NAPLEX Anticoagulation Questions with Correct Answers (Grade
A+)
Question 1: The most common side effect of anticoagulants is -
Answer: bleeding
Question 2: Where does warfarin work in the coagulation cascade?
Answer: inhibits factors II, VII, IX, and X
Question 3: Where does fondaparinux work in the coagulation cascade?
Answer: inhibits factor Xa via antithrombin
Question 4: Where do argatroban, bivalirudin, and dabigatran work in the coagulation cascade?
Answer: direct thrombin (IIa) inhibitors
Question 5: Where do heparin and LMWHs work in the coagulation cascade?
Answer: inhibit factor Xa and IIa (thrombin) by increasing antithrombin activity - LMWH have more
anti-Xa activity than anti-thrombin
Question 6: What is the purpose of thrombin?
Answer: converts fibrinogen to fibrin which crosslinks to hold the clot together
Question 7: DOACs are preferred for stroke prevention in afib, except -
Answer: moderate-severe mitral stenosis or mechanical heart valve -> use warfarin
Question 8: When should a DOAC not be used for VTE treatment?
Answer: antiphospholipid syndrome or mechanical heart valve -> use warfarin
Question 9: All anticoagulants are ___ medications.
Answer: high alert (significant bleeding risk)
Question 10: What processes should be in place for anticoagulants per Joint Commission's NSPG?
Answer: need protocols to standardize initiation and monitoring of anticoagulants - ordering, dispensing,
administration, monitoring, and patient/caregiver education (for treatment doses)
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, Question 11: What drop in hemoglobin could indicate bleeding?
Answer: e2
Question 12: What can cause blood in emesis?
Answer: esophageal varices, chronic reflux, stomach ulcer, duodenal ulcer
Question 13: What can cause rectal bleeding/blood in stool?
Answer: bright red - hemorrhoids, rectal tear; black/tarry - dripping from esophagus, stomach, or
duodenum; also diverticulosis, colon cancer, IBD, colon polyps
Question 14: UFH VTE ppx dosing
Answer: 5000 IU subQ q8-12h
Question 15: UFH VTE treatment dosing
Answer: 80 units/kg bolus, then 18 units/kg/h (TBW)
Question 16: UFH ACS/STEMI dosing
Answer: 60 units/kg bolus, then 12 units/kg/h (TBW)
Question 17: heparin ADE
Answer: bleeding, thrombocytopenia, HIT, hyperkalemia, osteoporosis, alopecia
Question 18: How should heparin be monitored?
Answer: aPTT or anti-Xa 6h after initiation and q6h until therapeutic, then q24h and with dose changes
Question 19: What is the aPTT therapeutic range for UFH?
Answer: 1.5-2x control
Question 20: What lab value suggests possible HIT?
Answer: decrease in platelets by >50% from baseline while on heparin
Question 21: What are the risks with heparin lock flushes?
Answer: used to keep central lines open; fatal errors in neonates using higher concentrations than indicated -
injection and flushes are look-alike, sound-alike
Page 2
A+)
Question 1: The most common side effect of anticoagulants is -
Answer: bleeding
Question 2: Where does warfarin work in the coagulation cascade?
Answer: inhibits factors II, VII, IX, and X
Question 3: Where does fondaparinux work in the coagulation cascade?
Answer: inhibits factor Xa via antithrombin
Question 4: Where do argatroban, bivalirudin, and dabigatran work in the coagulation cascade?
Answer: direct thrombin (IIa) inhibitors
Question 5: Where do heparin and LMWHs work in the coagulation cascade?
Answer: inhibit factor Xa and IIa (thrombin) by increasing antithrombin activity - LMWH have more
anti-Xa activity than anti-thrombin
Question 6: What is the purpose of thrombin?
Answer: converts fibrinogen to fibrin which crosslinks to hold the clot together
Question 7: DOACs are preferred for stroke prevention in afib, except -
Answer: moderate-severe mitral stenosis or mechanical heart valve -> use warfarin
Question 8: When should a DOAC not be used for VTE treatment?
Answer: antiphospholipid syndrome or mechanical heart valve -> use warfarin
Question 9: All anticoagulants are ___ medications.
Answer: high alert (significant bleeding risk)
Question 10: What processes should be in place for anticoagulants per Joint Commission's NSPG?
Answer: need protocols to standardize initiation and monitoring of anticoagulants - ordering, dispensing,
administration, monitoring, and patient/caregiver education (for treatment doses)
Page 1
, Question 11: What drop in hemoglobin could indicate bleeding?
Answer: e2
Question 12: What can cause blood in emesis?
Answer: esophageal varices, chronic reflux, stomach ulcer, duodenal ulcer
Question 13: What can cause rectal bleeding/blood in stool?
Answer: bright red - hemorrhoids, rectal tear; black/tarry - dripping from esophagus, stomach, or
duodenum; also diverticulosis, colon cancer, IBD, colon polyps
Question 14: UFH VTE ppx dosing
Answer: 5000 IU subQ q8-12h
Question 15: UFH VTE treatment dosing
Answer: 80 units/kg bolus, then 18 units/kg/h (TBW)
Question 16: UFH ACS/STEMI dosing
Answer: 60 units/kg bolus, then 12 units/kg/h (TBW)
Question 17: heparin ADE
Answer: bleeding, thrombocytopenia, HIT, hyperkalemia, osteoporosis, alopecia
Question 18: How should heparin be monitored?
Answer: aPTT or anti-Xa 6h after initiation and q6h until therapeutic, then q24h and with dose changes
Question 19: What is the aPTT therapeutic range for UFH?
Answer: 1.5-2x control
Question 20: What lab value suggests possible HIT?
Answer: decrease in platelets by >50% from baseline while on heparin
Question 21: What are the risks with heparin lock flushes?
Answer: used to keep central lines open; fatal errors in neonates using higher concentrations than indicated -
injection and flushes are look-alike, sound-alike
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