NURS 300 (Pharmacology) Unit Exam 3
Latest 2026/2027 | Newly Released
San Diego State University (SDSU).
50 Questions and Answers With Expert Rationales
Guaranteed Pass | Graded A +
Content:
Q1. A patient prescribed captopril develops a persistent dry cough. The nurse explains that this
adverse effect is caused by:
A. Accumulation of bradykinin due to ACE inhibition
B. Direct irritation of the bronchial mucosa by the drug
C. Increased histamine release from mast cells
D. Suppression of prostaglandin synthesis in the lungs
Correct Answer: A
Rationale: ACE inhibitors prevent the breakdown of bradykinin, leading to its accumulation in
the lungs and causing a dry, nonproductive cough in approximately 10-20% of patients. This is a
class effect of ACE inhibitors and is not seen with ARBs, which do not affect bradykinin
metabolism. The cough typically resolves within 1-2 weeks after discontinuation.
,Q2. SCENARIO – GI Medication Safety/PPI: A 62-year-old patient on long-term pantoprazole
40mg daily develops chronic kidney disease stage 3. Which action by the nurse is most
appropriate?
A. Continue pantoprazole at the current dose indefinitely
B. Switch to ranitidine 150mg twice daily without further assessment
C. Assess the indication for continued PPI therapy and consider step-down or H2 blocker
alternatives
D. Increase the pantoprazole dose to 80mg daily for better acid control
Correct Answer: D
Rationale: Long-term PPI use has been associated with acute interstitial nephritis and CKD
progression. In patients with declining renal function, the indication for PPI therapy should be
reassessed. Step-down to the lowest effective dose or switching to H2 blockers may be
appropriate. Continuing or increasing the dose without evaluation is not recommended.
Q3. SCENARIO – Anticoagulant Monitoring: A 68-year-old patient on warfarin for a mechanical
mitral valve presents with an INR of 4.2 and no bleeding. The nurse should recommend:
A. Administering vitamin K 10mg orally immediately
B. Holding the next 1-2 doses and reducing the weekly dose
C. Switching to dabigatran for better INR control
D. Increasing the dose to achieve an INR of 5.0-6.0
Correct Answer: D
Rationale: For an INR of 4.2 without bleeding in a mechanical valve patient (target 2.5-3.5), the
appropriate response is to hold 1-2 doses and reduce the maintenance dose. Vitamin K is
reserved for INR >10 or serious bleeding. DOACs are contraindicated in mechanical valves, and
increasing the dose would be dangerous.
Q4. A patient with acute coronary syndrome is started on aspirin and prasugrel. The nurse knows
that prasugrel is a prodrug activated by:
A. CYP2D6 metabolism in the liver
B. Hydrolysis by plasma esterases
C. CYP3A4 and CYP2B6 metabolism
D. CYP2C19 and CYP3A4 metabolism
Correct Answer: D
, Rationale: Prasugrel is a thienopyridine prodrug activated by CYP2C19 and CYP3A4 to its
active metabolite. Unlike clopidogrel, prasugrel activation is more efficient and less dependent
on CYP2C19 genotype, providing more consistent antiplatelet effect. However, it carries a
higher bleeding risk and is contraindicated in patients with prior stroke.
Q5. A patient with a history of DVT is transitioned from IV heparin to warfarin. The nurse
knows that heparin and warfarin must overlap for approximately how long?
A. At least 5 days and until the INR is therapeutic for 2 consecutive days
B. 24 hours only, regardless of INR value
C. Until the aPTT reaches twice the baseline value
D. For 3 days or until the platelet count normalizes
Correct Answer: A
Rationale: Heparin and warfarin must overlap for a minimum of 5 days because warfarin's
anticoagulant effect is delayed due to the long half-life of pre-existing clotting factors (especially
factor II). The overlap must continue until the INR has been in the therapeutic range for at least 2
consecutive days to ensure adequate anticoagulation.
Q6. A patient with atrial fibrillation is prescribed apixaban. Which statement by the patient
indicates understanding of this medication?
A. I need to have my INR checked monthly at the lab
B. I should take this medication with food to improve absorption
C. I can stop taking this if I feel fine for a few days
D. This drug works by inhibiting both thrombin and factor Xa
Correct Answer: B
Rationale: Apixaban 5mg and 10mg doses should be taken with food to enhance absorption.
Unlike warfarin, apixaban does not require routine INR monitoring. Patients should never stop
anticoagulation without provider guidance, and apixaban is a selective factor Xa inhibitor, not a
direct thrombin inhibitor.
Q7. A patient with a mechanical heart valve is prescribed warfarin. The nurse knows the target
INR range for this indication is:
A. 2.5 to 3.5
B. 1.5 to 2.0
Latest 2026/2027 | Newly Released
San Diego State University (SDSU).
50 Questions and Answers With Expert Rationales
Guaranteed Pass | Graded A +
Content:
Q1. A patient prescribed captopril develops a persistent dry cough. The nurse explains that this
adverse effect is caused by:
A. Accumulation of bradykinin due to ACE inhibition
B. Direct irritation of the bronchial mucosa by the drug
C. Increased histamine release from mast cells
D. Suppression of prostaglandin synthesis in the lungs
Correct Answer: A
Rationale: ACE inhibitors prevent the breakdown of bradykinin, leading to its accumulation in
the lungs and causing a dry, nonproductive cough in approximately 10-20% of patients. This is a
class effect of ACE inhibitors and is not seen with ARBs, which do not affect bradykinin
metabolism. The cough typically resolves within 1-2 weeks after discontinuation.
,Q2. SCENARIO – GI Medication Safety/PPI: A 62-year-old patient on long-term pantoprazole
40mg daily develops chronic kidney disease stage 3. Which action by the nurse is most
appropriate?
A. Continue pantoprazole at the current dose indefinitely
B. Switch to ranitidine 150mg twice daily without further assessment
C. Assess the indication for continued PPI therapy and consider step-down or H2 blocker
alternatives
D. Increase the pantoprazole dose to 80mg daily for better acid control
Correct Answer: D
Rationale: Long-term PPI use has been associated with acute interstitial nephritis and CKD
progression. In patients with declining renal function, the indication for PPI therapy should be
reassessed. Step-down to the lowest effective dose or switching to H2 blockers may be
appropriate. Continuing or increasing the dose without evaluation is not recommended.
Q3. SCENARIO – Anticoagulant Monitoring: A 68-year-old patient on warfarin for a mechanical
mitral valve presents with an INR of 4.2 and no bleeding. The nurse should recommend:
A. Administering vitamin K 10mg orally immediately
B. Holding the next 1-2 doses and reducing the weekly dose
C. Switching to dabigatran for better INR control
D. Increasing the dose to achieve an INR of 5.0-6.0
Correct Answer: D
Rationale: For an INR of 4.2 without bleeding in a mechanical valve patient (target 2.5-3.5), the
appropriate response is to hold 1-2 doses and reduce the maintenance dose. Vitamin K is
reserved for INR >10 or serious bleeding. DOACs are contraindicated in mechanical valves, and
increasing the dose would be dangerous.
Q4. A patient with acute coronary syndrome is started on aspirin and prasugrel. The nurse knows
that prasugrel is a prodrug activated by:
A. CYP2D6 metabolism in the liver
B. Hydrolysis by plasma esterases
C. CYP3A4 and CYP2B6 metabolism
D. CYP2C19 and CYP3A4 metabolism
Correct Answer: D
, Rationale: Prasugrel is a thienopyridine prodrug activated by CYP2C19 and CYP3A4 to its
active metabolite. Unlike clopidogrel, prasugrel activation is more efficient and less dependent
on CYP2C19 genotype, providing more consistent antiplatelet effect. However, it carries a
higher bleeding risk and is contraindicated in patients with prior stroke.
Q5. A patient with a history of DVT is transitioned from IV heparin to warfarin. The nurse
knows that heparin and warfarin must overlap for approximately how long?
A. At least 5 days and until the INR is therapeutic for 2 consecutive days
B. 24 hours only, regardless of INR value
C. Until the aPTT reaches twice the baseline value
D. For 3 days or until the platelet count normalizes
Correct Answer: A
Rationale: Heparin and warfarin must overlap for a minimum of 5 days because warfarin's
anticoagulant effect is delayed due to the long half-life of pre-existing clotting factors (especially
factor II). The overlap must continue until the INR has been in the therapeutic range for at least 2
consecutive days to ensure adequate anticoagulation.
Q6. A patient with atrial fibrillation is prescribed apixaban. Which statement by the patient
indicates understanding of this medication?
A. I need to have my INR checked monthly at the lab
B. I should take this medication with food to improve absorption
C. I can stop taking this if I feel fine for a few days
D. This drug works by inhibiting both thrombin and factor Xa
Correct Answer: B
Rationale: Apixaban 5mg and 10mg doses should be taken with food to enhance absorption.
Unlike warfarin, apixaban does not require routine INR monitoring. Patients should never stop
anticoagulation without provider guidance, and apixaban is a selective factor Xa inhibitor, not a
direct thrombin inhibitor.
Q7. A patient with a mechanical heart valve is prescribed warfarin. The nurse knows the target
INR range for this indication is:
A. 2.5 to 3.5
B. 1.5 to 2.0
