Ch. 26 Coagulation Modifier Drugs (EAQ)
4 (Presence of hematuria, melena, petechiae, and bleeding from the gums indicates that the patient has developed enoxaparin (Lovenox) toxicity due to overdosage. Protamine sulfate (protamine sulfate) reverses the actions of low molecular weight heparins, such as enoxaparin (Lovenox), and alleviates the symptoms of toxicity. Therefore, administering protamine sulfate will be most beneficial for the patient. Vitamin K1 (Phytonadione) reverses the symptoms of warfarin toxicity, but not heparin toxicity. Increasing the dose of enoxaparin (Lovenox) will worsen the patient's condition. Warfarin sodium (Coumadin) has anticoagulant action and may increase the risk of bleeding in the patient. Therefore, infusing 50 mL of warfarin sodium (Coumadin) to the patient will not be beneficial.)
A patient who is on enoxaparin (Lovenox) therapy has hematuria, melena, petechiae, and bleeding from the gums. Which treatment strategy will be most beneficial for the patient? 1 Administering vitamin K1 (Phytonadione) 2 Increasing the dose of enoxaparin (Lovenox) 3 Infusing 50 mL of warfarin sodium (Coumadin) 4 Administering protamine sulfate (Protamine sulfate)
2 (Cilostazol is an antiplatelet drug, which works through inhibition of type 3 phosphodiesterase in the platelets and primarily lower-extremity blood vessels.)
Cilostazol (Pletal) belongs to which drug class? 1 Anticoagulant 2 Antiplatelet 3 Thrombolytic 4 Antifibrinolytic
1 (Contraindications to the use of antiplatelet drugs include known drug allergy to a specific product, thrombocytopenia, active bleeding, leukemia, traumatic injury, gastrointestinal ulcer, vitamin K deficiency, and recent stroke. Acute instable angina, peripheral vascular disease, and transient ischemic attacks are all indications for antiplatelet therapy.)
Which condition is a contraindication to therapy with an antiplatelet drug? 1 Vitamin K deficiency 2 Acute unstable angina 3 Peripheral vascular disease 4 Transient ischemic attack
4 (The Joint Commission has made safe use of these drugs a national patient safety goal. This goal requires hospitals to take steps to prevent adverse events associated with the drugs.)
Which is a National Patient Safety Goal associated with anticoagulation therapy? 1 Decreasing the number of patients on anticoagulant therapy 2 Increasing the use of "natural" anticoagulants 3 Keeping patients on oral anticoagulants 4 Preventing adverse events associated with anticoagulant drugs
3 (Enoxaparin (Lovenox) is a low molecular weight heparin that is administered subcutaneously. The site should not be rubbed after injection, and the Z-track method also should never be used to administer enoxaparin sodium (Lovenox). The use of 22-gauge, 1½-inch needle is more appropriate for administration of an IM injection.)
A nurse is preparing to administer enoxaparin sodium (Lovenox) to a patient for prevention of deep vein thrombosis. Which is an essential nursing intervention? 1 Draw up the medication in a syringe with a 22-gauge, 1½-inch needle. 2 Utilize the Z-track method to inject the medication. 3 Administer the medication into subcutaneous tissue of the abdomen. 4 Rub the administration site after injecting
1 (A patient who is on prolonged bedrest would benefit from aspirin therapy to prevent the formation of deep vein thrombosis (DVT). Avoiding tight-fitting stockings, not crossing the legs at the knees, and getting up once each hour to walk around are all activities that prevent DVT and would not necessitate the need for aspirin therapy. )
A nurse is providing care to a patient who is at risk for deep vein thrombosis (DVT). The health care provider prescribes aspirin therapy. Which statement from the patient supports this prescription? 1 "I've been on prolonged bedrest." 2 "I avoid tight-fitting stockings or leggings." 3 "I never sit with my legs crossed at the knees." 4 "I get up and walk around at least once an hour."
3 (Hemophilia is a rare genetic disorder in which the coagulation factors are absent. Factors need to be given as replacement therapy so the patient does not bleed to death. Patients with hemophilia cannot receive warfarin or aspirin because they increase bleeding. Vitamin K is not used to treat hemophilia.)
A patient is diagnosed with hemophilia. Which is an essential intervention? 1 Daily administration of vitamin K 2 Administration of warfarin (Coumadin) daily 3 Administration of recombinant factors 4 Aspirin administration daily, 81 mg
2 (The aPTT value of 120 seconds is too prolonged. The heparin drip should be stopped per the provider order. The typical aPTT normal values for a patient on anticoagulant therapy are between 1.5 and 2.5 times the control value, with normal control values being between 25 and 35 seconds. The normal range for BUN is 7 to 20 mg/dL, and the normal platelet range is 150,000 to 400,000. Normal range for INR is 0.8 to 1.1. Note that heparin does not affect the INR or the BUN level.)
A patient is receiving an intravenous heparin drip. Which laboratory value requires immediate action by the nurse? 1 Platelet count of 150,000 mm3 2 Activated partial thromboplastin time (aPTT) of 120 seconds 3 International normalized ratio (INR) of 1.0 4 Blood urea nitrogen (BUN) level of 12 mg/dL
3 (Dark-green, leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Rather than increase the intake of these, it is important to maintain a consistent daily intake of vitamin K. The patient should monitor his or her incidence of bruising carefully. The medication will usually be ordered to be taken at the same time each day. )
A patient is receiving warfarin (Coumadin) for a chronic condition. Which patient statement requires immediate action by the nurse? 1 "I will avoid contact sports." 2 "I will take my medication at the same time each day." 3 "I will increase dark-green, leafy vegetables in my diet." 4 "I will contact my health care provider if I develop excessive bruising."
2 (Warfarin works by decreasing the production of clotting factors. However, it takes approximately 3 days for the body to metabolize present clotting factors and thus achieve a therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved.)
A patient is started on warfarin (Coumadin) therapy while also receiving intravenous heparin. The patient is concerned about the risk for bleeding. What will the nurse tell the patient? 1 "Your concern is valid. I will call the doctor to discontinue the heparin." 2 "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." 3 "Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than one alone." 4 "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."
4 (A thrombus can become an embolus and travel to the lungs. This pulmonary embolus can cause chest pain and difficulty breathing. It is not likely that fatigue, anxiety, or a medication reaction would cause chest pain and dyspnea in this case.)
A patient who was admitted with deep vein thrombophlebitis is complaining of difficulty breathing and chest pain. What is the most likely cause of these symptoms? 1 Fatigue from the extra work of walking with pain 2 Anxiety 3 Medication reaction 4 Embolus to the lungs
3 (Dabigatran (Pradaxa) has an anticoagulant action and prevents thrombus formation. Presence of pink and warm extremities indicates that the patient does not have peripheral clotting and has adequate blood supply to the extremities. Increase in bowel sounds indicates that patient has diarrhea. A heart rate of 50 beats/minute indicates that the patient has bradycardia. A respiratory rate of 11 breaths/minute indicates that the patient has difficulty in breathing. Urticaria, dizziness, and shortness of breath are the adverse effects of dabigatran (Pradaxa). Therefore, excess bowel sounds, bradycardia, and breathing difficulties do not indicate that the patient is receiving effective treatment.)
A patient with nonvalvular atrial fibrillation is receiving dabigatran (Pradaxa) therapy. After assessing the patient, the nurse concludes that the patient is receiving effective treatment. Which finding supports the nurse's conclusion? 1 The patient has increased bowl sounds. 2 The patient's heart rate is 50 beats/minute. 3 The patient's extremities are pink and warm. 4 The patient's rate of respiration is 11 breaths/minute
4 (Warfarin sodium (Coumadin) is an anticoagulant medication that reduces the synthesis of vitamin K-dependent clotting factors and inhibits clot formation. Herbal supplements such as ginkgo interacts with warfarin sodium (Coumadin) and increases the risk of bleeding. Though green leafy vegetables are rich in vitamin K, consistent intake of green leafy vegetables does not result in food-drug interaction. Therefore, the nurse should advise the patient to consume the same amount of green leafy vegetables daily. Aspirin (Acuprin) is a non-steroidal anti-inflammatory drug, which prevents platelet aggregation and increases risk of bleeding. Therefore, refraining from taking aspirin (Acuprin) will reduce the risk of bleeding in the patient. The intake of coffee and citrus fruit does not impair clotting process and does not increase risk of bleeding.)
After talking with a patient who is receiving warfarin sodium (Coumadin) therapy, the nurse believes that the patient is at increased risk for bleeding. Which statement made by the patient supports the nurse's conclusion? 1 "I eat 1 cup of green leafy vegetables daily." 2 "I do not take aspirin (Acuprin) for pain relief." 3 "I refrain from drinking coffee and citrus fruit juices daily." 4 "I take ginkgo supplements for memory enhancement
3 (A potential medication error is to give heparin in combination with enoxaparin.)
The nurse is caring for a newly admitted patient who will begin heparin therapy. While documenting the patient history, the nurse notes that the patient is currently undergoing treatment with enoxaparin. What is the nurse's highest priority? 1 Notify the provider that the dosage of heparin will need to be decreased. 2 Notify the provider that the dosage of heparin will need to be increased. 3 Notify the provider that heparin should not be started on the patient. 4 Notify the provider that the patient is at risk for an allergic reaction.
3 (Drug interactions include phenytoin (decreased effect) and amiodarone (increased effect).)
The nurse is caring for a patient who is being treated with dabigatran (Pradaxa) who is scheduled to be placed on phenytoin. The nurse anticipates which effect will occur when the phenytoin is administered? 1 Anaphylactic reaction to the dabigatran 2 Therapeutic effect of the dabigatran 3 Decreased effect of the dabigatran 4 Increased effect of the dabigatran
3 (If the patient develops a rash while taking one of the coagulation modifier drugs, the drug needs to be discontinued.)
The nurse is caring for a patient who is being treated with one of the coagulation modifier drugs. The patient tells the nurse that he has developed a rash. What is the nurse's highest priority action? 1 Notify the provider to obtain an order for a topical medication to apply to the rash. 2 Monitor the area of the rash; this is an expected side effect of the medication. 3 Notify the provider; the medication will need to be discontinued. 4 Instruct the patient to wash the area with mild soap and water and leave open to the air
3 (The target therapeutic level of anticoagulation is between 45 and 70 seconds for the aPTT value.)
The nurse is caring for a patient who is undergoing treatment with heparin therapy. The nurse assesses the patient's aPTT level and finds it to be 98 seconds. How will the nurse interpret this finding? 1 The level is within the expected target therapeutic level of anticoagulation. 2 The level is outside the expected target therapeutic level of anticoagulation; it is too low. 3 The level is outside the expected target therapeutic level of anticoagulation; it is too high. 4 The level cannot be interpreted without knowing the prothrombin time and INR
3 (The nurse should not administer an anticoagulant intramuscularly, as this would cause a high risk of bleeding into the muscle and a large hematoma to form at the injection site. The other medications can be administered via the routes listed.)
The nurse is preparing to administer an anticoagulant to a patient. Which action, if observed, is in error? 1 The nurse administers warfarin (Coumadin) orally to a patient. 2 The nurse administers heparin subcutaneously to a patient. 3 The nurse administers enoxaparin (Lovenox) intramuscularly to a patient. 4 The nurse administers dabigatran (Pradaxa) orally to a patient.
4 (A platelet count of less than 100,000/mm3 indicates thrombocytopenia. This significantly increases the patient's risk of bleeding. Heparin should be withheld. In addition, thrombocytopenia at the onset of heparin therapy confounds the ability of the health care team to detect heparin-induced thrombocytopenia. The INR, aPTT, and potassium levels are all within normal limits.)
The nurse is reviewing laboratory data before initiating a patient's heparin infusion. Which finding requires immediate action? 1 Activated partial thromboplastin time (aPTT) of 37 seconds 2 International normalized ratio (INR) of 1 3 Potassium 3.5 mEq/L 4 Platelets 95,000/mm3
8 (8 mL/hr)
The nurse is to administer heparin 800 units/hr. The solution is prepared with 25,000 units in 250 mL of normal saline. What rate will the nurse program into the infusion pump for the patient to receive the ordered dose? ___________ mL/hr
3 (Nausea accompanied by vomiting is an expected side effect of treatment with aspirin. Chest pain, edema, and itching are side effects that are more likely to be seen with use of clopidogrel. )
The patient has been placed on aspirin as an antiplatelet drug. Which side effect is the patient most likely to experience? 1 Chest pain 2 Edema 3 Nausea 4 Itching
1 (If at any time during treatment with this drug the platelet count drops below 90,000/mm3, the health care provider should be notified. Protamine sulfate is the antidote for an excessive amount of heparin.)
The patient is being treated with abciximab (ReoPro). The nurse assesses the patent's laboratory test results and finds that the platelet count has dropped to 75,000/mm3. What action will the nurse perform next? 1 Notify the primary care provider of this finding. 2 Document the finding and continue to monitor the patient. 3 No action is needed; this is a normal finding. 4 Prepare to administer protamine sulfate.
2 (The patient who is being treated with dabigatran (Pradaxa) should use all of the medication in the bottle within 60 days of opening the bottle.)
The patient is being treated with dabigatran (Pradaxa) and opens a new bottle of the medication on July 1. The nurse will instruct the patient to discard any unused medication by which date? 1 July 31 2 August 29 3 September 15 4 October 1
(Target levels of INR typically range from 2 to 3 with an average of 2.5; the average may increase to 3.0 for individuals taking warfarin for treatment of recurring systemic clots or emboli or those having mechanical heart valves.)
The patient is receiving warfarin therapy, and the nurse finds the INR to be 4.0. How will the nurse interpret this finding? 1 The level is within the expected target therapeutic level of anticoagulation. 2 The level is outside the expected target therapeutic level of anticoagulation; it is too low. 3 The level is outside the expected target therapeutic level of anticoagulation; it is too high. 4 The level cannot be interpreted without knowing the prothrombin time and aPTT value
