Cvs Pharmacology Actual Exams 2026 (2 Different
Versions) | Cardiovascular System Pharmacology
Exam | All Questions And Correct Answers |
Updated Versions
Section 1: Antihypertensive Agents (Questions 1-30)
1. A patient with chronic hypertension and stage 3 chronic kidney disease (CKD)
is prescribed an ACE inhibitor. The primary rationale for this choice is:
A. Reduced cardiac contractility
B. Decreased heart rate
C. Renoprotective effect via decreased intraglomerular pressure
D. Peripheral vasodilation
Correct Answer:
C. Renoprotective effect via decreased intraglomerular pressure
Rationale:
ACE inhibitors are particularly beneficial in patients with CKD and
proteinuria because they preferentially dilate the efferent arteriole, which
reduces intraglomerular pressure and slows the progression of kidney disease.
While they do cause peripheral vasodilation (D), their primary advantage in this
clinical scenario is renal protection.
2. Which of the following is a common adverse effect of ACE inhibitors that is
mediated by the accumulation of bradykinin?
A. Hyperkalemia
B. Dry cough
C. Angioedema
D. Both B and C
Correct Answer:
D. Both B and C
Rationale:
ACE inhibitors block the breakdown of bradykinin, leading to its
,accumulation. This is responsible for the characteristic dry, persistent cough and,
in some patients, angioedema (swelling of the lips, tongue, and face).
Hyperkalemia (A) is due to decreased aldosterone secretion.
3. A patient on lisinopril presents with a persistent, dry, hacking cough that is
affecting their quality of life. The most appropriate action is to:
A. Add a cough suppressant.
B. Reduce the dose of lisinopril.
C. Switch to an Angiotensin II Receptor Blocker (ARB).
D. Switch to a direct renin inhibitor.
Correct Answer:
C. Switch to an Angiotensin II Receptor Blocker (ARB).
Rationale:
The dry cough from ACE inhibitors is a class effect. ARBs do not affect
bradykinin metabolism and are therefore not associated with this side effect.
They provide similar blood pressure-lowering and renoprotective benefits. Adding
a cough suppressant is ineffective, and switching to a renin inhibitor (D) is less
standard than switching to an ARB.
4. Which of the following is an absolute contraindication to the use of ACE
inhibitors?
A. Diabetes mellitus
B. History of angioedema with an ACE inhibitor
C. Chronic kidney disease
D. Asthma
Correct Answer:
B. History of angioedema with an ACE inhibitor
Rationale:
A history of angioedema while taking an ACE inhibitor is an absolute
contraindication to their future use due to the risk of a life-threatening
recurrence. The other conditions are not absolute contraindications; in fact,
diabetes and CKD are often indications for their use.
,5. The mechanism of action of Angiotensin II Receptor Blockers (ARBs) is to:
A. Inhibit the conversion of angiotensin I to angiotensin II.
B. Block the AT1 receptor, preventing the actions of angiotensin II.
C. Inhibit renin release from the kidneys.
D. Block calcium channels in vascular smooth muscle.
Correct Answer:
B. Block the AT1 receptor, preventing the actions of angiotensin II.
Rationale:
ARBs, as the name implies, selectively block the angiotensin II type 1 (AT1)
receptor. This prevents the vasoconstrictive and aldosterone-secreting effects of
angiotensin II, leading to lower blood pressure. This is distinct from ACE inhibitors
(A) which reduce the production of angiotensin II.
6. A patient is started on both an ACE inhibitor and an ARB. This combination is
generally discouraged because:
A. It offers no additional benefit and increases the risk of hyperkalemia and renal
failure.
B. It causes an uncontrollable drop in blood pressure.
C. It leads to a severe cough in all patients.
D. It increases the risk of bleeding.
Correct Answer:
A. It offers no additional benefit and increases the risk of hyperkalemia
and renal failure.
Rationale:
Dual blockade of the RAAS system with both an ACE inhibitor and an ARB
provides no significant mortality benefit over monotherapy and is associated with
a higher incidence of adverse events, particularly hyperkalemia, hypotension, and
acute kidney injury.
7. What is the primary mechanism by which aliskiren lowers blood pressure?
A. Directly inhibiting renin, thereby reducing the production of angiotensin I.
B. Blocking AT1 receptors.
C. Inhibiting ACE.
D. Promoting natriuresis in the distal tubule.
, Correct Answer:
A. Directly inhibiting renin, thereby reducing the production of angiotensin
I.
Rationale:
Aliskiren is a direct renin inhibitor. By inhibiting renin, it blocks the very
first step of the Renin-Angiotensin-Aldosterone System (RAAS), preventing the
conversion of angiotensinogen to angiotensin I.
8. A 55-year-old male with hypertension is prescribed losartan. He also has a
history of gout. Which of the following effects might be beneficial for him?
A. Hyperkalemia
B. Uricosuric effect (lowering uric acid)
C. Increased uric acid retention
D. Hyperglycemia
Correct Answer:
B. Uricosuric effect (lowering uric acid)
Rationale:
ARBs, particularly losartan, have a mild uricosuric effect, meaning they can
help increase the excretion of uric acid in the urine. This is a beneficial side effect
for patients with a history of gout.
9. A patient taking enalapril calls the clinic complaining of swelling of the tongue
and lips. The nurse should:
A. Tell the patient to monitor the swelling for 24 hours.
B. Instruct the patient to stop the medication and seek emergency medical help
immediately.
C. Advise the patient to take an antihistamine.
D. Schedule an appointment for the next day.
Correct Answer:
B. Instruct the patient to stop the medication and seek emergency medical
help immediately.
Rationale:
Swelling of the tongue and lips is a classic sign of angioedema, a life-
Versions) | Cardiovascular System Pharmacology
Exam | All Questions And Correct Answers |
Updated Versions
Section 1: Antihypertensive Agents (Questions 1-30)
1. A patient with chronic hypertension and stage 3 chronic kidney disease (CKD)
is prescribed an ACE inhibitor. The primary rationale for this choice is:
A. Reduced cardiac contractility
B. Decreased heart rate
C. Renoprotective effect via decreased intraglomerular pressure
D. Peripheral vasodilation
Correct Answer:
C. Renoprotective effect via decreased intraglomerular pressure
Rationale:
ACE inhibitors are particularly beneficial in patients with CKD and
proteinuria because they preferentially dilate the efferent arteriole, which
reduces intraglomerular pressure and slows the progression of kidney disease.
While they do cause peripheral vasodilation (D), their primary advantage in this
clinical scenario is renal protection.
2. Which of the following is a common adverse effect of ACE inhibitors that is
mediated by the accumulation of bradykinin?
A. Hyperkalemia
B. Dry cough
C. Angioedema
D. Both B and C
Correct Answer:
D. Both B and C
Rationale:
ACE inhibitors block the breakdown of bradykinin, leading to its
,accumulation. This is responsible for the characteristic dry, persistent cough and,
in some patients, angioedema (swelling of the lips, tongue, and face).
Hyperkalemia (A) is due to decreased aldosterone secretion.
3. A patient on lisinopril presents with a persistent, dry, hacking cough that is
affecting their quality of life. The most appropriate action is to:
A. Add a cough suppressant.
B. Reduce the dose of lisinopril.
C. Switch to an Angiotensin II Receptor Blocker (ARB).
D. Switch to a direct renin inhibitor.
Correct Answer:
C. Switch to an Angiotensin II Receptor Blocker (ARB).
Rationale:
The dry cough from ACE inhibitors is a class effect. ARBs do not affect
bradykinin metabolism and are therefore not associated with this side effect.
They provide similar blood pressure-lowering and renoprotective benefits. Adding
a cough suppressant is ineffective, and switching to a renin inhibitor (D) is less
standard than switching to an ARB.
4. Which of the following is an absolute contraindication to the use of ACE
inhibitors?
A. Diabetes mellitus
B. History of angioedema with an ACE inhibitor
C. Chronic kidney disease
D. Asthma
Correct Answer:
B. History of angioedema with an ACE inhibitor
Rationale:
A history of angioedema while taking an ACE inhibitor is an absolute
contraindication to their future use due to the risk of a life-threatening
recurrence. The other conditions are not absolute contraindications; in fact,
diabetes and CKD are often indications for their use.
,5. The mechanism of action of Angiotensin II Receptor Blockers (ARBs) is to:
A. Inhibit the conversion of angiotensin I to angiotensin II.
B. Block the AT1 receptor, preventing the actions of angiotensin II.
C. Inhibit renin release from the kidneys.
D. Block calcium channels in vascular smooth muscle.
Correct Answer:
B. Block the AT1 receptor, preventing the actions of angiotensin II.
Rationale:
ARBs, as the name implies, selectively block the angiotensin II type 1 (AT1)
receptor. This prevents the vasoconstrictive and aldosterone-secreting effects of
angiotensin II, leading to lower blood pressure. This is distinct from ACE inhibitors
(A) which reduce the production of angiotensin II.
6. A patient is started on both an ACE inhibitor and an ARB. This combination is
generally discouraged because:
A. It offers no additional benefit and increases the risk of hyperkalemia and renal
failure.
B. It causes an uncontrollable drop in blood pressure.
C. It leads to a severe cough in all patients.
D. It increases the risk of bleeding.
Correct Answer:
A. It offers no additional benefit and increases the risk of hyperkalemia
and renal failure.
Rationale:
Dual blockade of the RAAS system with both an ACE inhibitor and an ARB
provides no significant mortality benefit over monotherapy and is associated with
a higher incidence of adverse events, particularly hyperkalemia, hypotension, and
acute kidney injury.
7. What is the primary mechanism by which aliskiren lowers blood pressure?
A. Directly inhibiting renin, thereby reducing the production of angiotensin I.
B. Blocking AT1 receptors.
C. Inhibiting ACE.
D. Promoting natriuresis in the distal tubule.
, Correct Answer:
A. Directly inhibiting renin, thereby reducing the production of angiotensin
I.
Rationale:
Aliskiren is a direct renin inhibitor. By inhibiting renin, it blocks the very
first step of the Renin-Angiotensin-Aldosterone System (RAAS), preventing the
conversion of angiotensinogen to angiotensin I.
8. A 55-year-old male with hypertension is prescribed losartan. He also has a
history of gout. Which of the following effects might be beneficial for him?
A. Hyperkalemia
B. Uricosuric effect (lowering uric acid)
C. Increased uric acid retention
D. Hyperglycemia
Correct Answer:
B. Uricosuric effect (lowering uric acid)
Rationale:
ARBs, particularly losartan, have a mild uricosuric effect, meaning they can
help increase the excretion of uric acid in the urine. This is a beneficial side effect
for patients with a history of gout.
9. A patient taking enalapril calls the clinic complaining of swelling of the tongue
and lips. The nurse should:
A. Tell the patient to monitor the swelling for 24 hours.
B. Instruct the patient to stop the medication and seek emergency medical help
immediately.
C. Advise the patient to take an antihistamine.
D. Schedule an appointment for the next day.
Correct Answer:
B. Instruct the patient to stop the medication and seek emergency medical
help immediately.
Rationale:
Swelling of the tongue and lips is a classic sign of angioedema, a life-
