NURS 629 EXAM 2 QUESTIONS AND ANSWERS LATEST
2026/2027 | Maryville University | Combined Versions |
Graded A | Advanced Pharmacology Complete Solutions |
Pass Guaranteed
Domain 1: Cardiovascular Pharmacology & Dyslipidemia Management (15
Questions)
Q1
A 58-year-old male with type 2 diabetes, hypertension, and a 10-year ASCVD risk of 18%
presents for medication management. His current lipid panel shows: LDL-C 142 mg/dL,
HDL-C 38 mg/dL, TG 280 mg/dL, non-HDL-C 172 mg/dL. According to the 2018
AHA/ACC/Multi-Society Cholesterol Guidelines and ADA Standards of Care, which
pharmacotherapy regimen represents the most appropriate initial strategy?
A. Start atorvastatin 20 mg daily and fenofibrate 145 mg daily for combined
dyslipidemia
B. Initiate high-intensity atorvastatin 40-80 mg daily with consideration of ezetimibe if
LDL-C goal not achieved [CORRECT]
C. Begin rosuvastatin 5 mg daily with gemfibrozil 600 mg BID to address
hypertriglyceridemia
D. Prescribe omega-3 fatty acids 4 g daily as first-line therapy given elevated
triglycerides
Correct Answer: B
Rationale: This patient has diabetes (age 40-75) with multiple ASCVD risk factors,
placing him in the "very high risk" category per 2018 guidelines. The evidence-based
approach (Maryville NURS 629 Module 3: CV Pharmacology) requires: (1) High-intensity
,statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) to achieve ≥50% LDL-C
reduction; (2) Target LDL-C <70 mg/dL or ≥50% reduction if baseline <100 mg/dL; (3)
Add ezetimibe if not at goal on maximally tolerated statin. Option A incorrectly uses
moderate-intensity statin and prematurely adds fibrate. Option C uses low-intensity
rosuvastatin and gemfibrozil, which increases myopathy risk with statins. Option D is
incorrect because omega-3s are not first-line for ASCVD prevention despite elevated TG;
statin therapy takes priority.
Q2
A 67-year-old female with heart failure with reduced ejection fraction (HFrEF, LVEF 30%),
NYHA Class II-III symptoms, hypertension, and CKD Stage 3 (eGFR 45 mL/min/1.73m²)
is on lisinopril 20 mg daily, carvedilol 12.5 mg BID, and furosemide 40 mg daily. Her
potassium is 4.2 mEq/L and creatinine is stable. According to the 2022 AHA/ACC/HFSA
Heart Failure Guidelines, which medication should be added next to reduce mortality
and hospitalization?
A. Add digoxin 0.125 mg daily for symptom control and mortality benefit
B. Initiate dapagliflozin 10 mg daily regardless of diabetes status [CORRECT]
C. Start spironolactone 25 mg daily immediately without further monitoring
D. Add hydralazine-isosorbide dinitrate (BiDil) as fixed-dose combination
Correct Answer: B
Rationale: The 2022 guidelines (Maryville NURS 629 Module 3: HF Management)
establish the "Four Pillars" of HFrEF therapy: (1) ARNI/ACEI/ARB; (2) Evidence-based
beta-blocker; (3) MRA (mineralocorticoid receptor antagonist); (4) SGLT2 inhibitor.
Dapagliflozin or empagliflozin are now Class I recommendations for all HFrEF patients
regardless of diabetes, based on DAPA-HF and EMPEROR-Reduced trials showing
reduced CV death and hospitalization. Option A is incorrect because digoxin provides
,symptom benefit only, not mortality reduction. Option C is incorrect because while
spironolactone is indicated, potassium (4.2) and renal function must be monitored
closely before initiation in CKD. Option D is reserved for Black patients or those with
ACEI intolerance, not first-line add-on.
Q3
Select all that apply: Which of the following statements regarding statin-associated
muscle symptoms (SAMS) and management are correct?
A. Statin therapy should be discontinued immediately if CK rises above 3x ULN with
muscle symptoms
B. Vitamin D deficiency should be corrected as it may contribute to SAMS
C. Coenzyme Q10 supplementation has proven efficacy in preventing SAMS based on
randomized controlled trials
D. Switching to a hydrophilic statin (pravastatin, rosuvastatin) may reduce SAMS in
intolerant patients
E. Statin-associated autoimmune myopathy (anti-HMGCR antibodies) requires
permanent statin discontinuation and immunosuppressive therapy
F. Ezetimibe monotherapy is the preferred alternative when statins are completely
contraindicated
Correct Answer: A, B, D, E, F
Rationale: (Maryville NURS 629 Module 3: Dyslipidemia) A is correct per ACC/AHA/NLA
recommendations—discontinue if CK >3x ULN with symptoms. B is correct because
vitamin D deficiency is associated with myalgia and supplementation may help. C is
incorrect because CoQ10 evidence is mixed/negative in RCTs for SAMS prevention. D is
correct—hydrophilic statins (pravastatin, rosuvastatin) have less muscle penetration and
may be better tolerated. E is correct—anti-HMGCR myopathy is rare but serious,
requiring permanent discontinuation and immunosuppression. F is correct—ezetimibe is
, first-line non-statin therapy, though PCSK9 inhibitors are preferred for very high risk if
statin-intolerant.
Q4
A 72-year-old male with atrial fibrillation (CHADS₂-VASc score 4), hypertension, and prior
GI bleed (2 years ago) presents for anticoagulation selection. His renal function is
normal. He is concerned about bleeding risk. Which anticoagulation strategy is most
appropriate?
A. Start warfarin (INR target 2.0-3.0) with PPI prophylaxis given prior GI bleed
B. Initiate apixaban 5 mg BID with consideration of reduced dose (2.5 mg BID) if two of
three dose-reduction criteria are met [CORRECT]
C. Prescribe rivaroxaban 20 mg daily with aspirin 81 mg for added stroke protection
D. Use dabigatran 150 mg BID with PPI for GI protection
Correct Answer: B
Rationale: Apixaban is preferred in patients with prior GI bleed due to lower bleeding risk
compared to warfarin and other DOACs (ARISTOTLE trial). The standard dose is 5 mg
BID; reduce to 2.5 mg BID if TWO of THREE criteria met: age ≥80, weight ≤60 kg,
creatinine ≥1.5 mg/dL (Maryville NURS 629 Module 3: Anticoagulation). Option A is
inferior—warfarin has higher bleeding risk and requires monitoring. Option C is
dangerous—adding aspirin to DOAC increases bleeding without stroke benefit. Option D
is less preferred—dabigatran has higher GI bleed risk than apixaban.
Q5
Order the following steps for initiating sacubitril/valsartan (Entresto) in a patient
currently on lisinopril for HFrEF:
2026/2027 | Maryville University | Combined Versions |
Graded A | Advanced Pharmacology Complete Solutions |
Pass Guaranteed
Domain 1: Cardiovascular Pharmacology & Dyslipidemia Management (15
Questions)
Q1
A 58-year-old male with type 2 diabetes, hypertension, and a 10-year ASCVD risk of 18%
presents for medication management. His current lipid panel shows: LDL-C 142 mg/dL,
HDL-C 38 mg/dL, TG 280 mg/dL, non-HDL-C 172 mg/dL. According to the 2018
AHA/ACC/Multi-Society Cholesterol Guidelines and ADA Standards of Care, which
pharmacotherapy regimen represents the most appropriate initial strategy?
A. Start atorvastatin 20 mg daily and fenofibrate 145 mg daily for combined
dyslipidemia
B. Initiate high-intensity atorvastatin 40-80 mg daily with consideration of ezetimibe if
LDL-C goal not achieved [CORRECT]
C. Begin rosuvastatin 5 mg daily with gemfibrozil 600 mg BID to address
hypertriglyceridemia
D. Prescribe omega-3 fatty acids 4 g daily as first-line therapy given elevated
triglycerides
Correct Answer: B
Rationale: This patient has diabetes (age 40-75) with multiple ASCVD risk factors,
placing him in the "very high risk" category per 2018 guidelines. The evidence-based
approach (Maryville NURS 629 Module 3: CV Pharmacology) requires: (1) High-intensity
,statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) to achieve ≥50% LDL-C
reduction; (2) Target LDL-C <70 mg/dL or ≥50% reduction if baseline <100 mg/dL; (3)
Add ezetimibe if not at goal on maximally tolerated statin. Option A incorrectly uses
moderate-intensity statin and prematurely adds fibrate. Option C uses low-intensity
rosuvastatin and gemfibrozil, which increases myopathy risk with statins. Option D is
incorrect because omega-3s are not first-line for ASCVD prevention despite elevated TG;
statin therapy takes priority.
Q2
A 67-year-old female with heart failure with reduced ejection fraction (HFrEF, LVEF 30%),
NYHA Class II-III symptoms, hypertension, and CKD Stage 3 (eGFR 45 mL/min/1.73m²)
is on lisinopril 20 mg daily, carvedilol 12.5 mg BID, and furosemide 40 mg daily. Her
potassium is 4.2 mEq/L and creatinine is stable. According to the 2022 AHA/ACC/HFSA
Heart Failure Guidelines, which medication should be added next to reduce mortality
and hospitalization?
A. Add digoxin 0.125 mg daily for symptom control and mortality benefit
B. Initiate dapagliflozin 10 mg daily regardless of diabetes status [CORRECT]
C. Start spironolactone 25 mg daily immediately without further monitoring
D. Add hydralazine-isosorbide dinitrate (BiDil) as fixed-dose combination
Correct Answer: B
Rationale: The 2022 guidelines (Maryville NURS 629 Module 3: HF Management)
establish the "Four Pillars" of HFrEF therapy: (1) ARNI/ACEI/ARB; (2) Evidence-based
beta-blocker; (3) MRA (mineralocorticoid receptor antagonist); (4) SGLT2 inhibitor.
Dapagliflozin or empagliflozin are now Class I recommendations for all HFrEF patients
regardless of diabetes, based on DAPA-HF and EMPEROR-Reduced trials showing
reduced CV death and hospitalization. Option A is incorrect because digoxin provides
,symptom benefit only, not mortality reduction. Option C is incorrect because while
spironolactone is indicated, potassium (4.2) and renal function must be monitored
closely before initiation in CKD. Option D is reserved for Black patients or those with
ACEI intolerance, not first-line add-on.
Q3
Select all that apply: Which of the following statements regarding statin-associated
muscle symptoms (SAMS) and management are correct?
A. Statin therapy should be discontinued immediately if CK rises above 3x ULN with
muscle symptoms
B. Vitamin D deficiency should be corrected as it may contribute to SAMS
C. Coenzyme Q10 supplementation has proven efficacy in preventing SAMS based on
randomized controlled trials
D. Switching to a hydrophilic statin (pravastatin, rosuvastatin) may reduce SAMS in
intolerant patients
E. Statin-associated autoimmune myopathy (anti-HMGCR antibodies) requires
permanent statin discontinuation and immunosuppressive therapy
F. Ezetimibe monotherapy is the preferred alternative when statins are completely
contraindicated
Correct Answer: A, B, D, E, F
Rationale: (Maryville NURS 629 Module 3: Dyslipidemia) A is correct per ACC/AHA/NLA
recommendations—discontinue if CK >3x ULN with symptoms. B is correct because
vitamin D deficiency is associated with myalgia and supplementation may help. C is
incorrect because CoQ10 evidence is mixed/negative in RCTs for SAMS prevention. D is
correct—hydrophilic statins (pravastatin, rosuvastatin) have less muscle penetration and
may be better tolerated. E is correct—anti-HMGCR myopathy is rare but serious,
requiring permanent discontinuation and immunosuppression. F is correct—ezetimibe is
, first-line non-statin therapy, though PCSK9 inhibitors are preferred for very high risk if
statin-intolerant.
Q4
A 72-year-old male with atrial fibrillation (CHADS₂-VASc score 4), hypertension, and prior
GI bleed (2 years ago) presents for anticoagulation selection. His renal function is
normal. He is concerned about bleeding risk. Which anticoagulation strategy is most
appropriate?
A. Start warfarin (INR target 2.0-3.0) with PPI prophylaxis given prior GI bleed
B. Initiate apixaban 5 mg BID with consideration of reduced dose (2.5 mg BID) if two of
three dose-reduction criteria are met [CORRECT]
C. Prescribe rivaroxaban 20 mg daily with aspirin 81 mg for added stroke protection
D. Use dabigatran 150 mg BID with PPI for GI protection
Correct Answer: B
Rationale: Apixaban is preferred in patients with prior GI bleed due to lower bleeding risk
compared to warfarin and other DOACs (ARISTOTLE trial). The standard dose is 5 mg
BID; reduce to 2.5 mg BID if TWO of THREE criteria met: age ≥80, weight ≤60 kg,
creatinine ≥1.5 mg/dL (Maryville NURS 629 Module 3: Anticoagulation). Option A is
inferior—warfarin has higher bleeding risk and requires monitoring. Option C is
dangerous—adding aspirin to DOAC increases bleeding without stroke benefit. Option D
is less preferred—dabigatran has higher GI bleed risk than apixaban.
Q5
Order the following steps for initiating sacubitril/valsartan (Entresto) in a patient
currently on lisinopril for HFrEF:
