NR565 Week 8 Final Exam 100 Actual Exam
Questions and Answers Examplify Online
Proctored Exam NR565 Advanced
Pharmacology Fundamentals | 100% Pass
Guaranteed | Graded A+ |
Domain 1: Cardiovascular Pharmacology (Questions 1–15)
Question 1
A 62-year-old with heart failure with reduced ejection fraction (HFrEF) is on
lisinopril, carvedilol, and furosemide. Which additional medication has been
shown to reduce mortality and hospitalizations in HFrEF?
A) Digoxin
B) Spironolactone
C) Hydralazine
D) Metolazone
Correct ,,answer,,,,: B
Rationale: Spironolactone (mineralocorticoid antagonist) reduces mortality and HF
hospitalizations in NYHA class II-IV HFrEF (RALES trial). Digoxin reduces
hospitalizations but not mortality.
Question 2
A patient on warfarin has an INR of 5.2 with no bleeding. What is the appropriate
management?
A) Administer vitamin K 10 mg IV
B) Hold warfarin; no vitamin K
C) Give fresh frozen plasma
D) Increase warfarin dose
,Correct ,,answer,,,,: B
Rationale: For INR 4.5-10 without bleeding, hold warfarin. No vitamin K is
needed unless high bleeding risk. IV vitamin K is for serious bleeding or INR >10.
Question 3
A patient with hypertension and stage 3 CKD (eGFR 40 mL/min) is started on
lisinopril. What lab must be monitored within 1-2 weeks?
A) Hemoglobin
B) Serum creatinine and potassium
C) Liver enzymes
D) Blood glucose
Correct ,,answer,,,,: B
Rationale: ACE inhibitors can cause acute kidney injury (rise in creatinine) and
hyperkalemia, especially in CKD. Monitor renal function and potassium 1-2 weeks
after starting or dose increase.
Question 4
Which of the following is a direct oral anticoagulant (DOAC) that requires
twice-daily dosing?
A) Rivaroxaban
B) Apixaban
C) Edoxaban
D) Dabigatran
Correct ,,answer,,,,: B
Rationale: Apixaban (Eliquis) is dosed BID. Rivaroxaban and edoxaban are daily.
Dabigatran is BID, but apixaban is the classic example for exams.
Question 5
A patient with a mechanical mitral valve requires anticoagulation. Which
anticoagulant is contraindicated?
A) Warfarin
B) Apixaban
C) Enoxaparin
D) Unfractionated heparin
,Correct ,,answer,,,,: B
Rationale: DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are
contraindicated in mechanical heart valves due to increased thromboembolic and
bleeding complications. Warfarin is the only approved agent.
Question 6
A patient on clopidogrel is prescribed omeprazole for GERD. What is the concern?
A) Decreased clopidogrel activation due to CYP2C19 inhibition
B) Increased bleeding risk
C) No interaction
D) Increased clopidogrel levels
Correct ,,answer,,,,: A
Rationale: Clopidogrel is a prodrug activated by CYP2C19. Omeprazole is a
strong CYP2C19 inhibitor, reducing activation and antiplatelet effect. Pantoprazole
has less interaction.
Question 7
A patient with chronic stable angina is prescribed a beta-blocker. What is the
primary mechanism of benefit?
A) Coronary artery vasodilation
B) Decreased myocardial oxygen demand (heart rate, contractility, BP)
C) Increased cardiac output
D) Platelet inhibition
Correct ,,answer,,,,: B
Rationale: Beta-blockers reduce heart rate, contractility, and blood pressure,
thereby decreasing myocardial oxygen demand, improving symptoms and reducing
mortality post-MI.
Question 8
A patient with hypertension is started on hydrochlorothiazide. Which electrolyte
abnormality is most common?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypocalcemia
, Correct ,,answer,,,,: B
Rationale: Thiazides cause potassium wasting → hypokalemia. They can also
cause hyponatremia and hypomagnesemia. Hyperkalemia is seen with ACEi/ARB
and potassium-sparing diuretics.
Question 9
A patient with paroxysmal atrial fibrillation is started on digoxin for rate control.
What is the primary mechanism?
A) Sodium channel blockade
B) Increased vagal tone and reduced AV nodal conduction
C) Beta-receptor blockade
D) Calcium channel blockade
Correct ,,answer,,,,: B
Rationale: Digoxin increases vagal (parasympathetic) tone, slowing AV nodal
conduction and reducing ventricular rate in atrial fibrillation.
Question 10
A patient on amiodarone develops cough and dyspnea with interstitial infiltrates on
chest X-ray. This is most likely:
A) Amiodarone-induced pulmonary toxicity
B) Heart failure exacerbation
C) Pneumonia
D) Pulmonary embolism
Correct ,,answer,,,,: A
Rationale: Amiodarone pulmonary toxicity occurs in up to 10% of patients,
presenting with cough, dyspnea, and infiltrates. Risk increases with dose and
duration. Discontinue amiodarone.
Question 11
A patient with hypertension and benign prostatic hyperplasia is prescribed
doxazosin. What adverse effect is most common with the first dose?
A) Tachycardia
B) Orthostatic hypotension
C) Urinary retention
D) Gynecomastia
Questions and Answers Examplify Online
Proctored Exam NR565 Advanced
Pharmacology Fundamentals | 100% Pass
Guaranteed | Graded A+ |
Domain 1: Cardiovascular Pharmacology (Questions 1–15)
Question 1
A 62-year-old with heart failure with reduced ejection fraction (HFrEF) is on
lisinopril, carvedilol, and furosemide. Which additional medication has been
shown to reduce mortality and hospitalizations in HFrEF?
A) Digoxin
B) Spironolactone
C) Hydralazine
D) Metolazone
Correct ,,answer,,,,: B
Rationale: Spironolactone (mineralocorticoid antagonist) reduces mortality and HF
hospitalizations in NYHA class II-IV HFrEF (RALES trial). Digoxin reduces
hospitalizations but not mortality.
Question 2
A patient on warfarin has an INR of 5.2 with no bleeding. What is the appropriate
management?
A) Administer vitamin K 10 mg IV
B) Hold warfarin; no vitamin K
C) Give fresh frozen plasma
D) Increase warfarin dose
,Correct ,,answer,,,,: B
Rationale: For INR 4.5-10 without bleeding, hold warfarin. No vitamin K is
needed unless high bleeding risk. IV vitamin K is for serious bleeding or INR >10.
Question 3
A patient with hypertension and stage 3 CKD (eGFR 40 mL/min) is started on
lisinopril. What lab must be monitored within 1-2 weeks?
A) Hemoglobin
B) Serum creatinine and potassium
C) Liver enzymes
D) Blood glucose
Correct ,,answer,,,,: B
Rationale: ACE inhibitors can cause acute kidney injury (rise in creatinine) and
hyperkalemia, especially in CKD. Monitor renal function and potassium 1-2 weeks
after starting or dose increase.
Question 4
Which of the following is a direct oral anticoagulant (DOAC) that requires
twice-daily dosing?
A) Rivaroxaban
B) Apixaban
C) Edoxaban
D) Dabigatran
Correct ,,answer,,,,: B
Rationale: Apixaban (Eliquis) is dosed BID. Rivaroxaban and edoxaban are daily.
Dabigatran is BID, but apixaban is the classic example for exams.
Question 5
A patient with a mechanical mitral valve requires anticoagulation. Which
anticoagulant is contraindicated?
A) Warfarin
B) Apixaban
C) Enoxaparin
D) Unfractionated heparin
,Correct ,,answer,,,,: B
Rationale: DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are
contraindicated in mechanical heart valves due to increased thromboembolic and
bleeding complications. Warfarin is the only approved agent.
Question 6
A patient on clopidogrel is prescribed omeprazole for GERD. What is the concern?
A) Decreased clopidogrel activation due to CYP2C19 inhibition
B) Increased bleeding risk
C) No interaction
D) Increased clopidogrel levels
Correct ,,answer,,,,: A
Rationale: Clopidogrel is a prodrug activated by CYP2C19. Omeprazole is a
strong CYP2C19 inhibitor, reducing activation and antiplatelet effect. Pantoprazole
has less interaction.
Question 7
A patient with chronic stable angina is prescribed a beta-blocker. What is the
primary mechanism of benefit?
A) Coronary artery vasodilation
B) Decreased myocardial oxygen demand (heart rate, contractility, BP)
C) Increased cardiac output
D) Platelet inhibition
Correct ,,answer,,,,: B
Rationale: Beta-blockers reduce heart rate, contractility, and blood pressure,
thereby decreasing myocardial oxygen demand, improving symptoms and reducing
mortality post-MI.
Question 8
A patient with hypertension is started on hydrochlorothiazide. Which electrolyte
abnormality is most common?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypocalcemia
, Correct ,,answer,,,,: B
Rationale: Thiazides cause potassium wasting → hypokalemia. They can also
cause hyponatremia and hypomagnesemia. Hyperkalemia is seen with ACEi/ARB
and potassium-sparing diuretics.
Question 9
A patient with paroxysmal atrial fibrillation is started on digoxin for rate control.
What is the primary mechanism?
A) Sodium channel blockade
B) Increased vagal tone and reduced AV nodal conduction
C) Beta-receptor blockade
D) Calcium channel blockade
Correct ,,answer,,,,: B
Rationale: Digoxin increases vagal (parasympathetic) tone, slowing AV nodal
conduction and reducing ventricular rate in atrial fibrillation.
Question 10
A patient on amiodarone develops cough and dyspnea with interstitial infiltrates on
chest X-ray. This is most likely:
A) Amiodarone-induced pulmonary toxicity
B) Heart failure exacerbation
C) Pneumonia
D) Pulmonary embolism
Correct ,,answer,,,,: A
Rationale: Amiodarone pulmonary toxicity occurs in up to 10% of patients,
presenting with cough, dyspnea, and infiltrates. Risk increases with dose and
duration. Discontinue amiodarone.
Question 11
A patient with hypertension and benign prostatic hyperplasia is prescribed
doxazosin. What adverse effect is most common with the first dose?
A) Tachycardia
B) Orthostatic hypotension
C) Urinary retention
D) Gynecomastia
