NR 667 Concepts and Clinical Scenarios |
Full Questions and Answers | 2026/2027
Updated | 100% Correct.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
148 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam assesses advanced practice nursing competencies in clinical decision-making,
pharmacotherapeutics, and evidence-based management of acute and chronic conditions across the lifespan.
It emphasizes application of current guidelines, drug interactions, and patient safety in primary care.
STUDY GUIDE
Recommended duration: 2.5 hours. Passing target: 80%.
HIGHP - Page 1 of 48
,1. A patient with heart failure with reduced ejection fraction (HFrEF) is initiated on
sacubitril/valsartan. Which pre-treatment lab value must be monitored and corrected if
low?
[ ] A. Serum potassium
[ ] B. Serum sodium
[ ] C. Serum magnesium
[ ] D. Serum calcium
CORRECT: A. Serum potassium
Sacubitril/valsartan can cause hyperkalemia, but pre-existing hypokalemia may increase risk of arrhythmias;
however, the key monitoring parameter is potassium because the drug can elevate it. Sodium, magnesium,
and calcium are not primary concerns for this medication. The correct answer is potassium due to its role in
cardiac stability and potential drug-induced hyperkalemia.
2. Which of the following is the most appropriate first-line treatment for a patient
diagnosed with uncomplicated acute bacterial rhinosinusitis who has no antibiotic use in
the past 4 weeks?
[ ] A. Amoxicillin-clavulanate
[ ] B. Azithromycin
[ ] C. Ciprofloxacin
[ ] D. Doxycycline
CORRECT: A. Amoxicillin-clavulanate
Amoxicillin-clavulanate is recommended as first-line therapy for acute bacterial rhinosinusitis due to its
coverage of Streptococcus pneumoniae and Haemophilus influenzae. Azithromycin and doxycycline have
higher resistance rates, and ciprofloxacin is not first-line. The other options are either less effective or
reserved for allergies.
3. A patient on warfarin has an INR of 5.2 and no active bleeding. Which intervention is
most appropriate?
[ ] A. Administer vitamin K 10 mg IV
[ ] B. Hold warfarin and monitor INR
[ ] C. Administer fresh frozen plasma
[ ] D. Continue warfarin and recheck in 1 week
CORRECT: B. Hold warfarin and monitor INR
For an INR of 5.2 without bleeding, guidelines recommend holding warfarin and monitoring, as the risk of
bleeding is not high enough to warrant reversal. IV vitamin K is reserved for serious bleeding or very high
INR, and FFP is for active bleeding. Continuing warfarin would increase bleeding risk.
HIGHP - Page 2 of 48
,4. Which class of medications is considered first-line for chronic management of asthma
in a patient with mild persistent symptoms?
[ ] A. Inhaled corticosteroids
[ ] B. Long-acting beta-agonists
[ ] C. Leukotriene receptor antagonists
[ ] D. Oral corticosteroids
CORRECT: A. Inhaled corticosteroids
Inhaled corticosteroids are the preferred controller medication for mild persistent asthma due to their
anti-inflammatory effects and safety profile. LABAs are not used as monotherapy, leukotriene antagonists are
alternative, and oral corticosteroids are for severe exacerbations. Thus, ICS is first-line.
5. A patient with type 2 diabetes and a history of heart failure is started on empagliflozin.
What is the primary benefit of this medication in this patient?
[ ] A. Weight loss
[ ] B. Reduced risk of cardiovascular death and heart failure hospitalization
[ ] C. Improved renal function
[ ] D. Lower risk of hypoglycemia
CORRECT: B. Reduced risk of cardiovascular death and heart failure hospitalization
SGLT2 inhibitors like empagliflozin have demonstrated significant reductions in cardiovascular death and
heart failure hospitalization in patients with type 2 diabetes and heart failure. While weight loss and renal
benefits exist, the primary benefit in this context is cardiovascular. Hypoglycemia risk is low but not the main
benefit.
6. Which of the following is a contraindication to prescribing combined oral
contraceptives?
[ ] A. History of migraine with aura
[ ] B. History of gestational diabetes
[ ] C. Family history of breast cancer
[ ] D. Current use of levothyroxine
CORRECT: A. History of migraine with aura
Migraine with aura is a contraindication for combined oral contraceptives due to increased risk of stroke.
Gestational diabetes, family history of breast cancer, and levothyroxine use are not absolute
contraindications. The other options may require monitoring but do not preclude use.
7. A patient presents with symptoms of major depressive disorder. Which medication is
considered first-line due to its favorable side effect profile and efficacy?
[ ] A. Sertraline
HIGHP - Page 3 of 48
, [ ] B. Amitriptyline
[ ] C. Phenelzine
[ ] D. Mirtazapine
CORRECT: A. Sertraline
SSRIs like sertraline are first-line for major depressive disorder due to their efficacy and tolerability. Tricyclics
(amitriptyline) and MAOIs (phenelzine) have more side effects and dietary restrictions. Mirtazapine is
effective but often used as second-line due to sedation and weight gain.
8. Which vaccine is contraindicated in a patient with a history of anaphylaxis to gelatin?
[ ] A. MMR
[ ] B. Influenza (inactivated)
[ ] C. Tdap
[ ] D. Hepatitis B
CORRECT: A. MMR
MMR vaccine contains gelatin as a stabilizer and is contraindicated in individuals with severe gelatin allergy.
Inactivated influenza, Tdap, and hepatitis B vaccines do not contain gelatin. Therefore, MMR is the correct
answer.
9. A patient with chronic kidney disease stage 4 is prescribed a medication. Which of the
following requires dose adjustment?
[ ] A. Metformin
[ ] B. Lisinopril
[ ] C. Atorvastatin
[ ] D. Levothyroxine
CORRECT: A. Metformin
Metformin is contraindicated in severe renal impairment (eGFR <30) due to risk of lactic acidosis. Lisinopril
may require monitoring but is not contraindicated. Atorvastatin and levothyroxine generally do not require
renal dose adjustment. Thus, metformin needs adjustment/avoidance.
10. Which of the following is the most appropriate initial treatment for a patient with acute
gout flare?
[ ] A. Colchicine
[ ] B. Allopurinol
[ ] C. Probenecid
[ ] D. Febuxostat
HIGHP - Page 4 of 48
Full Questions and Answers | 2026/2027
Updated | 100% Correct.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
148 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam assesses advanced practice nursing competencies in clinical decision-making,
pharmacotherapeutics, and evidence-based management of acute and chronic conditions across the lifespan.
It emphasizes application of current guidelines, drug interactions, and patient safety in primary care.
STUDY GUIDE
Recommended duration: 2.5 hours. Passing target: 80%.
HIGHP - Page 1 of 48
,1. A patient with heart failure with reduced ejection fraction (HFrEF) is initiated on
sacubitril/valsartan. Which pre-treatment lab value must be monitored and corrected if
low?
[ ] A. Serum potassium
[ ] B. Serum sodium
[ ] C. Serum magnesium
[ ] D. Serum calcium
CORRECT: A. Serum potassium
Sacubitril/valsartan can cause hyperkalemia, but pre-existing hypokalemia may increase risk of arrhythmias;
however, the key monitoring parameter is potassium because the drug can elevate it. Sodium, magnesium,
and calcium are not primary concerns for this medication. The correct answer is potassium due to its role in
cardiac stability and potential drug-induced hyperkalemia.
2. Which of the following is the most appropriate first-line treatment for a patient
diagnosed with uncomplicated acute bacterial rhinosinusitis who has no antibiotic use in
the past 4 weeks?
[ ] A. Amoxicillin-clavulanate
[ ] B. Azithromycin
[ ] C. Ciprofloxacin
[ ] D. Doxycycline
CORRECT: A. Amoxicillin-clavulanate
Amoxicillin-clavulanate is recommended as first-line therapy for acute bacterial rhinosinusitis due to its
coverage of Streptococcus pneumoniae and Haemophilus influenzae. Azithromycin and doxycycline have
higher resistance rates, and ciprofloxacin is not first-line. The other options are either less effective or
reserved for allergies.
3. A patient on warfarin has an INR of 5.2 and no active bleeding. Which intervention is
most appropriate?
[ ] A. Administer vitamin K 10 mg IV
[ ] B. Hold warfarin and monitor INR
[ ] C. Administer fresh frozen plasma
[ ] D. Continue warfarin and recheck in 1 week
CORRECT: B. Hold warfarin and monitor INR
For an INR of 5.2 without bleeding, guidelines recommend holding warfarin and monitoring, as the risk of
bleeding is not high enough to warrant reversal. IV vitamin K is reserved for serious bleeding or very high
INR, and FFP is for active bleeding. Continuing warfarin would increase bleeding risk.
HIGHP - Page 2 of 48
,4. Which class of medications is considered first-line for chronic management of asthma
in a patient with mild persistent symptoms?
[ ] A. Inhaled corticosteroids
[ ] B. Long-acting beta-agonists
[ ] C. Leukotriene receptor antagonists
[ ] D. Oral corticosteroids
CORRECT: A. Inhaled corticosteroids
Inhaled corticosteroids are the preferred controller medication for mild persistent asthma due to their
anti-inflammatory effects and safety profile. LABAs are not used as monotherapy, leukotriene antagonists are
alternative, and oral corticosteroids are for severe exacerbations. Thus, ICS is first-line.
5. A patient with type 2 diabetes and a history of heart failure is started on empagliflozin.
What is the primary benefit of this medication in this patient?
[ ] A. Weight loss
[ ] B. Reduced risk of cardiovascular death and heart failure hospitalization
[ ] C. Improved renal function
[ ] D. Lower risk of hypoglycemia
CORRECT: B. Reduced risk of cardiovascular death and heart failure hospitalization
SGLT2 inhibitors like empagliflozin have demonstrated significant reductions in cardiovascular death and
heart failure hospitalization in patients with type 2 diabetes and heart failure. While weight loss and renal
benefits exist, the primary benefit in this context is cardiovascular. Hypoglycemia risk is low but not the main
benefit.
6. Which of the following is a contraindication to prescribing combined oral
contraceptives?
[ ] A. History of migraine with aura
[ ] B. History of gestational diabetes
[ ] C. Family history of breast cancer
[ ] D. Current use of levothyroxine
CORRECT: A. History of migraine with aura
Migraine with aura is a contraindication for combined oral contraceptives due to increased risk of stroke.
Gestational diabetes, family history of breast cancer, and levothyroxine use are not absolute
contraindications. The other options may require monitoring but do not preclude use.
7. A patient presents with symptoms of major depressive disorder. Which medication is
considered first-line due to its favorable side effect profile and efficacy?
[ ] A. Sertraline
HIGHP - Page 3 of 48
, [ ] B. Amitriptyline
[ ] C. Phenelzine
[ ] D. Mirtazapine
CORRECT: A. Sertraline
SSRIs like sertraline are first-line for major depressive disorder due to their efficacy and tolerability. Tricyclics
(amitriptyline) and MAOIs (phenelzine) have more side effects and dietary restrictions. Mirtazapine is
effective but often used as second-line due to sedation and weight gain.
8. Which vaccine is contraindicated in a patient with a history of anaphylaxis to gelatin?
[ ] A. MMR
[ ] B. Influenza (inactivated)
[ ] C. Tdap
[ ] D. Hepatitis B
CORRECT: A. MMR
MMR vaccine contains gelatin as a stabilizer and is contraindicated in individuals with severe gelatin allergy.
Inactivated influenza, Tdap, and hepatitis B vaccines do not contain gelatin. Therefore, MMR is the correct
answer.
9. A patient with chronic kidney disease stage 4 is prescribed a medication. Which of the
following requires dose adjustment?
[ ] A. Metformin
[ ] B. Lisinopril
[ ] C. Atorvastatin
[ ] D. Levothyroxine
CORRECT: A. Metformin
Metformin is contraindicated in severe renal impairment (eGFR <30) due to risk of lactic acidosis. Lisinopril
may require monitoring but is not contraindicated. Atorvastatin and levothyroxine generally do not require
renal dose adjustment. Thus, metformin needs adjustment/avoidance.
10. Which of the following is the most appropriate initial treatment for a patient with acute
gout flare?
[ ] A. Colchicine
[ ] B. Allopurinol
[ ] C. Probenecid
[ ] D. Febuxostat
HIGHP - Page 4 of 48
