NR 565 Week 2 Quiz Questions And Answers
Latest Update 2026
,NR565 Week 8 Final Exam - Simulation (Questions 1-40)
1. A 65-year-old male with a history of hypertension and osteoarthritis is started
on celecoxib (Celebrex) for pain. The NP understands that this medication's
cardiovascular risk profile, compared to non-selective NSAIDs like ibuprofen, is
best described as:
A. Having no cardiovascular risk.
B. Having a lower gastrointestinal risk but a similar potential for increasing major
adverse cardiac events (MACE).
C. Having a higher cardiovascular risk due to COX-2 selectivity.
D. Having both lower GI and lower cardiovascular risk.
*Rationale: Celecoxib is a selective COX-2 inhibitor. It offers a lower risk of GI
bleeding compared to non-selective NSAIDs, but does not eliminate the
cardiovascular risk. The PRECISION trial showed it was non-inferior to
ibuprofen/naproxen for cardiovascular safety, meaning the risk is similar, not
higher. COX-2 selectivity does not confer cardioprotection.*
2. A patient with chronic plaque psoriasis and no other comorbidities is
prescribed ixekizumab (Taltz). The NP knows this biologic agent works by:
A. Inhibiting tumor necrosis factor-alpha (TNF-α).
B. Selectively binding to the interleukin-17A (IL-17A) cytokine.
C. Inhibiting the p40 subunit of IL-12 and IL-23.
D. Inhibiting the p19 subunit of IL-23.
*Rationale: Ixekizumab and secukinumab (Cosentyx) are IL-17A inhibitors. They
are highly effective for plaque psoriasis and psoriatic arthritis. TNF inhibitors
include adalimumab; the p40 inhibitor is ustekinumab; p19 inhibitors are
guselkumab, risankizumab.*
3. According to the CHEST guidelines (2021), what is the recommended duration
of therapeutic anticoagulation for a patient with a provoked proximal deep vein
thrombosis (DVT)?
A. 3 months
B. 6 months
C. 1 year
D. Indefinite
, *Rationale: For a first provoked VTE (e.g., due to surgery, trauma, estrogen), the
standard is 3 months of anticoagulation. For an unprovoked proximal DVT/PE,
indefinite therapy is considered if bleeding risk is low. This is a fundamental
management principle.*
4. A patient with mantle cell lymphoma is started on ibrutinib (Imbruvica). The
NP must counsel the patient to report which of the following immediately, as it
could indicate a life-threatening arrhythmia?
A. Headache
B. Joint pain
C. Palpitations, dizziness, or syncope (signs of atrial fibrillation)
D. Rash
Rationale: Ibrutinib, a Bruton's tyrosine kinase (BTK) inhibitor, carries a significant
risk of new-onset or worsening atrial fibrillation (AFib) and ventricular
arrhythmias. Patients must be monitored for symptoms of AFib, such as
palpitations, and may require anticoagulation. This is a major boxed warning.
5. An NP is treating a patient for acute bacterial sinusitis in an outpatient with
no recent antibiotic use. According to current IDSA guidelines, what is the first-
line antibiotic of choice?
A. Amoxicillin-clavulanate (Augmentin)
B. Amoxicillin (high-dose) or Augmentin
C. Azithromycin (Z-Pak)
D. Levofloxacin (Levaquin)
*Rationale: IDSA guidelines recommend amoxicillin-clavulanate as first-line due
to increasing resistance of S. pneumoniae to penicillin. High-dose amoxicillin (90
mg/kg/day divided BID) may be used in lower-risk areas. Macrolides
(azithromycin) are not recommended due to high resistance. Fluoroquinolones
(levofloxacin) are reserved for severe allergy or treatment failure.*
6. A patient with heart failure (NYHA Class II-III) and an ejection fraction of 40%
is started on sacubitril/valsartan (Entresto). The NP must ensure which
medication is discontinued at least 36 hours prior to initiation?
A. Metoprolol succinate
B. Spironolactone
C. Lisinopril or any other ACE inhibitor
Latest Update 2026
,NR565 Week 8 Final Exam - Simulation (Questions 1-40)
1. A 65-year-old male with a history of hypertension and osteoarthritis is started
on celecoxib (Celebrex) for pain. The NP understands that this medication's
cardiovascular risk profile, compared to non-selective NSAIDs like ibuprofen, is
best described as:
A. Having no cardiovascular risk.
B. Having a lower gastrointestinal risk but a similar potential for increasing major
adverse cardiac events (MACE).
C. Having a higher cardiovascular risk due to COX-2 selectivity.
D. Having both lower GI and lower cardiovascular risk.
*Rationale: Celecoxib is a selective COX-2 inhibitor. It offers a lower risk of GI
bleeding compared to non-selective NSAIDs, but does not eliminate the
cardiovascular risk. The PRECISION trial showed it was non-inferior to
ibuprofen/naproxen for cardiovascular safety, meaning the risk is similar, not
higher. COX-2 selectivity does not confer cardioprotection.*
2. A patient with chronic plaque psoriasis and no other comorbidities is
prescribed ixekizumab (Taltz). The NP knows this biologic agent works by:
A. Inhibiting tumor necrosis factor-alpha (TNF-α).
B. Selectively binding to the interleukin-17A (IL-17A) cytokine.
C. Inhibiting the p40 subunit of IL-12 and IL-23.
D. Inhibiting the p19 subunit of IL-23.
*Rationale: Ixekizumab and secukinumab (Cosentyx) are IL-17A inhibitors. They
are highly effective for plaque psoriasis and psoriatic arthritis. TNF inhibitors
include adalimumab; the p40 inhibitor is ustekinumab; p19 inhibitors are
guselkumab, risankizumab.*
3. According to the CHEST guidelines (2021), what is the recommended duration
of therapeutic anticoagulation for a patient with a provoked proximal deep vein
thrombosis (DVT)?
A. 3 months
B. 6 months
C. 1 year
D. Indefinite
, *Rationale: For a first provoked VTE (e.g., due to surgery, trauma, estrogen), the
standard is 3 months of anticoagulation. For an unprovoked proximal DVT/PE,
indefinite therapy is considered if bleeding risk is low. This is a fundamental
management principle.*
4. A patient with mantle cell lymphoma is started on ibrutinib (Imbruvica). The
NP must counsel the patient to report which of the following immediately, as it
could indicate a life-threatening arrhythmia?
A. Headache
B. Joint pain
C. Palpitations, dizziness, or syncope (signs of atrial fibrillation)
D. Rash
Rationale: Ibrutinib, a Bruton's tyrosine kinase (BTK) inhibitor, carries a significant
risk of new-onset or worsening atrial fibrillation (AFib) and ventricular
arrhythmias. Patients must be monitored for symptoms of AFib, such as
palpitations, and may require anticoagulation. This is a major boxed warning.
5. An NP is treating a patient for acute bacterial sinusitis in an outpatient with
no recent antibiotic use. According to current IDSA guidelines, what is the first-
line antibiotic of choice?
A. Amoxicillin-clavulanate (Augmentin)
B. Amoxicillin (high-dose) or Augmentin
C. Azithromycin (Z-Pak)
D. Levofloxacin (Levaquin)
*Rationale: IDSA guidelines recommend amoxicillin-clavulanate as first-line due
to increasing resistance of S. pneumoniae to penicillin. High-dose amoxicillin (90
mg/kg/day divided BID) may be used in lower-risk areas. Macrolides
(azithromycin) are not recommended due to high resistance. Fluoroquinolones
(levofloxacin) are reserved for severe allergy or treatment failure.*
6. A patient with heart failure (NYHA Class II-III) and an ejection fraction of 40%
is started on sacubitril/valsartan (Entresto). The NP must ensure which
medication is discontinued at least 36 hours prior to initiation?
A. Metoprolol succinate
B. Spironolactone
C. Lisinopril or any other ACE inhibitor
