Saudi Prometric Nursing Pharmacology — Questions and Answers
Question 1: What is the antidote for heparin overdose?
- Vitamin K
- Protamine sulfate (Correct answer)
- Naloxone
- Flumazenil
Correct answer: Protamine sulfate
Protamine sulfate is the specific antidote for heparin overdose. It binds to heparin and neutralizes its anticoagulant effect. The dose is 1 mg protamine for every 100 units of heparin, administered slowly IV. Vitamin K is the antidote for warfarin, not heparin.
Question 2: What is the therapeutic INR range for a patient on warfarin therapy for atrial fibrillation?
- 0.5-1.0
- 1.0-1.5
- 2.0-3.0 (Correct answer)
- 4.0-5.0
Correct answer: 2.0-3.0
The therapeutic INR range for warfarin in atrial fibrillation is 2.0-3.0. Below 2.0 increases thromboembolic risk; above 3.0 increases bleeding risk. Higher ranges (2.5-3.5) are used for mechanical heart valves. Regular INR monitoring is essential.
Question 3: Which vital sign must be assessed before administering digoxin?
- Blood pressure
- Apical heart rate for one full minute (Correct answer)
- Respiratory rate
- Temperature
Correct answer: Apical heart rate for one full minute
Apical heart rate must be counted for a full 60 seconds before digoxin administration. Hold the medication and notify the physician if the heart rate is below 60 bpm (adults) or below age-appropriate rates (pediatrics), as digoxin slows the heart rate.
Question 4: What is the mechanism of action of ACE inhibitors like enalapril?
- Increase heart rate
- Block the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone secretion (Correct answer)
- Increase blood volume
- Stimulate the sympathetic nervous system
Correct answer: Block the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone secretion
ACE inhibitors block the angiotensin-converting enzyme, preventing formation of angiotensin II (a potent vasoconstrictor) and reducing aldosterone secretion (decreasing sodium and water retention). This lowers blood pressure and reduces cardiac workload.
Question 5: What patient education should a nurse provide about metformin for type 2 diabetes?
- Take on an empty stomach
- Take with meals to reduce GI side effects, avoid excessive alcohol, report symptoms of lactic acidosis, and hold before contrast dye procedures (Correct answer)
- It causes weight gain
- No dietary changes are needed
Correct answer: Take with meals to reduce GI side effects, avoid excessive alcohol, report symptoms of lactic acidosis, and hold before contrast dye procedures
Metformin education: take with food (reduces GI effects), avoid excessive alcohol (increases lactic acidosis risk), report muscle pain/weakness/breathing difficulty (lactic acidosis signs), hold 48 hours before/after contrast dye, and monitor renal function regularly.
Question 6: What is the nurse's primary concern when administering IV potassium chloride?
- It must be given rapidly to be effective
- It must NEVER be given as an IV push — always diluted and infused slowly, with cardiac monitoring (Correct answer)
- It can be mixed with any IV fluid
- It should be given intramuscularly
Correct answer: It must NEVER be given as an IV push — always diluted and infused slowly, with cardiac monitoring
IV potassium must NEVER be given as a bolus/push — it can cause fatal cardiac arrest. It must be diluted (typically 10-20 mEq/100 mL) and infused slowly (no faster than 10-20 mEq/hour). Cardiac monitoring is required for rates above 10 mEq/hour.
Saudi Prometric Nursing Pharmacology
What is the antidote for heparin overdose?