RN Pharmacology Exam Preparation v3: 150 Advanced Practice
Questions with Evidence‑Based Answers and Detailed Rationales
Covering High‑Yield Drug Classes, Medication Safety, Adverse Effects,
Drug Interactions, and Emergency Antidotes for NCLEX Success.
Section 1: Anticoagulants & Antiplatelets (1–
15)
1. A patient on warfarin has an INR of 4.5 without bleeding. What
is the most appropriate action?
A. Give vitamin K 10 mg IV
B. Hold warfarin and recheck INR in 1–2 days
C. Give fresh frozen plasma
D. Increase warfarin dose
Answer: B – For INR 4.5–9 without bleeding, hold warfarin and
monitor; low‑dose oral vitamin K (1–2.5 mg) if high bleeding risk.
2. Which drug is a direct thrombin inhibitor used for stroke
prevention in atrial fibrillation?
A. Apixaban
B. Rivaroxaban
C. Dabigatran
D. Edoxaban
Answer: C – Dabigatran (Pradaxa) is a direct thrombin inhibitor;
others are factor Xa inhibitors.
,3. A patient on clopidogrel is scheduled for surgery. How many
days before surgery should it be stopped?
A. 1 day
B. 3 days
C. 5–7 days
D. 14 days
Answer: C – Clopidogrel should be stopped 5–7 days
pre‑operatively to reduce bleeding risk.
4. A patient on apixaban develops a life‑threatening bleed. Which
reversal agent is indicated?
A. Protamine sulfate
B. Vitamin K
C. Andexanet alfa
D. Idarucizumab
Answer: C – Andexanet alfa (Andexxa) reverses apixaban and
rivaroxaban.
5. A patient with HIT (heparin‑induced thrombocytopenia) has a
platelet count of 40,000. Which drug should be used instead of
heparin?
A. Warfarin
B. Argatroban
C. Enoxaparin
D. Bivalirudin (or argatroban)
Answer: D – Direct thrombin inhibitors (argatroban, bivalirudin) are
first‑line; warfarin is avoided until platelets recover.
6. A patient taking ticagrelor for acute coronary syndrome
reports dyspnea. What is the likely cause?
A. Heart failure
,B. Ticagrelor side effect (dyspnea occurs in ~14%)
C. Pulmonary embolism
D. Asthma exacerbation
Answer: B – Ticagrelor causes dyspnea via adenosine accumulation;
often self‑limiting.
7. Which antiplatelet agent irreversibly inhibits the P2Y12
receptor?
A. Aspirin
B. Ticagrelor (reversible)
C. Clopidogrel (irreversible)
D. Cangrelor (reversible)
Answer: C – Clopidogrel and prasugrel irreversibly block P2Y12;
ticagrelor and cangrelor are reversible.
8. A patient on warfarin is started on
sulfamethoxazole‑trimethoprim. What INR change is expected?
A. INR decreases
B. INR increases (TMP‑SMX inhibits warfarin metabolism)
C. No change
D. Unpredictable
Answer: B – TMP‑SMX is a strong CYP2C9 inhibitor; reduce warfarin
dose and monitor INR closely.
9. Which anticoagulant is safe to use in patients with mechanical
heart valves?
A. Dabigatran
B. Apixaban
C. Warfarin
D. Rivaroxaban
, Answer: C – Warfarin is the only approved oral anticoagulant for
mechanical valves; DOACs are contraindicated.
10. A patient on prasugrel has a history of prior stroke. Why is this
concerning?
A. Increased bleeding risk
B. Prasugrel is contraindicated in prior TIA/stroke (higher
intracranial hemorrhage)
C. No interaction
D. Decreased efficacy
Answer: B – Prasugrel is contraindicated in patients with prior
stroke/TIA due to increased ICH risk.
11. A patient receiving IV unfractionated heparin has an aPTT of
110 seconds (control 30 seconds). What action is correct?
A. Increase heparin drip rate
B. Hold heparin for 1 hour and recheck
C. Give protamine sulfate
D. No change
Answer: B – Hold heparin for 30–60 minutes; aPTT >100 seconds
increases bleeding risk.
12. Which drug is a parenteral direct thrombin inhibitor used in
HIT?
A. Enoxaparin
B. Fondaparinux
C. Bivalirudin
D. Dalteparin
Answer: C – Bivalirudin (Angiomax) and argatroban are direct
thrombin inhibitors used in HIT.
Questions with Evidence‑Based Answers and Detailed Rationales
Covering High‑Yield Drug Classes, Medication Safety, Adverse Effects,
Drug Interactions, and Emergency Antidotes for NCLEX Success.
Section 1: Anticoagulants & Antiplatelets (1–
15)
1. A patient on warfarin has an INR of 4.5 without bleeding. What
is the most appropriate action?
A. Give vitamin K 10 mg IV
B. Hold warfarin and recheck INR in 1–2 days
C. Give fresh frozen plasma
D. Increase warfarin dose
Answer: B – For INR 4.5–9 without bleeding, hold warfarin and
monitor; low‑dose oral vitamin K (1–2.5 mg) if high bleeding risk.
2. Which drug is a direct thrombin inhibitor used for stroke
prevention in atrial fibrillation?
A. Apixaban
B. Rivaroxaban
C. Dabigatran
D. Edoxaban
Answer: C – Dabigatran (Pradaxa) is a direct thrombin inhibitor;
others are factor Xa inhibitors.
,3. A patient on clopidogrel is scheduled for surgery. How many
days before surgery should it be stopped?
A. 1 day
B. 3 days
C. 5–7 days
D. 14 days
Answer: C – Clopidogrel should be stopped 5–7 days
pre‑operatively to reduce bleeding risk.
4. A patient on apixaban develops a life‑threatening bleed. Which
reversal agent is indicated?
A. Protamine sulfate
B. Vitamin K
C. Andexanet alfa
D. Idarucizumab
Answer: C – Andexanet alfa (Andexxa) reverses apixaban and
rivaroxaban.
5. A patient with HIT (heparin‑induced thrombocytopenia) has a
platelet count of 40,000. Which drug should be used instead of
heparin?
A. Warfarin
B. Argatroban
C. Enoxaparin
D. Bivalirudin (or argatroban)
Answer: D – Direct thrombin inhibitors (argatroban, bivalirudin) are
first‑line; warfarin is avoided until platelets recover.
6. A patient taking ticagrelor for acute coronary syndrome
reports dyspnea. What is the likely cause?
A. Heart failure
,B. Ticagrelor side effect (dyspnea occurs in ~14%)
C. Pulmonary embolism
D. Asthma exacerbation
Answer: B – Ticagrelor causes dyspnea via adenosine accumulation;
often self‑limiting.
7. Which antiplatelet agent irreversibly inhibits the P2Y12
receptor?
A. Aspirin
B. Ticagrelor (reversible)
C. Clopidogrel (irreversible)
D. Cangrelor (reversible)
Answer: C – Clopidogrel and prasugrel irreversibly block P2Y12;
ticagrelor and cangrelor are reversible.
8. A patient on warfarin is started on
sulfamethoxazole‑trimethoprim. What INR change is expected?
A. INR decreases
B. INR increases (TMP‑SMX inhibits warfarin metabolism)
C. No change
D. Unpredictable
Answer: B – TMP‑SMX is a strong CYP2C9 inhibitor; reduce warfarin
dose and monitor INR closely.
9. Which anticoagulant is safe to use in patients with mechanical
heart valves?
A. Dabigatran
B. Apixaban
C. Warfarin
D. Rivaroxaban
, Answer: C – Warfarin is the only approved oral anticoagulant for
mechanical valves; DOACs are contraindicated.
10. A patient on prasugrel has a history of prior stroke. Why is this
concerning?
A. Increased bleeding risk
B. Prasugrel is contraindicated in prior TIA/stroke (higher
intracranial hemorrhage)
C. No interaction
D. Decreased efficacy
Answer: B – Prasugrel is contraindicated in patients with prior
stroke/TIA due to increased ICH risk.
11. A patient receiving IV unfractionated heparin has an aPTT of
110 seconds (control 30 seconds). What action is correct?
A. Increase heparin drip rate
B. Hold heparin for 1 hour and recheck
C. Give protamine sulfate
D. No change
Answer: B – Hold heparin for 30–60 minutes; aPTT >100 seconds
increases bleeding risk.
12. Which drug is a parenteral direct thrombin inhibitor used in
HIT?
A. Enoxaparin
B. Fondaparinux
C. Bivalirudin
D. Dalteparin
Answer: C – Bivalirudin (Angiomax) and argatroban are direct
thrombin inhibitors used in HIT.
