NR 667 CHAMBERLAIN CEA FINAL EXAM
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.
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.
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.
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.
10. A patient presents with DKA. Which lab finding is expected?
A. Metabolic alkalosis
B. Hyperglycemia, anion gap metabolic acidosis
C. Hypokalemia only
D. Low ketones
Answer: B. Hyperglycemia, anion gap metabolic acidosis
Rationale: DKA causes increased ketones, metabolic acidosis, and high glucose.
11. A patient with asthma uses albuterol 6–8 times daily. What is the most
appropriate next step?
A. Continue current regimen
B. Add a long-acting beta-agonist
C. Add inhaled corticosteroid
D. Discontinue albuterol
Answer: C. Add inhaled corticosteroid
Rationale: Frequent albuterol use indicates poor control. Adding an inhaled
steroid improves control and reduces exacerbations.
12. A patient on lithium therapy reports tremors and diarrhea. Serum lithium
is elevated. What is the most appropriate action?
A. Increase lithium dose
B. Continue and monitor
C. Discontinue lithium and assess for toxicity
D. Add a thiazide diuretic
Answer: C. Discontinue lithium and assess for toxicity
Rationale: GI symptoms and tremors indicate lithium toxicity, requiring
discontinuation and evaluation.
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.
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.
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.
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.
10. A patient presents with DKA. Which lab finding is expected?
A. Metabolic alkalosis
B. Hyperglycemia, anion gap metabolic acidosis
C. Hypokalemia only
D. Low ketones
Answer: B. Hyperglycemia, anion gap metabolic acidosis
Rationale: DKA causes increased ketones, metabolic acidosis, and high glucose.
11. A patient with asthma uses albuterol 6–8 times daily. What is the most
appropriate next step?
A. Continue current regimen
B. Add a long-acting beta-agonist
C. Add inhaled corticosteroid
D. Discontinue albuterol
Answer: C. Add inhaled corticosteroid
Rationale: Frequent albuterol use indicates poor control. Adding an inhaled
steroid improves control and reduces exacerbations.
12. A patient on lithium therapy reports tremors and diarrhea. Serum lithium
is elevated. What is the most appropriate action?
A. Increase lithium dose
B. Continue and monitor
C. Discontinue lithium and assess for toxicity
D. Add a thiazide diuretic
Answer: C. Discontinue lithium and assess for toxicity
Rationale: GI symptoms and tremors indicate lithium toxicity, requiring
discontinuation and evaluation.
