NCLEX-RN Pharmacology Hematologic System
Practice Questions | 20 Original ATI & NGN-
Style MCQs with Detailed Rationales | Nursing
Exam Study Guide
Question 1
Clinical Scenario
A 72-year-old male with a history of atrial fibrillation and
hypertension is admitted with a left-sided deep vein
thrombosis. He is started on a continuous intravenous infusion
of unfractionated heparin per facility protocol. The nurse
reviews the morning laboratory results and notes the patient's
activated partial thromboplastin time (aPTT) is 108 seconds.
The baseline aPTT prior to heparin initiation was 30 seconds.
The patient denies any bleeding symptoms, and vital signs are
stable at 128/78 mmHg, heart rate 82 bpm, and respiratory rate
16/min. The patient's platelet count this morning is
210,000/mm³.
Question Stem
,Which action should the nurse take first?
A. Continue the infusion at the current rate and monitor for
signs of bleeding.
B. Administer protamine sulfate 25 mg intravenously.
C. Hold the heparin infusion and notify the healthcare provider.
D. Decrease the heparin infusion rate by 2 units/kg/hr per
protocol.
Correct Answer: C. Hold the heparin infusion and notify the
healthcare provider.
Detailed Rationale
The therapeutic range for aPTT during unfractionated heparin
therapy is typically 1.5 to 2.5 times the baseline value. For this
patient with a baseline aPTT of 30 seconds, the therapeutic
range would be 45 to 75 seconds. An aPTT of 108 seconds is
significantly supratherapeutic and places the patient at
increased risk for bleeding complications, including intracranial
hemorrhage and adrenal hemorrhage (which may present with
back pain, hypotension, and tachycardia) . The nurse's priority
action is to hold the infusion to prevent further anticoagulation
and notify the healthcare provider for orders to adjust the rate
per the facility's heparin nomogram.
,Option A is incorrect because continuing the infusion at the
current rate would further increase the aPTT and bleeding risk.
Option B is incorrect because protamine sulfate is the antidote
for heparin and is reserved for situations with active, life-
threatening bleeding, not for an elevated aPTT without clinical
bleeding . Option D is incorrect because although the
healthcare provider may ultimately order a rate reduction, the
nurse should first hold the infusion and consult the provider
before making any rate changes based solely on a single
elevated value.
Heparin is a high-alert medication requiring careful monitoring.
The nurse should also assess for early signs of bleeding such as
hypotension, tachycardia, hematomas, petechiae, or complaints
of back or flank pain .
Learning Objective
After completing this question, the learner should be able to:
• Identify therapeutic and supratherapeutic aPTT ranges
during heparin therapy.
• Prioritize nursing actions for abnormal coagulation
laboratory values.
• Recognize signs and symptoms of bleeding complications
during anticoagulant therapy.
Medication Safety Focus
, High-alert medication monitoring
Question 2
Clinical Scenario
A 66-year-old female with chronic atrial fibrillation has been
taking warfarin 5 mg daily for stroke prevention for the past 2
years. She presents to the anticoagulation clinic for a routine
INR check. Her INR today is 5.8. She denies any bleeding
symptoms, bruising, or dark stools. During medication
reconciliation, she reports that she started taking a new
antibiotic prescribed by her dentist 5 days ago for a dental
infection. She also reports that she has been eating more salads
recently as part of a new diet plan.
Question Stem
Which factor most likely contributed to this elevated INR?
A. Increased dietary intake of vitamin K-rich foods.
B. Drug interaction between warfarin and the antibiotic.
C. Missed doses of warfarin over the past week.
D. Concurrent use of over-the-counter ibuprofen.
Correct Answer: B. Drug interaction between warfarin and the
antibiotic.
Practice Questions | 20 Original ATI & NGN-
Style MCQs with Detailed Rationales | Nursing
Exam Study Guide
Question 1
Clinical Scenario
A 72-year-old male with a history of atrial fibrillation and
hypertension is admitted with a left-sided deep vein
thrombosis. He is started on a continuous intravenous infusion
of unfractionated heparin per facility protocol. The nurse
reviews the morning laboratory results and notes the patient's
activated partial thromboplastin time (aPTT) is 108 seconds.
The baseline aPTT prior to heparin initiation was 30 seconds.
The patient denies any bleeding symptoms, and vital signs are
stable at 128/78 mmHg, heart rate 82 bpm, and respiratory rate
16/min. The patient's platelet count this morning is
210,000/mm³.
Question Stem
,Which action should the nurse take first?
A. Continue the infusion at the current rate and monitor for
signs of bleeding.
B. Administer protamine sulfate 25 mg intravenously.
C. Hold the heparin infusion and notify the healthcare provider.
D. Decrease the heparin infusion rate by 2 units/kg/hr per
protocol.
Correct Answer: C. Hold the heparin infusion and notify the
healthcare provider.
Detailed Rationale
The therapeutic range for aPTT during unfractionated heparin
therapy is typically 1.5 to 2.5 times the baseline value. For this
patient with a baseline aPTT of 30 seconds, the therapeutic
range would be 45 to 75 seconds. An aPTT of 108 seconds is
significantly supratherapeutic and places the patient at
increased risk for bleeding complications, including intracranial
hemorrhage and adrenal hemorrhage (which may present with
back pain, hypotension, and tachycardia) . The nurse's priority
action is to hold the infusion to prevent further anticoagulation
and notify the healthcare provider for orders to adjust the rate
per the facility's heparin nomogram.
,Option A is incorrect because continuing the infusion at the
current rate would further increase the aPTT and bleeding risk.
Option B is incorrect because protamine sulfate is the antidote
for heparin and is reserved for situations with active, life-
threatening bleeding, not for an elevated aPTT without clinical
bleeding . Option D is incorrect because although the
healthcare provider may ultimately order a rate reduction, the
nurse should first hold the infusion and consult the provider
before making any rate changes based solely on a single
elevated value.
Heparin is a high-alert medication requiring careful monitoring.
The nurse should also assess for early signs of bleeding such as
hypotension, tachycardia, hematomas, petechiae, or complaints
of back or flank pain .
Learning Objective
After completing this question, the learner should be able to:
• Identify therapeutic and supratherapeutic aPTT ranges
during heparin therapy.
• Prioritize nursing actions for abnormal coagulation
laboratory values.
• Recognize signs and symptoms of bleeding complications
during anticoagulant therapy.
Medication Safety Focus
, High-alert medication monitoring
Question 2
Clinical Scenario
A 66-year-old female with chronic atrial fibrillation has been
taking warfarin 5 mg daily for stroke prevention for the past 2
years. She presents to the anticoagulation clinic for a routine
INR check. Her INR today is 5.8. She denies any bleeding
symptoms, bruising, or dark stools. During medication
reconciliation, she reports that she started taking a new
antibiotic prescribed by her dentist 5 days ago for a dental
infection. She also reports that she has been eating more salads
recently as part of a new diet plan.
Question Stem
Which factor most likely contributed to this elevated INR?
A. Increased dietary intake of vitamin K-rich foods.
B. Drug interaction between warfarin and the antibiotic.
C. Missed doses of warfarin over the past week.
D. Concurrent use of over-the-counter ibuprofen.
Correct Answer: B. Drug interaction between warfarin and the
antibiotic.
