Emergency, cardiovascular and anticoagulant drugs

26 AIIMS NORCET (Nursing Officer) practice questions on Emergency, cardiovascular and anticoagulant drugs, part of Pharmacology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Easy

   Adenosine for supraventricular tachycardia is given as:

   1. AA deep intramuscular injection
   2. BA slow IV injection over 5 minutes
   3. CAn IV infusion over 30 minutes
   4. DA rapid IV push followed by a saline flush

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   Answer: D · A rapid IV push followed by a saline flush

   Adenosine has a half-life of under 10 seconds, so it must reach the heart as a bolus. It is pushed rapidly into a large proximal vein and flushed at once with 20 mL of saline. It causes a brief AV block that ends re-entrant SVT. A short pause, flushing and chest discomfort are expected.

   • A: It is not given IM; it would be broken down long before reaching the heart.
   • B: A slow injection lets the drug be broken down before it reaches the heart.
   • C: An infusion cannot build the brief high level needed.

2. Question 2 · Hard

   A patient received an IV bolus of 5,000 units of unfractionated heparin 10 minutes ago and is now bleeding heavily. Using 1 mg protamine per 100 units of heparin, the dose of protamine is:

   1. A100 mg
   2. B500 mg
   3. C50 mg
   4. D5 mg

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   Answer: C · 50 mg

   Protamine 1 mg neutralises about 100 units of heparin. 5,000 units / 100 = 50 mg, which is also the maximum single dose. Because the bolus was given only 10 minutes ago, almost all of it is still active, so the full dose is used. It is given slowly IV over about 10 minutes to avoid hypotension and anaphylactoid reactions.

   • A: 100 mg doubles the required dose and exceeds the 50 mg maximum.
   • B: 500 mg is a tenfold overdose; excess protamine itself acts as an anticoagulant.
   • D: 5 mg is a tenfold error (dividing by 1,000).

3. Question 3 · Hard

   A patient on warfarin is vomiting blood. INR is 8.5, BP 90/60 mmHg and pulse 118/min. Along with stopping warfarin, the nurse should prepare to give:

   1. AOral vitamin K and recheck the INR in 24 hours
   2. BProtamine sulphate by slow IV injection
   3. CTranexamic acid alone and continue warfarin
   4. DIV vitamin K with prothrombin complex concentrate or FFP

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   Answer: D · IV vitamin K with prothrombin complex concentrate or FFP

   This is major bleeding with shock on warfarin, so immediate reversal is needed. IV vitamin K (5-10 mg) restores factor production over hours, while prothrombin complex concentrate, or FFP if PCC is unavailable, replaces factors at once. Oral vitamin K alone is for a high INR without bleeding. The nurse also gives fluids, sends a cross-match and monitors vital signs closely.

   • A: Oral vitamin K acts too slowly for active bleeding with shock.
   • B: Protamine reverses heparin, not warfarin.
   • C: Tranexamic acid does not replace the missing factors, and warfarin must be stopped.

4. Question 4 · Medium

   Before giving digoxin 0.25 mg to an adult, the nurse counts an apical pulse of 54/min. The nurse should:

   1. AWithhold the dose and inform the doctor
   2. BGive the dose and recheck in one hour
   3. CGive the dose with IV atropine
   4. DGive half the dose and record it

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   Answer: A · Withhold the dose and inform the doctor

   The apical pulse is counted for a full minute before each digoxin dose. In an adult, a rate below 60/min (or a new irregular rhythm) means the dose is withheld and the doctor informed, because digoxin slows AV conduction. Bradycardia may be an early sign of toxicity. The nurse also checks for nausea, vision changes and the potassium level.

   • B: Giving the dose can slow the heart further.
   • C: Atropine is not given routinely to allow a digoxin dose.
   • D: The nurse cannot change the prescribed dose.

5. Question 5 · Hard

   A 78-year-old with CKD on digoxin has nausea, ventricular bigeminy, K+ 5.9 mEq/L and digoxin 3.2 ng/mL (therapeutic 0.5-2.0). After stopping digoxin, the most appropriate treatment is:

   1. AIV furosemide for hyperkalaemia
   2. BA further digoxin dose for rate control
   3. CIV potassium chloride infusion
   4. DDigoxin-specific antibody fragments

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   Answer: D · Digoxin-specific antibody fragments

   A high digoxin level with ventricular arrhythmia and hyperkalaemia is life-threatening digoxin toxicity. Severe toxicity blocks Na+/K+ ATPase and raises potassium. Digoxin Fab fragments bind the drug, reverse the arrhythmia and correct the potassium. CKD reduces digoxin clearance, which explains the build-up.

   • A: A diuretic lowers potassium slowly and does not reverse digoxin toxicity.
   • B: More digoxin worsens the toxicity.
   • C: Potassium is already high, and more would worsen the arrhythmia.

6. Question 6 · Medium

   A man with chest pain is about to receive sublingual nitroglycerin. Which history should make the nurse withhold it and inform the doctor?

   1. AAtorvastatin taken at bedtime
   2. BAspirin taken this morning
   3. CMetformin for type 2 diabetes
   4. DSildenafil taken 6 hours ago

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7. Question 7 · Medium

   A patient on warfarin for atrial fibrillation has an INR of 2.4 and no bleeding. The nurse should:

   1. AWithhold the dose and request an order for vitamin K
   2. BGive the scheduled dose, as the INR is in range
   3. CAsk for protamine sulphate to be given
   4. DHold the dose until the INR is below 1.5

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8. Question 8 · Easy

   The first-line treatment for an adult with anaphylaxis is adrenaline 1 mg/mL (1:1000) given as:

   1. A1 mg undiluted by IV push
   2. B1 mg by nebuliser
   3. C0.5 mg subcutaneously in the arm
   4. D0.5 mg intramuscularly into the thigh

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9. Question 9 · Medium

   Streptokinase should not be given again to a patient who received it 8 months earlier because:

   1. AIts fibrinolytic effect lasts for a year
   2. BIt permanently depletes the body's fibrinogen
   3. CAntibodies from the first dose neutralise it
   4. DIt causes cumulative liver damage with each course

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10. Question 10 · Easy

    The antidote used to reverse the effect of warfarin is:

    1. AProtamine sulphate
    2. BTranexamic acid
    3. CDesmopressin
    4. DVitamin K (phytonadione)

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11. Question 11 · Easy

    Which drug is first-line for an adult with symptomatic sinus bradycardia?

    1. AAmiodarone
    2. BAtropine
    3. CDigoxin
    4. DAdenosine

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12. Question 12 · Easy

    The specific antidote for an overdose of unfractionated heparin is:

    1. AVitamin K (phytonadione)
    2. BFresh frozen plasma
    3. CTranexamic acid
    4. DProtamine sulphate

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13. Question 13 · Medium

    Clopidogrel prevents platelet aggregation by:

    1. AIrreversibly inhibiting cyclo-oxygenase
    2. BBlocking glycoprotein IIb/IIIa receptors
    3. CBlocking the P2Y12 ADP receptor
    4. DInhibiting vitamin K epoxide reductase

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14. Question 14 · Medium

    A patient on digoxin and furosemide reports nausea and seeing yellow halos around lights. Which result most increases the risk of this problem?

    1. ASerum calcium 9.4 mg/dL
    2. BSerum potassium 2.9 mEq/L
    3. CBlood glucose 110 mg/dL
    4. DSerum sodium 138 mEq/L

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15. Question 15 · Hard

    On day 7 of IV heparin after surgery, a patient's platelet count falls from 2.6 lakh/µL to 90,000/µL and a new leg vein thrombosis is found. The nurse anticipates:

    1. ATransfusing platelets and continuing the heparin infusion as ordered
    2. BStopping all heparin and starting a non-heparin anticoagulant
    3. CChanging to enoxaparin at a treatment dose
    4. DGiving protamine and restarting heparin at a lower dose

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16. Question 16 · Easy

    Which laboratory test is used to monitor oral warfarin therapy?

    1. AProthrombin time with INR
    2. BBleeding time
    3. CActivated partial thromboplastin time
    4. DPlatelet count

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17. Question 17 · Hard

    A patient has a regular narrow-complex tachycardia at 190/min with BP 118/76 mmHg. Vagal manoeuvres fail and adenosine 6 mg rapid IV gives no conversion. The next step by AHA guidance is:

    1. AUnsynchronised shock at 200 J
    2. BAdenosine 12 mg by rapid IV push
    3. CAtropine 1 mg IV
    4. DAdenosine 6 mg again by slow IV push

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18. Question 18 · Medium

    Which dietary advice is most appropriate for a patient discharged on warfarin?

    1. AEat extra spinach to prevent bleeding
    2. BAvoid all green leafy vegetables completely
    3. CKeep green leafy vegetable intake steady each day
    4. DTake a daily vitamin K tablet with each dose

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19. Question 19 · Medium

    A patient started on enalapril reports a persistent dry, tickly cough. This adverse effect is caused by accumulation of:

    1. ABradykinin
    2. BAldosterone
    3. CHistamine
    4. DAngiotensin II

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20. Question 20 · Medium

    A continuous IV unfractionated heparin infusion is usually adjusted to keep the aPTT at about:

    1. A4 to 5 times the control value
    2. BThe same as the control value
    3. C1.5 to 2.5 times the control value
    4. DBelow the control value

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21. Question 21 · Medium

    Which antihypertensive is contraindicated during pregnancy?

    1. AEnalapril
    2. BMethyldopa
    3. CLabetalol
    4. DNifedipine

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22. Question 22 · Medium

    For a patient with bronchial asthma, which antihypertensive order should the nurse question?

    1. APropranolol 40 mg twice daily
    2. BHydrochlorothiazide 12.5 mg daily
    3. CLosartan 50 mg once daily
    4. DAmlodipine 5 mg once daily

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23. Question 23 · Medium

    A patient on long-term oral amiodarone needs periodic monitoring of:

    1. ASerum uric acid and creatinine clearance rate
    2. BThyroid and liver function and chest X-ray
    3. CSerum amylase and lipase
    4. DUrine sugar and ketones

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24. Question 24 · Hard

    A patient stable on warfarin (INR 2.5) is started on metronidazole for amoebic colitis. Five days later he has gum bleeding. The INR is most likely:

    1. AUnchanged, because the bleeding is from the colitis
    2. BRaised, because metronidazole slows warfarin breakdown
    3. CLowered, because metronidazole binds warfarin in the gut
    4. DLowered, because metronidazole speeds warfarin breakdown

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25. Question 25 · Hard

    A 20 kg child develops anaphylaxis. The dose of adrenaline is 0.01 mg/kg IM, using the 1 mg/mL (1:1000) solution. What volume should be drawn up?

    1. A0.02 mL
    2. B2 mL
    3. C0.5 mL
    4. D0.2 mL

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