NR 567 ADVANCED PHARM MIDTERM EXAM GUIDE
ACTUAL EXAM |QUESTION AND VERIFIED ANSWERS
QUESTIONS WITH ACCURATE ANSWERS|GET IT
RIGHT|!
1. A patient on warfarin for atrial fibrillation presents with an INR of 6.2. The
patient is not bleeding. What is the most appropriate initial management?
A) Administer 10 mg IV Vitamin K
B) Administer Fresh Frozen Plasma (FFP)
C) Hold the next dose of warfarin and recheck INR in 24 hours
D) Administer 2 mg IV Vitamin K and hold warfarin
Correct Answer: C
Rationale: For an INR between 5.0 and 9.0 without clinically significant bleeding,
the standard recommendation is to hold the next 1-2 doses of warfarin and
monitor the INR. IV Vitamin K is reserved for INRs >10 or active bleeding. FFP is
reserved for life-threatening hemorrhage.
---
2. Which of the following receptors does norepinephrine primarily stimulate to
cause potent vasoconstriction?
A) Beta-1
B) Beta-2
,C) Alpha-1
D) Dopaminergic
Correct Answer: C
Rationale: Norepinephrine is a potent Alpha-1 agonist, which causes profound
peripheral vasoconstriction and increases systemic vascular resistance (SVR).
While it also has Beta-1 effects (increasing heart rate/contractility), Alpha-1 is
responsible for its vasopressor action.
---
3. A patient is started on metformin for type 2 diabetes. Which baseline laboratory
value is most critical to assess before initiating therapy?
A) Hemoglobin A1c
B) Serum creatinine/eGFR
C) Fasting blood glucose
D) Liver function tests (AST/ALT)
Correct Answer: B
Rationale: Metformin is renally excreted. Impaired renal function (eGFR < 30
mL/min) leads to drug accumulation, significantly increasing the risk of lactic
acidosis. Renal function must be assessed prior to initiation and monitored
annually.
---
4. A 62-year-old male with benign prostatic hyperplasia (BPH) and newly
diagnosed hypertension would benefit most from which antihypertensive agent?
,A) Hydrochlorothiazide
B) Lisinopril
C) Doxazosin
D) Amlodipine
Correct Answer: C
Rationale: Doxazosin is an Alpha-1 blocker. It provides a dual benefit by relaxing
smooth muscle in the prostate/bladder neck (improving urinary flow) and causing
peripheral vasodilation (lowering blood pressure). The other agents treat
hypertension but do not address BPH symptoms.
---
5. A patient with septic shock is persistently hypotensive despite adequate fluid
resuscitation. Which vasopressor is the established first-line agent?
A) Epinephrine
B) Dobutamine
C) Norepinephrine
D) Phenylephrine
Correct Answer: C
Rationale: According to the Surviving Sepsis Campaign guidelines, norepinephrine
is the first-line vasopressor for septic shock due to its potent Alpha-1-mediated
vasoconstriction combined with Beta-1 effects to support cardiac output.
---
, 6. A patient receiving IV heparin begins experiencing severe bleeding. Which
agent should be immediately administered to reverse the anticoagulant effect?
A) Vitamin K
B) Protamine sulfate
C) Naloxone
D) Flumazenil
Correct Answer: B
Rationale: Protamine sulfate is a cationic protein that binds to heparin (an anionic
molecule) to form a stable salt complex, effectively neutralizing its anticoagulant
properties. Vitamin K reverses warfarin, not heparin.
---
7. Digoxin toxicity is potentiated by which of the following electrolyte imbalances?
A) Hyperkalemia
B) Hypernatremia
C) Hypokalemia
D) Hypermagnesemia
Correct Answer: C
Rationale: Hypokalemia increases the binding of digoxin to the sodium-potassium
ATPase pump, predisposing the patient to digoxin toxicity and severe
dysrhythmias. Potassium levels must be maintained in the normal range during
digoxin therapy.
---
ACTUAL EXAM |QUESTION AND VERIFIED ANSWERS
QUESTIONS WITH ACCURATE ANSWERS|GET IT
RIGHT|!
1. A patient on warfarin for atrial fibrillation presents with an INR of 6.2. The
patient is not bleeding. What is the most appropriate initial management?
A) Administer 10 mg IV Vitamin K
B) Administer Fresh Frozen Plasma (FFP)
C) Hold the next dose of warfarin and recheck INR in 24 hours
D) Administer 2 mg IV Vitamin K and hold warfarin
Correct Answer: C
Rationale: For an INR between 5.0 and 9.0 without clinically significant bleeding,
the standard recommendation is to hold the next 1-2 doses of warfarin and
monitor the INR. IV Vitamin K is reserved for INRs >10 or active bleeding. FFP is
reserved for life-threatening hemorrhage.
---
2. Which of the following receptors does norepinephrine primarily stimulate to
cause potent vasoconstriction?
A) Beta-1
B) Beta-2
,C) Alpha-1
D) Dopaminergic
Correct Answer: C
Rationale: Norepinephrine is a potent Alpha-1 agonist, which causes profound
peripheral vasoconstriction and increases systemic vascular resistance (SVR).
While it also has Beta-1 effects (increasing heart rate/contractility), Alpha-1 is
responsible for its vasopressor action.
---
3. A patient is started on metformin for type 2 diabetes. Which baseline laboratory
value is most critical to assess before initiating therapy?
A) Hemoglobin A1c
B) Serum creatinine/eGFR
C) Fasting blood glucose
D) Liver function tests (AST/ALT)
Correct Answer: B
Rationale: Metformin is renally excreted. Impaired renal function (eGFR < 30
mL/min) leads to drug accumulation, significantly increasing the risk of lactic
acidosis. Renal function must be assessed prior to initiation and monitored
annually.
---
4. A 62-year-old male with benign prostatic hyperplasia (BPH) and newly
diagnosed hypertension would benefit most from which antihypertensive agent?
,A) Hydrochlorothiazide
B) Lisinopril
C) Doxazosin
D) Amlodipine
Correct Answer: C
Rationale: Doxazosin is an Alpha-1 blocker. It provides a dual benefit by relaxing
smooth muscle in the prostate/bladder neck (improving urinary flow) and causing
peripheral vasodilation (lowering blood pressure). The other agents treat
hypertension but do not address BPH symptoms.
---
5. A patient with septic shock is persistently hypotensive despite adequate fluid
resuscitation. Which vasopressor is the established first-line agent?
A) Epinephrine
B) Dobutamine
C) Norepinephrine
D) Phenylephrine
Correct Answer: C
Rationale: According to the Surviving Sepsis Campaign guidelines, norepinephrine
is the first-line vasopressor for septic shock due to its potent Alpha-1-mediated
vasoconstriction combined with Beta-1 effects to support cardiac output.
---
, 6. A patient receiving IV heparin begins experiencing severe bleeding. Which
agent should be immediately administered to reverse the anticoagulant effect?
A) Vitamin K
B) Protamine sulfate
C) Naloxone
D) Flumazenil
Correct Answer: B
Rationale: Protamine sulfate is a cationic protein that binds to heparin (an anionic
molecule) to form a stable salt complex, effectively neutralizing its anticoagulant
properties. Vitamin K reverses warfarin, not heparin.
---
7. Digoxin toxicity is potentiated by which of the following electrolyte imbalances?
A) Hyperkalemia
B) Hypernatremia
C) Hypokalemia
D) Hypermagnesemia
Correct Answer: C
Rationale: Hypokalemia increases the binding of digoxin to the sodium-potassium
ATPase pump, predisposing the patient to digoxin toxicity and severe
dysrhythmias. Potassium levels must be maintained in the normal range during
digoxin therapy.
---
