NUR 6011 ADV PHARMA EXAM MODULE
7 | QUESTIONS AND ANSWERS | 2026
UPDATE | 100% CORRECT - WPU.
SECTION 1: ANTICOAGULANTS (Questions 1-12)
Question 1
A patient is prescribed warfarin (Coumadin). Which statement indicates
understanding of the medication?
A. “I will take ibuprofen for headaches.”
B. “I will eat the same amount of green leafy vegetables each week.”
C. “I will stop taking warfarin if I see blood in my urine.”
D. “I will have my blood drawn every 6 months.”
Correct Answer: B. “I will eat the same amount of green leafy vegetables
each week.”
Rationale: Consistency in vitamin K intake (found in green leafy vegetables)
is essential for warfarin management to maintain a stable INR. Ibuprofen and
other NSAIDs increase bleeding risk and should be avoided. Patients should
notify the provider of signs of bleeding, not stop warfarin without instruction.
INR monitoring is initially frequent (daily to weekly) and may be monthly
once stable.
Subtopic: Warfarin – Patient Education
Question 2
A patient is receiving a continuous heparin infusion. The aPTT is 120 seconds
(therapeutic range 60-80 seconds). What is the priority nursing action?
,A. Increase the infusion rate
B. Decrease the infusion rate
C. Hold the infusion and notify the provider
D. Continue the infusion as ordered
Correct Answer: C. Hold the infusion and notify the provider
Rationale: An aPTT of 120 seconds is significantly supratherapeutic, placing
the patient at high risk for bleeding. The nurse should hold the heparin
infusion and notify the provider immediately. Continuing or increasing the
infusion would increase bleeding risk.
Subtopic: Heparin – aPTT Monitoring
Question 3
What is the antidote for heparin overdose?
A. Vitamin K
B. Protamine sulfate
C. Naloxone
D. Atropine
Correct Answer: B. Protamine sulfate
Rationale: Protamine sulfate is a specific antidote that neutralizes the
anticoagulant effect of heparin. It is a positively charged protein that binds to
negatively charged heparin, forming a stable complex with no anticoagulant
activity. Vitamin K is the antidote for warfarin.
Subtopic: Heparin – Antidote
Question 4
A patient is prescribed warfarin (Coumadin) and has an INR of 4.5 without
bleeding. What is the appropriate action?
A. Administer vitamin K 10 mg IM
B. Administer protamine sulfate
C. Hold the next dose and notify the provider
D. Increase the warfarin dose
, Correct Answer: C. Hold the next dose and notify the provider
Rationale: An INR of 4.5 is supratherapeutic (therapeutic range 2-3 for most
indications). Without bleeding, the guideline is to hold the next dose and
notify the provider. For INR >5 without bleeding, a small dose of oral vitamin
K may be given. Protamine sulfate is for heparin overdose.
Subtopic: Warfarin – INR Management
Question 5
A patient is prescribed enoxaparin (Lovenox) for DVT prophylaxis after
surgery. Which statement is correct about this medication?
A. It requires aPTT monitoring.
B. It is given subcutaneously once or twice daily.
C. It is reversed with vitamin K.
D. It is given intravenously.
Correct Answer: B. It is given subcutaneously once or twice daily.
Rationale: Enoxaparin is a low-molecular-weight heparin (LMWH). It is given
subcutaneously, does not require aPTT monitoring (unlike unfractionated
heparin), and has predictable pharmacokinetics. It is reversed with
protamine sulfate (partial reversal).
Subtopic: LMWH – Enoxaparin
Question 6
A patient with atrial fibrillation is prescribed rivaroxaban (Xarelto), a direct
oral anticoagulant (DOAC). Which statement about DOACs is correct?
A. Routine INR monitoring is required.
B. The antidote (andexanet alfa) is available for life-threatening bleeding.
C. They have more drug interactions than warfarin.
D. They are given by subcutaneous injection.
Correct Answer: B. The antidote (andexanet alfa) is available for life-
threatening bleeding.
7 | QUESTIONS AND ANSWERS | 2026
UPDATE | 100% CORRECT - WPU.
SECTION 1: ANTICOAGULANTS (Questions 1-12)
Question 1
A patient is prescribed warfarin (Coumadin). Which statement indicates
understanding of the medication?
A. “I will take ibuprofen for headaches.”
B. “I will eat the same amount of green leafy vegetables each week.”
C. “I will stop taking warfarin if I see blood in my urine.”
D. “I will have my blood drawn every 6 months.”
Correct Answer: B. “I will eat the same amount of green leafy vegetables
each week.”
Rationale: Consistency in vitamin K intake (found in green leafy vegetables)
is essential for warfarin management to maintain a stable INR. Ibuprofen and
other NSAIDs increase bleeding risk and should be avoided. Patients should
notify the provider of signs of bleeding, not stop warfarin without instruction.
INR monitoring is initially frequent (daily to weekly) and may be monthly
once stable.
Subtopic: Warfarin – Patient Education
Question 2
A patient is receiving a continuous heparin infusion. The aPTT is 120 seconds
(therapeutic range 60-80 seconds). What is the priority nursing action?
,A. Increase the infusion rate
B. Decrease the infusion rate
C. Hold the infusion and notify the provider
D. Continue the infusion as ordered
Correct Answer: C. Hold the infusion and notify the provider
Rationale: An aPTT of 120 seconds is significantly supratherapeutic, placing
the patient at high risk for bleeding. The nurse should hold the heparin
infusion and notify the provider immediately. Continuing or increasing the
infusion would increase bleeding risk.
Subtopic: Heparin – aPTT Monitoring
Question 3
What is the antidote for heparin overdose?
A. Vitamin K
B. Protamine sulfate
C. Naloxone
D. Atropine
Correct Answer: B. Protamine sulfate
Rationale: Protamine sulfate is a specific antidote that neutralizes the
anticoagulant effect of heparin. It is a positively charged protein that binds to
negatively charged heparin, forming a stable complex with no anticoagulant
activity. Vitamin K is the antidote for warfarin.
Subtopic: Heparin – Antidote
Question 4
A patient is prescribed warfarin (Coumadin) and has an INR of 4.5 without
bleeding. What is the appropriate action?
A. Administer vitamin K 10 mg IM
B. Administer protamine sulfate
C. Hold the next dose and notify the provider
D. Increase the warfarin dose
, Correct Answer: C. Hold the next dose and notify the provider
Rationale: An INR of 4.5 is supratherapeutic (therapeutic range 2-3 for most
indications). Without bleeding, the guideline is to hold the next dose and
notify the provider. For INR >5 without bleeding, a small dose of oral vitamin
K may be given. Protamine sulfate is for heparin overdose.
Subtopic: Warfarin – INR Management
Question 5
A patient is prescribed enoxaparin (Lovenox) for DVT prophylaxis after
surgery. Which statement is correct about this medication?
A. It requires aPTT monitoring.
B. It is given subcutaneously once or twice daily.
C. It is reversed with vitamin K.
D. It is given intravenously.
Correct Answer: B. It is given subcutaneously once or twice daily.
Rationale: Enoxaparin is a low-molecular-weight heparin (LMWH). It is given
subcutaneously, does not require aPTT monitoring (unlike unfractionated
heparin), and has predictable pharmacokinetics. It is reversed with
protamine sulfate (partial reversal).
Subtopic: LMWH – Enoxaparin
Question 6
A patient with atrial fibrillation is prescribed rivaroxaban (Xarelto), a direct
oral anticoagulant (DOAC). Which statement about DOACs is correct?
A. Routine INR monitoring is required.
B. The antidote (andexanet alfa) is available for life-threatening bleeding.
C. They have more drug interactions than warfarin.
D. They are given by subcutaneous injection.
Correct Answer: B. The antidote (andexanet alfa) is available for life-
threatening bleeding.
