NR 567 Exam 3 V1 | NR 567 Advanced
Pharmacology for the AGACNP | Actual
Q&A with Rationale (NR567 Exam 3) |
Chamberlain College of Nursing
1. A 62-year-old male with Heart Failure with Reduced Ejection Fraction (HFrEF) and an EF of
30% is currently taking Lisinopril 20mg daily and Carvedilol 25mg twice daily. Which of the
following medications should be added to his regimen to further reduce mortality based on
current Guideline-Directed Medical Therapy (GDMT)? (Select all that apply)
A. Spironolactone
B. Empagliflozin
C. Amlodipine
D. Sacubitril/Valsartan (to replace Lisinopril)
E. Furosemide
F. Ivabradine
Correct Answer: A, B, D
Guideline-directed medical therapy for HFrEF now emphasizes the ‘four pillars’ of treatment
which include an ARNI, evidence-based beta-blockers, mineralocorticoid receptor antagonists,
and SGLT2 inhibitors. Spironolactone and Empagliflozin have both shown significant
mortality benefits in large clinical trials for patients with reduced ejection fraction. While
,Loop diuretics like Furosemide help with volume status, they do not have a proven mortality
benefit.
2. Which of the following laboratory findings would most likely require the immediate
discontinuation of a statin in a patient complaining of severe muscle pain and dark-colored
urine?
A. Creatine kinase (CK) level > 10 times the upper limit of normal
B. ALT 3 times the upper limit of normal
C. Serum creatinine increase of 0.2 mg/dL
D. Total cholesterol of 150 mg/dL
Correct Answer: A
A creatine kinase level significantly exceeding 10 times the upper limit of normal is indicative
of rhabdomyolysis, a potentially life-threatening side effect of statin therapy. This condition
can lead to acute renal failure due to the release of myoglobin into the bloodstream, which is
suggested by the patient’s dark urine. The medication must be stopped immediately to
prevent further muscle breakdown and kidney damage.
3. A patient is being initiated on Amiodarone for rhythm control of atrial fibrillation. Which
baseline assessments are mandatory before starting this medication? (Select all that apply)
A. Pulmonary Function Tests (PFTs)
B. Thyroid Function Tests (TSH, free T4)
C. Liver Function Tests (AST, ALT)
,D. Chest X-ray
E. Complete Blood Count (CBC)
Correct Answer: A, B, C, D
Amiodarone has a very long half-life and is associated with significant toxicities in the lungs,
thyroid, and liver. Baseline pulmonary function tests and chest X-rays are necessary to
monitor for potential interstitial lung disease or fibrosis. Thyroid and liver assessments are
required because the drug contains high amounts of iodine and is metabolized in the liver,
posing risks for dysfunction in both organs.
4. When initiating Levothyroxine therapy for a 75-year-old patient with a history of coronary
artery disease, what is the most appropriate starting dose?
A. 100 mcg daily
B. 75 mcg daily
C. 50 mcg daily
D. 12.5 to 25 mcg daily
Correct Answer: D
In elderly patients or those with underlying cardiovascular disease, thyroid hormone
replacement should be started at a low dose and titrated slowly. Rapidly increasing the
metabolic rate can exacerbate myocardial oxygen demand and precipitate angina or
arrhythmias. The principle of ‘start low and go slow’ is essential to avoid cardiac
complications in this vulnerable population.
, 5. Which of the following anticoagulants is the preferred choice for a patient with a
mechanical prosthetic heart valve?
A. Apixaban
B. Rivaroxaban
C. Dabigatran
D. Warfarin
Correct Answer: D
Warfarin remains the only recommended oral anticoagulant for patients with mechanical
prosthetic heart valves due to the high risk of valve thrombosis. Direct-acting oral
anticoagulants (DOACs) like Dabigatran have been shown to be inferior and potentially
harmful in this specific population. The target INR for these patients is typically 2.5 to 3.5,
depending on the valve location and type.
6. A patient with Type 2 Diabetes is currently taking Metformin. The provider decides to add
a GLP-1 receptor agonist. Which clinical benefit is most associated with this class of
medication?
A. High risk of hypoglycemia
B. Cardiovascular and renal protection
C. Weight gain
D. Increased risk of bone fractures
Pharmacology for the AGACNP | Actual
Q&A with Rationale (NR567 Exam 3) |
Chamberlain College of Nursing
1. A 62-year-old male with Heart Failure with Reduced Ejection Fraction (HFrEF) and an EF of
30% is currently taking Lisinopril 20mg daily and Carvedilol 25mg twice daily. Which of the
following medications should be added to his regimen to further reduce mortality based on
current Guideline-Directed Medical Therapy (GDMT)? (Select all that apply)
A. Spironolactone
B. Empagliflozin
C. Amlodipine
D. Sacubitril/Valsartan (to replace Lisinopril)
E. Furosemide
F. Ivabradine
Correct Answer: A, B, D
Guideline-directed medical therapy for HFrEF now emphasizes the ‘four pillars’ of treatment
which include an ARNI, evidence-based beta-blockers, mineralocorticoid receptor antagonists,
and SGLT2 inhibitors. Spironolactone and Empagliflozin have both shown significant
mortality benefits in large clinical trials for patients with reduced ejection fraction. While
,Loop diuretics like Furosemide help with volume status, they do not have a proven mortality
benefit.
2. Which of the following laboratory findings would most likely require the immediate
discontinuation of a statin in a patient complaining of severe muscle pain and dark-colored
urine?
A. Creatine kinase (CK) level > 10 times the upper limit of normal
B. ALT 3 times the upper limit of normal
C. Serum creatinine increase of 0.2 mg/dL
D. Total cholesterol of 150 mg/dL
Correct Answer: A
A creatine kinase level significantly exceeding 10 times the upper limit of normal is indicative
of rhabdomyolysis, a potentially life-threatening side effect of statin therapy. This condition
can lead to acute renal failure due to the release of myoglobin into the bloodstream, which is
suggested by the patient’s dark urine. The medication must be stopped immediately to
prevent further muscle breakdown and kidney damage.
3. A patient is being initiated on Amiodarone for rhythm control of atrial fibrillation. Which
baseline assessments are mandatory before starting this medication? (Select all that apply)
A. Pulmonary Function Tests (PFTs)
B. Thyroid Function Tests (TSH, free T4)
C. Liver Function Tests (AST, ALT)
,D. Chest X-ray
E. Complete Blood Count (CBC)
Correct Answer: A, B, C, D
Amiodarone has a very long half-life and is associated with significant toxicities in the lungs,
thyroid, and liver. Baseline pulmonary function tests and chest X-rays are necessary to
monitor for potential interstitial lung disease or fibrosis. Thyroid and liver assessments are
required because the drug contains high amounts of iodine and is metabolized in the liver,
posing risks for dysfunction in both organs.
4. When initiating Levothyroxine therapy for a 75-year-old patient with a history of coronary
artery disease, what is the most appropriate starting dose?
A. 100 mcg daily
B. 75 mcg daily
C. 50 mcg daily
D. 12.5 to 25 mcg daily
Correct Answer: D
In elderly patients or those with underlying cardiovascular disease, thyroid hormone
replacement should be started at a low dose and titrated slowly. Rapidly increasing the
metabolic rate can exacerbate myocardial oxygen demand and precipitate angina or
arrhythmias. The principle of ‘start low and go slow’ is essential to avoid cardiac
complications in this vulnerable population.
, 5. Which of the following anticoagulants is the preferred choice for a patient with a
mechanical prosthetic heart valve?
A. Apixaban
B. Rivaroxaban
C. Dabigatran
D. Warfarin
Correct Answer: D
Warfarin remains the only recommended oral anticoagulant for patients with mechanical
prosthetic heart valves due to the high risk of valve thrombosis. Direct-acting oral
anticoagulants (DOACs) like Dabigatran have been shown to be inferior and potentially
harmful in this specific population. The target INR for these patients is typically 2.5 to 3.5,
depending on the valve location and type.
6. A patient with Type 2 Diabetes is currently taking Metformin. The provider decides to add
a GLP-1 receptor agonist. Which clinical benefit is most associated with this class of
medication?
A. High risk of hypoglycemia
B. Cardiovascular and renal protection
C. Weight gain
D. Increased risk of bone fractures
