NU 578 Unit 2 Exam – Advanced
Pharmacology Questions And Answers Plus
Rationales | Qs & Ans 2026 | Instant Pdf
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Question 1
A 68-year-old male with heart failure (HFrEF) is started on
sacubitril/valsartan. Which lab value requires the most immediate action?
A. Serum creatinine 1.2 mg/dL
B. Serum potassium 5.8 mEq/L
C. BNP 250 pg/mL
D. Hemoglobin 11.5 g/dL
Answer: B. Serum potassium 5.8 mEq/L
Expert Explanation: Sacubitril/valsartan is an ARNI (angiotensin
receptor-neprilysin inhibitor). Neprilysin inhibition increases bradykinin,
natriuretic peptides, and also can reduce potassium excretion, especially
when combined with RAAS blockade. Hyperkalemia (K >5.5 mEq/L) is a
serious risk and can lead to life-threatening arrhythmias. Creatinine 1.2 is
acceptable; BNP expected to be elevated in HF; hemoglobin 11.5 is mild
anemia but not emergent.
,Question 2
A patient taking warfarin for atrial fibrillation has an INR of 4.5 without
bleeding. What is the most appropriate management?
A. Administer vitamin K 10 mg IV
B. Hold one dose and monitor INR
C. Give fresh frozen plasma immediately
D. Increase warfarin dose
Answer: B. Hold one dose and monitor INR
Expert Explanation: For INR 4.5–10 without bleeding, standard practice
is to hold warfarin (1–2 doses) and monitor INR. Vitamin K is reserved for
INR >10 or bleeding. FFP is for active serious bleeding. Increasing
warfarin would worsen elevation.
Question 3
Which medication is most appropriate for first-line treatment of
neuropathic pain in a diabetic patient with normal renal function?
A. Ibuprofen
B. Duloxetine
C. Oxycodone
D. Cyclobenzaprine
Answer: B. Duloxetine
,Expert Explanation: Duloxetine is an SNRI with FDA approval for
diabetic peripheral neuropathy. First-line guidelines include
gabapentinoids or SNRIs. NSAIDs (ibuprofen) are not effective for
neuropathic pain. Opioids are second/third line due to risk.
Cyclobenzaprine is for muscle spasm.
Question 4
A 72-year-old with osteoporosis is prescribed alendronate. What
instruction is most important?
A. Take with breakfast
B. Lie down for 30 minutes after taking
C. Take with a full glass of water and remain upright for 30 minutes
D. Crush the tablet for easier swallowing
Answer: C. Take with a full glass of water and remain upright for 30
minutes
Expert Explanation: Alendronate (bisphosphonate) can cause
esophageal irritation/ulceration. It must be taken on an empty stomach
with plain water (not juice/coffee), and patient must remain upright for
at least 30 minutes to prevent reflux and esophageal injury. Lying down
increases risk.
, Question 5
A patient on metformin for type 2 diabetes is scheduled for IV contrast
CT scan. What should be done?
A. Continue metformin as usual
B. Stop metformin 48 hours before contrast
C. Stop metformin at time of procedure and restart 48 hours after if renal
function normal
D. Double the metformin dose after procedure
Answer: C. Stop metformin at time of procedure and restart 48 hours
after if renal function normal
Expert Explanation: IV contrast can cause acute kidney injury.
Metformin is renally cleared; if kidney injury occurs, metformin
accumulation increases risk of lactic acidosis. Current guidelines: hold
metformin at time of or before procedure (no need 48h before), and
restart 48h post-procedure if serum creatinine stable/normal.
Question 6
Which drug is most likely to cause QT prolongation and torsades de
pointes?
A. Amoxicillin
B. Hydrochlorothiazide
Pharmacology Questions And Answers Plus
Rationales | Qs & Ans 2026 | Instant Pdf
Download
Question 1
A 68-year-old male with heart failure (HFrEF) is started on
sacubitril/valsartan. Which lab value requires the most immediate action?
A. Serum creatinine 1.2 mg/dL
B. Serum potassium 5.8 mEq/L
C. BNP 250 pg/mL
D. Hemoglobin 11.5 g/dL
Answer: B. Serum potassium 5.8 mEq/L
Expert Explanation: Sacubitril/valsartan is an ARNI (angiotensin
receptor-neprilysin inhibitor). Neprilysin inhibition increases bradykinin,
natriuretic peptides, and also can reduce potassium excretion, especially
when combined with RAAS blockade. Hyperkalemia (K >5.5 mEq/L) is a
serious risk and can lead to life-threatening arrhythmias. Creatinine 1.2 is
acceptable; BNP expected to be elevated in HF; hemoglobin 11.5 is mild
anemia but not emergent.
,Question 2
A patient taking warfarin for atrial fibrillation has an INR of 4.5 without
bleeding. What is the most appropriate management?
A. Administer vitamin K 10 mg IV
B. Hold one dose and monitor INR
C. Give fresh frozen plasma immediately
D. Increase warfarin dose
Answer: B. Hold one dose and monitor INR
Expert Explanation: For INR 4.5–10 without bleeding, standard practice
is to hold warfarin (1–2 doses) and monitor INR. Vitamin K is reserved for
INR >10 or bleeding. FFP is for active serious bleeding. Increasing
warfarin would worsen elevation.
Question 3
Which medication is most appropriate for first-line treatment of
neuropathic pain in a diabetic patient with normal renal function?
A. Ibuprofen
B. Duloxetine
C. Oxycodone
D. Cyclobenzaprine
Answer: B. Duloxetine
,Expert Explanation: Duloxetine is an SNRI with FDA approval for
diabetic peripheral neuropathy. First-line guidelines include
gabapentinoids or SNRIs. NSAIDs (ibuprofen) are not effective for
neuropathic pain. Opioids are second/third line due to risk.
Cyclobenzaprine is for muscle spasm.
Question 4
A 72-year-old with osteoporosis is prescribed alendronate. What
instruction is most important?
A. Take with breakfast
B. Lie down for 30 minutes after taking
C. Take with a full glass of water and remain upright for 30 minutes
D. Crush the tablet for easier swallowing
Answer: C. Take with a full glass of water and remain upright for 30
minutes
Expert Explanation: Alendronate (bisphosphonate) can cause
esophageal irritation/ulceration. It must be taken on an empty stomach
with plain water (not juice/coffee), and patient must remain upright for
at least 30 minutes to prevent reflux and esophageal injury. Lying down
increases risk.
, Question 5
A patient on metformin for type 2 diabetes is scheduled for IV contrast
CT scan. What should be done?
A. Continue metformin as usual
B. Stop metformin 48 hours before contrast
C. Stop metformin at time of procedure and restart 48 hours after if renal
function normal
D. Double the metformin dose after procedure
Answer: C. Stop metformin at time of procedure and restart 48 hours
after if renal function normal
Expert Explanation: IV contrast can cause acute kidney injury.
Metformin is renally cleared; if kidney injury occurs, metformin
accumulation increases risk of lactic acidosis. Current guidelines: hold
metformin at time of or before procedure (no need 48h before), and
restart 48h post-procedure if serum creatinine stable/normal.
Question 6
Which drug is most likely to cause QT prolongation and torsades de
pointes?
A. Amoxicillin
B. Hydrochlorothiazide
