NR 566 Advanced Pharmacology For Care Of The Family
Weeks 5-7 Examination 2026-2027
Chamberlain University | 150 Questions & Answers with
Rationales
Instructions: Select the best answer for each question. Questions
are designed to reflect clinical application and the depth of
knowledge required for advanced practice nursing in the family
setting.
SECTION I: WEEK 5 CONTENT - HEMATOPOIETIC SYSTEM &
IMMUNOLOGY (Questions 1-50)
Part A: Anticoagulant Therapy (Questions 1-25)
1. Kenneth is 68 years old and has been on warfarin for three years
following a pulmonary embolism. He calls the clinic asking what
he can take for minor aches and pains. What is the best
recommendation?
A. Ibuprofen 400 mg three times daily as needed
B. Acetaminophen, not to exceed 2-3 grams per day
C. Naproxen 220 mg twice daily
D. Aspirin 325 mg daily
,Answer: B
Rationale: Patients on warfarin should avoid NSAIDs including
ibuprofen, naproxen, and aspirin due to increased bleeding risk
from platelet inhibition and gastric erosion. Acetaminophen is the
safest analgesic, though doses above 2-3 grams daily may
potentiate warfarin effect. The maximum recommended dose for
patients on anticoagulants is generally 2-3 grams, not the standard
4 grams .
2. Juanita was hospitalized for a deep vein thrombosis. She received
heparin intravenously during her hospital stay and was discharged
on warfarin. She asks her primary care provider why she was
getting both medications at the same time. The best response is:
A. "This was most likely a medication error during your admission;
you should contact the hospital."
B. "Warfarin is often started while a patient is still on heparin
because warfarin takes several days to become fully effective."
C. "You must have had a more complicated case that required dual
anticoagulation."
D. "The hospitalist wanted to make sure you were fully
anticoagulated before discharge."
,Answer: B
Rationale: Warfarin has a delayed onset of action of 3-5 days and
initially creates a transient hypercoagulable state by depleting
proteins C and S. Heparin or LMWH provides immediate
anticoagulation while warfarin reaches therapeutic levels. This
overlapping or "bridging" therapy is standard practice and
continues until INR is therapeutic for at least 24-48 hours .
3. A 32-year-old pregnant woman at 24 weeks gestation develops a
proximal DVT. She requires anticoagulation. Which agent is safest
in pregnancy?
A. Warfarin
B. Apixaban
C. Low molecular weight heparin (LMWH)
D. Rivaroxaban
Answer: C
Rationale: LMWH is the anticoagulant of choice in pregnancy. It
does not cross the placenta and has no teratogenic risk. Warfarin
crosses the placenta and is associated with fetal warfarin syndrome
and bleeding. Direct oral anticoagulants (DOACs) like apixaban
, and rivaroxaban lack safety data in pregnancy and are not
recommended .
4. The average starting dose of warfarin for most patients is 5 mg
daily. In which patient population should a higher starting dose of
7.5 mg be considered?
A. Elderly patients over 75 years
B. Patients with multiple comorbidities
C. Overweight or obese patients
D. Patients with hepatic impairment
Answer: C
Rationale: Higher warfarin starting doses (7.5 mg) may be
considered in younger, otherwise healthy, and overweight or obese
patients due to increased volume of distribution and altered
clearance. Lower doses (2.5-5 mg) are appropriate for elderly,
debilitated, or malnourished patients and those with multiple
comorbidities .
5. Cecil and his wife are planning a trip to Southeast Asia. He is
healthy with well-controlled hypertension and asks about getting a
Weeks 5-7 Examination 2026-2027
Chamberlain University | 150 Questions & Answers with
Rationales
Instructions: Select the best answer for each question. Questions
are designed to reflect clinical application and the depth of
knowledge required for advanced practice nursing in the family
setting.
SECTION I: WEEK 5 CONTENT - HEMATOPOIETIC SYSTEM &
IMMUNOLOGY (Questions 1-50)
Part A: Anticoagulant Therapy (Questions 1-25)
1. Kenneth is 68 years old and has been on warfarin for three years
following a pulmonary embolism. He calls the clinic asking what
he can take for minor aches and pains. What is the best
recommendation?
A. Ibuprofen 400 mg three times daily as needed
B. Acetaminophen, not to exceed 2-3 grams per day
C. Naproxen 220 mg twice daily
D. Aspirin 325 mg daily
,Answer: B
Rationale: Patients on warfarin should avoid NSAIDs including
ibuprofen, naproxen, and aspirin due to increased bleeding risk
from platelet inhibition and gastric erosion. Acetaminophen is the
safest analgesic, though doses above 2-3 grams daily may
potentiate warfarin effect. The maximum recommended dose for
patients on anticoagulants is generally 2-3 grams, not the standard
4 grams .
2. Juanita was hospitalized for a deep vein thrombosis. She received
heparin intravenously during her hospital stay and was discharged
on warfarin. She asks her primary care provider why she was
getting both medications at the same time. The best response is:
A. "This was most likely a medication error during your admission;
you should contact the hospital."
B. "Warfarin is often started while a patient is still on heparin
because warfarin takes several days to become fully effective."
C. "You must have had a more complicated case that required dual
anticoagulation."
D. "The hospitalist wanted to make sure you were fully
anticoagulated before discharge."
,Answer: B
Rationale: Warfarin has a delayed onset of action of 3-5 days and
initially creates a transient hypercoagulable state by depleting
proteins C and S. Heparin or LMWH provides immediate
anticoagulation while warfarin reaches therapeutic levels. This
overlapping or "bridging" therapy is standard practice and
continues until INR is therapeutic for at least 24-48 hours .
3. A 32-year-old pregnant woman at 24 weeks gestation develops a
proximal DVT. She requires anticoagulation. Which agent is safest
in pregnancy?
A. Warfarin
B. Apixaban
C. Low molecular weight heparin (LMWH)
D. Rivaroxaban
Answer: C
Rationale: LMWH is the anticoagulant of choice in pregnancy. It
does not cross the placenta and has no teratogenic risk. Warfarin
crosses the placenta and is associated with fetal warfarin syndrome
and bleeding. Direct oral anticoagulants (DOACs) like apixaban
, and rivaroxaban lack safety data in pregnancy and are not
recommended .
4. The average starting dose of warfarin for most patients is 5 mg
daily. In which patient population should a higher starting dose of
7.5 mg be considered?
A. Elderly patients over 75 years
B. Patients with multiple comorbidities
C. Overweight or obese patients
D. Patients with hepatic impairment
Answer: C
Rationale: Higher warfarin starting doses (7.5 mg) may be
considered in younger, otherwise healthy, and overweight or obese
patients due to increased volume of distribution and altered
clearance. Lower doses (2.5-5 mg) are appropriate for elderly,
debilitated, or malnourished patients and those with multiple
comorbidities .
5. Cecil and his wife are planning a trip to Southeast Asia. He is
healthy with well-controlled hypertension and asks about getting a
