, Question 1
A patient receiving continuous IV heparin has an aPTT of 98 seconds (control
30 seconds). Which intervention should the nurse anticipate?
A. Administer vitamin K 10 mg IV push
B. Stop the infusion and prepare protamine sulfate
C. Continue the infusion and recheck aPTT in 6 hours
D. Increase the infusion rate by 2 units/kg/hr
Correct Answer: B - Stop the infusion and prepare protamine
sulfate
RATIONALE
An aPTT of 98 seconds is markedly prolonged (therapeutic range is
typically 1.5-2.5 times control, or 45-75 seconds), indicating
supratherapeutic anticoagulation and bleeding risk; the heparin
infusion should be stopped and protamine sulfate administered as the
antidote. Vitamin K reverses warfarin, not heparin. Continuing or
increasing the infusion would worsen the coagulopathy.
Question 2
A patient with heart failure is prescribed digoxin. Which laboratory value most
increases the risk for digoxin toxicity?
A. Serum potassium 3.1 mEq/L
B. Serum sodium 138 mEq/L
C. Serum calcium 9.2 mg/dL
D. Serum magnesium 2.0 mg/dL
Correct Answer: A - Serum potassium 3.1 mEq/L
Page 2
, RATIONALE
Hypokalemia (potassium 3.1 mEq/L) potentiates digoxin binding at
the Na+/K+-ATPase pump, increasing the risk of toxicity even at
therapeutic serum levels. Sodium, calcium, and magnesium levels
within normal limits do not increase digoxin toxicity risk in the same
way.
Question 3
A patient on furosemide reports muscle weakness and palpitations. Which
acid-base and electrolyte imbalance should the nurse suspect?
A. Metabolic alkalosis with hypokalemia
B. Metabolic acidosis with hyperkalemia
C. Respiratory alkalosis with hypocalcemia
D. Respiratory acidosis with hypernatremia
Correct Answer: A - Metabolic alkalosis with hypokalemia
RATIONALE
Loop diuretics like furosemide cause loss of potassium and hydrogen
ions, leading to hypokalemia and metabolic alkalosis, which manifest
as muscle weakness and palpitations. The other options describe
imbalances inconsistent with furosemide's mechanism.
Question 4
Which instruction is most important for a patient prescribed sublingual
nitroglycerin for angina?
A. Swallow the tablet with water for faster absorption
B. Take one tablet every 5 minutes up to three doses; call 911 if pain
persists
C. Take the medication only when experiencing chest pain at rest
D. Store the medication in a warm, humid place to maintain potency
Correct Answer: B - Take one tablet every 5 minutes up to three
Page 3
, doses; call 911 if pain persists
RATIONALE
Sublingual nitroglycerin should be taken at the onset of chest pain,
repeated every 5 minutes for up to three doses, and emergency
services called if pain persists, per current guidelines. Swallowing the
tablet, limiting use to rest pain, or improper storage would reduce
efficacy.
Question 5
A patient with type 2 diabetes is prescribed metformin. Which statement
indicates the need for further teaching?
A. I should take this medication with meals to reduce stomach upset.
B. I will avoid excessive alcohol while taking this medication.
C. I can skip doses if I plan to have a contrast dye procedure.
D. I should report any unusual muscle pain or difficulty breathing.
Correct Answer: C - I can skip doses if I plan to have a contrast
dye procedure.
RATIONALE
Metformin should be temporarily discontinued before and after
procedures involving iodinated contrast dye due to the risk of acute
kidney injury and lactic acidosis; skipping doses only on procedure
days is insufficient. The other statements reflect correct understanding
of administration and adverse effect monitoring.
Question 6
A patient receiving morphine via patient-controlled analgesia has a respiratory
rate of 8/min and is difficult to arouse. Which action should the nurse take
first?
A. Administer naloxone 0.4 mg IV
B. Apply oxygen via non-rebreather mask
Page 4
A patient receiving continuous IV heparin has an aPTT of 98 seconds (control
30 seconds). Which intervention should the nurse anticipate?
A. Administer vitamin K 10 mg IV push
B. Stop the infusion and prepare protamine sulfate
C. Continue the infusion and recheck aPTT in 6 hours
D. Increase the infusion rate by 2 units/kg/hr
Correct Answer: B - Stop the infusion and prepare protamine
sulfate
RATIONALE
An aPTT of 98 seconds is markedly prolonged (therapeutic range is
typically 1.5-2.5 times control, or 45-75 seconds), indicating
supratherapeutic anticoagulation and bleeding risk; the heparin
infusion should be stopped and protamine sulfate administered as the
antidote. Vitamin K reverses warfarin, not heparin. Continuing or
increasing the infusion would worsen the coagulopathy.
Question 2
A patient with heart failure is prescribed digoxin. Which laboratory value most
increases the risk for digoxin toxicity?
A. Serum potassium 3.1 mEq/L
B. Serum sodium 138 mEq/L
C. Serum calcium 9.2 mg/dL
D. Serum magnesium 2.0 mg/dL
Correct Answer: A - Serum potassium 3.1 mEq/L
Page 2
, RATIONALE
Hypokalemia (potassium 3.1 mEq/L) potentiates digoxin binding at
the Na+/K+-ATPase pump, increasing the risk of toxicity even at
therapeutic serum levels. Sodium, calcium, and magnesium levels
within normal limits do not increase digoxin toxicity risk in the same
way.
Question 3
A patient on furosemide reports muscle weakness and palpitations. Which
acid-base and electrolyte imbalance should the nurse suspect?
A. Metabolic alkalosis with hypokalemia
B. Metabolic acidosis with hyperkalemia
C. Respiratory alkalosis with hypocalcemia
D. Respiratory acidosis with hypernatremia
Correct Answer: A - Metabolic alkalosis with hypokalemia
RATIONALE
Loop diuretics like furosemide cause loss of potassium and hydrogen
ions, leading to hypokalemia and metabolic alkalosis, which manifest
as muscle weakness and palpitations. The other options describe
imbalances inconsistent with furosemide's mechanism.
Question 4
Which instruction is most important for a patient prescribed sublingual
nitroglycerin for angina?
A. Swallow the tablet with water for faster absorption
B. Take one tablet every 5 minutes up to three doses; call 911 if pain
persists
C. Take the medication only when experiencing chest pain at rest
D. Store the medication in a warm, humid place to maintain potency
Correct Answer: B - Take one tablet every 5 minutes up to three
Page 3
, doses; call 911 if pain persists
RATIONALE
Sublingual nitroglycerin should be taken at the onset of chest pain,
repeated every 5 minutes for up to three doses, and emergency
services called if pain persists, per current guidelines. Swallowing the
tablet, limiting use to rest pain, or improper storage would reduce
efficacy.
Question 5
A patient with type 2 diabetes is prescribed metformin. Which statement
indicates the need for further teaching?
A. I should take this medication with meals to reduce stomach upset.
B. I will avoid excessive alcohol while taking this medication.
C. I can skip doses if I plan to have a contrast dye procedure.
D. I should report any unusual muscle pain or difficulty breathing.
Correct Answer: C - I can skip doses if I plan to have a contrast
dye procedure.
RATIONALE
Metformin should be temporarily discontinued before and after
procedures involving iodinated contrast dye due to the risk of acute
kidney injury and lactic acidosis; skipping doses only on procedure
days is insufficient. The other statements reflect correct understanding
of administration and adverse effect monitoring.
Question 6
A patient receiving morphine via patient-controlled analgesia has a respiratory
rate of 8/min and is difficult to arouse. Which action should the nurse take
first?
A. Administer naloxone 0.4 mg IV
B. Apply oxygen via non-rebreather mask
Page 4
