UNIVERSITY OF SOUTH CAROLINA
College of Nursing | NURS 711: Advanced Pharmacotherapies
EXAM 3 COMPREHENSIVE STUDY GUIDE
ADVANCED CLINICAL PHARMACOTHERAPEUTICS & DECISION MAKING
200 ORIGINAL PRACTICE QUESTIONS
THIS STUDY GUIDE FEATURES:
Complete coverage of Cardiovascular, Respiratory, Endocrine, CNS, and Antimicrobial
Pharmacology.
Clinical decision-making, patient safety, and priority assessment scenarios.
High-yield practice questions written specifically for advanced practice nursing standards.
Detailed rationale for correct options, emphasizing clinical judgment and pathophysiology.
Strict adherence to current clinical practice guidelines and evidence-based prescribing.
NURS 711 - Advanced Pharmacotherapies | Graduate Nursing Division
Designed for Examination Preparation & Clinical Knowledge Retention
,NURS 711: ADVANCED PHARMACOTHERAPIES EXAM 3 PREPARATION GUIDE
TABLE OF CONTENTS
Module 1: Advanced Cardiovascular Pharmacotherapy Questions 1–40
Module 2: Advanced Endocrine & Metabolic Pharmacotherapy Questions 41–80
Module 3: Advanced Respiratory Pharmacotherapy Questions 81–120
Module 4: Central Nervous System & Psychiatric Pharmacotherapy Questions 121–160
Module 5: Antimicrobial, Renal & Gastrointestinal Pharmacotherapy Questions 161–200
, MODULE 1: ADVANCED CARDIOVASCULAR PHARMACOTHERAPY
Focuses on antihypertensives, heart failure regimens, antiarrhythmics, lipid-lowering agents, and anticoagulation
therapy.
Question 1
A 58-year-old male with a history of hypertension and heart failure with reduced ejection fraction
(HFrEF) is prescribed sacubitril/valsartan. The patient was previously taking lisinopril 20 mg daily.
What clinical instruction must the advanced practice nurse provide regarding this medication
transition?
A. Start sacubitril/valsartan immediately after discontinuing lisinopril to avoid rebound hypertension.
B. Discontinue lisinopril and allow a 36-hour washout period before administering sacubitril/valsartan.
C. Take both lisinopril and sacubitril/valsartan concurrently for 7 days to maintain adequate hemodynamic
stability.
D. Taper the lisinopril over two weeks while introducing sacubitril/valsartan at half dose.
Correct Answer: B
Rationale: Sacubitril is a neprilysin inhibitor, and combining it with an ACE inhibitor like lisinopril significantly
increases the risk of severe, potentially life-threatening angioedema. A mandatory 36-hour washout period is
required when transitioning from an ACE inhibitor to an ARNI (sacubitril/valsartan).
, Question 2
A patient with persistent atrial fibrillation and stage 3 chronic kidney disease (eGFR 38
mL/min/1.73m²) is initiated on apixaban. Which factor makes apixaban a preferred choice among
Direct Oral Anticoagulants (DOACs) in renal impairment?
A. Apixaban is completely eliminated via biliary pathway.
B. Apixaban has the lowest renal clearance percentage among available DOACs.
C. Apixaban does not bind to plasma proteins and is filtered out completely.
D. Apixaban undergoes full hepatic metabolism without renal excretion.
Correct Answer: B
Rationale: Apixaban has approximately 27% renal clearance, which is lower than dabigatran (~80%) or
rivaroxaban (~36%), making it relatively safer and preferable in moderate renal insufficiency, though monitoring
remains essential.
Question 3
A 62-year-old female presents with hyperlipidemia. Her baseline LDL-C is 190 mg/dL. High-
intensity statin therapy with atorvastatin 80 mg daily is initiated. After 8 weeks, her LDL-C remains
elevated at 130 mg/dL despite strict adherence. What is the next guideline-recommended step in
managing her pharmacotherapy?
A. Switch from atorvastatin to rosuvastatin 10 mg daily.
B. Add ezetimibe 10 mg daily to the current high-intensity statin therapy.
C. Discontinue atorvastatin and initiate a bile acid sequestrant.
D. Double the dose of atorvastatin to 160 mg daily.
Correct Answer: B
Rationale: According to ACC/AHA cholesterol guidelines, if a patient on maximum tolerated high-intensity statin
therapy (atorvastatin 80 mg) has an LDL-C ≥70 mg/dL (or ≥100 mg/dL in non-ASCVD with severe primary
hypercholesterolemia), adding ezetimibe is the recommended first non-statin step.
College of Nursing | NURS 711: Advanced Pharmacotherapies
EXAM 3 COMPREHENSIVE STUDY GUIDE
ADVANCED CLINICAL PHARMACOTHERAPEUTICS & DECISION MAKING
200 ORIGINAL PRACTICE QUESTIONS
THIS STUDY GUIDE FEATURES:
Complete coverage of Cardiovascular, Respiratory, Endocrine, CNS, and Antimicrobial
Pharmacology.
Clinical decision-making, patient safety, and priority assessment scenarios.
High-yield practice questions written specifically for advanced practice nursing standards.
Detailed rationale for correct options, emphasizing clinical judgment and pathophysiology.
Strict adherence to current clinical practice guidelines and evidence-based prescribing.
NURS 711 - Advanced Pharmacotherapies | Graduate Nursing Division
Designed for Examination Preparation & Clinical Knowledge Retention
,NURS 711: ADVANCED PHARMACOTHERAPIES EXAM 3 PREPARATION GUIDE
TABLE OF CONTENTS
Module 1: Advanced Cardiovascular Pharmacotherapy Questions 1–40
Module 2: Advanced Endocrine & Metabolic Pharmacotherapy Questions 41–80
Module 3: Advanced Respiratory Pharmacotherapy Questions 81–120
Module 4: Central Nervous System & Psychiatric Pharmacotherapy Questions 121–160
Module 5: Antimicrobial, Renal & Gastrointestinal Pharmacotherapy Questions 161–200
, MODULE 1: ADVANCED CARDIOVASCULAR PHARMACOTHERAPY
Focuses on antihypertensives, heart failure regimens, antiarrhythmics, lipid-lowering agents, and anticoagulation
therapy.
Question 1
A 58-year-old male with a history of hypertension and heart failure with reduced ejection fraction
(HFrEF) is prescribed sacubitril/valsartan. The patient was previously taking lisinopril 20 mg daily.
What clinical instruction must the advanced practice nurse provide regarding this medication
transition?
A. Start sacubitril/valsartan immediately after discontinuing lisinopril to avoid rebound hypertension.
B. Discontinue lisinopril and allow a 36-hour washout period before administering sacubitril/valsartan.
C. Take both lisinopril and sacubitril/valsartan concurrently for 7 days to maintain adequate hemodynamic
stability.
D. Taper the lisinopril over two weeks while introducing sacubitril/valsartan at half dose.
Correct Answer: B
Rationale: Sacubitril is a neprilysin inhibitor, and combining it with an ACE inhibitor like lisinopril significantly
increases the risk of severe, potentially life-threatening angioedema. A mandatory 36-hour washout period is
required when transitioning from an ACE inhibitor to an ARNI (sacubitril/valsartan).
, Question 2
A patient with persistent atrial fibrillation and stage 3 chronic kidney disease (eGFR 38
mL/min/1.73m²) is initiated on apixaban. Which factor makes apixaban a preferred choice among
Direct Oral Anticoagulants (DOACs) in renal impairment?
A. Apixaban is completely eliminated via biliary pathway.
B. Apixaban has the lowest renal clearance percentage among available DOACs.
C. Apixaban does not bind to plasma proteins and is filtered out completely.
D. Apixaban undergoes full hepatic metabolism without renal excretion.
Correct Answer: B
Rationale: Apixaban has approximately 27% renal clearance, which is lower than dabigatran (~80%) or
rivaroxaban (~36%), making it relatively safer and preferable in moderate renal insufficiency, though monitoring
remains essential.
Question 3
A 62-year-old female presents with hyperlipidemia. Her baseline LDL-C is 190 mg/dL. High-
intensity statin therapy with atorvastatin 80 mg daily is initiated. After 8 weeks, her LDL-C remains
elevated at 130 mg/dL despite strict adherence. What is the next guideline-recommended step in
managing her pharmacotherapy?
A. Switch from atorvastatin to rosuvastatin 10 mg daily.
B. Add ezetimibe 10 mg daily to the current high-intensity statin therapy.
C. Discontinue atorvastatin and initiate a bile acid sequestrant.
D. Double the dose of atorvastatin to 160 mg daily.
Correct Answer: B
Rationale: According to ACC/AHA cholesterol guidelines, if a patient on maximum tolerated high-intensity statin
therapy (atorvastatin 80 mg) has an LDL-C ≥70 mg/dL (or ≥100 mg/dL in non-ASCVD with severe primary
hypercholesterolemia), adding ezetimibe is the recommended first non-statin step.
