1
NUR 651 Advanced Pharmacology Exam
3 Actual Exam 2026/2027 | Questions and
Answers with Complete Solutions | Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR PHARMACOTHERAPY (15 Questions)
Case Study 1: Heart Failure Management
Scenario: A 68-year-old male with HFrEF (ejection fraction 35%) is on lisinopril 20 mg daily
and metoprolol succinate 100 mg daily. He continues to have dyspnea on exertion and peripheral
edema.
Q1: According to current heart failure guidelines, which medication should be added next to
optimize his regimen?
A. Spironolactone
B. Amlodipine
C. Digoxin
D. Furosemide PRN
Correct Answer: A. [CORRECT]
Rationale: In patients with HFrEF already on ACE inhibitor and beta-blocker who remain
symptomatic, addition of an aldosterone antagonist (spironolactone or eplerenone) is
recommended by current guidelines to reduce mortality and hospitalizations for heart failure.
Q2: The patient asks about adding digoxin to his regimen. What is the primary indication for
digoxin in contemporary heart failure management?
A. Reduction of mortality in all HFrEF patients
B. Symptom control and reduction of hospitalizations in patients remaining symptomatic despite
GDMT
C. First-line therapy for patients unable to tolerate beta-blockers
D. Treatment of diastolic dysfunction in HFpEF
,2
Correct Answer: B. [CORRECT]
Rationale: Digoxin provides symptom relief and reduces heart failure hospitalizations in
patients with HFrEF who remain symptomatic despite guideline-directed medical therapy
(GDMT), though it does not reduce mortality and is not first-line therapy.
Q3: Three months later, the patient's potassium is 5.6 mEq/L. Which medication is most likely
contributing to this finding?
A. Lisinopril
B. Metoprolol
C. Spironolactone
D. Furosemide
Correct Answer: C. [CORRECT]
Rationale: Spironolactone is a potassium-sparing diuretic that antagonizes aldosterone receptors
in the distal nephron, reducing potassium excretion; when combined with ACE inhibitors, the
risk of hyperkalemia is significantly increased, requiring potassium monitoring and dose
adjustment when levels exceed 5.5 mEq/L.
Q4: A 72-year-old female with atrial fibrillation and mechanical mitral valve replacement
requires anticoagulation. Her INR has been stable on warfarin 5 mg daily. Which target INR
range is appropriate?
A. 1.5-2.0
B. 2.0-3.0
C. 2.5-3.5
D. 3.0-4.0
Correct Answer: C. [CORRECT]
Rationale: Mechanical mitral valve replacement requires a higher target INR (2.5-3.5) than
standard atrial fibrillation (2.0-3.0) due to the higher thrombogenicity of mitral prostheses and
the risk of systemic embolization.
Q5: [SATA - Select All That Apply] A patient with non-valvular atrial fibrillation and CHA₂DS₂-
VASc score of 4 is considering anticoagulation options. Which statements about direct oral
anticoagulants (DOACs) are accurate? (Select all that apply)
A. Dabigatran is a direct thrombin inhibitor
B. Rivaroxaban requires bridging with heparin when initiating
C. Apixaban has demonstrated lower bleeding rates than warfarin
, 3
D. DOACs are contraindicated in mechanical heart valves
E. Edoxaban requires dose reduction with CrCl 15-30 mL/min
Correct Answer: A, C, D, E. [CORRECT]
Rationale: Dabigatran inhibits thrombin directly; apixaban has superior safety profile with
reduced bleeding compared to warfarin; DOACs are absolutely contraindicated in mechanical
valves due to increased thrombosis risk; edoxaban requires dose reduction in severe renal
impairment; rivaroxaban does not require bridging due to rapid onset.
Q6: A patient presents with acute coronary syndrome and is started on dual antiplatelet therapy.
Which combination provides optimal inhibition of platelet aggregation through different
mechanisms?
A. Aspirin and warfarin
B. Aspirin and clopidogrel
C. Clopidogrel and heparin
D. Aspirin and enoxaparin
Correct Answer: B. [CORRECT]
Rationale: Dual antiplatelet therapy with aspirin (irreversible COX-1 inhibitor) and clopidogrel
(P2Y12 ADP receptor antagonist) provides synergistic platelet inhibition through complementary
pathways, reducing cardiovascular events post-ACS.
Q7: A patient on atorvastatin 80 mg daily reports severe muscle pain and weakness. CK is
elevated at 1200 U/L. Which lipid-lowering agent could be considered as an alternative that
works through a different mechanism?
A. Simvastatin 40 mg
B. Ezetimibe
C. Fenofibrate
D. Niacin
Correct Answer: B. [CORRECT]
Rationale: Ezetimibe inhibits intestinal cholesterol absorption via NPC1L1 transporter blockade,
providing LDL reduction through a mechanism distinct from HMG-CoA reductase inhibition,
making it suitable for patients with statin intolerance.
Q8: [SATA - Select All That Apply] Which medications are classified as Class III
antiarrhythmics (potassium channel blockers)? (Select all that apply)
NUR 651 Advanced Pharmacology Exam
3 Actual Exam 2026/2027 | Questions and
Answers with Complete Solutions | Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR PHARMACOTHERAPY (15 Questions)
Case Study 1: Heart Failure Management
Scenario: A 68-year-old male with HFrEF (ejection fraction 35%) is on lisinopril 20 mg daily
and metoprolol succinate 100 mg daily. He continues to have dyspnea on exertion and peripheral
edema.
Q1: According to current heart failure guidelines, which medication should be added next to
optimize his regimen?
A. Spironolactone
B. Amlodipine
C. Digoxin
D. Furosemide PRN
Correct Answer: A. [CORRECT]
Rationale: In patients with HFrEF already on ACE inhibitor and beta-blocker who remain
symptomatic, addition of an aldosterone antagonist (spironolactone or eplerenone) is
recommended by current guidelines to reduce mortality and hospitalizations for heart failure.
Q2: The patient asks about adding digoxin to his regimen. What is the primary indication for
digoxin in contemporary heart failure management?
A. Reduction of mortality in all HFrEF patients
B. Symptom control and reduction of hospitalizations in patients remaining symptomatic despite
GDMT
C. First-line therapy for patients unable to tolerate beta-blockers
D. Treatment of diastolic dysfunction in HFpEF
,2
Correct Answer: B. [CORRECT]
Rationale: Digoxin provides symptom relief and reduces heart failure hospitalizations in
patients with HFrEF who remain symptomatic despite guideline-directed medical therapy
(GDMT), though it does not reduce mortality and is not first-line therapy.
Q3: Three months later, the patient's potassium is 5.6 mEq/L. Which medication is most likely
contributing to this finding?
A. Lisinopril
B. Metoprolol
C. Spironolactone
D. Furosemide
Correct Answer: C. [CORRECT]
Rationale: Spironolactone is a potassium-sparing diuretic that antagonizes aldosterone receptors
in the distal nephron, reducing potassium excretion; when combined with ACE inhibitors, the
risk of hyperkalemia is significantly increased, requiring potassium monitoring and dose
adjustment when levels exceed 5.5 mEq/L.
Q4: A 72-year-old female with atrial fibrillation and mechanical mitral valve replacement
requires anticoagulation. Her INR has been stable on warfarin 5 mg daily. Which target INR
range is appropriate?
A. 1.5-2.0
B. 2.0-3.0
C. 2.5-3.5
D. 3.0-4.0
Correct Answer: C. [CORRECT]
Rationale: Mechanical mitral valve replacement requires a higher target INR (2.5-3.5) than
standard atrial fibrillation (2.0-3.0) due to the higher thrombogenicity of mitral prostheses and
the risk of systemic embolization.
Q5: [SATA - Select All That Apply] A patient with non-valvular atrial fibrillation and CHA₂DS₂-
VASc score of 4 is considering anticoagulation options. Which statements about direct oral
anticoagulants (DOACs) are accurate? (Select all that apply)
A. Dabigatran is a direct thrombin inhibitor
B. Rivaroxaban requires bridging with heparin when initiating
C. Apixaban has demonstrated lower bleeding rates than warfarin
, 3
D. DOACs are contraindicated in mechanical heart valves
E. Edoxaban requires dose reduction with CrCl 15-30 mL/min
Correct Answer: A, C, D, E. [CORRECT]
Rationale: Dabigatran inhibits thrombin directly; apixaban has superior safety profile with
reduced bleeding compared to warfarin; DOACs are absolutely contraindicated in mechanical
valves due to increased thrombosis risk; edoxaban requires dose reduction in severe renal
impairment; rivaroxaban does not require bridging due to rapid onset.
Q6: A patient presents with acute coronary syndrome and is started on dual antiplatelet therapy.
Which combination provides optimal inhibition of platelet aggregation through different
mechanisms?
A. Aspirin and warfarin
B. Aspirin and clopidogrel
C. Clopidogrel and heparin
D. Aspirin and enoxaparin
Correct Answer: B. [CORRECT]
Rationale: Dual antiplatelet therapy with aspirin (irreversible COX-1 inhibitor) and clopidogrel
(P2Y12 ADP receptor antagonist) provides synergistic platelet inhibition through complementary
pathways, reducing cardiovascular events post-ACS.
Q7: A patient on atorvastatin 80 mg daily reports severe muscle pain and weakness. CK is
elevated at 1200 U/L. Which lipid-lowering agent could be considered as an alternative that
works through a different mechanism?
A. Simvastatin 40 mg
B. Ezetimibe
C. Fenofibrate
D. Niacin
Correct Answer: B. [CORRECT]
Rationale: Ezetimibe inhibits intestinal cholesterol absorption via NPC1L1 transporter blockade,
providing LDL reduction through a mechanism distinct from HMG-CoA reductase inhibition,
making it suitable for patients with statin intolerance.
Q8: [SATA - Select All That Apply] Which medications are classified as Class III
antiarrhythmics (potassium channel blockers)? (Select all that apply)
