NCLEX-RN Pharmacology Practice
Questions |
Hematologic System |
20 Original ATI & NGN-Style NCLEX MCQs
with Detailed Rationales
Question 1
Clinical Scenario A 68-year-old male is admitted with a deep vein
thrombosis (DVT) in the left leg. The provider prescribes enoxaparin
1 mg/kg subcutaneously every 12 hours. The patient’s weight is 80
kg, creatinine clearance is 25 mL/min, and platelet count is
140,000/mm³.
Question Stem Which action should the nurse take prior to
administering the first dose of enoxaparin?
A. Administer the full prescribed dose of 80 mg. B. Hold the
medication and contact the provider due to renal impairment. C.
Request an order for protamine sulfate to be on standby. D. Apply
heat to the injection site to increase absorption.
Correct Answer B. Hold the medication and contact the provider
due to renal impairment.
,Detailed Rationale Enoxaparin is a low-molecular-weight heparin
(LMWH) that is primarily excreted by the kidneys. In patients with
severe renal impairment (creatinine clearance <30 mL/min), the
drug can accumulate, significantly increasing the risk of bleeding.
Therefore, the standard dosing regimen is often contraindicated or
requires adjustment (e.g., once-daily dosing or dose reduction). The
nurse must hold the medication and consult the provider for a safe
dosage modification. Option A is incorrect because administering
the full dose poses a high bleeding risk. Option C is incorrect
because while protamine sulfate can partially reverse LMWH, it is
not a routine precaution for administration; the priority is preventing
toxicity through dose adjustment. Option D is incorrect because
heat is not recommended for subcutaneous injections as it may
alter absorption rates unpredictably and increase irritation; rotation
of sites and avoiding massage are standard practices.
Learning Objective
Identify the impact of renal function on the pharmacokinetics of
low-molecular-weight heparins.
Prioritize nursing actions when encountering potential medication
contraindications related to organ dysfunction.
Recognize the need for dose adjustments in patients with renal
impairment.
Medication Safety Focus Contraindication / Renal Impairment
Question 2
, Clinical Scenario A 45-year-old female is receiving warfarin therapy
for atrial fibrillation. Her INR today is 5.8. She has no active
bleeding, no bruising, and her vital signs are stable.
Question Stem Which intervention should the nurse anticipate
implementing based on this laboratory value?
A. Administer vitamin K 10 mg IV push immediately. B. Hold the next
dose of warfarin and monitor INR closely. C. Prepare for an
immediate transfusion of fresh frozen plasma. D. Continue the
current dose and recheck INR in one week.
Correct Answer B. Hold the next dose of warfarin and monitor INR
closely.
Detailed Rationale The therapeutic range for INR in most
conditions (such as atrial fibrillation) is 2.0–3.0. An INR of 5.8 is
elevated but, in the absence of active bleeding, does not require
aggressive reversal with vitamin K or blood products. The standard
guideline for an INR between 4.5 and 10 without bleeding is to hold
one or more doses of warfarin and monitor the INR until it returns to
the therapeutic range. Option A is incorrect because IV vitamin K is
reserved for serious bleeding or extremely high INRs (>10) and
carries a risk of anaphylaxis if pushed rapidly; oral vitamin K might
be considered if the INR were higher, but holding the dose is the first
step for this level. Option C is incorrect because FFP is indicated for
life-threatening bleeding, which this patient does not have. Option D
is dangerous as continuing the dose would further elevate the INR
and increase bleeding risk.
Learning Objective
Questions |
Hematologic System |
20 Original ATI & NGN-Style NCLEX MCQs
with Detailed Rationales
Question 1
Clinical Scenario A 68-year-old male is admitted with a deep vein
thrombosis (DVT) in the left leg. The provider prescribes enoxaparin
1 mg/kg subcutaneously every 12 hours. The patient’s weight is 80
kg, creatinine clearance is 25 mL/min, and platelet count is
140,000/mm³.
Question Stem Which action should the nurse take prior to
administering the first dose of enoxaparin?
A. Administer the full prescribed dose of 80 mg. B. Hold the
medication and contact the provider due to renal impairment. C.
Request an order for protamine sulfate to be on standby. D. Apply
heat to the injection site to increase absorption.
Correct Answer B. Hold the medication and contact the provider
due to renal impairment.
,Detailed Rationale Enoxaparin is a low-molecular-weight heparin
(LMWH) that is primarily excreted by the kidneys. In patients with
severe renal impairment (creatinine clearance <30 mL/min), the
drug can accumulate, significantly increasing the risk of bleeding.
Therefore, the standard dosing regimen is often contraindicated or
requires adjustment (e.g., once-daily dosing or dose reduction). The
nurse must hold the medication and consult the provider for a safe
dosage modification. Option A is incorrect because administering
the full dose poses a high bleeding risk. Option C is incorrect
because while protamine sulfate can partially reverse LMWH, it is
not a routine precaution for administration; the priority is preventing
toxicity through dose adjustment. Option D is incorrect because
heat is not recommended for subcutaneous injections as it may
alter absorption rates unpredictably and increase irritation; rotation
of sites and avoiding massage are standard practices.
Learning Objective
Identify the impact of renal function on the pharmacokinetics of
low-molecular-weight heparins.
Prioritize nursing actions when encountering potential medication
contraindications related to organ dysfunction.
Recognize the need for dose adjustments in patients with renal
impairment.
Medication Safety Focus Contraindication / Renal Impairment
Question 2
, Clinical Scenario A 45-year-old female is receiving warfarin therapy
for atrial fibrillation. Her INR today is 5.8. She has no active
bleeding, no bruising, and her vital signs are stable.
Question Stem Which intervention should the nurse anticipate
implementing based on this laboratory value?
A. Administer vitamin K 10 mg IV push immediately. B. Hold the next
dose of warfarin and monitor INR closely. C. Prepare for an
immediate transfusion of fresh frozen plasma. D. Continue the
current dose and recheck INR in one week.
Correct Answer B. Hold the next dose of warfarin and monitor INR
closely.
Detailed Rationale The therapeutic range for INR in most
conditions (such as atrial fibrillation) is 2.0–3.0. An INR of 5.8 is
elevated but, in the absence of active bleeding, does not require
aggressive reversal with vitamin K or blood products. The standard
guideline for an INR between 4.5 and 10 without bleeding is to hold
one or more doses of warfarin and monitor the INR until it returns to
the therapeutic range. Option A is incorrect because IV vitamin K is
reserved for serious bleeding or extremely high INRs (>10) and
carries a risk of anaphylaxis if pushed rapidly; oral vitamin K might
be considered if the INR were higher, but holding the dose is the first
step for this level. Option C is incorrect because FFP is indicated for
life-threatening bleeding, which this patient does not have. Option D
is dangerous as continuing the dose would further elevate the INR
and increase bleeding risk.
Learning Objective
