NCLEX-RN Pharmacology Hematologic
System Exam Questions & Answers |
20 NGN-Style Practice MCQs with
Rationales |
ATI Pharmacology Review 2026
Question 1
Clinical Scenario
A 68-year-old male with nonvalvular atrial fibrillation is prescribed
apixaban. He reports easy bruising and asks the nurse how the
medication works. His blood pressure is 128/76 mm Hg, pulse
82/min, and oxygen saturation 98% on room air.
Question Stem
Which explanation by the nurse best describes the mechanism of
action of apixaban?
A. It inhibits platelet aggregation by blocking ADP receptors.
B. It directly inhibits Factor Xa, reducing thrombin generation.
C. It enhances antithrombin III activity against thrombin and Factor
Xa.
,D. It dissolves existing blood clots by converting plasminogen to
plasmin.
Correct Answer
Correct Answer: B. It directly inhibits Factor Xa, reducing
thrombin generation.
Detailed Rationale
Apixaban is a direct oral anticoagulant (DOAC) that selectively
inhibits Factor Xa, thereby decreasing thrombin production and
reducing clot formation. It is commonly prescribed for stroke
prevention in atrial fibrillation and treatment of venous
thromboembolism. Understanding its mechanism helps nurses
educate patients and anticipate bleeding risks.
Option A describes clopidogrel. Option C describes heparin and
low-molecular-weight heparins, which work through antithrombin
III. Option D describes alteplase, a thrombolytic used to dissolve
existing clots rather than prevent new clot formation.
Nursing considerations include monitoring for bleeding, assessing
renal function, reviewing concurrent medications that increase
bleeding risk, and teaching patients to report unusual bruising,
hematuria, or black stools. Unlike warfarin, routine INR monitoring
is generally not required with apixaban.
Learning Objective
After completing this question, the learner should be able to:
• Describe the mechanism of action of apixaban.
, • Differentiate anticoagulants from antiplatelet and thrombolytic
medications.
• Identify key bleeding precautions for patients receiving DOACs.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A nurse is preparing to administer unfractionated heparin to a
hospitalized client with a pulmonary embolism. The client's
activated partial thromboplastin time (aPTT) is 110 seconds
(reference range 25–35 seconds).
Question Stem
Which action should the nurse take first?
A. Administer the prescribed heparin dose.
B. Notify the provider and hold the heparin infusion.
C. Administer protamine sulfate immediately.
D. Repeat the aPTT in 24 hours.
Correct Answer
Correct Answer: B. Notify the provider and hold the heparin
infusion.
Detailed Rationale
System Exam Questions & Answers |
20 NGN-Style Practice MCQs with
Rationales |
ATI Pharmacology Review 2026
Question 1
Clinical Scenario
A 68-year-old male with nonvalvular atrial fibrillation is prescribed
apixaban. He reports easy bruising and asks the nurse how the
medication works. His blood pressure is 128/76 mm Hg, pulse
82/min, and oxygen saturation 98% on room air.
Question Stem
Which explanation by the nurse best describes the mechanism of
action of apixaban?
A. It inhibits platelet aggregation by blocking ADP receptors.
B. It directly inhibits Factor Xa, reducing thrombin generation.
C. It enhances antithrombin III activity against thrombin and Factor
Xa.
,D. It dissolves existing blood clots by converting plasminogen to
plasmin.
Correct Answer
Correct Answer: B. It directly inhibits Factor Xa, reducing
thrombin generation.
Detailed Rationale
Apixaban is a direct oral anticoagulant (DOAC) that selectively
inhibits Factor Xa, thereby decreasing thrombin production and
reducing clot formation. It is commonly prescribed for stroke
prevention in atrial fibrillation and treatment of venous
thromboembolism. Understanding its mechanism helps nurses
educate patients and anticipate bleeding risks.
Option A describes clopidogrel. Option C describes heparin and
low-molecular-weight heparins, which work through antithrombin
III. Option D describes alteplase, a thrombolytic used to dissolve
existing clots rather than prevent new clot formation.
Nursing considerations include monitoring for bleeding, assessing
renal function, reviewing concurrent medications that increase
bleeding risk, and teaching patients to report unusual bruising,
hematuria, or black stools. Unlike warfarin, routine INR monitoring
is generally not required with apixaban.
Learning Objective
After completing this question, the learner should be able to:
• Describe the mechanism of action of apixaban.
, • Differentiate anticoagulants from antiplatelet and thrombolytic
medications.
• Identify key bleeding precautions for patients receiving DOACs.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A nurse is preparing to administer unfractionated heparin to a
hospitalized client with a pulmonary embolism. The client's
activated partial thromboplastin time (aPTT) is 110 seconds
(reference range 25–35 seconds).
Question Stem
Which action should the nurse take first?
A. Administer the prescribed heparin dose.
B. Notify the provider and hold the heparin infusion.
C. Administer protamine sulfate immediately.
D. Repeat the aPTT in 24 hours.
Correct Answer
Correct Answer: B. Notify the provider and hold the heparin
infusion.
Detailed Rationale
