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 with a history of atrial fibrillation is admitted to
the medical-surgical unit. He has been taking warfarin 5 mg daily at
home for the past 3 months. His morning laboratory results reveal a
prothrombin time (PT) of 18 seconds and an International
Normalized Ratio (INR) of 2.6. He has no signs of active bleeding,
bruising, or petechiae. His vital signs are stable.
Question Stem
Which action should the nurse take based on these laboratory
findings?
Options
A. Hold the warfarin dose and prepare to administer intravenous
,vitamin K.
B. Request a prescription for fresh frozen plasma (FFP) to reverse
the anticoagulation.
C. Administer the scheduled daily dose of warfarin.
D. Decrease the warfarin dose by 50% for the next three days.
Correct Answer
Correct Answer: C. Administer the scheduled daily dose of warfarin.
Detailed Rationale
The correct action is to administer the scheduled daily dose of
warfarin. For patients with atrial fibrillation, the therapeutic INR
range is typically 2.0 to 3.0. An INR of 2.6 falls perfectly within this
therapeutic window, indicating that the current dosage is effective
and safe. The PT of 18 seconds is also consistent with therapeutic
anticoagulation (normal is 11-15 seconds). Holding the dose or
administering vitamin K (Option A) is inappropriate because the
patient is not supratherapeutic and shows no signs of bleeding.
Fresh frozen plasma (Option B) is reserved for life-threatening
bleeding or the need for emergent surgery in anticoagulated
patients, neither of which is present here. Decreasing the dose
(Option D) without a provider's order and without a supratherapeutic
INR is unsafe and could lead to subtherapeutic anticoagulation,
increasing the risk of thromboembolic events like stroke. The nurse
should continue to monitor for signs of bleeding and ensure
consistent dietary vitamin K intake.
Learning Objective
Interpret PT and INR laboratory values for patients on warfarin
therapy.
,Identify the therapeutic INR range for atrial fibrillation.
Prioritize appropriate nursing actions based on therapeutic
laboratory findings.
Medication Safety Focus
Laboratory monitoring and therapeutic range evaluation.
Question 2
Clinical Scenario
A 55-year-old female is receiving a continuous intravenous infusion
of unfractionated heparin for a deep vein thrombosis (DVT). On day
4 of therapy, the nurse reviews the morning laboratory results and
notes that the patient’s platelet count has dropped from
240,000/mm³ on admission to 110,000/mm³. The patient reports
new-onset mild pain and swelling in her left calf, and her vital signs
remain stable.
Question Stem
Which action should the nurse take first?
Options
A. Discontinue the heparin infusion immediately.
B. Administer the scheduled dose of enoxaparin subcutaneously.
C. Increase the heparin infusion rate by 10%.
D. Request a prescription for a platelet transfusion.
Correct Answer
Correct Answer: A. Discontinue the heparin infusion immediately.
, Detailed Rationale
The correct first action is to discontinue the heparin infusion
immediately. The patient is exhibiting classic signs of Heparin-
Induced Thrombocytopenia (HIT), a life-threatening immune-
mediated adverse reaction. HIT is characterized by a platelet count
drop of more than 50% from baseline (or below 150,000/mm³)
typically occurring 5–10 days after starting heparin, often
accompanied by new thrombosis (e.g., new calf pain/swelling
suggesting DVT extension). Continuing heparin or switching to
another heparin product like enoxaparin (Option B) is absolutely
contraindicated, as low-molecular-weight heparins can cross-react
and worsen the condition. Increasing the heparin rate (Option C)
would exacerbate the immune response and thrombotic risk.
Platelet transfusions (Option D) are generally contraindicated in HIT
unless there is life-threatening bleeding, as they can fuel further
thrombosis. After stopping heparin, the nurse must notify the
provider to initiate a non-heparin anticoagulant, such as argatroban
or bivalirudin.
Learning Objective
Recognize the clinical and laboratory manifestations of Heparin-
Induced Thrombocytopenia (HIT).
Prioritize immediate nursing interventions for suspected HIT.
Identify contraindications for low-molecular-weight heparins in
patients with HIT.
Medication Safety Focus
Adverse effect recognition and high-alert medication
discontinuation.
Hematologic System |
20 Original ATI & NGN-Style Practice
Questions with Detailed Rationales |
Nursing Study Guide
Question 1
Clinical Scenario
A 68-year-old male with a history of atrial fibrillation is admitted to
the medical-surgical unit. He has been taking warfarin 5 mg daily at
home for the past 3 months. His morning laboratory results reveal a
prothrombin time (PT) of 18 seconds and an International
Normalized Ratio (INR) of 2.6. He has no signs of active bleeding,
bruising, or petechiae. His vital signs are stable.
Question Stem
Which action should the nurse take based on these laboratory
findings?
Options
A. Hold the warfarin dose and prepare to administer intravenous
,vitamin K.
B. Request a prescription for fresh frozen plasma (FFP) to reverse
the anticoagulation.
C. Administer the scheduled daily dose of warfarin.
D. Decrease the warfarin dose by 50% for the next three days.
Correct Answer
Correct Answer: C. Administer the scheduled daily dose of warfarin.
Detailed Rationale
The correct action is to administer the scheduled daily dose of
warfarin. For patients with atrial fibrillation, the therapeutic INR
range is typically 2.0 to 3.0. An INR of 2.6 falls perfectly within this
therapeutic window, indicating that the current dosage is effective
and safe. The PT of 18 seconds is also consistent with therapeutic
anticoagulation (normal is 11-15 seconds). Holding the dose or
administering vitamin K (Option A) is inappropriate because the
patient is not supratherapeutic and shows no signs of bleeding.
Fresh frozen plasma (Option B) is reserved for life-threatening
bleeding or the need for emergent surgery in anticoagulated
patients, neither of which is present here. Decreasing the dose
(Option D) without a provider's order and without a supratherapeutic
INR is unsafe and could lead to subtherapeutic anticoagulation,
increasing the risk of thromboembolic events like stroke. The nurse
should continue to monitor for signs of bleeding and ensure
consistent dietary vitamin K intake.
Learning Objective
Interpret PT and INR laboratory values for patients on warfarin
therapy.
,Identify the therapeutic INR range for atrial fibrillation.
Prioritize appropriate nursing actions based on therapeutic
laboratory findings.
Medication Safety Focus
Laboratory monitoring and therapeutic range evaluation.
Question 2
Clinical Scenario
A 55-year-old female is receiving a continuous intravenous infusion
of unfractionated heparin for a deep vein thrombosis (DVT). On day
4 of therapy, the nurse reviews the morning laboratory results and
notes that the patient’s platelet count has dropped from
240,000/mm³ on admission to 110,000/mm³. The patient reports
new-onset mild pain and swelling in her left calf, and her vital signs
remain stable.
Question Stem
Which action should the nurse take first?
Options
A. Discontinue the heparin infusion immediately.
B. Administer the scheduled dose of enoxaparin subcutaneously.
C. Increase the heparin infusion rate by 10%.
D. Request a prescription for a platelet transfusion.
Correct Answer
Correct Answer: A. Discontinue the heparin infusion immediately.
, Detailed Rationale
The correct first action is to discontinue the heparin infusion
immediately. The patient is exhibiting classic signs of Heparin-
Induced Thrombocytopenia (HIT), a life-threatening immune-
mediated adverse reaction. HIT is characterized by a platelet count
drop of more than 50% from baseline (or below 150,000/mm³)
typically occurring 5–10 days after starting heparin, often
accompanied by new thrombosis (e.g., new calf pain/swelling
suggesting DVT extension). Continuing heparin or switching to
another heparin product like enoxaparin (Option B) is absolutely
contraindicated, as low-molecular-weight heparins can cross-react
and worsen the condition. Increasing the heparin rate (Option C)
would exacerbate the immune response and thrombotic risk.
Platelet transfusions (Option D) are generally contraindicated in HIT
unless there is life-threatening bleeding, as they can fuel further
thrombosis. After stopping heparin, the nurse must notify the
provider to initiate a non-heparin anticoagulant, such as argatroban
or bivalirudin.
Learning Objective
Recognize the clinical and laboratory manifestations of Heparin-
Induced Thrombocytopenia (HIT).
Prioritize immediate nursing interventions for suspected HIT.
Identify contraindications for low-molecular-weight heparins in
patients with HIT.
Medication Safety Focus
Adverse effect recognition and high-alert medication
discontinuation.
