NR 566 (NR566) Midterm Exam Advanced
Pharmacology for Care of the Family Correctly
Answered Questions | Complete Study Guide
This comprehensive guide contains actual NR566 Midterm Exam questions with verified correct
answers and detailed rationales. Based on Weeks 1-4 content covering Cardiovascular Pharmacology,
Antimicrobials, Dermatology, Pain Management, and Endocrine Disorders.
SECTION 1: CARDIOVASCULAR PHARMACOLOGY (Questions 1-20)
Question 1
A 58-year-old male with a history of heart failure with reduced ejection fraction (HFrEF) presents with
dyspnea. He is currently on Lisinopril, but his blood pressure remains elevated. What is the BEST next
step in his pharmacologic management to improve mortality?
A. Add Hydrochlorothiazide
B. Switch Lisinopril to Losartan
C. Add Metoprolol succinate
D. Add Amlodipine
Correct Answer: C. Add Metoprolol succinate
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) are cornerstone therapies for
HFrEF that improve mortality, along with ACE inhibitors. Adding a beta-blocker provides mortality
benefit beyond blood pressure control. Hydrochlorothiazide and amlodipine do not improve mortality in
heart failure.
Question 2
A patient with type 2 diabetes and Stage 3 chronic kidney disease (eGFR 45 mL/min) is started on
metformin. What is the primary concern regarding this medication in renal impairment?
A. Increased risk of hypoglycemia
B. Risk of lactic acidosis
C. Acute interstitial nephritis
D. Contrast-induced nephropathy
Correct Answer: B. Risk of lactic acidosis
Rationale: Metformin is renally cleared. Accumulation in renal impairment increases the risk of lactic
acidosis, a rare but life-threatening adverse effect. Current guidelines allow metformin use with eGFR
,>30 mL/min, but with caution and dose adjustment. Metformin does not cause nephrotoxicity or
contrast-induced nephropathy.
Question 3
When prescribing a statin for a 65-year-old female with atherosclerotic cardiovascular disease (ASCVD),
what is the target intensity required for secondary prevention?
A. Low-intensity statin
B. Moderate-intensity statin
C. High-intensity statin
D. No statin needed if LDL is <100 mg/dL
Correct Answer: C. High-intensity statin
Rationale: For secondary prevention (known ASCVD), high-intensity statins (atorvastatin 40-80 mg or
rosuvastatin 20-40 mg) are recommended to reduce LDL by ≥50%. Moderate-intensity statins are for
primary prevention.
Question 4
A patient on warfarin has an INR of 4.5 without bleeding. What is the appropriate management?
A. Administer Vitamin K 10 mg orally and hold warfarin for 2 days
B. Hold warfarin and recheck INR in 1-2 days
C. Administer Fresh Frozen Plasma immediately
D. Increase warfarin dose
Correct Answer: B. Hold warfarin and recheck INR in 1-2 days
Rationale: For an INR between 4.0-5.0 without bleeding, the standard of care is to withhold the next
dose and monitor. Vitamin K is usually reserved for INR >5-10 or with bleeding risk. FFP is for active
bleeding.
Question 5
A patient is prescribed digoxin for heart failure. What electrolyte imbalance increases the risk of digoxin
toxicity?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Correct Answer: B. Hypokalemia
,Rationale: Hypokalemia increases the binding of digoxin to the sodium-potassium ATPase pump,
increasing the risk of toxicity and arrhythmias. Hypercalcemia and hypomagnesemia also increase risk,
but hypokalemia is the most common electrolyte disturbance associated with digoxin toxicity.
Question 6
A 72-year-old male with benign prostatic hyperplasia (BPH) and hypertension is started on doxazosin.
What adverse effect is most critical to monitor during the first dose?
A. Reflex tachycardia
B. First-dose syncope
C. Gynecomastia
D. Urinary retention
Correct Answer: B. First-dose syncope
Rationale: Alpha-1 blockers (doxazosin, terazosin) can cause significant orthostatic hypotension and
syncope, especially with the first dose or dose escalation. Administer at bedtime and monitor blood
pressure closely.
Question 7
A patient is prescribed lisinopril. Which adverse effect requires immediate discontinuation and
reporting?
A. Dry cough
B. Angioedema
C. Dizziness with standing
D. Hyperkalemia
Correct Answer: B. Angioedema
Rationale: Angioedema (swelling of lips, tongue, throat, or face) is a life-threatening adverse effect of
ACE inhibitors requiring immediate discontinuation and emergency treatment. Dry cough is common but
not life-threatening.
Question 8
A patient with heart failure is prescribed spironolactone. Which finding should the nurse report
immediately?
A. Serum potassium 3.5 mEq/L
B. Serum potassium 5.8 mEq/L
C. Urine output 40 mL/hour
D. Blood pressure 130/85 mm Hg
, Correct Answer: B. Serum potassium 5.8 mEq/L
Rationale: Spironolactone is a potassium-sparing diuretic. Hyperkalemia (normal range 3.5-5.0 mEq/L) is
a serious adverse effect requiring immediate intervention. Potassium >5.5 mEq/L increases risk of
cardiac arrhythmias.
Question 9
Which of the following is the mechanism of action of GLP-1 receptor agonists (e.g., semaglutide)?
A. Increases insulin secretion, decreases glucagon secretion, slows gastric emptying
B. Increases urinary excretion of glucose
C. Increases peripheral insulin sensitivity
D. Stimulates the beta cells of the pancreas independent of glucose levels
Correct Answer: A. Increases insulin secretion, decreases glucagon secretion, slows gastric emptying
Rationale: GLP-1 receptor agonists work by increasing insulin secretion (glucose-dependent), decreasing
glucagon secretion, slowing gastric emptying, and promoting satiety. They are not SGLT2 inhibitors
(which increase urinary glucose excretion).
Question 10
A patient is started on atorvastatin. What baseline laboratory tests should be ordered before initiation?
A. Only a lipid panel
B. Lipid panel, liver function tests (LFTs), and creatine kinase (CK)
C. Complete blood count and renal function
D. Lipid panel and coagulation studies
Correct Answer: B. Lipid panel, liver function tests (LFTs), and creatine kinase (CK)
Rationale: Before starting statin therapy, baseline lipid panel, LFTs (to detect pre-existing liver disease),
and CK (to establish baseline for monitoring myopathy) should be obtained. Statins can cause
hepatotoxicity and myopathy.
Question 11
A patient is prescribed clopidogrel after a drug-eluting stent placement. Which medication should be
avoided due to reduced antiplatelet effect?
A. Aspirin
B. Omeprazole
C. Metoprolol
D. Lisinopril
Pharmacology for Care of the Family Correctly
Answered Questions | Complete Study Guide
This comprehensive guide contains actual NR566 Midterm Exam questions with verified correct
answers and detailed rationales. Based on Weeks 1-4 content covering Cardiovascular Pharmacology,
Antimicrobials, Dermatology, Pain Management, and Endocrine Disorders.
SECTION 1: CARDIOVASCULAR PHARMACOLOGY (Questions 1-20)
Question 1
A 58-year-old male with a history of heart failure with reduced ejection fraction (HFrEF) presents with
dyspnea. He is currently on Lisinopril, but his blood pressure remains elevated. What is the BEST next
step in his pharmacologic management to improve mortality?
A. Add Hydrochlorothiazide
B. Switch Lisinopril to Losartan
C. Add Metoprolol succinate
D. Add Amlodipine
Correct Answer: C. Add Metoprolol succinate
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) are cornerstone therapies for
HFrEF that improve mortality, along with ACE inhibitors. Adding a beta-blocker provides mortality
benefit beyond blood pressure control. Hydrochlorothiazide and amlodipine do not improve mortality in
heart failure.
Question 2
A patient with type 2 diabetes and Stage 3 chronic kidney disease (eGFR 45 mL/min) is started on
metformin. What is the primary concern regarding this medication in renal impairment?
A. Increased risk of hypoglycemia
B. Risk of lactic acidosis
C. Acute interstitial nephritis
D. Contrast-induced nephropathy
Correct Answer: B. Risk of lactic acidosis
Rationale: Metformin is renally cleared. Accumulation in renal impairment increases the risk of lactic
acidosis, a rare but life-threatening adverse effect. Current guidelines allow metformin use with eGFR
,>30 mL/min, but with caution and dose adjustment. Metformin does not cause nephrotoxicity or
contrast-induced nephropathy.
Question 3
When prescribing a statin for a 65-year-old female with atherosclerotic cardiovascular disease (ASCVD),
what is the target intensity required for secondary prevention?
A. Low-intensity statin
B. Moderate-intensity statin
C. High-intensity statin
D. No statin needed if LDL is <100 mg/dL
Correct Answer: C. High-intensity statin
Rationale: For secondary prevention (known ASCVD), high-intensity statins (atorvastatin 40-80 mg or
rosuvastatin 20-40 mg) are recommended to reduce LDL by ≥50%. Moderate-intensity statins are for
primary prevention.
Question 4
A patient on warfarin has an INR of 4.5 without bleeding. What is the appropriate management?
A. Administer Vitamin K 10 mg orally and hold warfarin for 2 days
B. Hold warfarin and recheck INR in 1-2 days
C. Administer Fresh Frozen Plasma immediately
D. Increase warfarin dose
Correct Answer: B. Hold warfarin and recheck INR in 1-2 days
Rationale: For an INR between 4.0-5.0 without bleeding, the standard of care is to withhold the next
dose and monitor. Vitamin K is usually reserved for INR >5-10 or with bleeding risk. FFP is for active
bleeding.
Question 5
A patient is prescribed digoxin for heart failure. What electrolyte imbalance increases the risk of digoxin
toxicity?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Correct Answer: B. Hypokalemia
,Rationale: Hypokalemia increases the binding of digoxin to the sodium-potassium ATPase pump,
increasing the risk of toxicity and arrhythmias. Hypercalcemia and hypomagnesemia also increase risk,
but hypokalemia is the most common electrolyte disturbance associated with digoxin toxicity.
Question 6
A 72-year-old male with benign prostatic hyperplasia (BPH) and hypertension is started on doxazosin.
What adverse effect is most critical to monitor during the first dose?
A. Reflex tachycardia
B. First-dose syncope
C. Gynecomastia
D. Urinary retention
Correct Answer: B. First-dose syncope
Rationale: Alpha-1 blockers (doxazosin, terazosin) can cause significant orthostatic hypotension and
syncope, especially with the first dose or dose escalation. Administer at bedtime and monitor blood
pressure closely.
Question 7
A patient is prescribed lisinopril. Which adverse effect requires immediate discontinuation and
reporting?
A. Dry cough
B. Angioedema
C. Dizziness with standing
D. Hyperkalemia
Correct Answer: B. Angioedema
Rationale: Angioedema (swelling of lips, tongue, throat, or face) is a life-threatening adverse effect of
ACE inhibitors requiring immediate discontinuation and emergency treatment. Dry cough is common but
not life-threatening.
Question 8
A patient with heart failure is prescribed spironolactone. Which finding should the nurse report
immediately?
A. Serum potassium 3.5 mEq/L
B. Serum potassium 5.8 mEq/L
C. Urine output 40 mL/hour
D. Blood pressure 130/85 mm Hg
, Correct Answer: B. Serum potassium 5.8 mEq/L
Rationale: Spironolactone is a potassium-sparing diuretic. Hyperkalemia (normal range 3.5-5.0 mEq/L) is
a serious adverse effect requiring immediate intervention. Potassium >5.5 mEq/L increases risk of
cardiac arrhythmias.
Question 9
Which of the following is the mechanism of action of GLP-1 receptor agonists (e.g., semaglutide)?
A. Increases insulin secretion, decreases glucagon secretion, slows gastric emptying
B. Increases urinary excretion of glucose
C. Increases peripheral insulin sensitivity
D. Stimulates the beta cells of the pancreas independent of glucose levels
Correct Answer: A. Increases insulin secretion, decreases glucagon secretion, slows gastric emptying
Rationale: GLP-1 receptor agonists work by increasing insulin secretion (glucose-dependent), decreasing
glucagon secretion, slowing gastric emptying, and promoting satiety. They are not SGLT2 inhibitors
(which increase urinary glucose excretion).
Question 10
A patient is started on atorvastatin. What baseline laboratory tests should be ordered before initiation?
A. Only a lipid panel
B. Lipid panel, liver function tests (LFTs), and creatine kinase (CK)
C. Complete blood count and renal function
D. Lipid panel and coagulation studies
Correct Answer: B. Lipid panel, liver function tests (LFTs), and creatine kinase (CK)
Rationale: Before starting statin therapy, baseline lipid panel, LFTs (to detect pre-existing liver disease),
and CK (to establish baseline for monitoring myopathy) should be obtained. Statins can cause
hepatotoxicity and myopathy.
Question 11
A patient is prescribed clopidogrel after a drug-eluting stent placement. Which medication should be
avoided due to reduced antiplatelet effect?
A. Aspirin
B. Omeprazole
C. Metoprolol
D. Lisinopril
