NSG 533 Advanced Pharmacology Exam
2 Wilkes University Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
[SECTION 1: Questions 1-10] - Cardiovascular Pharmacology
Q1: A 65-year-old male with heart failure with reduced ejection fraction (HFrEF) and
hypertension is prescribed lisinopril. Which mechanism of action best explains lisinopril’s
therapeutic effect in HFrEF?
A. Blockade of beta-1 adrenergic receptors to reduce heart rate
B. Inhibition of angiotensin-converting enzyme to reduce angiotensin II production
C. Direct vasodilation of arterial smooth muscle via calcium channel blockade
D. Inhibition of aldosterone receptors to promote sodium excretion
Correct Answer: B
Rationale: Lisinopril, an ACE inhibitor, reduces angiotensin II production, decreasing
vasoconstriction and aldosterone release, which improves cardiac remodeling in HFrEF.
This aligns with ACC/AHA guidelines for HFrEF management. Beta-blockers (A) target
heart rate, calcium channel blockers (C) are less preferred in HFrEF, and aldosterone
antagonists (D) like spironolactone are add-on therapies, not ACE inhibitors’ primary
mechanism.
,Q2: A patient on warfarin therapy for atrial fibrillation develops an INR of 8.0 without
bleeding. Which intervention is most appropriate?
A. Administer vitamin K 10 mg IV immediately
B. Hold warfarin and administer vitamin K 2.5-5 mg orally
C. Continue warfarin and increase dose by 10%
D. Switch to dabigatran 150 mg twice daily
Correct Answer: B
Rationale: For INR >5 without bleeding, holding warfarin and giving low-dose oral vitamin K
(2.5-5 mg) reverses excess anticoagulation safely. per FDA guidelines. High-dose IV
vitamin K (A) risks anaphylaxis, continuing warfarin (C) exacerbates bleeding risk, and
dabigatran (D) requires normal renal function and is not a direct reversal agent.
Q3: Which antiarrhythmic agent is preferred for acute conversion of stable monomorphic
ventricular tachycardia in a patient with preserved left ventricular function?
A. Amiodarone
B. Lidocaine
C. Procainamide
D. Diltiazem
Correct Answer: C
Rationale: Procainamide, a class Ia antiarrhythmic, is effective for acute VT conversion in
structurally normal hearts per ACLS guidelines. Amiodarone (A) is preferred in structural
heart disease, lidocaine (B) is less effective for VT, and diltiazem (D) is contraindicated in
VT as it may worsen hemodynamics.
Q4: A patient with hypertension and benign prostatic hyperplasia (BPH) would benefit most
from which antihypertensive agent?
A. Atenolol
B. Tamsulosin
, C. Losartan
D. Amlodipine
Correct Answer: B
Rationale: Tamsulosin, an alpha-1 blocker, reduces blood pressure and relieves BPH
symptoms by relaxing prostate smooth muscle. This dual benefit aligns with clinical
guidelines for comorbid hypertension and BPH. Beta-blockers (A), ARBs (C), and CCBs
(D) lack specific BPH benefits.
Q5: Which anticoagulant requires monitoring of activated partial thromboplastin time
(aPTT) for dose adjustment?
A. Rivaroxaban
B. Dabigatran
C. Unfractionated heparin
D. Apixaban
Correct Answer: C
Rationale: Unfractionated heparin’s effect is monitored via aPTT due to its variable
pharmacokinetics, per FDA labeling. Direct oral anticoagulants (A, B, D) have predictable
effects and do not require routine aPTT monitoring.
Q6: A patient with hypertension and chronic kidney disease (CKD) stage 3 should avoid
which antihypertensive due to risk of hyperkalemia?
A. Furosemide
B. Spironolactone
C. Amlodipine
D. Hydralazine
Correct Answer: B
Rationale: Spironolactone, an aldosterone antagonist, can cause hyperkalemia in CKD
2 Wilkes University Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
[SECTION 1: Questions 1-10] - Cardiovascular Pharmacology
Q1: A 65-year-old male with heart failure with reduced ejection fraction (HFrEF) and
hypertension is prescribed lisinopril. Which mechanism of action best explains lisinopril’s
therapeutic effect in HFrEF?
A. Blockade of beta-1 adrenergic receptors to reduce heart rate
B. Inhibition of angiotensin-converting enzyme to reduce angiotensin II production
C. Direct vasodilation of arterial smooth muscle via calcium channel blockade
D. Inhibition of aldosterone receptors to promote sodium excretion
Correct Answer: B
Rationale: Lisinopril, an ACE inhibitor, reduces angiotensin II production, decreasing
vasoconstriction and aldosterone release, which improves cardiac remodeling in HFrEF.
This aligns with ACC/AHA guidelines for HFrEF management. Beta-blockers (A) target
heart rate, calcium channel blockers (C) are less preferred in HFrEF, and aldosterone
antagonists (D) like spironolactone are add-on therapies, not ACE inhibitors’ primary
mechanism.
,Q2: A patient on warfarin therapy for atrial fibrillation develops an INR of 8.0 without
bleeding. Which intervention is most appropriate?
A. Administer vitamin K 10 mg IV immediately
B. Hold warfarin and administer vitamin K 2.5-5 mg orally
C. Continue warfarin and increase dose by 10%
D. Switch to dabigatran 150 mg twice daily
Correct Answer: B
Rationale: For INR >5 without bleeding, holding warfarin and giving low-dose oral vitamin K
(2.5-5 mg) reverses excess anticoagulation safely. per FDA guidelines. High-dose IV
vitamin K (A) risks anaphylaxis, continuing warfarin (C) exacerbates bleeding risk, and
dabigatran (D) requires normal renal function and is not a direct reversal agent.
Q3: Which antiarrhythmic agent is preferred for acute conversion of stable monomorphic
ventricular tachycardia in a patient with preserved left ventricular function?
A. Amiodarone
B. Lidocaine
C. Procainamide
D. Diltiazem
Correct Answer: C
Rationale: Procainamide, a class Ia antiarrhythmic, is effective for acute VT conversion in
structurally normal hearts per ACLS guidelines. Amiodarone (A) is preferred in structural
heart disease, lidocaine (B) is less effective for VT, and diltiazem (D) is contraindicated in
VT as it may worsen hemodynamics.
Q4: A patient with hypertension and benign prostatic hyperplasia (BPH) would benefit most
from which antihypertensive agent?
A. Atenolol
B. Tamsulosin
, C. Losartan
D. Amlodipine
Correct Answer: B
Rationale: Tamsulosin, an alpha-1 blocker, reduces blood pressure and relieves BPH
symptoms by relaxing prostate smooth muscle. This dual benefit aligns with clinical
guidelines for comorbid hypertension and BPH. Beta-blockers (A), ARBs (C), and CCBs
(D) lack specific BPH benefits.
Q5: Which anticoagulant requires monitoring of activated partial thromboplastin time
(aPTT) for dose adjustment?
A. Rivaroxaban
B. Dabigatran
C. Unfractionated heparin
D. Apixaban
Correct Answer: C
Rationale: Unfractionated heparin’s effect is monitored via aPTT due to its variable
pharmacokinetics, per FDA labeling. Direct oral anticoagulants (A, B, D) have predictable
effects and do not require routine aPTT monitoring.
Q6: A patient with hypertension and chronic kidney disease (CKD) stage 3 should avoid
which antihypertensive due to risk of hyperkalemia?
A. Furosemide
B. Spironolactone
C. Amlodipine
D. Hydralazine
Correct Answer: B
Rationale: Spironolactone, an aldosterone antagonist, can cause hyperkalemia in CKD
