NR566/ NR566 ADVANCED PHARMACOLOGY 2026
ACTUAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS (100% VERIFIED) PLUS
RATIONALES |ALREADY GRADED A+
(CHAMBERLAIN COLLEGE)
MULTIPLE CHOICES:
Question 1
A 68-year-old female with heart failure with reduced ejection fraction (HFrEF, EF 35%) is on
carvedilol 25 mg twice daily, lisinopril 20 mg daily, and furosemide 40 mg daily. She develops
new-onset atrial fibrillation with a ventricular rate of 140 bpm. Which medication should be
added for rate control?
A) Digoxin 0.125 mg daily
B) Metoprolol 25 mg twice daily (adding another beta-blocker not indicated)
C) Diltiazem 30 mg four times daily (CCB contraindicated in HFrEF)
D) Amiodarone 200 mg daily
Answer: A
Digoxin is indicated for atrial fibrillation with rapid ventricular response in patients with heart
failure. It should be added to the beta-blocker (carvedilol). Non-dihydropyridine CCBs
(diltiazem, verapamil) are contraindicated in HFrEF because they worsen heart failure (negative
inotropic effect). Amiodarone can be used for rhythm control but has significant toxicity
(pulmonary, thyroid, liver, corneal deposits, photosensitivity). Adding another beta-blocker is
not appropriate. Digoxin has a narrow therapeutic index (0.5-0.9 ng/mL); hypokalemia increases
toxicity risk.
SUCCESS!!!
1
,Question 2
A 55-year-old male with type 2 diabetes and hypertension is on metformin 1000 mg twice daily,
lisinopril 20 mg daily, and amlodipine 5 mg daily. His A1C is 8.2%, BP 132/84 mm Hg. He has
a history of heart failure with reduced ejection fraction (HFrEF, EF 40%). Which medication
should the nurse practitioner add for glycemic control and cardiovascular benefit?
A) Glipizide 5 mg daily (sulfonylurea – no CV benefit, hypoglycemia risk)
B) Empagliflozin 10 mg daily (SGLT2 inhibitor – reduces CV death and HF hospitalizations)
C) Sitagliptin 100 mg daily (DPP-4 inhibitor – neutral CV effect)
D) Pioglitazone 30 mg daily (TZD – fluid retention, contraindicated in HF)
Answer: B
Empagliflozin (and other SGLT2 inhibitors) reduce major adverse cardiovascular events
(MACE) and heart failure hospitalizations in patients with type 2 diabetes and established CVD
or HF (EMPA-REG OUTCOME trial). They also slow progression of CKD. Glipizide increases
hypoglycemia risk and weight gain. Sitagliptin is weight neutral with neutral CV effects.
Pioglitazone causes fluid retention and is contraindicated in NYHA class III-IV HF. SGLT2
inhibitors also promote weight loss (2-3 kg) and lower blood pressure (4-6 mm Hg).
Question 3
A 62-year-old female with osteoporosis has a T-score of -3.0 at the femoral neck. She has a
history of GERD and esophageal stricture. Which osteoporosis medication should the nurse
practitioner prescribe?
A) Alendronate 70 mg weekly (bisphosphonate – contraindicated in esophageal stricture)
B) Risedronate 35 mg weekly (also contraindicated in esophageal disorders)
C) Denosumab (Prolia) 60 mg subcutaneously every 6 months (no esophageal issues, no renal
dose adjustment)
D) Raloxifene 60 mg daily (less effective for hip fractures, increased VTE risk)
Answer: C
SUCCESS!!!
2
,Denosumab is a monoclonal antibody that inhibits RANKL, reducing bone resorption. It is
administered subcutaneously every 6 months and does not require dose adjustment for renal
impairment or esophageal dysfunction. Oral bisphosphonates (alendronate, risedronate) are
contraindicated in patients with esophageal stricture, achalasia, or inability to remain upright for
30 minutes (black box warning for esophagitis, esophageal ulcers). Raloxifene (SERM) reduces
vertebral but not hip fractures and increases DVT/PE risk. Denosumab does not require a drug
holiday (unlike bisphosphonates, which are associated with atypical femur fractures and
osteonecrosis of the jaw after long-term use).
Question 4
A 45-year-old male with newly diagnosed hypertension has a blood pressure of 152/96 mm Hg.
Labs: potassium 4.2 mEq/L, creatinine 0.9 mg/dL. He has no other comorbidities. Which
antihypertensive is recommended as first-line therapy?
A) Hydrochlorothiazide 25 mg daily
B) Lisinopril 10 mg daily
C) Amlodipine 5 mg daily
D) Any of the above (thiazide, ACE inhibitor, ARB, or CCB are first-line per guidelines)
Answer: D
Current hypertension guidelines (ACC/AHA 2017, JNC 8) recommend first-line therapy with a
thiazide diuretic, ACE inhibitor, ARB, or dihydropyridine CCB (amlodipine) for most patients
without compelling indications. The choice depends on patient factors (age, race, cost, side effect
profiles, comorbidities). In this patient without comorbidities (no diabetes, CKD, HF, post-MI),
any of these is appropriate. Black patients without CKD respond better to thiazides or CCBs than
ACE inhibitors/ARBs. ACE inhibitors and ARBs are preferred in patients with diabetes, CKD,
or proteinuria. Beta-blockers are not first-line for hypertension unless there is a compelling
indication (heart failure, post-MI, angina).
Question 5
A 35-year-old female with bipolar I disorder (acute mania) is hospitalized. She is agitated, has
pressured speech, and is not sleeping. She has a history of rash with lamotrigine. Which
medication should the nurse practitioner prescribe for acute mania?
SUCCESS!!!
3
, A) Lithium 600 mg twice daily (requires monitoring, slower onset)
B) Valproate 500 mg twice daily (rapid onset, effective for acute mania, teratogenic)
C) Risperidone 2 mg twice daily (atypical antipsychotic, rapid onset, no rash cross-reactivity)
D) Carbamazepine 200 mg twice daily (second-line, drug interactions)
Answer: C
Atypical antipsychotics (risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone,
asenapine, paliperidone) are first-line for acute mania with rapid onset (days). They are often
used as monotherapy or in combination with lithium or valproate. Risperidone is effective at
doses 2-6 mg daily. It has fewer metabolic side effects than olanzapine but more extrapyramidal
symptoms (EPS). Lithium and valproate are also first-line but have slower onset (7-14 days). The
patient has a history of rash with lamotrigine (which is not used for acute mania; it is for
maintenance). Lamotrigine rash can be benign (10%) or serious Stevens-Johnson syndrome (0.1-
0.3%). Carbamazepine is second-line due to drug interactions (CYP3A4 inducer) and
hematologic toxicity (aplastic anemia, agranulocytosis – black box warning).
Question 6
A 28-year-old female with generalized anxiety disorder (GAD) is requesting a medication that
does not cause weight gain or sexual dysfunction. She has no contraindications. Which
medication should the nurse practitioner prescribe?
A) Sertraline 50 mg daily (SSRI – causes weight gain and sexual dysfunction)
B) Buspirone 15 mg twice daily (azapirone – no weight gain, no sexual dysfunction, no sedation,
no dependence)
C) Venlafaxine 75 mg daily (SNRI – causes weight gain and sexual dysfunction)
D) Duloxetine 30 mg daily (SNRI – similar side effects)
Answer: B
Buspirone (BuSpar) is a 5-HT1A partial agonist that is effective for generalized anxiety disorder.
It does NOT cause weight gain, sexual dysfunction, or significant sedation. It has no abuse
potential, no withdrawal, and does not interact with alcohol. It is often used as first-line or
second-line for GAD, especially in patients who cannot tolerate SSRIs/SNRIs. However,
buspirone is less effective for panic disorder and does not have antidepressant effects. It must be
taken 2-3 times daily (a disadvantage). Onset of action is 2-4 weeks (not immediate). It does not
SUCCESS!!!
4
ACTUAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS (100% VERIFIED) PLUS
RATIONALES |ALREADY GRADED A+
(CHAMBERLAIN COLLEGE)
MULTIPLE CHOICES:
Question 1
A 68-year-old female with heart failure with reduced ejection fraction (HFrEF, EF 35%) is on
carvedilol 25 mg twice daily, lisinopril 20 mg daily, and furosemide 40 mg daily. She develops
new-onset atrial fibrillation with a ventricular rate of 140 bpm. Which medication should be
added for rate control?
A) Digoxin 0.125 mg daily
B) Metoprolol 25 mg twice daily (adding another beta-blocker not indicated)
C) Diltiazem 30 mg four times daily (CCB contraindicated in HFrEF)
D) Amiodarone 200 mg daily
Answer: A
Digoxin is indicated for atrial fibrillation with rapid ventricular response in patients with heart
failure. It should be added to the beta-blocker (carvedilol). Non-dihydropyridine CCBs
(diltiazem, verapamil) are contraindicated in HFrEF because they worsen heart failure (negative
inotropic effect). Amiodarone can be used for rhythm control but has significant toxicity
(pulmonary, thyroid, liver, corneal deposits, photosensitivity). Adding another beta-blocker is
not appropriate. Digoxin has a narrow therapeutic index (0.5-0.9 ng/mL); hypokalemia increases
toxicity risk.
SUCCESS!!!
1
,Question 2
A 55-year-old male with type 2 diabetes and hypertension is on metformin 1000 mg twice daily,
lisinopril 20 mg daily, and amlodipine 5 mg daily. His A1C is 8.2%, BP 132/84 mm Hg. He has
a history of heart failure with reduced ejection fraction (HFrEF, EF 40%). Which medication
should the nurse practitioner add for glycemic control and cardiovascular benefit?
A) Glipizide 5 mg daily (sulfonylurea – no CV benefit, hypoglycemia risk)
B) Empagliflozin 10 mg daily (SGLT2 inhibitor – reduces CV death and HF hospitalizations)
C) Sitagliptin 100 mg daily (DPP-4 inhibitor – neutral CV effect)
D) Pioglitazone 30 mg daily (TZD – fluid retention, contraindicated in HF)
Answer: B
Empagliflozin (and other SGLT2 inhibitors) reduce major adverse cardiovascular events
(MACE) and heart failure hospitalizations in patients with type 2 diabetes and established CVD
or HF (EMPA-REG OUTCOME trial). They also slow progression of CKD. Glipizide increases
hypoglycemia risk and weight gain. Sitagliptin is weight neutral with neutral CV effects.
Pioglitazone causes fluid retention and is contraindicated in NYHA class III-IV HF. SGLT2
inhibitors also promote weight loss (2-3 kg) and lower blood pressure (4-6 mm Hg).
Question 3
A 62-year-old female with osteoporosis has a T-score of -3.0 at the femoral neck. She has a
history of GERD and esophageal stricture. Which osteoporosis medication should the nurse
practitioner prescribe?
A) Alendronate 70 mg weekly (bisphosphonate – contraindicated in esophageal stricture)
B) Risedronate 35 mg weekly (also contraindicated in esophageal disorders)
C) Denosumab (Prolia) 60 mg subcutaneously every 6 months (no esophageal issues, no renal
dose adjustment)
D) Raloxifene 60 mg daily (less effective for hip fractures, increased VTE risk)
Answer: C
SUCCESS!!!
2
,Denosumab is a monoclonal antibody that inhibits RANKL, reducing bone resorption. It is
administered subcutaneously every 6 months and does not require dose adjustment for renal
impairment or esophageal dysfunction. Oral bisphosphonates (alendronate, risedronate) are
contraindicated in patients with esophageal stricture, achalasia, or inability to remain upright for
30 minutes (black box warning for esophagitis, esophageal ulcers). Raloxifene (SERM) reduces
vertebral but not hip fractures and increases DVT/PE risk. Denosumab does not require a drug
holiday (unlike bisphosphonates, which are associated with atypical femur fractures and
osteonecrosis of the jaw after long-term use).
Question 4
A 45-year-old male with newly diagnosed hypertension has a blood pressure of 152/96 mm Hg.
Labs: potassium 4.2 mEq/L, creatinine 0.9 mg/dL. He has no other comorbidities. Which
antihypertensive is recommended as first-line therapy?
A) Hydrochlorothiazide 25 mg daily
B) Lisinopril 10 mg daily
C) Amlodipine 5 mg daily
D) Any of the above (thiazide, ACE inhibitor, ARB, or CCB are first-line per guidelines)
Answer: D
Current hypertension guidelines (ACC/AHA 2017, JNC 8) recommend first-line therapy with a
thiazide diuretic, ACE inhibitor, ARB, or dihydropyridine CCB (amlodipine) for most patients
without compelling indications. The choice depends on patient factors (age, race, cost, side effect
profiles, comorbidities). In this patient without comorbidities (no diabetes, CKD, HF, post-MI),
any of these is appropriate. Black patients without CKD respond better to thiazides or CCBs than
ACE inhibitors/ARBs. ACE inhibitors and ARBs are preferred in patients with diabetes, CKD,
or proteinuria. Beta-blockers are not first-line for hypertension unless there is a compelling
indication (heart failure, post-MI, angina).
Question 5
A 35-year-old female with bipolar I disorder (acute mania) is hospitalized. She is agitated, has
pressured speech, and is not sleeping. She has a history of rash with lamotrigine. Which
medication should the nurse practitioner prescribe for acute mania?
SUCCESS!!!
3
, A) Lithium 600 mg twice daily (requires monitoring, slower onset)
B) Valproate 500 mg twice daily (rapid onset, effective for acute mania, teratogenic)
C) Risperidone 2 mg twice daily (atypical antipsychotic, rapid onset, no rash cross-reactivity)
D) Carbamazepine 200 mg twice daily (second-line, drug interactions)
Answer: C
Atypical antipsychotics (risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone,
asenapine, paliperidone) are first-line for acute mania with rapid onset (days). They are often
used as monotherapy or in combination with lithium or valproate. Risperidone is effective at
doses 2-6 mg daily. It has fewer metabolic side effects than olanzapine but more extrapyramidal
symptoms (EPS). Lithium and valproate are also first-line but have slower onset (7-14 days). The
patient has a history of rash with lamotrigine (which is not used for acute mania; it is for
maintenance). Lamotrigine rash can be benign (10%) or serious Stevens-Johnson syndrome (0.1-
0.3%). Carbamazepine is second-line due to drug interactions (CYP3A4 inducer) and
hematologic toxicity (aplastic anemia, agranulocytosis – black box warning).
Question 6
A 28-year-old female with generalized anxiety disorder (GAD) is requesting a medication that
does not cause weight gain or sexual dysfunction. She has no contraindications. Which
medication should the nurse practitioner prescribe?
A) Sertraline 50 mg daily (SSRI – causes weight gain and sexual dysfunction)
B) Buspirone 15 mg twice daily (azapirone – no weight gain, no sexual dysfunction, no sedation,
no dependence)
C) Venlafaxine 75 mg daily (SNRI – causes weight gain and sexual dysfunction)
D) Duloxetine 30 mg daily (SNRI – similar side effects)
Answer: B
Buspirone (BuSpar) is a 5-HT1A partial agonist that is effective for generalized anxiety disorder.
It does NOT cause weight gain, sexual dysfunction, or significant sedation. It has no abuse
potential, no withdrawal, and does not interact with alcohol. It is often used as first-line or
second-line for GAD, especially in patients who cannot tolerate SSRIs/SNRIs. However,
buspirone is less effective for panic disorder and does not have antidepressant effects. It must be
taken 2-3 times daily (a disadvantage). Onset of action is 2-4 weeks (not immediate). It does not
SUCCESS!!!
4
