NCLEX-RN Pharmacology Hematologic System
Practice Questions | 20 MCQs with Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 72-year-old male is admitted to the medical-surgical unit with
a new diagnosis of deep vein thrombosis (DVT) in his left calf.
The healthcare provider prescribes a continuous intravenous
infusion of unfractionated heparin. The patient's baseline
activated partial thromboplastin time (aPTT) is 28 seconds. The
nurse reviews the morning laboratory results and notes that the
current aPTT is 92 seconds. The patient denies any bleeding
symptoms, and vital signs are stable.
Question Stem
Which action should the nurse take first?
A. Administer protamine sulfate as a reversal agent.
B. Continue the infusion at the current rate and reassess in 4
hours.
,C. Discontinue the infusion and notify the healthcare provider
immediately.
D. Hold the infusion for 60 minutes and restart at a decreased
rate per the facility's heparin nomogram.
Correct Answer
D. Hold the infusion for 60 minutes and restart at a decreased
rate per the facility's heparin nomogram.
Detailed Rationale
The therapeutic range for aPTT in a patient receiving
unfractionated heparin is typically 1.5 to 2.5 times the baseline
control value. With a baseline of 28 seconds, the therapeutic
target range is approximately 42 to 70 seconds. A current aPTT
of 92 seconds is supratherapeutic, significantly increasing the
patient's risk for hemorrhage . The standard evidence-based
nursing action for a supratherapeutic aPTT without active
bleeding is to temporarily hold the infusion (usually for 30-60
minutes) and then restart it at a decreased rate according to the
facility's standardized heparin nomogram or protocol .
Option A is incorrect because protamine sulfate is reserved for
life-threatening hemorrhage, not asymptomatic laboratory
elevations. Option B would place the patient at continued risk
for bleeding complications. Option C is incorrect because
permanent discontinuation is not indicated unless there is
evidence of life-threatening bleeding or heparin-induced
,thrombocytopenia (HIT). Holding the infusion and decreasing
the rate allows the aPTT to return to therapeutic range while
maintaining anticoagulation.
Learning Objective
After completing this question, the learner should be able to:
• Interpret aPTT laboratory values in the context of
unfractionated heparin therapy.
• Prioritize nursing interventions for supratherapeutic
anticoagulation without active bleeding.
• Differentiate between reversal agents for various
anticoagulant medications.
Medication Safety Focus
Monitoring / Laboratory interpretation
Question 2
Clinical Scenario
A 68-year-old female is brought to the emergency department
with sudden onset of right-sided weakness, facial droop, and
expressive aphasia. The patient's symptoms began
approximately 90 minutes ago. A non-contrast CT scan confirms
an acute ischemic stroke without evidence of hemorrhage. The
, healthcare provider is considering prescribing intravenous
alteplase (tPA).
Question Stem
Which finding in the patient's history is an absolute
contraindication to the administration of alteplase?
A. History of well-controlled hypertension on lisinopril.
B. Current daily use of low-dose aspirin (81 mg).
C. History of an ischemic stroke 6 weeks ago.
D. Minor dental extraction performed 10 days ago.
Correct Answer
C. History of an ischemic stroke 6 weeks ago.
Detailed Rationale
Alteplase is a thrombolytic agent that carries a high risk of
severe bleeding, particularly intracranial hemorrhage.
According to current American Heart Association/American
Stroke Association (AHA/ASA) guidelines, a history of ischemic
stroke within the previous 3 months is an absolute
contraindication to alteplase administration due to the
unacceptably high risk of hemorrhagic conversion in the
recently infarcted brain tissue . The brain tissue in the area of a
recent stroke is fragile and has compromised blood vessels,
making it highly susceptible to bleeding when exposed to
thrombolytic therapy.
Practice Questions | 20 MCQs with Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 72-year-old male is admitted to the medical-surgical unit with
a new diagnosis of deep vein thrombosis (DVT) in his left calf.
The healthcare provider prescribes a continuous intravenous
infusion of unfractionated heparin. The patient's baseline
activated partial thromboplastin time (aPTT) is 28 seconds. The
nurse reviews the morning laboratory results and notes that the
current aPTT is 92 seconds. The patient denies any bleeding
symptoms, and vital signs are stable.
Question Stem
Which action should the nurse take first?
A. Administer protamine sulfate as a reversal agent.
B. Continue the infusion at the current rate and reassess in 4
hours.
,C. Discontinue the infusion and notify the healthcare provider
immediately.
D. Hold the infusion for 60 minutes and restart at a decreased
rate per the facility's heparin nomogram.
Correct Answer
D. Hold the infusion for 60 minutes and restart at a decreased
rate per the facility's heparin nomogram.
Detailed Rationale
The therapeutic range for aPTT in a patient receiving
unfractionated heparin is typically 1.5 to 2.5 times the baseline
control value. With a baseline of 28 seconds, the therapeutic
target range is approximately 42 to 70 seconds. A current aPTT
of 92 seconds is supratherapeutic, significantly increasing the
patient's risk for hemorrhage . The standard evidence-based
nursing action for a supratherapeutic aPTT without active
bleeding is to temporarily hold the infusion (usually for 30-60
minutes) and then restart it at a decreased rate according to the
facility's standardized heparin nomogram or protocol .
Option A is incorrect because protamine sulfate is reserved for
life-threatening hemorrhage, not asymptomatic laboratory
elevations. Option B would place the patient at continued risk
for bleeding complications. Option C is incorrect because
permanent discontinuation is not indicated unless there is
evidence of life-threatening bleeding or heparin-induced
,thrombocytopenia (HIT). Holding the infusion and decreasing
the rate allows the aPTT to return to therapeutic range while
maintaining anticoagulation.
Learning Objective
After completing this question, the learner should be able to:
• Interpret aPTT laboratory values in the context of
unfractionated heparin therapy.
• Prioritize nursing interventions for supratherapeutic
anticoagulation without active bleeding.
• Differentiate between reversal agents for various
anticoagulant medications.
Medication Safety Focus
Monitoring / Laboratory interpretation
Question 2
Clinical Scenario
A 68-year-old female is brought to the emergency department
with sudden onset of right-sided weakness, facial droop, and
expressive aphasia. The patient's symptoms began
approximately 90 minutes ago. A non-contrast CT scan confirms
an acute ischemic stroke without evidence of hemorrhage. The
, healthcare provider is considering prescribing intravenous
alteplase (tPA).
Question Stem
Which finding in the patient's history is an absolute
contraindication to the administration of alteplase?
A. History of well-controlled hypertension on lisinopril.
B. Current daily use of low-dose aspirin (81 mg).
C. History of an ischemic stroke 6 weeks ago.
D. Minor dental extraction performed 10 days ago.
Correct Answer
C. History of an ischemic stroke 6 weeks ago.
Detailed Rationale
Alteplase is a thrombolytic agent that carries a high risk of
severe bleeding, particularly intracranial hemorrhage.
According to current American Heart Association/American
Stroke Association (AHA/ASA) guidelines, a history of ischemic
stroke within the previous 3 months is an absolute
contraindication to alteplase administration due to the
unacceptably high risk of hemorrhagic conversion in the
recently infarcted brain tissue . The brain tissue in the area of a
recent stroke is fragile and has compromised blood vessels,
making it highly susceptible to bleeding when exposed to
thrombolytic therapy.
