BSN 315 Pharmacology HESI V2 —
COMPREHENSIVE EXAM QUESTIONS AND
ANSWERS|NEW 2026-2027 UPDATE
Question 1
A patient with HFrEF (EF 28%) is prescribed carvedilol 3.125 mg BID. The nurse
understands that the primary benefit of beta-blockers in HFrEF is:
A. Positive inotropic effect increasing cardiac contractility
B. Blockade of sympathetic overdrive, reduction of afterload, and prevention of
ventricular remodeling
C. Direct vasodilation of coronary arteries
D. Promotion of diuresis through natriuresis
Correct Answer: B
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) in HFrEF block
chronic sympathetic nervous system activation, reduce afterload, slow heart rate,
and prevent adverse ventricular remodeling. This improves survival and reduces
hospitalizations. They have NEGATIVE inotropic effects (reduce contractility), which
is why they must be started at low doses and titrated slowly in stable patients.
Question 2
A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4 (male). Which
anticoagulant is preferred for stroke prevention?
A. Aspirin 81 mg daily
B. Warfarin with INR target 2.0-3.0
C. Apixaban or rivaroxaban (DOAC)
D. Clopidogrel 75 mg daily
Correct Answer: C
1
, Rationale: For non-valvular AFib with CHA₂DS₂-VASc ≥2 in men (or ≥3 in women),
oral anticoagulation is indicated. DOACs (apixaban, rivaroxaban, dabigatran,
edoxaban) are preferred over warfarin due to lower intracranial hemorrhage risk, no
routine monitoring, and fewer drug/food interactions. Aspirin and clopidogrel are
insufficient for stroke prevention in AFib. Warfarin is still used for mechanical heart
valves and moderate-severe mitral stenosis.
Question 3
A patient on warfarin is started on amiodarone for atrial fibrillation. The nurse
anticipates which effect on the patient's INR?
A. INR will decrease, requiring warfarin dose increase
B. INR will increase, requiring warfarin dose reduction
C. No interaction between amiodarone and warfarin
D. INR will remain stable but bleeding risk increases
Correct Answer: B
Rationale: Amiodarone inhibits CYP2C9 and CYP1A2 metabolism of warfarin,
significantly increasing warfarin levels and INR. The warfarin dose typically needs to
be REDUCED by 30-50% when amiodarone is initiated. INR should be monitored
closely (every 3-7 days initially). This is a major drug interaction that nurses must
recognize.
Question 4
A patient with acute coronary syndrome is prescribed atorvastatin 80 mg daily. The
nurse understands that high-intensity statin therapy is recommended because it:
A. Relieves acute chest pain immediately
B. Reduces LDL cholesterol by ≥50% and reduces recurrent MI and stroke risk
C. Dissolves existing coronary artery thrombi
D. Increases HDL cholesterol by >100%
Correct Answer: B
2
COMPREHENSIVE EXAM QUESTIONS AND
ANSWERS|NEW 2026-2027 UPDATE
Question 1
A patient with HFrEF (EF 28%) is prescribed carvedilol 3.125 mg BID. The nurse
understands that the primary benefit of beta-blockers in HFrEF is:
A. Positive inotropic effect increasing cardiac contractility
B. Blockade of sympathetic overdrive, reduction of afterload, and prevention of
ventricular remodeling
C. Direct vasodilation of coronary arteries
D. Promotion of diuresis through natriuresis
Correct Answer: B
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) in HFrEF block
chronic sympathetic nervous system activation, reduce afterload, slow heart rate,
and prevent adverse ventricular remodeling. This improves survival and reduces
hospitalizations. They have NEGATIVE inotropic effects (reduce contractility), which
is why they must be started at low doses and titrated slowly in stable patients.
Question 2
A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4 (male). Which
anticoagulant is preferred for stroke prevention?
A. Aspirin 81 mg daily
B. Warfarin with INR target 2.0-3.0
C. Apixaban or rivaroxaban (DOAC)
D. Clopidogrel 75 mg daily
Correct Answer: C
1
, Rationale: For non-valvular AFib with CHA₂DS₂-VASc ≥2 in men (or ≥3 in women),
oral anticoagulation is indicated. DOACs (apixaban, rivaroxaban, dabigatran,
edoxaban) are preferred over warfarin due to lower intracranial hemorrhage risk, no
routine monitoring, and fewer drug/food interactions. Aspirin and clopidogrel are
insufficient for stroke prevention in AFib. Warfarin is still used for mechanical heart
valves and moderate-severe mitral stenosis.
Question 3
A patient on warfarin is started on amiodarone for atrial fibrillation. The nurse
anticipates which effect on the patient's INR?
A. INR will decrease, requiring warfarin dose increase
B. INR will increase, requiring warfarin dose reduction
C. No interaction between amiodarone and warfarin
D. INR will remain stable but bleeding risk increases
Correct Answer: B
Rationale: Amiodarone inhibits CYP2C9 and CYP1A2 metabolism of warfarin,
significantly increasing warfarin levels and INR. The warfarin dose typically needs to
be REDUCED by 30-50% when amiodarone is initiated. INR should be monitored
closely (every 3-7 days initially). This is a major drug interaction that nurses must
recognize.
Question 4
A patient with acute coronary syndrome is prescribed atorvastatin 80 mg daily. The
nurse understands that high-intensity statin therapy is recommended because it:
A. Relieves acute chest pain immediately
B. Reduces LDL cholesterol by ≥50% and reduces recurrent MI and stroke risk
C. Dissolves existing coronary artery thrombi
D. Increases HDL cholesterol by >100%
Correct Answer: B
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