NURS5463 EXAM 2 WITH COMPLETE
SOLUTION WITH CORRECT ANSWERS
GRADED A+
Q1. A 65-year-old patient presents with unilateral leg swelling, pain, and erythema. What Wells
Score indicates a high probability of DVT?
A) < 1
B) 2
C) > 2
D) > 6
Correct Answer: C) > 2
Rationale: A Wells Score >2 indicates a high probability of DVT and warrants diagnostic imaging
(compression ultrasound). A score of <1 indicates low probability, while a score of 2 indicates
moderate probability. For PE, a Wells score >6 indicates high probability .
Q2. Which anticoagulant is contraindicated in patients with mechanical heart valves and severe
renal impairment?
A) Warfarin
B) Heparin
C) Factor Xa inhibitors
D) Low molecular weight heparin (LMWH)
Correct Answer: C) Factor Xa inhibitors
Rationale: Factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) are contraindicated in
patients with mechanical heart valves and severe renal impairment (CrCl < 30 mL/min) .
Q3. What is the first-line anticoagulation for VTE in patients with active cancer?
,A) Warfarin
B) Heparin
C) Low molecular weight heparin (LMWH)
D) Factor Xa inhibitors
Correct Answer: C) Low molecular weight heparin (LMWH)
Rationale: LMWH is the first-line anticoagulation for VTE treatment in cancer patients due to its
predictable pharmacokinetics, efficacy, and lower bleeding risk compared to warfarin .
Q4. A patient with a GFR of 28 mL/min requires VTE prophylaxis. Which anticoagulant should be
avoided?
A) Unfractionated heparin
B) LMWH
C) Warfarin
D) Fondaparinux
Correct Answer: B) LMWH
Rationale: LMWH and fondaparinux are contraindicated in patients with GFR <30 mL/min due
to accumulation and increased bleeding risk. Unfractionated heparin is preferred in this
population .
Q5. A nonsurgical patient has a Padua prediction score of 4. What is the appropriate VTE
prophylaxis?
A) No prophylaxis needed
B) Pharmacologic prophylaxis
C) Mechanical prophylaxis only
D) Both pharmacologic and mechanical prophylaxis
Correct Answer: B) Pharmacologic prophylaxis
Rationale: A Padua score >4 indicates high VTE risk and warrants pharmacologic prophylaxis
(LMWH, fondaparinux, or UFH) unless the patient has a bleeding risk >2 .
,Q6. A patient with a low Padua prediction score (<4) requires which VTE prophylaxis?
A) Pharmacologic prophylaxis
B) Mechanical prophylaxis
C) No prophylaxis
D) Both pharmacologic and mechanical
Correct Answer: C) No prophylaxis
Rationale: For nonsurgical patients with a Padua score <4 (low VTE risk), no VTE prophylaxis is
indicated. Mechanical prophylaxis may be considered if mobility is limited .
Q7. What is the recommended duration of LMWH prophylaxis in orthopedic surgery patients?
A) 3-5 days
B) 7-10 days
C) 10-14 days
D) 30 days
Correct Answer: C) 10-14 days
Rationale: LMWH prophylaxis is recommended for 10-14 days in orthopedic surgery patients
(hip fracture, knee or hip replacement) due to the high risk of VTE .
Q8. Which is the most common inherited thrombophilia?
A) Protein C deficiency
B) Protein S deficiency
C) Factor V Leiden
D) Prothrombin G20210A mutation
Correct Answer: C) Factor V Leiden
Rationale: Factor V Leiden is the most common inherited thrombophilia, accounting for 40-50%
of cases. It causes activated protein C resistance .
, Q9. Which genetic mutation is identified by PCR testing for G20210A?
A) Factor V Leiden
B) Prothrombin mutation
C) Protein C deficiency
D) Antithrombin deficiency
Correct Answer: B) Prothrombin mutation
Rationale: The G20210A mutation is a prothrombin gene mutation that increases the risk of
VTE. This is diagnosed by PCR testing .
Q10. A patient with a PROS1 mutation is deficient in which anticoagulant protein?
A) Protein C
B) Protein S
C) Antithrombin
D) Factor VIII
Correct Answer: B) Protein S
Rationale: PROS1 mutation is associated with Protein S deficiency. Protein S is a cofactor for
activated protein C (APC) in the degradation of Factors Va and VIIIa .
Q11. Which laboratory test is affected by anticoagulation therapy (excluding heparin and
LMWH) and may interfere with hereditary thrombophilia testing?
A) PT/INR
B) PTT
C) Free protein S, protein C, and antithrombin functional assays
D) Fibrinogen
Correct Answer: C) Free protein S, protein C, and antithrombin functional assays
SOLUTION WITH CORRECT ANSWERS
GRADED A+
Q1. A 65-year-old patient presents with unilateral leg swelling, pain, and erythema. What Wells
Score indicates a high probability of DVT?
A) < 1
B) 2
C) > 2
D) > 6
Correct Answer: C) > 2
Rationale: A Wells Score >2 indicates a high probability of DVT and warrants diagnostic imaging
(compression ultrasound). A score of <1 indicates low probability, while a score of 2 indicates
moderate probability. For PE, a Wells score >6 indicates high probability .
Q2. Which anticoagulant is contraindicated in patients with mechanical heart valves and severe
renal impairment?
A) Warfarin
B) Heparin
C) Factor Xa inhibitors
D) Low molecular weight heparin (LMWH)
Correct Answer: C) Factor Xa inhibitors
Rationale: Factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) are contraindicated in
patients with mechanical heart valves and severe renal impairment (CrCl < 30 mL/min) .
Q3. What is the first-line anticoagulation for VTE in patients with active cancer?
,A) Warfarin
B) Heparin
C) Low molecular weight heparin (LMWH)
D) Factor Xa inhibitors
Correct Answer: C) Low molecular weight heparin (LMWH)
Rationale: LMWH is the first-line anticoagulation for VTE treatment in cancer patients due to its
predictable pharmacokinetics, efficacy, and lower bleeding risk compared to warfarin .
Q4. A patient with a GFR of 28 mL/min requires VTE prophylaxis. Which anticoagulant should be
avoided?
A) Unfractionated heparin
B) LMWH
C) Warfarin
D) Fondaparinux
Correct Answer: B) LMWH
Rationale: LMWH and fondaparinux are contraindicated in patients with GFR <30 mL/min due
to accumulation and increased bleeding risk. Unfractionated heparin is preferred in this
population .
Q5. A nonsurgical patient has a Padua prediction score of 4. What is the appropriate VTE
prophylaxis?
A) No prophylaxis needed
B) Pharmacologic prophylaxis
C) Mechanical prophylaxis only
D) Both pharmacologic and mechanical prophylaxis
Correct Answer: B) Pharmacologic prophylaxis
Rationale: A Padua score >4 indicates high VTE risk and warrants pharmacologic prophylaxis
(LMWH, fondaparinux, or UFH) unless the patient has a bleeding risk >2 .
,Q6. A patient with a low Padua prediction score (<4) requires which VTE prophylaxis?
A) Pharmacologic prophylaxis
B) Mechanical prophylaxis
C) No prophylaxis
D) Both pharmacologic and mechanical
Correct Answer: C) No prophylaxis
Rationale: For nonsurgical patients with a Padua score <4 (low VTE risk), no VTE prophylaxis is
indicated. Mechanical prophylaxis may be considered if mobility is limited .
Q7. What is the recommended duration of LMWH prophylaxis in orthopedic surgery patients?
A) 3-5 days
B) 7-10 days
C) 10-14 days
D) 30 days
Correct Answer: C) 10-14 days
Rationale: LMWH prophylaxis is recommended for 10-14 days in orthopedic surgery patients
(hip fracture, knee or hip replacement) due to the high risk of VTE .
Q8. Which is the most common inherited thrombophilia?
A) Protein C deficiency
B) Protein S deficiency
C) Factor V Leiden
D) Prothrombin G20210A mutation
Correct Answer: C) Factor V Leiden
Rationale: Factor V Leiden is the most common inherited thrombophilia, accounting for 40-50%
of cases. It causes activated protein C resistance .
, Q9. Which genetic mutation is identified by PCR testing for G20210A?
A) Factor V Leiden
B) Prothrombin mutation
C) Protein C deficiency
D) Antithrombin deficiency
Correct Answer: B) Prothrombin mutation
Rationale: The G20210A mutation is a prothrombin gene mutation that increases the risk of
VTE. This is diagnosed by PCR testing .
Q10. A patient with a PROS1 mutation is deficient in which anticoagulant protein?
A) Protein C
B) Protein S
C) Antithrombin
D) Factor VIII
Correct Answer: B) Protein S
Rationale: PROS1 mutation is associated with Protein S deficiency. Protein S is a cofactor for
activated protein C (APC) in the degradation of Factors Va and VIIIa .
Q11. Which laboratory test is affected by anticoagulation therapy (excluding heparin and
LMWH) and may interfere with hereditary thrombophilia testing?
A) PT/INR
B) PTT
C) Free protein S, protein C, and antithrombin functional assays
D) Fibrinogen
Correct Answer: C) Free protein S, protein C, and antithrombin functional assays
