Nur 641 E Final Exam Study Guide Grand Canyon
University | latest Update 2026/2027
1. A patient with HFrEF (EF 32%) is on carvedilol, sacubitril/valsartan, and
spironolactone. Which medication has Class 1A recommendation for
reducing cardiovascular death and heart failure hospitalizations regardless of
diabetes status?
A) Ivabradine
B) Dapagliflozin
C) Digoxin
D) Hydralazine/isosorbide dinitrate
Answer B: Dapagliflozin
Rationale: SGLT2 inhibitors (dapagliflozin, empagliflozin) are recommended for
HFrEF regardless of diabetes status; benefits include natriuresis, reduced
inflammation, and improved cardiac energetics .
2. A patient on simvastatin 80 mg daily develops severe myalgias and dark
urine. Which genetic polymorphism is most strongly associated with
increased risk of statin-induced myopathy?
A) CYP3A41B
B) SLCO1B1 rs4149056 (C allele)
C) VKORC1 -1639G>A
,D) ABCG2 c.421C>A
Answer B: SLCO1B1 rs4149056 (C allele)
Rationale: The SLCO1B1 gene encodes OATP1B1 for hepatic drug uptake; the
reduced-function C allele increases simvastatin acid plasma concentrations,
markedly elevating myopathy risk .
3. Which anticoagulant is preferred in a patient with a mechanical mitral
valve replacement and atrial fibrillation?
A) Apixaban
B) Rivaroxaban
C) Dabigatran
D) Warfarin
Answer D: Warfarin
Rationale: Warfarin is the only anticoagulant indicated for mechanical heart
valves; DOACs are contraindicated .
4. Pharmacokinetics involves which four processes?
A) Absorption, distribution, metabolism, excretion
B) Absorption, distribution, metabolism, elimination
C) Administration, distribution, metabolism, excretion
D) Absorption, distribution, metabolism, replication
Answer A: Absorption, distribution, metabolism, excretion
,Rationale: Pharmacokinetics describes what the body does to a drug through
ADME: absorption from administration site, distribution into tissues, metabolism
(biotransformation), and elimination .
5. The intravenous route of administration offers which advantage?
A) Erratic and variable absorption
B) Highest bioavailability; bypasses absorption; avoids first-pass metabolism
C) Requires first-pass metabolism
D) Limited to lipid-soluble drugs
Answer B: Highest bioavailability; bypasses absorption; avoids first-pass
metabolism
Rationale: IV administration delivers 100% bioavailability, bypasses absorption,
and avoids first-pass hepatic metabolism .
6. The normal aPTT (activated partial thromboplastin time) is:
A) 10-20 seconds
B) 30-40 seconds
C) 60-80 seconds
D) 15-25 seconds
Answer B: 30-40 seconds
Rationale: Normal aPTT is 30-40 seconds. Therapeutic aPTT for heparin is 1.5-2.5
times the normal value .
, 7. The therapeutic INR for warfarin is:
A) 1.0-1.5
B) 2.0-3.0
C) 3.0-4.0
D) 4.0-5.0
Answer B: 2.0-3.0
Rationale: INR of 2.0-3.0 is therapeutic for warfarin in most indications (e.g., atrial
fibrillation, DVT). Normal INR is <1.1 .
8. Which antidote reverses the effects of dabigatran?
A) Protamine sulfate
B) Idarucizumab
C) Vitamin K
D) Andexanet alfa
Answer B: Idarucizumab
Rationale: Idarucizumab (Praxbind) is a specific reversal agent for dabigatran
(Pradaxa), a direct thrombin inhibitor .
9. Which drugs are factor Xa inhibitors?
A) Apixaban, edoxaban, rivaroxaban, fondaparinux
B) Dabigatran, argatroban
C) Warfarin, heparin
University | latest Update 2026/2027
1. A patient with HFrEF (EF 32%) is on carvedilol, sacubitril/valsartan, and
spironolactone. Which medication has Class 1A recommendation for
reducing cardiovascular death and heart failure hospitalizations regardless of
diabetes status?
A) Ivabradine
B) Dapagliflozin
C) Digoxin
D) Hydralazine/isosorbide dinitrate
Answer B: Dapagliflozin
Rationale: SGLT2 inhibitors (dapagliflozin, empagliflozin) are recommended for
HFrEF regardless of diabetes status; benefits include natriuresis, reduced
inflammation, and improved cardiac energetics .
2. A patient on simvastatin 80 mg daily develops severe myalgias and dark
urine. Which genetic polymorphism is most strongly associated with
increased risk of statin-induced myopathy?
A) CYP3A41B
B) SLCO1B1 rs4149056 (C allele)
C) VKORC1 -1639G>A
,D) ABCG2 c.421C>A
Answer B: SLCO1B1 rs4149056 (C allele)
Rationale: The SLCO1B1 gene encodes OATP1B1 for hepatic drug uptake; the
reduced-function C allele increases simvastatin acid plasma concentrations,
markedly elevating myopathy risk .
3. Which anticoagulant is preferred in a patient with a mechanical mitral
valve replacement and atrial fibrillation?
A) Apixaban
B) Rivaroxaban
C) Dabigatran
D) Warfarin
Answer D: Warfarin
Rationale: Warfarin is the only anticoagulant indicated for mechanical heart
valves; DOACs are contraindicated .
4. Pharmacokinetics involves which four processes?
A) Absorption, distribution, metabolism, excretion
B) Absorption, distribution, metabolism, elimination
C) Administration, distribution, metabolism, excretion
D) Absorption, distribution, metabolism, replication
Answer A: Absorption, distribution, metabolism, excretion
,Rationale: Pharmacokinetics describes what the body does to a drug through
ADME: absorption from administration site, distribution into tissues, metabolism
(biotransformation), and elimination .
5. The intravenous route of administration offers which advantage?
A) Erratic and variable absorption
B) Highest bioavailability; bypasses absorption; avoids first-pass metabolism
C) Requires first-pass metabolism
D) Limited to lipid-soluble drugs
Answer B: Highest bioavailability; bypasses absorption; avoids first-pass
metabolism
Rationale: IV administration delivers 100% bioavailability, bypasses absorption,
and avoids first-pass hepatic metabolism .
6. The normal aPTT (activated partial thromboplastin time) is:
A) 10-20 seconds
B) 30-40 seconds
C) 60-80 seconds
D) 15-25 seconds
Answer B: 30-40 seconds
Rationale: Normal aPTT is 30-40 seconds. Therapeutic aPTT for heparin is 1.5-2.5
times the normal value .
, 7. The therapeutic INR for warfarin is:
A) 1.0-1.5
B) 2.0-3.0
C) 3.0-4.0
D) 4.0-5.0
Answer B: 2.0-3.0
Rationale: INR of 2.0-3.0 is therapeutic for warfarin in most indications (e.g., atrial
fibrillation, DVT). Normal INR is <1.1 .
8. Which antidote reverses the effects of dabigatran?
A) Protamine sulfate
B) Idarucizumab
C) Vitamin K
D) Andexanet alfa
Answer B: Idarucizumab
Rationale: Idarucizumab (Praxbind) is a specific reversal agent for dabigatran
(Pradaxa), a direct thrombin inhibitor .
9. Which drugs are factor Xa inhibitors?
A) Apixaban, edoxaban, rivaroxaban, fondaparinux
B) Dabigatran, argatroban
C) Warfarin, heparin
