Master the cellular mechanisms, lab monitoring, clinical scenarios, and nursing actions for every anticoagulant drug class tested on the NCLEX-PN.
📚 What You Will Master:
💜 LPN Scope Reminder: LPNs COLLECT DATA and REPORT! RNs ASSESS and DIAGNOSE!
Enter your name to begin:
Understanding normal hemostasis at the cellular level before we break it with drugs
Imagine your blood vessels as a massive highway system. When the highway is damaged, such as from a cut, your body has an incredible emergency repair crew that rushes to the scene. This repair process is called hemostasis, which literally means “stopping the blood.”
Hemostasis happens in three stages, like a factory assembly line:
| Feature | Intrinsic Pathway | Extrinsic Pathway |
|---|---|---|
| Triggered by | Blood contacts damaged collagen inside vessel | Damaged tissue releases tissue factor (Factor III) |
| Speed | Slower (minutes) | Faster (seconds) |
| Factors involved | XII, XI, IX, VIII | VII, III (tissue factor) |
| Lab test | aPTT (activated Partial Thromboplastin Time) | PT / INR (Prothrombin Time / International Normalized Ratio) |
| Drug monitored | HEPARIN | WARFARIN |
| They merge at | COMMON PATHWAY → Factor X → Prothrombin → Thrombin → Fibrin | |
“HIT the aPTT” = Heparin is monitored by aPTT
“WEPT” = Warfarin uses Extrinsic pathway, measured by PT (or INR)
“P for Protamine, P for Heparin Problem” = Protamine sulfate reverses heparin
“K for Coumadin Kure” = Vitamin K reverses warfarin (Coumadin)
“PT Boat on the ExTerior” = PT measures the Extrinsic pathway
On the NCLEX, you must recognize cues that indicate a patient on anticoagulants is bleeding. Look for:
NCLEX Tip: When the question says “Which finding would the nurse report IMMEDIATELY?” → Choose the bleeding sign for patients on anticoagulants!
15 questions — 80% required to unlock Section 2
Which blood test monitors the therapeutic effect of heparin?
The nurse is caring for a client receiving warfarin. Which lab value indicates the drug is at a therapeutic level?
The antidote for heparin overdose is:
Normal hemostasis occurs in three stages. Place them in the correct order:
The intrinsic clotting pathway is measured by which laboratory test?
Which cell factory produces clotting factors II, VII, IX, and X using Vitamin K?
A client on anticoagulant therapy presents with tachycardia, hypotension, and abdominal pain. The nurse should FIRST recognize these as cues for:
Thrombolytic drugs such as alteplase (tPA) work by:
Aspirin prevents clotting by blocking which enzyme on platelets?
Which of the following are appropriate bleeding precautions for a client on anticoagulants? Select All That Apply.
Where in the clotting cascade do Direct Oral Anticoagulants (DOACs) like dabigatran work?
The normal aPTT range is:
A client asks, “What is the difference between heparin and warfarin?” Which response by the nurse is most accurate?
Which finding is the LPN’s PRIORITY to report in a client receiving anticoagulant therapy?
Clopidogrel (Plavix) prevents clotting by blocking which receptor on platelets?
UFH vs LMWH, aPTT Monitoring, HIT, Administration & Protamine Sulfate
Your body already has a natural anti-clotting protein called Antithrombin III (AT-III). Think of AT-III as the factory’s safety inspector who walks around saying, “Slow down! Not too many clots!”
The problem? AT-III works very slowly on its own. Heparin is like giving the safety inspector a megaphone and a golf cart — it makes AT-III work 1,000 times faster!
Heparin + Antithrombin III → Blocks thrombin and Factor Xa → Prevents clot formation
Key Point: Heparin does NOT dissolve existing clots! It only prevents NEW clots from forming and existing clots from getting larger.
| Feature | UFH (Unfractionated Heparin) | LMWH (e.g., Enoxaparin/Lovenox) |
|---|---|---|
| Route | IV continuous infusion or SubQ | SubQ only (deep abdominal injection) |
| Onset | Immediate (IV bolus) | Slower (SubQ, 1–2 hours) |
| Half-life | Short (1–2 hours IV) | Longer (3–6 hours SubQ) |
| Monitoring | aPTT required (every 4–6 hours initially) | No routine aPTT needed |
| Therapeutic aPTT | 1.5–2.5 × normal (45–100 sec) | N/A |
| Dosing | Weight-based (units); bolus then infusion | Fixed dose (mg/kg); once or twice daily |
| Antidote | PROTAMINE SULFATE for both | |
| HIT risk | Higher | Lower |
| SubQ technique | Abdomen, 90° angle, ⅛″ needle (25–28 gauge), NO aspirate, NO rub | |
| Pregnancy | Used cautiously; does NOT cross placenta (preferred over warfarin) | |
This is heavily tested on NCLEX! Follow these rules for subcutaneous heparin and enoxaparin:
Roll the heparin vial between your hands gently. NEVER shake it!
HIT is one of the most dangerous complications of heparin therapy. Here is what happens at the cellular level:
Step 1: Patient receives heparin therapy
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Step 2: The immune system makes antibodies AGAINST heparin
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Step 3: These antibodies bind to platelets and ACTIVATE them
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Step 4: Activated platelets clump together → PLATELET COUNT DROPS (thrombocytopenia)
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Step 5: Paradoxically, the clumped platelets form SMALL CLOTS throughout the body
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THE PARADOX: Patient is on an ANTI-clotting drug but is CLOTTING! 🚨 LIFE-THREATENING!
If HIT progresses to form major clots blocking vessels, it becomes HITT (Heparin-Induced Thrombocytopenia and Thrombosis) — even more dangerous.
| aPTT Result | Interpretation | Action |
|---|---|---|
| < 45 seconds | Below therapeutic (subtherapeutic) | Dose may need to be INCREASED; report to PHCP |
| 45 – 100 seconds | THERAPEUTIC RANGE ✓ | Continue current dose; recheck per protocol |
| > 100 seconds | Above therapeutic (supratherapeutic) | HOLD heparin, report IMMEDIATELY, dose will be DECREASED |
| > 150 seconds | CRITICAL — HIGH BLEEDING RISK | HOLD heparin, NOTIFY stat, protamine may be needed |
Key Rules:
Protamine sulfate reverses the effects of heparin. It works by binding to heparin and forming a stable complex that has NO anticoagulant activity.
15 questions — 80% required to unlock Section 3
A client receiving continuous IV heparin has an aPTT of 120 seconds. What should the LPN do FIRST?
When administering subcutaneous heparin, the nurse should:
A client receiving heparin has a platelet count that dropped from 250,000 to 110,000 over 5 days. The nurse should recognize this as a potential sign of:
The therapeutic aPTT range for a client on continuous IV heparin is:
When drawing blood for aPTT in a client receiving IV heparin in the left arm, the nurse should:
Enoxaparin (Lovenox) differs from unfractionated heparin in that enoxaparin:
The nurse is preparing to administer enoxaparin subcutaneously. Which action is correct?
A client on heparin develops wheezing, shortness of breath, and facial swelling. The nurse should recognize this as:
The client is receiving both heparin and warfarin. The nurse understands this “bridge therapy” is necessary because:
A client on heparin has an aPTT of 55 seconds. What action should the nurse take?
Which client would the nurse anticipate receiving heparin prophylactically? Select All That Apply.
The nurse discovers the heparin solution appears discolored. What should the nurse do?
Heparin prevents clot formation by:
Which finding is MOST important for the nurse to report for a client on IV heparin?
Continuous IV heparin must be administered using:
Vitamin K Antagonism, INR Monitoring, Bridge Therapy, Drug/Food Interactions
Remember that the hepatocyte factory (liver cell) needs Vitamin K to manufacture clotting factors II, VII, IX, and X. Without these factors, the clotting cascade cannot complete.
Warfarin works by blocking the enzyme that recycles Vitamin K in the liver. Without recycled Vitamin K, the hepatocyte factory runs out of raw material and cannot produce these four critical clotting factors.
Key Difference from Heparin: Warfarin takes 3–5 days to work because the body must first USE UP its existing supply of clotting factors. This is why bridge therapy with heparin is needed!
| INR Value | Interpretation | Nursing Action |
|---|---|---|
| 0.8–1.2 | Normal (no anticoagulation effect) | Subtherapeutic if on warfarin — dose may need increase |
| 2.0–3.0 | THERAPEUTIC for standard warfarin ✓ | Continue current dose. Recheck per protocol. |
| 2.5–3.5 | THERAPEUTIC for mechanical heart valves | Higher target needed due to high clot risk in valve |
| > 3.0 | Supratherapeutic (standard therapy) | HOLD warfarin, REPORT. Dose will be decreased. |
| > 4.5 | CRITICAL — HIGH BLEEDING RISK | HOLD, NOTIFY stat. Vitamin K may be ordered. |
Normal PT: 11–12.5 seconds. Therapeutic PT: 1.5–2 times control value.
Key Rule: If PT > 32 seconds AND INR > 3.0 → Initiate BLEEDING PRECAUTIONS
Since warfarin takes 3–5 days to work, patients who need immediate anticoagulation receive BOTH drugs together:
Day 1: Start IV heparin (immediate anticoagulation) + Start oral warfarin (begins building effect)
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Days 2–4: Continue BOTH. Monitor aPTT for heparin AND INR for warfarin
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Day 3–5: INR reaches therapeutic range (2.0–3.0)
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Once INR is therapeutic: DISCONTINUE heparin. Continue warfarin alone.
Memory Trick: “Heparin is the bridge until warfarin can stand on its own!”
IMPORTANT: Heparin and warfarin CAN be given at the same time. Most other anticoagulants CANNOT be combined!
Patients do NOT need to avoid green leafy vegetables entirely. They should eat a consistent amount each day. Sudden INCREASES in these foods will decrease warfarin’s effect. Watch for:
15 questions — 80% required to unlock Section 4
A client taking warfarin has an INR of 2.8. The nurse should:
The antidote for warfarin overdose is:
Warfarin is contraindicated in pregnancy because it:
A client on warfarin states, “I had a large spinach salad every day this week because I heard it’s healthy.” The nurse recognizes this may:
Bridge therapy with heparin and warfarin is used because:
A client on warfarin has an INR of 4.8. The nurse should FIRST:
Warfarin suppresses coagulation by blocking which clotting factors?
Which statement by a client on warfarin indicates a need for further teaching?
The therapeutic INR range for a client with a mechanical heart valve on warfarin is:
Which herb or supplement would INCREASE bleeding risk in a client on warfarin? Select All That Apply.
After Vitamin K is given for warfarin overdose, clotting activity returns in approximately:
Older adults (>65 years) receiving warfarin typically require:
When should heparin be discontinued during bridge therapy?
A client on warfarin develops dark, tarry stools. The nurse recognizes this as:
The client asks why they cannot just take Vitamin K supplements to prevent bleeding while on warfarin. The nurse explains:
Direct Oral Anticoagulants, Aspirin, Clopidogrel & Platelet Inhibitors
Direct Oral Anticoagulants (DOACs) are newer drugs that block the common pathway of the clotting cascade directly, without needing Vitamin K or antithrombin III. They represent a major advance because they require NO routine lab monitoring.
| Drug | Target | Dosing | Key Points |
|---|---|---|---|
| Dabigatran (Pradaxa) | Direct thrombin inhibitor | 150 mg PO twice daily | Antidote: Idarucizumab (Praxbind); LIGHT SENSITIVE — keep in original bottle! |
| Rivaroxaban (Xarelto) | Factor Xa inhibitor | 20 mg PO daily | Take with evening meal for best absorption |
| Apixaban (Eliquis) | Factor Xa inhibitor | 2.5–5 mg PO twice daily | Lower stroke risk than warfarin in A-fib studies |
| Edoxaban (Savaysa) | Factor Xa inhibitor | 60 mg PO once daily | For nonvalvular A-fib and DVT/PE treatment |
| Feature | DOACs | Warfarin |
|---|---|---|
| Route | Oral | Oral |
| Monitoring | NO routine labs needed ✓ | Frequent PT/INR monitoring required |
| Food interactions | Minimal | MANY (Vitamin K foods) |
| Drug interactions | Fewer | MANY |
| Onset | Rapid (hours) | Slow (3–5 days) |
| Antidote | Idarucizumab for dabigatran only | Vitamin K (phytonadione) |
| Storage | Light sensitive! Original bottle only | Original dark container |
| Pregnancy | Avoid | NEVER (teratogenic) |
While anticoagulants affect the CLOTTING CASCADE, antiplatelets affect the PLATELETS themselves — preventing them from sticking together (aggregating).
| Drug | Mechanism | Uses | Key Points |
|---|---|---|---|
| Aspirin (ASA) | Blocks COX enzyme → ↓ thromboxane A₂ → ↓ platelet aggregation | MI prevention, stroke prevention, PAD | Irreversible for platelet lifespan (7–8 days). Stop 1 week before surgery. GI bleeding risk in older adults. |
| Clopidogrel (Plavix) | Blocks ADP receptor on platelets | Post-MI, post-stent placement, PAD, stroke prevention | NEVER stop abruptly after stent! Must take daily for 1+ year. Stent could clot! |
| Ticagrelor (Brilinta) | ADP receptor blocker (reversible) | Acute coronary syndrome | Loading dose 180 mg, then 90 mg twice daily |
| Cilostazol (Pletal) | PDE3 inhibitor | Intermittent claudication (PAD) | Improves walking distance in PAD |
When a stent is placed in a coronary artery, the metal mesh can trigger platelet aggregation. Clopidogrel prevents platelets from sticking to the stent.
15 questions — 80% required to unlock Section 5
The major advantage of DOACs over warfarin is:
The specific reversal agent for dabigatran (Pradaxa) is:
A client with a coronary stent placed 3 months ago asks if they can stop taking clopidogrel. The nurse’s best response is:
Aspirin’s antiplatelet effect is irreversible for the lifespan of the platelet, which is approximately:
Why must dabigatran (Pradaxa) be stored in its original container?
Which drug should a patient taking clopidogrel AVOID because it can decrease clopidogrel’s effectiveness?
The primary use of cilostazol (Pletal) is to treat:
A client taking a DOAC develops severe bleeding. The nurse should recognize that:
A patient asks if taking antacids will affect their antiplatelet medication. The nurse should advise:
Rivaroxaban (Xarelto) prevents clotting by directly inhibiting:
Before scheduling a dental procedure for a patient on aspirin, the nurse anticipates that aspirin should be stopped approximately:
The nurse teaches a client on anticoagulant therapy to report which early signs of bleeding? Select All That Apply.
Dabigatran capsules should NOT be chewed or broken because:
The primary concern for a client taking ANY anticoagulant, thrombolytic, or antiplatelet medication is:
Aspirin reduces the risk of blood vessel blockage in which conditions? Select All That Apply.
Clot Busters, Reversal Agents, and Emergency Bleeding Management
All other anticoagulants just prevent NEW clots. Thrombolytics (fibrinolytics) actually break down existing clots by activating the body’s own clot-dissolving system:
Thrombolytic drug (alteplase/tPA) enters the blood
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Converts plasminogen (inactive protein) → plasmin (active enzyme)
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Plasmin cuts through the fibrin mesh holding the clot together
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Clot dissolves! Blood flow restored to damaged tissue
Cell Factory Analogy: If the clot is a brick wall blocking a highway, thrombolytics send in the demolition crew (plasmin) to tear it down. All other drugs just prevent new walls from being built.
| Drug | Dose/Route | Time Window | Key Points |
|---|---|---|---|
| Alteplase (Activase, tPA) | IV; weight-based dosing varies by condition | MI: within 12 hours; Stroke: within 3 hours; PE: ASAP | Most commonly used. Given as bolus then infusion for MI. Followed by heparin therapy. |
| Reteplase (Retavase) | 10 units IV bolus × 2 (30 min apart) | MI: within 12 hours | Two-bolus dosing is simpler |
| Tenecteplase (TNKase) | Weight-based single IV push | MI: within 12 hours | Single bolus = easiest. Not given by LPN/VN |
| Drug | Antidote | Memory Trick | Time to Effect |
|---|---|---|---|
| Heparin (UFH & LMWH) | Protamine sulfate | “Pro-H” = Protamine for Heparin | Minutes (IV) |
| Warfarin (Coumadin) | Vitamin K (phytonadione) | “K for Coumadin Kure” | 48–72 hours |
| Dabigatran (Pradaxa) | Idarucizumab (Praxbind) | “Ida reverses Da-bi” | Minutes (IV) |
| Thrombolytics (tPA) | Aminocaproic acid | “Amino stops the Lysis” | Minutes (IV). Acute life-threatening use ONLY |
| Aspirin / Clopidogrel | No specific antidote | Platelet transfusion if severe bleeding | New platelets needed (7–8 days for aspirin) |
15 questions — 80% required to unlock Section 6
A client is receiving alteplase (tPA) for an acute MI. Which is the PRIORITY nursing intervention?
Thrombolytic drugs are most effective when given within which time frame after the onset of MI symptoms?
The antidote for thrombolytic drugs is:
Which client is a CONTRAINDICATION for thrombolytic therapy?
After a thrombolytic drug is given, the IV line must be removed. How long should pressure be applied?
A patient receiving tPA develops a sudden severe headache with confusion. The nurse should recognize this as a potential sign of:
All fibrinolytic drugs are classified as:
Match each antidote to the correct drug. Protamine sulfate reverses:
For suspected acute MI, the standard protocol is to have the patient chew:
A client’s blood pressure is 220/130 mmHg. The nurse recognizes that thrombolytic therapy:
During thrombolytic therapy, why should IM injections be avoided?
The time window for thrombolytic therapy after the onset of an ischemic stroke is:
Which signs indicate internal bleeding in a client on anticoagulant therapy? Select All That Apply.
Thrombolytic drugs differ from anticoagulants because thrombolytics:
Describe the nursing actions and monitoring priorities when caring for a client receiving thrombolytic therapy.
Case Studies, Lab Decision Algorithms, Discharge Teaching, & Comprehensive Review
This section brings together everything from Sections 1–5 into real clinical scenarios that test your ability to recognize cues, analyze data, prioritize actions, and evaluate outcomes — exactly how the NCLEX-PN Next Generation format works.
| Drug Class | Example | Mechanism | Lab | Therapeutic | Antidote | Route |
|---|---|---|---|---|---|---|
| UFH | Heparin | ↑ Antithrombin III | aPTT | 1.5–2.5× normal | Protamine sulfate | IV / SubQ |
| LMWH | Enoxaparin | ↑ Antithrombin III | None routine | N/A | Protamine sulfate | SubQ only |
| VKA | Warfarin | Blocks Vitamin K | PT/INR | INR 2–3 | Vitamin K | PO |
| DTI | Dabigatran | Direct thrombin block | None routine | N/A | Idarucizumab | PO |
| Factor Xa | Rivaroxaban | Blocks Factor Xa | None routine | N/A | None specific | PO |
| Antiplatelet | Aspirin | Blocks COX → ↓TXA₂ | Bleeding time | N/A | Platelet transfusion | PO |
| Antiplatelet | Clopidogrel | Blocks ADP receptor | Bleeding time | N/A | Platelet transfusion | PO |
| Thrombolytic | Alteplase | Plasminogen → plasmin | Fibrinogen, aPTT | N/A | Aminocaproic acid | IV only |
| Precaution | Rationale |
|---|---|
| Soft-bristled toothbrush | Prevents gum bleeding |
| Electric razor only | Prevents cuts |
| No IM injections if possible | Prevents hematoma |
| Hold pressure 5+ minutes at puncture sites | Promotes hemostasis |
| No rectal temps, suppositories, or enemas | Prevents mucosal trauma |
| Pad bed rails | Prevents bruising from contact |
| Monitor petechiae and ecchymosis | Early bleeding detection |
| Fall precautions | Prevents injury → hemorrhage |
| Avoid contact sports | Prevents trauma |
| MedicAlert bracelet | Alerts providers in emergencies |
| Check all stools for occult blood | Detects GI bleeding early |
| Use caution trimming nails | Prevents cuts |
When reinforcing discharge teaching for patients going home on anticoagulants, the LPN should include:
15 questions — 80% required to unlock Final Exam
Scenario: Mr. Davis, 68 years old, is on day 2 of heparin infusion for DVT. His aPTT is 38 seconds. What does this indicate and what should the nurse expect?
Scenario: Mrs. Chen is on warfarin for atrial fibrillation. Her INR today is 1.1. She asks why her doctor increased the warfarin dose. The nurse explains:
Scenario: A post-surgical client is receiving heparin SubQ for DVT prophylaxis and also started on warfarin yesterday. What lab should the nurse monitor for EACH drug?
Scenario: A client on warfarin is admitted with coffee-ground emesis. INR is 5.2. What is the PRIORITY nursing action?
Scenario: A client on heparin develops platelet count drop from 200,000 to 85,000 on day 7. The client also has new pain and swelling in the left calf. This combination suggests:
A nurse is reinforcing discharge teaching for a client going home on warfarin. Which client statement indicates CORRECT understanding?
A client on heparin has an aPTT of 88 seconds and shows no signs of bleeding. The nurse should:
Which client is at HIGHEST risk for bleeding complications from anticoagulant therapy?
A client receiving enoxaparin asks why the nurse does not rub the injection site. The nurse explains:
A client with a mechanical mitral valve has an INR of 2.2. The nurse recognizes this as:
The nurse prepares to draw blood for PT on a client receiving both IV heparin and warfarin. When should the blood be drawn?
A client on warfarin develops skin necrosis on day 4 of therapy. The nurse recognizes this is:
Anticoagulants are CONTRAINDICATED in which conditions? Select All That Apply.
Describe what bridge therapy is, when it is used, and the criteria for discontinuing heparin during bridge therapy.
A client taking clopidogrel after coronary stent placement 4 months ago is scheduled for dental surgery. The nurse should advise the client to:
25 NCLEX-PN questions across ALL anticoagulation topics • 80% to earn your certificate
Congratulations, ! You have completed all 6 sections of the Anticoagulation Deep Dive. This final exam covers every topic from the clotting cascade to clinical scenarios. You need 80% (20 of 25) to earn your Certificate of Completion.
⚠ Remember: This exam includes multiple-choice, Select All That Apply, ordering, and fill-in-the-blank questions — just like the Next Generation NCLEX.
💊 Key Drug → Antidote Pairs
🩸 Key Lab Ranges
The LPN is caring for a client who received IV heparin 2 hours ago. The aPTT result is 120 seconds. Which action should the LPN take FIRST?
A client on warfarin therapy asks why monthly blood tests are needed. The nurse’s best response is:
Which assessment findings indicate a client on anticoagulant therapy is experiencing internal bleeding? Select All That Apply.
The nurse is teaching a client being discharged on warfarin. Which statement by the client demonstrates a need for further teaching?
A client receiving enoxaparin (Lovenox) has a platelet count that dropped from 250,000 to 95,000 on day 7 of therapy. The nurse suspects:
At the cellular level, how does heparin prevent clot formation?
A client has an INR of 4.8 with no active bleeding. The nurse anticipates which intervention?
Which of the following is TRUE about direct oral anticoagulants (DOACs) compared to warfarin?
A client is receiving alteplase (tPA) for an acute ischemic stroke. Which nursing action is MOST important during the infusion?
A client is on both IV heparin and oral warfarin (bridge therapy). The INR is 2.4 and the aPTT is 72 seconds. What should the nurse anticipate?
The nurse is administering subcutaneous enoxaparin. Which technique is correct?
A client takes aspirin 81 mg daily for cardiovascular protection. Which statement by the client requires further teaching?
Arrange the steps of the coagulation cascade in the correct order.
A client on dabigatran (Pradaxa) is brought to the emergency department with life-threatening bleeding. Which reversal agent does the nurse anticipate?
The LPN is collecting data on a client taking clopidogrel (Plavix) after a coronary stent placed 3 months ago. Which finding requires IMMEDIATE reporting to the RN?
Which nursing action is appropriate for a client receiving thrombolytic therapy? Select All That Apply.
A client on warfarin has been eating consistently for months. They recently started a new diet that includes large daily servings of kale, broccoli, and brussels sprouts. What will happen to their INR?
During bridge therapy, blood for a PT/INR test should NOT be drawn within how many hours of IV heparin administration?
A client is prescribed rivaroxaban (Xarelto) for atrial fibrillation. Which client education point is MOST important?
Explain the difference between an anticoagulant, an antiplatelet, and a thrombolytic at the cellular level. Include one drug example for each.
A pregnant client in the first trimester develops a DVT. Which anticoagulant can be safely used?
Aspirin achieves its antiplatelet effect by:
A client receiving IV heparin has the following lab results: aPTT 52 sec, platelets 180,000, Hgb 12.5. Which finding is MOST concerning?
Which conditions are absolute contraindications for thrombolytic therapy? Select All That Apply.
Using the Cell Factory approach, explain why heparin-induced thrombocytopenia (HIT) causes CLOTTING despite LOW platelet counts. Describe the cellular mechanism and the nursing actions required.
This certifies that
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Cell-Factory Method • LPN NCLEX-PN Preparation
📊 Performance Summary
115 NCLEX-PN Questions • 7 Sections • Comprehensive Anticoagulation Mastery