NR 571 Advanced Pharmacology Midterm Study Set 2025 Q&A Guide with Rationales –
A+ Guaranteed
What is high sensitivity troponin and when to use? first line test for cardiac cell damage
used for initial injury << correct answer >>What is CKMBCK isoenzyme specific to cardiac muscle tissue
(MI) << correct answer >>When should CKMB be used? for suspicion of secondary ischemia after an
initial infarct << correct answer >>normal level for Troponin I <0.04 << correct answer >>normal level
for CKMB 3-5% of total CK << correct answer >>What is BNP B-type natriuretic peptide <<
correct answer >>Normal BNP levels <100 pg/mL << correct answer >>Differential for chest pain
Consider:
Myocardium- angina, MI, myocarditis, heart failure
Pericardium- pericarditis
Aorta- dissecting aortic aneurysm
Trachea and bronchi- bronchitis
Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural effusion, pulmonary embolus
Chest wall- costochondritis, herpes zoster
Esophagus- reflux, esophageal spasm, esophageal tear
Referred pain from elsewhere- cervical arthritis, biliary colic, gastritis
Psych: anxiety attacks << correct answer >>Revascularization in under ____ minutes 90 << correct
answer >>Initial diagnostics for chest pain 12-lead EKG
Troponin q3h x3 at least
BNP - HF
CBC - baseline H&H and Plts
PTT, PT/INR - baseline coagulation status
BMP - renal function and lytes
TSH, Mg, and Phos
ECHO
Cath << correct answer >>Requirements for STEMI dx new ST elevation in 2 contiguous leads of >0.1
mV except V2&V3
elevated troponin << correct answer >>STEMI findings in V2-V3 >0.2mV in >40yo M
,>0.25 mV in <40 yo M
>0.15 mV in women << correct answer >>Difference between NSTEMI and unstable angina NSTEMI
involves Elevated Cardiac Bio markers (cell death) << correct answer >>NSTEMI & unstable angina tx
Dual antiplatelet therapy
Full-dose AC
High-intensity statin
BB
Nitrates
oxygen
pain medication << correct answer >>Dual antiplatelet therapy DAPT
Aspirin (325 x1 = daily 81mg)
AND
P2Y2 inhibitor
clopidogrel or ticagrelor << correct answer >>full dose AC SQ lovenox 1mg/kg BID
if PCI planned of low GFR use heparin gtt
50-70 units/kg bolus plus 12units/kg/hr titrated to PTT 1.5-2.5 x baseline << correct answer >>High-
intensity statin atorvastatin 40-80 mg or rosuvastatin 20-40 mg << correct answer >>Considerations for
BB avoiding BB use HR <60
SBP <100
EF <30%
PR >240 ms
2nd or 3rd degree HB
active asthma or reactive airway disease
COPD
Cocaine use << correct answer >>When is NGT contraindicated? RV infarct b/c it reduces preload <<
correct answer >>Absolute contraindications for fibrinolytic therapy Any prior ICH
known structural cerebral vascular lesions
known malignant intracranial neoplasm
Ischemic stroke <3mo unless <4.5 h
suspected aortic dissection
, active bleeding
significant closed head or facial trauma within 3mo
severe uncontrolled hypertension (unresponsive to therapy) << correct answer >>Identification of LBBB
QRS is negatively deflected in V1 << correct answer >>Identification of RBBB QRS is
positively deflected in V1 << correct answer >>Relative contraindications for fibrinolytic therapy Hx of
chronic, severe, poorly controlled HTN
SBP >180 or DBP >110
Hx of ischemic stork >3mo
dementia
other known intracranial pathology
traumatic or prolonged >10min CPR
major surgery in last 3 wks
internal bleeding within 4 wks
noncompressible vascular punctures
pregnacy
active peptic ulcer
oral AC therapy << correct answer >>In cocaine induced STEMI use _____ instead of ______
benzodiazepines; BB << correct answer >>How long should a patient be on DAPT? 1 year
at least << correct answer >>A 72-year-old patient with a history of CAD presents to the ER with
unstable angina. TIMI score is 5. The nurse practitioner should expect which of the following is the next
step in the care for this patient?
A. coronary angiography
B. CABG
C. notify family that death is imminent
D. tPA A. coronary angiography << correct answer >>A 49-year-old patient presents to the ER and is
diagnosed with NSTEMI. The nurse practitioner can expect which of the following to be included in the
initial treatment plan?
a. tPA
b. ASA, clopidogrel, and enoxaparin
c. norvasc
d. CABG b. ASA, clopidogrel, and enoxaparin << correct answer >>All of the following are
appropriate treatments for a patient with cocaine-induced STEMI, except:
A+ Guaranteed
What is high sensitivity troponin and when to use? first line test for cardiac cell damage
used for initial injury << correct answer >>What is CKMBCK isoenzyme specific to cardiac muscle tissue
(MI) << correct answer >>When should CKMB be used? for suspicion of secondary ischemia after an
initial infarct << correct answer >>normal level for Troponin I <0.04 << correct answer >>normal level
for CKMB 3-5% of total CK << correct answer >>What is BNP B-type natriuretic peptide <<
correct answer >>Normal BNP levels <100 pg/mL << correct answer >>Differential for chest pain
Consider:
Myocardium- angina, MI, myocarditis, heart failure
Pericardium- pericarditis
Aorta- dissecting aortic aneurysm
Trachea and bronchi- bronchitis
Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural effusion, pulmonary embolus
Chest wall- costochondritis, herpes zoster
Esophagus- reflux, esophageal spasm, esophageal tear
Referred pain from elsewhere- cervical arthritis, biliary colic, gastritis
Psych: anxiety attacks << correct answer >>Revascularization in under ____ minutes 90 << correct
answer >>Initial diagnostics for chest pain 12-lead EKG
Troponin q3h x3 at least
BNP - HF
CBC - baseline H&H and Plts
PTT, PT/INR - baseline coagulation status
BMP - renal function and lytes
TSH, Mg, and Phos
ECHO
Cath << correct answer >>Requirements for STEMI dx new ST elevation in 2 contiguous leads of >0.1
mV except V2&V3
elevated troponin << correct answer >>STEMI findings in V2-V3 >0.2mV in >40yo M
,>0.25 mV in <40 yo M
>0.15 mV in women << correct answer >>Difference between NSTEMI and unstable angina NSTEMI
involves Elevated Cardiac Bio markers (cell death) << correct answer >>NSTEMI & unstable angina tx
Dual antiplatelet therapy
Full-dose AC
High-intensity statin
BB
Nitrates
oxygen
pain medication << correct answer >>Dual antiplatelet therapy DAPT
Aspirin (325 x1 = daily 81mg)
AND
P2Y2 inhibitor
clopidogrel or ticagrelor << correct answer >>full dose AC SQ lovenox 1mg/kg BID
if PCI planned of low GFR use heparin gtt
50-70 units/kg bolus plus 12units/kg/hr titrated to PTT 1.5-2.5 x baseline << correct answer >>High-
intensity statin atorvastatin 40-80 mg or rosuvastatin 20-40 mg << correct answer >>Considerations for
BB avoiding BB use HR <60
SBP <100
EF <30%
PR >240 ms
2nd or 3rd degree HB
active asthma or reactive airway disease
COPD
Cocaine use << correct answer >>When is NGT contraindicated? RV infarct b/c it reduces preload <<
correct answer >>Absolute contraindications for fibrinolytic therapy Any prior ICH
known structural cerebral vascular lesions
known malignant intracranial neoplasm
Ischemic stroke <3mo unless <4.5 h
suspected aortic dissection
, active bleeding
significant closed head or facial trauma within 3mo
severe uncontrolled hypertension (unresponsive to therapy) << correct answer >>Identification of LBBB
QRS is negatively deflected in V1 << correct answer >>Identification of RBBB QRS is
positively deflected in V1 << correct answer >>Relative contraindications for fibrinolytic therapy Hx of
chronic, severe, poorly controlled HTN
SBP >180 or DBP >110
Hx of ischemic stork >3mo
dementia
other known intracranial pathology
traumatic or prolonged >10min CPR
major surgery in last 3 wks
internal bleeding within 4 wks
noncompressible vascular punctures
pregnacy
active peptic ulcer
oral AC therapy << correct answer >>In cocaine induced STEMI use _____ instead of ______
benzodiazepines; BB << correct answer >>How long should a patient be on DAPT? 1 year
at least << correct answer >>A 72-year-old patient with a history of CAD presents to the ER with
unstable angina. TIMI score is 5. The nurse practitioner should expect which of the following is the next
step in the care for this patient?
A. coronary angiography
B. CABG
C. notify family that death is imminent
D. tPA A. coronary angiography << correct answer >>A 49-year-old patient presents to the ER and is
diagnosed with NSTEMI. The nurse practitioner can expect which of the following to be included in the
initial treatment plan?
a. tPA
b. ASA, clopidogrel, and enoxaparin
c. norvasc
d. CABG b. ASA, clopidogrel, and enoxaparin << correct answer >>All of the following are
appropriate treatments for a patient with cocaine-induced STEMI, except:
