Hematologic System Pharmacology NCLEX-RN
Practice Questions: 20 Original MCQs with
Detailed Rationales, Medication Safety &
Clinical Judgment
Question 1
Clinical Scenario
A 68-year-old client with nonvalvular atrial fibrillation is
prescribed warfarin. The client has a history of hypertension
and chronic kidney disease. Current laboratory results include
an international normalized ratio (INR) of 5.8. The client reports
new bruising and bleeding from the gums when brushing the
teeth. The prescription is for warfarin 5 mg orally each evening.
Question Stem
Which action should the nurse take first?
A. Administer the prescribed warfarin and recheck the INR in 1
week.
B. Hold the warfarin dose and notify the provider of the
,findings.
C. Encourage the client to increase intake of foods high in
vitamin K.
D. Administer oral vitamin K immediately without notifying the
provider.
Correct Answer
Correct Answer: B. Hold the warfarin dose and notify the
provider of the findings.
Detailed Rationale
Warfarin is an anticoagulant with a narrow therapeutic range,
and an INR of 5.8 combined with active bleeding and bruising
indicates an increased risk for serious hemorrhage. The nurse
should withhold the dose and promptly notify the provider so
the anticoagulation plan can be evaluated. The provider may
determine whether additional interventions, such as vitamin K
administration, are necessary based on the severity of bleeding
and overall clinical status. A is unsafe because administering
warfarin despite a markedly elevated INR and bleeding could
worsen hemorrhage. C is not the immediate intervention.
Clients taking warfarin should maintain a consistent intake of
vitamin K rather than abruptly increasing it, because sudden
dietary changes can alter anticoagulant effectiveness. D is
incorrect because vitamin K administration requires clinical
evaluation and an appropriate prescription or protocol; the
,nurse should not independently administer it. Nursing care
includes assessing for occult and visible bleeding, monitoring
hemoglobin and hematocrit as indicated, reviewing medication
interactions, and teaching the client to report unusual bleeding,
black stools, severe headache, or falls. Medication
reconciliation is particularly important because NSAIDs, aspirin,
and certain antimicrobials may increase bleeding risk.
Learning Objective
After completing this question, the learner should be able to:
• Interpret an elevated INR in a client receiving warfarin.
• Prioritize nursing actions for anticoagulant-associated
bleeding risk.
• Explain the importance of consistent vitamin K intake.
• Identify medications and findings that increase
hemorrhage risk.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
, A 74-year-old client with chronic atrial fibrillation takes
apixaban for stroke prevention. The client is admitted after
falling at home. The client is alert and reports a mild headache
but denies loss of consciousness. Vital signs are stable. The
medication administration record shows that the next dose of
apixaban is due in 30 minutes.
Question Stem
Which action should the nurse take first?
A. Administer the apixaban because the client’s vital signs are
stable.
B. Give acetaminophen and reassess the headache in 1 hour.
C. Hold the apixaban and immediately notify the provider of the
fall and headache.
D. Ask the client to ambulate to determine whether a
neurological problem is present.
Correct Answer
Correct Answer: C. Hold the apixaban and immediately notify
the provider of the fall and headache.
Detailed Rationale
Apixaban inhibits factor Xa and increases the risk of bleeding. A
fall followed by a new headache in an anticoagulated older
adult raises concern for possible intracranial bleeding, even
when vital signs are initially normal. The nurse should hold the
Practice Questions: 20 Original MCQs with
Detailed Rationales, Medication Safety &
Clinical Judgment
Question 1
Clinical Scenario
A 68-year-old client with nonvalvular atrial fibrillation is
prescribed warfarin. The client has a history of hypertension
and chronic kidney disease. Current laboratory results include
an international normalized ratio (INR) of 5.8. The client reports
new bruising and bleeding from the gums when brushing the
teeth. The prescription is for warfarin 5 mg orally each evening.
Question Stem
Which action should the nurse take first?
A. Administer the prescribed warfarin and recheck the INR in 1
week.
B. Hold the warfarin dose and notify the provider of the
,findings.
C. Encourage the client to increase intake of foods high in
vitamin K.
D. Administer oral vitamin K immediately without notifying the
provider.
Correct Answer
Correct Answer: B. Hold the warfarin dose and notify the
provider of the findings.
Detailed Rationale
Warfarin is an anticoagulant with a narrow therapeutic range,
and an INR of 5.8 combined with active bleeding and bruising
indicates an increased risk for serious hemorrhage. The nurse
should withhold the dose and promptly notify the provider so
the anticoagulation plan can be evaluated. The provider may
determine whether additional interventions, such as vitamin K
administration, are necessary based on the severity of bleeding
and overall clinical status. A is unsafe because administering
warfarin despite a markedly elevated INR and bleeding could
worsen hemorrhage. C is not the immediate intervention.
Clients taking warfarin should maintain a consistent intake of
vitamin K rather than abruptly increasing it, because sudden
dietary changes can alter anticoagulant effectiveness. D is
incorrect because vitamin K administration requires clinical
evaluation and an appropriate prescription or protocol; the
,nurse should not independently administer it. Nursing care
includes assessing for occult and visible bleeding, monitoring
hemoglobin and hematocrit as indicated, reviewing medication
interactions, and teaching the client to report unusual bleeding,
black stools, severe headache, or falls. Medication
reconciliation is particularly important because NSAIDs, aspirin,
and certain antimicrobials may increase bleeding risk.
Learning Objective
After completing this question, the learner should be able to:
• Interpret an elevated INR in a client receiving warfarin.
• Prioritize nursing actions for anticoagulant-associated
bleeding risk.
• Explain the importance of consistent vitamin K intake.
• Identify medications and findings that increase
hemorrhage risk.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
, A 74-year-old client with chronic atrial fibrillation takes
apixaban for stroke prevention. The client is admitted after
falling at home. The client is alert and reports a mild headache
but denies loss of consciousness. Vital signs are stable. The
medication administration record shows that the next dose of
apixaban is due in 30 minutes.
Question Stem
Which action should the nurse take first?
A. Administer the apixaban because the client’s vital signs are
stable.
B. Give acetaminophen and reassess the headache in 1 hour.
C. Hold the apixaban and immediately notify the provider of the
fall and headache.
D. Ask the client to ambulate to determine whether a
neurological problem is present.
Correct Answer
Correct Answer: C. Hold the apixaban and immediately notify
the provider of the fall and headache.
Detailed Rationale
Apixaban inhibits factor Xa and increases the risk of bleeding. A
fall followed by a new headache in an anticoagulated older
adult raises concern for possible intracranial bleeding, even
when vital signs are initially normal. The nurse should hold the
