NU578 Exam 3 Practice Questions & Answers
(Verified Updated)
This comprehensive study guide covers the core domains tested
on NU578 Exam 3, aligned with the 2026–2027 curriculum at
the University of South Alabama. It includes original practice
questions with detailed rationales, organized by topic:
Cardiovascular Medications, Respiratory Medications, and
Renal Medications & Diuretics.
Section 1: Cardiovascular Medications
1.1 Heart Failure & Antiarrhythmic Drug Therapy
Q1. A 68-year-old male with a history of chronic heart failure
presents with worsening dyspnea and peripheral edema despite
adherence to his current regimen. His ejection fraction is 35%.
The nurse practitioner decides to initiate an agent that reduces
preload and afterload while inhibiting neurohormonal
activation. Which medication best fits this mechanism?
A. Digoxin
B. Enalapril
C. Diltiazem
D. Atenolol
,Answer: B
Rationale: ACE inhibitors such as enalapril reduce preload and
afterload by decreasing angiotensin II-mediated
vasoconstriction and aldosterone secretion, thereby inhibiting
detrimental neurohormonal activation in heart failure. Digoxin
improves contractility but does not significantly reduce preload
or afterload. Diltiazem and atenolol are not first-line in this
scenario and may worsen heart failure.
Q2. A 54-year-old woman with atrial fibrillation and a CHA2DS2-
VASc score of 4 is started on warfarin. Two weeks later, her INR
is 3.8. She reports dark stools and mild epigastric discomfort.
What is the most appropriate immediate intervention?
A. Discontinue warfarin and administer vitamin K 10 mg orally
B. Hold the next dose and administer vitamin K 2.5 mg orally
C. Continue warfarin and recheck INR in one week
D. Switch to rivaroxaban immediately
Answer: B
Rationale: An INR of 3.8 with minor bleeding signs warrants
holding the next warfarin dose and giving a low dose of oral
vitamin K (2.5 mg) to gradually lower the INR without causing
resistance. High-dose vitamin K is reserved for serious bleeding.
Continuing warfarin or switching agents without addressing the
supratherapeutic INR is unsafe.
,Q3. A 72-year-old male with stable angina reports that his chest
pain episodes have increased to 3-4 times per week despite
using sublingual nitroglycerin. His blood pressure is 128/78
mmHg and heart rate is 76 bpm. Which long-acting antianginal
agent is most appropriate to add?
A. Amlodipine
B. Isosorbide mononitrate
C. Propranolol
D. Ranolazine
Answer: A
Rationale: Amlodipine, a dihydropyridine calcium channel
blocker, is effective for vasospastic and stable angina, reduces
myocardial oxygen demand by lowering afterload, and is safe
when blood pressure and heart rate are well-controlled.
Propranolol could be considered but is less ideal if the patient is
already at a low-normal heart rate. Ranolazine is typically
reserved for refractory angina.
Q4. Which drug is used for heart failure and dysrhythmias by
increasing cardiac contractility?
A. Digoxin
B. Enalapril
C. Diltiazem
D. Atenolol
, Answer: A
Rationale: Digoxin is used for HF and dysrhythmias, increasing
cardiac contractility. Treatment of CHF includes Digoxin
(increases cardiac contractility), diuretics (increases Na and H2O
excretion), ACEI (decreases BP and BV), and vasodilators
(decreases BP).
Q5. What is the mechanism of action of amiodarone?
A. Decreases PR interval in normal sinus rhythm
B. Increases action potential duration
C. Increases contractility
D. Often causes liver function abnormalities
E. Reduces resting potential
Answer: B
Rationale: Amiodarone increases action potential duration. It is
used for ventricular tachycardia and other arrhythmias.
Q6. A 36-year-old woman with poorly controlled thyrotoxicosis
develops a heart rate of 200 with slightly decreased blood
pressure during surgery. Which drug is most suitable?
A. Amiodarone
B. Disopyramide
C. Esmolol
D. Quinidine
E. Verapamil
(Verified Updated)
This comprehensive study guide covers the core domains tested
on NU578 Exam 3, aligned with the 2026–2027 curriculum at
the University of South Alabama. It includes original practice
questions with detailed rationales, organized by topic:
Cardiovascular Medications, Respiratory Medications, and
Renal Medications & Diuretics.
Section 1: Cardiovascular Medications
1.1 Heart Failure & Antiarrhythmic Drug Therapy
Q1. A 68-year-old male with a history of chronic heart failure
presents with worsening dyspnea and peripheral edema despite
adherence to his current regimen. His ejection fraction is 35%.
The nurse practitioner decides to initiate an agent that reduces
preload and afterload while inhibiting neurohormonal
activation. Which medication best fits this mechanism?
A. Digoxin
B. Enalapril
C. Diltiazem
D. Atenolol
,Answer: B
Rationale: ACE inhibitors such as enalapril reduce preload and
afterload by decreasing angiotensin II-mediated
vasoconstriction and aldosterone secretion, thereby inhibiting
detrimental neurohormonal activation in heart failure. Digoxin
improves contractility but does not significantly reduce preload
or afterload. Diltiazem and atenolol are not first-line in this
scenario and may worsen heart failure.
Q2. A 54-year-old woman with atrial fibrillation and a CHA2DS2-
VASc score of 4 is started on warfarin. Two weeks later, her INR
is 3.8. She reports dark stools and mild epigastric discomfort.
What is the most appropriate immediate intervention?
A. Discontinue warfarin and administer vitamin K 10 mg orally
B. Hold the next dose and administer vitamin K 2.5 mg orally
C. Continue warfarin and recheck INR in one week
D. Switch to rivaroxaban immediately
Answer: B
Rationale: An INR of 3.8 with minor bleeding signs warrants
holding the next warfarin dose and giving a low dose of oral
vitamin K (2.5 mg) to gradually lower the INR without causing
resistance. High-dose vitamin K is reserved for serious bleeding.
Continuing warfarin or switching agents without addressing the
supratherapeutic INR is unsafe.
,Q3. A 72-year-old male with stable angina reports that his chest
pain episodes have increased to 3-4 times per week despite
using sublingual nitroglycerin. His blood pressure is 128/78
mmHg and heart rate is 76 bpm. Which long-acting antianginal
agent is most appropriate to add?
A. Amlodipine
B. Isosorbide mononitrate
C. Propranolol
D. Ranolazine
Answer: A
Rationale: Amlodipine, a dihydropyridine calcium channel
blocker, is effective for vasospastic and stable angina, reduces
myocardial oxygen demand by lowering afterload, and is safe
when blood pressure and heart rate are well-controlled.
Propranolol could be considered but is less ideal if the patient is
already at a low-normal heart rate. Ranolazine is typically
reserved for refractory angina.
Q4. Which drug is used for heart failure and dysrhythmias by
increasing cardiac contractility?
A. Digoxin
B. Enalapril
C. Diltiazem
D. Atenolol
, Answer: A
Rationale: Digoxin is used for HF and dysrhythmias, increasing
cardiac contractility. Treatment of CHF includes Digoxin
(increases cardiac contractility), diuretics (increases Na and H2O
excretion), ACEI (decreases BP and BV), and vasodilators
(decreases BP).
Q5. What is the mechanism of action of amiodarone?
A. Decreases PR interval in normal sinus rhythm
B. Increases action potential duration
C. Increases contractility
D. Often causes liver function abnormalities
E. Reduces resting potential
Answer: B
Rationale: Amiodarone increases action potential duration. It is
used for ventricular tachycardia and other arrhythmias.
Q6. A 36-year-old woman with poorly controlled thyrotoxicosis
develops a heart rate of 200 with slightly decreased blood
pressure during surgery. Which drug is most suitable?
A. Amiodarone
B. Disopyramide
C. Esmolol
D. Quinidine
E. Verapamil
