ATI Pharmacology Made Easy Hematologic System
Exam Questions |
20 NCLEX-RN NGN Pharmacology Practice
Questions with Rationales |
Anticoagulants, Antiplatelets, Thrombolytics &
Hematologic Drugs Study Guide
Question 1
Clinical Scenario
A 72-year-old man is admitted with a newly diagnosed deep
vein thrombosis (DVT) of the left leg. His medical history
includes hypertension, atrial fibrillation, and chronic kidney
disease stage 3. The provider prescribes heparin by continuous
IV infusion. Baseline laboratory results include:
• Platelet count: 245,000/mm³
• aPTT: 31 seconds
• Hemoglobin: 13.8 g/dL
, • Creatinine: 1.8 mg/dL
Four days after therapy begins, the nurse notes new swelling of
the right calf and reviews the laboratory results. The platelet
count is now 82,000/mm³.
Question Stem
Which action should the nurse take first?
A. Administer the next scheduled dose of heparin and notify the
provider afterward.
B. Stop the heparin infusion and notify the provider
immediately.
C. Obtain an INR before making any changes.
D. Administer protamine sulfate immediately.
Correct Answer
B. Stop the heparin infusion and notify the provider
immediately.
Detailed Rationale
The client demonstrates findings highly suggestive of heparin-
induced thrombocytopenia (HIT), an immune-mediated
adverse reaction characterized by a significant decline in
platelet count (typically >50% from baseline) occurring 5–10
days after starting heparin, although it may occur earlier with
previous exposure. HIT paradoxically increases the risk of
, thrombosis despite thrombocytopenia, explaining the new calf
swelling. The priority nursing action is to discontinue all heparin
products immediately and notify the provider so an alternative
anticoagulant (such as argatroban or bivalirudin) can be
initiated.
Option A is unsafe because continuing heparin can worsen
thrombotic complications. Option C is incorrect because INR
monitors warfarin therapy and is not useful in diagnosing or
managing HIT. Option D is inappropriate because protamine
sulfate reverses acute heparin anticoagulation during bleeding
or overdose; HIT is an immune-mediated complication requiring
discontinuation rather than reversal unless active bleeding is
also present.
The nurse should monitor for signs of new thrombosis,
bleeding, and document heparin as a significant adverse
reaction in the medical record. Future exposure to heparin
should generally be avoided.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize clinical manifestations of heparin-induced
thrombocytopenia.
• Prioritize nursing interventions for suspected HIT.
• Differentiate HIT from heparin overdose.
Exam Questions |
20 NCLEX-RN NGN Pharmacology Practice
Questions with Rationales |
Anticoagulants, Antiplatelets, Thrombolytics &
Hematologic Drugs Study Guide
Question 1
Clinical Scenario
A 72-year-old man is admitted with a newly diagnosed deep
vein thrombosis (DVT) of the left leg. His medical history
includes hypertension, atrial fibrillation, and chronic kidney
disease stage 3. The provider prescribes heparin by continuous
IV infusion. Baseline laboratory results include:
• Platelet count: 245,000/mm³
• aPTT: 31 seconds
• Hemoglobin: 13.8 g/dL
, • Creatinine: 1.8 mg/dL
Four days after therapy begins, the nurse notes new swelling of
the right calf and reviews the laboratory results. The platelet
count is now 82,000/mm³.
Question Stem
Which action should the nurse take first?
A. Administer the next scheduled dose of heparin and notify the
provider afterward.
B. Stop the heparin infusion and notify the provider
immediately.
C. Obtain an INR before making any changes.
D. Administer protamine sulfate immediately.
Correct Answer
B. Stop the heparin infusion and notify the provider
immediately.
Detailed Rationale
The client demonstrates findings highly suggestive of heparin-
induced thrombocytopenia (HIT), an immune-mediated
adverse reaction characterized by a significant decline in
platelet count (typically >50% from baseline) occurring 5–10
days after starting heparin, although it may occur earlier with
previous exposure. HIT paradoxically increases the risk of
, thrombosis despite thrombocytopenia, explaining the new calf
swelling. The priority nursing action is to discontinue all heparin
products immediately and notify the provider so an alternative
anticoagulant (such as argatroban or bivalirudin) can be
initiated.
Option A is unsafe because continuing heparin can worsen
thrombotic complications. Option C is incorrect because INR
monitors warfarin therapy and is not useful in diagnosing or
managing HIT. Option D is inappropriate because protamine
sulfate reverses acute heparin anticoagulation during bleeding
or overdose; HIT is an immune-mediated complication requiring
discontinuation rather than reversal unless active bleeding is
also present.
The nurse should monitor for signs of new thrombosis,
bleeding, and document heparin as a significant adverse
reaction in the medical record. Future exposure to heparin
should generally be avoided.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize clinical manifestations of heparin-induced
thrombocytopenia.
• Prioritize nursing interventions for suspected HIT.
• Differentiate HIT from heparin overdose.
