NURS 323
FINAL EXAM
ACTUAL Questions with Answers
(Nursing Pharmacology Concepts I)
Drexel University
This Document Description:
• This document contains a collection of Verified
questions with accurate Answers.
• It covers core topics assessed in the course and
reflects the actual exam format and question style.
Ideal for exam preparation and concept reinforcement.
,A patient with deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the
nurse how this medication works. What is the nurse's best response?
a. Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting
factors.
b. Heparin suppresses coagulation by helping antithrombin perform its natural functions.
c. Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot
matrix.
d. Heparin inhibits the enzyme responsible for platelet activation and aggregation within
vessels.
b. Heparin suppresses coagulation by helping antithrombin perform its natural functions.
Rationale:
Heparin is an anticoagulant that works by helping antithrombin inactivate thrombin and factor
Xa, reducing the production of fibrin and thus decreasing the formation of clots.
The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary
embolism. Which assessment finding most likely relates to an adverse effect of heparin?
a. Heart rate of 60 beats/min
b. Blood pressure of 160/88 mm Hg
c. Discolored urine
d. Inspiratory wheezing
c. Discolored urine
Rationale:
The primary and most serious adverse effect of heparin is bleeding. Bleeding can occur from any
site and may be manifested in various ways, including reduced blood pressure, increased heart
rate, bruises, petechiae, hematomas, red or black stools, cloudy or discolored urine, pelvic pain,
headache, and lumbar pain.
The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient
receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by
the nurse is the most appropriate?
a. Notify the healthcare provider to discuss the reduction or withdrawal of heparin.
b. Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic
,level.
c. Obtain vitamin K and prepare to administer it by intramuscular (IM) injection.
d. Observe the patient and monitor the activated partial thromboplastin time (aPTT) as
indicated.
a. Notify the healthcare provider to discuss the reduction or withdrawal of heparin.
Rationale:
Heparin-induced thrombocytopenia (HIT) is a potential immune-mediated adverse effect of
heparin infusions that can prove fatal. HIT is suspected when the platelet counts fall
significantly. A platelet count below 100,000/mm3 would warrant discontinuation of the
heparin.
The nurse is ready to begin a heparin infusion for a patient with evolving stroke. The baseline
activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a
therapeutic dose has been achieved?
a. 50
b. 70
c. 90
d. 110
b. 70
Rationale:
The therapeutic level of heparin is achieved when the aPTT reaches 1.5 to 2 times normal. Thus,
a range of 60 to 80 seconds would be appropriate for this patient.
The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein
thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by
the nurse is most appropriate?
a. Administer intravenous (IV) push protamine sulfate.
b. Continue with the current prescription.
c. Prepare to administer vitamin K.
d. Call the healthcare provider to increase the dose.
d. Call the healthcare provider to increase the dose.
, Rationale:
An INR in the range of 2 to 3 is considered the level for warfarin therapy. For a level of 1.2, the
nurse should contact the healthcare provider to discuss an order for an increased dose.
A patient presents to the emergency department with symptoms of acute myocardial
infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of
alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which
finding by the nurse most likely indicates an adverse reaction to this drug?
a. Urticaria, itching, and flushing
b. Blood pressure of 90/50 mm Hg
c. Decreasing level of consciousness
d. Potassium level of 5.5 mEq/L
c. Decreasing level of consciousness
Rationale:
The greatest risk with this drug is bleeding, with intracranial bleeding being the greatest
concern. A decreasing level of consciousness indicates intracranial bleeding. Alteplase does not
cause an allergic reaction or hypotension. Thrombolytic agents, such as alteplase, do not
typically cause an elevated potassium level.
The nurse knows that which statement is accurate for enoxaparin [Lovenox]?
a. It equally reduces the activity of thrombin and factor Xa.
b. It has selective inhibition of factor Xa and no effect on thrombin.
c. It reduces the activity of factor Xa more than the activity of thrombin.
d. It has a lower bioavailability and shorter half-life than unfractionated heparin.
c. It reduces the activity of factor Xa more than the activity of thrombin.
Rationale:
Enoxaparin acts primarily on factor Xa and also, but to a lesser degree, on thrombin.
Unfractionated heparin equally reduces the action of thrombin and factor Xa. Low-molecular-
weight (LMW) heparins, such as enoxaparin, have greater bioavailability and a longer half-life
than unfractionated heparin.
A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein
thrombosis prevention. Which instructions should the nurse include in the patient's discharge
FINAL EXAM
ACTUAL Questions with Answers
(Nursing Pharmacology Concepts I)
Drexel University
This Document Description:
• This document contains a collection of Verified
questions with accurate Answers.
• It covers core topics assessed in the course and
reflects the actual exam format and question style.
Ideal for exam preparation and concept reinforcement.
,A patient with deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the
nurse how this medication works. What is the nurse's best response?
a. Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting
factors.
b. Heparin suppresses coagulation by helping antithrombin perform its natural functions.
c. Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot
matrix.
d. Heparin inhibits the enzyme responsible for platelet activation and aggregation within
vessels.
b. Heparin suppresses coagulation by helping antithrombin perform its natural functions.
Rationale:
Heparin is an anticoagulant that works by helping antithrombin inactivate thrombin and factor
Xa, reducing the production of fibrin and thus decreasing the formation of clots.
The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary
embolism. Which assessment finding most likely relates to an adverse effect of heparin?
a. Heart rate of 60 beats/min
b. Blood pressure of 160/88 mm Hg
c. Discolored urine
d. Inspiratory wheezing
c. Discolored urine
Rationale:
The primary and most serious adverse effect of heparin is bleeding. Bleeding can occur from any
site and may be manifested in various ways, including reduced blood pressure, increased heart
rate, bruises, petechiae, hematomas, red or black stools, cloudy or discolored urine, pelvic pain,
headache, and lumbar pain.
The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient
receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by
the nurse is the most appropriate?
a. Notify the healthcare provider to discuss the reduction or withdrawal of heparin.
b. Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic
,level.
c. Obtain vitamin K and prepare to administer it by intramuscular (IM) injection.
d. Observe the patient and monitor the activated partial thromboplastin time (aPTT) as
indicated.
a. Notify the healthcare provider to discuss the reduction or withdrawal of heparin.
Rationale:
Heparin-induced thrombocytopenia (HIT) is a potential immune-mediated adverse effect of
heparin infusions that can prove fatal. HIT is suspected when the platelet counts fall
significantly. A platelet count below 100,000/mm3 would warrant discontinuation of the
heparin.
The nurse is ready to begin a heparin infusion for a patient with evolving stroke. The baseline
activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a
therapeutic dose has been achieved?
a. 50
b. 70
c. 90
d. 110
b. 70
Rationale:
The therapeutic level of heparin is achieved when the aPTT reaches 1.5 to 2 times normal. Thus,
a range of 60 to 80 seconds would be appropriate for this patient.
The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein
thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by
the nurse is most appropriate?
a. Administer intravenous (IV) push protamine sulfate.
b. Continue with the current prescription.
c. Prepare to administer vitamin K.
d. Call the healthcare provider to increase the dose.
d. Call the healthcare provider to increase the dose.
, Rationale:
An INR in the range of 2 to 3 is considered the level for warfarin therapy. For a level of 1.2, the
nurse should contact the healthcare provider to discuss an order for an increased dose.
A patient presents to the emergency department with symptoms of acute myocardial
infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of
alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which
finding by the nurse most likely indicates an adverse reaction to this drug?
a. Urticaria, itching, and flushing
b. Blood pressure of 90/50 mm Hg
c. Decreasing level of consciousness
d. Potassium level of 5.5 mEq/L
c. Decreasing level of consciousness
Rationale:
The greatest risk with this drug is bleeding, with intracranial bleeding being the greatest
concern. A decreasing level of consciousness indicates intracranial bleeding. Alteplase does not
cause an allergic reaction or hypotension. Thrombolytic agents, such as alteplase, do not
typically cause an elevated potassium level.
The nurse knows that which statement is accurate for enoxaparin [Lovenox]?
a. It equally reduces the activity of thrombin and factor Xa.
b. It has selective inhibition of factor Xa and no effect on thrombin.
c. It reduces the activity of factor Xa more than the activity of thrombin.
d. It has a lower bioavailability and shorter half-life than unfractionated heparin.
c. It reduces the activity of factor Xa more than the activity of thrombin.
Rationale:
Enoxaparin acts primarily on factor Xa and also, but to a lesser degree, on thrombin.
Unfractionated heparin equally reduces the action of thrombin and factor Xa. Low-molecular-
weight (LMW) heparins, such as enoxaparin, have greater bioavailability and a longer half-life
than unfractionated heparin.
A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein
thrombosis prevention. Which instructions should the nurse include in the patient's discharge
