NR 566 – Advanced Pathopharmacology
Advanced Case Bank 2025/2026 |Graduate / NP-level|
Each question includes the correct answer and a clear clinical rationale
1.
A 62-year-old male with HFrEF (EF 30%), type 2 diabetes, and CKD stage 3 is being optimized
on guideline-directed therapy. Which medication provides both mortality benefit and renal
protection?
A. Furosemide
B. Metoprolol tartrate
C. Dapagliflozin
D. Digoxin
Correct Answer: C
Rationale:
SGLT2 inhibitors such as dapagliflozin reduce heart failure hospitalizations, improve mortality,
and slow CKD progression regardless of diabetes status.
2. (SATA)
A patient with atrial fibrillation is prescribed apixaban. Which factors must be assessed before
initiation?
Select all that apply.
A. Renal function
B. Hepatic function
C. INR level
D. Age
E. Body weight
Correct Answers: A, B, D, E
Rationale:
Apixaban dosing is influenced by renal function, hepatic status, age, and body weight. INR
monitoring is not required for DOACs.
,3.
A 55-year-old woman with hypothyroidism continues to have elevated TSH despite
levothyroxine therapy. Which medication most likely interferes with absorption?
A. Acetaminophen
B. Calcium carbonate
C. Atorvastatin
D. Metformin
Correct Answer: B
Rationale:
Calcium binds levothyroxine in the gut, reducing absorption. Dosing separation is required.
4.
A patient with asthma develops worsening symptoms after starting propranolol. The mechanism
is best explained by:
A. Increased histamine release
B. Beta-2 receptor blockade
C. Reduced prostaglandin synthesis
D. Anticholinergic effects
Correct Answer: B
Rationale:
Nonselective beta-blockers block beta-2 receptors in bronchial smooth muscle, precipitating
bronchoconstriction.
5. (SATA)
Which medications increase the risk of hyperkalemia in a patient with CKD?
Select all that apply.
A. Spironolactone
B. Lisinopril
C. Furosemide
,D. Trimethoprim-sulfamethoxazole
E. Albuterol
Correct Answers: A, B, D
Rationale:
Aldosterone antagonists, ACE inhibitors, and TMP-SMX impair potassium excretion or mimic
potassium-sparing effects.
6.
A patient with Parkinson disease develops hallucinations. Which medication is most appropriate?
A. Haloperidol
B. Risperidone
C. Quetiapine
D. Chlorpromazine
Correct Answer: C
Rationale:
Quetiapine has minimal dopamine blockade and is preferred in Parkinson disease–associated
psychosis.
7.
A patient on long-term prednisone presents with proximal muscle weakness and hyperglycemia.
These findings are due to:
A. Mineralocorticoid excess
B. Suppression of ACTH
C. Catabolic effects of glucocorticoids
D. Aldosterone resistance
Correct Answer: C
Rationale:
Glucocorticoids promote protein catabolism and insulin resistance, leading to myopathy and
hyperglycemia.
, 8. (SATA)
Which drugs require dose adjustment in renal impairment?
Select all that apply.
A. Gabapentin
B. Metformin
C. Vancomycin
D. Warfarin
E. Lithium
Correct Answers: A, B, C, E
Rationale:
These medications are renally cleared or nephrotoxic. Warfarin is hepatically metabolized.
9.
A patient with gout and CKD is prescribed allopurinol. What is the most important safety
consideration?
A. Risk of hypoglycemia
B. Stevens–Johnson syndrome
C. QT prolongation
D. Hepatotoxicity
Correct Answer: B
Rationale:
Allopurinol can cause severe hypersensitivity reactions, especially in renal impairment.
10.
A patient with major depressive disorder is taking phenelzine. Which medication is
contraindicated?
A. Bupropion
B. Sertraline
C. Mirtazapine
D. Trazodone
Correct Answer: B
Advanced Case Bank 2025/2026 |Graduate / NP-level|
Each question includes the correct answer and a clear clinical rationale
1.
A 62-year-old male with HFrEF (EF 30%), type 2 diabetes, and CKD stage 3 is being optimized
on guideline-directed therapy. Which medication provides both mortality benefit and renal
protection?
A. Furosemide
B. Metoprolol tartrate
C. Dapagliflozin
D. Digoxin
Correct Answer: C
Rationale:
SGLT2 inhibitors such as dapagliflozin reduce heart failure hospitalizations, improve mortality,
and slow CKD progression regardless of diabetes status.
2. (SATA)
A patient with atrial fibrillation is prescribed apixaban. Which factors must be assessed before
initiation?
Select all that apply.
A. Renal function
B. Hepatic function
C. INR level
D. Age
E. Body weight
Correct Answers: A, B, D, E
Rationale:
Apixaban dosing is influenced by renal function, hepatic status, age, and body weight. INR
monitoring is not required for DOACs.
,3.
A 55-year-old woman with hypothyroidism continues to have elevated TSH despite
levothyroxine therapy. Which medication most likely interferes with absorption?
A. Acetaminophen
B. Calcium carbonate
C. Atorvastatin
D. Metformin
Correct Answer: B
Rationale:
Calcium binds levothyroxine in the gut, reducing absorption. Dosing separation is required.
4.
A patient with asthma develops worsening symptoms after starting propranolol. The mechanism
is best explained by:
A. Increased histamine release
B. Beta-2 receptor blockade
C. Reduced prostaglandin synthesis
D. Anticholinergic effects
Correct Answer: B
Rationale:
Nonselective beta-blockers block beta-2 receptors in bronchial smooth muscle, precipitating
bronchoconstriction.
5. (SATA)
Which medications increase the risk of hyperkalemia in a patient with CKD?
Select all that apply.
A. Spironolactone
B. Lisinopril
C. Furosemide
,D. Trimethoprim-sulfamethoxazole
E. Albuterol
Correct Answers: A, B, D
Rationale:
Aldosterone antagonists, ACE inhibitors, and TMP-SMX impair potassium excretion or mimic
potassium-sparing effects.
6.
A patient with Parkinson disease develops hallucinations. Which medication is most appropriate?
A. Haloperidol
B. Risperidone
C. Quetiapine
D. Chlorpromazine
Correct Answer: C
Rationale:
Quetiapine has minimal dopamine blockade and is preferred in Parkinson disease–associated
psychosis.
7.
A patient on long-term prednisone presents with proximal muscle weakness and hyperglycemia.
These findings are due to:
A. Mineralocorticoid excess
B. Suppression of ACTH
C. Catabolic effects of glucocorticoids
D. Aldosterone resistance
Correct Answer: C
Rationale:
Glucocorticoids promote protein catabolism and insulin resistance, leading to myopathy and
hyperglycemia.
, 8. (SATA)
Which drugs require dose adjustment in renal impairment?
Select all that apply.
A. Gabapentin
B. Metformin
C. Vancomycin
D. Warfarin
E. Lithium
Correct Answers: A, B, C, E
Rationale:
These medications are renally cleared or nephrotoxic. Warfarin is hepatically metabolized.
9.
A patient with gout and CKD is prescribed allopurinol. What is the most important safety
consideration?
A. Risk of hypoglycemia
B. Stevens–Johnson syndrome
C. QT prolongation
D. Hepatotoxicity
Correct Answer: B
Rationale:
Allopurinol can cause severe hypersensitivity reactions, especially in renal impairment.
10.
A patient with major depressive disorder is taking phenelzine. Which medication is
contraindicated?
A. Bupropion
B. Sertraline
C. Mirtazapine
D. Trazodone
Correct Answer: B
