NR 565 Exam 2: Advanced Pharmacology Fundamentals V2
Updated and Latest Questions and Correct Answers with
Rationale
1. A patient is prescribed Lisinopril for hypertension but develops a persistent, dry cough.
Which mechanism explains this side effect?
A. Inhibition of the sympathetic nervous system
B. Accumulation of bradykinin in the lungs
C. Direct irritation of the bronchial mucosa
D. Increased production of aldosterone
Ans: B
Rationale: ACE inhibitors block the enzyme that converts angiotensin I to angiotensin II. This enzyme is
also responsible for the breakdown of bradykinin. When the enzyme is inhibited, bradykinin levels rise in
the respiratory tract. This accumulation triggers a dry, hacking cough in many patients. If the cough is
intolerable, the patient may switch to an ARB. This effect is a class-specific reaction for ACE inhibitors.
2. Which of the following is a selective Beta-1 receptor antagonist?
A. Metoprolol
B. Propranolol
C. Carvedilol
D. Labetalol
Ans: A
,Rationale: Metoprolol is classified as a cardioselective beta-blocker. It primarily targets Beta-1 receptors
located in the heart. This selectivity helps minimize effects on Beta-2 receptors in the lungs. In contrast,
Propranolol is a non-selective beta-blocker. Carvedilol and Labetalol block both beta and alpha receptors.
Selective agents are safer for patients with stable asthma. However, selectivity may be lost at higher
doses.
3. A patient taking Warfarin has an INR of 1.2. How should the provider interpret this result
for a patient with atrial fibrillation?
A. The dose is therapeutic
B. The dose is too high and should be reduced
C. The patient is at high risk for bleeding
D. The dose is subtherapeutic and needs adjustment
Ans: D
Rationale: For most patients on Warfarin, the target INR is 2.0 to 3.0. An INR of 1.2 indicates that the
blood is not sufficiently anticoagulated. This puts the patient at an increased risk for thromboembolic
events. The provider should evaluate the patient’s adherence and diet. A dose increase is likely necessary
to achieve the target range. Regular monitoring remains essential until the INR stabilizes.
, 4. What is the primary mechanism of action of Spironolactone?
A. Inhibits the Na-K-Cl symporter in the loop of Henle
B. Inhibits carbonic anhydrase in the proximal tubule
C. Blocks aldosterone receptors in the distal tubule
D. Blocks sodium channels in the collecting duct
Ans: C
Rationale: Spironolactone is classified as a potassium-sparing diuretic. It works by competing with
aldosterone for receptor sites in the distal tubule. This leads to the excretion of sodium and water.
Concurrently, it causes the retention of potassium. It is often used in heart failure to prevent cardiac
remodeling. Patients must be monitored closely for signs of hyperkalemia.
5. Which medication is considered a ‘rescue’ inhaler for acute bronchospasm?
A. Salmeterol
B. Fluticasone
C. Albuterol
D. Tiotropium
Ans: C
Rationale: Albuterol is a short-acting beta-2 agonist (SABA). It provides rapid relief of symptoms during
an asthma attack. The onset of action is typically within minutes. It works by relaxing smooth muscles in
the airway. This medication should not be used for daily maintenance therapy alone. Patients relying on
it too frequently may need inhaled corticosteroids.
Updated and Latest Questions and Correct Answers with
Rationale
1. A patient is prescribed Lisinopril for hypertension but develops a persistent, dry cough.
Which mechanism explains this side effect?
A. Inhibition of the sympathetic nervous system
B. Accumulation of bradykinin in the lungs
C. Direct irritation of the bronchial mucosa
D. Increased production of aldosterone
Ans: B
Rationale: ACE inhibitors block the enzyme that converts angiotensin I to angiotensin II. This enzyme is
also responsible for the breakdown of bradykinin. When the enzyme is inhibited, bradykinin levels rise in
the respiratory tract. This accumulation triggers a dry, hacking cough in many patients. If the cough is
intolerable, the patient may switch to an ARB. This effect is a class-specific reaction for ACE inhibitors.
2. Which of the following is a selective Beta-1 receptor antagonist?
A. Metoprolol
B. Propranolol
C. Carvedilol
D. Labetalol
Ans: A
,Rationale: Metoprolol is classified as a cardioselective beta-blocker. It primarily targets Beta-1 receptors
located in the heart. This selectivity helps minimize effects on Beta-2 receptors in the lungs. In contrast,
Propranolol is a non-selective beta-blocker. Carvedilol and Labetalol block both beta and alpha receptors.
Selective agents are safer for patients with stable asthma. However, selectivity may be lost at higher
doses.
3. A patient taking Warfarin has an INR of 1.2. How should the provider interpret this result
for a patient with atrial fibrillation?
A. The dose is therapeutic
B. The dose is too high and should be reduced
C. The patient is at high risk for bleeding
D. The dose is subtherapeutic and needs adjustment
Ans: D
Rationale: For most patients on Warfarin, the target INR is 2.0 to 3.0. An INR of 1.2 indicates that the
blood is not sufficiently anticoagulated. This puts the patient at an increased risk for thromboembolic
events. The provider should evaluate the patient’s adherence and diet. A dose increase is likely necessary
to achieve the target range. Regular monitoring remains essential until the INR stabilizes.
, 4. What is the primary mechanism of action of Spironolactone?
A. Inhibits the Na-K-Cl symporter in the loop of Henle
B. Inhibits carbonic anhydrase in the proximal tubule
C. Blocks aldosterone receptors in the distal tubule
D. Blocks sodium channels in the collecting duct
Ans: C
Rationale: Spironolactone is classified as a potassium-sparing diuretic. It works by competing with
aldosterone for receptor sites in the distal tubule. This leads to the excretion of sodium and water.
Concurrently, it causes the retention of potassium. It is often used in heart failure to prevent cardiac
remodeling. Patients must be monitored closely for signs of hyperkalemia.
5. Which medication is considered a ‘rescue’ inhaler for acute bronchospasm?
A. Salmeterol
B. Fluticasone
C. Albuterol
D. Tiotropium
Ans: C
Rationale: Albuterol is a short-acting beta-2 agonist (SABA). It provides rapid relief of symptoms during
an asthma attack. The onset of action is typically within minutes. It works by relaxing smooth muscles in
the airway. This medication should not be used for daily maintenance therapy alone. Patients relying on
it too frequently may need inhaled corticosteroids.
