NAGELHOUT PHARM 2 Exam 2 Questions
and Answers with Rationales
Question 1
A patient taking warfarin asks which food choice could significantly interfere
with anticoagulation therapy. Which food contains a high amount of vitamin K?
A. Apples
B. Spinach
C. White rice
D. Chicken breast
Answer: B. Spinach
Rationale:
Spinach and other dark green leafy vegetables contain substantial amounts of
vitamin K, which can reduce warfarin's anticoagulant effect. Patients do not
necessarily need to eliminate vitamin K-containing foods, but they should maintain
a consistent intake and notify the prescriber about major dietary changes.
Warfarin therapy is monitored using the INR.
Question 2
A patient receiving heparin develops a platelet count that falls substantially
several days after therapy begins. The patient also develops a new thrombosis.
Which complication should the nurse suspect?
A. Disseminated intravascular coagulation
B. Thrombotic thrombocytopenic purpura
C. Heparin-induced thrombocytopenia
D. Vitamin K deficiency
Answer: C. Heparin-induced thrombocytopenia
Rationale:
Heparin-induced thrombocytopenia (HIT) is an immune-mediated reaction
,characterized by a significant platelet decrease, typically occurring several days
after exposure, accompanied by an increased risk of thrombosis. Heparin should
be discontinued and an alternative non-heparin anticoagulant initiated when HIT is
suspected.
Question 3
Which medication directly reverses the anticoagulant effect of unfractionated
heparin?
A. Protamine sulfate
B. Vitamin K
C. Idarucizumab
D. Tranexamic acid
Answer: A. Protamine sulfate
Rationale:
Protamine sulfate binds to and neutralizes heparin. Vitamin K reverses warfarin's
effect, while idarucizumab specifically reverses dabigatran. Tranexamic acid is an
antifibrinolytic and is not the specific reversal agent for heparin.
Question 4
A patient taking apixaban asks whether routine INR testing is required to
determine the therapeutic effect of the drug. Which response is most appropriate?
A. “Yes. INR must be maintained between 2 and 3.”
B. “Yes. INR should be checked every day.”
C. “No routine INR monitoring is required for therapeutic dosing.”
D. “INR is required only when you experience bruising.”
Answer: C. “No routine INR monitoring is required for therapeutic dosing.”
Rationale:
Apixaban is a direct factor Xa inhibitor and does not require routine INR
monitoring for dose adjustment. Renal and hepatic function, bleeding risk,
,adherence, drug interactions, and appropriate dosing remain important
considerations.
Question 5
A patient taking dabigatran develops life-threatening bleeding. Which specific
reversal agent is available?
A. Andexanet alfa
B. Protamine sulfate
C. Idarucizumab
D. Vitamin K
Answer: C. Idarucizumab
Rationale:
Idarucizumab is a specific reversal agent for dabigatran. Andexanet alfa is used
for reversal of certain factor Xa inhibitors. Protamine reverses heparin, while
vitamin K reverses warfarin.
Question 6
A patient with heart failure is prescribed spironolactone. Which laboratory value
is most important to monitor?
A. Potassium
B. Calcium
C. Chloride
D. Hemoglobin
Answer: A. Potassium
Rationale:
Spironolactone is a potassium-sparing diuretic and aldosterone antagonist. It can
cause hyperkalemia, particularly in patients with renal impairment or those taking
other medications that increase potassium. Renal function and serum potassium
should therefore be monitored.
, Question 7
A patient taking furosemide reports muscle weakness and palpitations. Which
electrolyte abnormality should the nurse suspect?
A. Hypermagnesemia
B. Hypokalemia
C. Hyperkalemia
D. Hypercalcemia
Answer: B. Hypokalemia
Rationale:
Furosemide is a loop diuretic that increases urinary excretion of sodium, chloride,
potassium, calcium, and magnesium. Hypokalemia can cause muscle weakness,
cramps, and potentially dangerous cardiac dysrhythmias.
Question 8
Which medication is commonly used as a potassium-sparing diuretic?
A. Hydrochlorothiazide
B. Bumetanide
C. Chlorthalidone
D. Amiloride
Answer: D. Amiloride
Rationale:
Amiloride is a potassium-sparing diuretic that blocks epithelial sodium channels in
the distal nephron. Unlike loop and thiazide diuretics, it tends to retain potassium,
creating a risk for hyperkalemia.
Question 9
and Answers with Rationales
Question 1
A patient taking warfarin asks which food choice could significantly interfere
with anticoagulation therapy. Which food contains a high amount of vitamin K?
A. Apples
B. Spinach
C. White rice
D. Chicken breast
Answer: B. Spinach
Rationale:
Spinach and other dark green leafy vegetables contain substantial amounts of
vitamin K, which can reduce warfarin's anticoagulant effect. Patients do not
necessarily need to eliminate vitamin K-containing foods, but they should maintain
a consistent intake and notify the prescriber about major dietary changes.
Warfarin therapy is monitored using the INR.
Question 2
A patient receiving heparin develops a platelet count that falls substantially
several days after therapy begins. The patient also develops a new thrombosis.
Which complication should the nurse suspect?
A. Disseminated intravascular coagulation
B. Thrombotic thrombocytopenic purpura
C. Heparin-induced thrombocytopenia
D. Vitamin K deficiency
Answer: C. Heparin-induced thrombocytopenia
Rationale:
Heparin-induced thrombocytopenia (HIT) is an immune-mediated reaction
,characterized by a significant platelet decrease, typically occurring several days
after exposure, accompanied by an increased risk of thrombosis. Heparin should
be discontinued and an alternative non-heparin anticoagulant initiated when HIT is
suspected.
Question 3
Which medication directly reverses the anticoagulant effect of unfractionated
heparin?
A. Protamine sulfate
B. Vitamin K
C. Idarucizumab
D. Tranexamic acid
Answer: A. Protamine sulfate
Rationale:
Protamine sulfate binds to and neutralizes heparin. Vitamin K reverses warfarin's
effect, while idarucizumab specifically reverses dabigatran. Tranexamic acid is an
antifibrinolytic and is not the specific reversal agent for heparin.
Question 4
A patient taking apixaban asks whether routine INR testing is required to
determine the therapeutic effect of the drug. Which response is most appropriate?
A. “Yes. INR must be maintained between 2 and 3.”
B. “Yes. INR should be checked every day.”
C. “No routine INR monitoring is required for therapeutic dosing.”
D. “INR is required only when you experience bruising.”
Answer: C. “No routine INR monitoring is required for therapeutic dosing.”
Rationale:
Apixaban is a direct factor Xa inhibitor and does not require routine INR
monitoring for dose adjustment. Renal and hepatic function, bleeding risk,
,adherence, drug interactions, and appropriate dosing remain important
considerations.
Question 5
A patient taking dabigatran develops life-threatening bleeding. Which specific
reversal agent is available?
A. Andexanet alfa
B. Protamine sulfate
C. Idarucizumab
D. Vitamin K
Answer: C. Idarucizumab
Rationale:
Idarucizumab is a specific reversal agent for dabigatran. Andexanet alfa is used
for reversal of certain factor Xa inhibitors. Protamine reverses heparin, while
vitamin K reverses warfarin.
Question 6
A patient with heart failure is prescribed spironolactone. Which laboratory value
is most important to monitor?
A. Potassium
B. Calcium
C. Chloride
D. Hemoglobin
Answer: A. Potassium
Rationale:
Spironolactone is a potassium-sparing diuretic and aldosterone antagonist. It can
cause hyperkalemia, particularly in patients with renal impairment or those taking
other medications that increase potassium. Renal function and serum potassium
should therefore be monitored.
, Question 7
A patient taking furosemide reports muscle weakness and palpitations. Which
electrolyte abnormality should the nurse suspect?
A. Hypermagnesemia
B. Hypokalemia
C. Hyperkalemia
D. Hypercalcemia
Answer: B. Hypokalemia
Rationale:
Furosemide is a loop diuretic that increases urinary excretion of sodium, chloride,
potassium, calcium, and magnesium. Hypokalemia can cause muscle weakness,
cramps, and potentially dangerous cardiac dysrhythmias.
Question 8
Which medication is commonly used as a potassium-sparing diuretic?
A. Hydrochlorothiazide
B. Bumetanide
C. Chlorthalidone
D. Amiloride
Answer: D. Amiloride
Rationale:
Amiloride is a potassium-sparing diuretic that blocks epithelial sodium channels in
the distal nephron. Unlike loop and thiazide diuretics, it tends to retain potassium,
creating a risk for hyperkalemia.
Question 9
