Galen College NU 150 Exam 2 (pdf) | 2026/2027 | Pharmacology Q&A
| Pharmacology
1. The nurse is preparing to administer warfarin to a client. Which laboratory
value is most important to review before administration?
A) aPTT
B) INR
C) Serum creatinine
D) Complete blood count
Correct Answer: INR
Rationale: Warfarin therapy is monitored using the International Normalized
Ratio (INR), with a therapeutic range typically 2.0–3.0 for most indications
(DVT, atrial fibrillation, PE). Mechanical heart valves require a higher range of
2.5–3.5. aPTT is used to monitor heparin therapy. INR must be checked
before each dose to prevent bleeding complications.
2. A client prescribed warfarin asks about dietary restrictions. Which
statement by the client indicates correct understanding?
A) "I will avoid all carbohydrates."
B) "I will limit the amount of spinach salad I eat."
C) "I will stop drinking water."
D) "I will increase my intake of green leafy vegetables."
Correct Answer: "I will limit the amount of spinach salad I eat."
Rationale: Spinach is high in vitamin K, which antagonizes warfarin's effects.
Clients should keep vitamin K intake consistent and avoid sudden increases.
Green leafy vegetables should be consumed in consistent amounts rather
than avoided completely.
,3. A client is receiving a continuous heparin infusion. The nurse notes the
aPTT is 95 seconds. What should the nurse do first?
A) Continue the infusion as ordered
B) Stop the infusion and notify the healthcare provider
C) Decrease the infusion rate by half
D) Administer protamine sulfate
Correct Answer: Stop the infusion and notify the healthcare provider
Rationale: The therapeutic aPTT for heparin is typically 1.5–2.5 times the
control (45–75 seconds). An aPTT of 95 seconds indicates excessive
anticoagulation and increased bleeding risk. The infusion should be stopped
and the provider notified for dose adjustment. Protamine sulfate is the
antidote for severe bleeding, not for an elevated aPTT alone.
4. Which medication is the antidote for heparin overdose?
A) Vitamin K
B) Protamine sulfate
C) Naloxone
D) Flumazenil
Correct Answer: Protamine sulfate
Rationale: Protamine sulfate is the specific antidote for heparin, binding to
heparin and neutralizing its anticoagulant effects. Vitamin K is the antidote
for warfarin. Naloxone reverses opioids, and flumazenil reverses
benzodiazepines.
,5. A client prescribed enoxaparin (Lovenox) asks the nurse how to administer
the medication. Which instruction is correct?
A) "Inject into the deltoid muscle."
B) "Administer subcutaneously in the abdomen at a 90-degree angle,
pinching the skin."
C) "Administer intravenously over 2 minutes."
D) "Massage the site after injection."
Correct Answer: "Administer subcutaneously in the abdomen at a 90-degree
angle, pinching the skin."
Rationale: Enoxaparin is a low-molecular-weight heparin (LMWH)
administered subcutaneously in the abdomen at a 90-degree angle with the
skin pinched. No aspiration or massage is required.
6. A client on clopidogrel (Plavix) reports black, tarry stools. The nurse should
first:
A) Administer vitamin K
B) Notify the healthcare provider immediately
C) Document the finding as normal
D) Administer protamine sulfate
Correct Answer: Notify the healthcare provider immediately
Rationale: Black, tarry stools indicate gastrointestinal bleeding, a serious
adverse effect of antiplatelet therapy. The provider should be notified
immediately. Vitamin K is not effective for antiplatelet-induced bleeding.
7. A client with a drug-eluting stent is prescribed dual antiplatelet therapy.
Which medications are typically used?
, A) Warfarin and heparin
B) Aspirin and clopidogrel
C) Enoxaparin and dabigatran
D) TPA and heparin
Correct Answer: Aspirin and clopidogrel
Rationale: Dual antiplatelet therapy with aspirin and clopidogrel is
recommended for 6–12 months after a drug-eluting stent to prevent stent
thrombosis. Aspirin irreversibly inhibits COX-1 and platelet aggregation for
the life of the platelet (7–10 days).
8. The nurse is administering dabigatran (Pradaxa) to a client. Which action
is correct?
A) Open the capsule and mix with applesauce
B) Store the medication in the original bottle
C) Crush the capsule for easier swallowing
D) Monitor INR levels regularly
Correct Answer: Store the medication in the original bottle
Rationale: Dabigatran is moisture-sensitive and should be stored in the
original bottle to maintain stability. The capsules should not be opened,
crushed, or chewed, as this increases bleeding risk. No routine INR
monitoring is required.
9. A client prescribed rivaroxaban (Xarelto) asks how to take the medication.
Which instruction is correct?
A) "Take on an empty stomach."
| Pharmacology
1. The nurse is preparing to administer warfarin to a client. Which laboratory
value is most important to review before administration?
A) aPTT
B) INR
C) Serum creatinine
D) Complete blood count
Correct Answer: INR
Rationale: Warfarin therapy is monitored using the International Normalized
Ratio (INR), with a therapeutic range typically 2.0–3.0 for most indications
(DVT, atrial fibrillation, PE). Mechanical heart valves require a higher range of
2.5–3.5. aPTT is used to monitor heparin therapy. INR must be checked
before each dose to prevent bleeding complications.
2. A client prescribed warfarin asks about dietary restrictions. Which
statement by the client indicates correct understanding?
A) "I will avoid all carbohydrates."
B) "I will limit the amount of spinach salad I eat."
C) "I will stop drinking water."
D) "I will increase my intake of green leafy vegetables."
Correct Answer: "I will limit the amount of spinach salad I eat."
Rationale: Spinach is high in vitamin K, which antagonizes warfarin's effects.
Clients should keep vitamin K intake consistent and avoid sudden increases.
Green leafy vegetables should be consumed in consistent amounts rather
than avoided completely.
,3. A client is receiving a continuous heparin infusion. The nurse notes the
aPTT is 95 seconds. What should the nurse do first?
A) Continue the infusion as ordered
B) Stop the infusion and notify the healthcare provider
C) Decrease the infusion rate by half
D) Administer protamine sulfate
Correct Answer: Stop the infusion and notify the healthcare provider
Rationale: The therapeutic aPTT for heparin is typically 1.5–2.5 times the
control (45–75 seconds). An aPTT of 95 seconds indicates excessive
anticoagulation and increased bleeding risk. The infusion should be stopped
and the provider notified for dose adjustment. Protamine sulfate is the
antidote for severe bleeding, not for an elevated aPTT alone.
4. Which medication is the antidote for heparin overdose?
A) Vitamin K
B) Protamine sulfate
C) Naloxone
D) Flumazenil
Correct Answer: Protamine sulfate
Rationale: Protamine sulfate is the specific antidote for heparin, binding to
heparin and neutralizing its anticoagulant effects. Vitamin K is the antidote
for warfarin. Naloxone reverses opioids, and flumazenil reverses
benzodiazepines.
,5. A client prescribed enoxaparin (Lovenox) asks the nurse how to administer
the medication. Which instruction is correct?
A) "Inject into the deltoid muscle."
B) "Administer subcutaneously in the abdomen at a 90-degree angle,
pinching the skin."
C) "Administer intravenously over 2 minutes."
D) "Massage the site after injection."
Correct Answer: "Administer subcutaneously in the abdomen at a 90-degree
angle, pinching the skin."
Rationale: Enoxaparin is a low-molecular-weight heparin (LMWH)
administered subcutaneously in the abdomen at a 90-degree angle with the
skin pinched. No aspiration or massage is required.
6. A client on clopidogrel (Plavix) reports black, tarry stools. The nurse should
first:
A) Administer vitamin K
B) Notify the healthcare provider immediately
C) Document the finding as normal
D) Administer protamine sulfate
Correct Answer: Notify the healthcare provider immediately
Rationale: Black, tarry stools indicate gastrointestinal bleeding, a serious
adverse effect of antiplatelet therapy. The provider should be notified
immediately. Vitamin K is not effective for antiplatelet-induced bleeding.
7. A client with a drug-eluting stent is prescribed dual antiplatelet therapy.
Which medications are typically used?
, A) Warfarin and heparin
B) Aspirin and clopidogrel
C) Enoxaparin and dabigatran
D) TPA and heparin
Correct Answer: Aspirin and clopidogrel
Rationale: Dual antiplatelet therapy with aspirin and clopidogrel is
recommended for 6–12 months after a drug-eluting stent to prevent stent
thrombosis. Aspirin irreversibly inhibits COX-1 and platelet aggregation for
the life of the platelet (7–10 days).
8. The nurse is administering dabigatran (Pradaxa) to a client. Which action
is correct?
A) Open the capsule and mix with applesauce
B) Store the medication in the original bottle
C) Crush the capsule for easier swallowing
D) Monitor INR levels regularly
Correct Answer: Store the medication in the original bottle
Rationale: Dabigatran is moisture-sensitive and should be stored in the
original bottle to maintain stability. The capsules should not be opened,
crushed, or chewed, as this increases bleeding risk. No routine INR
monitoring is required.
9. A client prescribed rivaroxaban (Xarelto) asks how to take the medication.
Which instruction is correct?
A) "Take on an empty stomach."
