GNRS 576 Pharmacology EXAM 4 ACTUAL EXAM
2025 100% ACCUTARE FALL SESSION GDADED A
WITH RATIONALE
A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient asks
the nurse why he has to be on two medications. The nurse's response is based on which rationale?
a.
The oral and injection forms work synergistically.
b.
The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used
alone.
c.
Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone is unable
to do so.
d.
Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach
adequate levels.
ANS: D
This overlap therapy is required in patients who have been receiving heparin for anticoagulation and are
to be switched to warfarin so that prevention of clotting is continuous. This overlapping is done
purposefully to allow time for the blood levels of warfarin to rise, so that when the heparin is eventually
discontinued, therapeutic anticoagulation levels of warfarin will have been achieved. Recommendations
are to continue overlap therapy of the heparin and warfarin for at least 5 days; the heparin is stopped
after day 5 when the international normalized ratio (INR) is above 2.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 417
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
,While a patient is receiving antilipemic therapy, the nurse knows to monitor the patient closely for the
development of which problem?
a. Neutropenia
b. Pulmonary problems
c. Vitamin C deficiency
d. Liver dysfunction
D
Antilipemic drugs may adversely affect liver function; therefore, liver function studies need to be closely
monitored. The other options do not reflect problems that may occur with antilipemic drugs.
A patient tells the nurse that he likes to eat large amounts of garlic "to help lower his cholesterol levels
naturally." The nurse reviews his medication history and notes that which drug has a potential
interaction with the garlic?
a. Acetaminophen (Tylenol)
b. Warfarin (Coumadin)
c. Digoxin (Lanoxin)
d. Phenytoin (Dilantin)
B
When using garlic, it is recommended to avoid any other drugs that may interfere with platelet and
clotting function. These drugs include antiplatelet drugs, anticoagulants, nonsteroidal antiinflammatory
drugs, and aspirin. The other drugs listed do not have known interactions with garlic.
A patient with coronary artery disease asks the nurse about the "good cholesterol" laboratory values.
The nurse knows that "good cholesterol" refers to which lipids?
a. Triglycerides
,b. Low-density lipoproteins (LDLs)
c. Very-low-density lipoproteins (VLDLs)
d. High-density lipoproteins (HDLs)
D
HDLs are responsible for the "recycling" of cholesterol. HDLs are sometimes referred to as the "good"
lipid (or good cholesterol) because they are believed to be cardioprotective. LDLs are known as the
"bad" cholesterol.
A patient who has recently started therapy on a statin drug asks the nurse how long it will take until he
sees an effect on his serum cholesterol. Which statement would be the nurse's best response?
a. "Blood levels return to normal within a week of beginning therapy."
b. "It takes 6 to 8 weeks to see a change in cholesterol levels."
c. "It takes at least 6 months to see a change in cholesterol levels."
d. "You will need to take this medication for almost a year to see significant results."
B
The maximum extent to which lipid levels are lowered may not occur until 6 to 8 weeks after the start of
therapy. The other responses are incorrect.
The nurse will monitor for myopathy (muscle pain) when a patient is taking which class of antilipemic
drugs?
a. Niacin
b. HMG-CoA reductase inhibitors
c. Fibric acid derivatives
d. Bile acid sequestrants
B
, Myopathy (muscle pain) is a clinically important adverse effect that may occur with HMG-CoA reductase
inhibitors. It may progress to a serious condition known as rhabdomyolysis. Patients receiving statin
therapy need to be advised to report any unexplained muscular pain or discomfort to their health care
providers immediately. The other drugs and drug classes do not cause muscle pain or myopathy.
When teaching a patient who is beginning antilipemic therapy about possible drug-food interactions, the
nurse will discuss which food?
a. Oatmeal
b. Grapefruit juice
c. Licorice
d. Dairy products
B
Taking HMG-CoA reductase inhibitors with grapefruit juice may cause complications. Components in
grapefruit juice inactivate CYP3A4 in both the liver and intestines. This enzyme plays a key role in statin
metabolism. The presence of grapefruit juice in the body may therefore result in sustained levels of
unmetabolized statin drug, which increases the risk for major drug toxicity, possibly leading to
rhabdomyolysis. The other foods do not interact with these drugs.
The nurse is conducting a class about antilipemic drugs. The antilipemic drug ezetimibe (Zetia) works by
which mechanism?
a. Inhibiting HMG-CoA reductase
b. Preventing resorption of bile acids from the small intestines
c. Activating lipase, which breaks down cholesterol
d. Inhibiting cholesterol absorption in the small intestine
D
2025 100% ACCUTARE FALL SESSION GDADED A
WITH RATIONALE
A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient asks
the nurse why he has to be on two medications. The nurse's response is based on which rationale?
a.
The oral and injection forms work synergistically.
b.
The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used
alone.
c.
Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone is unable
to do so.
d.
Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach
adequate levels.
ANS: D
This overlap therapy is required in patients who have been receiving heparin for anticoagulation and are
to be switched to warfarin so that prevention of clotting is continuous. This overlapping is done
purposefully to allow time for the blood levels of warfarin to rise, so that when the heparin is eventually
discontinued, therapeutic anticoagulation levels of warfarin will have been achieved. Recommendations
are to continue overlap therapy of the heparin and warfarin for at least 5 days; the heparin is stopped
after day 5 when the international normalized ratio (INR) is above 2.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 417
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
,While a patient is receiving antilipemic therapy, the nurse knows to monitor the patient closely for the
development of which problem?
a. Neutropenia
b. Pulmonary problems
c. Vitamin C deficiency
d. Liver dysfunction
D
Antilipemic drugs may adversely affect liver function; therefore, liver function studies need to be closely
monitored. The other options do not reflect problems that may occur with antilipemic drugs.
A patient tells the nurse that he likes to eat large amounts of garlic "to help lower his cholesterol levels
naturally." The nurse reviews his medication history and notes that which drug has a potential
interaction with the garlic?
a. Acetaminophen (Tylenol)
b. Warfarin (Coumadin)
c. Digoxin (Lanoxin)
d. Phenytoin (Dilantin)
B
When using garlic, it is recommended to avoid any other drugs that may interfere with platelet and
clotting function. These drugs include antiplatelet drugs, anticoagulants, nonsteroidal antiinflammatory
drugs, and aspirin. The other drugs listed do not have known interactions with garlic.
A patient with coronary artery disease asks the nurse about the "good cholesterol" laboratory values.
The nurse knows that "good cholesterol" refers to which lipids?
a. Triglycerides
,b. Low-density lipoproteins (LDLs)
c. Very-low-density lipoproteins (VLDLs)
d. High-density lipoproteins (HDLs)
D
HDLs are responsible for the "recycling" of cholesterol. HDLs are sometimes referred to as the "good"
lipid (or good cholesterol) because they are believed to be cardioprotective. LDLs are known as the
"bad" cholesterol.
A patient who has recently started therapy on a statin drug asks the nurse how long it will take until he
sees an effect on his serum cholesterol. Which statement would be the nurse's best response?
a. "Blood levels return to normal within a week of beginning therapy."
b. "It takes 6 to 8 weeks to see a change in cholesterol levels."
c. "It takes at least 6 months to see a change in cholesterol levels."
d. "You will need to take this medication for almost a year to see significant results."
B
The maximum extent to which lipid levels are lowered may not occur until 6 to 8 weeks after the start of
therapy. The other responses are incorrect.
The nurse will monitor for myopathy (muscle pain) when a patient is taking which class of antilipemic
drugs?
a. Niacin
b. HMG-CoA reductase inhibitors
c. Fibric acid derivatives
d. Bile acid sequestrants
B
, Myopathy (muscle pain) is a clinically important adverse effect that may occur with HMG-CoA reductase
inhibitors. It may progress to a serious condition known as rhabdomyolysis. Patients receiving statin
therapy need to be advised to report any unexplained muscular pain or discomfort to their health care
providers immediately. The other drugs and drug classes do not cause muscle pain or myopathy.
When teaching a patient who is beginning antilipemic therapy about possible drug-food interactions, the
nurse will discuss which food?
a. Oatmeal
b. Grapefruit juice
c. Licorice
d. Dairy products
B
Taking HMG-CoA reductase inhibitors with grapefruit juice may cause complications. Components in
grapefruit juice inactivate CYP3A4 in both the liver and intestines. This enzyme plays a key role in statin
metabolism. The presence of grapefruit juice in the body may therefore result in sustained levels of
unmetabolized statin drug, which increases the risk for major drug toxicity, possibly leading to
rhabdomyolysis. The other foods do not interact with these drugs.
The nurse is conducting a class about antilipemic drugs. The antilipemic drug ezetimibe (Zetia) works by
which mechanism?
a. Inhibiting HMG-CoA reductase
b. Preventing resorption of bile acids from the small intestines
c. Activating lipase, which breaks down cholesterol
d. Inhibiting cholesterol absorption in the small intestine
D
