NUR 426 EXAM 1 VOIT ASU SPRING
2026 WITH COMPLETE SOLUTIONS
You should know the significance of the following (why would it be high vs low), but
do not need to memorize normal ranges - ANSWER-The concept of "therapeutic
ranges" (pertaining to PT/INR, aPTT, PTT)
PT/INR→ (high=longer time in sec to form clot) warfarin, vitamin K deficiency, risk for
bleeding; (low= shorter time in sec to form clot) vitamin K supplementation, diet high
in vitamin K, birth control, risk for clots
aPTT/PTT→ (high=longer time in sec to form clot) heparin, hemophilia, risk for
bleeding; (low= shorter time in sec to form clot) vitamin K supplementation, risk for
clots→ lead to MI or stroke
Fibrinogen→ (high) lots of clotting→ lead to stroke or MI; (low) no clotting, DIC,
cancer
Clotting factors→ (high) smoking, overweight, pregnancy; (low) hemophilia,
hemorrhage
D-dimer→ (high) DVT, smoking, infection, clotting disorder; (low) inc risk for bleeding
Platelet count→ (high) inflammation, infection, splenectomy, autoimmune; (low)
bleeding, thrombocytopenia, B12 deficiency
RBCs→ (high) COPD, congenital heart disease, dehydration, recent transfusion;
(low) bleeding, anemia, B12 deficiency, folate deficiency
Hemoglobin→ (high) chronically low blood O2 levels due to heart or lung issue; (low)
bleeding, iron deficiency, pregnancy, ASA
Hematocrit→ (high) dehydration; (low) bleeding, anemia
WBCs→ (high) infection, inflammation; (low) immunocompromised, cancer,
chemotherapy, malnutrition
ANC (Absolute Neutrophil Count)→ (high) autoimmune reaction; (low)
immunocompromised, neutropenia, TB, sepsis
Factor VIII - ANSWER-Indications→ deficiency of factor 8 (Hemophilia A)
Side effects→ allergic rxn, rash (Benadryl), anaphylaxis (epi)
Considerations→ NSAIDs
Hydroxyurea - ANSWER-Indications→ inc production of Hb F (these cells do not
sickle), reduce adhesion and improve hydration of sickle cells
Side effects→ suppress blood cells in general (bleeding and infection), N/V, mouth
sores, bleeding
Considerations→ dec WBC and platelets (protective precautions), dec
vasoconstriction (monitor BP), increases Hb
Desmopressin - ANSWER-Indications→ mild hemophilia (stimulates inc in factor 8);
a form of ADH; only effective if one can produce factor 7
Side effects→ fluid retention, hyponatremia, HA, nausea, GI upset
Considerations→ monitor I&Os, diuretics for fluid retention
Aspirin (ASA) - ANSWER-Indications→ inflammation suppression, fever reduction,
inhibit platelet aggregation
, Side effects→ GI upset, heartburn, kidney dysfunction, bleeding
Considerations→ risk for bleeding especially when combined with blood thinners
Ibuprofen - ANSWER-Indications→ mild pain and inflammation
Side effects→ headache, drowsiness, GI bleeds
Considerations→ risk for bleeding
Celecoxib - ANSWER-Indications→ inflammation suppression, fever reduction, mild
to mod pain
Side effects→ GI upset, kidney dysfunction
Considerations→ risk of bleeding with warfarin and glucocorticoids
The following additional drugs/drug categories could be tested as potential drug
interactions. Be able to identify how these medications/drug categories would
interact with medications related to your Pharmacology Made Easy modules -
ANSWER-All other drugs reviewed in the Hematologic System module (eg. how do
these drugs interact with each other)→ anticoagulants/antiplatelets/antithrombotics→
inc bleeding; factor 8 and desmopressin→ help with fibrinogen production; folic acid,
iron preps, and B12→ tx for anemias
NSAIDS→ bleeding when combined with blood thinners/alcohol; dec ASA effects
Glucocorticoids→ celecoxib inc bleeding
Vitamin K→ Warfarin antidote
Aspirin→ bleeding when combined with blood thinners/alcohol; ibuprofen dec ASA
effects
Live Vaccines→ inc in clotting?
Caffeine→ warfarin effects enhanced
Acetaminophen→ inc risk of bleeding w/Warfarin
Discuss the pharmacokinetic and pharmacodynamic concepts of hematologic drugs
including: mechanisms of action, adverse drug reactions, drug and food interactions,
nursing implications, and client education. - ANSWER--Mechanism of Action→
works on coagulation cascade; anticoagulants prevent clots; thrombolytics dissolve
clots
-Heparin (anticoagulants target intrinsic pathway) works quickly
-Warfarin (works on extrinsic pathway) works slowly
-Adverse Reactions→ bleeding from over toxicity; bruising is expected but excessive
bruising is not
-Flu-like symptoms and bruising together is a medical emergency
-Interactions→ vitamin K (Warfarin), NSAIDs, Aspirin, anticoagulants, antiplatelets,
thrombolytics
-Nursing Interventions→ monitor for signs of bleeding (HOTN, tachycardia,
petechiae, purpura, ALOC, restlessness); labs (Hgb, Hct, RBCs trending down)
-Heparin and Warfarin can be given together
-Monitor with Heparin→ aPTT/PTT, platelets, potassium
-remember 3 Ps of Heparin!!
-Monitor with Warfarin→ PT
-Tx for overdose→ transfuse clotting factors for replacement (ex. FFP,
cryoprecipitate) + any additional reversal agents
-Client Education→ soft bristled toothbrush, fall risk, signs of bleeding
2026 WITH COMPLETE SOLUTIONS
You should know the significance of the following (why would it be high vs low), but
do not need to memorize normal ranges - ANSWER-The concept of "therapeutic
ranges" (pertaining to PT/INR, aPTT, PTT)
PT/INR→ (high=longer time in sec to form clot) warfarin, vitamin K deficiency, risk for
bleeding; (low= shorter time in sec to form clot) vitamin K supplementation, diet high
in vitamin K, birth control, risk for clots
aPTT/PTT→ (high=longer time in sec to form clot) heparin, hemophilia, risk for
bleeding; (low= shorter time in sec to form clot) vitamin K supplementation, risk for
clots→ lead to MI or stroke
Fibrinogen→ (high) lots of clotting→ lead to stroke or MI; (low) no clotting, DIC,
cancer
Clotting factors→ (high) smoking, overweight, pregnancy; (low) hemophilia,
hemorrhage
D-dimer→ (high) DVT, smoking, infection, clotting disorder; (low) inc risk for bleeding
Platelet count→ (high) inflammation, infection, splenectomy, autoimmune; (low)
bleeding, thrombocytopenia, B12 deficiency
RBCs→ (high) COPD, congenital heart disease, dehydration, recent transfusion;
(low) bleeding, anemia, B12 deficiency, folate deficiency
Hemoglobin→ (high) chronically low blood O2 levels due to heart or lung issue; (low)
bleeding, iron deficiency, pregnancy, ASA
Hematocrit→ (high) dehydration; (low) bleeding, anemia
WBCs→ (high) infection, inflammation; (low) immunocompromised, cancer,
chemotherapy, malnutrition
ANC (Absolute Neutrophil Count)→ (high) autoimmune reaction; (low)
immunocompromised, neutropenia, TB, sepsis
Factor VIII - ANSWER-Indications→ deficiency of factor 8 (Hemophilia A)
Side effects→ allergic rxn, rash (Benadryl), anaphylaxis (epi)
Considerations→ NSAIDs
Hydroxyurea - ANSWER-Indications→ inc production of Hb F (these cells do not
sickle), reduce adhesion and improve hydration of sickle cells
Side effects→ suppress blood cells in general (bleeding and infection), N/V, mouth
sores, bleeding
Considerations→ dec WBC and platelets (protective precautions), dec
vasoconstriction (monitor BP), increases Hb
Desmopressin - ANSWER-Indications→ mild hemophilia (stimulates inc in factor 8);
a form of ADH; only effective if one can produce factor 7
Side effects→ fluid retention, hyponatremia, HA, nausea, GI upset
Considerations→ monitor I&Os, diuretics for fluid retention
Aspirin (ASA) - ANSWER-Indications→ inflammation suppression, fever reduction,
inhibit platelet aggregation
, Side effects→ GI upset, heartburn, kidney dysfunction, bleeding
Considerations→ risk for bleeding especially when combined with blood thinners
Ibuprofen - ANSWER-Indications→ mild pain and inflammation
Side effects→ headache, drowsiness, GI bleeds
Considerations→ risk for bleeding
Celecoxib - ANSWER-Indications→ inflammation suppression, fever reduction, mild
to mod pain
Side effects→ GI upset, kidney dysfunction
Considerations→ risk of bleeding with warfarin and glucocorticoids
The following additional drugs/drug categories could be tested as potential drug
interactions. Be able to identify how these medications/drug categories would
interact with medications related to your Pharmacology Made Easy modules -
ANSWER-All other drugs reviewed in the Hematologic System module (eg. how do
these drugs interact with each other)→ anticoagulants/antiplatelets/antithrombotics→
inc bleeding; factor 8 and desmopressin→ help with fibrinogen production; folic acid,
iron preps, and B12→ tx for anemias
NSAIDS→ bleeding when combined with blood thinners/alcohol; dec ASA effects
Glucocorticoids→ celecoxib inc bleeding
Vitamin K→ Warfarin antidote
Aspirin→ bleeding when combined with blood thinners/alcohol; ibuprofen dec ASA
effects
Live Vaccines→ inc in clotting?
Caffeine→ warfarin effects enhanced
Acetaminophen→ inc risk of bleeding w/Warfarin
Discuss the pharmacokinetic and pharmacodynamic concepts of hematologic drugs
including: mechanisms of action, adverse drug reactions, drug and food interactions,
nursing implications, and client education. - ANSWER--Mechanism of Action→
works on coagulation cascade; anticoagulants prevent clots; thrombolytics dissolve
clots
-Heparin (anticoagulants target intrinsic pathway) works quickly
-Warfarin (works on extrinsic pathway) works slowly
-Adverse Reactions→ bleeding from over toxicity; bruising is expected but excessive
bruising is not
-Flu-like symptoms and bruising together is a medical emergency
-Interactions→ vitamin K (Warfarin), NSAIDs, Aspirin, anticoagulants, antiplatelets,
thrombolytics
-Nursing Interventions→ monitor for signs of bleeding (HOTN, tachycardia,
petechiae, purpura, ALOC, restlessness); labs (Hgb, Hct, RBCs trending down)
-Heparin and Warfarin can be given together
-Monitor with Heparin→ aPTT/PTT, platelets, potassium
-remember 3 Ps of Heparin!!
-Monitor with Warfarin→ PT
-Tx for overdose→ transfuse clotting factors for replacement (ex. FFP,
cryoprecipitate) + any additional reversal agents
-Client Education→ soft bristled toothbrush, fall risk, signs of bleeding
