Maryville University NURS 615 Advanced
Pharmacology ACTUAL EXAM 2026/2027
| Examination 2 Practice Test | 75 Questions
| Correct Answers | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR PHARMACOLOGY
Q1: A 72-year-old African American male with HFrEF (LVEF 35%) is currently receiving optimal
doses of carvedilol, lisinopril, and furosemide. His blood pressure is 118/72 mmHg and potassium is
4.2 mEq/L. According to current ACC/AHA guidelines, which medication should be added next to
reduce mortality?
A. Digoxin 0.125 mg daily
B. Spironolactone 25 mg daily [CORRECT]
C. Hydralazine/isosorbide dinitrate
D. Amlodipine 5 mg daily
Correct Answer: B
Rationale: Aldosterone antagonists (spironolactone or eplerenone) are recommended in HFrEF
(NYHA Class II-IV) to reduce mortality and hospitalization, provided eGFR is >30 mL/min and
potassium is <5.0 mEq/L. While hydralazine/isosorbide dinitrate (C) is particularly beneficial in
African Americans with HFrEF, aldosterone antagonists have broader mortality benefit across
populations. Digoxin (A) improves symptoms but not mortality. Amlodipine (D) is not indicated for
HFrEF mortality benefit.
Maryville Note: Know the GDMT "quadruple therapy" for HFrEF: ACE-I/ARB/ARNI + evidence-based
beta-blocker + MRA + SGLT2 inhibitor.
Q2: A 58-year-old patient presents with STEMI and is scheduled for primary PCI within 90 minutes.
Which antiplatelet regimen is most appropriate to initiate immediately?
A. Aspirin 325 mg chewable + clopidogrel 600 mg loading [CORRECT]
B. Aspirin 81 mg daily only
C. Clopidogrel 75 mg daily only
D. Warfarin 5 mg daily
,Correct Answer: A
Rationale: Dual antiplatelet therapy (DAPT) with aspirin (non-enteric coated, chewable 325 mg)
and a P2Y12 inhibitor (clopidogrel 600 mg loading dose, or prasugrel/ticagrelor) is standard for
ACS management. Clopidogrel requires loading for rapid platelet inhibition. Prasugrel is
contraindicated if prior stroke/TIA; ticagrelor is preferred in some guidelines but requires bid
dosing.
Maryville Note: ACS = Aspirin + Antiplatelet (P2Y12). Time is muscle—give aspirin immediately,
even before PCI.
Q3: A patient with resistant hypertension is taking chlorthalidone 25 mg, lisinopril 40 mg, and
amlodipine 10 mg daily. Blood pressure remains 158/92 mmHg. Which medication is most
appropriate to add as fourth-line therapy?
A. Metoprolol tartrate 50 mg twice daily
B. Spironolactone 25 mg daily [CORRECT]
C. Doxazosin 4 mg daily
D. Hydralazine 50 mg three times daily
Correct Answer: B
Rationale: Resistant hypertension is defined as BP remaining above goal despite ≥3
antihypertensives of different classes at optimal doses, including a diuretic. Spironolactone is the
preferred fourth-line agent due to strong evidence for BP reduction through mineralocorticoid
receptor blockade and volume reduction. PATHWAY-2 trial demonstrated superior efficacy of
spironolactone over doxazosin and bisoprolol.
Maryville Note: PATHWAY-2 = spironolactone wins for resistant HTN.
Q4: A 68-year-old with atrial fibrillation (CHA₂DS₂-VASc score 3 in female) is initiating apixaban.
Which statement regarding monitoring is correct?
A. INR should be checked weekly for the first month
B. No routine coagulation monitoring is required, but renal function should be assessed annually
[CORRECT]
C. aPTT should be monitored monthly
D. Anti-Xa levels must be drawn with each dose adjustment
Correct Answer: B
Rationale: Direct oral anticoagulants (DOACs) including apixaban do not require routine
coagulation monitoring like warfarin. However, renal function should be assessed at least annually
(more frequently if age >75 or eGFR <60) as dose adjustments are needed for renal impairment.
Anti-Xa levels (D) are not routinely monitored but may be considered in special situations (extreme
obesity, pregnancy, suspected overdose).
Maryville Note: DOACs = "Don't Observe ACtivity" (no routine monitoring), but check kidneys
annually.
, Q5: A patient presents with hypertensive emergency (BP 220/140 mmHg) with acute pulmonary
edema. Which IV agent is most appropriate for rapid BP reduction while maintaining cerebral
perfusion?
A. Clonidine 0.1 mg PO
B. Nitroprusside 0.3 mcg/kg/min IV [CORRECT]
C. Lisinopril 10 mg PO
D. Amlodipine 5 mg PO
Correct Answer: B
Rationale: Hypertensive emergencies require IV therapy with titratable agents. Nitroprusside is a
direct vasodilator (arterial and venous) with immediate onset, making it ideal for acute pulmonary
edema with afterload reduction. Reduce MAP by no more than 25% in first hour. Oral agents (A, C,
D) are contraindicated in hypertensive emergencies due to unpredictable responses and inability
to titrate.
Maryville Note: Emergency = IV + ICU setting. Reduce MAP by max 25% in first hour to avoid
cerebral hypoperfusion.
Q6: A 55-year-old patient with stable angina and normal LV function reports chest pain with
exertion. Current BP 138/88 mmHg, HR 72 bpm. Which medication is first-line for symptom control?
A. Amlodipine 5 mg daily
B. Isosorbide mononitrate 30 mg daily
C. Metoprolol succinate 50 mg daily [CORRECT]
D. Ranolazine 1000 mg twice daily
Correct Answer: C
Rationale: Beta-blockers are first-line for stable angina symptom control as they reduce myocardial
oxygen demand by decreasing heart rate, contractility, and blood pressure. They improve exercise
tolerance and reduce angina frequency. Calcium channel blockers (A) or long-acting nitrates (B)
are second-line or for those with contraindications to beta-blockers. Ranolazine (D) is reserved for
refractory angina.
Maryville Note: Beta-blockers = first-line for angina (unless contraindicated: severe COPD,
high-degree AV block, acute decompensated HF).
Q7: A patient on warfarin for mechanical heart valve presents with INR 7.2 and minor mucosal
bleeding. Which is the appropriate management?
A. 10 mg vitamin K IV immediately
B. 4-factor prothrombin complex concentrate (PCC) + 2.5 mg oral vitamin K [CORRECT]
C. Fresh frozen plasma only
D. Idarucizumab 5g IV
Correct Answer: B
Rationale: For INR >4.5 with bleeding, 4-factor PCC provides rapid factor replacement,
supplemented with low-dose oral vitamin K (2.5-5 mg) to sustain reversal. High-dose IV vitamin K
(A) can cause anaphylaxis and make re-anticoagulation difficult. FFP (C) requires large volumes
and is less effective. Idarucizumab (D) reverses dabigatran only, not warfarin.
Pharmacology ACTUAL EXAM 2026/2027
| Examination 2 Practice Test | 75 Questions
| Correct Answers | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR PHARMACOLOGY
Q1: A 72-year-old African American male with HFrEF (LVEF 35%) is currently receiving optimal
doses of carvedilol, lisinopril, and furosemide. His blood pressure is 118/72 mmHg and potassium is
4.2 mEq/L. According to current ACC/AHA guidelines, which medication should be added next to
reduce mortality?
A. Digoxin 0.125 mg daily
B. Spironolactone 25 mg daily [CORRECT]
C. Hydralazine/isosorbide dinitrate
D. Amlodipine 5 mg daily
Correct Answer: B
Rationale: Aldosterone antagonists (spironolactone or eplerenone) are recommended in HFrEF
(NYHA Class II-IV) to reduce mortality and hospitalization, provided eGFR is >30 mL/min and
potassium is <5.0 mEq/L. While hydralazine/isosorbide dinitrate (C) is particularly beneficial in
African Americans with HFrEF, aldosterone antagonists have broader mortality benefit across
populations. Digoxin (A) improves symptoms but not mortality. Amlodipine (D) is not indicated for
HFrEF mortality benefit.
Maryville Note: Know the GDMT "quadruple therapy" for HFrEF: ACE-I/ARB/ARNI + evidence-based
beta-blocker + MRA + SGLT2 inhibitor.
Q2: A 58-year-old patient presents with STEMI and is scheduled for primary PCI within 90 minutes.
Which antiplatelet regimen is most appropriate to initiate immediately?
A. Aspirin 325 mg chewable + clopidogrel 600 mg loading [CORRECT]
B. Aspirin 81 mg daily only
C. Clopidogrel 75 mg daily only
D. Warfarin 5 mg daily
,Correct Answer: A
Rationale: Dual antiplatelet therapy (DAPT) with aspirin (non-enteric coated, chewable 325 mg)
and a P2Y12 inhibitor (clopidogrel 600 mg loading dose, or prasugrel/ticagrelor) is standard for
ACS management. Clopidogrel requires loading for rapid platelet inhibition. Prasugrel is
contraindicated if prior stroke/TIA; ticagrelor is preferred in some guidelines but requires bid
dosing.
Maryville Note: ACS = Aspirin + Antiplatelet (P2Y12). Time is muscle—give aspirin immediately,
even before PCI.
Q3: A patient with resistant hypertension is taking chlorthalidone 25 mg, lisinopril 40 mg, and
amlodipine 10 mg daily. Blood pressure remains 158/92 mmHg. Which medication is most
appropriate to add as fourth-line therapy?
A. Metoprolol tartrate 50 mg twice daily
B. Spironolactone 25 mg daily [CORRECT]
C. Doxazosin 4 mg daily
D. Hydralazine 50 mg three times daily
Correct Answer: B
Rationale: Resistant hypertension is defined as BP remaining above goal despite ≥3
antihypertensives of different classes at optimal doses, including a diuretic. Spironolactone is the
preferred fourth-line agent due to strong evidence for BP reduction through mineralocorticoid
receptor blockade and volume reduction. PATHWAY-2 trial demonstrated superior efficacy of
spironolactone over doxazosin and bisoprolol.
Maryville Note: PATHWAY-2 = spironolactone wins for resistant HTN.
Q4: A 68-year-old with atrial fibrillation (CHA₂DS₂-VASc score 3 in female) is initiating apixaban.
Which statement regarding monitoring is correct?
A. INR should be checked weekly for the first month
B. No routine coagulation monitoring is required, but renal function should be assessed annually
[CORRECT]
C. aPTT should be monitored monthly
D. Anti-Xa levels must be drawn with each dose adjustment
Correct Answer: B
Rationale: Direct oral anticoagulants (DOACs) including apixaban do not require routine
coagulation monitoring like warfarin. However, renal function should be assessed at least annually
(more frequently if age >75 or eGFR <60) as dose adjustments are needed for renal impairment.
Anti-Xa levels (D) are not routinely monitored but may be considered in special situations (extreme
obesity, pregnancy, suspected overdose).
Maryville Note: DOACs = "Don't Observe ACtivity" (no routine monitoring), but check kidneys
annually.
, Q5: A patient presents with hypertensive emergency (BP 220/140 mmHg) with acute pulmonary
edema. Which IV agent is most appropriate for rapid BP reduction while maintaining cerebral
perfusion?
A. Clonidine 0.1 mg PO
B. Nitroprusside 0.3 mcg/kg/min IV [CORRECT]
C. Lisinopril 10 mg PO
D. Amlodipine 5 mg PO
Correct Answer: B
Rationale: Hypertensive emergencies require IV therapy with titratable agents. Nitroprusside is a
direct vasodilator (arterial and venous) with immediate onset, making it ideal for acute pulmonary
edema with afterload reduction. Reduce MAP by no more than 25% in first hour. Oral agents (A, C,
D) are contraindicated in hypertensive emergencies due to unpredictable responses and inability
to titrate.
Maryville Note: Emergency = IV + ICU setting. Reduce MAP by max 25% in first hour to avoid
cerebral hypoperfusion.
Q6: A 55-year-old patient with stable angina and normal LV function reports chest pain with
exertion. Current BP 138/88 mmHg, HR 72 bpm. Which medication is first-line for symptom control?
A. Amlodipine 5 mg daily
B. Isosorbide mononitrate 30 mg daily
C. Metoprolol succinate 50 mg daily [CORRECT]
D. Ranolazine 1000 mg twice daily
Correct Answer: C
Rationale: Beta-blockers are first-line for stable angina symptom control as they reduce myocardial
oxygen demand by decreasing heart rate, contractility, and blood pressure. They improve exercise
tolerance and reduce angina frequency. Calcium channel blockers (A) or long-acting nitrates (B)
are second-line or for those with contraindications to beta-blockers. Ranolazine (D) is reserved for
refractory angina.
Maryville Note: Beta-blockers = first-line for angina (unless contraindicated: severe COPD,
high-degree AV block, acute decompensated HF).
Q7: A patient on warfarin for mechanical heart valve presents with INR 7.2 and minor mucosal
bleeding. Which is the appropriate management?
A. 10 mg vitamin K IV immediately
B. 4-factor prothrombin complex concentrate (PCC) + 2.5 mg oral vitamin K [CORRECT]
C. Fresh frozen plasma only
D. Idarucizumab 5g IV
Correct Answer: B
Rationale: For INR >4.5 with bleeding, 4-factor PCC provides rapid factor replacement,
supplemented with low-dose oral vitamin K (2.5-5 mg) to sustain reversal. High-dose IV vitamin K
(A) can cause anaphylaxis and make re-anticoagulation difficult. FFP (C) requires large volumes
and is less effective. Idarucizumab (D) reverses dabigatran only, not warfarin.
