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NURS 251 Pharmacology Module 4 Exam Portage
Learning Actual Exam 2026/2027 – Complete Exam-
Style Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Pharmacology — Questions 1-15]
Q1: A patient with hypertension starts taking lisinopril, an ACE inhibitor. During the follow-up
visit, the patient reports a persistent, dry, non-productive cough that bothers them at night. The
nurse understands that this side effect is caused by the accumulation of which substance due to
the inhibition of ACE?
A. Angiotensin I
B. Angiotensin II
C. Bradykinin [CORRECT]
D. Aldosterone
Correct Answer: C
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II and
simultaneously inhibit the breakdown of bradykinin. The accumulation of bradykinin in the
lungs is believed to be the primary cause of the dry, persistent cough associated with ACE
inhibitor therapy. Angiotensin II and aldosterone levels are decreased by this medication, not
increased. If the cough is intolerable, the provider may switch the patient to an ARB, which does
not affect bradykinin.
Q2: A 55-year-old male is prescribed amlodipine, a dihydropyridine calcium channel blocker, for
the management of hypertension. Which specific side effect should the nurse prioritize in patient
education due to its high prevalence with this drug class?
A. Bradycardia
B. Constipation
C. Peripheral edema [CORRECT]
D. Dry cough
,2
Correct Answer: C
Rationale: Peripheral edema is a common dose-dependent side effect of dihydropyridine calcium
channel blockers like amlodipine, resulting from preferential arteriolar vasodilation rather than
venous dilation. This side effect can be distressing to patients and may require dose adjustment
or the addition of a medication that promotes venous dilation. Bradycardia and constipation are
more typical of non-dihydropyridine CCBs like verapamil or diltiazem. A dry cough is associated
with ACE inhibitors, not CCBs.
Q3: The nurse is reviewing the medication list of a patient with heart failure who is taking
carvedilol. The nurse understands that this medication is a beta-blocker. Which statement best
describes the mechanism of action of beta-blockers in the treatment of heart failure and
hypertension?
A. They block calcium channels in the cardiac conduction system.
B. They inhibit the conversion of angiotensin I to angiotensin II.
C. They antagonize beta-1 adrenergic receptors, reducing heart rate and contractility.
[CORRECT]
D. They promote the excretion of sodium and water in the renal tubules.
Correct Answer: C
Rationale: Beta-blockers work by blocking beta-1 adrenergic receptors in the heart, which
decreases the heart rate (chronotropy), reduces the force of contraction (inotropy), and lowers
cardiac output, thereby reducing blood pressure. In heart failure, they reduce the workload of the
heart and prevent the harmful effects of chronic sympathetic nervous system activation. Calcium
channel blockers block calcium channels, ACE inhibitors affect the renin-angiotensin-
aldosterone system, and diuretics promote fluid excretion, none of which are the primary
mechanism of beta-blockers.
Q4: A patient with atrial fibrillation is prescribed warfarin (Coumadin) for anticoagulation. The
nurse teaches the patient about the importance of dietary consistency regarding Vitamin K intake.
Which laboratory value does the nurse explain must be regularly monitored to ensure the
medication is effective and safe?
A. aPTT (activated Partial Thromboplastin Time)
B. PT (Prothrombin Time) and INR (International Normalized Ratio)
, 3
C. INR (International Normalized Ratio) [CORRECT]
D. Platelet count
Correct Answer: C
Rationale: Warfarin therapy requires monitoring of the INR, which standardizes the Prothrombin
Time (PT) results to account for variations in thromboplastin reagents between labs. The
therapeutic range for most indications is an INR of 2.0 to 3.0, while mechanical heart valves may
require a higher range of 2.5 to 3.5. aPTT is used to monitor heparin therapy, not warfarin. While
platelet counts are monitored for heparin-induced thrombocytopenia, they are not used to
measure warfarin efficacy.
Q5: A patient is admitted to the emergency department with a deep vein thrombosis (DVT). The
physician orders an unfractionated heparin infusion. What is the primary mechanism of action of
unfractionated heparin?
A. It acts as a vitamin K antagonist.
B. It inhibits platelet aggregation by irreversibly binding to COX-1.
C. It potentiates the action of antithrombin III to inhibit factors IIa and Xa. [CORRECT]
D. It directly inhibits factor Xa without requiring antithrombin.
Correct Answer: C
Rationale: Unfractionated heparin works by binding to antithrombin III, inducing a
conformational change that dramatically accelerates the ability of antithrombin III to inactivate
thrombin (factor IIa) and factor Xa. This prevents the conversion of fibrinogen to fibrin and halts
clot formation. Warfarin is a vitamin K antagonist, and aspirin inhibits platelet aggregation.
Direct factor Xa inhibitors, like fondaparinux, work differently than heparin.
Q6: A patient taking atorvastatin (Lipitor) complains of muscle pain and weakness. The nurse
notes the patient recently started drinking large amounts of grapefruit juice daily. What is the
nurse's priority action regarding this interaction?
A. Encourage the patient to increase fluid intake to flush the kidneys.
B. Explain that grapefruit juice increases the metabolism of the drug, reducing effectiveness.
NURS 251 Pharmacology Module 4 Exam Portage
Learning Actual Exam 2026/2027 – Complete Exam-
Style Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Pharmacology — Questions 1-15]
Q1: A patient with hypertension starts taking lisinopril, an ACE inhibitor. During the follow-up
visit, the patient reports a persistent, dry, non-productive cough that bothers them at night. The
nurse understands that this side effect is caused by the accumulation of which substance due to
the inhibition of ACE?
A. Angiotensin I
B. Angiotensin II
C. Bradykinin [CORRECT]
D. Aldosterone
Correct Answer: C
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II and
simultaneously inhibit the breakdown of bradykinin. The accumulation of bradykinin in the
lungs is believed to be the primary cause of the dry, persistent cough associated with ACE
inhibitor therapy. Angiotensin II and aldosterone levels are decreased by this medication, not
increased. If the cough is intolerable, the provider may switch the patient to an ARB, which does
not affect bradykinin.
Q2: A 55-year-old male is prescribed amlodipine, a dihydropyridine calcium channel blocker, for
the management of hypertension. Which specific side effect should the nurse prioritize in patient
education due to its high prevalence with this drug class?
A. Bradycardia
B. Constipation
C. Peripheral edema [CORRECT]
D. Dry cough
,2
Correct Answer: C
Rationale: Peripheral edema is a common dose-dependent side effect of dihydropyridine calcium
channel blockers like amlodipine, resulting from preferential arteriolar vasodilation rather than
venous dilation. This side effect can be distressing to patients and may require dose adjustment
or the addition of a medication that promotes venous dilation. Bradycardia and constipation are
more typical of non-dihydropyridine CCBs like verapamil or diltiazem. A dry cough is associated
with ACE inhibitors, not CCBs.
Q3: The nurse is reviewing the medication list of a patient with heart failure who is taking
carvedilol. The nurse understands that this medication is a beta-blocker. Which statement best
describes the mechanism of action of beta-blockers in the treatment of heart failure and
hypertension?
A. They block calcium channels in the cardiac conduction system.
B. They inhibit the conversion of angiotensin I to angiotensin II.
C. They antagonize beta-1 adrenergic receptors, reducing heart rate and contractility.
[CORRECT]
D. They promote the excretion of sodium and water in the renal tubules.
Correct Answer: C
Rationale: Beta-blockers work by blocking beta-1 adrenergic receptors in the heart, which
decreases the heart rate (chronotropy), reduces the force of contraction (inotropy), and lowers
cardiac output, thereby reducing blood pressure. In heart failure, they reduce the workload of the
heart and prevent the harmful effects of chronic sympathetic nervous system activation. Calcium
channel blockers block calcium channels, ACE inhibitors affect the renin-angiotensin-
aldosterone system, and diuretics promote fluid excretion, none of which are the primary
mechanism of beta-blockers.
Q4: A patient with atrial fibrillation is prescribed warfarin (Coumadin) for anticoagulation. The
nurse teaches the patient about the importance of dietary consistency regarding Vitamin K intake.
Which laboratory value does the nurse explain must be regularly monitored to ensure the
medication is effective and safe?
A. aPTT (activated Partial Thromboplastin Time)
B. PT (Prothrombin Time) and INR (International Normalized Ratio)
, 3
C. INR (International Normalized Ratio) [CORRECT]
D. Platelet count
Correct Answer: C
Rationale: Warfarin therapy requires monitoring of the INR, which standardizes the Prothrombin
Time (PT) results to account for variations in thromboplastin reagents between labs. The
therapeutic range for most indications is an INR of 2.0 to 3.0, while mechanical heart valves may
require a higher range of 2.5 to 3.5. aPTT is used to monitor heparin therapy, not warfarin. While
platelet counts are monitored for heparin-induced thrombocytopenia, they are not used to
measure warfarin efficacy.
Q5: A patient is admitted to the emergency department with a deep vein thrombosis (DVT). The
physician orders an unfractionated heparin infusion. What is the primary mechanism of action of
unfractionated heparin?
A. It acts as a vitamin K antagonist.
B. It inhibits platelet aggregation by irreversibly binding to COX-1.
C. It potentiates the action of antithrombin III to inhibit factors IIa and Xa. [CORRECT]
D. It directly inhibits factor Xa without requiring antithrombin.
Correct Answer: C
Rationale: Unfractionated heparin works by binding to antithrombin III, inducing a
conformational change that dramatically accelerates the ability of antithrombin III to inactivate
thrombin (factor IIa) and factor Xa. This prevents the conversion of fibrinogen to fibrin and halts
clot formation. Warfarin is a vitamin K antagonist, and aspirin inhibits platelet aggregation.
Direct factor Xa inhibitors, like fondaparinux, work differently than heparin.
Q6: A patient taking atorvastatin (Lipitor) complains of muscle pain and weakness. The nurse
notes the patient recently started drinking large amounts of grapefruit juice daily. What is the
nurse's priority action regarding this interaction?
A. Encourage the patient to increase fluid intake to flush the kidneys.
B. Explain that grapefruit juice increases the metabolism of the drug, reducing effectiveness.
