NURS 629 EXAM 3 LATEST 2026/2027 GUIDE | Maryville
University | Advanced Pharmacology | Actual Questions
Solved 100% | Aligned with ADA, AHA/ACC, APA, GOLD,
ACG | Pass Guaranteed - A+ Graded
Domain 1: Cardiovascular Pharmacology (20 Questions)
Q1: A 58-year-old male with hypertension and type 2 diabetes presents with a blood
pressure of 148/92 mmHg. He is currently taking metformin 1000 mg BID and lisinopril
10 mg daily. According to current ACC/AHA guidelines, which medication adjustment
would be most appropriate for both BP control and renal protection?
A. Add amlodipine 5 mg daily [INCORRECT - Second-line option, doesn't address ACEI
optimization]
B. Increase lisinopril to 20 mg daily [CORRECT]
C. Switch to losartan 50 mg daily [INCORRECT - No benefit to switching ACEI to ARB in
this context]
D. Add metoprolol succinate 50 mg daily [INCORRECT - Not first-line without compelling
indication]
Correct Answer: B
Rationale: Per 2023 ACC/AHA Hypertension Guidelines and ADA Standards of Care: The
patient has diabetes with albuminuric chronic kidney disease risk. Current lisinopril 10
mg is subtherapeutic for renal protection (maximum 40 mg daily for nephroprotection).
Increasing to 20 mg daily optimizes ACE inhibitor therapy for both BP control and renal
,protection before adding second agent. ACE inhibitors reduce progression of diabetic
nephropathy by lowering intraglomerular pressure via efferent arteriole vasodilation.
Amlodipine (A) is appropriate as second-line if ACEI maximized. Switching to ARB (C)
offers no advantage over optimized ACEI. Beta-blockers (D) are not first-line for
hypertension without heart failure, post-MI, or other compelling indication.
Q2: [Select-All-That-Apply] A 65-year-old female with atrial fibrillation is prescribed
apixaban 5 mg BID for stroke prevention. Which monitoring parameters and patient
education points are essential?
A. Monthly INR monitoring [INCORRECT - Not required for direct oral anticoagulants]
B. Assess for signs of bleeding (bruising, melena, hematuria) [CORRECT]
C. Renal function assessment at baseline and annually [CORRECT]
D. Avoid concomitant NSAIDs without gastroprotection [CORRECT]
E. Hold dose 48 hours before major surgery [CORRECT]
F. Therapeutic drug monitoring required [INCORRECT - Routine TDM not indicated for
apixaban]
Correct Answer: B, C, D, E
Rationale: Apixaban (Factor Xa inhibitor) monitoring: Bleeding assessment (B) is
primary safety concern - educate patients on warning signs. Renal function (C) affects
drug clearance; assess at baseline and at least annually (more frequently if eGFR <60).
NSAIDs increase bleeding risk (D) - avoid or use PPI protection if unavoidable.
Perioperative management (E): Hold 48 hours before major surgery (CrCl ≥30) or 72
hours if CrCl 15-29. INR monitoring (A) is for warfarin only. Routine therapeutic drug
,monitoring (F) is not indicated for DOACs (unlike warfarin) as predictable
pharmacokinetics exist.
Q3: A 72-year-old male with HFrEF (EF 35%) is on lisinopril 20 mg, metoprolol succinate
100 mg, and furosemide 40 mg daily. He remains symptomatic with NYHA Class II-III
symptoms. Which medication addition is indicated per current AHA/ACC/HFSA
guidelines?
A. Digoxin 0.25 mg daily [INCORRECT - Third-line, not first add-on]
B. Sacubitril-valsartan (Entresto) 49/51 mg BID [CORRECT]
C. Amlodipine 5 mg daily [INCORRECT - CCBs not indicated in HFrEF]
D. Hydralazine-isosorbide dinitrate [INCORRECT - Reserved for ACEI/ARB intolerance or
specific populations]
Correct Answer: B
Rationale: Per 2022 AHA/ACC/HFSA Heart Failure Guidelines: Sacubitril-valsartan
(ARNI) is preferred over ACE inhibitor for HFrEF (Class I recommendation) to reduce
mortality and hospitalization. The PARADIGM-HF trial demonstrated superiority to
enalapril. Patient must be off ACEI for 36 hours before starting ARNI (angioedema risk).
Starting dose 49/51 mg BID, titrate to 97/103 mg BID. Digoxin (A) is for symptom
control in persistent afib or refractory symptoms. Dihydropyridine CCBs (C) are
neutral/negative in HFrEF. Hydralazine-nitrate (D) is for ACEI/ARB intolerance or African
Americans with persistent symptoms on optimal therapy.
, Q4: [Ordered Response] Place the following steps in correct order for initiating statin
therapy in a 60-year-old male with LDL 130 mg/dL, diabetes, and 10-year ASCVD risk
15%:
A. Calculate 10-year ASCVD risk using Pooled Cohort Equations [First]
B. Determine intensity needed (high-intensity for risk-enhancing factors) [Second]
C. Initiate atorvastatin 40-80 mg or rosuvastatin 20-40 mg [Third]
D. Recheck lipid panel and adherence at 4-12 weeks [Fourth]
Correct Order: A, B, C, D
Rationale: Per 2018 AHA/ACC Cholesterol Guidelines: First, calculate 10-year risk (A) -
this patient has diabetes and 10-year risk >7.5%, indicating moderate-to-high intensity
statin. Risk-enhancing factors (diabetes, LDL >100) support high-intensity (B).
High-intensity statins (C) reduce LDL ≥50%: atorvastatin 40-80 mg or rosuvastatin 20-40
mg. Follow-up lipid panel (D) assesses response and adherence; target LDL <100 for
this risk category (or <70 if very high risk). If inadequate response, consider ezetimibe or
PCSK9 inhibitor.
Q5: A 55-year-old female presents with hypertensive urgency (BP 185/110 mmHg, no
target organ damage). Which is the appropriate management?
A. Immediate IV labetalol in emergency department [INCORRECT - Not hypertensive
emergency]
B. Oral clonidine 0.2 mg stat [INCORRECT - Risk of overshoot hypotension]
C. Gradual BP reduction over 24-48 hours with oral agents [CORRECT]
University | Advanced Pharmacology | Actual Questions
Solved 100% | Aligned with ADA, AHA/ACC, APA, GOLD,
ACG | Pass Guaranteed - A+ Graded
Domain 1: Cardiovascular Pharmacology (20 Questions)
Q1: A 58-year-old male with hypertension and type 2 diabetes presents with a blood
pressure of 148/92 mmHg. He is currently taking metformin 1000 mg BID and lisinopril
10 mg daily. According to current ACC/AHA guidelines, which medication adjustment
would be most appropriate for both BP control and renal protection?
A. Add amlodipine 5 mg daily [INCORRECT - Second-line option, doesn't address ACEI
optimization]
B. Increase lisinopril to 20 mg daily [CORRECT]
C. Switch to losartan 50 mg daily [INCORRECT - No benefit to switching ACEI to ARB in
this context]
D. Add metoprolol succinate 50 mg daily [INCORRECT - Not first-line without compelling
indication]
Correct Answer: B
Rationale: Per 2023 ACC/AHA Hypertension Guidelines and ADA Standards of Care: The
patient has diabetes with albuminuric chronic kidney disease risk. Current lisinopril 10
mg is subtherapeutic for renal protection (maximum 40 mg daily for nephroprotection).
Increasing to 20 mg daily optimizes ACE inhibitor therapy for both BP control and renal
,protection before adding second agent. ACE inhibitors reduce progression of diabetic
nephropathy by lowering intraglomerular pressure via efferent arteriole vasodilation.
Amlodipine (A) is appropriate as second-line if ACEI maximized. Switching to ARB (C)
offers no advantage over optimized ACEI. Beta-blockers (D) are not first-line for
hypertension without heart failure, post-MI, or other compelling indication.
Q2: [Select-All-That-Apply] A 65-year-old female with atrial fibrillation is prescribed
apixaban 5 mg BID for stroke prevention. Which monitoring parameters and patient
education points are essential?
A. Monthly INR monitoring [INCORRECT - Not required for direct oral anticoagulants]
B. Assess for signs of bleeding (bruising, melena, hematuria) [CORRECT]
C. Renal function assessment at baseline and annually [CORRECT]
D. Avoid concomitant NSAIDs without gastroprotection [CORRECT]
E. Hold dose 48 hours before major surgery [CORRECT]
F. Therapeutic drug monitoring required [INCORRECT - Routine TDM not indicated for
apixaban]
Correct Answer: B, C, D, E
Rationale: Apixaban (Factor Xa inhibitor) monitoring: Bleeding assessment (B) is
primary safety concern - educate patients on warning signs. Renal function (C) affects
drug clearance; assess at baseline and at least annually (more frequently if eGFR <60).
NSAIDs increase bleeding risk (D) - avoid or use PPI protection if unavoidable.
Perioperative management (E): Hold 48 hours before major surgery (CrCl ≥30) or 72
hours if CrCl 15-29. INR monitoring (A) is for warfarin only. Routine therapeutic drug
,monitoring (F) is not indicated for DOACs (unlike warfarin) as predictable
pharmacokinetics exist.
Q3: A 72-year-old male with HFrEF (EF 35%) is on lisinopril 20 mg, metoprolol succinate
100 mg, and furosemide 40 mg daily. He remains symptomatic with NYHA Class II-III
symptoms. Which medication addition is indicated per current AHA/ACC/HFSA
guidelines?
A. Digoxin 0.25 mg daily [INCORRECT - Third-line, not first add-on]
B. Sacubitril-valsartan (Entresto) 49/51 mg BID [CORRECT]
C. Amlodipine 5 mg daily [INCORRECT - CCBs not indicated in HFrEF]
D. Hydralazine-isosorbide dinitrate [INCORRECT - Reserved for ACEI/ARB intolerance or
specific populations]
Correct Answer: B
Rationale: Per 2022 AHA/ACC/HFSA Heart Failure Guidelines: Sacubitril-valsartan
(ARNI) is preferred over ACE inhibitor for HFrEF (Class I recommendation) to reduce
mortality and hospitalization. The PARADIGM-HF trial demonstrated superiority to
enalapril. Patient must be off ACEI for 36 hours before starting ARNI (angioedema risk).
Starting dose 49/51 mg BID, titrate to 97/103 mg BID. Digoxin (A) is for symptom
control in persistent afib or refractory symptoms. Dihydropyridine CCBs (C) are
neutral/negative in HFrEF. Hydralazine-nitrate (D) is for ACEI/ARB intolerance or African
Americans with persistent symptoms on optimal therapy.
, Q4: [Ordered Response] Place the following steps in correct order for initiating statin
therapy in a 60-year-old male with LDL 130 mg/dL, diabetes, and 10-year ASCVD risk
15%:
A. Calculate 10-year ASCVD risk using Pooled Cohort Equations [First]
B. Determine intensity needed (high-intensity for risk-enhancing factors) [Second]
C. Initiate atorvastatin 40-80 mg or rosuvastatin 20-40 mg [Third]
D. Recheck lipid panel and adherence at 4-12 weeks [Fourth]
Correct Order: A, B, C, D
Rationale: Per 2018 AHA/ACC Cholesterol Guidelines: First, calculate 10-year risk (A) -
this patient has diabetes and 10-year risk >7.5%, indicating moderate-to-high intensity
statin. Risk-enhancing factors (diabetes, LDL >100) support high-intensity (B).
High-intensity statins (C) reduce LDL ≥50%: atorvastatin 40-80 mg or rosuvastatin 20-40
mg. Follow-up lipid panel (D) assesses response and adherence; target LDL <100 for
this risk category (or <70 if very high risk). If inadequate response, consider ezetimibe or
PCSK9 inhibitor.
Q5: A 55-year-old female presents with hypertensive urgency (BP 185/110 mmHg, no
target organ damage). Which is the appropriate management?
A. Immediate IV labetalol in emergency department [INCORRECT - Not hypertensive
emergency]
B. Oral clonidine 0.2 mg stat [INCORRECT - Risk of overshoot hypotension]
C. Gradual BP reduction over 24-48 hours with oral agents [CORRECT]
