NR 566 Advanced Pharmacology For Care Of The Family Week
5- & Answers (Verified Answers) Chamberlain University (
Update) - 177 Questions
This exam assesses advanced understanding of cardiovascular pharmacology for family care, including
pharmacokinetics, pharmacodynamics, clinical application, and evidence-based prescribing of antihypertensives,
antiarrhythmics, anticoagulants, and lipid-lowering agents. Questions require synthesis of guidelines, drug
interactions, adverse effects, and patient-specific considerations. It contains 177 multiple-choice questions, each
with four distractors and a fully worked rationale that explains why the keyed answer is correct. Content is
organized into 10 focused sections: Cardiovascular Pharmacology, Endocrine Pharmacology, Neurological and
Psychiatric Pharmacology, Respiratory Pharmacology, Gastrointestinal Pharmacology, Infectious Disease
Pharmacology, Pain Management and Analgesics, Women's Health and Reproductive Pharmacology, Pediatric
and Geriatric Pharmacotherapy, Pharmacokinetics and Pharmacodynamics. Targeted learning outcomes include:
Analyze the mechanisms of action, indications, and contraindications of major cardiovascular drug classes.;
Evaluate drug-drug interactions and adverse effects in the context of polypharmacy and comorbidities.; Apply
clinical guidelines to select appropriate pharmacotherapy for hypertension, heart failure, arrhythmias, and
dyslipidemia.; Integrate pharmacokinetic principles to optimize dosing and monitoring in diverse patient
populations.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that students
can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
Section 1: Cardiovascular Pharmacology (Questions 1-20)
1 A patient with resistant hypertension is currently on a maximally tolerated dose of lisinopril, amlodipine, and
hydrochlorothiazide. Despite adherence, blood pressure remains 158/96 mmHg. Which additional agent is most
appropriate based on current guidelines, and what is the primary mechanism of action?
A) Spironolactone; aldosterone receptor antagonist
B) Clonidine; central alpha-2 agonist
C) Doxazosin; alpha-1 blocker
D) Minoxidil; direct vasodilator
Answer: A
Rationale: Spironolactone is recommended as the fourth agent in resistant hypertension due to its
aldosterone-blocking effect, which reduces sodium and water retention. Clonidine, doxazosin, and minoxidil are
less preferred because they are associated with more adverse effects and lack mortality benefit in this setting.
2 A patient with chronic heart failure with reduced ejection fraction (HFrEF) is on a beta-blocker, ACE inhibitor,
and loop diuretic. The ejection fraction is 35%. Which of the following pharmacologic interventions has been
shown to reduce mortality in this population and should be considered next?
A) Add digoxin
B) Add sacubitril/valsartan
C) Switch ACE inhibitor to hydralazine/isosorbide dinitrate
D) Add dronedarone
Answer: B
Rationale: Sacubitril/valsartan (ARNI) has demonstrated superior reduction in cardiovascular death and heart failure
hospitalizations compared to ACE inhibitors alone. Digoxin reduces hospitalizations but not mortality.
Hydralazine/isosorbide dinitrate is reserved for African Americans not tolerating ACE inhibitors. Dronedarone is
contraindicated in HFrEF due to increased mortality.
,3 A patient on warfarin for atrial fibrillation presents with an INR of 7.2 and minor epistaxis. Which of the
following is the most appropriate immediate management?
A) Administer vitamin K 10 mg orally
B) Administer fresh frozen plasma
C) Hold warfarin and give vitamin K 1 mg orally
D) Administer prothrombin complex concentrate
Answer: C
Rationale: For an INR >6 but <9 with minor bleeding, guidelines recommend holding warfarin and giving low-dose
(1 mg) oral vitamin K. Higher doses (10 mg) are for serious bleeding. Fresh frozen plasma and prothrombin
complex concentrate are reserved for life-threatening hemorrhage.
4 Which of the following best explains the increased risk of atrial fibrillation in patients with hyperthyroidism?
A) Increased sympathetic tone and shortened atrial refractory period
B) Direct thyrotoxic myocardial injury leading to fibrosis
C) Increased vagal tone causing bradycardia-induced arrhythmia
D) Autoantibodies cross-reacting with cardiac sodium channels
Answer: A
Rationale: Hyperthyroidism increases beta-adrenergic sensitivity and shortens the atrial effective refractory period,
predisposing to atrial fibrillation. Fibrosis (B) is not a direct acute effect. Vagal tone is decreased, not increased.
Autoantibodies (D) are not the primary mechanism.
5 A patient with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD) is being started
on a statin. Which of the following statins and intensities is recommended by the ACC/AHA guidelines for
secondary prevention?
A) Atorvastatin 10 mg daily (moderate intensity)
B) Rosuvastatin 40 mg daily (high intensity)
C) Simvastatin 40 mg daily (moderate intensity)
D) Pravastatin 80 mg daily (high intensity)
Answer: B
Rationale: For patients with ASCVD, high-intensity statin therapy (atorvastatin 40-80 mg or rosuvastatin 20-40 mg)
is recommended to achieve 50% LDL reduction. Atorvastatin 10 mg is moderate, simvastatin 40 mg is moderate,
and pravastatin 80 mg is moderate (not high intensity).
6 A patient with atrial fibrillation and a CHA2DS2-VASc score of 4 is started on apixaban. Which of the
following statements about apixaban monitoring and reversal is correct?
A) Routine INR monitoring is required to ensure therapeutic levels
B) Andexanet alfa is FDA-approved for reversal of apixaban in life-threatening bleeding
C) Apixaban is contraindicated in patients with a creatinine clearance of 25 mL/min
D) Apixaban has a higher risk of gastrointestinal bleeding compared to warfarin
Answer: B
Rationale: Andexanet alfa is a specific reversal agent for factor Xa inhibitors including apixaban. INR monitoring is
not required. Apixaban is not contraindicated in CrCl 25 mL/min but requires dose reduction. Apixaban has a lower
risk of GI bleeding than warfarin.
7 A patient with hypertension and asthma is being treated with a beta-blocker. Which of the following
beta-blockers would be the safest choice due to its cardioselectivity?
A) Propranolol
,B) Metoprolol
C) Labetalol
D) Carvedilol
Answer: B
Rationale: Metoprolol is a cardioselective beta-1 blocker, making it safer in asthma compared to non-selective
agents like propranolol, labetalol, and carvedilol, which can block beta-2 receptors and precipitate bronchospasm.
8 A patient with coronary artery disease is started on ticagrelor in addition to aspirin. Which of the following is a
unique adverse effect of ticagrelor that requires patient education?
A) Increased risk of gout
B) Dyspnea that is usually self-limiting
C) QT prolongation
D) Hepatic enzyme elevation
Answer: B
Rationale: Ticagrelor commonly causes dyspnea, thought to be due to adenosine reuptake inhibition; it is generally
mild and resolves without treatment. Gout (A) is more associated with thiazides. QT prolongation (C) is not
typical. Hepatic enzyme elevation (D) is less common and usually asymptomatic.
9 A patient with heart failure with preserved ejection fraction (HFpEF) has persistent symptoms despite diuretic
therapy. Which of the following medications has been shown to reduce heart failure hospitalizations in this
population?
A) Sacubitril/valsartan
B) Spironolactone
C) Dapagliflozin
D) Ivabradine
Answer: C
Rationale: Dapagliflozin (SGLT2 inhibitor) has been shown to reduce heart failure hospitalizations in patients with
HFpEF (DELIVER trial). Sacubitril/valsartan showed benefit in a subgroup with lower EF. Spironolactone
(TOPCAT) was neutral overall. Ivabradine is only for HFrEF.
10 A patient presents with acute chest pain and ECG shows ST-segment elevation in leads V1-V4. Which of the
following antiplatelet regimens is recommended as part of immediate management for ST-elevation myocardial
infarction (STEMI)?
A) Aspirin plus clopidogrel
B) Aspirin plus ticagrelor
C) Aspirin plus prasugrel
D) Ticagrelor alone
Answer: B
Rationale: Current guidelines recommend dual antiplatelet therapy with aspirin and a potent P2Y12 inhibitor
(ticagrelor or prasugrel) for STEMI. Ticagrelor is preferred over prasugrel in patients with uncertain coronary
anatomy or high bleeding risk. Clopidogrel is less potent and reserved for when others are contraindicated.
Ticagrelor alone is not recommended.
11 A patient with chronic heart failure (HFrEF, NYHA class III) is currently on lisinopril 20 mg daily, metoprolol
succinate 100 mg daily, and furosemide 40 mg daily. The patient develops new-onset atrial fibrillation with
rapid ventricular response. Which of the following is the most appropriate next step in pharmacotherapy?
A) Add digoxin 0.125 mg daily
, B) Add amiodarone 200 mg daily
C) Increase metoprolol succinate to 200 mg daily
D) Add diltiazem extended-release 180 mg daily
Answer: C
Rationale: In HFrEF, beta-blockers (e.g., metoprolol succinate) are first-line for rate control in atrial fibrillation due
to their mortality benefit. Increasing the dose is preferred over adding a new agent. Digoxin may be used but is
second-line. Amiodarone is for rhythm control. Diltiazem is contraindicated in HFrEF due to negative inotropic
effects.
12 A patient with essential hypertension has been on hydrochlorothiazide 25 mg daily for 6 months. Current blood
pressure is 148/92 mm Hg. Serum potassium is 3.3 mEq/L. Which of the following changes is most
appropriate?
A) Add lisinopril 10 mg daily
B) Increase hydrochlorothiazide to 50 mg daily
C) Add spironolactone 25 mg daily
D) Switch to chlorthalidone 25 mg daily
Answer: A
Rationale: Hypokalemia is a known adverse effect of thiazides. Adding an ACE inhibitor (lisinopril) can counteract
potassium loss and provide additive antihypertensive effect. Increasing thiazide dose would worsen hypokalemia.
Spironolactone is a potassium-sparing diuretic but is not first-line add-on. Chlorthalidone is similar to HCTZ and
would not correct hypokalemia.
13 A patient with stable angina and a history of severe asthma presents with persistent chest pain despite
sublingual nitroglycerin. Which of the following antianginal agents is most appropriate to add?
A) Metoprolol
B) Amlodipine
C) Verapamil
D) Ranolazine
Answer: D
Rationale: Ranolazine is a first-line add-on for angina in patients with contraindications to beta-blockers or calcium
channel blockers. Beta-blockers (metoprolol) are relatively contraindicated in asthma. Verapamil and diltiazem can
exacerbate asthma due to bronchospasm risk. Amlodipine is generally safe but may not be optimal if asthma is
severe; ranolazine has no bronchoconstrictive effects.
14 A patient with hypertension and chronic kidney disease (eGFR 35 mL/min/1.73 m²) is on lisinopril 20 mg
daily. Serum potassium is 5.6 mEq/L. What is the most appropriate action?
A) Continue lisinopril and add a loop diuretic
B) Discontinue lisinopril and start amlodipine
C) Reduce lisinopril to 10 mg daily
D) Add spironolactone 25 mg daily
Answer: B
Rationale: Hyperkalemia (K+ >5.5) with ACE inhibitor in CKD requires discontinuation of the ACE inhibitor.
Amlodipine is a safe alternative that does not affect potassium. Continuing lisinopril with a loop diuretic may not
adequately lower potassium. Reducing dose is insufficient. Adding spironolactone would worsen hyperkalemia.
5- & Answers (Verified Answers) Chamberlain University (
Update) - 177 Questions
This exam assesses advanced understanding of cardiovascular pharmacology for family care, including
pharmacokinetics, pharmacodynamics, clinical application, and evidence-based prescribing of antihypertensives,
antiarrhythmics, anticoagulants, and lipid-lowering agents. Questions require synthesis of guidelines, drug
interactions, adverse effects, and patient-specific considerations. It contains 177 multiple-choice questions, each
with four distractors and a fully worked rationale that explains why the keyed answer is correct. Content is
organized into 10 focused sections: Cardiovascular Pharmacology, Endocrine Pharmacology, Neurological and
Psychiatric Pharmacology, Respiratory Pharmacology, Gastrointestinal Pharmacology, Infectious Disease
Pharmacology, Pain Management and Analgesics, Women's Health and Reproductive Pharmacology, Pediatric
and Geriatric Pharmacotherapy, Pharmacokinetics and Pharmacodynamics. Targeted learning outcomes include:
Analyze the mechanisms of action, indications, and contraindications of major cardiovascular drug classes.;
Evaluate drug-drug interactions and adverse effects in the context of polypharmacy and comorbidities.; Apply
clinical guidelines to select appropriate pharmacotherapy for hypertension, heart failure, arrhythmias, and
dyslipidemia.; Integrate pharmacokinetic principles to optimize dosing and monitoring in diverse patient
populations.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that students
can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
Section 1: Cardiovascular Pharmacology (Questions 1-20)
1 A patient with resistant hypertension is currently on a maximally tolerated dose of lisinopril, amlodipine, and
hydrochlorothiazide. Despite adherence, blood pressure remains 158/96 mmHg. Which additional agent is most
appropriate based on current guidelines, and what is the primary mechanism of action?
A) Spironolactone; aldosterone receptor antagonist
B) Clonidine; central alpha-2 agonist
C) Doxazosin; alpha-1 blocker
D) Minoxidil; direct vasodilator
Answer: A
Rationale: Spironolactone is recommended as the fourth agent in resistant hypertension due to its
aldosterone-blocking effect, which reduces sodium and water retention. Clonidine, doxazosin, and minoxidil are
less preferred because they are associated with more adverse effects and lack mortality benefit in this setting.
2 A patient with chronic heart failure with reduced ejection fraction (HFrEF) is on a beta-blocker, ACE inhibitor,
and loop diuretic. The ejection fraction is 35%. Which of the following pharmacologic interventions has been
shown to reduce mortality in this population and should be considered next?
A) Add digoxin
B) Add sacubitril/valsartan
C) Switch ACE inhibitor to hydralazine/isosorbide dinitrate
D) Add dronedarone
Answer: B
Rationale: Sacubitril/valsartan (ARNI) has demonstrated superior reduction in cardiovascular death and heart failure
hospitalizations compared to ACE inhibitors alone. Digoxin reduces hospitalizations but not mortality.
Hydralazine/isosorbide dinitrate is reserved for African Americans not tolerating ACE inhibitors. Dronedarone is
contraindicated in HFrEF due to increased mortality.
,3 A patient on warfarin for atrial fibrillation presents with an INR of 7.2 and minor epistaxis. Which of the
following is the most appropriate immediate management?
A) Administer vitamin K 10 mg orally
B) Administer fresh frozen plasma
C) Hold warfarin and give vitamin K 1 mg orally
D) Administer prothrombin complex concentrate
Answer: C
Rationale: For an INR >6 but <9 with minor bleeding, guidelines recommend holding warfarin and giving low-dose
(1 mg) oral vitamin K. Higher doses (10 mg) are for serious bleeding. Fresh frozen plasma and prothrombin
complex concentrate are reserved for life-threatening hemorrhage.
4 Which of the following best explains the increased risk of atrial fibrillation in patients with hyperthyroidism?
A) Increased sympathetic tone and shortened atrial refractory period
B) Direct thyrotoxic myocardial injury leading to fibrosis
C) Increased vagal tone causing bradycardia-induced arrhythmia
D) Autoantibodies cross-reacting with cardiac sodium channels
Answer: A
Rationale: Hyperthyroidism increases beta-adrenergic sensitivity and shortens the atrial effective refractory period,
predisposing to atrial fibrillation. Fibrosis (B) is not a direct acute effect. Vagal tone is decreased, not increased.
Autoantibodies (D) are not the primary mechanism.
5 A patient with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD) is being started
on a statin. Which of the following statins and intensities is recommended by the ACC/AHA guidelines for
secondary prevention?
A) Atorvastatin 10 mg daily (moderate intensity)
B) Rosuvastatin 40 mg daily (high intensity)
C) Simvastatin 40 mg daily (moderate intensity)
D) Pravastatin 80 mg daily (high intensity)
Answer: B
Rationale: For patients with ASCVD, high-intensity statin therapy (atorvastatin 40-80 mg or rosuvastatin 20-40 mg)
is recommended to achieve 50% LDL reduction. Atorvastatin 10 mg is moderate, simvastatin 40 mg is moderate,
and pravastatin 80 mg is moderate (not high intensity).
6 A patient with atrial fibrillation and a CHA2DS2-VASc score of 4 is started on apixaban. Which of the
following statements about apixaban monitoring and reversal is correct?
A) Routine INR monitoring is required to ensure therapeutic levels
B) Andexanet alfa is FDA-approved for reversal of apixaban in life-threatening bleeding
C) Apixaban is contraindicated in patients with a creatinine clearance of 25 mL/min
D) Apixaban has a higher risk of gastrointestinal bleeding compared to warfarin
Answer: B
Rationale: Andexanet alfa is a specific reversal agent for factor Xa inhibitors including apixaban. INR monitoring is
not required. Apixaban is not contraindicated in CrCl 25 mL/min but requires dose reduction. Apixaban has a lower
risk of GI bleeding than warfarin.
7 A patient with hypertension and asthma is being treated with a beta-blocker. Which of the following
beta-blockers would be the safest choice due to its cardioselectivity?
A) Propranolol
,B) Metoprolol
C) Labetalol
D) Carvedilol
Answer: B
Rationale: Metoprolol is a cardioselective beta-1 blocker, making it safer in asthma compared to non-selective
agents like propranolol, labetalol, and carvedilol, which can block beta-2 receptors and precipitate bronchospasm.
8 A patient with coronary artery disease is started on ticagrelor in addition to aspirin. Which of the following is a
unique adverse effect of ticagrelor that requires patient education?
A) Increased risk of gout
B) Dyspnea that is usually self-limiting
C) QT prolongation
D) Hepatic enzyme elevation
Answer: B
Rationale: Ticagrelor commonly causes dyspnea, thought to be due to adenosine reuptake inhibition; it is generally
mild and resolves without treatment. Gout (A) is more associated with thiazides. QT prolongation (C) is not
typical. Hepatic enzyme elevation (D) is less common and usually asymptomatic.
9 A patient with heart failure with preserved ejection fraction (HFpEF) has persistent symptoms despite diuretic
therapy. Which of the following medications has been shown to reduce heart failure hospitalizations in this
population?
A) Sacubitril/valsartan
B) Spironolactone
C) Dapagliflozin
D) Ivabradine
Answer: C
Rationale: Dapagliflozin (SGLT2 inhibitor) has been shown to reduce heart failure hospitalizations in patients with
HFpEF (DELIVER trial). Sacubitril/valsartan showed benefit in a subgroup with lower EF. Spironolactone
(TOPCAT) was neutral overall. Ivabradine is only for HFrEF.
10 A patient presents with acute chest pain and ECG shows ST-segment elevation in leads V1-V4. Which of the
following antiplatelet regimens is recommended as part of immediate management for ST-elevation myocardial
infarction (STEMI)?
A) Aspirin plus clopidogrel
B) Aspirin plus ticagrelor
C) Aspirin plus prasugrel
D) Ticagrelor alone
Answer: B
Rationale: Current guidelines recommend dual antiplatelet therapy with aspirin and a potent P2Y12 inhibitor
(ticagrelor or prasugrel) for STEMI. Ticagrelor is preferred over prasugrel in patients with uncertain coronary
anatomy or high bleeding risk. Clopidogrel is less potent and reserved for when others are contraindicated.
Ticagrelor alone is not recommended.
11 A patient with chronic heart failure (HFrEF, NYHA class III) is currently on lisinopril 20 mg daily, metoprolol
succinate 100 mg daily, and furosemide 40 mg daily. The patient develops new-onset atrial fibrillation with
rapid ventricular response. Which of the following is the most appropriate next step in pharmacotherapy?
A) Add digoxin 0.125 mg daily
, B) Add amiodarone 200 mg daily
C) Increase metoprolol succinate to 200 mg daily
D) Add diltiazem extended-release 180 mg daily
Answer: C
Rationale: In HFrEF, beta-blockers (e.g., metoprolol succinate) are first-line for rate control in atrial fibrillation due
to their mortality benefit. Increasing the dose is preferred over adding a new agent. Digoxin may be used but is
second-line. Amiodarone is for rhythm control. Diltiazem is contraindicated in HFrEF due to negative inotropic
effects.
12 A patient with essential hypertension has been on hydrochlorothiazide 25 mg daily for 6 months. Current blood
pressure is 148/92 mm Hg. Serum potassium is 3.3 mEq/L. Which of the following changes is most
appropriate?
A) Add lisinopril 10 mg daily
B) Increase hydrochlorothiazide to 50 mg daily
C) Add spironolactone 25 mg daily
D) Switch to chlorthalidone 25 mg daily
Answer: A
Rationale: Hypokalemia is a known adverse effect of thiazides. Adding an ACE inhibitor (lisinopril) can counteract
potassium loss and provide additive antihypertensive effect. Increasing thiazide dose would worsen hypokalemia.
Spironolactone is a potassium-sparing diuretic but is not first-line add-on. Chlorthalidone is similar to HCTZ and
would not correct hypokalemia.
13 A patient with stable angina and a history of severe asthma presents with persistent chest pain despite
sublingual nitroglycerin. Which of the following antianginal agents is most appropriate to add?
A) Metoprolol
B) Amlodipine
C) Verapamil
D) Ranolazine
Answer: D
Rationale: Ranolazine is a first-line add-on for angina in patients with contraindications to beta-blockers or calcium
channel blockers. Beta-blockers (metoprolol) are relatively contraindicated in asthma. Verapamil and diltiazem can
exacerbate asthma due to bronchospasm risk. Amlodipine is generally safe but may not be optimal if asthma is
severe; ranolazine has no bronchoconstrictive effects.
14 A patient with hypertension and chronic kidney disease (eGFR 35 mL/min/1.73 m²) is on lisinopril 20 mg
daily. Serum potassium is 5.6 mEq/L. What is the most appropriate action?
A) Continue lisinopril and add a loop diuretic
B) Discontinue lisinopril and start amlodipine
C) Reduce lisinopril to 10 mg daily
D) Add spironolactone 25 mg daily
Answer: B
Rationale: Hyperkalemia (K+ >5.5) with ACE inhibitor in CKD requires discontinuation of the ACE inhibitor.
Amlodipine is a safe alternative that does not affect potassium. Continuing lisinopril with a loop diuretic may not
adequately lower potassium. Reducing dose is insufficient. Adding spironolactone would worsen hyperkalemia.
