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NCLEX-RN Heparin practice questions

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These are original practice items written to the NCLEX-RN blueprint (4 options, no penalty for wrong answers), not actual exam questions. Try each one before you open the answer.

What this topic covers

Heparin sits inside the Pharmacological and Parenteral Therapies category of the NCLEX-RN. Our bank holds 33 verified items tagged to it, and the 4 below are a fixed sample so the page stays the same every time you open it. Each one shows the reasoning, not just the letter.

The topic tag comes from our own items rather than from a published syllabus, so treat it as a map of what we cover. For the official category breakdown see the NCLEX-RN page.

Heparin sample questions

Question 1

A 58-year-old client in the intensive care unit is receiving a continuous intravenous infusion of unfractionated heparin for a deep vein thrombosis. The current aPTT is 95 seconds; the prescribed therapeutic range is 60 to 80 seconds. The nurse's priority action is to:

  1. A Decrease the heparin infusion rate by 2 mL/hr and recheck the aPTT in 6 hours.
  2. B Stop the heparin infusion immediately and notify the healthcare provider of the aPTT value.
  3. C Administer protamine sulfate 25 mg intravenously over 10 minutes as a stat dose.
  4. D Continue the infusion at the current rate and document the aPTT result in the electronic record.
Show the answer and explanation

Correct answer: B

The correct answer is to stop the heparin infusion immediately and notify the healthcare provider because the aPTT of 95 seconds is above the therapeutic range, placing the client at high risk for bleeding. The nurse must hold the infusion to prevent hemorrhage and then obtain further orders. Decreasing the infusion rate (the option "Decrease the heparin infusion rate by 2 mL/hr and recheck the aPTT in 6 hours." may be considered after notification, but immediate discontinuation is the safest first step. Administering protamine sulfate (the option "Administer protamine sulfate 25 mg intravenously over 10 minutes as a stat dose." is reserved for reversal of heparin in life-threatening bleeding, not for a supratherapeutic aPTT without signs of bleeding. Continuing the infusion (the option "Continue the infusion at the current rate and document the aPTT result in the electronic r..." ignores the elevated aPTT and exposes the client to unnecessary bleeding risk.

Question 2

A 55-year-old client with a pulmonary embolism is receiving an IV heparin infusion at 18 units/kg/hr. The aPTT is 90 seconds (therapeutic range 60-80 seconds). What is the nurse's priority action?

  1. A Increase the heparin infusion rate per protocol.
  2. B Continue the current heparin infusion rate.
  3. C Decrease the heparin infusion rate per protocol.
  4. D Administer protamine sulfate per the protocol.
Show the answer and explanation

Correct answer: C

An aPTT of 90 seconds is above the therapeutic range of 60 to 80 seconds, so the client is over-anticoagulated and at increased risk of bleeding. The nurse should reduce the infusion according to the heparin protocol and recheck the aPTT as directed.

Why the other options are wrong:
A: Increasing the rate would raise the aPTT even further and increase the risk of bleeding.
B: Continuing the current rate leaves the client above the therapeutic range.
D: Protamine sulfate reverses heparin and is reserved for significant bleeding or severe overdose, which is not described here.

Question 3

A 62-year-old client in the intensive care unit is receiving a continuous intravenous heparin infusion for a pulmonary embolism. The current aPTT is 92 seconds, and the previous aPTT was 75 seconds. The nurse reviews the heparin protocol, which specifies holding the infusion for 1 hour when the aPTT is above 85 seconds. The nurse checks the infusion pump and notes the rate is 18 mL/hr. What is the nurse's best action?

  1. A Decrease the infusion rate to 14 mL/hr and recheck the aPTT in 6 hours.
  2. B Stop the heparin infusion immediately and notify the healthcare provider for a new order.
  3. C Hold the heparin infusion for 1 hour and then restart at 16 mL/hr per protocol.
  4. D Administer a heparin bolus as per protocol and continue the infusion at 18 mL/hr.
Show the answer and explanation

Correct answer: C

The protocol directs the nurse to hold the infusion for 1 hour when the aPTT is above 85 seconds. An aPTT of 92 seconds meets that criterion, so the nurse holds heparin for 1 hour and then resumes at the lower rate the protocol specifies, 16 mL/hr, with a repeat aPTT as scheduled.

Why the other options are wrong:
A: Lowering the rate without the 1-hour hold does not follow the protocol for an aPTT above 85 seconds.
B: The protocol already authorizes the hold and rate change, so stopping and waiting for a new order delays therapy.
D: A bolus is given for a low aPTT; giving one now would push anticoagulation even higher.

Question 4

A 66-year-old client in the medical-surgical unit is receiving a continuous intravenous infusion of heparin for a deep vein thrombosis. The nurse reviews the coagulation panel: activated partial thromboplastin time (aPTT) is 95 seconds. The prescribed therapeutic range is 60 to 80 seconds. Which action should the nurse take?

  1. A Decrease the heparin infusion rate per the facility titration protocol.
  2. B Increase the heparin infusion rate by 2 units/kg/hr per protocol.
  3. C Document the aPTT as therapeutic and continue the current rate.
  4. D Stop the heparin infusion and administer protamine sulfate.
Show the answer and explanation

Correct answer: A

An aPTT of 95 seconds is above the therapeutic range of 60 to 80 seconds, indicating the client is supratherapeutic and at increased bleeding risk; the correct action is to decrease the infusion rate per the titration protocol. Increasing the rate (the option "Increase the heparin infusion rate by 2 units/kg/hr per protocol." would worsen the supratherapeutic state. Stopping the infusion and giving protamine (the option "Stop the heparin infusion and administer protamine sulfate." is reserved for severe bleeding or a critically elevated aPTT, not a moderate elevation without signs of hemorrhage. Documenting as therapeutic (the option "Document the aPTT as therapeutic and continue the current rate." is incorrect because 95 seconds exceeds the target range.

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