NR 565 AdvANced PhARmAcology FiNAl ActuAl exAm –
chAmbeRlAiN uNiveRsity college oF NuRsiNg – 2026/2027
AcAdemic yeAR – veRiFied QuestioNs ANd ANsweRs || bRANd New .
This comprehensive practice examination contains 100 original items aligned with the NR 565
Advanced Pharmacology blueprint for the 2026/2027 final actual exam. The content is
organized into four balanced domains:
DOMAIN I: CARDIOVASCULAR AND RESPIRATORY PHARMACOLOGY (Questions 1–25)
Question 1
For a patient with type 2 diabetes and albuminuria, which antihypertensive class is
preferred first-line for renoprotection?
• A) Non-dihydropyridine calcium channel blocker
• B) Thiazide diuretic
• C) Beta-blocker
• D) Angiotensin-converting enzyme (ACE) inhibitor
ANsweR: D — Angiotensin-converting enzyme (ACE) inhibitor
RAtioNAle: ACE inhibitors reduce intraglomerular pressure and albuminuria, slowing the
progression of diabetic kidney disease. ARBs are also appropriate choices for renoprotection.
Calcium channel blockers (A) and beta-blockers (C) do not have the same renoprotective effects,
though they may be used as adjunctive therapy. Thiazide diuretics (B) are effective for blood
pressure control but do not provide specific renal protection.
Question 2
A patient started on lisinopril reports a persistent dry cough. This effect is most likely
caused by:
• A) Histamine release
, • B) Accumulation of bradykinin
• C) Anticholinergic blockade
• D) Activation of beta-2 receptors
ANsweR: B — Accumulation of bradykinin
RAtioNAle: ACE inhibitors prevent the breakdown of bradykinin, leading to its accumulation
in the respiratory tract and causing a persistent dry cough. This is a common side effect of ACE
inhibitors and is one reason patients may switch to ARBs, which do not affect bradykinin.
Angioedema is a more serious but rare side effect also related to bradykinin accumulation.
Question 3
A patient with heart failure with reduced ejection fraction (HFrEF) is being initiated on
sacubitril/valsartan. Which of the following is the most important consideration before
starting this therapy?
• A) Patient must be on a high-dose ACE inhibitor
• B) Patient must have an ejection fraction > 45%
• C) The ACE inhibitor must be discontinued for 36 hours before starting
• D) Patient must be on a beta-blocker
ANsweR: C — The ACE inhibitor must be discontinued for 36 hours before starting
RAtioNAle: Sacubitril/valsartan (Entresto) is an ARNI (angiotensin receptor-neprilysin inhibitor)
used in HFrEF. It must not be co-administered with ACE inhibitors due to the risk of
angioedema. A 36-hour washout period is required between stopping the ACE inhibitor and
starting sacubitril/valsartan. The ejection fraction must be ≤ 40% for HFrEF indication (B). The
patient does not need to be on a beta-blocker (D) to start Entresto.
Question 4
A patient is prescribed diltiazem for rate control in atrial fibrillation. Which statement
accurately describes the mechanism of action of diltiazem?
• A) Blocks sodium channels in cardiac muscle
• B) Blocks calcium channels in the heart and blood vessels
• C) Blocks beta-1 receptors in the heart
, • D) Blocks potassium channels in cardiac muscle
ANsweR: B — Blocks calcium channels in the heart and blood vessels
RAtioNAle: Diltiazem is a non-dihydropyridine calcium channel blocker that blocks calcium
channels in the heart (slowing AV conduction and heart rate) and blood vessels (causing
vasodilation). It is commonly used for rate control in atrial fibrillation. Sodium channel blockade
(A) is a mechanism of Class I antiarrhythmics. Beta-1 receptor blockade (C) is the mechanism of
beta-blockers. Potassium channel blockade (D) is a mechanism of Class III antiarrhythmics.
Question 5
A patient is prescribed enoxaparin for prophylaxis of deep vein thrombosis (DVT). What is
the primary mechanism of action of enoxaparin?
• A) Direct thrombin inhibitor
• B) Factor Xa inhibitor
• C) Binds to antithrombin III, enhancing its inactivation of factor Xa and thrombin
• D) Vitamin K antagonist
ANsweR: C — Binds to antithrombin III, enhancing its inactivation of factor Xa and
thrombin
RAtioNAle: Enoxaparin is a low molecular weight heparin (LMWH) . It binds to antithrombin
III, enhancing its activity to inactivate factor Xa and thrombin. LMWH has greater activity
against factor Xa compared to unfractionated heparin. Direct thrombin inhibitors (A) include
dabigatran. Factor Xa inhibitors (B) include rivaroxaban and apixaban. Vitamin K antagonists (D)
include warfarin.
Question 6
A patient with asthma is prescribed a LABA/ICS combination (fluticasone/salmeterol).
Which statement by the patient indicates understanding of the medication regimen?
• A) "I will use this inhaler for acute asthma attacks."
• B) "I will use this inhaler daily for maintenance and use my rescue inhaler for acute
symptoms."
• C) "I can stop using this inhaler when I feel better."
• D) "This inhaler works immediately to relieve my symptoms."
, ANsweR: B — "I will use this inhaler daily for maintenance and use my rescue inhaler for
acute symptoms."
RAtioNAle: LABA/ICS combinations are used for maintenance therapy in asthma and must be
used daily. They should not be used for acute symptom relief (A, D). Rescue inhalers (SABAs like
albuterol) are used for acute symptoms. LABAs should never be used as monotherapy in asthma
without an ICS due to the risk of asthma-related death. The medication should not be stopped
abruptly (C).
Question 7
A patient with COPD is prescribed tiotropium. What is the mechanism of action of
tiotropium?
• A) Beta-2 agonist
• B) Long-acting muscarinic antagonist (LAMA)
• C) Inhaled corticosteroid
• D) Leukotriene receptor antagonist
ANsweR: B — Long-acting muscarinic antagonist (LAMA)
RAtioNAle: Tiotropium is a long-acting muscarinic antagonist (LAMA) that provides
bronchodilation by blocking muscarinic receptors in the airways. It is a mainstay of COPD
maintenance therapy. Albuterol (A) is a SABA. Fluticasone (C) is an ICS. Montelukast (D) is a
leukotriene receptor antagonist used in asthma.
Question 8
A patient on chronic warfarin therapy is started on amiodarone. What is the most
important monitoring consideration?
• A) Monitor INR frequently; amiodarone increases warfarin levels
• B) Monitor liver function tests
• C) Monitor serum potassium
• D) Monitor thyroid function
ANsweR: A — Monitor INR frequently; amiodarone increases warfarin levels
RAtioNAle: Amiodarone is a potent CYP3A4 inhibitor that decreases warfarin metabolism,
leading to elevated INR and increased bleeding risk. The INR should be monitored frequently,
chAmbeRlAiN uNiveRsity college oF NuRsiNg – 2026/2027
AcAdemic yeAR – veRiFied QuestioNs ANd ANsweRs || bRANd New .
This comprehensive practice examination contains 100 original items aligned with the NR 565
Advanced Pharmacology blueprint for the 2026/2027 final actual exam. The content is
organized into four balanced domains:
DOMAIN I: CARDIOVASCULAR AND RESPIRATORY PHARMACOLOGY (Questions 1–25)
Question 1
For a patient with type 2 diabetes and albuminuria, which antihypertensive class is
preferred first-line for renoprotection?
• A) Non-dihydropyridine calcium channel blocker
• B) Thiazide diuretic
• C) Beta-blocker
• D) Angiotensin-converting enzyme (ACE) inhibitor
ANsweR: D — Angiotensin-converting enzyme (ACE) inhibitor
RAtioNAle: ACE inhibitors reduce intraglomerular pressure and albuminuria, slowing the
progression of diabetic kidney disease. ARBs are also appropriate choices for renoprotection.
Calcium channel blockers (A) and beta-blockers (C) do not have the same renoprotective effects,
though they may be used as adjunctive therapy. Thiazide diuretics (B) are effective for blood
pressure control but do not provide specific renal protection.
Question 2
A patient started on lisinopril reports a persistent dry cough. This effect is most likely
caused by:
• A) Histamine release
, • B) Accumulation of bradykinin
• C) Anticholinergic blockade
• D) Activation of beta-2 receptors
ANsweR: B — Accumulation of bradykinin
RAtioNAle: ACE inhibitors prevent the breakdown of bradykinin, leading to its accumulation
in the respiratory tract and causing a persistent dry cough. This is a common side effect of ACE
inhibitors and is one reason patients may switch to ARBs, which do not affect bradykinin.
Angioedema is a more serious but rare side effect also related to bradykinin accumulation.
Question 3
A patient with heart failure with reduced ejection fraction (HFrEF) is being initiated on
sacubitril/valsartan. Which of the following is the most important consideration before
starting this therapy?
• A) Patient must be on a high-dose ACE inhibitor
• B) Patient must have an ejection fraction > 45%
• C) The ACE inhibitor must be discontinued for 36 hours before starting
• D) Patient must be on a beta-blocker
ANsweR: C — The ACE inhibitor must be discontinued for 36 hours before starting
RAtioNAle: Sacubitril/valsartan (Entresto) is an ARNI (angiotensin receptor-neprilysin inhibitor)
used in HFrEF. It must not be co-administered with ACE inhibitors due to the risk of
angioedema. A 36-hour washout period is required between stopping the ACE inhibitor and
starting sacubitril/valsartan. The ejection fraction must be ≤ 40% for HFrEF indication (B). The
patient does not need to be on a beta-blocker (D) to start Entresto.
Question 4
A patient is prescribed diltiazem for rate control in atrial fibrillation. Which statement
accurately describes the mechanism of action of diltiazem?
• A) Blocks sodium channels in cardiac muscle
• B) Blocks calcium channels in the heart and blood vessels
• C) Blocks beta-1 receptors in the heart
, • D) Blocks potassium channels in cardiac muscle
ANsweR: B — Blocks calcium channels in the heart and blood vessels
RAtioNAle: Diltiazem is a non-dihydropyridine calcium channel blocker that blocks calcium
channels in the heart (slowing AV conduction and heart rate) and blood vessels (causing
vasodilation). It is commonly used for rate control in atrial fibrillation. Sodium channel blockade
(A) is a mechanism of Class I antiarrhythmics. Beta-1 receptor blockade (C) is the mechanism of
beta-blockers. Potassium channel blockade (D) is a mechanism of Class III antiarrhythmics.
Question 5
A patient is prescribed enoxaparin for prophylaxis of deep vein thrombosis (DVT). What is
the primary mechanism of action of enoxaparin?
• A) Direct thrombin inhibitor
• B) Factor Xa inhibitor
• C) Binds to antithrombin III, enhancing its inactivation of factor Xa and thrombin
• D) Vitamin K antagonist
ANsweR: C — Binds to antithrombin III, enhancing its inactivation of factor Xa and
thrombin
RAtioNAle: Enoxaparin is a low molecular weight heparin (LMWH) . It binds to antithrombin
III, enhancing its activity to inactivate factor Xa and thrombin. LMWH has greater activity
against factor Xa compared to unfractionated heparin. Direct thrombin inhibitors (A) include
dabigatran. Factor Xa inhibitors (B) include rivaroxaban and apixaban. Vitamin K antagonists (D)
include warfarin.
Question 6
A patient with asthma is prescribed a LABA/ICS combination (fluticasone/salmeterol).
Which statement by the patient indicates understanding of the medication regimen?
• A) "I will use this inhaler for acute asthma attacks."
• B) "I will use this inhaler daily for maintenance and use my rescue inhaler for acute
symptoms."
• C) "I can stop using this inhaler when I feel better."
• D) "This inhaler works immediately to relieve my symptoms."
, ANsweR: B — "I will use this inhaler daily for maintenance and use my rescue inhaler for
acute symptoms."
RAtioNAle: LABA/ICS combinations are used for maintenance therapy in asthma and must be
used daily. They should not be used for acute symptom relief (A, D). Rescue inhalers (SABAs like
albuterol) are used for acute symptoms. LABAs should never be used as monotherapy in asthma
without an ICS due to the risk of asthma-related death. The medication should not be stopped
abruptly (C).
Question 7
A patient with COPD is prescribed tiotropium. What is the mechanism of action of
tiotropium?
• A) Beta-2 agonist
• B) Long-acting muscarinic antagonist (LAMA)
• C) Inhaled corticosteroid
• D) Leukotriene receptor antagonist
ANsweR: B — Long-acting muscarinic antagonist (LAMA)
RAtioNAle: Tiotropium is a long-acting muscarinic antagonist (LAMA) that provides
bronchodilation by blocking muscarinic receptors in the airways. It is a mainstay of COPD
maintenance therapy. Albuterol (A) is a SABA. Fluticasone (C) is an ICS. Montelukast (D) is a
leukotriene receptor antagonist used in asthma.
Question 8
A patient on chronic warfarin therapy is started on amiodarone. What is the most
important monitoring consideration?
• A) Monitor INR frequently; amiodarone increases warfarin levels
• B) Monitor liver function tests
• C) Monitor serum potassium
• D) Monitor thyroid function
ANsweR: A — Monitor INR frequently; amiodarone increases warfarin levels
RAtioNAle: Amiodarone is a potent CYP3A4 inhibitor that decreases warfarin metabolism,
leading to elevated INR and increased bleeding risk. The INR should be monitored frequently,
