NR 341 Pharmacology Clinical Judgment Exam
(CJE), Chamberlain University College of
Nursing, 2026/2027 – Pharmacology
Competency Assessment
SECTION 1: CARDIOVASCULAR PHARMACOLOGY
(Questions 1-15)
Q1. A patient is receiving a continuous heparin infusion. The nurse
notes that the patient's aPTT is 110 seconds. The control value is 30
seconds. What is the nurse's priority action?
A) Increase the heparin infusion rate
B) Stop the heparin infusion and notify the healthcare provider
C) Continue the infusion as prescribed
D) Administer vitamin K
Correct Answer: B. Stop the heparin infusion and notify the
healthcare provider
Rationale: The therapeutic aPTT for heparin is typically 1.5 to 2.5 times the
control (approximately 45-75 seconds). An aPTT of 110 seconds is critically
high, indicating a high bleeding risk. The infusion should be stopped, and the
provider notified immediately. Vitamin K is the antidote for warfarin, not
heparin. The antidote for heparin is protamine sulfate.
Q2. A patient with atrial fibrillation is prescribed warfarin
(Coumadin). Which laboratory value should the nurse monitor to
determine therapeutic effectiveness?
,A) aPTT
B) INR (International Normalized Ratio)
C) Platelet count
D) Bleeding time
Correct Answer: B. INR (International Normalized Ratio)
Rationale: Warfarin is monitored using the INR (International Normalized
Ratio). The therapeutic INR range for atrial fibrillation is typically 2.0-3.0.
aPTT monitors heparin therapy. Platelet count monitors for heparin-induced
thrombocytopenia (HIT), not warfarin effectiveness. Bleeding time is not
used for warfarin monitoring.
Q3. A patient with heart failure is prescribed digoxin (Lanoxin). The
nurse notes the patient's serum potassium level is 3.2 mEq/L. Which
action should the nurse take first?
A) Administer the digoxin as prescribed
B) Hold the digoxin and notify the provider
C) Administer potassium chloride IV push
D) Double the next dose of digoxin
Correct Answer: B. Hold the digoxin and notify the provider
Rationale: Hypokalemia (normal range 3.5-5.0 mEq/L) increases the risk of
digoxin toxicity. The nurse should hold the digoxin and notify the provider.
Potassium should be replaced as prescribed, but not as an IV push. Double-
dosing digoxin would increase toxicity risk.
Q4. A patient is prescribed amiodarone for ventricular tachycardia.
Which adverse effect requires long-term monitoring? (Select all that
apply)
A) Pulmonary toxicity
B) Thyroid dysfunction
C) Corneal microdeposits
D) Hepatotoxicity
E) Photosensitivity
, Correct Answers: A, B, C, D, E
Rationale: Amiodarone has multiple serious adverse effects requiring long-
term monitoring. Pulmonary toxicity (pulmonary fibrosis) can be fatal;
baseline and periodic chest X-rays and PFTs are recommended. Thyroid
dysfunction (hypo- or hyperthyroidism) occurs due to amiodarone's high
iodine content. Corneal microdeposits occur in nearly all patients but are
usually benign. Hepatotoxicity requires LFT monitoring. Photosensitivity
requires sun protection education.
Q5. A patient is prescribed enoxaparin (Lovenox) subcutaneously for
DVT prophylaxis. Which injection technique is correct?
A) Expel the air bubble from the prefilled syringe before injecting
B) Inject into the abdomen, 2 inches away from the umbilicus
C) Massage the injection site after administration
D) Aspirate before injecting to check for blood return
Correct Answer: B. Inject into the abdomen, 2 inches away from the
umbilicus
Rationale: Enoxaparin (LMWH) should be administered subcutaneously into
the abdomen at least 2 inches from the umbilicus. The air bubble in the
prefilled syringe should NOT be expelled (it ensures full dose delivery). Do
not massage the site (can cause bruising). Aspiration is not required for
subcutaneous heparin injections.
Q6. A patient is prescribed lisinopril for hypertension. Which
adverse effect is most characteristic of ACE inhibitors?
A) Peripheral edema
B) Dry, persistent cough
C) Hyperglycemia
D) Bradycardia
Correct Answer: B. Dry, persistent cough
(CJE), Chamberlain University College of
Nursing, 2026/2027 – Pharmacology
Competency Assessment
SECTION 1: CARDIOVASCULAR PHARMACOLOGY
(Questions 1-15)
Q1. A patient is receiving a continuous heparin infusion. The nurse
notes that the patient's aPTT is 110 seconds. The control value is 30
seconds. What is the nurse's priority action?
A) Increase the heparin infusion rate
B) Stop the heparin infusion and notify the healthcare provider
C) Continue the infusion as prescribed
D) Administer vitamin K
Correct Answer: B. Stop the heparin infusion and notify the
healthcare provider
Rationale: The therapeutic aPTT for heparin is typically 1.5 to 2.5 times the
control (approximately 45-75 seconds). An aPTT of 110 seconds is critically
high, indicating a high bleeding risk. The infusion should be stopped, and the
provider notified immediately. Vitamin K is the antidote for warfarin, not
heparin. The antidote for heparin is protamine sulfate.
Q2. A patient with atrial fibrillation is prescribed warfarin
(Coumadin). Which laboratory value should the nurse monitor to
determine therapeutic effectiveness?
,A) aPTT
B) INR (International Normalized Ratio)
C) Platelet count
D) Bleeding time
Correct Answer: B. INR (International Normalized Ratio)
Rationale: Warfarin is monitored using the INR (International Normalized
Ratio). The therapeutic INR range for atrial fibrillation is typically 2.0-3.0.
aPTT monitors heparin therapy. Platelet count monitors for heparin-induced
thrombocytopenia (HIT), not warfarin effectiveness. Bleeding time is not
used for warfarin monitoring.
Q3. A patient with heart failure is prescribed digoxin (Lanoxin). The
nurse notes the patient's serum potassium level is 3.2 mEq/L. Which
action should the nurse take first?
A) Administer the digoxin as prescribed
B) Hold the digoxin and notify the provider
C) Administer potassium chloride IV push
D) Double the next dose of digoxin
Correct Answer: B. Hold the digoxin and notify the provider
Rationale: Hypokalemia (normal range 3.5-5.0 mEq/L) increases the risk of
digoxin toxicity. The nurse should hold the digoxin and notify the provider.
Potassium should be replaced as prescribed, but not as an IV push. Double-
dosing digoxin would increase toxicity risk.
Q4. A patient is prescribed amiodarone for ventricular tachycardia.
Which adverse effect requires long-term monitoring? (Select all that
apply)
A) Pulmonary toxicity
B) Thyroid dysfunction
C) Corneal microdeposits
D) Hepatotoxicity
E) Photosensitivity
, Correct Answers: A, B, C, D, E
Rationale: Amiodarone has multiple serious adverse effects requiring long-
term monitoring. Pulmonary toxicity (pulmonary fibrosis) can be fatal;
baseline and periodic chest X-rays and PFTs are recommended. Thyroid
dysfunction (hypo- or hyperthyroidism) occurs due to amiodarone's high
iodine content. Corneal microdeposits occur in nearly all patients but are
usually benign. Hepatotoxicity requires LFT monitoring. Photosensitivity
requires sun protection education.
Q5. A patient is prescribed enoxaparin (Lovenox) subcutaneously for
DVT prophylaxis. Which injection technique is correct?
A) Expel the air bubble from the prefilled syringe before injecting
B) Inject into the abdomen, 2 inches away from the umbilicus
C) Massage the injection site after administration
D) Aspirate before injecting to check for blood return
Correct Answer: B. Inject into the abdomen, 2 inches away from the
umbilicus
Rationale: Enoxaparin (LMWH) should be administered subcutaneously into
the abdomen at least 2 inches from the umbilicus. The air bubble in the
prefilled syringe should NOT be expelled (it ensures full dose delivery). Do
not massage the site (can cause bruising). Aspiration is not required for
subcutaneous heparin injections.
Q6. A patient is prescribed lisinopril for hypertension. Which
adverse effect is most characteristic of ACE inhibitors?
A) Peripheral edema
B) Dry, persistent cough
C) Hyperglycemia
D) Bradycardia
Correct Answer: B. Dry, persistent cough
