NR 508 – Advanced Pharmacology for Nurse
Practitioners | 2025/2026 Verified Questions
and Detailed Rationales
Cardiovascular Pharmacology (Questions 1-10)
Question 1: A 55-year-old female patient with newly diagnosed hypertension (BP 150/95 mmHg) and no
comorbidities presents for initial therapy. According to 2025 guidelines, what is the first-line
pharmacologic recommendation for this patient?
A) Hydrochlorothiazide 25 mg daily
B) Amlodipine 5 mg daily
C) Lisinopril 10 mg daily
D) Metoprolol 50 mg twice daily
Rationale: The 2025 AHA/ACC/AANP guideline for high blood pressure management recommends
calcium channel blockers (e.g., amlodipine) or thiazide diuretics as first-line for uncomplicated
hypertension in adults without specific compelling indications. This choice balances efficacy, tolerability,
and low AE risk (e.g., orthostasis with diuretics in older adults). PK: Amlodipine has a long half-life
(30-50 hours), supporting once-daily dosing. PD: Vasodilation reduces peripheral resistance.
Contraindications: Avoid in aortic stenosis. Monitor for edema (AE).
Question 2: In a patient with acute coronary syndrome (ACS) and ST-elevation, what antiplatelet agent is
recommended for loading dose per 2025 ACC/AHA guidelines?
A) Clopidogrel 300 mg
B) Aspirin 162-325 mg
C) Ticagrelor 90 mg
D) Prasugrel 30 mg
Rationale: The 2025 ACC/AHA guideline for ACS management emphasizes immediate aspirin loading
(162-325 mg chewed) as foundational therapy to inhibit platelet aggregation via COX-1 inhibition. PD:
Irreversible acetylation of cyclooxygenase. PK: Rapid absorption (peak 30-60 min). AEs: GI bleeding
(contraindicated in active ulcer). Follow with P2Y12 inhibitor for dual therapy in NPs' therapeutic
decision-making.
Question 3: A 65-year-old male with familial hypercholesterolemia (LDL 180 mg/dL) requires statin
intensification. What is the preferred high-intensity statin per 2025 AACE guidelines?
A) Simvastatin 40 mg
,B) Atorvastatin 40-80 mg
C) Rosuvastatin 10 mg
D) Pravastatin 40 mg
Rationale: The 2025 AACE pharmacologic management guideline for dyslipidemia recommends
high-intensity statins like atorvastatin 40-80 mg for high-risk patients to achieve ≥50% LDL reduction.
PK: Hepatic CYP3A4 metabolism; half-life 14 hours. PD: HMG-CoA reductase inhibition. AEs:
Myopathy (monitor CK); contraindicated in active liver disease. NPs should assess ASCVD risk for
personalized prescribing.
Question 4: For a patient with heart failure with preserved ejection fraction (HFpEF), what medication
class improves outcomes per 2025 ACC/AHA core principles?
A) Digoxin
B) SGLT2 inhibitors (e.g., empagliflozin)
C) Ivabradine
D) Spironolactone
Rationale: 2025 ACC/AHA guidelines highlight SGLT2 inhibitors for HFpEF to reduce hospitalization
risk via natriuresis and cardioprotection. PK: Renal excretion; dose adjust in eGFR <45. PD:
Glucose-independent diuresis. AEs: Genital mycotic infections; contraindicated in type 1 DM.
Therapeutic decision: Combine with loop diuretics if volume overload.
Question 5: A patient on warfarin develops atrial fibrillation. What is the preferred anticoagulant switch
per 2025 guidelines?
A) Continue warfarin
B) Apixaban 5 mg BID
C) Enoxaparin bridge
D) Clopidogrel
Rationale: DOACs like apixaban are preferred over warfarin for nonvalvular AF in 2025 AHA/ACC
guidelines due to lower intracranial bleed risk. PK: Renal/hepatic clearance; half-life 12 hours. PD: Factor
Xa inhibition. AEs: Bleeding (monitor CrCl); contraindicated in CrCl <15. NPs: Use CHA2DS2-VASc
for stroke risk assessment.
Question 6: In managing resistant hypertension, what adjunctive agent is recommended after triple
therapy failure?
A) Beta-blocker escalation
B) Mineralocorticoid receptor antagonist (e.g., spironolactone)
C) Alpha-blocker
D) Central agonist
, Rationale: 2025 hypertension guidelines endorse spironolactone as fourth-line for resistant HTN,
targeting aldosterone excess. PK: Hepatic; half-life 1.4 hours. PD: Aldosterone antagonism. AEs:
Hyperkalemia (monitor K+); contraindicated in hyperkalemia. NP practice: Lifestyle integration essential.
Question 7: A diabetic patient with CVD starts a GLP-1 RA. What CV benefit is evidenced in 2025
guidelines?
A) Bradycardia
B) Reduced MACE (MI, stroke, CV death)
C) Hypoglycemia
D) Weight loss only
Rationale: GLP-1 RAs reduce MACE in T2DM with CVD per 2025 ACC/AHA updates. PK: SubQ;
half-life 13 hours (semaglutide). PD: GLP-1 mimicry. AEs: GI upset; contraindicated in MTC history.
Therapeutic: First-line with metformin.
Question 8: For lipid management in CKD, what statin dose adjustment is needed?
A) No change
B) Reduce to moderate-intensity (e.g., atorvastatin 20 mg)
C) High-intensity
D) Discontinue
Rationale: 2025 AACE guidelines recommend moderate-intensity statins in CKD stage 3-5 to minimize
myopathy risk. PK: Reduced clearance in renal impairment. PD: Same. AEs: Rhabdomyolysis. NPs:
eGFR-guided dosing.
Question 9: A post-MI patient on dual antiplatelet therapy develops GI bleed. What intervention?
A) Continue therapy
B) Add PPI (e.g., pantoprazole)
C) Switch to ticagrelor
D) Stop aspirin
Rationale: 2025 ACS guidelines recommend PPI prophylaxis in high GI risk on DAPT. PK: Hepatic;
half-life 1 hour. PD: H+/K+ ATPase inhibition. AEs: C. diff; contraindicated in allergy. Decision-making:
Risk-benefit assessment.
Question 10: In HF with reduced EF, what ARNI is preferred over ACEI?
A) Lisinopril
B) Sacubitril/valsartan
C) Losartan
D) Enalapril
Practitioners | 2025/2026 Verified Questions
and Detailed Rationales
Cardiovascular Pharmacology (Questions 1-10)
Question 1: A 55-year-old female patient with newly diagnosed hypertension (BP 150/95 mmHg) and no
comorbidities presents for initial therapy. According to 2025 guidelines, what is the first-line
pharmacologic recommendation for this patient?
A) Hydrochlorothiazide 25 mg daily
B) Amlodipine 5 mg daily
C) Lisinopril 10 mg daily
D) Metoprolol 50 mg twice daily
Rationale: The 2025 AHA/ACC/AANP guideline for high blood pressure management recommends
calcium channel blockers (e.g., amlodipine) or thiazide diuretics as first-line for uncomplicated
hypertension in adults without specific compelling indications. This choice balances efficacy, tolerability,
and low AE risk (e.g., orthostasis with diuretics in older adults). PK: Amlodipine has a long half-life
(30-50 hours), supporting once-daily dosing. PD: Vasodilation reduces peripheral resistance.
Contraindications: Avoid in aortic stenosis. Monitor for edema (AE).
Question 2: In a patient with acute coronary syndrome (ACS) and ST-elevation, what antiplatelet agent is
recommended for loading dose per 2025 ACC/AHA guidelines?
A) Clopidogrel 300 mg
B) Aspirin 162-325 mg
C) Ticagrelor 90 mg
D) Prasugrel 30 mg
Rationale: The 2025 ACC/AHA guideline for ACS management emphasizes immediate aspirin loading
(162-325 mg chewed) as foundational therapy to inhibit platelet aggregation via COX-1 inhibition. PD:
Irreversible acetylation of cyclooxygenase. PK: Rapid absorption (peak 30-60 min). AEs: GI bleeding
(contraindicated in active ulcer). Follow with P2Y12 inhibitor for dual therapy in NPs' therapeutic
decision-making.
Question 3: A 65-year-old male with familial hypercholesterolemia (LDL 180 mg/dL) requires statin
intensification. What is the preferred high-intensity statin per 2025 AACE guidelines?
A) Simvastatin 40 mg
,B) Atorvastatin 40-80 mg
C) Rosuvastatin 10 mg
D) Pravastatin 40 mg
Rationale: The 2025 AACE pharmacologic management guideline for dyslipidemia recommends
high-intensity statins like atorvastatin 40-80 mg for high-risk patients to achieve ≥50% LDL reduction.
PK: Hepatic CYP3A4 metabolism; half-life 14 hours. PD: HMG-CoA reductase inhibition. AEs:
Myopathy (monitor CK); contraindicated in active liver disease. NPs should assess ASCVD risk for
personalized prescribing.
Question 4: For a patient with heart failure with preserved ejection fraction (HFpEF), what medication
class improves outcomes per 2025 ACC/AHA core principles?
A) Digoxin
B) SGLT2 inhibitors (e.g., empagliflozin)
C) Ivabradine
D) Spironolactone
Rationale: 2025 ACC/AHA guidelines highlight SGLT2 inhibitors for HFpEF to reduce hospitalization
risk via natriuresis and cardioprotection. PK: Renal excretion; dose adjust in eGFR <45. PD:
Glucose-independent diuresis. AEs: Genital mycotic infections; contraindicated in type 1 DM.
Therapeutic decision: Combine with loop diuretics if volume overload.
Question 5: A patient on warfarin develops atrial fibrillation. What is the preferred anticoagulant switch
per 2025 guidelines?
A) Continue warfarin
B) Apixaban 5 mg BID
C) Enoxaparin bridge
D) Clopidogrel
Rationale: DOACs like apixaban are preferred over warfarin for nonvalvular AF in 2025 AHA/ACC
guidelines due to lower intracranial bleed risk. PK: Renal/hepatic clearance; half-life 12 hours. PD: Factor
Xa inhibition. AEs: Bleeding (monitor CrCl); contraindicated in CrCl <15. NPs: Use CHA2DS2-VASc
for stroke risk assessment.
Question 6: In managing resistant hypertension, what adjunctive agent is recommended after triple
therapy failure?
A) Beta-blocker escalation
B) Mineralocorticoid receptor antagonist (e.g., spironolactone)
C) Alpha-blocker
D) Central agonist
, Rationale: 2025 hypertension guidelines endorse spironolactone as fourth-line for resistant HTN,
targeting aldosterone excess. PK: Hepatic; half-life 1.4 hours. PD: Aldosterone antagonism. AEs:
Hyperkalemia (monitor K+); contraindicated in hyperkalemia. NP practice: Lifestyle integration essential.
Question 7: A diabetic patient with CVD starts a GLP-1 RA. What CV benefit is evidenced in 2025
guidelines?
A) Bradycardia
B) Reduced MACE (MI, stroke, CV death)
C) Hypoglycemia
D) Weight loss only
Rationale: GLP-1 RAs reduce MACE in T2DM with CVD per 2025 ACC/AHA updates. PK: SubQ;
half-life 13 hours (semaglutide). PD: GLP-1 mimicry. AEs: GI upset; contraindicated in MTC history.
Therapeutic: First-line with metformin.
Question 8: For lipid management in CKD, what statin dose adjustment is needed?
A) No change
B) Reduce to moderate-intensity (e.g., atorvastatin 20 mg)
C) High-intensity
D) Discontinue
Rationale: 2025 AACE guidelines recommend moderate-intensity statins in CKD stage 3-5 to minimize
myopathy risk. PK: Reduced clearance in renal impairment. PD: Same. AEs: Rhabdomyolysis. NPs:
eGFR-guided dosing.
Question 9: A post-MI patient on dual antiplatelet therapy develops GI bleed. What intervention?
A) Continue therapy
B) Add PPI (e.g., pantoprazole)
C) Switch to ticagrelor
D) Stop aspirin
Rationale: 2025 ACS guidelines recommend PPI prophylaxis in high GI risk on DAPT. PK: Hepatic;
half-life 1 hour. PD: H+/K+ ATPase inhibition. AEs: C. diff; contraindicated in allergy. Decision-making:
Risk-benefit assessment.
Question 10: In HF with reduced EF, what ARNI is preferred over ACEI?
A) Lisinopril
B) Sacubitril/valsartan
C) Losartan
D) Enalapril
