MARYVILLE NURS 615 PHARM 3 EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027
Section One: Questions 1–100
Question 1
A 64-year-old male with chronic heart failure and atrial fibrillation is taking digoxin. He reports nausea,
vomiting, and seeing yellow-green halos around lights. Which laboratory finding most critically increases
the risk for this presentation?
A. Hypernatremia
B. Hypokalemia
C. Hypocalcemia
D. Hypermagnesemia
🟢 B. Hypokalemia
🔴 RATIONALE: Hypokalemia increases the risk of digoxin toxicity because low extracellular potassium
levels increase digoxin binding to the Na+/K+-ATPase pump, intensifying its therapeutic and toxic effects.
Question 2
The advanced practice registered nurse (APRN) is managing a patient on lithium therapy for bipolar
disorder. The patient has been diagnosed with hypertension and requires a diuretic. Which diuretic class
should the APRN completely avoid?
A. Loop diuretics
B. Thiazide diuretics
C. Potassium-sparing diuretics
D. Osmotic diuretics
🟢 B. Thiazide diuretics
🔴 RATIONALE: Thiazide diuretics promote sodium excretion in the distal convoluted tubule, which
leads to compensatory renal reabsorption of both sodium and lithium, rapidly increasing lithium serum
levels and risk of toxicity.
,Question 3
A patient is prescribed warfarin for mechanical heart valve prophylaxis. The patient requires short-term
antibiotic therapy with sulfamethoxazole/trimethoprim for a urinary tract infection. What adjustment or
monitoring plan must the APRN implement?
A. Increase the warfarin dose and check the INR in 2 weeks
B. Decrease the warfarin dose and check the INR in 3 to 5 days
C. Discontinue warfarin entirely during the antibiotic course
D. Maintain the current warfarin dose and check the INR in 1 month
🟢 B. Decrease the warfarin dose and check the INR in 3 to 5 days
🔴 RATIONALE: Sulfamethoxazole/trimethoprim displaces warfarin from plasma proteins and inhibits its
metabolism via CYP2C9, significantly increasing the INR and bleeding risk, necessitating a preemptive
dose reduction and early monitoring.
Question 4
A 45-year-old female presents with a deep vein thrombosis and is started on enoxaparin. Which
laboratory parameter must be closely monitored if the patient has a history of stage 4 chronic kidney
disease?
A. Activated partial thromboplastin time (aPTT)
B. International Normalized Ratio (INR)
C. Anti-factor Xa levels
D. Prothrombin time (PT)
🟢 C. Anti-factor Xa levels
🔴 RATIONALE: Enoxaparin is a low-molecular-weight heparin excreted primarily by the kidneys. In
severe renal impairment, it accumulates, and anti-factor Xa levels provide the most accurate assessment
of therapeutic anticoagulation and safety.
Question 5
An APRN is reviewing the mechanism of action of class IC antiarrhythmic agents like flecainide. Which
statement accurately describes their primary cellular effect?
,A. Blockade of beta-1 adrenergic receptors
B. Prolongation of the action potential duration via potassium channel blockade
C. Potent blockade of fast sodium channels with slow dissociation kinetics
D. Blockade of L-type calcium channels in the AV node
🟢 C. Potent blockade of fast sodium channels with slow dissociation kinetics
🔴 RATIONALE: Class IC antiarrhythmics like flecainide strongly inhibit open sodium channels,
markedly slowing conduction velocity throughout the His-Purkinje system and myocardium with minimal
effect on action potential duration.
Question 6
A 55-year-old male is prescribed amiodarone for refractory ventricular tachycardia. Which diagnostic
evaluation must be performed at baseline and monitored at least every 6 months during long-term
therapy?
A. Pulmonary function tests and thyroid panel
B. Audiogram and serum creatinine
C. Complete blood count and bone density scan
D. Fasting lipid panel and hemoglobin A1c
🟢 A. Pulmonary function tests and thyroid panel
🔴 RATIONALE: Amiodarone carries a high risk of pulmonary toxicity (interstitial lung disease) and
thyroid dysfunction (hypo- or hyperthyroidism due to high iodine content), requiring strict baseline and
periodic objective screenings.
Question 7
A patient with an acute myocardial infarction is receiving an intravenous infusion of nitroglycerin. The
patient develops a severe headache but remains hemodynamically stable. What is the most appropriate
action by the APRN?
A. Immediately discontinue the nitroglycerin infusion
B. Administer acetaminophen and reassure the patient this is an expected effect
C. Administer a bolus of intravenous fluids to resolve cerebral ischemia
, D. Switch the patient to oral isosorbide mononitrate immediately
🟢 B. Administer acetaminophen and reassure the patient this is an expected effect
🔴 RATIONALE: Nitroglycerin-induced headache is caused by direct cerebral vasodilation. If the patient
is hemodynamically stable and achieving therapeutic cardiac benefit, the headache should be managed
symptomatically with mild analgesics rather than stopping therapy.
Question 8
Which medication is classified as a direct thrombin inhibitor and is approved for oral use to reduce the
risk of stroke in patients with non-valvular atrial fibrillation?
A. Rivaroxaban
B. Apixaban
C. Dabigatran
D. Edoxaban
🟢 C. Dabigatran
🔴 RATIONALE: Dabigatran etexilate is an oral prodrug that binds reversibly to the active site of both
free and clot-bound thrombin (Factor IIa), distinct from rivaroxaban, apixaban, and edoxaban, which are
Factor Xa inhibitors.
Question 9
A 68-year-old female with a history of severe bronchospastic asthma requires medication for rate control
of rapid atrial fibrillation. Which beta-blocker is safest for the APRN to prescribe?
A. Propranolol
B. Metoprolol
C. Carvedilol
D. Nadolol
🟢 B. Metoprolol
🔴 RATIONALE: Metoprolol is a cardioselective beta-blocker that preferentially inhibits beta-1 receptors
ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027
Section One: Questions 1–100
Question 1
A 64-year-old male with chronic heart failure and atrial fibrillation is taking digoxin. He reports nausea,
vomiting, and seeing yellow-green halos around lights. Which laboratory finding most critically increases
the risk for this presentation?
A. Hypernatremia
B. Hypokalemia
C. Hypocalcemia
D. Hypermagnesemia
🟢 B. Hypokalemia
🔴 RATIONALE: Hypokalemia increases the risk of digoxin toxicity because low extracellular potassium
levels increase digoxin binding to the Na+/K+-ATPase pump, intensifying its therapeutic and toxic effects.
Question 2
The advanced practice registered nurse (APRN) is managing a patient on lithium therapy for bipolar
disorder. The patient has been diagnosed with hypertension and requires a diuretic. Which diuretic class
should the APRN completely avoid?
A. Loop diuretics
B. Thiazide diuretics
C. Potassium-sparing diuretics
D. Osmotic diuretics
🟢 B. Thiazide diuretics
🔴 RATIONALE: Thiazide diuretics promote sodium excretion in the distal convoluted tubule, which
leads to compensatory renal reabsorption of both sodium and lithium, rapidly increasing lithium serum
levels and risk of toxicity.
,Question 3
A patient is prescribed warfarin for mechanical heart valve prophylaxis. The patient requires short-term
antibiotic therapy with sulfamethoxazole/trimethoprim for a urinary tract infection. What adjustment or
monitoring plan must the APRN implement?
A. Increase the warfarin dose and check the INR in 2 weeks
B. Decrease the warfarin dose and check the INR in 3 to 5 days
C. Discontinue warfarin entirely during the antibiotic course
D. Maintain the current warfarin dose and check the INR in 1 month
🟢 B. Decrease the warfarin dose and check the INR in 3 to 5 days
🔴 RATIONALE: Sulfamethoxazole/trimethoprim displaces warfarin from plasma proteins and inhibits its
metabolism via CYP2C9, significantly increasing the INR and bleeding risk, necessitating a preemptive
dose reduction and early monitoring.
Question 4
A 45-year-old female presents with a deep vein thrombosis and is started on enoxaparin. Which
laboratory parameter must be closely monitored if the patient has a history of stage 4 chronic kidney
disease?
A. Activated partial thromboplastin time (aPTT)
B. International Normalized Ratio (INR)
C. Anti-factor Xa levels
D. Prothrombin time (PT)
🟢 C. Anti-factor Xa levels
🔴 RATIONALE: Enoxaparin is a low-molecular-weight heparin excreted primarily by the kidneys. In
severe renal impairment, it accumulates, and anti-factor Xa levels provide the most accurate assessment
of therapeutic anticoagulation and safety.
Question 5
An APRN is reviewing the mechanism of action of class IC antiarrhythmic agents like flecainide. Which
statement accurately describes their primary cellular effect?
,A. Blockade of beta-1 adrenergic receptors
B. Prolongation of the action potential duration via potassium channel blockade
C. Potent blockade of fast sodium channels with slow dissociation kinetics
D. Blockade of L-type calcium channels in the AV node
🟢 C. Potent blockade of fast sodium channels with slow dissociation kinetics
🔴 RATIONALE: Class IC antiarrhythmics like flecainide strongly inhibit open sodium channels,
markedly slowing conduction velocity throughout the His-Purkinje system and myocardium with minimal
effect on action potential duration.
Question 6
A 55-year-old male is prescribed amiodarone for refractory ventricular tachycardia. Which diagnostic
evaluation must be performed at baseline and monitored at least every 6 months during long-term
therapy?
A. Pulmonary function tests and thyroid panel
B. Audiogram and serum creatinine
C. Complete blood count and bone density scan
D. Fasting lipid panel and hemoglobin A1c
🟢 A. Pulmonary function tests and thyroid panel
🔴 RATIONALE: Amiodarone carries a high risk of pulmonary toxicity (interstitial lung disease) and
thyroid dysfunction (hypo- or hyperthyroidism due to high iodine content), requiring strict baseline and
periodic objective screenings.
Question 7
A patient with an acute myocardial infarction is receiving an intravenous infusion of nitroglycerin. The
patient develops a severe headache but remains hemodynamically stable. What is the most appropriate
action by the APRN?
A. Immediately discontinue the nitroglycerin infusion
B. Administer acetaminophen and reassure the patient this is an expected effect
C. Administer a bolus of intravenous fluids to resolve cerebral ischemia
, D. Switch the patient to oral isosorbide mononitrate immediately
🟢 B. Administer acetaminophen and reassure the patient this is an expected effect
🔴 RATIONALE: Nitroglycerin-induced headache is caused by direct cerebral vasodilation. If the patient
is hemodynamically stable and achieving therapeutic cardiac benefit, the headache should be managed
symptomatically with mild analgesics rather than stopping therapy.
Question 8
Which medication is classified as a direct thrombin inhibitor and is approved for oral use to reduce the
risk of stroke in patients with non-valvular atrial fibrillation?
A. Rivaroxaban
B. Apixaban
C. Dabigatran
D. Edoxaban
🟢 C. Dabigatran
🔴 RATIONALE: Dabigatran etexilate is an oral prodrug that binds reversibly to the active site of both
free and clot-bound thrombin (Factor IIa), distinct from rivaroxaban, apixaban, and edoxaban, which are
Factor Xa inhibitors.
Question 9
A 68-year-old female with a history of severe bronchospastic asthma requires medication for rate control
of rapid atrial fibrillation. Which beta-blocker is safest for the APRN to prescribe?
A. Propranolol
B. Metoprolol
C. Carvedilol
D. Nadolol
🟢 B. Metoprolol
🔴 RATIONALE: Metoprolol is a cardioselective beta-blocker that preferentially inhibits beta-1 receptors
