NCLEX-RN Hematologic System Pharmacology
Practice Questions |
20 Original NGN-Style MCQs with Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 72-year-old male patient with a history of atrial fibrillation
and hypertension is admitted to the medical-surgical unit after a
fall at home. He reports taking warfarin (Coumadin) 5 mg daily.
His admission laboratory results show an international
normalized ratio (INR) of 6.8 (reference range: 0.8–1.2 for
patients not on anticoagulation, 2.0–3.0 for atrial fibrillation).
He has a 3 cm bruise on his right hip and reports mild
discomfort but denies bleeding from gums or in urine/stool. His
vital signs are: blood pressure 148/88 mmHg, heart rate 92
bpm, respiratory rate 18/min, temperature 37.0°C. The nurse
reviews the medication administration record and notes the
warfarin is scheduled for administration at 0900.
Question Stem
,Which action should the nurse take first?
Options
A. Hold the warfarin and notify the healthcare provider of the
INR result.
B. Administer the warfarin as scheduled since the patient has
no active bleeding.
C. Administer vitamin K (phytonadione) 2.5 mg orally per
protocol.
D. Obtain a prescription for fresh frozen plasma to reverse the
anticoagulation.
Correct Answer: A. Hold the warfarin and notify the healthcare
provider of the INR result.
Detailed Rationale
The correct first action is to hold the warfarin and notify the
healthcare provider of the critically elevated INR of 6.8.
Warfarin has a narrow therapeutic index, and an INR >5.0
significantly increases bleeding risk even without active
hemorrhage . The patient's age (72 years) and recent fall further
elevate concern for occult bleeding. The nurse must use clinical
judgment to withhold the medication and report the value to
the provider for further management instructions. This
,demonstrates the priority nursing action of medication safety
and preventing adverse drug events.
Option B is incorrect because administering warfarin with an
INR of 6.8 would place the patient at imminent risk of severe
bleeding complications. Option C is premature; while vitamin K
is the antidote for warfarin, administering it without provider
order and without assessing the full clinical picture could
overcorrect the INR, putting the patient at risk for thrombotic
events. The decision to administer vitamin K depends on the
INR level and presence of bleeding. Option D is incorrect
because fresh frozen plasma is reserved for active bleeding with
warfarin overdose, not for an elevated INR without
hemorrhage . The INR measures the extrinsic pathway and is
the standard monitoring parameter for warfarin therapy.
Learning Objective
After completing this question, the learner should be able to:
• Identify the critical INR threshold requiring warfarin hold
and provider notification.
• Prioritize nursing actions for patients on anticoagulation
therapy with supratherapeutic laboratory values.
• Understand the therapeutic range for warfarin in patients
with atrial fibrillation.
, • Recognize the clinical importance of INR monitoring for
medication safety in older adults.
Medication Safety Focus: High-alert medication, Laboratory
monitoring, Medication administration, Medication
reconciliation.
Question 2
Clinical Scenario
A 58-year-old female patient is admitted with new-onset deep
vein thrombosis (DVT) in her left lower extremity. The
healthcare provider orders a heparin infusion. The patient's
baseline aPTT is 28 seconds (reference range: 25–35 seconds),
platelet count is 250,000/mm³, and hemoglobin is 12.5 g/dL.
The patient has a history of hypertension, type 2 diabetes, and
osteoporosis. She reports no known drug allergies. The nurse
starts the heparin infusion per protocol with a bolus dose of 80
units/kg and an initial infusion rate of 18 units/kg/hour. Six
hours later, the patient's aPTT is 45 seconds, and the provider's
order specifies a target aPTT of 60–80 seconds.
Question Stem
Which action should the nurse anticipate?
Options
Practice Questions |
20 Original NGN-Style MCQs with Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 72-year-old male patient with a history of atrial fibrillation
and hypertension is admitted to the medical-surgical unit after a
fall at home. He reports taking warfarin (Coumadin) 5 mg daily.
His admission laboratory results show an international
normalized ratio (INR) of 6.8 (reference range: 0.8–1.2 for
patients not on anticoagulation, 2.0–3.0 for atrial fibrillation).
He has a 3 cm bruise on his right hip and reports mild
discomfort but denies bleeding from gums or in urine/stool. His
vital signs are: blood pressure 148/88 mmHg, heart rate 92
bpm, respiratory rate 18/min, temperature 37.0°C. The nurse
reviews the medication administration record and notes the
warfarin is scheduled for administration at 0900.
Question Stem
,Which action should the nurse take first?
Options
A. Hold the warfarin and notify the healthcare provider of the
INR result.
B. Administer the warfarin as scheduled since the patient has
no active bleeding.
C. Administer vitamin K (phytonadione) 2.5 mg orally per
protocol.
D. Obtain a prescription for fresh frozen plasma to reverse the
anticoagulation.
Correct Answer: A. Hold the warfarin and notify the healthcare
provider of the INR result.
Detailed Rationale
The correct first action is to hold the warfarin and notify the
healthcare provider of the critically elevated INR of 6.8.
Warfarin has a narrow therapeutic index, and an INR >5.0
significantly increases bleeding risk even without active
hemorrhage . The patient's age (72 years) and recent fall further
elevate concern for occult bleeding. The nurse must use clinical
judgment to withhold the medication and report the value to
the provider for further management instructions. This
,demonstrates the priority nursing action of medication safety
and preventing adverse drug events.
Option B is incorrect because administering warfarin with an
INR of 6.8 would place the patient at imminent risk of severe
bleeding complications. Option C is premature; while vitamin K
is the antidote for warfarin, administering it without provider
order and without assessing the full clinical picture could
overcorrect the INR, putting the patient at risk for thrombotic
events. The decision to administer vitamin K depends on the
INR level and presence of bleeding. Option D is incorrect
because fresh frozen plasma is reserved for active bleeding with
warfarin overdose, not for an elevated INR without
hemorrhage . The INR measures the extrinsic pathway and is
the standard monitoring parameter for warfarin therapy.
Learning Objective
After completing this question, the learner should be able to:
• Identify the critical INR threshold requiring warfarin hold
and provider notification.
• Prioritize nursing actions for patients on anticoagulation
therapy with supratherapeutic laboratory values.
• Understand the therapeutic range for warfarin in patients
with atrial fibrillation.
, • Recognize the clinical importance of INR monitoring for
medication safety in older adults.
Medication Safety Focus: High-alert medication, Laboratory
monitoring, Medication administration, Medication
reconciliation.
Question 2
Clinical Scenario
A 58-year-old female patient is admitted with new-onset deep
vein thrombosis (DVT) in her left lower extremity. The
healthcare provider orders a heparin infusion. The patient's
baseline aPTT is 28 seconds (reference range: 25–35 seconds),
platelet count is 250,000/mm³, and hemoglobin is 12.5 g/dL.
The patient has a history of hypertension, type 2 diabetes, and
osteoporosis. She reports no known drug allergies. The nurse
starts the heparin infusion per protocol with a bolus dose of 80
units/kg and an initial infusion rate of 18 units/kg/hour. Six
hours later, the patient's aPTT is 45 seconds, and the provider's
order specifies a target aPTT of 60–80 seconds.
Question Stem
Which action should the nurse anticipate?
Options
