NURS 6521N Exam 2 V2 | NURS 6521N
Advanced Pharmacology | Actual Q&A
with Rationale (NURS6521N Exam 2) |
Walden University
1. When initiating warfarin therapy for a patient with atrial fibrillation, which laboratory
parameter must the advanced practice nurse monitor to adjust the dosage?
A. Activated partial thromboplastin time (aPTT)
B. Platelet count
C. International Normalized Ratio (INR)
D. Bleeding time
Answer: C
Rationale: Warfarin is a vitamin K antagonist that requires precise monitoring to balance
the risk of thromboembolism and hemorrhage. The International Normalized Ratio (INR) is
the standard metric used to assess the drug’s effect on the extrinsic coagulation pathway.
Clinicians typically aim for a therapeutic range of 2.0 to 3.0 for conditions like atrial
fibrillation.
2. A patient is receiving heparin intravenously for a deep vein thrombosis. What is the priority
laboratory test to monitor the therapeutic effect of this medication?
A. Activated partial thromboplastin time (aPTT)
,B. Prothrombin time (PT)
C. Hemoglobin and hematocrit
D. Serum creatinine
Answer: A
Rationale: Unfractionated heparin works by accelerating the activity of antithrombin III,
which inactivates thrombin and factor Xa. The aPTT is used to measure the inhibitory effect
on the intrinsic and common pathways of coagulation. Monitoring this value ensures the
patient remains within a therapeutic window, usually 1.5 to 2.5 times the normal baseline.
3. An advanced practice nurse is teaching a patient about the onset of action for insulin
lispro. How soon should the patient eat after administering this medication?
A. Within 30 to 60 minutes
B. Exactly 1 hour later
C. Immediately before bed
D. Within 15 minutes
Answer: D
Rationale: Insulin lispro is a rapid-acting insulin analogue with an onset of action
occurring approximately 15 minutes after subcutaneous injection. Administering the dose
too long before a meal can lead to significant hypoglycemia due to its rapid effect. Patients
must be educated to have their meal ready or already eating when the dose is given.
, 4. Which characteristic of insulin glargine makes it unique compared to other insulin
formulations?
A. It is the only insulin that can be given intravenously.
B. It has a rapid onset of less than 15 minutes.
C. It provides a basal level of insulin with no peak effect.
D. It should be mixed with NPH in the same syringe.
Answer: C
Rationale: Insulin glargine is a long-acting insulin designed to provide a steady, 24-hour
basal coverage of insulin requirements. Unlike intermediate-acting insulins, it does not
have a pronounced peak, which significantly reduces the risk of nocturnal hypoglycemia. It
is formulated at a low pH and must not be mixed with other insulins to maintain its
solubility characteristics.
5. A patient taking metformin is scheduled for an imaging procedure requiring iodinated
contrast media. What is the most appropriate clinical action?
A. Increase the metformin dose for three days following the procedure.
B. Switch the patient to a sulfonylurea permanently.
C. Administer metformin with a large bolus of intravenous fluids.
D. Withhold metformin for 48 hours after the procedure.
Answer: D
Advanced Pharmacology | Actual Q&A
with Rationale (NURS6521N Exam 2) |
Walden University
1. When initiating warfarin therapy for a patient with atrial fibrillation, which laboratory
parameter must the advanced practice nurse monitor to adjust the dosage?
A. Activated partial thromboplastin time (aPTT)
B. Platelet count
C. International Normalized Ratio (INR)
D. Bleeding time
Answer: C
Rationale: Warfarin is a vitamin K antagonist that requires precise monitoring to balance
the risk of thromboembolism and hemorrhage. The International Normalized Ratio (INR) is
the standard metric used to assess the drug’s effect on the extrinsic coagulation pathway.
Clinicians typically aim for a therapeutic range of 2.0 to 3.0 for conditions like atrial
fibrillation.
2. A patient is receiving heparin intravenously for a deep vein thrombosis. What is the priority
laboratory test to monitor the therapeutic effect of this medication?
A. Activated partial thromboplastin time (aPTT)
,B. Prothrombin time (PT)
C. Hemoglobin and hematocrit
D. Serum creatinine
Answer: A
Rationale: Unfractionated heparin works by accelerating the activity of antithrombin III,
which inactivates thrombin and factor Xa. The aPTT is used to measure the inhibitory effect
on the intrinsic and common pathways of coagulation. Monitoring this value ensures the
patient remains within a therapeutic window, usually 1.5 to 2.5 times the normal baseline.
3. An advanced practice nurse is teaching a patient about the onset of action for insulin
lispro. How soon should the patient eat after administering this medication?
A. Within 30 to 60 minutes
B. Exactly 1 hour later
C. Immediately before bed
D. Within 15 minutes
Answer: D
Rationale: Insulin lispro is a rapid-acting insulin analogue with an onset of action
occurring approximately 15 minutes after subcutaneous injection. Administering the dose
too long before a meal can lead to significant hypoglycemia due to its rapid effect. Patients
must be educated to have their meal ready or already eating when the dose is given.
, 4. Which characteristic of insulin glargine makes it unique compared to other insulin
formulations?
A. It is the only insulin that can be given intravenously.
B. It has a rapid onset of less than 15 minutes.
C. It provides a basal level of insulin with no peak effect.
D. It should be mixed with NPH in the same syringe.
Answer: C
Rationale: Insulin glargine is a long-acting insulin designed to provide a steady, 24-hour
basal coverage of insulin requirements. Unlike intermediate-acting insulins, it does not
have a pronounced peak, which significantly reduces the risk of nocturnal hypoglycemia. It
is formulated at a low pH and must not be mixed with other insulins to maintain its
solubility characteristics.
5. A patient taking metformin is scheduled for an imaging procedure requiring iodinated
contrast media. What is the most appropriate clinical action?
A. Increase the metformin dose for three days following the procedure.
B. Switch the patient to a sulfonylurea permanently.
C. Administer metformin with a large bolus of intravenous fluids.
D. Withhold metformin for 48 hours after the procedure.
Answer: D
