A patient with a Vitamin K deficiency is at risk for prolonged bleeding. This is because Vitamin K is essential for the synthesis of which clotting factors in the liver?

1. A

   Factors I, II, V, and X

2. B

   Factors II, VII, IX, and X

3. C

   Factors VIII, IX, and XI

4. D

   Factors I and V

Appeared in: NCL (MP) Nursing Officer - 2020

Explanation

• Vitamin K is a necessary cofactor for the synthesis of specific clotting factors in the liver.
• These factors are II (prothrombin), VII, IX, and X.
• Vitamin K facilitates a process called carboxylation, which activates these factors, enabling them to participate in the coagulation cascade.
• A deficiency leads to the production of inactive factors, resulting in impaired blood clotting and an increased risk of bleeding.
• This group of factors is often remembered by the mnemonic '1972' (for factors 10, 9, 7, and 2).

Why Other Options Were Wrong

• Option A: This option incorrectly includes Factors I (Fibrinogen) and V, which are not dependent on Vitamin K for their synthesis.
• Option C: This option incorrectly includes Factors VIII and XI. While Factor IX is Vitamin K-dependent, Factors VIII and XI are part of the intrinsic pathway but their synthesis is not dependent on Vitamin K.
• Option D: This option is incorrect because neither Factor I (Fibrinogen) nor Factor V is dependent on Vitamin K for synthesis.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Role of Vitamin K in the synthesis of clotting factors to guide bedside assessment, documentation, and the next nursing action.
• Nurses must monitor PT/INR for patients on warfarin (a Vitamin K antagonist) or those with liver disease, as these values directly reflect the activity of Vitamin K-dependent factors.
• Prophylactic administration of Vitamin K (phytonadione) is a standard nursing practice for all newborns to prevent Vitamin K Deficiency Bleeding (VKDB), as they have low stores at birth.
• Implementing bleeding precautions is a critical nursing responsibility for any patient with a prolonged PT/INR, including using soft toothbrushes, avoiding IM injections, and monitoring for signs of bleeding like petechiae, ecchymosis, or hematuria.

How to Approach the Question

• First, identify the core concept of the question, which is the relationship between Vitamin K and blood clotting.
• Recall the specific function of Vitamin K in the coagulation cascade. It is essential for the synthesis of certain clotting factors.
• Access your knowledge of hematology to remember which specific factors are Vitamin K-dependent. A common mnemonic is '1972' representing factors 10, 9, 7, and 2.
• Evaluate each option against this knowledge.
• Option A includes non-dependent factors (I, V).
• Option B correctly lists all four Vitamin K-dependent factors (II, VII, IX, X).

Concept Tested & Keywords

• Concept Tested: Role of Vitamin K in the synthesis of clotting factors.
• Stem keywords: Vitamin K deficiency, prolonged bleeding, clotting factors, liver
• Lead-in keywords: which clotting factors

Question ID

qOsk2j9IHXpLycDCaAbWB

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 pp. 527-529, 1136-1138, 1137-1139