NCLEX-RN Pharmacology Hematologic System
Exam Questions with Detailed Rationales |
Anticoagulants, Antiplatelets, Thrombolytics,
Anemia Drugs, NGN Nursing Practice Test
Question 1
Clinical Scenario
A 68-year-old male client with a history of atrial fibrillation is
admitted to the medical-surgical unit with a new diagnosis of
deep vein thrombosis (DVT) in his left calf. The provider orders
intravenous heparin infusion per protocol. The client's baseline
aPTT is 32 seconds. Six hours after initiating the infusion, the
client's aPTT is 98 seconds. The client reports mild gum
bleeding when brushing his teeth and has a small amount of
oozing from his intravenous site.
Question Stem
Which action should the nurse take first?
,A. Apply direct pressure to the IV site and notify the provider of
the bleeding
B. Administer vitamin K (phytonadione) as a reversal agent
C. Continue the heparin infusion and monitor the client closely
D. Decrease the heparin infusion rate per the facility's protocol
Options
A.
B.
C.
D.
Correct Answer
Correct Answer: D. Decrease the heparin infusion rate per the
facility's protocol
Detailed Rationale
The correct answer is to decrease the heparin infusion rate per
the facility's protocol. The client's aPTT of 98 seconds
represents a therapeutic but elevated value, as typical
therapeutic targets for heparin therapy are 1.5 to 2.5 times the
baseline aPTT. With a baseline of 32 seconds, the therapeutic
target range would be 48 to 80 seconds. An aPTT of 98 seconds
indicates the client is above the therapeutic range and at
,increased risk for bleeding. The appropriate nursing action is to
follow the facility's heparin titration protocol, which typically
requires decreasing the infusion rate when the aPTT exceeds
the target range.
Option A is incorrect because while the nurse should monitor
the IV site, notifying the provider is not the immediate priority.
The nurse has standing orders through the heparin protocol to
titrate the infusion based on aPTT results. Option B is incorrect
because vitamin K is the antidote for warfarin (Coumadin)
toxicity, not heparin. The reversal agent for heparin is
protamine sulfate, which would only be indicated in cases of
severe hemorrhage, not for a mildly elevated aPTT with minor
oozing. Option C is incorrect because continuing the infusion at
the current rate would place the client at continued risk for
bleeding complications.
The nurse should monitor the client for signs of bleeding,
including checking for occult blood in stool and urine, assessing
for petechiae or ecchymosis, and monitoring vital signs for
changes indicating hemorrhage. The nurse should also ensure
protamine sulfate is available at the bedside in case of severe
bleeding.
Learning Objective
After completing this question, the learner should be able to:
, • Interpret aPTT values in relation to therapeutic ranges for
heparin therapy.
• Implement appropriate nursing actions based on
laboratory monitoring results.
• Differentiate between reversal agents for heparin and
warfarin.
• Identify signs of bleeding complications during
anticoagulant therapy.
Medication Safety Focus
Medication administration/monitoring
Question 2
Clinical Scenario
A 32-year-old female client with a history of iron deficiency
anemia presents to the clinic for a follow-up visit. She has been
taking oral ferrous sulfate 325 mg three times daily for the past
two weeks. She reports that she has been taking the medication
with meals to avoid stomach upset and drinking orange juice
with each dose. She reports that her energy level remains low,
and she is still experiencing fatigue. Her hemoglobin level is 9.8
g/dL, down from 10.2 g/dL two weeks ago.
Question Stem
Exam Questions with Detailed Rationales |
Anticoagulants, Antiplatelets, Thrombolytics,
Anemia Drugs, NGN Nursing Practice Test
Question 1
Clinical Scenario
A 68-year-old male client with a history of atrial fibrillation is
admitted to the medical-surgical unit with a new diagnosis of
deep vein thrombosis (DVT) in his left calf. The provider orders
intravenous heparin infusion per protocol. The client's baseline
aPTT is 32 seconds. Six hours after initiating the infusion, the
client's aPTT is 98 seconds. The client reports mild gum
bleeding when brushing his teeth and has a small amount of
oozing from his intravenous site.
Question Stem
Which action should the nurse take first?
,A. Apply direct pressure to the IV site and notify the provider of
the bleeding
B. Administer vitamin K (phytonadione) as a reversal agent
C. Continue the heparin infusion and monitor the client closely
D. Decrease the heparin infusion rate per the facility's protocol
Options
A.
B.
C.
D.
Correct Answer
Correct Answer: D. Decrease the heparin infusion rate per the
facility's protocol
Detailed Rationale
The correct answer is to decrease the heparin infusion rate per
the facility's protocol. The client's aPTT of 98 seconds
represents a therapeutic but elevated value, as typical
therapeutic targets for heparin therapy are 1.5 to 2.5 times the
baseline aPTT. With a baseline of 32 seconds, the therapeutic
target range would be 48 to 80 seconds. An aPTT of 98 seconds
indicates the client is above the therapeutic range and at
,increased risk for bleeding. The appropriate nursing action is to
follow the facility's heparin titration protocol, which typically
requires decreasing the infusion rate when the aPTT exceeds
the target range.
Option A is incorrect because while the nurse should monitor
the IV site, notifying the provider is not the immediate priority.
The nurse has standing orders through the heparin protocol to
titrate the infusion based on aPTT results. Option B is incorrect
because vitamin K is the antidote for warfarin (Coumadin)
toxicity, not heparin. The reversal agent for heparin is
protamine sulfate, which would only be indicated in cases of
severe hemorrhage, not for a mildly elevated aPTT with minor
oozing. Option C is incorrect because continuing the infusion at
the current rate would place the client at continued risk for
bleeding complications.
The nurse should monitor the client for signs of bleeding,
including checking for occult blood in stool and urine, assessing
for petechiae or ecchymosis, and monitoring vital signs for
changes indicating hemorrhage. The nurse should also ensure
protamine sulfate is available at the bedside in case of severe
bleeding.
Learning Objective
After completing this question, the learner should be able to:
, • Interpret aPTT values in relation to therapeutic ranges for
heparin therapy.
• Implement appropriate nursing actions based on
laboratory monitoring results.
• Differentiate between reversal agents for heparin and
warfarin.
• Identify signs of bleeding complications during
anticoagulant therapy.
Medication Safety Focus
Medication administration/monitoring
Question 2
Clinical Scenario
A 32-year-old female client with a history of iron deficiency
anemia presents to the clinic for a follow-up visit. She has been
taking oral ferrous sulfate 325 mg three times daily for the past
two weeks. She reports that she has been taking the medication
with meals to avoid stomach upset and drinking orange juice
with each dose. She reports that her energy level remains low,
and she is still experiencing fatigue. Her hemoglobin level is 9.8
g/dL, down from 10.2 g/dL two weeks ago.
Question Stem
