NR 567 Advanced Pharmacology Final Exam
Prep 2026/2027 | 150 Q&A with Rationale |
(MOST RECENT) Graded A+
1. A patient on warfarin has an INR of 6.5 and is actively bleeding.
Which agent should be administered immediately?
Answer: Prothrombin complex concentrate (PCC) + Vitamin K IV.
Rationale: PCC rapidly replaces clotting factors II, VII, IX, and X, reversing
warfarin's effect within minutes. IV vitamin K supports sustained reversal
but takes hours to work. Fresh frozen plasma is a second-line option if PCC
is unavailable.
2. Which beta-blocker is most appropriate for a patient with acute
decompensated heart failure with reduced ejection fraction (HFrEF)
who is hemodynamically stable?
Answer: Metoprolol succinate (extended-release).
Rationale: Carvedilol, metoprolol succinate, and bisoprolol are the three
evidence-based beta-blockers for chronic HFrEF. Metoprolol succinate is
preferred for its once-daily dosing and proven mortality benefit. Metoprolol
tartrate (immediate-release) is not used for HF.
3. A patient with sepsis develops acute kidney injury (AKI). Which
antibiotic requires significant dose reduction?
Answer: Vancomycin.
Rationale: Vancomycin is primarily cleared renally. In AKI, the dose must be
adjusted based on serum trough levels and renal function to prevent
,nephrotoxicity and ototoxicity. Piperacillin-tazobactam also requires renal
adjustment.
4. What is the mechanism of action of furosemide?
Answer: Inhibits the Na-K-2Cl cotransporter in the thick ascending limb of
the loop of Henle.
Rationale: This inhibition blocks sodium and chloride reabsorption, leading
to marked diuresis. It is the most potent of the loop diuretics and is used
for pulmonary edema and heart failure exacerbations.
5. Which medication is the antidote for heparin overdose?
Answer: Protamine sulfate.
Rationale: Protamine sulfate is a positively charged molecule that binds to
negatively charged heparin, forming an inactive complex. It reverses both
unfractionated heparin and, to a lesser extent, low-molecular-weight
heparin.
6. A patient on lisinopril develops a dry cough and angioedema. What
is the most likely cause?
Answer: Accumulation of bradykinin.
Rationale: ACE inhibitors prevent the breakdown of bradykinin, leading to
its accumulation. This causes vasodilation, increased vascular permeability,
cough, and potentially life-threatening angioedema. ARBs are a safe
alternative.
,7. Which induction agent is contraindicated in a patient with
hyperkalemia?
Answer: Succinylcholine.
Rationale: Succinylcholine depolarizes the neuromuscular junction, causing
potassium to efflux from muscle cells. This can raise serum potassium by
0.5–1.0 mEq/L, which is dangerous in hyperkalemic patients.
8. What is the first-line treatment for status epilepticus?
Answer: IV Lorazepam.
Rationale: Benzodiazepines, especially IV lorazepam, are first-line due to
rapid onset (1–3 minutes) and high efficacy in terminating seizure activity.
Diazepam and midazolam are alternatives.
9. A patient with a mechanical mitral valve requires lifelong
anticoagulation. Which agent is preferred?
Answer: Warfarin.
Rationale: DOACs (apixaban, rivaroxaban, dabigatran) are contraindicated
in mechanical heart valves due to increased thrombotic and bleeding risks.
Warfarin with a target INR of 2.5–3.5 is the standard of care.
10. Which antiarrhythmic drug is associated with pulmonary fibrosis?
Answer: Amiodarone.
Rationale: Amiodarone is a class III antiarrhythmic with significant
pulmonary toxicity, including interstitial pneumonitis and pulmonary
fibrosis. Baseline and annual pulmonary function tests are recommended.
, 11. What is the primary concern when administering IV potassium
chloride?
Answer: Hyperkalemia and cardiac arrhythmias.
Rationale: Rapid IV infusion or high concentrations can cause fatal
hyperkalemia, leading to peaked T-waves, widened QRS, and ventricular
fibrillation. Maximum infusion rate is typically 10–20 mEq/hour via
peripheral line.
12. Which antibiotic is first-line for methicillin-susceptible
Staphylococcus aureus (MSSA) pneumonia?
Answer: Nafcillin or Oxacillin.
Rationale: For MSSA, beta-lactam antibiotics (nafcillin, oxacillin, cefazolin)
are preferred over vancomycin due to superior efficacy and narrower
spectrum. Vancomycin is reserved for MRSA.
13. A patient on digoxin presents with nausea, vomiting, and yellow
halos around lights. What is the next step?
Answer: Check digoxin level and hold the drug.
Rationale: These symptoms indicate digoxin toxicity. The therapeutic range
is narrow (0.8–2.0 ng/mL). Treatment includes holding the dose, checking
electrolytes (especially potassium), and administering digoxin immune Fab
fragments if severe.
14. Which statin has the highest potency for lowering LDL cholesterol?
Answer: Rosuvastatin.
Rationale: Rosuvastatin (20–40 mg) and atorvastatin (40–80 mg) are high-
intensity statins, but rosuvastatin generally produces the greatest LDL
Prep 2026/2027 | 150 Q&A with Rationale |
(MOST RECENT) Graded A+
1. A patient on warfarin has an INR of 6.5 and is actively bleeding.
Which agent should be administered immediately?
Answer: Prothrombin complex concentrate (PCC) + Vitamin K IV.
Rationale: PCC rapidly replaces clotting factors II, VII, IX, and X, reversing
warfarin's effect within minutes. IV vitamin K supports sustained reversal
but takes hours to work. Fresh frozen plasma is a second-line option if PCC
is unavailable.
2. Which beta-blocker is most appropriate for a patient with acute
decompensated heart failure with reduced ejection fraction (HFrEF)
who is hemodynamically stable?
Answer: Metoprolol succinate (extended-release).
Rationale: Carvedilol, metoprolol succinate, and bisoprolol are the three
evidence-based beta-blockers for chronic HFrEF. Metoprolol succinate is
preferred for its once-daily dosing and proven mortality benefit. Metoprolol
tartrate (immediate-release) is not used for HF.
3. A patient with sepsis develops acute kidney injury (AKI). Which
antibiotic requires significant dose reduction?
Answer: Vancomycin.
Rationale: Vancomycin is primarily cleared renally. In AKI, the dose must be
adjusted based on serum trough levels and renal function to prevent
,nephrotoxicity and ototoxicity. Piperacillin-tazobactam also requires renal
adjustment.
4. What is the mechanism of action of furosemide?
Answer: Inhibits the Na-K-2Cl cotransporter in the thick ascending limb of
the loop of Henle.
Rationale: This inhibition blocks sodium and chloride reabsorption, leading
to marked diuresis. It is the most potent of the loop diuretics and is used
for pulmonary edema and heart failure exacerbations.
5. Which medication is the antidote for heparin overdose?
Answer: Protamine sulfate.
Rationale: Protamine sulfate is a positively charged molecule that binds to
negatively charged heparin, forming an inactive complex. It reverses both
unfractionated heparin and, to a lesser extent, low-molecular-weight
heparin.
6. A patient on lisinopril develops a dry cough and angioedema. What
is the most likely cause?
Answer: Accumulation of bradykinin.
Rationale: ACE inhibitors prevent the breakdown of bradykinin, leading to
its accumulation. This causes vasodilation, increased vascular permeability,
cough, and potentially life-threatening angioedema. ARBs are a safe
alternative.
,7. Which induction agent is contraindicated in a patient with
hyperkalemia?
Answer: Succinylcholine.
Rationale: Succinylcholine depolarizes the neuromuscular junction, causing
potassium to efflux from muscle cells. This can raise serum potassium by
0.5–1.0 mEq/L, which is dangerous in hyperkalemic patients.
8. What is the first-line treatment for status epilepticus?
Answer: IV Lorazepam.
Rationale: Benzodiazepines, especially IV lorazepam, are first-line due to
rapid onset (1–3 minutes) and high efficacy in terminating seizure activity.
Diazepam and midazolam are alternatives.
9. A patient with a mechanical mitral valve requires lifelong
anticoagulation. Which agent is preferred?
Answer: Warfarin.
Rationale: DOACs (apixaban, rivaroxaban, dabigatran) are contraindicated
in mechanical heart valves due to increased thrombotic and bleeding risks.
Warfarin with a target INR of 2.5–3.5 is the standard of care.
10. Which antiarrhythmic drug is associated with pulmonary fibrosis?
Answer: Amiodarone.
Rationale: Amiodarone is a class III antiarrhythmic with significant
pulmonary toxicity, including interstitial pneumonitis and pulmonary
fibrosis. Baseline and annual pulmonary function tests are recommended.
, 11. What is the primary concern when administering IV potassium
chloride?
Answer: Hyperkalemia and cardiac arrhythmias.
Rationale: Rapid IV infusion or high concentrations can cause fatal
hyperkalemia, leading to peaked T-waves, widened QRS, and ventricular
fibrillation. Maximum infusion rate is typically 10–20 mEq/hour via
peripheral line.
12. Which antibiotic is first-line for methicillin-susceptible
Staphylococcus aureus (MSSA) pneumonia?
Answer: Nafcillin or Oxacillin.
Rationale: For MSSA, beta-lactam antibiotics (nafcillin, oxacillin, cefazolin)
are preferred over vancomycin due to superior efficacy and narrower
spectrum. Vancomycin is reserved for MRSA.
13. A patient on digoxin presents with nausea, vomiting, and yellow
halos around lights. What is the next step?
Answer: Check digoxin level and hold the drug.
Rationale: These symptoms indicate digoxin toxicity. The therapeutic range
is narrow (0.8–2.0 ng/mL). Treatment includes holding the dose, checking
electrolytes (especially potassium), and administering digoxin immune Fab
fragments if severe.
14. Which statin has the highest potency for lowering LDL cholesterol?
Answer: Rosuvastatin.
Rationale: Rosuvastatin (20–40 mg) and atorvastatin (40–80 mg) are high-
intensity statins, but rosuvastatin generally produces the greatest LDL
