NCLEX-RN Hematologic System
Pharmacology Practice Questions with
Rationales |
20 Original NGN-Style Nursing MCQs
Question 1
Clinical Scenario
A 68-year-old male is admitted with a deep vein thrombosis (DVT)
and is receiving a continuous intravenous heparin infusion. The
laboratory reports that the client’s activated partial thromboplastin
time (aPTT) is 95 seconds (control value is 30 seconds). The client
has no active signs of bleeding.
Question Stem
Which action should the nurse take first?
A. Increase the heparin infusion rate to achieve a therapeutic level.
B. Administer intravenous protamine sulfate immediately.
C. Pause or decrease the heparin infusion rate per the facility’s
protocol.
D. Obtain a STAT international normalized ratio (INR).
,Correct Answer
Correct Answer: C. Pause or decrease the heparin infusion rate per
the facility’s protocol.
Detailed Rationale
The correct answer is C. The therapeutic range for aPTT in a patient
receiving IV heparin is typically 1.5 to 2 times the control value
(approximately 45 to 70 seconds, depending on the laboratory). An
aPTT of 95 seconds is supratherapeutic, placing the client at a high
risk for severe bleeding. The nurse's priority action is to pause or
decrease the heparin infusion rate according to the facility's
standardized heparin nomogram or protocol and notify the
healthcare provider.
Option A is incorrect because increasing the infusion rate would
further elevate the aPTT and exacerbate the bleeding risk. Option B
is incorrect because protamine sulfate is the reversal agent for
heparin, but it is typically reserved for life-threatening bleeding or
extreme supratherapeutic levels, not as a first-line intervention for
an elevated aPTT without active bleeding. Option D is incorrect
because the INR is used to monitor warfarin therapy, not heparin
therapy.
This scenario highlights the critical nursing responsibility of
monitoring laboratory values for high-alert medications like heparin.
Clinical judgment requires recognizing the supratherapeutic value
and acting swiftly to prevent hemorrhage by adjusting the infusion
per protocol.
Learning Objective
Interpret aPTT laboratory values in the context of IV heparin therapy.
,Prioritize nursing interventions for supratherapeutic anticoagulation
levels.
Differentiate between monitoring parameters for heparin and
warfarin.
Medication Safety Focus
High-alert medication
Question 2
Clinical Scenario
A 72-year-old female with a history of atrial fibrillation is being
discharged with a new prescription for warfarin. The nurse is
providing discharge education regarding medication safety and
lifestyle modifications.
Question Stem
Which statement by the client indicates an understanding of the
teaching?
A. "I will increase my daily intake of leafy green vegetables to stay
healthy."
B. "I will use a soft-bristled toothbrush and an electric razor for
shaving."
C. "I will take ibuprofen for my occasional tension headaches."
D. "I will stop taking the medication if I notice my urine looks dark."
Correct Answer
Correct Answer: B. "I will use a soft-bristled toothbrush and an
electric razor for shaving."
, Detailed Rationale
The correct answer is B. Warfarin is an oral anticoagulant that
increases the risk of bleeding. Using a soft-bristled toothbrush and
an electric razor are essential safety measures to prevent minor
trauma that could lead to prolonged or severe bleeding.
Option A is incorrect because clients on warfarin should maintain a
consistent intake of vitamin K-rich foods (like leafy greens), not
increase them, as sudden increases can decrease warfarin’s
effectiveness and lower the INR. Option C is incorrect because
nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
increase the risk of gastrointestinal bleeding and should be avoided;
acetaminophen is the preferred analgesic. Option D is incorrect
because dark or bloody urine is a sign of potential hemorrhage and
should be reported to the healthcare provider immediately, rather
than independently discontinuing the medication, which could lead
to a thromboembolic event.
Learning Objective
Identify patient teaching points for safe living while on oral
anticoagulants.
Recognize dietary and drug interactions that affect warfarin therapy.
Differentiate between expected side effects and adverse reactions
requiring medical evaluation.
Medication Safety Focus
Patient education
Question 3
Pharmacology Practice Questions with
Rationales |
20 Original NGN-Style Nursing MCQs
Question 1
Clinical Scenario
A 68-year-old male is admitted with a deep vein thrombosis (DVT)
and is receiving a continuous intravenous heparin infusion. The
laboratory reports that the client’s activated partial thromboplastin
time (aPTT) is 95 seconds (control value is 30 seconds). The client
has no active signs of bleeding.
Question Stem
Which action should the nurse take first?
A. Increase the heparin infusion rate to achieve a therapeutic level.
B. Administer intravenous protamine sulfate immediately.
C. Pause or decrease the heparin infusion rate per the facility’s
protocol.
D. Obtain a STAT international normalized ratio (INR).
,Correct Answer
Correct Answer: C. Pause or decrease the heparin infusion rate per
the facility’s protocol.
Detailed Rationale
The correct answer is C. The therapeutic range for aPTT in a patient
receiving IV heparin is typically 1.5 to 2 times the control value
(approximately 45 to 70 seconds, depending on the laboratory). An
aPTT of 95 seconds is supratherapeutic, placing the client at a high
risk for severe bleeding. The nurse's priority action is to pause or
decrease the heparin infusion rate according to the facility's
standardized heparin nomogram or protocol and notify the
healthcare provider.
Option A is incorrect because increasing the infusion rate would
further elevate the aPTT and exacerbate the bleeding risk. Option B
is incorrect because protamine sulfate is the reversal agent for
heparin, but it is typically reserved for life-threatening bleeding or
extreme supratherapeutic levels, not as a first-line intervention for
an elevated aPTT without active bleeding. Option D is incorrect
because the INR is used to monitor warfarin therapy, not heparin
therapy.
This scenario highlights the critical nursing responsibility of
monitoring laboratory values for high-alert medications like heparin.
Clinical judgment requires recognizing the supratherapeutic value
and acting swiftly to prevent hemorrhage by adjusting the infusion
per protocol.
Learning Objective
Interpret aPTT laboratory values in the context of IV heparin therapy.
,Prioritize nursing interventions for supratherapeutic anticoagulation
levels.
Differentiate between monitoring parameters for heparin and
warfarin.
Medication Safety Focus
High-alert medication
Question 2
Clinical Scenario
A 72-year-old female with a history of atrial fibrillation is being
discharged with a new prescription for warfarin. The nurse is
providing discharge education regarding medication safety and
lifestyle modifications.
Question Stem
Which statement by the client indicates an understanding of the
teaching?
A. "I will increase my daily intake of leafy green vegetables to stay
healthy."
B. "I will use a soft-bristled toothbrush and an electric razor for
shaving."
C. "I will take ibuprofen for my occasional tension headaches."
D. "I will stop taking the medication if I notice my urine looks dark."
Correct Answer
Correct Answer: B. "I will use a soft-bristled toothbrush and an
electric razor for shaving."
, Detailed Rationale
The correct answer is B. Warfarin is an oral anticoagulant that
increases the risk of bleeding. Using a soft-bristled toothbrush and
an electric razor are essential safety measures to prevent minor
trauma that could lead to prolonged or severe bleeding.
Option A is incorrect because clients on warfarin should maintain a
consistent intake of vitamin K-rich foods (like leafy greens), not
increase them, as sudden increases can decrease warfarin’s
effectiveness and lower the INR. Option C is incorrect because
nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
increase the risk of gastrointestinal bleeding and should be avoided;
acetaminophen is the preferred analgesic. Option D is incorrect
because dark or bloody urine is a sign of potential hemorrhage and
should be reported to the healthcare provider immediately, rather
than independently discontinuing the medication, which could lead
to a thromboembolic event.
Learning Objective
Identify patient teaching points for safe living while on oral
anticoagulants.
Recognize dietary and drug interactions that affect warfarin therapy.
Differentiate between expected side effects and adverse reactions
requiring medical evaluation.
Medication Safety Focus
Patient education
Question 3
