NUR 555 Quiz 6 | Advanced Pharmacotherapeutics 2026 Update
NUR 555 Quiz 6
Advanced Pharmacotherapeutics: Cardiovascular and Renal
Systems
Questions and Answers | 2026 Update | With Complete Solutions
Section 1: Antihypertensive Medications
ACE Inhibitors, ARBs, Beta-Blockers, Calcium Channel Blockers, Alpha-Blockers, and Diuretics (Q1-Q10)
Q1: A 58-year-old patient with hypertension starts Lisinopril. At the 2-week follow-up, the patient reports a
persistent dry cough that is interfering with sleep. What is the most appropriate next step in management?
A. A. Continue Lisinopril and add a cough suppressant
B. B. Switch to Losartan **[CORRECT]**
C. C. Switch to Amlodipine
D. D. Discontinue all antihypertensive therapy
Correct Answer: B
Rationale: The dry cough is a well-documented adverse effect of ACE inhibitors caused by bradykinin accumulation. ARBs such
as Losartan block angiotensin II type 1 receptors without affecting bradykinin breakdown, making them the ideal substitute with
comparable efficacy. Option A treats the symptom without addressing the underlying drug-related cause. Option C switches to a
different drug class (calcium channel blocker) unnecessarily when an ARB provides the same mechanism without the cough.
Option D is unsafe; hypertension requires continued pharmacotherapy.
Q2: A 72-year-old patient with Stage 2 hypertension is prescribed a combination pill containing Valsartan and
Hydrochlorothiazide. What is the primary rationale for using fixed-dose combination therapy in this patient?
A. A. It reduces the cost of therapy by 50%
B. B. It improves medication adherence and provides synergistic blood pressure reduction **[CORRECT]**
C. C. It eliminates the need for lifestyle modifications
D. D. It reduces the risk of angioedema compared to either agent alone
Correct Answer: B
Rationale: Fixed-dose combinations improve adherence by reducing pill burden and provide synergistic BP reduction through
complementary mechanisms: ARBs block the renin-angiotensin system while thiazides promote sodium and water excretion. They
are specifically preferred for Stage 2 hypertension per 2026 guidelines. Option A is not consistently true as cost varies by insurance
formulary. Option C is incorrect because lifestyle modifications remain a cornerstone of hypertension management regardless of
pharmacotherapy. Option D is false; the risk of angioedema remains with the ARB component.
Q3: A 45-year-old patient with hypertension and benign prostatic hyperplasia (BPH) is experiencing
orthostatic dizziness after starting an alpha-1 blocker. Which medication class is most likely responsible?
A. A. ACE Inhibitor
B. B. Calcium Channel Blocker
C. C. Alpha-1 Blocker **[CORRECT]**
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, NUR 555 Quiz 6 | Advanced Pharmacotherapeutics 2026 Update
D. D. Beta-Blocker
Correct Answer: C
Rationale: Alpha-1 blockers such as Doxazosin and Terazosin cause orthostatic hypotension, with first-dose syncope being the most
significant concern. This occurs because alpha-1 receptor blockade on vascular smooth muscle causes rapid vasodilation upon
standing. These agents are useful in BPH because they also relax prostatic smooth muscle. Option A (ACE inhibitor) typically
causes cough and hyperkalemia. Option B (CCB) commonly causes peripheral edema. Option D (beta-blocker) causes bradycardia
and may mask hypoglycemia symptoms.
Q4: A patient on Hydrochlorothiazide for hypertension presents with a serum potassium of 3.1 mEq/L.
Which of the following findings is most likely also present in this patient?
A. A. Hypercalcemia
B. B. Hyperglycemia **[CORRECT]**
C. C. Metabolic alkalosis
D. D. Respiratory acidosis
Correct Answer: B
Rationale: Thiazide diuretics cause hypokalemia, hyponatremia, hyperglycemia, hyperuricemia, and hyperlipidemia. The
hyperglycemia results from impaired insulin secretion secondary to potassium depletion. Option A is incorrect because thiazides
cause hypercalcemia, but this would not be directly linked to the hypokalemia presentation. Option C is incorrect; thiazide-induced
hypokalemia typically leads to metabolic alkalosis due to hydrogen ion retention, but hyperglycemia is the more clinically
significant and commonly tested association. Option D is unrelated to thiazide diuretic use.
Q5: A 65-year-old patient with hypertension and asthma is being considered for a beta-blocker. Which of the
following beta-blockers is the safest choice for this patient?
A. A. Propranolol
B. B. Carvedilol
C. C. Metoprolol **[CORRECT]**
D. D. Nadolol
Correct Answer: C
Rationale: Metoprolol is a cardioselective (beta-1 selective) blocker, making it the safest option for patients with asthma or COPD
because it primarily affects the heart with minimal beta-2 (pulmonary) receptor blockade. Non-selective beta-blockers like
Propranolol (Option A) and Nadolol (Option D) block both beta-1 and beta-2 receptors, causing bronchospasm in patients with
reactive airway disease. Option C, Carvedilol, has both alpha and non-selective beta-blocking activity, making it less suitable for
asthma patients despite its benefits in heart failure.
Q6: A pregnant patient in her second trimester is found to have new-onset hypertension. Which of the
following antihypertensive medications is absolutely contraindicated?
A. A. Methyldopa
B. B. Labetalol
C. C. Lisinopril **[CORRECT]**
D. D. Nifedipine
Correct Answer: C
Rationale: ACE inhibitors are absolutely contraindicated in pregnancy due to the risk of fetal renal agenesis, oligohydramnios, and
pulmonary hypoplasia. They are FDA Pregnancy Category D and carry a black box warning. Options A (Methyldopa) and B
(Labetalol) are preferred agents for gestational hypertension because of their established safety profiles. Option D (Nifedipine), a
calcium channel blocker, may be used cautiously in pregnancy. This contraindication is a critical NUR 555 prescribing safety
Page 2
NUR 555 Quiz 6
Advanced Pharmacotherapeutics: Cardiovascular and Renal
Systems
Questions and Answers | 2026 Update | With Complete Solutions
Section 1: Antihypertensive Medications
ACE Inhibitors, ARBs, Beta-Blockers, Calcium Channel Blockers, Alpha-Blockers, and Diuretics (Q1-Q10)
Q1: A 58-year-old patient with hypertension starts Lisinopril. At the 2-week follow-up, the patient reports a
persistent dry cough that is interfering with sleep. What is the most appropriate next step in management?
A. A. Continue Lisinopril and add a cough suppressant
B. B. Switch to Losartan **[CORRECT]**
C. C. Switch to Amlodipine
D. D. Discontinue all antihypertensive therapy
Correct Answer: B
Rationale: The dry cough is a well-documented adverse effect of ACE inhibitors caused by bradykinin accumulation. ARBs such
as Losartan block angiotensin II type 1 receptors without affecting bradykinin breakdown, making them the ideal substitute with
comparable efficacy. Option A treats the symptom without addressing the underlying drug-related cause. Option C switches to a
different drug class (calcium channel blocker) unnecessarily when an ARB provides the same mechanism without the cough.
Option D is unsafe; hypertension requires continued pharmacotherapy.
Q2: A 72-year-old patient with Stage 2 hypertension is prescribed a combination pill containing Valsartan and
Hydrochlorothiazide. What is the primary rationale for using fixed-dose combination therapy in this patient?
A. A. It reduces the cost of therapy by 50%
B. B. It improves medication adherence and provides synergistic blood pressure reduction **[CORRECT]**
C. C. It eliminates the need for lifestyle modifications
D. D. It reduces the risk of angioedema compared to either agent alone
Correct Answer: B
Rationale: Fixed-dose combinations improve adherence by reducing pill burden and provide synergistic BP reduction through
complementary mechanisms: ARBs block the renin-angiotensin system while thiazides promote sodium and water excretion. They
are specifically preferred for Stage 2 hypertension per 2026 guidelines. Option A is not consistently true as cost varies by insurance
formulary. Option C is incorrect because lifestyle modifications remain a cornerstone of hypertension management regardless of
pharmacotherapy. Option D is false; the risk of angioedema remains with the ARB component.
Q3: A 45-year-old patient with hypertension and benign prostatic hyperplasia (BPH) is experiencing
orthostatic dizziness after starting an alpha-1 blocker. Which medication class is most likely responsible?
A. A. ACE Inhibitor
B. B. Calcium Channel Blocker
C. C. Alpha-1 Blocker **[CORRECT]**
Page 1
, NUR 555 Quiz 6 | Advanced Pharmacotherapeutics 2026 Update
D. D. Beta-Blocker
Correct Answer: C
Rationale: Alpha-1 blockers such as Doxazosin and Terazosin cause orthostatic hypotension, with first-dose syncope being the most
significant concern. This occurs because alpha-1 receptor blockade on vascular smooth muscle causes rapid vasodilation upon
standing. These agents are useful in BPH because they also relax prostatic smooth muscle. Option A (ACE inhibitor) typically
causes cough and hyperkalemia. Option B (CCB) commonly causes peripheral edema. Option D (beta-blocker) causes bradycardia
and may mask hypoglycemia symptoms.
Q4: A patient on Hydrochlorothiazide for hypertension presents with a serum potassium of 3.1 mEq/L.
Which of the following findings is most likely also present in this patient?
A. A. Hypercalcemia
B. B. Hyperglycemia **[CORRECT]**
C. C. Metabolic alkalosis
D. D. Respiratory acidosis
Correct Answer: B
Rationale: Thiazide diuretics cause hypokalemia, hyponatremia, hyperglycemia, hyperuricemia, and hyperlipidemia. The
hyperglycemia results from impaired insulin secretion secondary to potassium depletion. Option A is incorrect because thiazides
cause hypercalcemia, but this would not be directly linked to the hypokalemia presentation. Option C is incorrect; thiazide-induced
hypokalemia typically leads to metabolic alkalosis due to hydrogen ion retention, but hyperglycemia is the more clinically
significant and commonly tested association. Option D is unrelated to thiazide diuretic use.
Q5: A 65-year-old patient with hypertension and asthma is being considered for a beta-blocker. Which of the
following beta-blockers is the safest choice for this patient?
A. A. Propranolol
B. B. Carvedilol
C. C. Metoprolol **[CORRECT]**
D. D. Nadolol
Correct Answer: C
Rationale: Metoprolol is a cardioselective (beta-1 selective) blocker, making it the safest option for patients with asthma or COPD
because it primarily affects the heart with minimal beta-2 (pulmonary) receptor blockade. Non-selective beta-blockers like
Propranolol (Option A) and Nadolol (Option D) block both beta-1 and beta-2 receptors, causing bronchospasm in patients with
reactive airway disease. Option C, Carvedilol, has both alpha and non-selective beta-blocking activity, making it less suitable for
asthma patients despite its benefits in heart failure.
Q6: A pregnant patient in her second trimester is found to have new-onset hypertension. Which of the
following antihypertensive medications is absolutely contraindicated?
A. A. Methyldopa
B. B. Labetalol
C. C. Lisinopril **[CORRECT]**
D. D. Nifedipine
Correct Answer: C
Rationale: ACE inhibitors are absolutely contraindicated in pregnancy due to the risk of fetal renal agenesis, oligohydramnios, and
pulmonary hypoplasia. They are FDA Pregnancy Category D and carry a black box warning. Options A (Methyldopa) and B
(Labetalol) are preferred agents for gestational hypertension because of their established safety profiles. Option D (Nifedipine), a
calcium channel blocker, may be used cautiously in pregnancy. This contraindication is a critical NUR 555 prescribing safety
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