NCLEX-RN Pharmacology Hematologic System
Practice Questions |
20 NGN-Style Nursing Exam MCQs with
Detailed Rationales |
Anticoagulants, Antiplatelets, Anemia Drugs,
ATI & NCLEX Review
NCLEX-RN Pharmacology Practice Examination
Topic: Hematologic System
Part 1 (Questions 1–5)
Question 1
Clinical Scenario
A 68-year-old man is admitted with a newly diagnosed deep
vein thrombosis (DVT) of the left leg. His medical history
includes hypertension and type 2 diabetes mellitus. The
provider prescribes unfractionated heparin by continuous IV
infusion. Six hours after initiation, laboratory results reveal:
, • aPTT: 94 seconds (reference: 25–35 seconds)
• Platelets: 235,000/mm³
• Hemoglobin: 14.1 g/dL
• BP: 128/76 mm Hg
• HR: 82/min
The client denies pain but reports mild bleeding when brushing
his teeth.
Question Stem
Which nursing action is the priority?
A. Continue the infusion and reassess the aPTT in 6 hours.
B. Stop the heparin infusion and notify the provider.
C. Administer protamine sulfate immediately without further
assessment.
D. Encourage the client to increase vitamin K intake.
Correct Answer
Correct Answer: B. Stop the heparin infusion and notify the
provider.
Detailed Rationale
Unfractionated heparin is titrated using the activated partial
thromboplastin time (aPTT), with a typical therapeutic target of
,approximately 1.5–2.5 times the control value. An aPTT of 94
seconds is significantly above the expected therapeutic range,
indicating excessive anticoagulation and an increased risk for
bleeding. The client's report of gingival bleeding further
supports concern for over-anticoagulation. The nurse should
immediately stop the infusion and notify the provider so the
dosage can be adjusted or additional treatment ordered.
Option A is incorrect because continuing an infusion when the
aPTT is markedly elevated increases the risk of serious
hemorrhage. Option C is incorrect because protamine sulfate is
the antidote for heparin but is not automatically indicated. The
provider should determine whether reversal is necessary based
on the severity of bleeding and laboratory findings. Option D is
incorrect because vitamin K reverses warfarin, not heparin, and
dietary vitamin K has no therapeutic role in correcting heparin-
induced anticoagulation.
Medication safety requires frequent monitoring of coagulation
parameters, assessment for occult bleeding, verification of
infusion pump settings, and prompt communication of
abnormal laboratory values.
Learning Objectives
After completing this question, the learner should be able to:
• Interpret aPTT values during unfractionated heparin
therapy.
, • Recognize early manifestations of excessive
anticoagulation.
• Prioritize nursing interventions for abnormal coagulation
results.
• Differentiate the reversal agents for heparin and warfarin.
Medication Safety Focus
Monitoring – High-alert anticoagulant medication
Question 2
Clinical Scenario
A 74-year-old woman with chronic atrial fibrillation has been
taking warfarin for several years. During discharge teaching, the
nurse evaluates the client's understanding of medication
management.
Question Stem
Which statement by the client indicates a need for further
teaching?
A. "I'll notify my provider before taking herbal supplements."
B. "I'll try to eat about the same amount of leafy green
vegetables each week."
C. "If I miss a dose today, I'll double tomorrow's dose."
Practice Questions |
20 NGN-Style Nursing Exam MCQs with
Detailed Rationales |
Anticoagulants, Antiplatelets, Anemia Drugs,
ATI & NCLEX Review
NCLEX-RN Pharmacology Practice Examination
Topic: Hematologic System
Part 1 (Questions 1–5)
Question 1
Clinical Scenario
A 68-year-old man is admitted with a newly diagnosed deep
vein thrombosis (DVT) of the left leg. His medical history
includes hypertension and type 2 diabetes mellitus. The
provider prescribes unfractionated heparin by continuous IV
infusion. Six hours after initiation, laboratory results reveal:
, • aPTT: 94 seconds (reference: 25–35 seconds)
• Platelets: 235,000/mm³
• Hemoglobin: 14.1 g/dL
• BP: 128/76 mm Hg
• HR: 82/min
The client denies pain but reports mild bleeding when brushing
his teeth.
Question Stem
Which nursing action is the priority?
A. Continue the infusion and reassess the aPTT in 6 hours.
B. Stop the heparin infusion and notify the provider.
C. Administer protamine sulfate immediately without further
assessment.
D. Encourage the client to increase vitamin K intake.
Correct Answer
Correct Answer: B. Stop the heparin infusion and notify the
provider.
Detailed Rationale
Unfractionated heparin is titrated using the activated partial
thromboplastin time (aPTT), with a typical therapeutic target of
,approximately 1.5–2.5 times the control value. An aPTT of 94
seconds is significantly above the expected therapeutic range,
indicating excessive anticoagulation and an increased risk for
bleeding. The client's report of gingival bleeding further
supports concern for over-anticoagulation. The nurse should
immediately stop the infusion and notify the provider so the
dosage can be adjusted or additional treatment ordered.
Option A is incorrect because continuing an infusion when the
aPTT is markedly elevated increases the risk of serious
hemorrhage. Option C is incorrect because protamine sulfate is
the antidote for heparin but is not automatically indicated. The
provider should determine whether reversal is necessary based
on the severity of bleeding and laboratory findings. Option D is
incorrect because vitamin K reverses warfarin, not heparin, and
dietary vitamin K has no therapeutic role in correcting heparin-
induced anticoagulation.
Medication safety requires frequent monitoring of coagulation
parameters, assessment for occult bleeding, verification of
infusion pump settings, and prompt communication of
abnormal laboratory values.
Learning Objectives
After completing this question, the learner should be able to:
• Interpret aPTT values during unfractionated heparin
therapy.
, • Recognize early manifestations of excessive
anticoagulation.
• Prioritize nursing interventions for abnormal coagulation
results.
• Differentiate the reversal agents for heparin and warfarin.
Medication Safety Focus
Monitoring – High-alert anticoagulant medication
Question 2
Clinical Scenario
A 74-year-old woman with chronic atrial fibrillation has been
taking warfarin for several years. During discharge teaching, the
nurse evaluates the client's understanding of medication
management.
Question Stem
Which statement by the client indicates a need for further
teaching?
A. "I'll notify my provider before taking herbal supplements."
B. "I'll try to eat about the same amount of leafy green
vegetables each week."
C. "If I miss a dose today, I'll double tomorrow's dose."
