NR 565 Advanced Pharmacology — Week 4 Midterm exam with
correct answers plus rationales 2026/2027
1. A patient taking an ACE inhibitor develops swelling of the lips and tongue. Which action
should the nurse take FIRST?
A. Administer the next dose with food
B. Hold the medication and seek immediate medical attention
C. Encourage increased fluid intake
D. Reassure the patient that this is expected
Answer: B. Hold the medication and seek immediate medical attention.
Rationale: Angioedema involving the lips or tongue can compromise the airway and is a
potentially life-threatening adverse effect of ACE inhibitors.
2. Which electrolyte abnormality is most concerning in a patient taking a loop diuretic?
A. Hypercalcemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypernatremia
Answer: B. Hypokalemia.
Rationale: Loop diuretics increase urinary potassium loss. Significant hypokalemia can cause
muscle weakness and potentially dangerous cardiac dysrhythmias.
3. A patient taking furosemide reports ringing in the ears. What should the nurse suspect?
A. Ototoxicity
B. Hyperglycemia
C. Hypoglycemia
D. Constipation
Answer: A. Ototoxicity.
Rationale: High-dose or rapidly administered loop diuretics can cause ototoxicity, which may
manifest as tinnitus or hearing changes.
,4. Which medication is an angiotensin II receptor blocker (ARB)?
A. Losartan
B. Lisinopril
C. Metoprolol
D. Amlodipine
Answer: A. Losartan.
Rationale: Losartan is an ARB. Lisinopril is an ACE inhibitor, metoprolol is a beta blocker, and
amlodipine is a calcium channel blocker.
5. Which adverse effect is commonly associated with ACE inhibitors?
A. Persistent dry cough
B. Severe constipation
C. Orange urine
D. Hearing loss in every patient
Answer: A. Persistent dry cough.
Rationale: ACE inhibition increases bradykinin, which can contribute to a persistent dry cough.
6. Which medication should generally be avoided during pregnancy because of fetal renal
effects?
A. Lisinopril
B. Penicillin V
C. Acetaminophen
D. Insulin
Answer: A. Lisinopril.
Rationale: ACE inhibitors can cause fetal renal injury and other adverse fetal effects and are
contraindicated during pregnancy.
7. A patient taking spironolactone should be monitored closely for which electrolyte
abnormality?
,A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypochloremia
Answer: B. Hyperkalemia.
Rationale: Spironolactone is a potassium-sparing diuretic and can increase serum potassium.
8. Which patient statement indicates correct understanding of spironolactone therapy?
A. “I should use potassium-based salt substitutes freely.”
B. “I should ask before using potassium supplements.”
C. “I should avoid all fluids.”
D. “This medication will always lower my potassium.”
Answer: B. “I should ask before using potassium supplements.”
Rationale: Spironolactone can cause hyperkalemia, so potassium supplements and potassium-
containing salt substitutes should generally be avoided unless specifically prescribed.
9. A patient with hypertension is prescribed amlodipine. Which adverse effect should the
nurse monitor for?
A. Peripheral edema
B. Severe hypoglycemia
C. Ototoxicity
D. Orange discoloration of urine
Answer: A. Peripheral edema.
Rationale: Dihydropyridine calcium channel blockers such as amlodipine commonly cause
peripheral edema, flushing, headache, and dizziness.
10. Which medication is a beta-1 selective blocker commonly used for hypertension?
A. Metoprolol
B. Losartan
C. Hydrochlorothiazide
D. Amlodipine
, Answer: A. Metoprolol.
Rationale: Metoprolol is a beta-1 selective adrenergic blocker that decreases heart rate, cardiac
output, and renin release.
11. Which assessment is most important before administering metoprolol?
A. Heart rate and blood pressure
B. Bowel sounds only
C. Skin temperature only
D. Visual acuity only
Answer: A. Heart rate and blood pressure.
Rationale: Beta blockers can cause bradycardia and hypotension. The patient's vital signs
should be assessed before administration according to the prescribed parameters.
12. Which instruction is appropriate for a patient taking a beta blocker?
A. Stop the medication abruptly when feeling better
B. Change positions slowly if dizziness occurs
C. Double the dose after a missed dose
D. Take extra doses for chest discomfort
Answer: B. Change positions slowly if dizziness occurs.
Rationale: Beta blockers can cause hypotension and dizziness. Abrupt discontinuation can cause
rebound sympathetic activity and should generally be avoided.
13. A patient taking hydrochlorothiazide should have which laboratory value monitored?
A. Potassium
B. Hemoglobin A1c only
C. Troponin only
D. Amylase only
Answer: A. Potassium.
Rationale: Thiazide diuretics can increase urinary potassium loss and cause hypokalemia.
correct answers plus rationales 2026/2027
1. A patient taking an ACE inhibitor develops swelling of the lips and tongue. Which action
should the nurse take FIRST?
A. Administer the next dose with food
B. Hold the medication and seek immediate medical attention
C. Encourage increased fluid intake
D. Reassure the patient that this is expected
Answer: B. Hold the medication and seek immediate medical attention.
Rationale: Angioedema involving the lips or tongue can compromise the airway and is a
potentially life-threatening adverse effect of ACE inhibitors.
2. Which electrolyte abnormality is most concerning in a patient taking a loop diuretic?
A. Hypercalcemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypernatremia
Answer: B. Hypokalemia.
Rationale: Loop diuretics increase urinary potassium loss. Significant hypokalemia can cause
muscle weakness and potentially dangerous cardiac dysrhythmias.
3. A patient taking furosemide reports ringing in the ears. What should the nurse suspect?
A. Ototoxicity
B. Hyperglycemia
C. Hypoglycemia
D. Constipation
Answer: A. Ototoxicity.
Rationale: High-dose or rapidly administered loop diuretics can cause ototoxicity, which may
manifest as tinnitus or hearing changes.
,4. Which medication is an angiotensin II receptor blocker (ARB)?
A. Losartan
B. Lisinopril
C. Metoprolol
D. Amlodipine
Answer: A. Losartan.
Rationale: Losartan is an ARB. Lisinopril is an ACE inhibitor, metoprolol is a beta blocker, and
amlodipine is a calcium channel blocker.
5. Which adverse effect is commonly associated with ACE inhibitors?
A. Persistent dry cough
B. Severe constipation
C. Orange urine
D. Hearing loss in every patient
Answer: A. Persistent dry cough.
Rationale: ACE inhibition increases bradykinin, which can contribute to a persistent dry cough.
6. Which medication should generally be avoided during pregnancy because of fetal renal
effects?
A. Lisinopril
B. Penicillin V
C. Acetaminophen
D. Insulin
Answer: A. Lisinopril.
Rationale: ACE inhibitors can cause fetal renal injury and other adverse fetal effects and are
contraindicated during pregnancy.
7. A patient taking spironolactone should be monitored closely for which electrolyte
abnormality?
,A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypochloremia
Answer: B. Hyperkalemia.
Rationale: Spironolactone is a potassium-sparing diuretic and can increase serum potassium.
8. Which patient statement indicates correct understanding of spironolactone therapy?
A. “I should use potassium-based salt substitutes freely.”
B. “I should ask before using potassium supplements.”
C. “I should avoid all fluids.”
D. “This medication will always lower my potassium.”
Answer: B. “I should ask before using potassium supplements.”
Rationale: Spironolactone can cause hyperkalemia, so potassium supplements and potassium-
containing salt substitutes should generally be avoided unless specifically prescribed.
9. A patient with hypertension is prescribed amlodipine. Which adverse effect should the
nurse monitor for?
A. Peripheral edema
B. Severe hypoglycemia
C. Ototoxicity
D. Orange discoloration of urine
Answer: A. Peripheral edema.
Rationale: Dihydropyridine calcium channel blockers such as amlodipine commonly cause
peripheral edema, flushing, headache, and dizziness.
10. Which medication is a beta-1 selective blocker commonly used for hypertension?
A. Metoprolol
B. Losartan
C. Hydrochlorothiazide
D. Amlodipine
, Answer: A. Metoprolol.
Rationale: Metoprolol is a beta-1 selective adrenergic blocker that decreases heart rate, cardiac
output, and renin release.
11. Which assessment is most important before administering metoprolol?
A. Heart rate and blood pressure
B. Bowel sounds only
C. Skin temperature only
D. Visual acuity only
Answer: A. Heart rate and blood pressure.
Rationale: Beta blockers can cause bradycardia and hypotension. The patient's vital signs
should be assessed before administration according to the prescribed parameters.
12. Which instruction is appropriate for a patient taking a beta blocker?
A. Stop the medication abruptly when feeling better
B. Change positions slowly if dizziness occurs
C. Double the dose after a missed dose
D. Take extra doses for chest discomfort
Answer: B. Change positions slowly if dizziness occurs.
Rationale: Beta blockers can cause hypotension and dizziness. Abrupt discontinuation can cause
rebound sympathetic activity and should generally be avoided.
13. A patient taking hydrochlorothiazide should have which laboratory value monitored?
A. Potassium
B. Hemoglobin A1c only
C. Troponin only
D. Amylase only
Answer: A. Potassium.
Rationale: Thiazide diuretics can increase urinary potassium loss and cause hypokalemia.
