,NU 150 — Exam 5: Clinical Pharmacology and Advanced
Medication Management; Comprehensive Questions &
Verified Answers — Spring 2026 Edition.
1. Which of the following best describes the mechanism of action of alteplase?
A) Inhibition of vitamin K epoxide reductase
B) Direct thrombin inhibition
C) Conversion of plasminogen to plasmin
D) Blockade of glycoprotein IIb/IIIa receptors
Correct Answer: Conversion of plasminogen to plasmin
Rationale: Alteplase is a recombinant tissue plasminogen activator that cleaves plasminogen to plasmin,
which then degrades fibrin clots. It is used in acute ischemic stroke and myocardial infarction. Vitamin K
inhibition is warfarin’s effect, direct thrombin inhibition is dabigatran, and glycoprotein blockade is for
antiplatelet agents.
2. The nurse is caring for a patient receiving a continuous IV infusion of regular insulin. Which electrolyte
must be monitored most closely?
A) Sodium
B) Calcium
C) Potassium
D) Magnesium
Correct Answer: Potassium
Rationale: Insulin drives potassium into cells, leading to hypokalemia. Serum potassium levels must be
checked frequently during insulin infusions, with replacement as needed. Sodium, calcium, and
magnesium are not directly shifted by insulin to the same extent.
,3. The nurse is teaching a patient who is prescribed a new anticoagulant, apixaban. The patient should
be instructed that
A) routine INR monitoring is required
B) the medication can be crushed and sprinkled on food
C) the medication is a direct factor Xa inhibitor
D) vitamin K is the antidote for bleeding
Correct Answer: The medication is a direct factor Xa inhibitor
Rationale: Apixaban directly inhibits factor Xa, disrupting the coagulation cascade. It does not require
routine INR monitoring, unlike warfarin. Andexanet alfa is the reversal agent, not vitamin K. Crushing or
opening capsules is not recommended.
4. The nurse is administering an IV bolus of procainamide for a ventricular arrhythmia. The nurse must
monitor for
A) hypertension and tachycardia
B) hypotension and widening QRS complex
C) bronchospasm and wheezing
D) hyperglycemia and hypokalemia
Correct Answer: Hypotension and widening QRS complex
Rationale: Procainamide can cause significant hypotension, especially if infused too rapidly, and can
prolong the QRS interval (and QT interval). The infusion should be stopped if QRS widens >50% or
hypotension occurs. It does not typically cause bronchospasm or hyperglycemia.
5. The nurse is preparing to administer an IV infusion of nitroprusside for a hypertensive emergency.
Which safety measure is essential?
A) Protect the solution from light with an opaque covering
B) Administer via a peripheral IV line without a filter
C) Use only normal saline as the diluent
, D) Monitor blood glucose every hour
Correct Answer: Protect the solution from light with an opaque covering
Rationale: Nitroprusside is light-sensitive; the IV bag and tubing must be wrapped to prevent
degradation, which can release toxic thiocyanate. An inline filter is not required. Dextrose in water is the
diluent, not saline. Blood glucose is not directly affected.
6. A patient receiving a blood transfusion develops hives and widespread itching. What should the nurse
do first?
A) Increase the transfusion rate
B) Stop the transfusion and maintain the IV line with normal saline
C) Administer an antipyretic
D) Call the blood bank
Correct Answer: Stop the transfusion and maintain the IV line with normal saline
Rationale: Hives and itching indicate a mild allergic transfusion reaction. The transfusion must be
stopped, the line kept open with saline, and the provider notified. Antihistamines may be ordered.
Antipyretics are for febrile reactions.
7. The nurse is monitoring a patient receiving IV dobutamine for acute decompensated heart failure.
Which parameter indicates a therapeutic response?
A) Decreased urine output
B) Increased systemic vascular resistance
C) Improved cardiac output and tissue perfusion
D) Decreased heart rate
Correct Answer: Improved cardiac output and tissue perfusion
Medication Management; Comprehensive Questions &
Verified Answers — Spring 2026 Edition.
1. Which of the following best describes the mechanism of action of alteplase?
A) Inhibition of vitamin K epoxide reductase
B) Direct thrombin inhibition
C) Conversion of plasminogen to plasmin
D) Blockade of glycoprotein IIb/IIIa receptors
Correct Answer: Conversion of plasminogen to plasmin
Rationale: Alteplase is a recombinant tissue plasminogen activator that cleaves plasminogen to plasmin,
which then degrades fibrin clots. It is used in acute ischemic stroke and myocardial infarction. Vitamin K
inhibition is warfarin’s effect, direct thrombin inhibition is dabigatran, and glycoprotein blockade is for
antiplatelet agents.
2. The nurse is caring for a patient receiving a continuous IV infusion of regular insulin. Which electrolyte
must be monitored most closely?
A) Sodium
B) Calcium
C) Potassium
D) Magnesium
Correct Answer: Potassium
Rationale: Insulin drives potassium into cells, leading to hypokalemia. Serum potassium levels must be
checked frequently during insulin infusions, with replacement as needed. Sodium, calcium, and
magnesium are not directly shifted by insulin to the same extent.
,3. The nurse is teaching a patient who is prescribed a new anticoagulant, apixaban. The patient should
be instructed that
A) routine INR monitoring is required
B) the medication can be crushed and sprinkled on food
C) the medication is a direct factor Xa inhibitor
D) vitamin K is the antidote for bleeding
Correct Answer: The medication is a direct factor Xa inhibitor
Rationale: Apixaban directly inhibits factor Xa, disrupting the coagulation cascade. It does not require
routine INR monitoring, unlike warfarin. Andexanet alfa is the reversal agent, not vitamin K. Crushing or
opening capsules is not recommended.
4. The nurse is administering an IV bolus of procainamide for a ventricular arrhythmia. The nurse must
monitor for
A) hypertension and tachycardia
B) hypotension and widening QRS complex
C) bronchospasm and wheezing
D) hyperglycemia and hypokalemia
Correct Answer: Hypotension and widening QRS complex
Rationale: Procainamide can cause significant hypotension, especially if infused too rapidly, and can
prolong the QRS interval (and QT interval). The infusion should be stopped if QRS widens >50% or
hypotension occurs. It does not typically cause bronchospasm or hyperglycemia.
5. The nurse is preparing to administer an IV infusion of nitroprusside for a hypertensive emergency.
Which safety measure is essential?
A) Protect the solution from light with an opaque covering
B) Administer via a peripheral IV line without a filter
C) Use only normal saline as the diluent
, D) Monitor blood glucose every hour
Correct Answer: Protect the solution from light with an opaque covering
Rationale: Nitroprusside is light-sensitive; the IV bag and tubing must be wrapped to prevent
degradation, which can release toxic thiocyanate. An inline filter is not required. Dextrose in water is the
diluent, not saline. Blood glucose is not directly affected.
6. A patient receiving a blood transfusion develops hives and widespread itching. What should the nurse
do first?
A) Increase the transfusion rate
B) Stop the transfusion and maintain the IV line with normal saline
C) Administer an antipyretic
D) Call the blood bank
Correct Answer: Stop the transfusion and maintain the IV line with normal saline
Rationale: Hives and itching indicate a mild allergic transfusion reaction. The transfusion must be
stopped, the line kept open with saline, and the provider notified. Antihistamines may be ordered.
Antipyretics are for febrile reactions.
7. The nurse is monitoring a patient receiving IV dobutamine for acute decompensated heart failure.
Which parameter indicates a therapeutic response?
A) Decreased urine output
B) Increased systemic vascular resistance
C) Improved cardiac output and tissue perfusion
D) Decreased heart rate
Correct Answer: Improved cardiac output and tissue perfusion
