NR565 Week 4 Midterm Exam Review Examplify
Online Proctored Exam, NR-565 Advanced
Pharmacology: Comprehensive Midterm Exam
Practice Set (Questions, Answers & Rationales)
,
1. A patient newly diagnosed with hypertension is started on lisinopril.
Two weeks later, the patient develops a persistent dry cough. What is
the best management?
A. Discontinue lisinopril and start an ARB
B. Add benzonatate for cough suppression
C. Continue lisinopril and monitor
D. Increase hydration and reevaluate in 1 month
✔ Correct Answer: A – Discontinue lisinopril and start an ARB
Expanded Rationale:
ACE inhibitors increase levels of bradykinin and substance P → this
irritates airway receptors → persistent dry cough in up to 10–20% of
patients.
Stopping the ACE inhibitor resolves the cough.
ARBs (losartan, valsartan) do not affect bradykinin → no cough →
guideline-recommended alternative.
,Treating the cough (B, D) does nothing because the problem is the drug
itself.
2. A patient presents with severe CAP and a prolonged QT interval.
Which antibiotic is safest?
A. Azithromycin
B. Levofloxacin
C. Clarithromycin
D. Doxycycline
✔ Correct Answer: D – Doxycycline
Expanded Rationale:
Macrolides (A, C) and fluoroquinolones (B) block potassium channels in
the myocardium → prolong QT → risk of torsades.
Doxycycline covers atypicals (Mycoplasma, Chlamydia) and
Streptococcus pneumoniae without cardiac effects, making it the safest
choice.
3. A patient taking simvastatin reports muscle pain and dark cola-
colored urine. What is the top concern?
A. Hepatitis
B. Nephrolithiasis
C. Rhabdomyolysis
D. GERD
✔ Correct Answer: C – Rhabdomyolysis
Expanded Rationale:
,Statins rarely cause severe myositis → muscle breakdown → myoglobin
release → dark urine → acute kidney injury.
Urinalysis shows myoglobin, and CK levels are markedly elevated.
Immediate action: STOP the statin + hydrate aggressively.
Liver injury (A) causes jaundice, not dark urine.
4. A patient with diabetes is started on metformin. Which condition is a
contraindication?
A. Hemoglobin A1c 10%
B. GFR 20 mL/min
C. Obesity
D. Hypertriglyceridemia
✔ Correct Answer: B – GFR 20 mL/min
Expanded Rationale:
Metformin is cleared renally.
Severe renal impairment (GFR <30) → dangerous accumulation → lactic
acidosis.
A1c (A) and obesity (C) actually make metformin more beneficial.
Triglycerides (D) are irrelevant.
5. Which medication is preferred for rate control in atrial fibrillation in
patients with asthma?
A. Propranolol
B. Metoprolol
C. Verapamil
D. Carvedilol
, ✔ Correct Answer: C – Verapamil
Expanded Rationale:
Non-selective beta-blockers (propranolol, carvedilol) can trigger
bronchospasm in asthma.
Metoprolol is relatively selective but still carries risk.
Verapamil (and diltiazem) slow AV conduction without affecting bronchi
→ safe & effective.
6. Which drug for depression is most likely to increase blood pressure?
A. Sertraline
B. Venlafaxine
C. Fluoxetine
D. Escitalopram
✔ Correct Answer: B – Venlafaxine
Expanded Rationale:
SNRIs (venlafaxine, duloxetine) increase norepinephrine → peripheral
vasoconstriction → dose-dependent hypertension.
SSRIs (A, C, D) do not significantly affect BP.
7. A patient is prescribed amlodipine. What adverse effect is common?
A. Hyperkalemia
B. Peripheral edema
C. Bradycardia
D. Constipation
Online Proctored Exam, NR-565 Advanced
Pharmacology: Comprehensive Midterm Exam
Practice Set (Questions, Answers & Rationales)
,
1. A patient newly diagnosed with hypertension is started on lisinopril.
Two weeks later, the patient develops a persistent dry cough. What is
the best management?
A. Discontinue lisinopril and start an ARB
B. Add benzonatate for cough suppression
C. Continue lisinopril and monitor
D. Increase hydration and reevaluate in 1 month
✔ Correct Answer: A – Discontinue lisinopril and start an ARB
Expanded Rationale:
ACE inhibitors increase levels of bradykinin and substance P → this
irritates airway receptors → persistent dry cough in up to 10–20% of
patients.
Stopping the ACE inhibitor resolves the cough.
ARBs (losartan, valsartan) do not affect bradykinin → no cough →
guideline-recommended alternative.
,Treating the cough (B, D) does nothing because the problem is the drug
itself.
2. A patient presents with severe CAP and a prolonged QT interval.
Which antibiotic is safest?
A. Azithromycin
B. Levofloxacin
C. Clarithromycin
D. Doxycycline
✔ Correct Answer: D – Doxycycline
Expanded Rationale:
Macrolides (A, C) and fluoroquinolones (B) block potassium channels in
the myocardium → prolong QT → risk of torsades.
Doxycycline covers atypicals (Mycoplasma, Chlamydia) and
Streptococcus pneumoniae without cardiac effects, making it the safest
choice.
3. A patient taking simvastatin reports muscle pain and dark cola-
colored urine. What is the top concern?
A. Hepatitis
B. Nephrolithiasis
C. Rhabdomyolysis
D. GERD
✔ Correct Answer: C – Rhabdomyolysis
Expanded Rationale:
,Statins rarely cause severe myositis → muscle breakdown → myoglobin
release → dark urine → acute kidney injury.
Urinalysis shows myoglobin, and CK levels are markedly elevated.
Immediate action: STOP the statin + hydrate aggressively.
Liver injury (A) causes jaundice, not dark urine.
4. A patient with diabetes is started on metformin. Which condition is a
contraindication?
A. Hemoglobin A1c 10%
B. GFR 20 mL/min
C. Obesity
D. Hypertriglyceridemia
✔ Correct Answer: B – GFR 20 mL/min
Expanded Rationale:
Metformin is cleared renally.
Severe renal impairment (GFR <30) → dangerous accumulation → lactic
acidosis.
A1c (A) and obesity (C) actually make metformin more beneficial.
Triglycerides (D) are irrelevant.
5. Which medication is preferred for rate control in atrial fibrillation in
patients with asthma?
A. Propranolol
B. Metoprolol
C. Verapamil
D. Carvedilol
, ✔ Correct Answer: C – Verapamil
Expanded Rationale:
Non-selective beta-blockers (propranolol, carvedilol) can trigger
bronchospasm in asthma.
Metoprolol is relatively selective but still carries risk.
Verapamil (and diltiazem) slow AV conduction without affecting bronchi
→ safe & effective.
6. Which drug for depression is most likely to increase blood pressure?
A. Sertraline
B. Venlafaxine
C. Fluoxetine
D. Escitalopram
✔ Correct Answer: B – Venlafaxine
Expanded Rationale:
SNRIs (venlafaxine, duloxetine) increase norepinephrine → peripheral
vasoconstriction → dose-dependent hypertension.
SSRIs (A, C, D) do not significantly affect BP.
7. A patient is prescribed amlodipine. What adverse effect is common?
A. Hyperkalemia
B. Peripheral edema
C. Bradycardia
D. Constipation
