NR 667 CHAMBERLAIN CEA FINAL EXAM
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A 62-year-old female with COPD is admitted for exacerbation. She is on
albuterol/ipratropium, prednisone, and oxygen. She reports new-onset tremors,
palpitations, and insomnia. Which medication is most likely causing these symptoms?
A. Ipratropium
B. Prednisone
C. Albuterol
D. Oxygen
Answer: C. Albuterol
Rationale: Albuterol is a beta-2 agonist and can cause sympathetic stimulation
resulting in tremors, palpitations, and insomnia. Prednisone can cause insomnia but is
less likely to cause tremors and palpitations in this context.
2. A patient with HFpEF presents with worsening dyspnea and peripheral edema.
Which intervention is most appropriate?
A. Increase dietary sodium
B. Initiate a beta-blocker
C. Add a thiazide diuretic
D. Stop all antihypertensives
Answer: C. Add a thiazide diuretic
Rationale: HFpEF management includes diuresis for volume overload and controlling
blood pressure. Thiazide diuretics reduce volume and improve symptoms.
1|Page
,3. A 28-year-old female presents with palpitations and anxiety. ECG shows a narrow-
complex SVT at 190 bpm. Vagal maneuvers fail. What is the next best step?
A. IV adenosine
B. IV amiodarone
C. Oral metoprolol
D. Immediate synchronized cardioversion
Answer: A. IV adenosine
Rationale: Adenosine is first-line for stable SVT when vagal maneuvers fail.
Cardioversion is reserved for unstable patients.
4. A patient with a history of peptic ulcer disease is prescribed NSAIDs for chronic pain.
Which co-prescription is most appropriate to prevent ulcer complications?
A. Omeprazole
B. Metoclopramide
C. Sucralfate
D. Ranitidine
Answer: A. Omeprazole
Rationale: PPIs reduce gastric acid secretion and protect the gastric lining, decreasing
risk of NSAID-related ulcers. Ranitidine is no longer preferred due to safety concerns.
2|Page
,5. A patient with T2DM on metformin presents with elevated creatinine and decreased
GFR. What is the most appropriate action?
A. Increase metformin dose
B. Stop metformin
C. Add a sulfonylurea
D. Switch to insulin
Answer: B. Stop metformin
Rationale: Metformin is contraindicated in renal insufficiency due to risk of lactic
acidosis. Insulin may be considered, but the immediate action is to discontinue
metformin.
6. A patient is started on warfarin and has a new INR of 5.5 with no bleeding. What is
the best next step?
A. Hold warfarin for 1–2 doses
B. Give vitamin K immediately
C. Increase warfarin dose
D. Switch to heparin
Answer: A. Hold warfarin for 1–2 doses
Rationale: INR >5 without bleeding is managed by holding doses and monitoring.
Vitamin K is reserved for INR >10 or bleeding.
3|Page
, 7. A 70-year-old with atrial fibrillation presents with sudden weakness and facial
droop. CT shows ischemic stroke. Which medication should be avoided within 24
hours?
A. Aspirin
B. Alteplase
C. Heparin
D. Atorvastatin
Answer: C. Heparin
Rationale: Heparin is contraindicated in acute ischemic stroke due to hemorrhagic
conversion risk. Alteplase may be considered if within window.
8. A patient with chronic kidney disease stage 4 has hyperphosphatemia. Which
medication is appropriate?
A. Calcium acetate
B. Furosemide
C. Sodium bicarbonate
D. Metformin
Answer: A. Calcium acetate
Rationale: Calcium acetate binds phosphate in the GI tract to reduce absorption.
Furosemide does not manage phosphate levels.
9. A patient with CHF is started on an ACE inhibitor. Which adverse effect requires
immediate discontinuation?
A. Cough
B. Hyperkalemia
C. Angioedema
D. Hypotension
Answer: C. Angioedema
Rationale: Angioedema is life-threatening and requires immediate discontinuation.
Cough is common but not emergent.
4|Page
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A 62-year-old female with COPD is admitted for exacerbation. She is on
albuterol/ipratropium, prednisone, and oxygen. She reports new-onset tremors,
palpitations, and insomnia. Which medication is most likely causing these symptoms?
A. Ipratropium
B. Prednisone
C. Albuterol
D. Oxygen
Answer: C. Albuterol
Rationale: Albuterol is a beta-2 agonist and can cause sympathetic stimulation
resulting in tremors, palpitations, and insomnia. Prednisone can cause insomnia but is
less likely to cause tremors and palpitations in this context.
2. A patient with HFpEF presents with worsening dyspnea and peripheral edema.
Which intervention is most appropriate?
A. Increase dietary sodium
B. Initiate a beta-blocker
C. Add a thiazide diuretic
D. Stop all antihypertensives
Answer: C. Add a thiazide diuretic
Rationale: HFpEF management includes diuresis for volume overload and controlling
blood pressure. Thiazide diuretics reduce volume and improve symptoms.
1|Page
,3. A 28-year-old female presents with palpitations and anxiety. ECG shows a narrow-
complex SVT at 190 bpm. Vagal maneuvers fail. What is the next best step?
A. IV adenosine
B. IV amiodarone
C. Oral metoprolol
D. Immediate synchronized cardioversion
Answer: A. IV adenosine
Rationale: Adenosine is first-line for stable SVT when vagal maneuvers fail.
Cardioversion is reserved for unstable patients.
4. A patient with a history of peptic ulcer disease is prescribed NSAIDs for chronic pain.
Which co-prescription is most appropriate to prevent ulcer complications?
A. Omeprazole
B. Metoclopramide
C. Sucralfate
D. Ranitidine
Answer: A. Omeprazole
Rationale: PPIs reduce gastric acid secretion and protect the gastric lining, decreasing
risk of NSAID-related ulcers. Ranitidine is no longer preferred due to safety concerns.
2|Page
,5. A patient with T2DM on metformin presents with elevated creatinine and decreased
GFR. What is the most appropriate action?
A. Increase metformin dose
B. Stop metformin
C. Add a sulfonylurea
D. Switch to insulin
Answer: B. Stop metformin
Rationale: Metformin is contraindicated in renal insufficiency due to risk of lactic
acidosis. Insulin may be considered, but the immediate action is to discontinue
metformin.
6. A patient is started on warfarin and has a new INR of 5.5 with no bleeding. What is
the best next step?
A. Hold warfarin for 1–2 doses
B. Give vitamin K immediately
C. Increase warfarin dose
D. Switch to heparin
Answer: A. Hold warfarin for 1–2 doses
Rationale: INR >5 without bleeding is managed by holding doses and monitoring.
Vitamin K is reserved for INR >10 or bleeding.
3|Page
, 7. A 70-year-old with atrial fibrillation presents with sudden weakness and facial
droop. CT shows ischemic stroke. Which medication should be avoided within 24
hours?
A. Aspirin
B. Alteplase
C. Heparin
D. Atorvastatin
Answer: C. Heparin
Rationale: Heparin is contraindicated in acute ischemic stroke due to hemorrhagic
conversion risk. Alteplase may be considered if within window.
8. A patient with chronic kidney disease stage 4 has hyperphosphatemia. Which
medication is appropriate?
A. Calcium acetate
B. Furosemide
C. Sodium bicarbonate
D. Metformin
Answer: A. Calcium acetate
Rationale: Calcium acetate binds phosphate in the GI tract to reduce absorption.
Furosemide does not manage phosphate levels.
9. A patient with CHF is started on an ACE inhibitor. Which adverse effect requires
immediate discontinuation?
A. Cough
B. Hyperkalemia
C. Angioedema
D. Hypotension
Answer: C. Angioedema
Rationale: Angioedema is life-threatening and requires immediate discontinuation.
Cough is common but not emergent.
4|Page
