NR 565 Exam 2: Advanced Pharmacology Fundamentals V3
Updated and Latest Questions and Correct Answers with
Rationale
1. Which of the following describes the primary mechanism of action for Lisinopril?
A. Directly inhibits renin production
B. Antagonizes the angiotensin II receptor sites
C. Blocks the conversion of angiotensin I to angiotensin II
D. Inhibits calcium influx into smooth muscle cells
Ans: C
Rationale: Lisinopril belongs to the ACE inhibitor class of antihypertensive medications. It functions by
inhibiting the angiotensin-converting enzyme which prevents the formation of angiotensin II.
Angiotensin II is a potent vasoconstrictor and stimulator of aldosterone secretion. By blocking this
conversion, lisinopril promotes vasodilation and reduces sodium retention. Common side effects include
a dry cough due to bradykinin accumulation. Clinicians must monitor for hyperkalemia and changes in
renal function after initiation.
,2. A patient with asthma is diagnosed with hypertension. Which beta-blocker should be
avoided?
A. Metoprolol
B. Propranolol
C. Atenolol
D. Bisoprolol
Ans: B
Rationale: Propranolol is a non-selective beta-adrenergic antagonist that blocks both beta-1 and beta-2
receptors. Blocking beta-2 receptors in the lungs can lead to bronchoconstriction, which is dangerous for
asthma patients. Cardioselective beta-blockers like metoprolol and atenolol primarily target beta-1
receptors. Even cardioselective agents should be used with caution in severe respiratory disease. The
blockage of beta-2 receptors can also mask symptoms of hypoglycemia. Providers must prioritize
selective agents to minimize the risk of respiratory distress.
3. What is the most common side effect associated with the use of Verapamil?
A. Constipation
B. Diarrhea
C. Hyperkalemia
D. Dry cough
Ans: A
,Rationale: Verapamil is a non-dihydropyridine calcium channel blocker used for hypertension and
arrhythmias. It acts on the calcium channels in the gastrointestinal tract, leading to slowed motility. This
effect frequently results in significant constipation for many patients. Increasing dietary fiber and fluid
intake can help manage this common issue. Unlike ACE inhibitors, verapamil does not cause a bradykinin-
mediated cough. It is important to monitor heart rate as verapamil can also cause bradycardia.
4. Which electrolyte abnormality is most likely to occur with Hydrochlorothiazide therapy?
A. Hyperkalemia
B. Hypercalcemia
C. Hyponatremia
D. Hypokalemia
Ans: D
Rationale: Hydrochlorothiazide is a thiazide diuretic that acts on the distal convoluted tubule. It
promotes the excretion of sodium, chloride, and water to lower blood pressure. During this process,
potassium is also excreted, often leading to hypokalemia. Patients may require potassium supplements or
dietary changes to maintain balance. Thiazides can also cause hyperuricemia, which might trigger gout in
susceptible individuals. Monitoring the basic metabolic panel is essential during the first weeks of
therapy.
, 5. Furosemide is known to cause ototoxicity primarily when administered in which manner?
A. Chronic low-dose oral therapy
B. Combination with ACE inhibitors
C. Twice daily morning dosing
D. Rapid intravenous push
Ans: D
Rationale: Furosemide is a potent loop diuretic that inhibits the sodium-potassium-chloride
cotransporter. Rapid intravenous administration can lead to transient or permanent hearing loss and
tinnitus. This ototoxicity is more common when serum levels peak quickly or when used with other
ototoxic drugs. To minimize risk, intravenous furosemide should be infused slowly at controlled rates.
Oral administration rarely causes this specific adverse effect compared to high-dose IV therapy. Patients
should be educated to report any changes in hearing or balance immediately.
6. Which drug is classified as a potassium-sparing diuretic that may cause gynecomastia?
A. Triamterene
B. Amiloride
C. Eplerenone
D. Spironolactone
Ans: D
Rationale: Spironolactone is an aldosterone antagonist used for heart failure and resistant hypertension.
Because it has a steroid-like structure, it can bind to androgen and progesterone receptors. This lack of
Updated and Latest Questions and Correct Answers with
Rationale
1. Which of the following describes the primary mechanism of action for Lisinopril?
A. Directly inhibits renin production
B. Antagonizes the angiotensin II receptor sites
C. Blocks the conversion of angiotensin I to angiotensin II
D. Inhibits calcium influx into smooth muscle cells
Ans: C
Rationale: Lisinopril belongs to the ACE inhibitor class of antihypertensive medications. It functions by
inhibiting the angiotensin-converting enzyme which prevents the formation of angiotensin II.
Angiotensin II is a potent vasoconstrictor and stimulator of aldosterone secretion. By blocking this
conversion, lisinopril promotes vasodilation and reduces sodium retention. Common side effects include
a dry cough due to bradykinin accumulation. Clinicians must monitor for hyperkalemia and changes in
renal function after initiation.
,2. A patient with asthma is diagnosed with hypertension. Which beta-blocker should be
avoided?
A. Metoprolol
B. Propranolol
C. Atenolol
D. Bisoprolol
Ans: B
Rationale: Propranolol is a non-selective beta-adrenergic antagonist that blocks both beta-1 and beta-2
receptors. Blocking beta-2 receptors in the lungs can lead to bronchoconstriction, which is dangerous for
asthma patients. Cardioselective beta-blockers like metoprolol and atenolol primarily target beta-1
receptors. Even cardioselective agents should be used with caution in severe respiratory disease. The
blockage of beta-2 receptors can also mask symptoms of hypoglycemia. Providers must prioritize
selective agents to minimize the risk of respiratory distress.
3. What is the most common side effect associated with the use of Verapamil?
A. Constipation
B. Diarrhea
C. Hyperkalemia
D. Dry cough
Ans: A
,Rationale: Verapamil is a non-dihydropyridine calcium channel blocker used for hypertension and
arrhythmias. It acts on the calcium channels in the gastrointestinal tract, leading to slowed motility. This
effect frequently results in significant constipation for many patients. Increasing dietary fiber and fluid
intake can help manage this common issue. Unlike ACE inhibitors, verapamil does not cause a bradykinin-
mediated cough. It is important to monitor heart rate as verapamil can also cause bradycardia.
4. Which electrolyte abnormality is most likely to occur with Hydrochlorothiazide therapy?
A. Hyperkalemia
B. Hypercalcemia
C. Hyponatremia
D. Hypokalemia
Ans: D
Rationale: Hydrochlorothiazide is a thiazide diuretic that acts on the distal convoluted tubule. It
promotes the excretion of sodium, chloride, and water to lower blood pressure. During this process,
potassium is also excreted, often leading to hypokalemia. Patients may require potassium supplements or
dietary changes to maintain balance. Thiazides can also cause hyperuricemia, which might trigger gout in
susceptible individuals. Monitoring the basic metabolic panel is essential during the first weeks of
therapy.
, 5. Furosemide is known to cause ototoxicity primarily when administered in which manner?
A. Chronic low-dose oral therapy
B. Combination with ACE inhibitors
C. Twice daily morning dosing
D. Rapid intravenous push
Ans: D
Rationale: Furosemide is a potent loop diuretic that inhibits the sodium-potassium-chloride
cotransporter. Rapid intravenous administration can lead to transient or permanent hearing loss and
tinnitus. This ototoxicity is more common when serum levels peak quickly or when used with other
ototoxic drugs. To minimize risk, intravenous furosemide should be infused slowly at controlled rates.
Oral administration rarely causes this specific adverse effect compared to high-dose IV therapy. Patients
should be educated to report any changes in hearing or balance immediately.
6. Which drug is classified as a potassium-sparing diuretic that may cause gynecomastia?
A. Triamterene
B. Amiloride
C. Eplerenone
D. Spironolactone
Ans: D
Rationale: Spironolactone is an aldosterone antagonist used for heart failure and resistant hypertension.
Because it has a steroid-like structure, it can bind to androgen and progesterone receptors. This lack of
