taking lisinopril reports swelling of the lips and tongue.
What is the priority nursing action?
A. Administer the next dose with food
B. Encourage increased fluid intake
C. Discontinue the medication and obtain emergency medical
evaluation
D. Reassure the patient that this is an expected adverse effect
1|Page
,Rationale: Angioedema is a potentially life-threatening adverse effect
of ACE inhibitors because airway obstruction can occur. The
medication should be stopped and urgent evaluation obtained.
3. Which laboratory value should be monitored most closely in a
patient taking an ACE inhibitor?
A. Hemoglobin
B. Platelet count
C. Serum potassium and creatinine
D. Serum amylase
Rationale: ACE inhibitors can increase potassium levels and may alter
renal function. Serum creatinine and potassium should therefore be
monitored, particularly after initiation or dose changes.
4. A patient taking hydrochlorothiazide for hypertension asks why
the medication is prescribed. Which response is most
appropriate?
A. “It directly blocks beta receptors in the heart.”
B. “It promotes renal sodium and water excretion, which lowers blood
volume and blood pressure.”
C. “It increases aldosterone production.”
D. “It prevents calcium from entering cardiac muscle cells.”
Rationale: Hydrochlorothiazide is a thiazide diuretic that decreases
sodium reabsorption in the distal convoluted tubule, increasing
sodium and water excretion and lowering blood pressure.
5. Which electrolyte abnormality is particularly associated with
hydrochlorothiazide therapy?
A. Hyperkalemia
B. Hypermagnesemia
2|Page
,C. Hypokalemia
D. Hyperphosphatemia
Rationale: Thiazide diuretics can increase urinary potassium loss,
producing hypokalemia. Potassium should be monitored during
therapy.
6. A patient with asthma is prescribed propranolol for hypertension.
Why should the nurse question this prescription?
A. Propranolol causes severe hyperglycemia
B. Propranolol causes excessive sodium retention
C. Nonselective beta blockade can cause bronchoconstriction
D. Propranolol directly stimulates beta-2 receptors
Rationale: Propranolol blocks both beta-1 and beta-2 receptors. Beta-
2 blockade can cause bronchoconstriction and may worsen asthma
symptoms.
7. Which medication is a selective beta-1 adrenergic blocker?
A. Propranolol
B. Carvedilol
C. Metoprolol
D. Labetalol
Rationale: Metoprolol primarily blocks beta-1 receptors at usual
therapeutic doses, decreasing heart rate, myocardial contractility, and
blood pressure.
8. A patient taking metoprolol has a pulse of 48 beats/minute and
reports dizziness. What should the nurse do first?
A. Administer the medication as prescribed
B. Encourage caffeine intake
C. Hold the dose and notify the prescriber according to the prescribed
3|Page
, parameters
D. Double the next dose
Rationale: Beta blockers can cause bradycardia and hypotension.
Significant symptomatic bradycardia warrants withholding the
medication and contacting the prescriber.
9. Which adverse effect is commonly associated with amlodipine?
A. Severe hypoglycemia
B. Peripheral edema
C. Ototoxicity
D. Pulmonary fibrosis
Rationale: Amlodipine is a dihydropyridine calcium-channel blocker.
Peripheral edema is a common adverse effect caused by arteriolar
vasodilation.
10. Which calcium-channel blocker has a greater effect on
cardiac conduction and heart rate than amlodipine?
A. Hydrochlorothiazide
B. Losartan
C. Verapamil
D. Furosemide
Rationale: Verapamil is a nondihydropyridine calcium-channel blocker
that slows AV-node conduction and decreases heart rate and
contractility.
11. A patient taking verapamil reports constipation. What is the
most appropriate response?
A. “Constipation indicates an allergic reaction.”
B. “Constipation is a recognized adverse effect of verapamil.”
4|Page
Questions & [Verified Answers], Plus
Explained Rationales|2027 Latest
Update| Instant Download PDF
1. A patient with hypertension is prescribed lisinopril. Which
mechanism best explains the antihypertensive effect of this
medication?
A. Direct relaxation of vascular smooth muscle through calcium-channel
blockade
B. Inhibition of angiotensin-converting enzyme, reducing angiotensin
II formation
C. Increased sodium and water excretion through direct renal tubular
toxicity
D. Blockade of beta-1 receptors in the myocardium
Rationale: ACE inhibitors decrease conversion of angiotensin I to
angiotensin II. This reduces vasoconstriction and aldosterone
secretion, resulting in decreased blood pressure and reduced sodium
and water retention.
2. A patient taking lisinopril reports swelling of the lips and tongue.
What is the priority nursing action?
A. Administer the next dose with food
B. Encourage increased fluid intake
C. Discontinue the medication and obtain emergency medical
evaluation
D. Reassure the patient that this is an expected adverse effect
1|Page
,Rationale: Angioedema is a potentially life-threatening adverse effect
of ACE inhibitors because airway obstruction can occur. The
medication should be stopped and urgent evaluation obtained.
3. Which laboratory value should be monitored most closely in a
patient taking an ACE inhibitor?
A. Hemoglobin
B. Platelet count
C. Serum potassium and creatinine
D. Serum amylase
Rationale: ACE inhibitors can increase potassium levels and may alter
renal function. Serum creatinine and potassium should therefore be
monitored, particularly after initiation or dose changes.
4. A patient taking hydrochlorothiazide for hypertension asks why
the medication is prescribed. Which response is most
appropriate?
A. “It directly blocks beta receptors in the heart.”
B. “It promotes renal sodium and water excretion, which lowers blood
volume and blood pressure.”
C. “It increases aldosterone production.”
D. “It prevents calcium from entering cardiac muscle cells.”
Rationale: Hydrochlorothiazide is a thiazide diuretic that decreases
sodium reabsorption in the distal convoluted tubule, increasing
sodium and water excretion and lowering blood pressure.
5. Which electrolyte abnormality is particularly associated with
hydrochlorothiazide therapy?
A. Hyperkalemia
B. Hypermagnesemia
2|Page
,C. Hypokalemia
D. Hyperphosphatemia
Rationale: Thiazide diuretics can increase urinary potassium loss,
producing hypokalemia. Potassium should be monitored during
therapy.
6. A patient with asthma is prescribed propranolol for hypertension.
Why should the nurse question this prescription?
A. Propranolol causes severe hyperglycemia
B. Propranolol causes excessive sodium retention
C. Nonselective beta blockade can cause bronchoconstriction
D. Propranolol directly stimulates beta-2 receptors
Rationale: Propranolol blocks both beta-1 and beta-2 receptors. Beta-
2 blockade can cause bronchoconstriction and may worsen asthma
symptoms.
7. Which medication is a selective beta-1 adrenergic blocker?
A. Propranolol
B. Carvedilol
C. Metoprolol
D. Labetalol
Rationale: Metoprolol primarily blocks beta-1 receptors at usual
therapeutic doses, decreasing heart rate, myocardial contractility, and
blood pressure.
8. A patient taking metoprolol has a pulse of 48 beats/minute and
reports dizziness. What should the nurse do first?
A. Administer the medication as prescribed
B. Encourage caffeine intake
C. Hold the dose and notify the prescriber according to the prescribed
3|Page
, parameters
D. Double the next dose
Rationale: Beta blockers can cause bradycardia and hypotension.
Significant symptomatic bradycardia warrants withholding the
medication and contacting the prescriber.
9. Which adverse effect is commonly associated with amlodipine?
A. Severe hypoglycemia
B. Peripheral edema
C. Ototoxicity
D. Pulmonary fibrosis
Rationale: Amlodipine is a dihydropyridine calcium-channel blocker.
Peripheral edema is a common adverse effect caused by arteriolar
vasodilation.
10. Which calcium-channel blocker has a greater effect on
cardiac conduction and heart rate than amlodipine?
A. Hydrochlorothiazide
B. Losartan
C. Verapamil
D. Furosemide
Rationale: Verapamil is a nondihydropyridine calcium-channel blocker
that slows AV-node conduction and decreases heart rate and
contractility.
11. A patient taking verapamil reports constipation. What is the
most appropriate response?
A. “Constipation indicates an allergic reaction.”
B. “Constipation is a recognized adverse effect of verapamil.”
4|Page
