NR 568 FINAL EXAM BUNDLE 2026/2027 | Weeks
4-8 | Advanced Pharmacology AGPCNP |
Complete Solutions and Rationales
SECTION 1: CARDIOVASCULAR PHARMACOLOGY (Q1–20)
Q1. A patient taking digoxin reports seeing yellow-green halos around lights. What does this
indicate?
A. Therapeutic effect
B. Digoxin toxicity
C. Expected side effect
D. Need for increased dose
Answer: B
Rationale: Digoxin toxicity can cause gastrointestinal symptoms, dysrhythmias, and visual
disturbances such as blurred or yellow-green vision .
Q2. Which electrolyte abnormality increases the risk of digoxin toxicity?
A. Hypokalemia
B. Hypernatremia
C. Hyperchloremia
D. Hyperphosphatemia
Answer: A
Rationale: Low serum potassium increases digoxin binding to Na⁺/K⁺-ATPase and increases the
risk of toxicity .
Q3. A patient receiving warfarin requires routine monitoring of which laboratory test?
A. aPTT
B. INR
C. Troponin
D. D-dimer
Answer: B
Rationale: The international normalized ratio (INR) is used to monitor the anticoagulant effect
of warfarin .
Q4. Which medication is commonly used to rapidly reverse the anticoagulant effect of
unfractionated heparin?
A. Vitamin K
,B. Protamine sulfate
C. Idarucizumab
D. Naloxone
Answer: B
Rationale: Protamine sulfate binds to and neutralizes heparin. Vitamin K is used for warfarin
reversal .
Q5. Which medication is a direct oral factor Xa inhibitor?
A. Apixaban
B. Warfarin
C. Clopidogrel
D. Aspirin
Answer: A
Rationale: Apixaban directly inhibits factor Xa and is an oral anticoagulant .
Q6. A patient taking apixaban asks why routine INR testing is not required. What is the best
response?
A. "Apixaban has no effect on coagulation."
B. "Apixaban has a predictable anticoagulant effect and does not require routine INR
monitoring."
C. "INR testing is only required during hospitalization."
D. "INR testing is replaced by daily platelet counts."
Answer: B
Rationale: Unlike warfarin, direct oral anticoagulants such as apixaban generally do not require
routine INR monitoring .
Q7. A patient taking metoprolol has a heart rate of 48/min and reports dizziness. What is the
best action?
A. Administer the medication immediately
B. Assess the patient and follow parameters for holding the medication
C. Give an additional dose
D. Encourage vigorous exercise
Answer: B
Rationale: Beta blockers decrease heart rate. Significant symptomatic bradycardia requires
assessment and may warrant withholding the dose and contacting the prescriber .
Q8. Which beta blocker is nonselective?
A. Atenolol
, B. Metoprolol
C. Propranolol
D. Bisoprolol
Answer: C
Rationale: Propranolol blocks both beta-1 and beta-2 receptors and is therefore classified as a
nonselective beta blocker .
Q9. Why should nonselective beta blockers be used cautiously in patients with asthma?
A. They cause severe hyperglycemia
B. They can produce bronchoconstriction
C. They increase thyroid hormone production
D. They cause pulmonary fibrosis
Answer: B
Rationale: Beta-2 blockade can interfere with bronchodilation and precipitate bronchospasm in
susceptible patients .
Q10. Which calcium channel blocker is commonly used for rate control in atrial fibrillation?
A. Amlodipine
B. Nifedipine
C. Diltiazem
D. Felodipine
Answer: C
Rationale: Diltiazem is a non-dihydropyridine calcium channel blocker used for rate control in
atrial fibrillation .
Q11. A 65-year-old male with HFrEF (EF 35%) is on carvedilol, lisinopril, and furosemide but
continues to have symptoms. Which add-on therapy reduces mortality?
A. Spironolactone
B. Digoxin
C. Hydralazine/isosorbide dinitrate
D. Amlodipine
Answer: A
Rationale: Guideline-directed medical therapy for HFrEF includes an aldosterone antagonist
(spironolactone). Spironolactone reduces mortality by approximately 30% .
Q12. A patient on warfarin with a subtherapeutic INR is prescribed a strong CYP2C9 inhibitor.
What adjustment is most appropriate?
A. Increase warfarin dose by 50%
4-8 | Advanced Pharmacology AGPCNP |
Complete Solutions and Rationales
SECTION 1: CARDIOVASCULAR PHARMACOLOGY (Q1–20)
Q1. A patient taking digoxin reports seeing yellow-green halos around lights. What does this
indicate?
A. Therapeutic effect
B. Digoxin toxicity
C. Expected side effect
D. Need for increased dose
Answer: B
Rationale: Digoxin toxicity can cause gastrointestinal symptoms, dysrhythmias, and visual
disturbances such as blurred or yellow-green vision .
Q2. Which electrolyte abnormality increases the risk of digoxin toxicity?
A. Hypokalemia
B. Hypernatremia
C. Hyperchloremia
D. Hyperphosphatemia
Answer: A
Rationale: Low serum potassium increases digoxin binding to Na⁺/K⁺-ATPase and increases the
risk of toxicity .
Q3. A patient receiving warfarin requires routine monitoring of which laboratory test?
A. aPTT
B. INR
C. Troponin
D. D-dimer
Answer: B
Rationale: The international normalized ratio (INR) is used to monitor the anticoagulant effect
of warfarin .
Q4. Which medication is commonly used to rapidly reverse the anticoagulant effect of
unfractionated heparin?
A. Vitamin K
,B. Protamine sulfate
C. Idarucizumab
D. Naloxone
Answer: B
Rationale: Protamine sulfate binds to and neutralizes heparin. Vitamin K is used for warfarin
reversal .
Q5. Which medication is a direct oral factor Xa inhibitor?
A. Apixaban
B. Warfarin
C. Clopidogrel
D. Aspirin
Answer: A
Rationale: Apixaban directly inhibits factor Xa and is an oral anticoagulant .
Q6. A patient taking apixaban asks why routine INR testing is not required. What is the best
response?
A. "Apixaban has no effect on coagulation."
B. "Apixaban has a predictable anticoagulant effect and does not require routine INR
monitoring."
C. "INR testing is only required during hospitalization."
D. "INR testing is replaced by daily platelet counts."
Answer: B
Rationale: Unlike warfarin, direct oral anticoagulants such as apixaban generally do not require
routine INR monitoring .
Q7. A patient taking metoprolol has a heart rate of 48/min and reports dizziness. What is the
best action?
A. Administer the medication immediately
B. Assess the patient and follow parameters for holding the medication
C. Give an additional dose
D. Encourage vigorous exercise
Answer: B
Rationale: Beta blockers decrease heart rate. Significant symptomatic bradycardia requires
assessment and may warrant withholding the dose and contacting the prescriber .
Q8. Which beta blocker is nonselective?
A. Atenolol
, B. Metoprolol
C. Propranolol
D. Bisoprolol
Answer: C
Rationale: Propranolol blocks both beta-1 and beta-2 receptors and is therefore classified as a
nonselective beta blocker .
Q9. Why should nonselective beta blockers be used cautiously in patients with asthma?
A. They cause severe hyperglycemia
B. They can produce bronchoconstriction
C. They increase thyroid hormone production
D. They cause pulmonary fibrosis
Answer: B
Rationale: Beta-2 blockade can interfere with bronchodilation and precipitate bronchospasm in
susceptible patients .
Q10. Which calcium channel blocker is commonly used for rate control in atrial fibrillation?
A. Amlodipine
B. Nifedipine
C. Diltiazem
D. Felodipine
Answer: C
Rationale: Diltiazem is a non-dihydropyridine calcium channel blocker used for rate control in
atrial fibrillation .
Q11. A 65-year-old male with HFrEF (EF 35%) is on carvedilol, lisinopril, and furosemide but
continues to have symptoms. Which add-on therapy reduces mortality?
A. Spironolactone
B. Digoxin
C. Hydralazine/isosorbide dinitrate
D. Amlodipine
Answer: A
Rationale: Guideline-directed medical therapy for HFrEF includes an aldosterone antagonist
(spironolactone). Spironolactone reduces mortality by approximately 30% .
Q12. A patient on warfarin with a subtherapeutic INR is prescribed a strong CYP2C9 inhibitor.
What adjustment is most appropriate?
A. Increase warfarin dose by 50%
