NR566 | NR566 Advanced Pharmacology for Care
of the Family Wk 2 Midterm v1 | Questions with
Correct Answers and Expert Explanation for Each
Question | Chamberlain
1. A patient taking Lisinopril develops a persistent, dry cough. What is the
physiological cause of this side effect?
A. Increased production of prostaglandins in the lungs
B. Accumulation of bradykinin in the respiratory tract
C. Direct irritation of the alveolar basement membrane
D. Local allergic reaction to the sulfhydryl group
Correct Answer: B
Expert Explanation: ACE inhibitors prevent the breakdown of bradykinin and
substance P, which leads to their accumulation in the lungs. This accumulation
triggers the cough reflex in approximately 10-20% of patients. Switching the patient
to an Angiotensin II Receptor Blocker (ARB) is the standard next step because ARBs
do not affect bradykinin levels.
2. Which of the following classes of antihypertensives is considered first-line
treatment for a patient of African American descent without chronic kidney disease?
A. ACE Inhibitors
,B. Beta-blockers
C. Calcium Channel Blockers
D. Angiotensin II Receptor Blockers
Correct Answer: C
Expert Explanation: Clinical guidelines, such as JNC 8, recommend Calcium
Channel Blockers (CCBs) or thiazide-type diuretics as initial therapy for the general
Black population. This is because this demographic often responds better to these
classes than to ACE inhibitors or ARBs when used as monotherapy. However, if the
patient has CKD, an ACEI or ARB would be prioritized regardless of race.
3. A patient is started on Amiodarone for atrial fibrillation. Which monitoring
parameter is most critical due to potential long-term toxicity?
A. Annual hearing tests
B. Serial echocardiograms every 3 months
C. Pulmonary function tests and chest X-rays
D. Weekly complete blood counts
Correct Answer: C
Expert Explanation: Amiodarone is associated with significant pulmonary toxicity,
which can lead to fatal pulmonary fibrosis. Baseline and periodic pulmonary
,function tests and chest X-rays are required to monitor for early signs of lung
damage. Additionally, thyroid and liver function must be monitored regularly due to
the drug’s high iodine content and hepatic metabolism.
4. A patient with a history of gout is diagnosed with hypertension. Which diuretic
should be used with caution?
A. Spironolactone
B. Triamterene
C. Eplerenone
D. Hydrochlorothiazide
Correct Answer: D
Expert Explanation: Thiazide diuretics like Hydrochlorothiazide compete with uric
acid for excretion in the kidneys. This competition can lead to hyperuricemia,
potentially precipitating an acute gouty attack. Providers should monitor uric acid
levels closely or choose an alternative class if the patient has frequent gout flares.
5. A patient is prescribed Warfarin for a prosthetic heart valve. What is the target
International Normalized Ratio (INR) range?
A. 1.5 - 2.5
B. 2.0 - 3.0
, C. 2.5 - 3.5
D. 3.5 - 4.5
Correct Answer: C
Expert Explanation: For patients with mechanical prosthetic heart valves, the
target INR is typically higher than for atrial fibrillation, usually ranging from 2.5 to
3.5. This higher range is necessary to prevent thrombus formation on the
mechanical surface of the valve. Regular monitoring is essential to balance the risk
of clotting against the risk of major bleeding.
6. Which medication is known to cause a ‘Lupus-like syndrome’ as a potential side
effect?
A. Metoprolol
B. Amlodipine
C. Hydralazine
D. Lisinopril
Correct Answer: C
Expert Explanation: Hydralazine, a direct vasodilator, is associated with drug-
induced lupus erythematosus (DILE). Symptoms often include arthralgia, fever, and
of the Family Wk 2 Midterm v1 | Questions with
Correct Answers and Expert Explanation for Each
Question | Chamberlain
1. A patient taking Lisinopril develops a persistent, dry cough. What is the
physiological cause of this side effect?
A. Increased production of prostaglandins in the lungs
B. Accumulation of bradykinin in the respiratory tract
C. Direct irritation of the alveolar basement membrane
D. Local allergic reaction to the sulfhydryl group
Correct Answer: B
Expert Explanation: ACE inhibitors prevent the breakdown of bradykinin and
substance P, which leads to their accumulation in the lungs. This accumulation
triggers the cough reflex in approximately 10-20% of patients. Switching the patient
to an Angiotensin II Receptor Blocker (ARB) is the standard next step because ARBs
do not affect bradykinin levels.
2. Which of the following classes of antihypertensives is considered first-line
treatment for a patient of African American descent without chronic kidney disease?
A. ACE Inhibitors
,B. Beta-blockers
C. Calcium Channel Blockers
D. Angiotensin II Receptor Blockers
Correct Answer: C
Expert Explanation: Clinical guidelines, such as JNC 8, recommend Calcium
Channel Blockers (CCBs) or thiazide-type diuretics as initial therapy for the general
Black population. This is because this demographic often responds better to these
classes than to ACE inhibitors or ARBs when used as monotherapy. However, if the
patient has CKD, an ACEI or ARB would be prioritized regardless of race.
3. A patient is started on Amiodarone for atrial fibrillation. Which monitoring
parameter is most critical due to potential long-term toxicity?
A. Annual hearing tests
B. Serial echocardiograms every 3 months
C. Pulmonary function tests and chest X-rays
D. Weekly complete blood counts
Correct Answer: C
Expert Explanation: Amiodarone is associated with significant pulmonary toxicity,
which can lead to fatal pulmonary fibrosis. Baseline and periodic pulmonary
,function tests and chest X-rays are required to monitor for early signs of lung
damage. Additionally, thyroid and liver function must be monitored regularly due to
the drug’s high iodine content and hepatic metabolism.
4. A patient with a history of gout is diagnosed with hypertension. Which diuretic
should be used with caution?
A. Spironolactone
B. Triamterene
C. Eplerenone
D. Hydrochlorothiazide
Correct Answer: D
Expert Explanation: Thiazide diuretics like Hydrochlorothiazide compete with uric
acid for excretion in the kidneys. This competition can lead to hyperuricemia,
potentially precipitating an acute gouty attack. Providers should monitor uric acid
levels closely or choose an alternative class if the patient has frequent gout flares.
5. A patient is prescribed Warfarin for a prosthetic heart valve. What is the target
International Normalized Ratio (INR) range?
A. 1.5 - 2.5
B. 2.0 - 3.0
, C. 2.5 - 3.5
D. 3.5 - 4.5
Correct Answer: C
Expert Explanation: For patients with mechanical prosthetic heart valves, the
target INR is typically higher than for atrial fibrillation, usually ranging from 2.5 to
3.5. This higher range is necessary to prevent thrombus formation on the
mechanical surface of the valve. Regular monitoring is essential to balance the risk
of clotting against the risk of major bleeding.
6. Which medication is known to cause a ‘Lupus-like syndrome’ as a potential side
effect?
A. Metoprolol
B. Amlodipine
C. Hydralazine
D. Lisinopril
Correct Answer: C
Expert Explanation: Hydralazine, a direct vasodilator, is associated with drug-
induced lupus erythematosus (DILE). Symptoms often include arthralgia, fever, and
