NURS 8024 Pharmacology Final Exam Practice 100
Questions with Verified Answers and Rationales
1. A patient is prescribed a medication that acts as a full agonist at the mu-opioid receptor.
Which effect would the nurse anticipate?
• A. Constipation and respiratory depression
• B. Increased gastrointestinal motility
• C. Bronchodilation
• D. Decreased pain perception without respiratory effects
Answer: A. Constipation and respiratory depression
Rationale: Full mu-opioid receptor agonists (e.g., morphine, fentanyl) produce analgesia,
respiratory depression, constipation, sedation, and euphoria. Respiratory depression is the most
serious adverse effect.
2. A patient is taking digoxin for heart failure. The nurse notes a serum digoxin level of 2.5
ng/mL. The nurse should:
• A. Continue the medication as prescribed
• B. Hold the medication and notify the provider
• C. Administer an additional dose
• D. Increase the dose
Answer: B. Hold the medication and notify the provider
Rationale: Therapeutic digoxin level is 0.8-2.0 ng/mL. A level of 2.5 ng/mL is toxic and places
the patient at risk for digoxin toxicity, which can cause nausea, vomiting, visual disturbances,
and cardiac arrhythmias.
3. A patient with a history of peptic ulcer disease is prescribed ibuprofen for arthritis pain.
The nurse should:
• A. Administer the medication with food
• B. Request a COX-2 inhibitor instead
• C. Monitor for GI bleeding
• D. All of the above
,Answer: D. All of the above
Rationale: NSAIDs can cause GI irritation and bleeding. COX-2 inhibitors have less GI toxicity.
Administering with food reduces GI irritation. Monitoring for signs of GI bleeding is essential in
patients with a history of PUD.
4. Warfarin exerts its anticoagulant effect by:
• A. Directly inhibiting factor Xa
• B. Inhibiting platelet aggregation
• C. Inhibiting vitamin K-dependent clotting factors (II, VII, IX, X)
• D. Activating antithrombin III
Answer: C. Inhibiting vitamin K-dependent clotting factors (II, VII, IX, X)
Rationale: Warfarin is a vitamin K antagonist. It inhibits the synthesis of vitamin K-dependent
clotting factors II, VII, IX, X, and proteins C and S. It takes several days to achieve therapeutic
effect.
5. A patient on warfarin has an INR of 1.2. The nurse should anticipate:
• A. No change in dose
• B. An increase in warfarin dose
• C. A decrease in warfarin dose
• D. Administration of vitamin K
Answer: B. An increase in warfarin dose
Rationale: Therapeutic INR for most indications is 2-3. An INR of 1.2 indicates subtherapeutic
anticoagulation. The provider may increase the warfarin dose to reach therapeutic range.
6. Which medication is used as the antidote for warfarin overdose?
• A. Protamine sulfate
• B. Vitamin K (phytonadione)
• C. Naloxone
• D. Flumazenil
,Answer: B. Vitamin K (phytonadione)
Rationale: Vitamin K is the antidote for warfarin toxicity. It promotes the synthesis of active
clotting factors. Protamine sulfate is the antidote for heparin. Naloxone reverses opioids.
Flumazenil reverses benzodiazepines.
7. Heparin exerts its anticoagulant effect by:
• A. Inhibiting vitamin K-dependent clotting factors
• B. Binding to antithrombin III and inactivating thrombin and factor Xa
• C. Inhibiting platelet aggregation
• D. Directly inhibiting factor Xa
Answer: B. Binding to antithrombin III and inactivating thrombin and factor Xa
Rationale: Heparin binds to antithrombin III, causing a conformational change that increases
antithrombin III's activity. It inactivates thrombin (factor IIa) and factor Xa. Unfractionated
heparin inactivates both; low molecular weight heparin primarily inactivates factor Xa.
8. A patient receiving heparin therapy is experiencing bleeding complications. The nurse
should prepare to administer:
• A. Vitamin K
• B. Protamine sulfate
• C. Fresh frozen plasma
• D. Naloxone
Answer: B. Protamine sulfate
Rationale: Protamine sulfate is the specific antidote for heparin. It binds to heparin and forms a
stable complex, neutralizing its anticoagulant effect. Vitamin K reverses warfarin.
9. A patient is prescribed enoxaparin (Lovenox) for DVT prophylaxis. Which statement
indicates the patient understands the teaching?
• A. "I will take this medication by mouth every morning."
• B. "I will need to have my INR checked regularly."
, • C. "I will inject this medication into my abdomen twice daily."
• D. "I don't need to worry about bleeding because it's a low dose."
Answer: C. "I will inject this medication into my abdomen twice daily."
Rationale: Enoxaparin is a low molecular weight heparin administered subcutaneously in the
abdomen. It does not require INR monitoring like warfarin. Bleeding is still a risk.
10. A patient with atrial fibrillation is started on apixaban (Eliquis). The nurse should
monitor for:
• A. Bleeding
• B. Heparin-induced thrombocytopenia
• C. Elevated INR
• D. Hyperkalemia
Answer: A. Bleeding
Rationale: Apixaban is a direct factor Xa inhibitor and carries a risk of bleeding. Unlike
warfarin, routine INR monitoring is not required. HIT is associated with heparin.
11. Aspirin exerts its antiplatelet effect by:
• A. Inhibiting COX-1 and thromboxane A2 production
• B. Inhibiting COX-2 only
• C. Blocking ADP receptors on platelets
• D. Activating antithrombin III
Answer: A. Inhibiting COX-1 and thromboxane A2 production
Rationale: Aspirin irreversibly inhibits COX-1, preventing the production of thromboxane A2,
which is a potent platelet aggregator. This effect lasts for the lifespan of the platelet (7-10 days).
12. Clopidogrel (Plavix) should be used cautiously with which medication due to reduced
efficacy?
• A. Omeprazole
Questions with Verified Answers and Rationales
1. A patient is prescribed a medication that acts as a full agonist at the mu-opioid receptor.
Which effect would the nurse anticipate?
• A. Constipation and respiratory depression
• B. Increased gastrointestinal motility
• C. Bronchodilation
• D. Decreased pain perception without respiratory effects
Answer: A. Constipation and respiratory depression
Rationale: Full mu-opioid receptor agonists (e.g., morphine, fentanyl) produce analgesia,
respiratory depression, constipation, sedation, and euphoria. Respiratory depression is the most
serious adverse effect.
2. A patient is taking digoxin for heart failure. The nurse notes a serum digoxin level of 2.5
ng/mL. The nurse should:
• A. Continue the medication as prescribed
• B. Hold the medication and notify the provider
• C. Administer an additional dose
• D. Increase the dose
Answer: B. Hold the medication and notify the provider
Rationale: Therapeutic digoxin level is 0.8-2.0 ng/mL. A level of 2.5 ng/mL is toxic and places
the patient at risk for digoxin toxicity, which can cause nausea, vomiting, visual disturbances,
and cardiac arrhythmias.
3. A patient with a history of peptic ulcer disease is prescribed ibuprofen for arthritis pain.
The nurse should:
• A. Administer the medication with food
• B. Request a COX-2 inhibitor instead
• C. Monitor for GI bleeding
• D. All of the above
,Answer: D. All of the above
Rationale: NSAIDs can cause GI irritation and bleeding. COX-2 inhibitors have less GI toxicity.
Administering with food reduces GI irritation. Monitoring for signs of GI bleeding is essential in
patients with a history of PUD.
4. Warfarin exerts its anticoagulant effect by:
• A. Directly inhibiting factor Xa
• B. Inhibiting platelet aggregation
• C. Inhibiting vitamin K-dependent clotting factors (II, VII, IX, X)
• D. Activating antithrombin III
Answer: C. Inhibiting vitamin K-dependent clotting factors (II, VII, IX, X)
Rationale: Warfarin is a vitamin K antagonist. It inhibits the synthesis of vitamin K-dependent
clotting factors II, VII, IX, X, and proteins C and S. It takes several days to achieve therapeutic
effect.
5. A patient on warfarin has an INR of 1.2. The nurse should anticipate:
• A. No change in dose
• B. An increase in warfarin dose
• C. A decrease in warfarin dose
• D. Administration of vitamin K
Answer: B. An increase in warfarin dose
Rationale: Therapeutic INR for most indications is 2-3. An INR of 1.2 indicates subtherapeutic
anticoagulation. The provider may increase the warfarin dose to reach therapeutic range.
6. Which medication is used as the antidote for warfarin overdose?
• A. Protamine sulfate
• B. Vitamin K (phytonadione)
• C. Naloxone
• D. Flumazenil
,Answer: B. Vitamin K (phytonadione)
Rationale: Vitamin K is the antidote for warfarin toxicity. It promotes the synthesis of active
clotting factors. Protamine sulfate is the antidote for heparin. Naloxone reverses opioids.
Flumazenil reverses benzodiazepines.
7. Heparin exerts its anticoagulant effect by:
• A. Inhibiting vitamin K-dependent clotting factors
• B. Binding to antithrombin III and inactivating thrombin and factor Xa
• C. Inhibiting platelet aggregation
• D. Directly inhibiting factor Xa
Answer: B. Binding to antithrombin III and inactivating thrombin and factor Xa
Rationale: Heparin binds to antithrombin III, causing a conformational change that increases
antithrombin III's activity. It inactivates thrombin (factor IIa) and factor Xa. Unfractionated
heparin inactivates both; low molecular weight heparin primarily inactivates factor Xa.
8. A patient receiving heparin therapy is experiencing bleeding complications. The nurse
should prepare to administer:
• A. Vitamin K
• B. Protamine sulfate
• C. Fresh frozen plasma
• D. Naloxone
Answer: B. Protamine sulfate
Rationale: Protamine sulfate is the specific antidote for heparin. It binds to heparin and forms a
stable complex, neutralizing its anticoagulant effect. Vitamin K reverses warfarin.
9. A patient is prescribed enoxaparin (Lovenox) for DVT prophylaxis. Which statement
indicates the patient understands the teaching?
• A. "I will take this medication by mouth every morning."
• B. "I will need to have my INR checked regularly."
, • C. "I will inject this medication into my abdomen twice daily."
• D. "I don't need to worry about bleeding because it's a low dose."
Answer: C. "I will inject this medication into my abdomen twice daily."
Rationale: Enoxaparin is a low molecular weight heparin administered subcutaneously in the
abdomen. It does not require INR monitoring like warfarin. Bleeding is still a risk.
10. A patient with atrial fibrillation is started on apixaban (Eliquis). The nurse should
monitor for:
• A. Bleeding
• B. Heparin-induced thrombocytopenia
• C. Elevated INR
• D. Hyperkalemia
Answer: A. Bleeding
Rationale: Apixaban is a direct factor Xa inhibitor and carries a risk of bleeding. Unlike
warfarin, routine INR monitoring is not required. HIT is associated with heparin.
11. Aspirin exerts its antiplatelet effect by:
• A. Inhibiting COX-1 and thromboxane A2 production
• B. Inhibiting COX-2 only
• C. Blocking ADP receptors on platelets
• D. Activating antithrombin III
Answer: A. Inhibiting COX-1 and thromboxane A2 production
Rationale: Aspirin irreversibly inhibits COX-1, preventing the production of thromboxane A2,
which is a potent platelet aggregator. This effect lasts for the lifespan of the platelet (7-10 days).
12. Clopidogrel (Plavix) should be used cautiously with which medication due to reduced
efficacy?
• A. Omeprazole
