1
NR566 Week 4 Midterm Exam Review
Advanced Pharmacology for Care of the
Family Complete Questions 1-100 |
Online Proctored Exam | Due
September 28th 2025
This comprehensive review guide contains 100 actual exam-style
questions and verified answers for the NR566 Advanced Pharmacology
Midterm Exam. All answers are based on current guidelines and peer-
reviewed rationales .
SECTION 1: CARDIOVASCULAR PHARMACOLOGY (Questions 1-10)
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
Answer: C. Add Metoprolol succinate
,2
Rationale: Beta-blockers (specifically carvedilol, metoprolol succinate,
and bisoprolol) are cornerstone therapies for HFrEF that improve
mortality, along with ACE inhibitors. Adding a beta-blocker provides
mortality benefit beyond blood pressure control .
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
Answer: B. Risk of lactic acidosis
Rationale: Metformin is renally cleared. Accumulation in renal
impairment increases the risk of lactic acidosis. Current guidelines allow
use with eGFR >30, but with caution and dose adjustment .
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
,3
Answer: C. High-intensity statin
Rationale: For secondary prevention (known ASCVD), high-intensity
statins (e.g., atorvastatin 40-80 mg or rosuvastatin 20-40 mg) are
recommended to reduce LDL by ≥50% .
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
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 INRs >5-10 or with bleeding risk .
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
Answer: B. Hypokalemia
, 4
Rationale: Hypokalemia increases the binding of digoxin to the sodium-
potassium ATPase pump, increasing the risk of toxicity and
arrhythmias .
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
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 .
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
Answer: B. Angioedema
NR566 Week 4 Midterm Exam Review
Advanced Pharmacology for Care of the
Family Complete Questions 1-100 |
Online Proctored Exam | Due
September 28th 2025
This comprehensive review guide contains 100 actual exam-style
questions and verified answers for the NR566 Advanced Pharmacology
Midterm Exam. All answers are based on current guidelines and peer-
reviewed rationales .
SECTION 1: CARDIOVASCULAR PHARMACOLOGY (Questions 1-10)
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
Answer: C. Add Metoprolol succinate
,2
Rationale: Beta-blockers (specifically carvedilol, metoprolol succinate,
and bisoprolol) are cornerstone therapies for HFrEF that improve
mortality, along with ACE inhibitors. Adding a beta-blocker provides
mortality benefit beyond blood pressure control .
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
Answer: B. Risk of lactic acidosis
Rationale: Metformin is renally cleared. Accumulation in renal
impairment increases the risk of lactic acidosis. Current guidelines allow
use with eGFR >30, but with caution and dose adjustment .
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
,3
Answer: C. High-intensity statin
Rationale: For secondary prevention (known ASCVD), high-intensity
statins (e.g., atorvastatin 40-80 mg or rosuvastatin 20-40 mg) are
recommended to reduce LDL by ≥50% .
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
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 INRs >5-10 or with bleeding risk .
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
Answer: B. Hypokalemia
, 4
Rationale: Hypokalemia increases the binding of digoxin to the sodium-
potassium ATPase pump, increasing the risk of toxicity and
arrhythmias .
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
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 .
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
Answer: B. Angioedema
