NURS 5334 Advanced Nursing Final
Comprehensive Exam 2026–2027 Exam
Preparation With Complete Questions
And Correct Answers With Rationales |
Already Graded A+||Brand New Version!!
1. A patient with heart failure (HFrEF) is prescribed
sacubitril/valsartan. What is the most critical lab value to
monitor before initiating therapy?
A. Serum potassium
B. Serum creatinine
C. BNP level
D. Serum sodium
Rationale: Sacubitril/valsartan can cause angioedema and
hyperkalemia, but the most critical pretreatment lab is serum
sodium (hypotension risk) and renal function. However, current
guidelines stress checking potassium and renal function prior to
initiation. (Correct answer per 2026 HF guidelines: Serum
potassium – but since A and B are both key, the most
critical is potassium because hyperkalemia is a contraindication if
>5.4 mEq/L.) Correction: Official answer is A. Serum potassium.
2. Which medication is first-line for neuropathic pain in older
adults (≥65 years) with minimal cardiac risk?
,A. Amitriptyline
B. Gabapentin
C. Duloxetine
D. Lidocaine patch 5%
Rationale: Gabapentin is preferred in older adults due to fewer
drug interactions and less anticholinergic burden than
amitriptyline. Duloxetine is effective but has more nausea and
drug interactions.
3. A patient on warfarin has an INR of 4.5 without bleeding.
What management is recommended per 2026 ACCP
guidelines?
A. Hold warfarin and give vitamin K 10 mg orally
B. Hold warfarin and give vitamin K 1–2.5 mg orally
C. Give fresh frozen plasma immediately
D. Reduce warfarin dose by 50%
Rationale: For INR 4.5–10 without bleeding, hold warfarin and
give low-dose oral vitamin K (1–2.5 mg). High-dose vitamin K can
cause resistance for days.
4. Which antidepressant carries the highest risk of serotonin
syndrome when combined with linezolid?
A. Bupropion
B. Mirtazapine
C. Sertraline
D. Trazodone
Rationale: Linezolid is a weak MAOI. SSRIs like sertraline pose a
high risk of serotonin syndrome. Avoid combining or monitor
closely.
,5. A patient with type 2 diabetes and CKD (eGFR 35 mL/min)
is on metformin 2000 mg/day. What action is needed?
A. Continue metformin as is
B. Reduce metformin to 1000 mg/day
C. Discontinue metformin immediately
D. Add pioglitazone
Rationale: FDA/KDIGO 2026: Metformin can be used down to
eGFR 30, but dose adjustment (max 1000 mg/day) for eGFR 30–
45. No need to stop until eGFR <30.
6. Which beta-blocker is most cardioprotective in heart failure
with reduced ejection fraction (HFrEF)?
A. Atenolol
B. Carvedilol
C. Nebivolol
D. Esmolol
Rationale: Carvedilol, bisoprolol, and metoprolol succinate are
evidence-based for HFrEF. Carvedilol has additional alpha-1
blockade and antioxidant effects.
7. A patient on atorvastatin 80 mg reports diffuse myalgia
and dark urine. CPK is 12,000 U/L. The next step is:
A. Add coenzyme Q10
B. Discontinue atorvastatin and check renal function
C. Switch to rosuvastatin 40 mg
D. Reduce dose to 40 mg
Rationale: CPK >10x normal with symptoms suggests
rhabdomyolysis. Immediate statin discontinuation and monitor for
acute kidney injury.
, 8. Which antibiotic is safe in pregnancy for a UTI?
A. Ciprofloxacin
B. Doxycycline
C. Nitrofurantoin
D. Trimethoprim-sulfamethoxazole
Rationale: Nitrofurantoin is pregnancy category B (now "not
associated with major malformations" in new FDA labeling) except
near term (risk of hemolytic anemia in neonate). Avoid TMP-SMX
in first trimester (folate antagonist) and near term.
9. A patient with cirrhosis (Child-Pugh B) requires pain
management. Which opioid is preferred?
A. Morphine
B. Hydromorphone
C. Meperidine
D. Codeine
Rationale: Hydromorphone and oxycodone are preferred in
moderate hepatic impairment because they have less active
metabolite accumulation. Morphine has active M6G accumulation.
10. What is the mechanism of action of empagliflozin?
A. GLP-1 receptor agonist
B. SGLT2 inhibitor
C. DPP-4 inhibitor
D. Thiazolidinedione
Rationale: Empagliflozin inhibits sodium-glucose cotransporter 2
in proximal tubule, causing glycosuria and reducing
preload/afterload (CV benefit).
11. A patient on lithium develops polyuria, nephrogenic
diabetes insipidus. The best management is:
Comprehensive Exam 2026–2027 Exam
Preparation With Complete Questions
And Correct Answers With Rationales |
Already Graded A+||Brand New Version!!
1. A patient with heart failure (HFrEF) is prescribed
sacubitril/valsartan. What is the most critical lab value to
monitor before initiating therapy?
A. Serum potassium
B. Serum creatinine
C. BNP level
D. Serum sodium
Rationale: Sacubitril/valsartan can cause angioedema and
hyperkalemia, but the most critical pretreatment lab is serum
sodium (hypotension risk) and renal function. However, current
guidelines stress checking potassium and renal function prior to
initiation. (Correct answer per 2026 HF guidelines: Serum
potassium – but since A and B are both key, the most
critical is potassium because hyperkalemia is a contraindication if
>5.4 mEq/L.) Correction: Official answer is A. Serum potassium.
2. Which medication is first-line for neuropathic pain in older
adults (≥65 years) with minimal cardiac risk?
,A. Amitriptyline
B. Gabapentin
C. Duloxetine
D. Lidocaine patch 5%
Rationale: Gabapentin is preferred in older adults due to fewer
drug interactions and less anticholinergic burden than
amitriptyline. Duloxetine is effective but has more nausea and
drug interactions.
3. A patient on warfarin has an INR of 4.5 without bleeding.
What management is recommended per 2026 ACCP
guidelines?
A. Hold warfarin and give vitamin K 10 mg orally
B. Hold warfarin and give vitamin K 1–2.5 mg orally
C. Give fresh frozen plasma immediately
D. Reduce warfarin dose by 50%
Rationale: For INR 4.5–10 without bleeding, hold warfarin and
give low-dose oral vitamin K (1–2.5 mg). High-dose vitamin K can
cause resistance for days.
4. Which antidepressant carries the highest risk of serotonin
syndrome when combined with linezolid?
A. Bupropion
B. Mirtazapine
C. Sertraline
D. Trazodone
Rationale: Linezolid is a weak MAOI. SSRIs like sertraline pose a
high risk of serotonin syndrome. Avoid combining or monitor
closely.
,5. A patient with type 2 diabetes and CKD (eGFR 35 mL/min)
is on metformin 2000 mg/day. What action is needed?
A. Continue metformin as is
B. Reduce metformin to 1000 mg/day
C. Discontinue metformin immediately
D. Add pioglitazone
Rationale: FDA/KDIGO 2026: Metformin can be used down to
eGFR 30, but dose adjustment (max 1000 mg/day) for eGFR 30–
45. No need to stop until eGFR <30.
6. Which beta-blocker is most cardioprotective in heart failure
with reduced ejection fraction (HFrEF)?
A. Atenolol
B. Carvedilol
C. Nebivolol
D. Esmolol
Rationale: Carvedilol, bisoprolol, and metoprolol succinate are
evidence-based for HFrEF. Carvedilol has additional alpha-1
blockade and antioxidant effects.
7. A patient on atorvastatin 80 mg reports diffuse myalgia
and dark urine. CPK is 12,000 U/L. The next step is:
A. Add coenzyme Q10
B. Discontinue atorvastatin and check renal function
C. Switch to rosuvastatin 40 mg
D. Reduce dose to 40 mg
Rationale: CPK >10x normal with symptoms suggests
rhabdomyolysis. Immediate statin discontinuation and monitor for
acute kidney injury.
, 8. Which antibiotic is safe in pregnancy for a UTI?
A. Ciprofloxacin
B. Doxycycline
C. Nitrofurantoin
D. Trimethoprim-sulfamethoxazole
Rationale: Nitrofurantoin is pregnancy category B (now "not
associated with major malformations" in new FDA labeling) except
near term (risk of hemolytic anemia in neonate). Avoid TMP-SMX
in first trimester (folate antagonist) and near term.
9. A patient with cirrhosis (Child-Pugh B) requires pain
management. Which opioid is preferred?
A. Morphine
B. Hydromorphone
C. Meperidine
D. Codeine
Rationale: Hydromorphone and oxycodone are preferred in
moderate hepatic impairment because they have less active
metabolite accumulation. Morphine has active M6G accumulation.
10. What is the mechanism of action of empagliflozin?
A. GLP-1 receptor agonist
B. SGLT2 inhibitor
C. DPP-4 inhibitor
D. Thiazolidinedione
Rationale: Empagliflozin inhibits sodium-glucose cotransporter 2
in proximal tubule, causing glycosuria and reducing
preload/afterload (CV benefit).
11. A patient on lithium develops polyuria, nephrogenic
diabetes insipidus. The best management is:
