NR 565 Final Exam 2026/2027 Advanced Pharmacology –
Complete Exam-Style Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
Time Allowed: 120 Minutes
Total Questions: 50 (40 Multiple-Choice, 10 Select All That Apply)
1. A 62-year-old male with hypertension and a history of gout presents with blood
pressure 152/94 mmHg and serum uric acid 9.2 mg/dL. Which antihypertensive agent
is preferred as initial therapy?
A. Chlorthalidone 25 mg daily
B. Lisinopril 10 mg daily
C. Amlodipine 5 mg daily
D. Losartan 50 mg daily
Correct Answer: D
Rationale: Losartan is an ARB with a unique uricosuric effect that lowers serum uric
acid. Thiazide diuretics (A) can precipitate or worsen gout. ACE inhibitors (B) and
amlodipine (C) do not offer this advantage.
2. A patient with HFrEF (EF 28%, NYHA class III) is receiving carvedilol 25 mg BID,
sacubitril/valsartan 97/103 mg BID, and furosemide 80 mg daily. The patient remains
dyspneic on exertion. eGFR is 55 mL/min and potassium is 4.2 mEq/L. Which
medication should be added next?
A. Dapagliflozin 10 mg daily
,B. Spironolactone 25 mg daily
C. Digoxin 0.125 mg daily
D. Hydralazine/isosorbide dinitrate
Correct Answer: B
Rationale: The four pillars of HFrEF therapy include an ARNI (or ACE/ARB),
evidence-based beta-blocker, MRA, and SGLT2 inhibitor. Since the patient is already on
an ARNI and beta-blocker with acceptable potassium and renal function, adding an MRA
(spironolactone or eplerenone) is the next evidence-based step per ACC/AHA
guidelines.
3. A patient with atrial fibrillation and moderate rheumatic mitral stenosis has a
CHA₂DS₂-VASc score of 5. Which anticoagulation strategy is indicated?
A. Apixaban 5 mg BID
B. Rivaroxaban 20 mg daily with food
C. Warfarin with a target INR of 2.0–3.0
D. Dabigatran 150 mg BID
Correct Answer: C
Rationale: Moderate-to-severe mitral stenosis is considered "valvular" atrial fibrillation.
DOACs are not recommended in this setting; warfarin is the anticoagulant of choice
with a target INR of 2.0–3.0.
,4. A patient with established ASCVD is taking atorvastatin 40 mg daily (maximum
tolerated). The fasting LDL is 168 mg/dL. Which agent should be added first to achieve
target reduction?
A. Ezetimibe 10 mg daily
B. Bempedoic acid 180 mg daily
C. Evolocumab 140 mg every 2 weeks
D. Switch to rosuvastatin 20 mg daily
Correct Answer: A
Rationale: Ezetimibe is the first-line add-on to maximally tolerated statin therapy for
patients with ASCVD who have not reached LDL goals. It provides an additional 15–20%
LDL reduction with excellent safety. PCSK9 inhibitors (C) and bempedoic acid (B) are
reserved for patients who remain above goal after statin + ezetimibe.
5. A patient on warfarin for a bioprosthetic mitral valve has had an INR of 1.1 for two
consecutive weeks despite reported adherence. The patient reports eating large
amounts of spinach, kale, and broccoli. Which action is most appropriate?
A. Increase the warfarin dose by 15%
B. Counsel the patient on maintaining consistent vitamin K intake and recheck INR
C. Switch to apixaban 5 mg BID
D. Administer vitamin K 5 mg orally to boost the INR
Correct Answer: B
, Rationale: Wide fluctuations in dietary vitamin K intake are a common cause of INR
variability. The patient should be counseled to maintain a consistent intake of vitamin
K-containing foods rather than eliminating them. Increasing warfarin (A) without
addressing diet is shortsighted. Vitamin K (D) would lower the INR further.
6. A patient with active cancer (lung adenocarcinoma) and no GI/GU bleeding history is
diagnosed with a proximal DVT. Creatinine clearance is 85 mL/min. Which anticoagulant
is preferred?
A. Warfarin with LMWH bridge
B. Enoxaparin 1 mg/kg q12h
C. Apixaban 10 mg BID for 7 days, then 5 mg BID
D. Unfractionated heparin IV
Correct Answer: C
Rationale: For cancer-associated thrombosis in patients without GI/GU malignancies,
DOACs (apixaban, edoxaban, rivaroxaban) are now preferred over LMWH due to
comparable efficacy and better quality of life. LMWH (B) is preferred for GI/GU cancers.
Warfarin (A) is no longer first-line in active cancer.
7. A patient with heart failure and atrial fibrillation is taking digoxin 0.125 mg daily.
Amiodarone is initiated for rhythm control. Why is a digoxin dose reduction necessary?
A. Amiodarone increases digoxin renal clearance
B. Amiodarone displaces digoxin from tissue binding sites
C. Amiodarone inhibits P-glycoprotein and reduces digoxin clearance
Complete Exam-Style Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
Time Allowed: 120 Minutes
Total Questions: 50 (40 Multiple-Choice, 10 Select All That Apply)
1. A 62-year-old male with hypertension and a history of gout presents with blood
pressure 152/94 mmHg and serum uric acid 9.2 mg/dL. Which antihypertensive agent
is preferred as initial therapy?
A. Chlorthalidone 25 mg daily
B. Lisinopril 10 mg daily
C. Amlodipine 5 mg daily
D. Losartan 50 mg daily
Correct Answer: D
Rationale: Losartan is an ARB with a unique uricosuric effect that lowers serum uric
acid. Thiazide diuretics (A) can precipitate or worsen gout. ACE inhibitors (B) and
amlodipine (C) do not offer this advantage.
2. A patient with HFrEF (EF 28%, NYHA class III) is receiving carvedilol 25 mg BID,
sacubitril/valsartan 97/103 mg BID, and furosemide 80 mg daily. The patient remains
dyspneic on exertion. eGFR is 55 mL/min and potassium is 4.2 mEq/L. Which
medication should be added next?
A. Dapagliflozin 10 mg daily
,B. Spironolactone 25 mg daily
C. Digoxin 0.125 mg daily
D. Hydralazine/isosorbide dinitrate
Correct Answer: B
Rationale: The four pillars of HFrEF therapy include an ARNI (or ACE/ARB),
evidence-based beta-blocker, MRA, and SGLT2 inhibitor. Since the patient is already on
an ARNI and beta-blocker with acceptable potassium and renal function, adding an MRA
(spironolactone or eplerenone) is the next evidence-based step per ACC/AHA
guidelines.
3. A patient with atrial fibrillation and moderate rheumatic mitral stenosis has a
CHA₂DS₂-VASc score of 5. Which anticoagulation strategy is indicated?
A. Apixaban 5 mg BID
B. Rivaroxaban 20 mg daily with food
C. Warfarin with a target INR of 2.0–3.0
D. Dabigatran 150 mg BID
Correct Answer: C
Rationale: Moderate-to-severe mitral stenosis is considered "valvular" atrial fibrillation.
DOACs are not recommended in this setting; warfarin is the anticoagulant of choice
with a target INR of 2.0–3.0.
,4. A patient with established ASCVD is taking atorvastatin 40 mg daily (maximum
tolerated). The fasting LDL is 168 mg/dL. Which agent should be added first to achieve
target reduction?
A. Ezetimibe 10 mg daily
B. Bempedoic acid 180 mg daily
C. Evolocumab 140 mg every 2 weeks
D. Switch to rosuvastatin 20 mg daily
Correct Answer: A
Rationale: Ezetimibe is the first-line add-on to maximally tolerated statin therapy for
patients with ASCVD who have not reached LDL goals. It provides an additional 15–20%
LDL reduction with excellent safety. PCSK9 inhibitors (C) and bempedoic acid (B) are
reserved for patients who remain above goal after statin + ezetimibe.
5. A patient on warfarin for a bioprosthetic mitral valve has had an INR of 1.1 for two
consecutive weeks despite reported adherence. The patient reports eating large
amounts of spinach, kale, and broccoli. Which action is most appropriate?
A. Increase the warfarin dose by 15%
B. Counsel the patient on maintaining consistent vitamin K intake and recheck INR
C. Switch to apixaban 5 mg BID
D. Administer vitamin K 5 mg orally to boost the INR
Correct Answer: B
, Rationale: Wide fluctuations in dietary vitamin K intake are a common cause of INR
variability. The patient should be counseled to maintain a consistent intake of vitamin
K-containing foods rather than eliminating them. Increasing warfarin (A) without
addressing diet is shortsighted. Vitamin K (D) would lower the INR further.
6. A patient with active cancer (lung adenocarcinoma) and no GI/GU bleeding history is
diagnosed with a proximal DVT. Creatinine clearance is 85 mL/min. Which anticoagulant
is preferred?
A. Warfarin with LMWH bridge
B. Enoxaparin 1 mg/kg q12h
C. Apixaban 10 mg BID for 7 days, then 5 mg BID
D. Unfractionated heparin IV
Correct Answer: C
Rationale: For cancer-associated thrombosis in patients without GI/GU malignancies,
DOACs (apixaban, edoxaban, rivaroxaban) are now preferred over LMWH due to
comparable efficacy and better quality of life. LMWH (B) is preferred for GI/GU cancers.
Warfarin (A) is no longer first-line in active cancer.
7. A patient with heart failure and atrial fibrillation is taking digoxin 0.125 mg daily.
Amiodarone is initiated for rhythm control. Why is a digoxin dose reduction necessary?
A. Amiodarone increases digoxin renal clearance
B. Amiodarone displaces digoxin from tissue binding sites
C. Amiodarone inhibits P-glycoprotein and reduces digoxin clearance
