NR566 Week 5 Quiz Bank | Chapters 18, 19, 27 Chamberlain College of Nursing
NR 566 / NR566 Advanced Pharmacology
Care of the Family - Week 5 Quiz Bank
Chapters 18, 19, 27 | 50 Questions with Verified Answers
Chamberlain College of Nursing | Aligned 2026-2027
Section 1: Chapter 18 - Drugs for Heart Failure (Q1-Q15)
Q1: A 68-year-old patient with heart failure with reduced ejection fraction (HFrEF) is started on lisinopril. The nurse
practitioner understands that ACE inhibitors improve outcomes in HFrEF primarily through which mechanism?
A. Increasing myocardial contractility and cardiac output
B. Blocking aldosterone secretion and reducing ventricular remodeling [CORRECT]
C. Increasing heart rate to improve tissue perfusion
D. Promoting sodium and water retention to increase preload
Correct Answer: B
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II, which reduces aldosterone secretion,
decreases sodium and water retention, and causes vasodilation. The primary benefit in HFrEF is attenuation of adverse
ventricular remodeling and reduction of afterload, which slows disease progression and decreases mortality per
AHA/ACC/HFSA 2022 guidelines. Increasing contractility (A) describes inotropes, not ACE inhibitors. Increasing heart rate (C)
would increase myocardial oxygen demand and is contraindicated in HF. Promoting sodium retention (D) is the opposite of ACE
inhibitor action and would worsen HF.
Q2: A patient with chronic heart failure presents with a serum potassium level of 5.8 mEq/L and a digoxin level of
2.4 ng/mL. The patient reports nausea, visual disturbances described as yellow-green halos, and frequent premature
ventricular contractions. Which intervention should the nurse practitioner prioritize?
A. Administer a diuretic and recheck digoxin level in 48 hours
B. Hold digoxin, obtain an ECG, administer potassium-binding resin, and consider digoxin-specific antibody
fragments (Digifib) [CORRECT]
C. Reduce the digoxin dose by 50% and add a loop diuretic
D. Switch from digoxin to dobutamine and monitor for improvement
Correct Answer: B
Rationale: This patient demonstrates classic digoxin toxicity with elevated serum digoxin level (therapeutic range 0.5-2.0
ng/mL), hyperkalemia, gastrointestinal symptoms (nausea), visual disturbances (yellow-green halos), and ventricular ectopy.
Hyperkalemia in this context is particularly dangerous because it potentiates digoxin-induced arrhythmias. The priority is to
hold digoxin, obtain an ECG to assess rhythm disturbances, treat hyperkalemia, and consider Digifib for severe toxicity.
Administering a diuretic (A) could worsen hypokalemia if it were present, but this patient is hyperkalemic. Reducing the dose by
50% (C) is insufficient for toxicity with ECG changes. Switching to dobutamine (D) does not address the life-threatening digoxin
toxicity.
Page 1
,Q3: A nurse practitioner is educating a patient with HFrEF about the purpose of carvedilol. Which statement by the
patient indicates an accurate understanding of this medication?
A. This medication will increase the strength of my heart contractions
B. This medication will help my heart pump faster so I feel less tired
C. This medication blocks the harmful effects of adrenaline on my heart and helps prevent my heart from
getting worse over time [CORRECT]
D. This medication will help my kidneys remove more fluid so I have less swelling
Correct Answer: C
Rationale: Carvedilol is a third-generation nonselective beta-blocker with alpha-1 blocking activity that is a cornerstone of
HFrEF guideline-directed medical therapy (GDMT). It works by blocking sympathetic nervous system activation (adrenergic
stimulation) that contributes to cardiac remodeling, tachycardia, and increased myocardial oxygen demand. The
AHA/ACC/HFSA guidelines recommend carvedilol, metoprolol succinate, or bisoprolol as the three evidence-based
beta-blockers for HFrEF. Increasing contractility (A) describes inotrope action. Increasing heart rate (B) is the opposite of
beta-blockade. Promoting diuresis (D) describes loop diuretic action, not beta-blocker action.
Q4: A 72-year-old patient with HFrEF and NYHA Class III symptoms is currently on lisinopril, carvedilol, and
furosemide. The nurse practitioner is considering adding sacubitril/valsartan (Entresto). What is the most critical
safety consideration before initiating this medication?
A. Ensure the patient has been off ACE inhibitors for at least 36 hours to avoid angioedema risk [CORRECT]
B. Obtain a baseline echocardiogram to confirm LVEF is below 30%
C. Check serum sodium levels to confirm they are above 140 mEq/L
D. Verify the patient is not taking any beta-blockers before initiation
Correct Answer: A
Rationale: Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) that combines a neprilysin inhibitor with
an ARB. The critical safety requirement is a 36-hour washout period after discontinuing ACE inhibitors before starting
sacubitril/valsartan due to the risk of life-threatening angioedema from dual inhibition of bradykinin breakdown. The
PARADIGM-HF trial demonstrated superior mortality and hospitalization reduction compared to enalapril. LVEF below 30%
(B) is not required; the indication is HFrEF with LVEF less than or equal to 35%. Checking sodium (C) is not the critical safety
concern. Beta-blockers (D) should be continued as part of GDMT and are not a contraindication to ARNI therapy.
Q5: A patient with HFrEF is prescribed furosemide 40 mg PO daily. The nurse practitioner notes the patient has
developed a serum potassium of 3.0 mEq/L. Which pharmacological approach is most appropriate for managing this
hypokalemia while continuing HF therapy?
A. Add spironolactone 25 mg daily [CORRECT]
B. Switch from furosemide to hydrochlorothiazide
C. Increase dietary potassium and monitor without medication changes
D. Add potassium chloride supplements 40 mEq daily and reduce furosemide dose
Correct Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic and mineralocorticoid receptor antagonist (MRA) that is
recommended as part of GDMT for HFrEF (NYHA Class II-IV) per AHA/ACC/HFSA guidelines. It treats hypokalemia while
simultaneously providing mortality benefit by counteracting aldosterone-mediated cardiac remodeling. The RALES trial
demonstrated a 30% reduction in mortality with spironolactone in HFrEF. Switching to hydrochlorothiazide (B) would provide
weaker diuresis and still cause potassium loss. Dietary potassium alone (C) is insufficient for a level of 3.0 mEq/L. While
, potassium supplements (D) may be needed acutely, adding an MRA provides both potassium-sparing and mortality benefits,
making it the superior long-term strategy.
Q6: A patient with stage C HFrEF (LVEF 30%) on lisinopril, carvedilol, furosemide, and spironolactone reports
persistent dyspnea on exertion despite optimal doses. Blood pressure is 105/68 mmHg and heart rate is 72 bpm.
Based on 2022 AHA/ACC/HFSA guideline updates, which medication should the nurse practitioner consider adding
next?
A. Hydralazine plus isosorbide dinitrate
B. Sacubitril/valsartan (Entresto) [CORRECT]
C. Digoxin 0.125 mg daily
D. Ivabradine
Correct Answer: B
Rationale: In a patient already on ACE inhibitor (or switching to ARNI), beta-blocker, diuretic, and MRA with persistent
symptoms, the next step per updated AHA/ACC/HFSA guidelines is to substitute the ACE inhibitor with sacubitril/valsartan
(Entresto) if not already prescribed, as it provides superior outcomes compared to ACE inhibitors alone. The heart rate of 72
bpm does not meet the threshold for ivabradine (D), which requires a resting heart rate of 70 bpm or greater in sinus rhythm.
Hydralazine-isosorbide dinitrate (A) is recommended specifically for self-identified African American patients who remain
symptomatic despite optimal GDMT. Digoxin (C) may be considered for symptom control but does not reduce mortality and is
not the preferred next agent per guideline-directed sequencing.
Q7: A 55-year-old African American patient with HFrEF (LVEF 28%) remains symptomatic (NYHA Class III)
despite maximum tolerated doses of ACE inhibitor, beta-blocker, and diuretic. Blood pressure is 110/70 mmHg. The
patient is not on an ARNI due to insurance limitations. Which combination therapy is most appropriate to add based
on evidence-based guidelines?
A. Hydralazine 25 mg TID plus isosorbide dinitrate 20 mg TID [CORRECT]
B. Amlodipine 5 mg daily plus carvedilol 25 mg BID
C. Digoxin 0.25 mg daily plus furosemide 80 mg daily
D. Losartan 50 mg daily plus spironolactone 50 mg daily
Correct Answer: A
Rationale: The A-HeFT trial demonstrated that the combination of hydralazine and isosorbide dinitrate significantly reduced
mortality and hospitalization in self-identified African American patients with HFrEF who remained symptomatic despite
standard therapy. This combination is given a Class I recommendation for this population in the AHA/ACC/HFSA guidelines.
Hydralazine provides afterload reduction through direct vasodilation, while isosorbide dinitrate provides venous dilation and
nitric oxide supplementation. Amlodipine (B) is not recommended for routine HF management. Digoxin 0.25 mg (C) is too high a
starting dose and does not address the guideline-recommended approach for this population. Adding losartan plus
spironolactone (D) to an ACE inhibitor would risk dual renin-angiotensin system blockade and hyperkalemia.
Q8: A nurse practitioner is monitoring a patient with HFrEF who has been on digoxin 0.25 mg daily for 2 weeks.
The patient reports new-onset anorexia, nausea, and blurred vision. The serum digoxin level is 2.6 ng/mL, serum
potassium is 3.4 mEq/L, and the ECG shows first-degree AV block. The nurse practitioner identifies this as digoxin
toxicity. What is the most appropriate initial management?
A. Administer activated charcoal and increase oral potassium intake
NR 566 / NR566 Advanced Pharmacology
Care of the Family - Week 5 Quiz Bank
Chapters 18, 19, 27 | 50 Questions with Verified Answers
Chamberlain College of Nursing | Aligned 2026-2027
Section 1: Chapter 18 - Drugs for Heart Failure (Q1-Q15)
Q1: A 68-year-old patient with heart failure with reduced ejection fraction (HFrEF) is started on lisinopril. The nurse
practitioner understands that ACE inhibitors improve outcomes in HFrEF primarily through which mechanism?
A. Increasing myocardial contractility and cardiac output
B. Blocking aldosterone secretion and reducing ventricular remodeling [CORRECT]
C. Increasing heart rate to improve tissue perfusion
D. Promoting sodium and water retention to increase preload
Correct Answer: B
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II, which reduces aldosterone secretion,
decreases sodium and water retention, and causes vasodilation. The primary benefit in HFrEF is attenuation of adverse
ventricular remodeling and reduction of afterload, which slows disease progression and decreases mortality per
AHA/ACC/HFSA 2022 guidelines. Increasing contractility (A) describes inotropes, not ACE inhibitors. Increasing heart rate (C)
would increase myocardial oxygen demand and is contraindicated in HF. Promoting sodium retention (D) is the opposite of ACE
inhibitor action and would worsen HF.
Q2: A patient with chronic heart failure presents with a serum potassium level of 5.8 mEq/L and a digoxin level of
2.4 ng/mL. The patient reports nausea, visual disturbances described as yellow-green halos, and frequent premature
ventricular contractions. Which intervention should the nurse practitioner prioritize?
A. Administer a diuretic and recheck digoxin level in 48 hours
B. Hold digoxin, obtain an ECG, administer potassium-binding resin, and consider digoxin-specific antibody
fragments (Digifib) [CORRECT]
C. Reduce the digoxin dose by 50% and add a loop diuretic
D. Switch from digoxin to dobutamine and monitor for improvement
Correct Answer: B
Rationale: This patient demonstrates classic digoxin toxicity with elevated serum digoxin level (therapeutic range 0.5-2.0
ng/mL), hyperkalemia, gastrointestinal symptoms (nausea), visual disturbances (yellow-green halos), and ventricular ectopy.
Hyperkalemia in this context is particularly dangerous because it potentiates digoxin-induced arrhythmias. The priority is to
hold digoxin, obtain an ECG to assess rhythm disturbances, treat hyperkalemia, and consider Digifib for severe toxicity.
Administering a diuretic (A) could worsen hypokalemia if it were present, but this patient is hyperkalemic. Reducing the dose by
50% (C) is insufficient for toxicity with ECG changes. Switching to dobutamine (D) does not address the life-threatening digoxin
toxicity.
Page 1
,Q3: A nurse practitioner is educating a patient with HFrEF about the purpose of carvedilol. Which statement by the
patient indicates an accurate understanding of this medication?
A. This medication will increase the strength of my heart contractions
B. This medication will help my heart pump faster so I feel less tired
C. This medication blocks the harmful effects of adrenaline on my heart and helps prevent my heart from
getting worse over time [CORRECT]
D. This medication will help my kidneys remove more fluid so I have less swelling
Correct Answer: C
Rationale: Carvedilol is a third-generation nonselective beta-blocker with alpha-1 blocking activity that is a cornerstone of
HFrEF guideline-directed medical therapy (GDMT). It works by blocking sympathetic nervous system activation (adrenergic
stimulation) that contributes to cardiac remodeling, tachycardia, and increased myocardial oxygen demand. The
AHA/ACC/HFSA guidelines recommend carvedilol, metoprolol succinate, or bisoprolol as the three evidence-based
beta-blockers for HFrEF. Increasing contractility (A) describes inotrope action. Increasing heart rate (B) is the opposite of
beta-blockade. Promoting diuresis (D) describes loop diuretic action, not beta-blocker action.
Q4: A 72-year-old patient with HFrEF and NYHA Class III symptoms is currently on lisinopril, carvedilol, and
furosemide. The nurse practitioner is considering adding sacubitril/valsartan (Entresto). What is the most critical
safety consideration before initiating this medication?
A. Ensure the patient has been off ACE inhibitors for at least 36 hours to avoid angioedema risk [CORRECT]
B. Obtain a baseline echocardiogram to confirm LVEF is below 30%
C. Check serum sodium levels to confirm they are above 140 mEq/L
D. Verify the patient is not taking any beta-blockers before initiation
Correct Answer: A
Rationale: Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) that combines a neprilysin inhibitor with
an ARB. The critical safety requirement is a 36-hour washout period after discontinuing ACE inhibitors before starting
sacubitril/valsartan due to the risk of life-threatening angioedema from dual inhibition of bradykinin breakdown. The
PARADIGM-HF trial demonstrated superior mortality and hospitalization reduction compared to enalapril. LVEF below 30%
(B) is not required; the indication is HFrEF with LVEF less than or equal to 35%. Checking sodium (C) is not the critical safety
concern. Beta-blockers (D) should be continued as part of GDMT and are not a contraindication to ARNI therapy.
Q5: A patient with HFrEF is prescribed furosemide 40 mg PO daily. The nurse practitioner notes the patient has
developed a serum potassium of 3.0 mEq/L. Which pharmacological approach is most appropriate for managing this
hypokalemia while continuing HF therapy?
A. Add spironolactone 25 mg daily [CORRECT]
B. Switch from furosemide to hydrochlorothiazide
C. Increase dietary potassium and monitor without medication changes
D. Add potassium chloride supplements 40 mEq daily and reduce furosemide dose
Correct Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic and mineralocorticoid receptor antagonist (MRA) that is
recommended as part of GDMT for HFrEF (NYHA Class II-IV) per AHA/ACC/HFSA guidelines. It treats hypokalemia while
simultaneously providing mortality benefit by counteracting aldosterone-mediated cardiac remodeling. The RALES trial
demonstrated a 30% reduction in mortality with spironolactone in HFrEF. Switching to hydrochlorothiazide (B) would provide
weaker diuresis and still cause potassium loss. Dietary potassium alone (C) is insufficient for a level of 3.0 mEq/L. While
, potassium supplements (D) may be needed acutely, adding an MRA provides both potassium-sparing and mortality benefits,
making it the superior long-term strategy.
Q6: A patient with stage C HFrEF (LVEF 30%) on lisinopril, carvedilol, furosemide, and spironolactone reports
persistent dyspnea on exertion despite optimal doses. Blood pressure is 105/68 mmHg and heart rate is 72 bpm.
Based on 2022 AHA/ACC/HFSA guideline updates, which medication should the nurse practitioner consider adding
next?
A. Hydralazine plus isosorbide dinitrate
B. Sacubitril/valsartan (Entresto) [CORRECT]
C. Digoxin 0.125 mg daily
D. Ivabradine
Correct Answer: B
Rationale: In a patient already on ACE inhibitor (or switching to ARNI), beta-blocker, diuretic, and MRA with persistent
symptoms, the next step per updated AHA/ACC/HFSA guidelines is to substitute the ACE inhibitor with sacubitril/valsartan
(Entresto) if not already prescribed, as it provides superior outcomes compared to ACE inhibitors alone. The heart rate of 72
bpm does not meet the threshold for ivabradine (D), which requires a resting heart rate of 70 bpm or greater in sinus rhythm.
Hydralazine-isosorbide dinitrate (A) is recommended specifically for self-identified African American patients who remain
symptomatic despite optimal GDMT. Digoxin (C) may be considered for symptom control but does not reduce mortality and is
not the preferred next agent per guideline-directed sequencing.
Q7: A 55-year-old African American patient with HFrEF (LVEF 28%) remains symptomatic (NYHA Class III)
despite maximum tolerated doses of ACE inhibitor, beta-blocker, and diuretic. Blood pressure is 110/70 mmHg. The
patient is not on an ARNI due to insurance limitations. Which combination therapy is most appropriate to add based
on evidence-based guidelines?
A. Hydralazine 25 mg TID plus isosorbide dinitrate 20 mg TID [CORRECT]
B. Amlodipine 5 mg daily plus carvedilol 25 mg BID
C. Digoxin 0.25 mg daily plus furosemide 80 mg daily
D. Losartan 50 mg daily plus spironolactone 50 mg daily
Correct Answer: A
Rationale: The A-HeFT trial demonstrated that the combination of hydralazine and isosorbide dinitrate significantly reduced
mortality and hospitalization in self-identified African American patients with HFrEF who remained symptomatic despite
standard therapy. This combination is given a Class I recommendation for this population in the AHA/ACC/HFSA guidelines.
Hydralazine provides afterload reduction through direct vasodilation, while isosorbide dinitrate provides venous dilation and
nitric oxide supplementation. Amlodipine (B) is not recommended for routine HF management. Digoxin 0.25 mg (C) is too high a
starting dose and does not address the guideline-recommended approach for this population. Adding losartan plus
spironolactone (D) to an ACE inhibitor would risk dual renin-angiotensin system blockade and hyperkalemia.
Q8: A nurse practitioner is monitoring a patient with HFrEF who has been on digoxin 0.25 mg daily for 2 weeks.
The patient reports new-onset anorexia, nausea, and blurred vision. The serum digoxin level is 2.6 ng/mL, serum
potassium is 3.4 mEq/L, and the ECG shows first-degree AV block. The nurse practitioner identifies this as digoxin
toxicity. What is the most appropriate initial management?
A. Administer activated charcoal and increase oral potassium intake
