NU 578 | Unit 3
OBJECTIVE ASSESSMENT - EXAM
NU 578 Unit 3 Exam (2026/2027
Update) University Of South
Alabama, Questions & Answers
(Verified Answers) | Complete
A+ Guide - PDF
Pharmacology for Advanced Practice Nurses | Board Exam
100 100%
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
o Heart Failure & Antiarrhythmic Drug Therapy o Anticoagulation & Lipid Management
o Diuretics & RAAS Modulation o Renal Disease Pharmacokinetics
o Antihypertensive Agent Selection o Geriatric & Pediatric Dosing Considerations
COVER PAGE - 1
, SECTION 1 | Cardiovascular Pharmacology | Q1-Q25 | NU 578 Unit 3 Exam (2026/2027 Update) University O
Q1 Question 1 of 100
A 68-year-old male with a history of chronic heart failure presents with worsening
dyspnea and peripheral edema despite adherence to his current regimen. His
ejection fraction is 35%. The nurse practitioner decides to initiate an agent that
reduces preload and afterload while inhibiting neurohormonal activation. Which
medication best fits this mechanism?
A. Digoxin
B. Enalapril
C. Diltiazem
D. Atenolol
Correct Answer: B
Rationale:
ACE inhibitors such as enalapril reduce preload and afterload by decreasing angiotensin II-mediated
vasoconstriction and aldosterone secretion, thereby inhibiting detrimental neurohormonal activation in
heart failure. Digoxin improves contractility but does not significantly reduce preload or afterload.
Diltiazem and atenolol are not first-line in this scenario and may worsen heart failure.
Q2 Question 2 of 100
A 54-year-old woman with atrial fibrillation and a CHA2DS2-VASc score of 4 is
started on warfarin. Two weeks later, her INR is 3.8. She reports dark stools and mild
epigastric discomfort. What is the most appropriate immediate intervention?
A. Discontinue warfarin and administer vitamin K 10 mg orally
B. Hold the next dose and administer vitamin K 2.5 mg orally
C. Continue warfarin and recheck INR in one week
D. Switch to rivaroxaban immediately
Correct Answer: B
Rationale:
An INR of 3.8 with minor bleeding signs warrants holding the next warfarin dose and giving a low dose of
oral vitamin K (2.5 mg) to gradually lower the INR without causing resistance. High-dose vitamin K is
reserved for serious bleeding. Continuing warfarin or switching agents without addressing the
supratherapeutic INR is unsafe.
NU 578 Unit 3 Exam (2026/2027 Update) University Of South Alabama, Questions & Answers (Verified Answers) | Complete A+ Guide - PDF -- 2026/2027 | P
, Q3 Question 3 of 100
A 72-year-old male with stable angina reports that his chest pain episodes have
increased to 3-4 times per week despite using sublingual nitroglycerin. His blood
pressure is 128/78 mmHg and heart rate is 76 bpm. Which long-acting antianginal
agent is most appropriate to add?
A. Amlodipine
B. Isosorbide mononitrate
C. Propranolol
D. Ranolazine
Correct Answer: A
Rationale:
Amlodipine, a dihydropyridine calcium channel blocker, is effective for vasospastic and stable angina,
reduces myocardial oxygen demand by lowering afterload, and is safe when blood pressure and heart
rate are well-controlled. Propranolol could be considered but is less ideal if the patient is already at a
low-normal heart rate. Ranolazine is typically reserved for refractory angina.
Q4 Question 4 of 100
A 45-year-old man with a history of myocardial infarction six months ago presents
for follow-up. He is currently on metoprolol, lisinopril, and atorvastatin. His LDL
cholesterol is 78 mg/dL. According to current guidelines, what is the next best step
in his lipid management?
A. Increase atorvastatin to 80 mg daily
B. Add ezetimibe to further lower LDL
C. Continue current atorvastatin dose and monitor
D. Switch to rosuvastatin 40 mg daily
Correct Answer: C
Rationale:
For secondary prevention in a patient with prior MI, an LDL below 100 mg/dL on moderate-to-high
intensity statin therapy is generally acceptable, and continuing the current regimen with monitoring is
appropriate. Adding ezetimibe or switching to higher doses is not indicated unless LDL remains above
goal or the patient has additional high-risk features.
NU 578 Unit 3 Exam (2026/2027 Update) University Of South Alabama, Questions & Answers (Verified Answers) | Complete A+ Guide - PDF -- 2026/2027 | P
, Q5 Question 5 of 100
A 62-year-old female with hypertension and type 2 diabetes mellitus has a serum
potassium of 5.2 mEq/L and a creatinine of 1.8 mg/dL. She is currently taking
lisinopril 20 mg daily. Which modification is most appropriate?
A. Reduce lisinopril to 10 mg and recheck labs in one week
B. Discontinue lisinopril and start losartan
C. Continue lisinopril and add a thiazide diuretic
D. Discontinue lisinopril and start amlodipine
Correct Answer: A
Rationale:
Mild hyperkalemia (5.2 mEq/L) and elevated creatinine in a patient on an ACE inhibitor warrant dose
reduction and close monitoring rather than immediate discontinuation, especially since the medication
provides renal and cardiovascular protection. Switching to losartan may not resolve hyperkalemia, as
ARBs have a similar effect. Adding a thiazide or discontinuing entirely is premature without attempting
dose adjustment.
Q6 Question 6 of 100
A 58-year-old man with paroxysmal atrial fibrillation is started on flecainide for
rhythm control. Before initiating therapy, the nurse practitioner must confirm which
of the following?
A. The patient has no history of structural heart disease
B. The patient has a left ventricular ejection fraction greater than 40%
C. The patient is concurrently on a beta-blocker
D. The patient has a normal thyroid-stimulating hormone level
Correct Answer: A
Rationale:
Flecainide is contraindicated in patients with structural heart disease due to an increased risk of
proarrhythmia and mortality, as demonstrated in the CAST trial. While beta-blocker coadministration and
normal thyroid function are clinically relevant, the absolute prerequisite for flecainide use is the absence
of structural heart disease.
NU 578 Unit 3 Exam (2026/2027 Update) University Of South Alabama, Questions & Answers (Verified Answers) | Complete A+ Guide - PDF -- 2026/2027 | P
OBJECTIVE ASSESSMENT - EXAM
NU 578 Unit 3 Exam (2026/2027
Update) University Of South
Alabama, Questions & Answers
(Verified Answers) | Complete
A+ Guide - PDF
Pharmacology for Advanced Practice Nurses | Board Exam
100 100%
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
o Heart Failure & Antiarrhythmic Drug Therapy o Anticoagulation & Lipid Management
o Diuretics & RAAS Modulation o Renal Disease Pharmacokinetics
o Antihypertensive Agent Selection o Geriatric & Pediatric Dosing Considerations
COVER PAGE - 1
, SECTION 1 | Cardiovascular Pharmacology | Q1-Q25 | NU 578 Unit 3 Exam (2026/2027 Update) University O
Q1 Question 1 of 100
A 68-year-old male with a history of chronic heart failure presents with worsening
dyspnea and peripheral edema despite adherence to his current regimen. His
ejection fraction is 35%. The nurse practitioner decides to initiate an agent that
reduces preload and afterload while inhibiting neurohormonal activation. Which
medication best fits this mechanism?
A. Digoxin
B. Enalapril
C. Diltiazem
D. Atenolol
Correct Answer: B
Rationale:
ACE inhibitors such as enalapril reduce preload and afterload by decreasing angiotensin II-mediated
vasoconstriction and aldosterone secretion, thereby inhibiting detrimental neurohormonal activation in
heart failure. Digoxin improves contractility but does not significantly reduce preload or afterload.
Diltiazem and atenolol are not first-line in this scenario and may worsen heart failure.
Q2 Question 2 of 100
A 54-year-old woman with atrial fibrillation and a CHA2DS2-VASc score of 4 is
started on warfarin. Two weeks later, her INR is 3.8. She reports dark stools and mild
epigastric discomfort. What is the most appropriate immediate intervention?
A. Discontinue warfarin and administer vitamin K 10 mg orally
B. Hold the next dose and administer vitamin K 2.5 mg orally
C. Continue warfarin and recheck INR in one week
D. Switch to rivaroxaban immediately
Correct Answer: B
Rationale:
An INR of 3.8 with minor bleeding signs warrants holding the next warfarin dose and giving a low dose of
oral vitamin K (2.5 mg) to gradually lower the INR without causing resistance. High-dose vitamin K is
reserved for serious bleeding. Continuing warfarin or switching agents without addressing the
supratherapeutic INR is unsafe.
NU 578 Unit 3 Exam (2026/2027 Update) University Of South Alabama, Questions & Answers (Verified Answers) | Complete A+ Guide - PDF -- 2026/2027 | P
, Q3 Question 3 of 100
A 72-year-old male with stable angina reports that his chest pain episodes have
increased to 3-4 times per week despite using sublingual nitroglycerin. His blood
pressure is 128/78 mmHg and heart rate is 76 bpm. Which long-acting antianginal
agent is most appropriate to add?
A. Amlodipine
B. Isosorbide mononitrate
C. Propranolol
D. Ranolazine
Correct Answer: A
Rationale:
Amlodipine, a dihydropyridine calcium channel blocker, is effective for vasospastic and stable angina,
reduces myocardial oxygen demand by lowering afterload, and is safe when blood pressure and heart
rate are well-controlled. Propranolol could be considered but is less ideal if the patient is already at a
low-normal heart rate. Ranolazine is typically reserved for refractory angina.
Q4 Question 4 of 100
A 45-year-old man with a history of myocardial infarction six months ago presents
for follow-up. He is currently on metoprolol, lisinopril, and atorvastatin. His LDL
cholesterol is 78 mg/dL. According to current guidelines, what is the next best step
in his lipid management?
A. Increase atorvastatin to 80 mg daily
B. Add ezetimibe to further lower LDL
C. Continue current atorvastatin dose and monitor
D. Switch to rosuvastatin 40 mg daily
Correct Answer: C
Rationale:
For secondary prevention in a patient with prior MI, an LDL below 100 mg/dL on moderate-to-high
intensity statin therapy is generally acceptable, and continuing the current regimen with monitoring is
appropriate. Adding ezetimibe or switching to higher doses is not indicated unless LDL remains above
goal or the patient has additional high-risk features.
NU 578 Unit 3 Exam (2026/2027 Update) University Of South Alabama, Questions & Answers (Verified Answers) | Complete A+ Guide - PDF -- 2026/2027 | P
, Q5 Question 5 of 100
A 62-year-old female with hypertension and type 2 diabetes mellitus has a serum
potassium of 5.2 mEq/L and a creatinine of 1.8 mg/dL. She is currently taking
lisinopril 20 mg daily. Which modification is most appropriate?
A. Reduce lisinopril to 10 mg and recheck labs in one week
B. Discontinue lisinopril and start losartan
C. Continue lisinopril and add a thiazide diuretic
D. Discontinue lisinopril and start amlodipine
Correct Answer: A
Rationale:
Mild hyperkalemia (5.2 mEq/L) and elevated creatinine in a patient on an ACE inhibitor warrant dose
reduction and close monitoring rather than immediate discontinuation, especially since the medication
provides renal and cardiovascular protection. Switching to losartan may not resolve hyperkalemia, as
ARBs have a similar effect. Adding a thiazide or discontinuing entirely is premature without attempting
dose adjustment.
Q6 Question 6 of 100
A 58-year-old man with paroxysmal atrial fibrillation is started on flecainide for
rhythm control. Before initiating therapy, the nurse practitioner must confirm which
of the following?
A. The patient has no history of structural heart disease
B. The patient has a left ventricular ejection fraction greater than 40%
C. The patient is concurrently on a beta-blocker
D. The patient has a normal thyroid-stimulating hormone level
Correct Answer: A
Rationale:
Flecainide is contraindicated in patients with structural heart disease due to an increased risk of
proarrhythmia and mortality, as demonstrated in the CAST trial. While beta-blocker coadministration and
normal thyroid function are clinically relevant, the absolute prerequisite for flecainide use is the absence
of structural heart disease.
NU 578 Unit 3 Exam (2026/2027 Update) University Of South Alabama, Questions & Answers (Verified Answers) | Complete A+ Guide - PDF -- 2026/2027 | P
