NURS 661 MARYVILLE EXAM 2 2026/2027 | Questions and
Answers with Complete Solutions | Graduate Nursing | Pass
Guaranteed - A+ Graded
Advanced Pharmacology & Pharmacotherapeutics
Q1: A 62-year-old patient with HFrEF is prescribed lisinopril. Which mechanism explains
this medication's mortality benefit in heart failure?
A. Pure vasodilation reducing afterload only
B. Inhibition of angiotensin-converting enzyme, reducing afterload, preload, and
preventing ventricular remodeling [CORRECT]
C. Direct stimulation of cardiac contractility
D. Diuretic effect reducing fluid overload
Correct Answer: B
Rationale: ACE inhibitors block angiotensin II formation and aldosterone secretion,
reducing afterload and preload while preventing adverse cardiac remodeling—key for
mortality reduction in HFrEF. Option A describes hydralazine/isosorbide. Option C
describes inotropes like digoxin. Option D describes loop diuretics which improve
symptoms but not mortality.
Q2: A patient on warfarin has an INR of 3.8 without bleeding. They are scheduled for
dental extraction. Which management is appropriate?
A. Vitamin K 10 mg IV immediately
,B. Hold warfarin 2-3 days pre-procedure; bridge with LMWH if high thrombotic risk
[CORRECT]
C. Continue warfarin at current dose
D. Fresh frozen plasma transfusion
Correct Answer: B
Rationale: For minor procedures, warfarin is typically held 2-3 days to achieve INR <1.5;
bridging depends on thrombotic risk (mechanical valves, recent VTE). Option A is for
serious bleeding. Option C risks excessive bleeding. Option D is unnecessary for minor
procedures.
Q3: A patient with type 2 diabetes and ASCVD is starting empagliflozin. Which
cardiovascular benefit is expected beyond glucose control?
A. Increased risk of heart failure hospitalization
B. Reduced risk of cardiovascular death and heart failure hospitalization [CORRECT]
C. Increased risk of stroke
D. No cardiovascular benefit
Correct Answer: B
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) reduce CV death and HF
hospitalization in T2DM with ASCVD (EMPA-REG OUTCOME trial). Options A, C, and D
are incorrect; SGLT2is have demonstrated cardioprotective effects.
,Q4: A patient with community-acquired pneumonia has a penicillin allergy (anaphylaxis).
Which antibiotic is the best alternative?
A. Amoxicillin
B. Azithromycin or doxycycline [CORRECT]
C. Cefuroxime
D. Piperacillin-tazobactam
Correct Answer: B
Rationale: For outpatient CAP in patients with severe penicillin allergy, macrolides
(azithromycin) or doxycycline are appropriate alternatives. Option A is penicillin-class.
Option C has 10% cross-reactivity with penicillin. Option D is penicillin-class and
reserved for severe inpatient infections.
Q5: A patient with depression is started on fluoxetine. Which adverse effect should be
monitored, especially in younger patients?
A. Hypertension
B. Suicidal ideation (black box warning for patients <24 years) [CORRECT]
C. Hyperglycemia
D. Bradycardia
Correct Answer: B
Rationale: SSRIs carry an FDA black box warning for increased suicidal thoughts and
behavior in children, adolescents, and young adults under 24. Options A, C, and D are
, not typical SSRI adverse effects; fluoxetine may actually cause mild bradycardia or be
weight-neutral.
Q6: A patient with atrial fibrillation is prescribed dabigatran. Which characteristic
distinguishes this medication from warfarin?
A. Requires INR monitoring
B. Direct thrombin inhibitor with fixed dosing and no routine monitoring [CORRECT]
C. Reversible with vitamin K
D. Extensive drug-food interactions
Correct Answer: B
Rationale: Dabigatran is a direct thrombin inhibitor with predictable pharmacokinetics,
fixed dosing, and no routine monitoring—advantages over warfarin. Option A describes
warfarin. Option C is false; idarucizumab reverses dabigatran. Option D describes
warfarin.
Q7: A patient with COPD is prescribed tiotropium. Which mechanism explains its
bronchodilator effect?
A. Beta-2 adrenergic agonism
B. Muscarinic receptor antagonism reducing vagal tone [CORRECT]
C. Phosphodiesterase inhibition
D. Leukotriene receptor blockade
Correct Answer: B
Answers with Complete Solutions | Graduate Nursing | Pass
Guaranteed - A+ Graded
Advanced Pharmacology & Pharmacotherapeutics
Q1: A 62-year-old patient with HFrEF is prescribed lisinopril. Which mechanism explains
this medication's mortality benefit in heart failure?
A. Pure vasodilation reducing afterload only
B. Inhibition of angiotensin-converting enzyme, reducing afterload, preload, and
preventing ventricular remodeling [CORRECT]
C. Direct stimulation of cardiac contractility
D. Diuretic effect reducing fluid overload
Correct Answer: B
Rationale: ACE inhibitors block angiotensin II formation and aldosterone secretion,
reducing afterload and preload while preventing adverse cardiac remodeling—key for
mortality reduction in HFrEF. Option A describes hydralazine/isosorbide. Option C
describes inotropes like digoxin. Option D describes loop diuretics which improve
symptoms but not mortality.
Q2: A patient on warfarin has an INR of 3.8 without bleeding. They are scheduled for
dental extraction. Which management is appropriate?
A. Vitamin K 10 mg IV immediately
,B. Hold warfarin 2-3 days pre-procedure; bridge with LMWH if high thrombotic risk
[CORRECT]
C. Continue warfarin at current dose
D. Fresh frozen plasma transfusion
Correct Answer: B
Rationale: For minor procedures, warfarin is typically held 2-3 days to achieve INR <1.5;
bridging depends on thrombotic risk (mechanical valves, recent VTE). Option A is for
serious bleeding. Option C risks excessive bleeding. Option D is unnecessary for minor
procedures.
Q3: A patient with type 2 diabetes and ASCVD is starting empagliflozin. Which
cardiovascular benefit is expected beyond glucose control?
A. Increased risk of heart failure hospitalization
B. Reduced risk of cardiovascular death and heart failure hospitalization [CORRECT]
C. Increased risk of stroke
D. No cardiovascular benefit
Correct Answer: B
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) reduce CV death and HF
hospitalization in T2DM with ASCVD (EMPA-REG OUTCOME trial). Options A, C, and D
are incorrect; SGLT2is have demonstrated cardioprotective effects.
,Q4: A patient with community-acquired pneumonia has a penicillin allergy (anaphylaxis).
Which antibiotic is the best alternative?
A. Amoxicillin
B. Azithromycin or doxycycline [CORRECT]
C. Cefuroxime
D. Piperacillin-tazobactam
Correct Answer: B
Rationale: For outpatient CAP in patients with severe penicillin allergy, macrolides
(azithromycin) or doxycycline are appropriate alternatives. Option A is penicillin-class.
Option C has 10% cross-reactivity with penicillin. Option D is penicillin-class and
reserved for severe inpatient infections.
Q5: A patient with depression is started on fluoxetine. Which adverse effect should be
monitored, especially in younger patients?
A. Hypertension
B. Suicidal ideation (black box warning for patients <24 years) [CORRECT]
C. Hyperglycemia
D. Bradycardia
Correct Answer: B
Rationale: SSRIs carry an FDA black box warning for increased suicidal thoughts and
behavior in children, adolescents, and young adults under 24. Options A, C, and D are
, not typical SSRI adverse effects; fluoxetine may actually cause mild bradycardia or be
weight-neutral.
Q6: A patient with atrial fibrillation is prescribed dabigatran. Which characteristic
distinguishes this medication from warfarin?
A. Requires INR monitoring
B. Direct thrombin inhibitor with fixed dosing and no routine monitoring [CORRECT]
C. Reversible with vitamin K
D. Extensive drug-food interactions
Correct Answer: B
Rationale: Dabigatran is a direct thrombin inhibitor with predictable pharmacokinetics,
fixed dosing, and no routine monitoring—advantages over warfarin. Option A describes
warfarin. Option C is false; idarucizumab reverses dabigatran. Option D describes
warfarin.
Q7: A patient with COPD is prescribed tiotropium. Which mechanism explains its
bronchodilator effect?
A. Beta-2 adrenergic agonism
B. Muscarinic receptor antagonism reducing vagal tone [CORRECT]
C. Phosphodiesterase inhibition
D. Leukotriene receptor blockade
Correct Answer: B
