NSG 5442 FINAL EXAM 2026/2027-EDITION
REAL EXAM 105- QUESTIONS AND 100%
VERIFIED ANSWERS
105 High-Yield Questions with Rationales | Advanced Pharmacology & Clinical Management
OVERVIEW
Course: NSG 5442 - Advanced Pharmacology / Psychopharmacology & Advanced
Pathophysiology for the Advanced Practice Nurse
Purpose: This practice exam mimics the 2026 final exam blueprint in a way someone can
easily understand. Organized by subtitles for focused review.
How to use: 105 Questions in 9 domains. Correct answer is BOLD GREEN. Rationale
explains mechanism, safety, and NP pearls.
High-Yield 2026: Beers Criteria, GLP-1 RA, SGLT2 inhibitors, DOACs, serotonin syndrome vs
NMS, stewardship, CYP450 interactions.
Section 1: Cardiovascular & Renal (Q1-Q15)
Q1. A 72yo male with atrial fibrillation (CHA2DS2-VASc 4) and CrCl 35 mL/min. Safest DOAC
dosing?
A. Apixaban 5mg BID (2.5mg if 2 criteria)
B. Rivaroxaban 20mg daily
C. Dabigatran 150mg BID
D. No anticoagulation needed
Rationale: Apixaban has least renal dependence, preferred in CKD. Dose reduction if age80,
weight60kg, Cr1.5.
Q2. Mechanism of sacubitril/valsartan (Entresto):
A. Neprilysin inhibition + ARB
B. ACE inhibition only
C. Beta blockade + diuresis
D. Calcium channel blockade
Rationale: Sacubitril inhibits neprilysin ( natriuretic peptides), valsartan blocks AT1.
Q3. Hypertensive emergency with aortic dissection, best first IV agent?
A. Esmolol (short-acting beta-blocker)
B. Hydralazine
C. Lisinopril
D. Amlodipine
Rationale: In dissection, reduce HR and shear stress first with esmolol, then vasodilator. Target HR <60.
,Q4. Loop diuretic furosemide acts on:
A. Ascending loop of Henle, Na-K-2Cl cotransporter
B. Distal convoluted tubule
C. Collecting duct
D. Proximal tubule
Rationale: Loop diuretics block NKCC2 in thick ascending limb - most potent.
Q5. Spironolactone monitoring parameter:
A. Potassium and renal function
B. Sodium only
C. Glucose
D. INR
Rationale: K+-sparing MRA can cause hyperkalemia, especially with ACE-I/ARB, CKD.
Q6. Clonidine withdrawal causes:
A. Rebound hypertension, tachycardia, anxiety
B. Hypotension
C. Bradycardia only
D. No syndrome
Rationale: Clonidine central alpha-2 agonist; abrupt stop = sympathetic surge. Must taper.
Q7. Heparin-induced thrombocytopenia (HIT) treatment:
A. Stop heparin, start argatroban/bivalirudin
B. Continue heparin
C. Give platelet transfusion
D. Start warfarin alone
Rationale: HIT is prothrombotic. Stop all heparin, start non-heparin anticoagulant.
Q8. Statin that needs dose adjustment with CYP3A4 inhibitors:
A. Simvastatin and atorvastatin
B. Rosuvastatin and pravastatin
C. All statins equally
D. No statin interacts
Rationale: Simvastatin/lovastatin/atorvastatin are CYP3A4 substrates. Rosuvastatin/pravastatin not.
Q9. First-line hypertension in Black patients without CKD/HF:
A. Thiazide diuretic or dihydropyridine CCB
B. ACE-I alone
C. Beta-blocker alone
D. ARB alone
Rationale: Black patients respond better to thiazide/CCB than ACE-I/ARB monotherapy.
, Q10. Nitroglycerin contraindicated with:
A. Sildenafil (PDE5 inhibitor) within 24-48h
B. Metoprolol
C. Aspirin
D. Heparin
Rationale: Both cause vasodilation → severe hypotension.
Q11. A 68yo with AFib on warfarin has INR 3.8, no bleeding. Best action?
A. Hold 1-2 doses and recheck INR, consider lower dose
B. Give vitamin K 10mg IV
C. Give FFP immediately
D. Continue same dose
Rationale: Supratherapeutic INR without bleeding: hold warfarin, no vitamin K unless bleeding/high risk.
Q12. Thiazide diuretic adverse effect triad:
A. HypoKalemia, HyperCalcemia, HyperUricemia
B. Hyperkalemia, Hypocalcemia
C. Hypernatremia, alkalosis
D. Hypoglycemia
Rationale: Thiazides cause hypokalemia, hyponatremia, hypercalcemia, hyperglycemia, hyperuricemia.
Q13. Lisinopril counseling: Patient develops dry cough, what to do?
A. Switch to ARB like losartan
B. Add dextromethorphan
C. Increase dose
D. Switch to amlodipine only
Rationale: ACE-I dry cough from bradykinin accumulation - switch to ARB.
Q14. Drug interaction: Amiodarone + warfarin leads to:
A. Decreased INR
B. Increased INR/bleeding risk due to CYP2C9 inhibition
C. No interaction
D. Amiodarone toxicity only
Rationale: Amiodarone inhibits CYP2C9 and CYP1A2, drastically increasing warfarin effect.
Q15. First-line for HFrEF (EF 30%) includes all EXCEPT:
A. ARNI
B. Beta-blocker
C. SGLT2 inhibitor
D. Non-dihydropyridine CCB (diltiazem)
Rationale: Four pillars: ARNI/ACE-I, BB, MRA, SGLT2i. Non-DHP CCBs negative inotropes.
REAL EXAM 105- QUESTIONS AND 100%
VERIFIED ANSWERS
105 High-Yield Questions with Rationales | Advanced Pharmacology & Clinical Management
OVERVIEW
Course: NSG 5442 - Advanced Pharmacology / Psychopharmacology & Advanced
Pathophysiology for the Advanced Practice Nurse
Purpose: This practice exam mimics the 2026 final exam blueprint in a way someone can
easily understand. Organized by subtitles for focused review.
How to use: 105 Questions in 9 domains. Correct answer is BOLD GREEN. Rationale
explains mechanism, safety, and NP pearls.
High-Yield 2026: Beers Criteria, GLP-1 RA, SGLT2 inhibitors, DOACs, serotonin syndrome vs
NMS, stewardship, CYP450 interactions.
Section 1: Cardiovascular & Renal (Q1-Q15)
Q1. A 72yo male with atrial fibrillation (CHA2DS2-VASc 4) and CrCl 35 mL/min. Safest DOAC
dosing?
A. Apixaban 5mg BID (2.5mg if 2 criteria)
B. Rivaroxaban 20mg daily
C. Dabigatran 150mg BID
D. No anticoagulation needed
Rationale: Apixaban has least renal dependence, preferred in CKD. Dose reduction if age80,
weight60kg, Cr1.5.
Q2. Mechanism of sacubitril/valsartan (Entresto):
A. Neprilysin inhibition + ARB
B. ACE inhibition only
C. Beta blockade + diuresis
D. Calcium channel blockade
Rationale: Sacubitril inhibits neprilysin ( natriuretic peptides), valsartan blocks AT1.
Q3. Hypertensive emergency with aortic dissection, best first IV agent?
A. Esmolol (short-acting beta-blocker)
B. Hydralazine
C. Lisinopril
D. Amlodipine
Rationale: In dissection, reduce HR and shear stress first with esmolol, then vasodilator. Target HR <60.
,Q4. Loop diuretic furosemide acts on:
A. Ascending loop of Henle, Na-K-2Cl cotransporter
B. Distal convoluted tubule
C. Collecting duct
D. Proximal tubule
Rationale: Loop diuretics block NKCC2 in thick ascending limb - most potent.
Q5. Spironolactone monitoring parameter:
A. Potassium and renal function
B. Sodium only
C. Glucose
D. INR
Rationale: K+-sparing MRA can cause hyperkalemia, especially with ACE-I/ARB, CKD.
Q6. Clonidine withdrawal causes:
A. Rebound hypertension, tachycardia, anxiety
B. Hypotension
C. Bradycardia only
D. No syndrome
Rationale: Clonidine central alpha-2 agonist; abrupt stop = sympathetic surge. Must taper.
Q7. Heparin-induced thrombocytopenia (HIT) treatment:
A. Stop heparin, start argatroban/bivalirudin
B. Continue heparin
C. Give platelet transfusion
D. Start warfarin alone
Rationale: HIT is prothrombotic. Stop all heparin, start non-heparin anticoagulant.
Q8. Statin that needs dose adjustment with CYP3A4 inhibitors:
A. Simvastatin and atorvastatin
B. Rosuvastatin and pravastatin
C. All statins equally
D. No statin interacts
Rationale: Simvastatin/lovastatin/atorvastatin are CYP3A4 substrates. Rosuvastatin/pravastatin not.
Q9. First-line hypertension in Black patients without CKD/HF:
A. Thiazide diuretic or dihydropyridine CCB
B. ACE-I alone
C. Beta-blocker alone
D. ARB alone
Rationale: Black patients respond better to thiazide/CCB than ACE-I/ARB monotherapy.
, Q10. Nitroglycerin contraindicated with:
A. Sildenafil (PDE5 inhibitor) within 24-48h
B. Metoprolol
C. Aspirin
D. Heparin
Rationale: Both cause vasodilation → severe hypotension.
Q11. A 68yo with AFib on warfarin has INR 3.8, no bleeding. Best action?
A. Hold 1-2 doses and recheck INR, consider lower dose
B. Give vitamin K 10mg IV
C. Give FFP immediately
D. Continue same dose
Rationale: Supratherapeutic INR without bleeding: hold warfarin, no vitamin K unless bleeding/high risk.
Q12. Thiazide diuretic adverse effect triad:
A. HypoKalemia, HyperCalcemia, HyperUricemia
B. Hyperkalemia, Hypocalcemia
C. Hypernatremia, alkalosis
D. Hypoglycemia
Rationale: Thiazides cause hypokalemia, hyponatremia, hypercalcemia, hyperglycemia, hyperuricemia.
Q13. Lisinopril counseling: Patient develops dry cough, what to do?
A. Switch to ARB like losartan
B. Add dextromethorphan
C. Increase dose
D. Switch to amlodipine only
Rationale: ACE-I dry cough from bradykinin accumulation - switch to ARB.
Q14. Drug interaction: Amiodarone + warfarin leads to:
A. Decreased INR
B. Increased INR/bleeding risk due to CYP2C9 inhibition
C. No interaction
D. Amiodarone toxicity only
Rationale: Amiodarone inhibits CYP2C9 and CYP1A2, drastically increasing warfarin effect.
Q15. First-line for HFrEF (EF 30%) includes all EXCEPT:
A. ARNI
B. Beta-blocker
C. SGLT2 inhibitor
D. Non-dihydropyridine CCB (diltiazem)
Rationale: Four pillars: ARNI/ACE-I, BB, MRA, SGLT2i. Non-DHP CCBs negative inotropes.
