NCLEX-RN Pharmacology Exam |
Hematologic System |
20 Original ATI & NGN Style Practice
Questions with Detailed Rationales |
Nursing Study Guide
Question 1
Clinical Scenario
A 68-year-old male is admitted to the medical-surgical unit with a
deep vein thrombosis (DVT). He is receiving a continuous
intravenous infusion of unfractionated heparin. The baseline
activated partial thromboplastin time (aPTT) was 30 seconds. The
nurse reviews the morning laboratory results and notes the client's
current aPTT is 110 seconds. The client has no active signs of
bleeding.
Question Stem
Which action should the nurse take first?
,Options
A. Increase the heparin infusion rate to achieve a therapeutic level.
B. Administer intravenous protamine sulfate immediately.
C. Decrease or pause the heparin infusion per the facility's protocol.
D. Obtain a STAT international normalized ratio (INR) to evaluate
coagulation.
Correct Answer
Correct Answer: C. Decrease or pause the heparin infusion per the
facility's protocol.
Detailed Rationale
The therapeutic range for aPTT in a client receiving unfractionated
heparin is typically 1.5 to 2 times the control value (approximately
45 to 70 seconds). An aPTT of 110 seconds is supratherapeutic,
placing the client at a high risk for spontaneous bleeding. The
priority nursing action is to decrease or pause the infusion
immediately according to the facility's standardized heparin
nomogram and notify the healthcare provider. Option A is incorrect
because increasing the rate would exacerbate the bleeding risk.
Option B is incorrect because protamine sulfate (the heparin
reversal agent) is generally reserved for life-threatening bleeding or
severe overdose, not an elevated aPTT without active hemorrhage.
Option D is incorrect because INR is used to monitor warfarin
therapy, not unfractionated heparin.
Learning Objective
Interpret aPTT laboratory values in the context of unfractionated
heparin therapy.
,Prioritize nursing interventions for supratherapeutic anticoagulation
levels.
Differentiate between monitoring parameters for various
anticoagulant medications.
Medication Safety Focus
High-alert medication / Monitoring parameters
Question 2
Clinical Scenario
A 72-year-old female with a history of atrial fibrillation is being
discharged with a new prescription for warfarin 5 mg PO daily. The
nurse is providing discharge education regarding medication safety
and lifestyle modifications.
Question Stem
Which statement by the client indicates a need for further teaching?
Options
A. "I will use a soft-bristled toothbrush and an electric razor to
prevent bleeding."
B. "I will keep my intake of leafy green vegetables consistent from
day to day."
C. "I will report any unusual bruising, bleeding gums, or dark stools
to my doctor."
D. "I will take ibuprofen for my occasional knee pain instead of
acetaminophen."
, Correct Answer
Correct Answer: D. "I will take ibuprofen for my occasional knee pain
instead of acetaminophen."
Detailed Rationale
Warfarin is a vitamin K antagonist that requires careful management
to prevent bleeding complications. Nonsteroidal anti-inflammatory
drugs (NSAIDs) like ibuprofen inhibit platelet aggregation and can
cause gastric mucosal irritation, significantly increasing the risk of
gastrointestinal bleeding when combined with warfarin.
Acetaminophen is the preferred analgesic for mild pain in clients on
warfarin. Option A is a correct safety measure to minimize trauma.
Option B is correct because consistency, not avoidance, of vitamin
K-rich foods is recommended to maintain a stable INR. Option C is
correct as it demonstrates understanding of the signs of bleeding
that require immediate medical evaluation.
Learning Objective
Identify drug-drug interactions that increase bleeding risk with
warfarin.
Educate patients on appropriate dietary habits while taking vitamin
K antagonists.
Recognize signs of bleeding that warrant immediate medical
attention.
Medication Safety Focus
Drug interaction / Patient education
Hematologic System |
20 Original ATI & NGN Style Practice
Questions with Detailed Rationales |
Nursing Study Guide
Question 1
Clinical Scenario
A 68-year-old male is admitted to the medical-surgical unit with a
deep vein thrombosis (DVT). He is receiving a continuous
intravenous infusion of unfractionated heparin. The baseline
activated partial thromboplastin time (aPTT) was 30 seconds. The
nurse reviews the morning laboratory results and notes the client's
current aPTT is 110 seconds. The client has no active signs of
bleeding.
Question Stem
Which action should the nurse take first?
,Options
A. Increase the heparin infusion rate to achieve a therapeutic level.
B. Administer intravenous protamine sulfate immediately.
C. Decrease or pause the heparin infusion per the facility's protocol.
D. Obtain a STAT international normalized ratio (INR) to evaluate
coagulation.
Correct Answer
Correct Answer: C. Decrease or pause the heparin infusion per the
facility's protocol.
Detailed Rationale
The therapeutic range for aPTT in a client receiving unfractionated
heparin is typically 1.5 to 2 times the control value (approximately
45 to 70 seconds). An aPTT of 110 seconds is supratherapeutic,
placing the client at a high risk for spontaneous bleeding. The
priority nursing action is to decrease or pause the infusion
immediately according to the facility's standardized heparin
nomogram and notify the healthcare provider. Option A is incorrect
because increasing the rate would exacerbate the bleeding risk.
Option B is incorrect because protamine sulfate (the heparin
reversal agent) is generally reserved for life-threatening bleeding or
severe overdose, not an elevated aPTT without active hemorrhage.
Option D is incorrect because INR is used to monitor warfarin
therapy, not unfractionated heparin.
Learning Objective
Interpret aPTT laboratory values in the context of unfractionated
heparin therapy.
,Prioritize nursing interventions for supratherapeutic anticoagulation
levels.
Differentiate between monitoring parameters for various
anticoagulant medications.
Medication Safety Focus
High-alert medication / Monitoring parameters
Question 2
Clinical Scenario
A 72-year-old female with a history of atrial fibrillation is being
discharged with a new prescription for warfarin 5 mg PO daily. The
nurse is providing discharge education regarding medication safety
and lifestyle modifications.
Question Stem
Which statement by the client indicates a need for further teaching?
Options
A. "I will use a soft-bristled toothbrush and an electric razor to
prevent bleeding."
B. "I will keep my intake of leafy green vegetables consistent from
day to day."
C. "I will report any unusual bruising, bleeding gums, or dark stools
to my doctor."
D. "I will take ibuprofen for my occasional knee pain instead of
acetaminophen."
, Correct Answer
Correct Answer: D. "I will take ibuprofen for my occasional knee pain
instead of acetaminophen."
Detailed Rationale
Warfarin is a vitamin K antagonist that requires careful management
to prevent bleeding complications. Nonsteroidal anti-inflammatory
drugs (NSAIDs) like ibuprofen inhibit platelet aggregation and can
cause gastric mucosal irritation, significantly increasing the risk of
gastrointestinal bleeding when combined with warfarin.
Acetaminophen is the preferred analgesic for mild pain in clients on
warfarin. Option A is a correct safety measure to minimize trauma.
Option B is correct because consistency, not avoidance, of vitamin
K-rich foods is recommended to maintain a stable INR. Option C is
correct as it demonstrates understanding of the signs of bleeding
that require immediate medical evaluation.
Learning Objective
Identify drug-drug interactions that increase bleeding risk with
warfarin.
Educate patients on appropriate dietary habits while taking vitamin
K antagonists.
Recognize signs of bleeding that warrant immediate medical
attention.
Medication Safety Focus
Drug interaction / Patient education
