NR566 Finals Exam Questions 1-100 Actual Exam
Examplify Online Proctored Exam NR566 Advanced
Pharmacology For Care Of The Family Questions and
Answers | 100% Pass Guaranteed | Graded A+ |
Domain 1: Cardiovascular & Hypertension (Questions 1–15)
Question 1
A 55-year-old Black patient with hypertension (BP 148/92 mmHg) and no other
comorbidities. According to ACC/AHA guidelines, which antihypertensive is
recommended as first-line monotherapy?
A) Lisinopril
B) Amlodipine
C) Metoprolol
D) Losartan
Correct ,,answer,,,,: B
Rationale: In Black patients, thiazide diuretics or calcium channel blockers
(amlodipine) are preferred first-line due to lower renin levels. ACEi/ARB
monotherapy is less effective but can be used in combination.
Question 2
A 72-year-old with heart failure with preserved ejection fraction (HFpEF) presents
with dyspnea on exertion and edema. Which medication has been shown to reduce
hospitalizations in HFpEF?
A) Spironolactone
B) Digoxin
C) Empagliflozin
D) Hydralazine
Correct ,,answer,,,,: C
Rationale: EMPEROR-Preserved trial showed empagliflozin reduces
cardiovascular death or HF hospitalization in HFpEF. Spironolactone (TOPCAT)
showed mixed results. Empagliflozin is now guideline-recommended.
,Question 3
A patient with atrial fibrillation is on apixaban. She develops acute kidney injury
(CrCl 25 mL/min). What is the appropriate dose adjustment?
A) Continue 5 mg BID
B) Reduce to 2.5 mg BID
C) Discontinue apixaban and start warfarin
D) Double the dose
Correct ,,answer,,,,: B
Rationale: Apixaban dose reduction to 2.5 mg BID is recommended if any two of:
age ≥80, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL. For CrCl 15-29 mL/min,
use 2.5 mg BID. CrCl <15: avoid.
Question 4
A patient on warfarin has an INR of 1.2 (goal 2-3) despite adherence. He recently
started a new medication. Which drug is most likely causing a decreased INR?
A) Amiodarone
B) Rifampin
C) Fluconazole
D) Metronidazole
Correct ,,answer,,,,: B
Rationale: Rifampin is a potent CYP2C9 inducer, increasing warfarin metabolism
and decreasing INR. The other options are inhibitors (increase INR).
Question 5
A 65-year-old with hypertension and hyperlipidemia is on atorvastatin 40 mg daily
and develops myalgia. CK is normal. What is the best next step?
A) Discontinue atorvastatin
B) Reduce atorvastatin to 20 mg daily
C) Switch to rosuvastatin 10 mg
D) Add coenzyme Q10
Correct ,,answer,,,,: B
Rationale: For mild myalgia with normal CK, reduce statin dose or switch to
another statin. Complete discontinuation increases cardiovascular risk.
Rosuvastatin is more potent, not necessarily better.
,Question 6
A patient with chronic stable angina is prescribed ranolazine. What is the
mechanism?
A) Beta-1 blockade
B) Late sodium current inhibition, reducing intracellular calcium
C) Calcium channel blockade
D) Nitrate vasodilation
Correct ,,answer,,,,: B
Rationale: Ranolazine inhibits the late sodium current, reducing intracellular
calcium overload and improving myocardial relaxation. It does not affect heart rate
or blood pressure significantly.
Question 7
A 58-year-old with heart failure (HFrEF, EF 35%) is on target doses of lisinopril,
carvedilol, and spironolactone but remains symptomatic (NYHA class III). Which
medication has been shown to reduce mortality when added?
A) Digoxin
B) Hydralazine/isosorbide dinitrate
C) Ivabradine
D) Furosemide
Correct ,,answer,,,,: B
Rationale: Hydralazine/isosorbide dinitrate is indicated for persistent symptoms in
African American patients (A-HeFT trial) and can be considered in others.
Ivabradine reduces HF hospitalizations but not mortality.
Question 8
A patient with hypertension and gout is started on hydrochlorothiazide. What effect
on uric acid is expected?
A) Decreased uric acid
B) Increased uric acid (hyperuricemia)
C) No change
D) Uric acid excretion increased
Correct ,,answer,,,,: B
Rationale: Thiazide diuretics increase uric acid reabsorption, causing
, hyperuricemia and potentially precipitating gout. Consider alternative
antihypertensives in gout patients.
Question 9
A patient with paroxysmal atrial fibrillation is started on dronedarone. Which
baseline test is required?
A) Echocardiogram
B) Chest X-ray
C) Liver function tests and pulmonary function tests
D) Serum digoxin level
Correct ,,answer,,,,: C
Rationale: Dronedarone can cause hepatotoxicity and pulmonary toxicity. Baseline
and periodic LFTs and pulmonary function tests are recommended. It is
contraindicated in decompensated HF.
Question 10
A patient on clopidogrel after drug-eluting stent placement requires a PPI for
GERD. Which PPI is preferred to minimize interaction?
A) Omeprazole
B) Esomeprazole
C) Pantoprazole
D) Lansoprazole
Correct ,,answer,,,,: C
Rationale: Pantoprazole has the least CYP2C19 inhibition, minimizing reduction
of clopidogrel activation. Omeprazole and esomeprazole significantly reduce
antiplatelet effect.
Question 11
A 70-year-old with hypertension and benign prostatic hyperplasia is prescribed
tamsulosin. What is the most common adverse effect?
A) First-dose orthostatic hypotension
B) Gynecomastia
C) Retrograde ejaculation
D) Tachycardia
Examplify Online Proctored Exam NR566 Advanced
Pharmacology For Care Of The Family Questions and
Answers | 100% Pass Guaranteed | Graded A+ |
Domain 1: Cardiovascular & Hypertension (Questions 1–15)
Question 1
A 55-year-old Black patient with hypertension (BP 148/92 mmHg) and no other
comorbidities. According to ACC/AHA guidelines, which antihypertensive is
recommended as first-line monotherapy?
A) Lisinopril
B) Amlodipine
C) Metoprolol
D) Losartan
Correct ,,answer,,,,: B
Rationale: In Black patients, thiazide diuretics or calcium channel blockers
(amlodipine) are preferred first-line due to lower renin levels. ACEi/ARB
monotherapy is less effective but can be used in combination.
Question 2
A 72-year-old with heart failure with preserved ejection fraction (HFpEF) presents
with dyspnea on exertion and edema. Which medication has been shown to reduce
hospitalizations in HFpEF?
A) Spironolactone
B) Digoxin
C) Empagliflozin
D) Hydralazine
Correct ,,answer,,,,: C
Rationale: EMPEROR-Preserved trial showed empagliflozin reduces
cardiovascular death or HF hospitalization in HFpEF. Spironolactone (TOPCAT)
showed mixed results. Empagliflozin is now guideline-recommended.
,Question 3
A patient with atrial fibrillation is on apixaban. She develops acute kidney injury
(CrCl 25 mL/min). What is the appropriate dose adjustment?
A) Continue 5 mg BID
B) Reduce to 2.5 mg BID
C) Discontinue apixaban and start warfarin
D) Double the dose
Correct ,,answer,,,,: B
Rationale: Apixaban dose reduction to 2.5 mg BID is recommended if any two of:
age ≥80, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL. For CrCl 15-29 mL/min,
use 2.5 mg BID. CrCl <15: avoid.
Question 4
A patient on warfarin has an INR of 1.2 (goal 2-3) despite adherence. He recently
started a new medication. Which drug is most likely causing a decreased INR?
A) Amiodarone
B) Rifampin
C) Fluconazole
D) Metronidazole
Correct ,,answer,,,,: B
Rationale: Rifampin is a potent CYP2C9 inducer, increasing warfarin metabolism
and decreasing INR. The other options are inhibitors (increase INR).
Question 5
A 65-year-old with hypertension and hyperlipidemia is on atorvastatin 40 mg daily
and develops myalgia. CK is normal. What is the best next step?
A) Discontinue atorvastatin
B) Reduce atorvastatin to 20 mg daily
C) Switch to rosuvastatin 10 mg
D) Add coenzyme Q10
Correct ,,answer,,,,: B
Rationale: For mild myalgia with normal CK, reduce statin dose or switch to
another statin. Complete discontinuation increases cardiovascular risk.
Rosuvastatin is more potent, not necessarily better.
,Question 6
A patient with chronic stable angina is prescribed ranolazine. What is the
mechanism?
A) Beta-1 blockade
B) Late sodium current inhibition, reducing intracellular calcium
C) Calcium channel blockade
D) Nitrate vasodilation
Correct ,,answer,,,,: B
Rationale: Ranolazine inhibits the late sodium current, reducing intracellular
calcium overload and improving myocardial relaxation. It does not affect heart rate
or blood pressure significantly.
Question 7
A 58-year-old with heart failure (HFrEF, EF 35%) is on target doses of lisinopril,
carvedilol, and spironolactone but remains symptomatic (NYHA class III). Which
medication has been shown to reduce mortality when added?
A) Digoxin
B) Hydralazine/isosorbide dinitrate
C) Ivabradine
D) Furosemide
Correct ,,answer,,,,: B
Rationale: Hydralazine/isosorbide dinitrate is indicated for persistent symptoms in
African American patients (A-HeFT trial) and can be considered in others.
Ivabradine reduces HF hospitalizations but not mortality.
Question 8
A patient with hypertension and gout is started on hydrochlorothiazide. What effect
on uric acid is expected?
A) Decreased uric acid
B) Increased uric acid (hyperuricemia)
C) No change
D) Uric acid excretion increased
Correct ,,answer,,,,: B
Rationale: Thiazide diuretics increase uric acid reabsorption, causing
, hyperuricemia and potentially precipitating gout. Consider alternative
antihypertensives in gout patients.
Question 9
A patient with paroxysmal atrial fibrillation is started on dronedarone. Which
baseline test is required?
A) Echocardiogram
B) Chest X-ray
C) Liver function tests and pulmonary function tests
D) Serum digoxin level
Correct ,,answer,,,,: C
Rationale: Dronedarone can cause hepatotoxicity and pulmonary toxicity. Baseline
and periodic LFTs and pulmonary function tests are recommended. It is
contraindicated in decompensated HF.
Question 10
A patient on clopidogrel after drug-eluting stent placement requires a PPI for
GERD. Which PPI is preferred to minimize interaction?
A) Omeprazole
B) Esomeprazole
C) Pantoprazole
D) Lansoprazole
Correct ,,answer,,,,: C
Rationale: Pantoprazole has the least CYP2C19 inhibition, minimizing reduction
of clopidogrel activation. Omeprazole and esomeprazole significantly reduce
antiplatelet effect.
Question 11
A 70-year-old with hypertension and benign prostatic hyperplasia is prescribed
tamsulosin. What is the most common adverse effect?
A) First-dose orthostatic hypotension
B) Gynecomastia
C) Retrograde ejaculation
D) Tachycardia
