NU 578 Unit 3 Final Examination ACTUAL
EXAM 2026/2027 | Pharmacology for
Advanced Practice | Verified Q&A | Pass
Guaranteed - A+ Graded
Time Limit: 2 hours
Passing Score: 90%
SECTION A: Cardiovascular Pharmacology (Questions 1-15)
Q1: A 68-year-old female with hypertension, type 2 diabetes, and stage 3 chronic kidney disease (eGFR
45 mL/min) is prescribed lisinopril 10 mg daily. Which laboratory value requires the MOST immediate
monitoring after starting this medication?
A. Hemoglobin A1c
B. Serum potassium [CORRECT]
C. LDL cholesterol
D. Urine albumin-to-creatinine ratio
Correct Answer: B
Rationale: ACE inhibitors (lisinopril) reduce aldosterone secretion, leading to potassium retention.
Hyperkalemia risk is significantly increased in CKD (eGFR <60) and diabetes. Per KDIGO and ADA
guidelines, potassium must be checked within 2-4 weeks of ACE inhibitor initiation in this high-risk
population. Distractor A – A1c reflects long-term glucose control, not acute safety. Distractor C – no
direct effect on lipids. Distractor D – urine albumin monitoring is important for diabetic nephropathy
assessment but not the most immediate safety concern.
Q2: A 72-year-old male with atrial fibrillation (CHADS2-VASc score 4) is prescribed apixaban for stroke
prevention. He also takes amiodarone for rate control. The NP should be aware that this combination:
A. Requires routine INR monitoring
B. Increases the risk of bleeding due to drug interaction [CORRECT]
C. Is contraindicated and should not be used together
D. Decreases apixaban efficacy requiring dose increase
,Correct Answer: B
Rationale: Amiodarone is a moderate CYP3A4 and P-glycoprotein inhibitor, which can increase
apixaban plasma levels and bleeding risk. Per prescribing information, dose reduction (2.5 mg BID)
should be considered if two or more risk factors present (age ≥80, weight ≤60 kg, creatinine ≥1.5
mg/dL). Distractor A – DOACs do NOT require INR monitoring (unlike warfarin). Distractor C – not
absolutely contraindicated but requires caution. Distractor D – levels increase, not decrease.
Q3: A 65-year-old male with heart failure with reduced ejection fraction (HFrEF, EF 35%) is on carvedilol
12.5 mg BID, lisinopril 20 mg daily, and furosemide 40 mg daily. He reports worsening dyspnea and
weight gain of 5 lbs in 3 days. What is the MOST appropriate adjustment?
A. Increase carvedilol to 25 mg BID
B. Increase lisinopril to 40 mg daily
C. Increase furosemide to 80 mg daily [CORRECT]
D. Add spironolactone 25 mg daily
Correct Answer: C
Rationale: Acute decompensation with volume overload (weight gain, dyspnea) requires diuretic
optimization first. Increasing furosemide addresses the immediate congestion. Per AHA/ACC guidelines,
GDMT optimization (carvedilol, ACE inhibitor) should occur when euvolemic. Spironolactone (D) is
appropriate for chronic HFrEF but not for acute decompensation. Beta-blocker increase (A) during
decompensation can worsen heart failure.
Q4: A 58-year-old male with hypertension is prescribed amlodipine 10 mg daily. At follow-up, he
complains of bilateral ankle edema. The edema is pitting, non-tender, and without erythema. What is
the MOST likely cause?
A. Heart failure exacerbation
B. Calcium channel blocker-induced vasodilation and capillary pressure increase [CORRECT]
C. Deep vein thrombosis
D. Renal failure
Correct Answer: B
Rationale: Dihydropyridine CCBs (amlodipine) cause pedal edema via preferential arteriolar
vasodilation (without commensurate venous dilation), leading to capillary hydrostatic pressure increase
and fluid extravasation. This is a dose-dependent, benign side effect (not allergic). Distractor A – would
have other signs (JVD, crackles). Distractor C – typically unilateral, painful, with risk factors. Distractor D
– would have other findings (elevated creatinine, decreased urine output).
, Q5: A 70-year-old female with atrial fibrillation on warfarin (INR therapeutic 2.5) develops a urinary tract
infection. Which antibiotic is SAFEST to prescribe?
A. Ciprofloxacin
B. Trimethoprim-sulfamethoxazole
C. Nitrofurantoin [CORRECT]
D. Metronidazole
Correct Answer: C
Rationale: Nitrofurantoin has minimal CYP450 interaction with warfarin and does NOT significantly
affect INR. Ciprofloxacin (A) and TMP-SMX (B) inhibit CYP1A2 and CYP2C9 respectively, increasing
warfarin effect and bleeding risk. Metronidazole (D) inhibits CYP2C9 and significantly potentiates
warfarin. Per IDSA guidelines, nitrofurantoin is first-line for uncomplicated UTI and safest with warfarin.
Q6: A 55-year-old male with hyperlipidemia is prescribed atorvastatin 40 mg daily. He also takes
clarithromycin for community-acquired pneumonia. What is the PRIMARY concern with this
combination?
A. Increased risk of myopathy/rhabdomyolysis [CORRECT]
B. Decreased statin efficacy
C. Increased risk of hepatotoxicity
D. QT prolongation
Correct Answer: A
Rationale: Clarithromycin is a strong CYP3A4 inhibitor. Atorvastatin is metabolized by CYP3A4;
concurrent use increases statin levels and myopathy/rhabdomyolysis risk. Per FDA guidance, avoid
simvastatin with strong CYP3A4 inhibitors; use lowest atorvastatin dose or temporarily hold. Distractor B
– efficacy is not decreased. Distractor C – hepatotoxicity is not the primary interaction. Distractor D –
clarithromycin causes QT prolongation, but this is not related to the statin interaction.
Q7: A 62-year-old female with hypertension and gout is prescribed hydrochlorothiazide 25 mg daily.
Which metabolic effect requires monitoring?
A. Hyperkalemia
B. Hyperuricemia and gout exacerbation [CORRECT]
C. Hypernatremia
D. Metabolic alkalosis with hypochloremia
Correct Answer: B
Rationale: Thiazide diuretics reduce uric acid excretion, causing hyperuricemia and can precipitate gout
attacks. This patient has pre-existing gout—thiazides are relatively contraindicated or require close
EXAM 2026/2027 | Pharmacology for
Advanced Practice | Verified Q&A | Pass
Guaranteed - A+ Graded
Time Limit: 2 hours
Passing Score: 90%
SECTION A: Cardiovascular Pharmacology (Questions 1-15)
Q1: A 68-year-old female with hypertension, type 2 diabetes, and stage 3 chronic kidney disease (eGFR
45 mL/min) is prescribed lisinopril 10 mg daily. Which laboratory value requires the MOST immediate
monitoring after starting this medication?
A. Hemoglobin A1c
B. Serum potassium [CORRECT]
C. LDL cholesterol
D. Urine albumin-to-creatinine ratio
Correct Answer: B
Rationale: ACE inhibitors (lisinopril) reduce aldosterone secretion, leading to potassium retention.
Hyperkalemia risk is significantly increased in CKD (eGFR <60) and diabetes. Per KDIGO and ADA
guidelines, potassium must be checked within 2-4 weeks of ACE inhibitor initiation in this high-risk
population. Distractor A – A1c reflects long-term glucose control, not acute safety. Distractor C – no
direct effect on lipids. Distractor D – urine albumin monitoring is important for diabetic nephropathy
assessment but not the most immediate safety concern.
Q2: A 72-year-old male with atrial fibrillation (CHADS2-VASc score 4) is prescribed apixaban for stroke
prevention. He also takes amiodarone for rate control. The NP should be aware that this combination:
A. Requires routine INR monitoring
B. Increases the risk of bleeding due to drug interaction [CORRECT]
C. Is contraindicated and should not be used together
D. Decreases apixaban efficacy requiring dose increase
,Correct Answer: B
Rationale: Amiodarone is a moderate CYP3A4 and P-glycoprotein inhibitor, which can increase
apixaban plasma levels and bleeding risk. Per prescribing information, dose reduction (2.5 mg BID)
should be considered if two or more risk factors present (age ≥80, weight ≤60 kg, creatinine ≥1.5
mg/dL). Distractor A – DOACs do NOT require INR monitoring (unlike warfarin). Distractor C – not
absolutely contraindicated but requires caution. Distractor D – levels increase, not decrease.
Q3: A 65-year-old male with heart failure with reduced ejection fraction (HFrEF, EF 35%) is on carvedilol
12.5 mg BID, lisinopril 20 mg daily, and furosemide 40 mg daily. He reports worsening dyspnea and
weight gain of 5 lbs in 3 days. What is the MOST appropriate adjustment?
A. Increase carvedilol to 25 mg BID
B. Increase lisinopril to 40 mg daily
C. Increase furosemide to 80 mg daily [CORRECT]
D. Add spironolactone 25 mg daily
Correct Answer: C
Rationale: Acute decompensation with volume overload (weight gain, dyspnea) requires diuretic
optimization first. Increasing furosemide addresses the immediate congestion. Per AHA/ACC guidelines,
GDMT optimization (carvedilol, ACE inhibitor) should occur when euvolemic. Spironolactone (D) is
appropriate for chronic HFrEF but not for acute decompensation. Beta-blocker increase (A) during
decompensation can worsen heart failure.
Q4: A 58-year-old male with hypertension is prescribed amlodipine 10 mg daily. At follow-up, he
complains of bilateral ankle edema. The edema is pitting, non-tender, and without erythema. What is
the MOST likely cause?
A. Heart failure exacerbation
B. Calcium channel blocker-induced vasodilation and capillary pressure increase [CORRECT]
C. Deep vein thrombosis
D. Renal failure
Correct Answer: B
Rationale: Dihydropyridine CCBs (amlodipine) cause pedal edema via preferential arteriolar
vasodilation (without commensurate venous dilation), leading to capillary hydrostatic pressure increase
and fluid extravasation. This is a dose-dependent, benign side effect (not allergic). Distractor A – would
have other signs (JVD, crackles). Distractor C – typically unilateral, painful, with risk factors. Distractor D
– would have other findings (elevated creatinine, decreased urine output).
, Q5: A 70-year-old female with atrial fibrillation on warfarin (INR therapeutic 2.5) develops a urinary tract
infection. Which antibiotic is SAFEST to prescribe?
A. Ciprofloxacin
B. Trimethoprim-sulfamethoxazole
C. Nitrofurantoin [CORRECT]
D. Metronidazole
Correct Answer: C
Rationale: Nitrofurantoin has minimal CYP450 interaction with warfarin and does NOT significantly
affect INR. Ciprofloxacin (A) and TMP-SMX (B) inhibit CYP1A2 and CYP2C9 respectively, increasing
warfarin effect and bleeding risk. Metronidazole (D) inhibits CYP2C9 and significantly potentiates
warfarin. Per IDSA guidelines, nitrofurantoin is first-line for uncomplicated UTI and safest with warfarin.
Q6: A 55-year-old male with hyperlipidemia is prescribed atorvastatin 40 mg daily. He also takes
clarithromycin for community-acquired pneumonia. What is the PRIMARY concern with this
combination?
A. Increased risk of myopathy/rhabdomyolysis [CORRECT]
B. Decreased statin efficacy
C. Increased risk of hepatotoxicity
D. QT prolongation
Correct Answer: A
Rationale: Clarithromycin is a strong CYP3A4 inhibitor. Atorvastatin is metabolized by CYP3A4;
concurrent use increases statin levels and myopathy/rhabdomyolysis risk. Per FDA guidance, avoid
simvastatin with strong CYP3A4 inhibitors; use lowest atorvastatin dose or temporarily hold. Distractor B
– efficacy is not decreased. Distractor C – hepatotoxicity is not the primary interaction. Distractor D –
clarithromycin causes QT prolongation, but this is not related to the statin interaction.
Q7: A 62-year-old female with hypertension and gout is prescribed hydrochlorothiazide 25 mg daily.
Which metabolic effect requires monitoring?
A. Hyperkalemia
B. Hyperuricemia and gout exacerbation [CORRECT]
C. Hypernatremia
D. Metabolic alkalosis with hypochloremia
Correct Answer: B
Rationale: Thiazide diuretics reduce uric acid excretion, causing hyperuricemia and can precipitate gout
attacks. This patient has pre-existing gout—thiazides are relatively contraindicated or require close
