NCLEX-RN Pharmacology Hematologic System
Exam Questions & Rationales |
20 Original ATI & NGN-Style Practice MCQs |
Anticoagulants, Antiplatelets, Thrombolytics, Iron
Therapy, Blood Disorders |
Nursing Exam Study Guide
Question 1
Clinical Scenario
A 72-year-old man is admitted with a newly diagnosed deep
vein thrombosis (DVT) of the left leg. His medical history
includes hypertension, chronic kidney disease stage 3, and
osteoarthritis. The provider prescribes an IV unfractionated
heparin infusion. Baseline laboratory values are: aPTT 31
seconds, platelet count 235,000/mm³, hemoglobin 13.8 g/dL,
and serum creatinine 1.8 mg/dL. Six hours after initiating
therapy, the nurse receives an aPTT result of 104 seconds.
Question Stem
,Which nursing action is most appropriate?
A. Increase the infusion rate to achieve therapeutic
anticoagulation.
B. Stop the heparin infusion temporarily and notify the provider
according to protocol.
C. Administer vitamin K immediately.
D. Discontinue the IV catheter and apply a pressure dressing.
Correct Answer
Correct Answer: B. Stop the heparin infusion temporarily and
notify the provider according to protocol.
Detailed Rationale
Unfractionated heparin is a high-alert medication that requires
close monitoring using the activated partial thromboplastin
time (aPTT). A therapeutic aPTT is generally 1.5–2.5 times the
normal value, depending on institutional protocols. An aPTT of
104 seconds indicates excessive anticoagulation and
significantly increases the patient's risk for spontaneous
bleeding. Following institutional heparin protocols, the nurse
should temporarily stop the infusion, notify the provider, and
anticipate dosage adjustment or repeat laboratory testing. If
bleeding develops, protamine sulfate—not vitamin K—is the
reversal agent.
,Option A is incorrect because increasing the infusion would
further elevate anticoagulation and increase hemorrhage risk.
Option C is incorrect because vitamin K reverses warfarin, not
heparin.
Option D is unnecessary unless there is evidence of catheter-
related bleeding or complications.
The nurse should also perform a comprehensive bleeding
assessment, inspect urine and stool for occult blood, assess
neurologic status for intracranial bleeding, and reinforce
bleeding precautions. Because heparin is considered a high-
alert medication, independent double-checks and protocol-
driven adjustments are essential for safe administration.
Learning Objectives
After completing this question, the learner should be able to:
• Interpret aPTT values during unfractionated heparin
therapy.
• Prioritize nursing interventions for excessive
anticoagulation.
• Differentiate reversal agents for anticoagulants.
• Apply bleeding precautions during heparin therapy.
Medication Safety Focus
High-alert medication monitoring
, Question 2
Clinical Scenario
A 66-year-old woman with chronic atrial fibrillation has been
taking warfarin for stroke prevention. She presents for a routine
clinic visit. Her INR today is 5.4. She denies active bleeding but
reports recently starting trimethoprim-sulfamethoxazole for a
urinary tract infection prescribed by an urgent care clinic.
Question Stem
Which factor most likely contributed to this laboratory finding?
A. Increased dietary vitamin K intake
B. Drug interaction between warfarin and trimethoprim-
sulfamethoxazole
C. Daily aspirin therapy
D. Drinking additional water each day
Correct Answer
Correct Answer: B. Drug interaction between warfarin and
trimethoprim-sulfamethoxazole
Detailed Rationale
Warfarin has numerous clinically significant drug interactions.
Trimethoprim-sulfamethoxazole inhibits warfarin metabolism
Exam Questions & Rationales |
20 Original ATI & NGN-Style Practice MCQs |
Anticoagulants, Antiplatelets, Thrombolytics, Iron
Therapy, Blood Disorders |
Nursing Exam Study Guide
Question 1
Clinical Scenario
A 72-year-old man is admitted with a newly diagnosed deep
vein thrombosis (DVT) of the left leg. His medical history
includes hypertension, chronic kidney disease stage 3, and
osteoarthritis. The provider prescribes an IV unfractionated
heparin infusion. Baseline laboratory values are: aPTT 31
seconds, platelet count 235,000/mm³, hemoglobin 13.8 g/dL,
and serum creatinine 1.8 mg/dL. Six hours after initiating
therapy, the nurse receives an aPTT result of 104 seconds.
Question Stem
,Which nursing action is most appropriate?
A. Increase the infusion rate to achieve therapeutic
anticoagulation.
B. Stop the heparin infusion temporarily and notify the provider
according to protocol.
C. Administer vitamin K immediately.
D. Discontinue the IV catheter and apply a pressure dressing.
Correct Answer
Correct Answer: B. Stop the heparin infusion temporarily and
notify the provider according to protocol.
Detailed Rationale
Unfractionated heparin is a high-alert medication that requires
close monitoring using the activated partial thromboplastin
time (aPTT). A therapeutic aPTT is generally 1.5–2.5 times the
normal value, depending on institutional protocols. An aPTT of
104 seconds indicates excessive anticoagulation and
significantly increases the patient's risk for spontaneous
bleeding. Following institutional heparin protocols, the nurse
should temporarily stop the infusion, notify the provider, and
anticipate dosage adjustment or repeat laboratory testing. If
bleeding develops, protamine sulfate—not vitamin K—is the
reversal agent.
,Option A is incorrect because increasing the infusion would
further elevate anticoagulation and increase hemorrhage risk.
Option C is incorrect because vitamin K reverses warfarin, not
heparin.
Option D is unnecessary unless there is evidence of catheter-
related bleeding or complications.
The nurse should also perform a comprehensive bleeding
assessment, inspect urine and stool for occult blood, assess
neurologic status for intracranial bleeding, and reinforce
bleeding precautions. Because heparin is considered a high-
alert medication, independent double-checks and protocol-
driven adjustments are essential for safe administration.
Learning Objectives
After completing this question, the learner should be able to:
• Interpret aPTT values during unfractionated heparin
therapy.
• Prioritize nursing interventions for excessive
anticoagulation.
• Differentiate reversal agents for anticoagulants.
• Apply bleeding precautions during heparin therapy.
Medication Safety Focus
High-alert medication monitoring
, Question 2
Clinical Scenario
A 66-year-old woman with chronic atrial fibrillation has been
taking warfarin for stroke prevention. She presents for a routine
clinic visit. Her INR today is 5.4. She denies active bleeding but
reports recently starting trimethoprim-sulfamethoxazole for a
urinary tract infection prescribed by an urgent care clinic.
Question Stem
Which factor most likely contributed to this laboratory finding?
A. Increased dietary vitamin K intake
B. Drug interaction between warfarin and trimethoprim-
sulfamethoxazole
C. Daily aspirin therapy
D. Drinking additional water each day
Correct Answer
Correct Answer: B. Drug interaction between warfarin and
trimethoprim-sulfamethoxazole
Detailed Rationale
Warfarin has numerous clinically significant drug interactions.
Trimethoprim-sulfamethoxazole inhibits warfarin metabolism
