NR565 Week 4 Midterm Exam Review Online
Proctored Exam, NR-565 Advanced
Pharmacology
A patient taking simvastatin reports muscle pain and dark colacolored
urine. What is the top concern?
A. Hepatitis
B. Nephrolithiasis
C. Rhabdomyolysis
D. GERD
✔ Correct Answer: C – Rhabdomyolysis
Expanded Rationale:
Statins rarely cause severe myositis → muscle breakdown → myoglobin
release → dark urine → acute kidney injury.
Urinalysis shows myoglobin, and CK levels are markedly elevated.
Immediate action: STOP the statin + hydrate aggressively.
Liver injury (A) causes jaundice, not dark urine.
4. A patient with diabetes is started on metformin. Which condition is
a contraindication?
,A. Hemoglobin A1c 10%
B. GFR 20 mL/min
C. Obesity
D. Hypertriglyceridemia
✔ Correct Answer: B – GFR 20 mL/min
Expanded Rationale:
Metformin is cleared renally.
Severe renal impairment (GFR <30) → dangerous accumulation → lactic
acidosis.
A1c (A) and obesity (C) actually make metformin more beneficial.
Triglycerides (D) are irrelevant
1. A patient newly diagnosed with hypertension is started on
lisinopril. Two weeks later, the patient develops a persistent dry
cough. What is the best management?
A. Discontinue lisinopril and start an ARB
B. Add benzonatate for cough suppression
C. Continue lisinopril and monitor
D. Increase hydration and reevaluate in 1 month
✔ Correct Answer: A – Discontinue lisinopril and start an ARB
Expanded Rationale:
ACE inhibitors increase levels of bradykinin and substance P → this
irritates airway receptors → persistent dry cough in up to 10–20% of
patients.
Stopping the ACE inhibitor resolves the cough.
,ARBs (losartan, valsartan) do not affect bradykinin → no cough →
guideline-recommended alternative.
Treating the cough (B, D) does nothing because the problem is the drug
itself.
2. A patient presents with severe CAP and a prolonged QT interval.
Which antibiotic is safest?
A. Azithromycin
B. Levofloxacin
C. Clarithromycin
D. Doxycycline
✔ Correct Answer: D – Doxycycline
Expanded Rationale:
Macrolides (A, C) and fluoroquinolones (B) block potassium channels in
the myocardium → prolong QT → risk of torsades.
Doxycycline covers atypicals (Mycoplasma, Chlamydia) and
Streptococcus pneumoniae without cardiac effects, making it the safest
choice.
3.
.
5. Which medication is preferred for rate control in atrial fibrillation in
patients with asthma?
, A. Propranolol
B. Metoprolol
C. Verapamil
D. Carvedilol
Proctored Exam, NR-565 Advanced
Pharmacology
A patient taking simvastatin reports muscle pain and dark colacolored
urine. What is the top concern?
A. Hepatitis
B. Nephrolithiasis
C. Rhabdomyolysis
D. GERD
✔ Correct Answer: C – Rhabdomyolysis
Expanded Rationale:
Statins rarely cause severe myositis → muscle breakdown → myoglobin
release → dark urine → acute kidney injury.
Urinalysis shows myoglobin, and CK levels are markedly elevated.
Immediate action: STOP the statin + hydrate aggressively.
Liver injury (A) causes jaundice, not dark urine.
4. A patient with diabetes is started on metformin. Which condition is
a contraindication?
,A. Hemoglobin A1c 10%
B. GFR 20 mL/min
C. Obesity
D. Hypertriglyceridemia
✔ Correct Answer: B – GFR 20 mL/min
Expanded Rationale:
Metformin is cleared renally.
Severe renal impairment (GFR <30) → dangerous accumulation → lactic
acidosis.
A1c (A) and obesity (C) actually make metformin more beneficial.
Triglycerides (D) are irrelevant
1. A patient newly diagnosed with hypertension is started on
lisinopril. Two weeks later, the patient develops a persistent dry
cough. What is the best management?
A. Discontinue lisinopril and start an ARB
B. Add benzonatate for cough suppression
C. Continue lisinopril and monitor
D. Increase hydration and reevaluate in 1 month
✔ Correct Answer: A – Discontinue lisinopril and start an ARB
Expanded Rationale:
ACE inhibitors increase levels of bradykinin and substance P → this
irritates airway receptors → persistent dry cough in up to 10–20% of
patients.
Stopping the ACE inhibitor resolves the cough.
,ARBs (losartan, valsartan) do not affect bradykinin → no cough →
guideline-recommended alternative.
Treating the cough (B, D) does nothing because the problem is the drug
itself.
2. A patient presents with severe CAP and a prolonged QT interval.
Which antibiotic is safest?
A. Azithromycin
B. Levofloxacin
C. Clarithromycin
D. Doxycycline
✔ Correct Answer: D – Doxycycline
Expanded Rationale:
Macrolides (A, C) and fluoroquinolones (B) block potassium channels in
the myocardium → prolong QT → risk of torsades.
Doxycycline covers atypicals (Mycoplasma, Chlamydia) and
Streptococcus pneumoniae without cardiac effects, making it the safest
choice.
3.
.
5. Which medication is preferred for rate control in atrial fibrillation in
patients with asthma?
, A. Propranolol
B. Metoprolol
C. Verapamil
D. Carvedilol
