NCLEX-RN Pharmacology Exam Questions &
Answers | Hematologic System | 20 Original NGN-
Style Practice Questions with Rationales | ATI
Pharmacology Made Easy Review | Nursing Exam
Study Guide
Question 1
Clinical Scenario
A 68-year-old male with a history of atrial fibrillation is admitted
to the medical-surgical unit with a new diagnosis of deep vein
thrombosis (DVT). The healthcare provider prescribes a
continuous intravenous infusion of unfractionated heparin. The
nurse reviews the facility's heparin protocol and notes the
patient's baseline activated partial thromboplastin time (aPTT)
is 28 seconds. Four hours after initiating the infusion, the
patient's aPTT is reported as 98 seconds. The patient denies any
bleeding, and vital signs are stable.
Question Stem
,Which action should the nurse take first?
A. Continue the heparin infusion at the current rate and
reassess aPTT in 6 hours
B. Discontinue the heparin infusion and notify the healthcare
provider immediately
C. Hold the infusion for 60 minutes, then restart at a decreased
rate per protocol
D. Administer protamine sulfate 50 mg IV push as a reversal
agent
Correct Answer: C. Hold the infusion for 60 minutes, then
restart at a decreased rate per protocol
Detailed Rationale
The therapeutic range for aPTT during unfractionated heparin
therapy is typically 1.5 to 2.5 times the control value, which
would be 42 to 70 seconds for this patient (28 × 1.5 = 42; 28 ×
2.5 = 70). An aPTT of 98 seconds is significantly
supratherapeutic, placing the patient at increased risk for
hemorrhage . The standard evidence-based nursing action for a
supratherapeutic aPTT without active bleeding is to temporarily
hold the infusion (usually 30-60 minutes) and restart at a
,decreased rate according to the facility's heparin nomogram.
This approach balances the need for therapeutic
anticoagulation with patient safety.
Option A is incorrect because continuing the current rate would
further elevate the aPTT and increase bleeding risk. Option B is
incorrect because permanent discontinuation is not indicated
unless there is life-threatening bleeding, heparin-induced
thrombocytopenia (HIT), or another serious adverse event.
Option D is incorrect because protamine sulfate is the reversal
agent for heparin, but it is reserved for severe, life-threatening
bleeding, not asymptomatic laboratory elevations.
Administering protamine for an elevated aPTT without bleeding
could reverse all anticoagulation and place the patient at risk
for thrombotic complications.
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 standard protocol adjustments and
emergent reversal for heparin therapy
, • Apply clinical judgment when managing anticoagulant
therapy
Medication Safety Focus
High-alert medication / Monitoring parameters
Question 2
Clinical Scenario
A 72-year-old female is discharged home after undergoing total
knee replacement surgery. Her discharge medications include
warfarin 5 mg daily for DVT prophylaxis. During a follow-up
phone call 5 days later, the patient tells the nurse, "I've been
eating a lot of spinach salads because I heard green vegetables
are good for my bones. I hope that's okay with my new blood
thinner."
Question Stem
Which response by the nurse is most appropriate?
A. "Spinach is fine to eat, but you should take your warfarin
with a full glass of milk to enhance its absorption."
B. "You should avoid all green leafy vegetables while taking
warfarin because they will make your blood too thin."
Answers | Hematologic System | 20 Original NGN-
Style Practice Questions with Rationales | ATI
Pharmacology Made Easy Review | Nursing Exam
Study Guide
Question 1
Clinical Scenario
A 68-year-old male with a history of atrial fibrillation is admitted
to the medical-surgical unit with a new diagnosis of deep vein
thrombosis (DVT). The healthcare provider prescribes a
continuous intravenous infusion of unfractionated heparin. The
nurse reviews the facility's heparin protocol and notes the
patient's baseline activated partial thromboplastin time (aPTT)
is 28 seconds. Four hours after initiating the infusion, the
patient's aPTT is reported as 98 seconds. The patient denies any
bleeding, and vital signs are stable.
Question Stem
,Which action should the nurse take first?
A. Continue the heparin infusion at the current rate and
reassess aPTT in 6 hours
B. Discontinue the heparin infusion and notify the healthcare
provider immediately
C. Hold the infusion for 60 minutes, then restart at a decreased
rate per protocol
D. Administer protamine sulfate 50 mg IV push as a reversal
agent
Correct Answer: C. Hold the infusion for 60 minutes, then
restart at a decreased rate per protocol
Detailed Rationale
The therapeutic range for aPTT during unfractionated heparin
therapy is typically 1.5 to 2.5 times the control value, which
would be 42 to 70 seconds for this patient (28 × 1.5 = 42; 28 ×
2.5 = 70). An aPTT of 98 seconds is significantly
supratherapeutic, placing the patient at increased risk for
hemorrhage . The standard evidence-based nursing action for a
supratherapeutic aPTT without active bleeding is to temporarily
hold the infusion (usually 30-60 minutes) and restart at a
,decreased rate according to the facility's heparin nomogram.
This approach balances the need for therapeutic
anticoagulation with patient safety.
Option A is incorrect because continuing the current rate would
further elevate the aPTT and increase bleeding risk. Option B is
incorrect because permanent discontinuation is not indicated
unless there is life-threatening bleeding, heparin-induced
thrombocytopenia (HIT), or another serious adverse event.
Option D is incorrect because protamine sulfate is the reversal
agent for heparin, but it is reserved for severe, life-threatening
bleeding, not asymptomatic laboratory elevations.
Administering protamine for an elevated aPTT without bleeding
could reverse all anticoagulation and place the patient at risk
for thrombotic complications.
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 standard protocol adjustments and
emergent reversal for heparin therapy
, • Apply clinical judgment when managing anticoagulant
therapy
Medication Safety Focus
High-alert medication / Monitoring parameters
Question 2
Clinical Scenario
A 72-year-old female is discharged home after undergoing total
knee replacement surgery. Her discharge medications include
warfarin 5 mg daily for DVT prophylaxis. During a follow-up
phone call 5 days later, the patient tells the nurse, "I've been
eating a lot of spinach salads because I heard green vegetables
are good for my bones. I hope that's okay with my new blood
thinner."
Question Stem
Which response by the nurse is most appropriate?
A. "Spinach is fine to eat, but you should take your warfarin
with a full glass of milk to enhance its absorption."
B. "You should avoid all green leafy vegetables while taking
warfarin because they will make your blood too thin."
