Hematologic System Pharmacology NCLEX-RN
Practice Questions |
15 Original ATI & NGN-Style MCQs with Rationales
| Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old man is admitted with a newly diagnosed deep
vein thrombosis (DVT) of the left leg. His medical history
includes hypertension and chronic kidney disease stage 3. The
provider prescribes an intravenous infusion of unfractionated
heparin. Baseline laboratory results include: platelet count
245,000/mm³, hemoglobin 14.2 g/dL, serum creatinine 1.8
mg/dL, PT 12 seconds, INR 1.0, and aPTT 31 seconds.
Six hours after initiating therapy, the nurse receives the
laboratory results showing an aPTT of 92 seconds.
Question Stem
Which action should the nurse take first?
A. Continue the infusion at the current rate and repeat the aPTT
in 24 hours.
,B. Stop the heparin infusion and notify the provider according
to protocol.
C. Administer vitamin K immediately.
D. Encourage the patient to ambulate to improve venous
circulation.
Correct Answer
Correct Answer: B. Stop the heparin infusion and notify the
provider according to protocol.
Detailed Rationale
Unfractionated heparin is a high-alert anticoagulant that
requires careful monitoring using the activated partial
thromboplastin time (aPTT). Most therapeutic protocols target
an aPTT approximately 1.5–2.5 times the normal value. An aPTT
of 92 seconds is significantly elevated, increasing the patient's
risk for serious bleeding. The priority nursing action is to stop or
hold the infusion based on institutional protocol and promptly
notify the provider for dosage adjustment. Continuous
assessment for bleeding—including bruising, hematuria,
melena, epistaxis, and neurologic changes—is also essential.
Protamine sulfate should be readily available if significant
bleeding develops.
Option A is incorrect because maintaining an excessively
prolonged aPTT exposes the patient to unnecessary bleeding
,risk. Option C is incorrect because vitamin K reverses warfarin,
not heparin. Protamine sulfate is the reversal agent for
unfractionated heparin. Option D is inappropriate because
ambulation does not address the immediate safety concern and
may increase injury risk if occult bleeding occurs.
The nurse should also verify infusion pump settings, review
recent laboratory trends, assess renal function, and document
all interventions. Prompt recognition and response to
supratherapeutic anticoagulation prevent life-threatening
hemorrhage.
Learning Objectives
After completing this question, the learner should be able to:
• Interpret aPTT values during unfractionated heparin
therapy.
• Prioritize nursing interventions for supratherapeutic
anticoagulation.
• Identify the reversal agent for unfractionated heparin.
• Recognize bleeding risks associated with high-alert
anticoagulants.
Medication Safety Focus
High-alert medication—monitoring and prevention of bleeding
complications.
, Question 2
Clinical Scenario
A 74-year-old woman with chronic atrial fibrillation has been
taking warfarin for several years. During a follow-up visit, she
tells the nurse, "I've started drinking large green smoothies
every morning because they're healthy."
Her vital signs are stable. Laboratory results today reveal an INR
of 1.4, decreased from 2.6 one month ago.
Question Stem
Which nursing response is most appropriate?
A. "Continue your diet because leafy greens do not affect
warfarin."
B. "Stop eating vegetables completely while taking warfarin."
C. "Maintain a consistent intake of vitamin K–containing foods
and notify your provider about the dietary change."
D. "Double today's warfarin dose to increase your INR."
Correct Answer
Correct Answer: C. Maintain a consistent intake of vitamin K–
containing foods and notify your provider about the dietary
change.
Practice Questions |
15 Original ATI & NGN-Style MCQs with Rationales
| Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old man is admitted with a newly diagnosed deep
vein thrombosis (DVT) of the left leg. His medical history
includes hypertension and chronic kidney disease stage 3. The
provider prescribes an intravenous infusion of unfractionated
heparin. Baseline laboratory results include: platelet count
245,000/mm³, hemoglobin 14.2 g/dL, serum creatinine 1.8
mg/dL, PT 12 seconds, INR 1.0, and aPTT 31 seconds.
Six hours after initiating therapy, the nurse receives the
laboratory results showing an aPTT of 92 seconds.
Question Stem
Which action should the nurse take first?
A. Continue the infusion at the current rate and repeat the aPTT
in 24 hours.
,B. Stop the heparin infusion and notify the provider according
to protocol.
C. Administer vitamin K immediately.
D. Encourage the patient to ambulate to improve venous
circulation.
Correct Answer
Correct Answer: B. Stop the heparin infusion and notify the
provider according to protocol.
Detailed Rationale
Unfractionated heparin is a high-alert anticoagulant that
requires careful monitoring using the activated partial
thromboplastin time (aPTT). Most therapeutic protocols target
an aPTT approximately 1.5–2.5 times the normal value. An aPTT
of 92 seconds is significantly elevated, increasing the patient's
risk for serious bleeding. The priority nursing action is to stop or
hold the infusion based on institutional protocol and promptly
notify the provider for dosage adjustment. Continuous
assessment for bleeding—including bruising, hematuria,
melena, epistaxis, and neurologic changes—is also essential.
Protamine sulfate should be readily available if significant
bleeding develops.
Option A is incorrect because maintaining an excessively
prolonged aPTT exposes the patient to unnecessary bleeding
,risk. Option C is incorrect because vitamin K reverses warfarin,
not heparin. Protamine sulfate is the reversal agent for
unfractionated heparin. Option D is inappropriate because
ambulation does not address the immediate safety concern and
may increase injury risk if occult bleeding occurs.
The nurse should also verify infusion pump settings, review
recent laboratory trends, assess renal function, and document
all interventions. Prompt recognition and response to
supratherapeutic anticoagulation prevent life-threatening
hemorrhage.
Learning Objectives
After completing this question, the learner should be able to:
• Interpret aPTT values during unfractionated heparin
therapy.
• Prioritize nursing interventions for supratherapeutic
anticoagulation.
• Identify the reversal agent for unfractionated heparin.
• Recognize bleeding risks associated with high-alert
anticoagulants.
Medication Safety Focus
High-alert medication—monitoring and prevention of bleeding
complications.
, Question 2
Clinical Scenario
A 74-year-old woman with chronic atrial fibrillation has been
taking warfarin for several years. During a follow-up visit, she
tells the nurse, "I've started drinking large green smoothies
every morning because they're healthy."
Her vital signs are stable. Laboratory results today reveal an INR
of 1.4, decreased from 2.6 one month ago.
Question Stem
Which nursing response is most appropriate?
A. "Continue your diet because leafy greens do not affect
warfarin."
B. "Stop eating vegetables completely while taking warfarin."
C. "Maintain a consistent intake of vitamin K–containing foods
and notify your provider about the dietary change."
D. "Double today's warfarin dose to increase your INR."
Correct Answer
Correct Answer: C. Maintain a consistent intake of vitamin K–
containing foods and notify your provider about the dietary
change.
