NP Exam Prep Pack: Pharmacology &
Diagnosis – 2026 Topic Test||Questions
And Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Instructions: Choose the best answer. Correct answers are highlighted in bold.
Rationales are provided for each question.
Section 1: Cardiovascular Pharmacology & Diagnosis (Q1-15)
1. A 58-year-old male with HTN and HFrEF (EF 35%) presents with
worsening dyspnea. Which medication combination provides the greatest
mortality benefit?
• A) Hydrochlorothiazide + Amlodipine
• B) Sacubitril/valsartan + Bisoprolol
• C) Furosemide + Hydralazine
• D) Doxazosin + Metolazone
Rationale: Sacubitril/valsartan (ARNI) plus a beta-blocker (bisoprolol) is first-line
for HFrEF, reducing mortality vs. ACE inhibitors. Thiazides/amlodipine don't have
mortality benefit in HFrEF.
2. Which ECG finding is most specific for digoxin toxicity?
• A) Prolonged QT interval
• B) Down-sloping ST depression (reverse tick)
• C) Tall T waves
• D) Delta wave
,Rationale: Down-sloping ST depression ("reverse tick" or Salvador Dali sign) is
classic for digoxin effect/toxicity. Prolonged QT is seen with class III
antiarrhythmics.
3. A 72-year-old with Afib (CHA₂DS₂-VASc = 5) on warfarin has INR 4.5
without bleeding. What is the best next step?
• A) Give vitamin K 10 mg IV
• B) Hold warfarin, no vitamin K
• C) Give FFP immediately
• D) Increase warfarin dose
Rationale: INR 4.5 (supertherapeutic but ≤ 4.5) without bleeding → hold
warfarin. Vitamin K only if >10 or bleeding. FFP for life-threatening bleed.
4. First-line drug for acute decompensated HF with pulmonary edema?
• A) Metoprolol IV
• B) Spironolactone
• C) Furosemide IV
• D) Lisinopril SL
Rationale: IV loop diuretics (furosemide) rapidly reduce preload. Beta-blockers
are not acute therapy.
5. Diagnosis of Prinzmetal (variant) angina is best confirmed by?
• A) Positive exercise stress test
• B) Transient ST elevation during chest pain
• C) Elevated troponin
• D) Fixed perfusion defect on MPI
Rationale: Prinzmetal angina shows transient ST elevation from coronary
vasospasm. Troponin normal unless infarction.
6. Which antihypertensive is contraindicated in pregnancy?
• A) Labetalol
, • B) Methyldopa
• C) Nifedipine
• D) Lisinopril
Rationale: ACE inhibitors (lisinopril) cause fetal renal agenesis and
oligohydramnios. Labetalol, methyldopa, nifedipine are pregnancy-safe.
7. A patient on amiodarone develops cough, dyspnea, and lung infiltrates.
Most likely diagnosis?
• A) Pneumonia
• B) Pulmonary toxicity
• C) Heart failure exacerbation
• D) Bronchospasm
Rationale: Amiodarone pulmonary toxicity presents with cough, dyspnea, and
interstitial infiltrates after cumulative dose >100-200g.
8. Drug of choice for rate control in Afib with WPW syndrome?
• A) Digoxin
• B) Metoprolol
• C) Procainamide
• D) Verapamil
Rationale: AV nodal blockers (digoxin, beta-blockers, verapamil) can accelerate
conduction via accessory pathway → VF. Procainamide blocks pathway.
9. In hypertensive urgency, which oral agent is most rapidly effective?
• A) Clonidine
• B) Captopril
• C) Hydralazine
• D) Minoxidil
Rationale: Captopril (ACE inhibitor) has onset within 15-30 min. Clonidine
causes rebound HTN.
Diagnosis – 2026 Topic Test||Questions
And Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Instructions: Choose the best answer. Correct answers are highlighted in bold.
Rationales are provided for each question.
Section 1: Cardiovascular Pharmacology & Diagnosis (Q1-15)
1. A 58-year-old male with HTN and HFrEF (EF 35%) presents with
worsening dyspnea. Which medication combination provides the greatest
mortality benefit?
• A) Hydrochlorothiazide + Amlodipine
• B) Sacubitril/valsartan + Bisoprolol
• C) Furosemide + Hydralazine
• D) Doxazosin + Metolazone
Rationale: Sacubitril/valsartan (ARNI) plus a beta-blocker (bisoprolol) is first-line
for HFrEF, reducing mortality vs. ACE inhibitors. Thiazides/amlodipine don't have
mortality benefit in HFrEF.
2. Which ECG finding is most specific for digoxin toxicity?
• A) Prolonged QT interval
• B) Down-sloping ST depression (reverse tick)
• C) Tall T waves
• D) Delta wave
,Rationale: Down-sloping ST depression ("reverse tick" or Salvador Dali sign) is
classic for digoxin effect/toxicity. Prolonged QT is seen with class III
antiarrhythmics.
3. A 72-year-old with Afib (CHA₂DS₂-VASc = 5) on warfarin has INR 4.5
without bleeding. What is the best next step?
• A) Give vitamin K 10 mg IV
• B) Hold warfarin, no vitamin K
• C) Give FFP immediately
• D) Increase warfarin dose
Rationale: INR 4.5 (supertherapeutic but ≤ 4.5) without bleeding → hold
warfarin. Vitamin K only if >10 or bleeding. FFP for life-threatening bleed.
4. First-line drug for acute decompensated HF with pulmonary edema?
• A) Metoprolol IV
• B) Spironolactone
• C) Furosemide IV
• D) Lisinopril SL
Rationale: IV loop diuretics (furosemide) rapidly reduce preload. Beta-blockers
are not acute therapy.
5. Diagnosis of Prinzmetal (variant) angina is best confirmed by?
• A) Positive exercise stress test
• B) Transient ST elevation during chest pain
• C) Elevated troponin
• D) Fixed perfusion defect on MPI
Rationale: Prinzmetal angina shows transient ST elevation from coronary
vasospasm. Troponin normal unless infarction.
6. Which antihypertensive is contraindicated in pregnancy?
• A) Labetalol
, • B) Methyldopa
• C) Nifedipine
• D) Lisinopril
Rationale: ACE inhibitors (lisinopril) cause fetal renal agenesis and
oligohydramnios. Labetalol, methyldopa, nifedipine are pregnancy-safe.
7. A patient on amiodarone develops cough, dyspnea, and lung infiltrates.
Most likely diagnosis?
• A) Pneumonia
• B) Pulmonary toxicity
• C) Heart failure exacerbation
• D) Bronchospasm
Rationale: Amiodarone pulmonary toxicity presents with cough, dyspnea, and
interstitial infiltrates after cumulative dose >100-200g.
8. Drug of choice for rate control in Afib with WPW syndrome?
• A) Digoxin
• B) Metoprolol
• C) Procainamide
• D) Verapamil
Rationale: AV nodal blockers (digoxin, beta-blockers, verapamil) can accelerate
conduction via accessory pathway → VF. Procainamide blocks pathway.
9. In hypertensive urgency, which oral agent is most rapidly effective?
• A) Clonidine
• B) Captopril
• C) Hydralazine
• D) Minoxidil
Rationale: Captopril (ACE inhibitor) has onset within 15-30 min. Clonidine
causes rebound HTN.
