NR 567 Final Exam – Advanced Pharmacology for the AGACNP |
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A 68-year-old male with heart failure with reduced ejection fraction (HFrEF) is
currently on lisinopril 20 mg daily and metoprolol succinate 100 mg daily. His
blood pressure is 138/82 mmHg, and he reports persistent fatigue and dyspnea
on exertion. Which medication should be added next according to current
guidelines?
A. Digoxin 0.25 mg daily
B. Spironolactone 25 mg daily
C. Furosemide 40 mg twice daily
D. Isosorbide dinitrate 20 mg three times daily
Correct Answer: B ✓
Rationale: Mineralocorticoid receptor antagonists (spironolactone or eplerenone)
are recommended in patients with HFrEF who remain symptomatic despite ACE
inhibitor and beta-blocker therapy, provided renal function and potassium levels
are monitored. This reduces mortality and hospitalizations.
,A 72-year-old female presents with new-onset atrial fibrillation. She has a
CHA2DS2-VASc score of 4. Her creatinine clearance is 45 mL/min. Which
anticoagulant would be most appropriate for stroke prevention?
A. Warfarin with target INR 2.0-3.0
B. Apixaban 5 mg twice daily
C. Apixaban 2.5 mg twice daily
D. Dabigatran 150 mg twice daily
Correct Answer: C ✓
Rationale: For apixaban, dose reduction to 2.5 mg twice daily is indicated when at
least two of the following criteria are present: age ≥80 years, body weight ≤60 kg,
or serum creatinine ≥1.5 mg/dL. However, with CrCl 45 mL/min, standard dosing
may still apply depending on other factors. Given her age and likely other risk
factors, careful assessment is needed. If she meets dose reduction criteria, 2.5 mg
BID is appropriate.
A patient with hypertensive emergency presents with blood pressure of 220/120
mmHg and evidence of end-organ damage. Which intravenous medication is
preferred for rapid blood pressure control?
A. Labetalol
B. Hydralazine
C. Nitroprusside
D. Nicardipine
,Correct Answer: D ✓
Rationale: Nicardipine is a calcium channel blocker that provides predictable,
titratable blood pressure reduction with minimal effect on cerebral blood flow,
making it ideal for hypertensive emergencies. Nitroprusside carries risk of cyanide
toxicity with prolonged use.
A 55-year-old male with stable angina is prescribed sublingual nitroglycerin.
Which instruction is most important for the AGACNP to provide?
A. Take one tablet every 5 minutes until pain resolves, up to three doses
B. Store tablets in a clear plastic container for easy access
C. Expect headache as a sign the medication is not working
D. Take the medication with food to prevent gastric irritation
Correct Answer: A ✓
Rationale: Patients should take one nitroglycerin tablet sublingually every 5
minutes for chest pain, up to three doses. If pain persists after three doses, they
should seek emergency care. Tablets should be stored in original dark glass
container, headache is a common side effect indicating vasodilation, and the
medication should be taken on an empty tongue.
Which beta-blocker is contraindicated in a patient with acute decompensated
heart failure?
A. Metoprolol succinate
B. Carvedilol
, C. Bisoprolol
D. Atenolol
Correct Answer: D ✓
Rationale: Atenolol is not one of the three beta-blockers proven to reduce
mortality in heart failure (metoprolol succinate, carvedilol, and bisoprolol). In
acute decompensated HF, beta-blockers should generally be withheld or reduced,
but among chronic therapy options, atenolol lacks evidence for HF benefit.
A patient receiving amiodarone for atrial fibrillation develops progressive dyspnea
and dry cough. Chest X-ray shows bilateral interstitial infiltrates. What is the most
likely diagnosis?
A. Congestive heart failure
B. Amiodarone-induced pulmonary toxicity
C. Pneumonia
D. Pulmonary embolism
Correct Answer: B ✓
Rationale: Amiodarone can cause pulmonary toxicity including interstitial
pneumonitis, which presents with dyspnea, cough, and radiographic findings. This
serious adverse effect requires discontinuation of the drug and possibly
corticosteroid treatment.
Which statement regarding direct oral anticoagulants (DOACs) is correct?
A. They require routine INR monitoring
Comprehensive Practice Examination | High-Yield Questions, Answers
& Detailed Rationales | Advanced Pharmacotherapy & Clinical
Decision-Making Review | Ultimate Exam Mastery Guide | Premium
Study Companion
A 68-year-old male with heart failure with reduced ejection fraction (HFrEF) is
currently on lisinopril 20 mg daily and metoprolol succinate 100 mg daily. His
blood pressure is 138/82 mmHg, and he reports persistent fatigue and dyspnea
on exertion. Which medication should be added next according to current
guidelines?
A. Digoxin 0.25 mg daily
B. Spironolactone 25 mg daily
C. Furosemide 40 mg twice daily
D. Isosorbide dinitrate 20 mg three times daily
Correct Answer: B ✓
Rationale: Mineralocorticoid receptor antagonists (spironolactone or eplerenone)
are recommended in patients with HFrEF who remain symptomatic despite ACE
inhibitor and beta-blocker therapy, provided renal function and potassium levels
are monitored. This reduces mortality and hospitalizations.
,A 72-year-old female presents with new-onset atrial fibrillation. She has a
CHA2DS2-VASc score of 4. Her creatinine clearance is 45 mL/min. Which
anticoagulant would be most appropriate for stroke prevention?
A. Warfarin with target INR 2.0-3.0
B. Apixaban 5 mg twice daily
C. Apixaban 2.5 mg twice daily
D. Dabigatran 150 mg twice daily
Correct Answer: C ✓
Rationale: For apixaban, dose reduction to 2.5 mg twice daily is indicated when at
least two of the following criteria are present: age ≥80 years, body weight ≤60 kg,
or serum creatinine ≥1.5 mg/dL. However, with CrCl 45 mL/min, standard dosing
may still apply depending on other factors. Given her age and likely other risk
factors, careful assessment is needed. If she meets dose reduction criteria, 2.5 mg
BID is appropriate.
A patient with hypertensive emergency presents with blood pressure of 220/120
mmHg and evidence of end-organ damage. Which intravenous medication is
preferred for rapid blood pressure control?
A. Labetalol
B. Hydralazine
C. Nitroprusside
D. Nicardipine
,Correct Answer: D ✓
Rationale: Nicardipine is a calcium channel blocker that provides predictable,
titratable blood pressure reduction with minimal effect on cerebral blood flow,
making it ideal for hypertensive emergencies. Nitroprusside carries risk of cyanide
toxicity with prolonged use.
A 55-year-old male with stable angina is prescribed sublingual nitroglycerin.
Which instruction is most important for the AGACNP to provide?
A. Take one tablet every 5 minutes until pain resolves, up to three doses
B. Store tablets in a clear plastic container for easy access
C. Expect headache as a sign the medication is not working
D. Take the medication with food to prevent gastric irritation
Correct Answer: A ✓
Rationale: Patients should take one nitroglycerin tablet sublingually every 5
minutes for chest pain, up to three doses. If pain persists after three doses, they
should seek emergency care. Tablets should be stored in original dark glass
container, headache is a common side effect indicating vasodilation, and the
medication should be taken on an empty tongue.
Which beta-blocker is contraindicated in a patient with acute decompensated
heart failure?
A. Metoprolol succinate
B. Carvedilol
, C. Bisoprolol
D. Atenolol
Correct Answer: D ✓
Rationale: Atenolol is not one of the three beta-blockers proven to reduce
mortality in heart failure (metoprolol succinate, carvedilol, and bisoprolol). In
acute decompensated HF, beta-blockers should generally be withheld or reduced,
but among chronic therapy options, atenolol lacks evidence for HF benefit.
A patient receiving amiodarone for atrial fibrillation develops progressive dyspnea
and dry cough. Chest X-ray shows bilateral interstitial infiltrates. What is the most
likely diagnosis?
A. Congestive heart failure
B. Amiodarone-induced pulmonary toxicity
C. Pneumonia
D. Pulmonary embolism
Correct Answer: B ✓
Rationale: Amiodarone can cause pulmonary toxicity including interstitial
pneumonitis, which presents with dyspnea, cough, and radiographic findings. This
serious adverse effect requires discontinuation of the drug and possibly
corticosteroid treatment.
Which statement regarding direct oral anticoagulants (DOACs) is correct?
A. They require routine INR monitoring
