Tissue factor released from injured tissue starts the extrinsic coagulation pathway.
Correct Answer
True
True. Tissue factor combines with factor VIIa to activate factor X, which begins the common pathway that produces thrombin. The intrinsic pathway is started by contact with exposed collagen instead.
Category: Clotting Physiology
Question 2
Proteins C and S act as natural anticoagulants in the body.
Correct Answer
True
True. Proteins C and S, along with antithrombin and tissue factor pathway inhibitor, keep clotting in check. A deficiency of these proteins makes the blood hypercoagulable and raises the risk of thrombosis.
Category: Clotting Physiology
Question 3
Atrial fibrillation raises the risk of embolic stroke because blood stagnates in the poorly contracting atria and can form clots.
Correct Answer
True
True. In atrial fibrillation the atria quiver instead of contracting, blood pools and clots can form, especially in the left atrial appendage. A clot that travels to the brain causes an embolic stroke, which is why anticoagulants are used.
Category: Clotting Physiology
Question 4
Estrogen-containing oral contraceptives lower the risk of deep vein thrombosis.
Correct Answer
False
False. Estrogen, whether from oral contraceptives, hormone therapy or pregnancy, increases the production of clotting factors and raises the risk of deep vein thrombosis. It is a listed risk factor for clot formation.
Category: Clotting Physiology
Question 5
Enoxaparin usually does not require routine coagulation lab monitoring.
Correct Answer
True
True. Enoxaparin has predictable subcutaneous absorption and a longer half-life, so it is given at set intervals without titrating to a lab value. This is why patients can use it at home, though platelets and kidney function are still checked.
Category: Heparin and LMWH
Question 6
A patient who develops heparin-induced thrombocytopenia should be switched from heparin to enoxaparin.
Correct Answer
False
False. Enoxaparin is a heparin product and can also trigger or worsen heparin-induced thrombocytopenia. All heparin is stopped and a non-heparin anticoagulant, such as the direct thrombin inhibitor argatroban, is used.
Category: Heparin and LMWH
Question 7
Unfractionated heparin given subcutaneously is absorbed more reliably than enoxaparin.
Correct Answer
False
False. Subcutaneous heparin is absorbed erratically with low bioavailability, which is why treatment doses are usually given IV. Enoxaparin's reliable subcutaneous absorption is one of its main advantages.
Category: Heparin and LMWH
Question 8
Heparin lowers serum potassium levels.
Correct Answer
False
False. Heparin can cause hyperkalemia by suppressing aldosterone production. Potassium is monitored during therapy, especially in patients with kidney disease or those taking other potassium-raising drugs.
Category: Heparin and LMWH
Question 9
Giving protamine too rapidly by IV push can cause hypotension.
Correct Answer
True
True. Protamine is given by slow IV injection because a rapid push can cause a sharp drop in blood pressure and other severe reactions. Resuscitation equipment is kept available because hypersensitivity reactions can also occur.
Category: Heparin and LMWH
Question 10
The anticoagulant effect of warfarin wears off within a few hours of the last dose.
Correct Answer
False
False. Warfarin's effect lasts for several days after it is stopped, because the body needs time to make new vitamin K-dependent clotting factors. This matters when warfarin is held before surgery.
Category: Warfarin
Question 11
Andexanet alfa is a reversal agent for the factor Xa inhibitors apixaban and rivaroxaban.
Correct Answer
True
True. Andexanet alfa is a modified, inactive form of factor Xa that binds these drugs and soaks them up, restoring clotting. It is used for life-threatening or uncontrolled bleeding.
Category: Direct Oral Anticoagulants
Question 12
Dabigatran is a factor Xa inhibitor.
Correct Answer
False
False. Dabigatran is an oral direct thrombin inhibitor. Apixaban, rivaroxaban and edoxaban are the oral factor Xa inhibitors.
Category: Direct Oral Anticoagulants
Question 13
Without a loading dose, the full antiplatelet effect of clopidogrel can be delayed for several days.
Correct Answer
True
True. Clopidogrel's effect builds up gradually, so a loading dose is given in acute coronary syndrome to inhibit platelets quickly. Without it, full effect may take several days.
Category: Antiplatelets
Question 14
Prasugrel carries a lower bleeding risk than clopidogrel.
Correct Answer
False
False. Prasugrel inhibits platelets more strongly than clopidogrel and carries a higher bleeding risk, including fatal bleeding. This is why it is avoided in patients with prior stroke and used cautiously in older or low-weight patients.
Category: Antiplatelets
Question 15
Eptifibatide works by blocking ADP P2Y12 receptors on platelets.
Correct Answer
False
False. Eptifibatide blocks the glycoprotein IIb/IIIa receptor, which fibrinogen and von Willebrand factor use to link platelets together in the final step of aggregation. Clopidogrel, prasugrel and ticagrelor are the P2Y12 blockers.
Category: Antiplatelets
Question 16
Ticagrelor is safe to give to a patient with a history of intracranial hemorrhage.
Correct Answer
False
False. A history of intracranial hemorrhage is a contraindication to ticagrelor because of the risk of serious bleeding. Active pathological bleeding is also a contraindication.
Category: Antiplatelets
Question 17
Aspirin raises the risk of gastrointestinal bleeding partly by blocking prostaglandins that protect the stomach lining.
Correct Answer
True
True. Aspirin inhibits cyclooxygenase, which lowers the prostaglandins that maintain the stomach's protective mucus and blood flow. Combined with its antiplatelet effect, this raises the risk of ulcers and GI bleeding.
Category: Antiplatelets
Question 18
Alteplase requires a dedicated IV line.
Correct Answer
True
True. Alteplase is infused through its own IV line and should not share tubing with other drugs. Its reconstitution and administration follow the product labeling closely.
Category: Thrombolytics
Question 19
Patients should begin walking soon after receiving a thrombolytic to prevent bleeding.
Correct Answer
False
False. Patients remain on bedrest after thrombolytic therapy to lower the risk of falls and bleeding. The nurse monitors for bleeding at puncture sites and for changes in neurologic status.
Category: Thrombolytics
Question 20
A patient taking an anticoagulant who reports a sudden, severe headache needs prompt evaluation for bleeding in the brain.
Correct Answer
True
True. A sudden, severe headache can signal intracranial hemorrhage, the most dangerous bleeding complication of anticoagulants. The provider is notified at once so imaging can be done.
Category: Bleeding Precautions