NCLEX-RN Pharmacology Practice Questions:
Hematologic System |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales
Question 1
Clinical Scenario
A 65-year-old male is admitted to the medical-surgical unit with a
deep vein thrombosis (DVT) in his left lower extremity. The provider
prescribes a continuous intravenous infusion of unfractionated
heparin. After 24 hours, the nurse reviews the patient’s laboratory
results and notes an activated partial thromboplastin time (aPTT) of
98 seconds (normal range: 25–35 seconds; therapeutic range: 1.5–
2.0 times normal). The patient’s vital signs are stable, and there is no
evidence of active bleeding.
Question Stem
Which action should the nurse take first?
Options
A. Administer protamine sulfate immediately.
B. Continue the infusion and recheck the aPTT in 6 hours.
C. Hold the heparin infusion and notify the healthcare provider.
D. Increase the heparin infusion rate by 2 mL/hr.
,Correct Answer
Correct Answer: C. Hold the heparin infusion and notify the
healthcare provider.
Detailed Rationale
The therapeutic range for aPTT in a patient receiving unfractionated
heparin is typically 1.5 to 2.0 times the normal control value
(approximately 37.5 to 70 seconds). An aPTT of 98 seconds is
significantly elevated, indicating a high risk for hemorrhage. The
priority nursing action is to hold the heparin infusion immediately to
prevent bleeding complications and notify the healthcare provider
for further orders, which may include decreasing the infusion rate or
holding the dose temporarily. Administering protamine sulfate
(Option A) is the antidote for heparin, but it is reserved for life-
threatening bleeding or severe overdose, not an asymptomatic
elevated aPTT. Continuing the infusion (Option B) would further
increase the bleeding risk. Increasing the rate (Option D) is
contraindicated when the aPTT is already supratherapeutic. This
scenario emphasizes the importance of vigilant laboratory
monitoring and timely clinical intervention when administering high-
alert anticoagulant medications.
Learning Objective
Interpret aPTT laboratory values in the context of unfractionated
heparin therapy.
Prioritize nursing interventions for supratherapeutic anticoagulation.
Recognize the appropriate use of heparin antidotes.
,Medication Safety Focus
High-alert medication / Monitoring parameters
Question 2
Clinical Scenario
A 72-year-old female is being discharged home after being newly
diagnosed with atrial fibrillation. The healthcare provider prescribes
warfarin 5 mg orally once daily. The nurse is providing discharge
education regarding dietary modifications and medication safety.
Question Stem
Which statement by the client indicates an understanding of the
teaching?
Options
A. "I will increase my intake of spinach and kale to boost my iron
levels."
B. "I should maintain a consistent intake of foods rich in vitamin K."
C. "I will take an over-the-counter ibuprofen if I develop a headache."
D. "I can stop taking the medication once my heart feels like it is
beating normally."
Correct Answer
Correct Answer: B. "I should maintain a consistent intake of foods
rich in vitamin K."
Detailed Rationale
Warfarin is a vitamin K antagonist. Fluctuations in dietary vitamin K
intake can significantly alter the medication’s effectiveness, leading
to subtherapeutic or supratherapeutic INR levels. Therefore,
, patients should be taught to maintain a consistent (not necessarily
restricted) intake of vitamin K-rich foods, such as leafy green
vegetables (e.g., spinach, kale, broccoli). Option A is incorrect
because suddenly increasing vitamin K intake will decrease
warfarin’s anticoagulant effect, increasing the risk of thrombosis.
Option C is incorrect because NSAIDs like ibuprofen increase the
risk of gastrointestinal bleeding and should be avoided;
acetaminophen is the preferred analgesic. Option D is incorrect
because warfarin must be taken exactly as prescribed indefinitely
for atrial fibrillation to prevent stroke, regardless of symptomatic
improvement. This question highlights the critical role of patient
education in medication adherence and safety.
Learning Objective
Educate patients on dietary considerations related to warfarin
therapy.
Identify medications that interact adversely with warfarin.
Emphasize the importance of medication adherence in chronic
anticoagulation.
Medication Safety Focus
Patient education / Drug interaction
Question 3
Clinical Scenario
A 28-year-old female at 20 weeks gestation is diagnosed with iron
deficiency anemia. The healthcare provider prescribes ferrous
Hematologic System |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales
Question 1
Clinical Scenario
A 65-year-old male is admitted to the medical-surgical unit with a
deep vein thrombosis (DVT) in his left lower extremity. The provider
prescribes a continuous intravenous infusion of unfractionated
heparin. After 24 hours, the nurse reviews the patient’s laboratory
results and notes an activated partial thromboplastin time (aPTT) of
98 seconds (normal range: 25–35 seconds; therapeutic range: 1.5–
2.0 times normal). The patient’s vital signs are stable, and there is no
evidence of active bleeding.
Question Stem
Which action should the nurse take first?
Options
A. Administer protamine sulfate immediately.
B. Continue the infusion and recheck the aPTT in 6 hours.
C. Hold the heparin infusion and notify the healthcare provider.
D. Increase the heparin infusion rate by 2 mL/hr.
,Correct Answer
Correct Answer: C. Hold the heparin infusion and notify the
healthcare provider.
Detailed Rationale
The therapeutic range for aPTT in a patient receiving unfractionated
heparin is typically 1.5 to 2.0 times the normal control value
(approximately 37.5 to 70 seconds). An aPTT of 98 seconds is
significantly elevated, indicating a high risk for hemorrhage. The
priority nursing action is to hold the heparin infusion immediately to
prevent bleeding complications and notify the healthcare provider
for further orders, which may include decreasing the infusion rate or
holding the dose temporarily. Administering protamine sulfate
(Option A) is the antidote for heparin, but it is reserved for life-
threatening bleeding or severe overdose, not an asymptomatic
elevated aPTT. Continuing the infusion (Option B) would further
increase the bleeding risk. Increasing the rate (Option D) is
contraindicated when the aPTT is already supratherapeutic. This
scenario emphasizes the importance of vigilant laboratory
monitoring and timely clinical intervention when administering high-
alert anticoagulant medications.
Learning Objective
Interpret aPTT laboratory values in the context of unfractionated
heparin therapy.
Prioritize nursing interventions for supratherapeutic anticoagulation.
Recognize the appropriate use of heparin antidotes.
,Medication Safety Focus
High-alert medication / Monitoring parameters
Question 2
Clinical Scenario
A 72-year-old female is being discharged home after being newly
diagnosed with atrial fibrillation. The healthcare provider prescribes
warfarin 5 mg orally once daily. The nurse is providing discharge
education regarding dietary modifications and medication safety.
Question Stem
Which statement by the client indicates an understanding of the
teaching?
Options
A. "I will increase my intake of spinach and kale to boost my iron
levels."
B. "I should maintain a consistent intake of foods rich in vitamin K."
C. "I will take an over-the-counter ibuprofen if I develop a headache."
D. "I can stop taking the medication once my heart feels like it is
beating normally."
Correct Answer
Correct Answer: B. "I should maintain a consistent intake of foods
rich in vitamin K."
Detailed Rationale
Warfarin is a vitamin K antagonist. Fluctuations in dietary vitamin K
intake can significantly alter the medication’s effectiveness, leading
to subtherapeutic or supratherapeutic INR levels. Therefore,
, patients should be taught to maintain a consistent (not necessarily
restricted) intake of vitamin K-rich foods, such as leafy green
vegetables (e.g., spinach, kale, broccoli). Option A is incorrect
because suddenly increasing vitamin K intake will decrease
warfarin’s anticoagulant effect, increasing the risk of thrombosis.
Option C is incorrect because NSAIDs like ibuprofen increase the
risk of gastrointestinal bleeding and should be avoided;
acetaminophen is the preferred analgesic. Option D is incorrect
because warfarin must be taken exactly as prescribed indefinitely
for atrial fibrillation to prevent stroke, regardless of symptomatic
improvement. This question highlights the critical role of patient
education in medication adherence and safety.
Learning Objective
Educate patients on dietary considerations related to warfarin
therapy.
Identify medications that interact adversely with warfarin.
Emphasize the importance of medication adherence in chronic
anticoagulation.
Medication Safety Focus
Patient education / Drug interaction
Question 3
Clinical Scenario
A 28-year-old female at 20 weeks gestation is diagnosed with iron
deficiency anemia. The healthcare provider prescribes ferrous
