NURS 711
EXAM 3
(Pharmacotherapies for Nursing Practice)
Actual Questions w/Correct Answers
(NCLEX / Advanced Practice Style)
University of South Carolina
What you Will Get:
• verified questions
• Correct answers with Rationales.
• Ideal for exam preparation and concept
reinforcement.
,Question 1. A patient taking warfarin has just vomited blood. The provider orders
lab work revealing a PT of 62 seconds and an INR of 4.5. Which intervention will
the nurse expect to administer?
A. Protamine sulfate 1 mg IV push
B. Vitamin K 1 mg IV over 1 hour
C. Fresh frozen plasma 2 units over 30 minutes
D. Heparin 5,000 units subcutaneously
Correct Answer: B
Rationale:
An INR of 4.5 with active bleeding (hematemesis) indicates supratherapeutic
anticoagulation requiring reversal. Vitamin K (phytonadione) is the specific antidote for
warfarin overdose. A dose of 1–10 mg IV is standard, infused slowly over 30–60
minutes to avoid anaphylactoid reactions. The INR goal for most warfarin indications is
2.0–3.0; 4.5 with bleeding is a medical emergency.
Incorrect:
• Option A: Protamine sulfate is the antidote for heparin, not warfarin.
• Option C: FFP contains clotting factors and may be used adjunctively for life-
threatening bleeding, but it is not the primary reversal agent; vitamin K is required
to restore factor synthesis.
• Option D: Administering additional anticoagulation would worsen hemorrhage
and is contraindicated.
Question 2. A patient arrives in the ER after becoming dehydrated. Based on the
patient's history, the provider determines that isotonic dehydration has occurred.
Which solution will the nurse expect to infuse?
A. 0.45% sodium chloride in sterile water
B. 3% sodium chloride in sterile water
C. 0.9% sodium chloride in sterile water
D. Dextrose 5% in 0.225% normal saline
Correct Answer: C
Rationale:
Isotonic dehydration (loss of water and electrolytes in proportional amounts) is treated
with isotonic crystalloids. 0.9% sodium chloride (normal saline) is an isotonic solution
, with an osmolarity of approximately 308 mOsm/L, making it the standard replacement
fluid for isotonic dehydration and hypovolemic shock resuscitation.
Incorrect:
• Option A: 0.45% saline is hypotonic and used for hypertonic dehydration or free-
water deficit; it would not adequately restore intravascular volume.
• Option B: 3% saline is hypertonic and reserved for severe symptomatic
hyponatremia; it would worsen cellular dehydration.
• Option D: D5 in 0.225% NS is a maintenance solution, not a resuscitative fluid
for isotonic dehydration.
Question 3. A nurse administers an ACE inhibitor to a patient who is taking the
drug for the first time. What is the nurse's priority action?
A. Instruct the patient to remain supine for 2 hours after the dose
B. Instruct the patient not to get up without assistance
C. Administer the medication with a high-fat meal
D. Teach the patient to monitor for hyperkalemia before ambulating
Correct Answer: B
Rationale:
First-dose hypotension (orthostatic hypotension) is a well-documented adverse effect of
ACE inhibitors, particularly in patients who are volume-depleted or on diuretics. The
nurse must ensure patient safety by instructing the patient to call for assistance before
ambulating to prevent falls.
Incorrect:
• Option A: Remaining supine for 2 hours is excessive and not standard protocol;
gradual position changes are sufficient.
• Option C: ACE inhibitors are not affected by fat content of meals; some (like
captopril) should be taken on an empty stomach.
• Option D: Hyperkalemia is a potential adverse effect but is not an immediate
safety concern following the first dose; orthostatic hypotension is the priority.
Question 4. Which statement indicates that a patient understands teaching about
a nitroglycerin transdermal patch?
EXAM 3
(Pharmacotherapies for Nursing Practice)
Actual Questions w/Correct Answers
(NCLEX / Advanced Practice Style)
University of South Carolina
What you Will Get:
• verified questions
• Correct answers with Rationales.
• Ideal for exam preparation and concept
reinforcement.
,Question 1. A patient taking warfarin has just vomited blood. The provider orders
lab work revealing a PT of 62 seconds and an INR of 4.5. Which intervention will
the nurse expect to administer?
A. Protamine sulfate 1 mg IV push
B. Vitamin K 1 mg IV over 1 hour
C. Fresh frozen plasma 2 units over 30 minutes
D. Heparin 5,000 units subcutaneously
Correct Answer: B
Rationale:
An INR of 4.5 with active bleeding (hematemesis) indicates supratherapeutic
anticoagulation requiring reversal. Vitamin K (phytonadione) is the specific antidote for
warfarin overdose. A dose of 1–10 mg IV is standard, infused slowly over 30–60
minutes to avoid anaphylactoid reactions. The INR goal for most warfarin indications is
2.0–3.0; 4.5 with bleeding is a medical emergency.
Incorrect:
• Option A: Protamine sulfate is the antidote for heparin, not warfarin.
• Option C: FFP contains clotting factors and may be used adjunctively for life-
threatening bleeding, but it is not the primary reversal agent; vitamin K is required
to restore factor synthesis.
• Option D: Administering additional anticoagulation would worsen hemorrhage
and is contraindicated.
Question 2. A patient arrives in the ER after becoming dehydrated. Based on the
patient's history, the provider determines that isotonic dehydration has occurred.
Which solution will the nurse expect to infuse?
A. 0.45% sodium chloride in sterile water
B. 3% sodium chloride in sterile water
C. 0.9% sodium chloride in sterile water
D. Dextrose 5% in 0.225% normal saline
Correct Answer: C
Rationale:
Isotonic dehydration (loss of water and electrolytes in proportional amounts) is treated
with isotonic crystalloids. 0.9% sodium chloride (normal saline) is an isotonic solution
, with an osmolarity of approximately 308 mOsm/L, making it the standard replacement
fluid for isotonic dehydration and hypovolemic shock resuscitation.
Incorrect:
• Option A: 0.45% saline is hypotonic and used for hypertonic dehydration or free-
water deficit; it would not adequately restore intravascular volume.
• Option B: 3% saline is hypertonic and reserved for severe symptomatic
hyponatremia; it would worsen cellular dehydration.
• Option D: D5 in 0.225% NS is a maintenance solution, not a resuscitative fluid
for isotonic dehydration.
Question 3. A nurse administers an ACE inhibitor to a patient who is taking the
drug for the first time. What is the nurse's priority action?
A. Instruct the patient to remain supine for 2 hours after the dose
B. Instruct the patient not to get up without assistance
C. Administer the medication with a high-fat meal
D. Teach the patient to monitor for hyperkalemia before ambulating
Correct Answer: B
Rationale:
First-dose hypotension (orthostatic hypotension) is a well-documented adverse effect of
ACE inhibitors, particularly in patients who are volume-depleted or on diuretics. The
nurse must ensure patient safety by instructing the patient to call for assistance before
ambulating to prevent falls.
Incorrect:
• Option A: Remaining supine for 2 hours is excessive and not standard protocol;
gradual position changes are sufficient.
• Option C: ACE inhibitors are not affected by fat content of meals; some (like
captopril) should be taken on an empty stomach.
• Option D: Hyperkalemia is a potential adverse effect but is not an immediate
safety concern following the first dose; orthostatic hypotension is the priority.
Question 4. Which statement indicates that a patient understands teaching about
a nitroglycerin transdermal patch?
