NCLEX-RN Pharmacology Hematologic
System Exam |
20 Original ATI & NGN-Style Practice
Questions with Detailed Rationales
Question 1
Clinical Scenario
A 68-year-old male is admitted to the medical-surgical unit with a
diagnosis of deep vein thrombosis (DVT). The provider prescribes a
continuous intravenous infusion of unfractionated heparin. The
client’s baseline activated partial thromboplastin time (aPTT) is 30
seconds. After 6 hours of the infusion, the nurse reviews the client’s
laboratory results and notes the aPTT is 90 seconds. The normal
therapeutic range for aPTT is 1.5 to 2 times the baseline value.
Question Stem
Which action should the nurse take first?
Options
A. Increase the heparin infusion rate by 2 mL/hr.
B. Administer protamine sulfate intravenously immediately.
,C. Pause the heparin infusion and notify the health care provider.
D. Continue the current infusion rate and recheck the aPTT in 6
hours.
Correct Answer
Correct Answer: C. Pause the heparin infusion and notify the health
care provider.
Detailed Rationale
The correct action is to pause the heparin infusion and notify the
health care provider. The client’s baseline aPTT is 30 seconds,
making the therapeutic range 45 to 60 seconds (1.5 to 2 times
baseline). An aPTT of 90 seconds is supratherapeutic, placing the
client at a high risk for severe bleeding. Standard protocol for a
supratherapeutic aPTT on a heparin drip requires pausing the
infusion, assessing the client for any signs of active bleeding, and
notifying the provider for further orders (which may include a dose
reduction or, if active bleeding is present, administration of
protamine sulfate).
Increasing the infusion rate (Option A) would dangerously
exacerbate the bleeding risk. Administering protamine sulfate
(Option B) is premature without an order and is typically reserved for
life-threatening bleeding or severe overdose, not an isolated
elevated aPTT without clinical bleeding. Continuing the current rate
(Option D) ignores the critical lab value and violates medication
safety protocols.
Learning Objective
Interpret aPTT laboratory values in the context of unfractionated
heparin therapy.
,Prioritize nursing interventions for supratherapeutic anticoagulation
levels.
Recognize the signs and risks of heparin-induced bleeding.
Medication Safety Focus
High-alert medication / Laboratory monitoring
Question 2
Clinical Scenario
A 55-year-old female is being discharged home with a new
prescription for warfarin 5 mg orally once daily for atrial fibrillation.
She has a history of mechanical heart valve replacement. During
discharge teaching, the nurse evaluates the client’s understanding
of dietary modifications and medication safety.
Question Stem
Which statement by the client indicates a need for further teaching?
Options
A. "I will use a soft-bristled toothbrush to prevent gum bleeding."
B. "I can eat a large spinach salad every day as long as I take my pill
at night."
C. "I will report any unusual bruising or dark, tarry stools to my
doctor immediately."
D. "I will make sure all my doctors and dentists know I am taking
warfarin."
, Correct Answer
Correct Answer: B. "I can eat a large spinach salad every day as long
as I take my pill at night."
Detailed Rationale
The statement indicating a need for further teaching is Option B.
Warfarin is a vitamin K antagonist. Spinach is highly rich in vitamin K,
which directly counteracts the therapeutic effect of warfarin,
leading to a subtherapeutic INR and increased risk of thrombosis.
Clients should be taught to maintain a consistent intake of vitamin
K-rich foods, not to abruptly increase or eliminate them, and
certainly not to consume large, variable amounts daily.
Option A is correct understanding, as a soft-bristled toothbrush
minimizes mucosal trauma and bleeding risk. Option C reflects
accurate knowledge of major bleeding signs (ecchymosis, melena)
that require immediate reporting. Option D is crucial for care
coordination, as warfarin has numerous drug-drug interactions and
affects procedural bleeding risks.
Learning Objective
Identify dietary sources of vitamin K that interact with warfarin.
Educate patients on consistent dietary habits while on
anticoagulant therapy.
Recognize clinical signs of bleeding that require immediate medical
evaluation.
Medication Safety Focus
Drug interaction / Patient education
System Exam |
20 Original ATI & NGN-Style Practice
Questions with Detailed Rationales
Question 1
Clinical Scenario
A 68-year-old male is admitted to the medical-surgical unit with a
diagnosis of deep vein thrombosis (DVT). The provider prescribes a
continuous intravenous infusion of unfractionated heparin. The
client’s baseline activated partial thromboplastin time (aPTT) is 30
seconds. After 6 hours of the infusion, the nurse reviews the client’s
laboratory results and notes the aPTT is 90 seconds. The normal
therapeutic range for aPTT is 1.5 to 2 times the baseline value.
Question Stem
Which action should the nurse take first?
Options
A. Increase the heparin infusion rate by 2 mL/hr.
B. Administer protamine sulfate intravenously immediately.
,C. Pause the heparin infusion and notify the health care provider.
D. Continue the current infusion rate and recheck the aPTT in 6
hours.
Correct Answer
Correct Answer: C. Pause the heparin infusion and notify the health
care provider.
Detailed Rationale
The correct action is to pause the heparin infusion and notify the
health care provider. The client’s baseline aPTT is 30 seconds,
making the therapeutic range 45 to 60 seconds (1.5 to 2 times
baseline). An aPTT of 90 seconds is supratherapeutic, placing the
client at a high risk for severe bleeding. Standard protocol for a
supratherapeutic aPTT on a heparin drip requires pausing the
infusion, assessing the client for any signs of active bleeding, and
notifying the provider for further orders (which may include a dose
reduction or, if active bleeding is present, administration of
protamine sulfate).
Increasing the infusion rate (Option A) would dangerously
exacerbate the bleeding risk. Administering protamine sulfate
(Option B) is premature without an order and is typically reserved for
life-threatening bleeding or severe overdose, not an isolated
elevated aPTT without clinical bleeding. Continuing the current rate
(Option D) ignores the critical lab value and violates medication
safety protocols.
Learning Objective
Interpret aPTT laboratory values in the context of unfractionated
heparin therapy.
,Prioritize nursing interventions for supratherapeutic anticoagulation
levels.
Recognize the signs and risks of heparin-induced bleeding.
Medication Safety Focus
High-alert medication / Laboratory monitoring
Question 2
Clinical Scenario
A 55-year-old female is being discharged home with a new
prescription for warfarin 5 mg orally once daily for atrial fibrillation.
She has a history of mechanical heart valve replacement. During
discharge teaching, the nurse evaluates the client’s understanding
of dietary modifications and medication safety.
Question Stem
Which statement by the client indicates a need for further teaching?
Options
A. "I will use a soft-bristled toothbrush to prevent gum bleeding."
B. "I can eat a large spinach salad every day as long as I take my pill
at night."
C. "I will report any unusual bruising or dark, tarry stools to my
doctor immediately."
D. "I will make sure all my doctors and dentists know I am taking
warfarin."
, Correct Answer
Correct Answer: B. "I can eat a large spinach salad every day as long
as I take my pill at night."
Detailed Rationale
The statement indicating a need for further teaching is Option B.
Warfarin is a vitamin K antagonist. Spinach is highly rich in vitamin K,
which directly counteracts the therapeutic effect of warfarin,
leading to a subtherapeutic INR and increased risk of thrombosis.
Clients should be taught to maintain a consistent intake of vitamin
K-rich foods, not to abruptly increase or eliminate them, and
certainly not to consume large, variable amounts daily.
Option A is correct understanding, as a soft-bristled toothbrush
minimizes mucosal trauma and bleeding risk. Option C reflects
accurate knowledge of major bleeding signs (ecchymosis, melena)
that require immediate reporting. Option D is crucial for care
coordination, as warfarin has numerous drug-drug interactions and
affects procedural bleeding risks.
Learning Objective
Identify dietary sources of vitamin K that interact with warfarin.
Educate patients on consistent dietary habits while on
anticoagulant therapy.
Recognize clinical signs of bleeding that require immediate medical
evaluation.
Medication Safety Focus
Drug interaction / Patient education
