NCLEX-RN Pharmacology Hematologic
System Practice Questions |
20 ATI & NGN-Style MCQs with Rationales,
Medication Safety, Anticoagulants,
Antiplatelets & Hematology Review
Question 1
Clinical Scenario
A 68-year-old male is admitted with a newly diagnosed deep vein
thrombosis (DVT). The provider prescribes a continuous intravenous
unfractionated heparin infusion. Six hours after initiation, the nurse
reviews laboratory results: aPTT 96 seconds (reference range 25–35
seconds), platelet count 220,000/mm³, HR 82/min, BP 128/74 mm
Hg. The client reports mild bruising at previous venipuncture sites.
Question Stem
Which action should the nurse take first?
A. Continue the infusion and reassess in 6 hours
B. Administer protamine sulfate
,C. Notify the provider and anticipate adjustment of the heparin
infusion
D. Administer vitamin K
Correct Answer
Correct Answer: C. Notify the provider and anticipate
adjustment of the heparin infusion
Detailed Rationale
Unfractionated heparin therapy is monitored using the activated
partial thromboplastin time (aPTT). A value of 96 seconds is
significantly above the typical therapeutic range (often 1.5–2.5 times
control), increasing the client's risk for bleeding. The priority action
is to notify the provider and anticipate adjustment or temporary
interruption of the infusion according to facility protocol.
Option A is incorrect because continuing the infusion without
intervention could further increase bleeding risk.
Option B is incorrect because protamine sulfate is reserved for
significant bleeding or severe heparin overdose. The client currently
has no evidence of major hemorrhage.
Option D is incorrect because vitamin K reverses warfarin, not
heparin.
Nurses should monitor for overt and occult bleeding, assess trends
in coagulation studies, and evaluate medication administration
records for dosing errors. Heparin is considered a high-alert
medication due to the potential for serious patient harm if
administered incorrectly.
, Learning Objective
After completing this question, the learner should be able to:
• Interpret aPTT values during heparin therapy.
• Prioritize interventions for excessive anticoagulation.
• Recognize indications for heparin dose adjustment.
• Differentiate reversal agents for anticoagulants.
Medication Safety Focus
High-alert medication
Question 2
Clinical Scenario
A 72-year-old female taking warfarin for atrial fibrillation presents for
routine follow-up. Laboratory results reveal an INR of 4.8. She
denies bleeding but reports recently starting an over-the-counter
herbal supplement.
Question Stem
Which herbal supplement is most likely contributing to the elevated
INR?
A. Ginkgo biloba
B. Echinacea
C. Saw palmetto
D. Glucosamine
System Practice Questions |
20 ATI & NGN-Style MCQs with Rationales,
Medication Safety, Anticoagulants,
Antiplatelets & Hematology Review
Question 1
Clinical Scenario
A 68-year-old male is admitted with a newly diagnosed deep vein
thrombosis (DVT). The provider prescribes a continuous intravenous
unfractionated heparin infusion. Six hours after initiation, the nurse
reviews laboratory results: aPTT 96 seconds (reference range 25–35
seconds), platelet count 220,000/mm³, HR 82/min, BP 128/74 mm
Hg. The client reports mild bruising at previous venipuncture sites.
Question Stem
Which action should the nurse take first?
A. Continue the infusion and reassess in 6 hours
B. Administer protamine sulfate
,C. Notify the provider and anticipate adjustment of the heparin
infusion
D. Administer vitamin K
Correct Answer
Correct Answer: C. Notify the provider and anticipate
adjustment of the heparin infusion
Detailed Rationale
Unfractionated heparin therapy is monitored using the activated
partial thromboplastin time (aPTT). A value of 96 seconds is
significantly above the typical therapeutic range (often 1.5–2.5 times
control), increasing the client's risk for bleeding. The priority action
is to notify the provider and anticipate adjustment or temporary
interruption of the infusion according to facility protocol.
Option A is incorrect because continuing the infusion without
intervention could further increase bleeding risk.
Option B is incorrect because protamine sulfate is reserved for
significant bleeding or severe heparin overdose. The client currently
has no evidence of major hemorrhage.
Option D is incorrect because vitamin K reverses warfarin, not
heparin.
Nurses should monitor for overt and occult bleeding, assess trends
in coagulation studies, and evaluate medication administration
records for dosing errors. Heparin is considered a high-alert
medication due to the potential for serious patient harm if
administered incorrectly.
, Learning Objective
After completing this question, the learner should be able to:
• Interpret aPTT values during heparin therapy.
• Prioritize interventions for excessive anticoagulation.
• Recognize indications for heparin dose adjustment.
• Differentiate reversal agents for anticoagulants.
Medication Safety Focus
High-alert medication
Question 2
Clinical Scenario
A 72-year-old female taking warfarin for atrial fibrillation presents for
routine follow-up. Laboratory results reveal an INR of 4.8. She
denies bleeding but reports recently starting an over-the-counter
herbal supplement.
Question Stem
Which herbal supplement is most likely contributing to the elevated
INR?
A. Ginkgo biloba
B. Echinacea
C. Saw palmetto
D. Glucosamine
