NR 603 Week 2, 3, 4, & 5 Quiz – Full Questions, Answers and Rationales

NR 603 Week 2, 3, 4, & 5 Quiz –
Full Questions, Answers and
Rationales




NR 603 Week 2 – Cardiovascular & Pulmonary Disorders (Q 1–50)


Part 1: Hypertension & Antihypertensives (Q 1–10)

Question 1: A 55-year-old African American male with newly diagnosed
hypertension (BP 148/92) has no other comorbidities. According to current
guidelines, which medication should be initiated first?

• A) Lisinopril
• B) Metoprolol
• C) Amlodipine
• D) Hydrochlorothiazide

,,,ANSWER,,,: D

Rationale: For African American patients with hypertension and no
comorbidities, thiazide diuretics (hydrochlorothiazide, chlorthalidone) or calcium
channel blockers (amlodipine) are preferred first-line agents due to lower renin
levels in this population. ACE inhibitors (lisinopril) are less effective as
monotherapy in African Americans but are still indicated for comorbidities

,(diabetes, CKD, heart failure). Beta-blockers (metoprolol) are not first-line for
uncomplicated hypertension.




Question 2: A 32-year-old pregnant woman with chronic hypertension has BP
150/95. Which antihypertensive is contraindicated during pregnancy (especially
second/third trimester)?

• A) Labetalol
• B) Nifedipine
• C) Lisinopril
• D) Methyldopa

,,,ANSWER,,,: C

Rationale: ACE inhibitors (lisinopril) and ARBs are contraindicated in
pregnancy due to risk of fetal renal agenesis, oligohydramnios, and neonatal renal
failure. Labetalol (beta-blocker), nifedipine (CCB), and methyldopa (central
alpha agonist) are considered safe first-line agents for hypertension in pregnancy.




Question 3: A patient on hydrochlorothiazide develops muscle weakness, fatigue,
and ECG changes (U waves, flattened T waves). Which electrolyte abnormality is
most likely?

• A) Hyperkalemia
• B) Hypokalemia
• C) Hypernatremia
• D) Hypercalcemia

,,,,ANSWER,,,: B

Rationale: Thiazide diuretics cause potassium wasting, leading to hypokalemia.
Hypokalemia presents with muscle weakness, fatigue, and ECG changes including
U waves, flattened T waves, and prolonged QT. Other thiazide effects include
hyponatremia, hypercalcemia (reduced calcium excretion), hyperuricemia, and
metabolic alkalosis.




Question 4: A patient with resistant hypertension (BP >140/90 on 3 or more
antihypertensives including a diuretic) should be evaluated for:

• A) Primary aldosteronism
• B) Medication nonadherence only
• C) White coat hypertension
• D) Decreased salt intake

,,,ANSWER,,,: A

Rationale: Primary aldosteronism (Conn syndrome) is a common cause of
resistant hypertension (up to 20% of cases). Screening includes plasma
aldosterone-to-renin ratio (ARR). Other causes include renal artery stenosis,
pheochromocytoma, Cushing syndrome, and medication nonadherence or
suboptimal therapy. White coat hypertension is unlikely with resistant
hypertension.




Question 5: A patient with hypertension and diabetes mellitus has a urine
albumin-to-creatinine ratio (UACR) of 150 mg/g. Which medication class provides
renal protection beyond blood pressure lowering?

, • A) Beta-blocker
• B) Calcium channel blocker
• C) ACE inhibitor or ARB
• D) Thiazide diuretic

,,,ANSWER,,,: C

Rationale: ACE inhibitors or ARBs are preferred in hypertensive patients with
diabetes and albuminuria because they reduce intraglomerular pressure and slow
progression of diabetic nephropathy (proteinuria reduction). They are also
indicated for heart failure and post-MI patients. Beta-blockers are not first-line for
uncomplicated diabetes unless another indication exists.




Question 6: Which beta-blocker is considered cardioselective (beta-1 selective)
and has less risk of bronchospasm?

• A) Propranolol
• B) Metoprolol
• C) Carvedilol
• D) Labetalol

,,,ANSWER,,,: B

Rationale: Metoprolol (succinate or tartrate) is a beta-1 selective (cardioselective)
beta-blocker, meaning it has greater affinity for cardiac beta-1 receptors than
pulmonary beta-2 receptors. This reduces risk of bronchospasm compared to non-
selective agents (propranolol, carvedilol, labetalol). However, caution is still
needed in patients with reactive airway disease.