Clotting Assessment

A nurse is educating a group of clients about the contraindications of warfarin therapy. Which of the following statement should the nurse include in the teaching?

"Clients who are pregnant should not take warfarin."

A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give?

"Does not dissolve clots. It stops new clots from forming."

A nurse is teaching a client who takes Warfarin daily. Which of the following statements by the client indicates a need for further teaching?

"I have started taking ginger root to treat my joint stiffness." (Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding.)

A nurse is teaching a parent of a child who has hemophilia how to control a minor bleeding episode. Which of the following statements by the parent indicates a need for further teaching?

"I will apply heat."

A nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which of the following statements by the client indicates an understanding of the teaching?

"I'll use my electric razor for shaving."

A nurse is teaching a client scheduled for an activated partial thromboplastin time (aPPT). Which of the following statements by the client indicates an understanding of the teaching?

"It measures deficiencies in clotting factors."

A nurse is providing teaching to a client who is taking warfarin about monitoring its therapeutic effects. Which of the following explanations should the nurse provide about the international normalized ratio (INR) test?

"The INR is a standardized test that eliminates the variations between laboratories reports in prothrombin times." (Results will be the same no matter which lab performs it.)

A nurse is caring for a client who has been admitted to the emergency department (ED). Complete the diagram by dragging the choices below to specify what condition the client is most likely experiencing, two actions the nurse should take to address the condition, and two parameters the nurse should monitor to assess the client's progress.

- The client is most likely experiencing a Pulmonary embolism. - Actions to Take: Place the client in high-Fowler's position Obtain Venous access -Parameters to monitor: Cardiac dysrhythmias aPTT values

A nurse is caring for a client who is postoperative following the left hip arthroplasty. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address the condition, and two parameters the nurse should monitor to assess the client's progress.

-Actions to take: Apply Supplemental oxygen Plan to initiate thrombolytic therapy -Potential condition: Pulmonary Embolism -Parameters to monitor: Oxygen saturation Coagulation levels

A nurse is creating a teaching plan for a client who has thrombocytopenia. Which of the following instructions should the nurse include? (SATA)

-Lubricate lips with water soluble ointment. -Brush teeth with a soft toothbrush. -Blow nose gently.

A nurse is giving a presentation about preventing deep vein thrombosis DVT. Which of the following should the nurse include as a risk factor for this disorder? SATA.

-Oral contraceptive use -Immobility

A nurse is teaching a client about performing leg exercises to reduce the risk for deep vein thrombosis. Which of the following instructions should the nurse include?

-Point the toes toward the foot of the bed. -Rotate the feet in a circular motion. -Point the toes toward the head.

A nurse is planning care for a client who has thrombocytopenia. Of the following interventions should the nurse include in the plan?

Apply pressure to needlestick sites for 10 min.

A nurse in a clinic is caring for a client who has recently begun taking warfarin. The nurse is reviewing potential drug and food interaction risks and should instruct the client to avoid which of the following?

Cabbage (rich in vitamin K)

A nurse is caring for a client who is receiving a continuous IV infusion of heparin. Which of the following actions should the nurse take?

Check the activated partial thromboplastin (aPTT) time every 4 hours.

A nurse is planning care for a client who has deep vein thrombosis (DVT) and is receiving anticoagulation therapy. Which of the following interventions should the nurse include in the plan of care?

Encourage the client to walk.

A nurse is receiving a client who is immediately postoperative following hip arthroplasty. Which of the following medications should the nurse plan to administer for DVT prophylaxis?

Enoxaparin subcutaneous (Lovenox)

A nurse is caring for a client on a medical-surgical unit. The client has been taking Warfarin at home and her laboratory values reveal her INR is 3.5. The client states she is checking herself out of the hospital and refuses to wait until her provider can discuss the situation with her. Which of the following action should the nurse take?

Explain the risk the client faces if she leaves the facility.

A nurse is preparing an in-service about the various supplements clients might use. Which of the following herbal supplements should the nurse include as potentially increasing the anticoagulant effects of aspirin and other oral anticoagulants?

Feverfew

A nurse is obtaining a medical history from a client who is to start warfarin therapy and currently uses herbal supplements at home. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin?

Feverfew (Will increase the anticoagulant effect of Warfarin).

A nurse is providing discharge instructions to a client who developed deep-vein thrombosis (DVT) postoperatively and is prescribed anticoagulant therapy. Which of the following instructions should the nurse include?

Flexing her knees and feet frequently

A nurse on a medical surgical unit is caring for four clients who are 24 to 36 hr postoperative. Which of the following surgical procedures places the client at risk for deep-vein thrombosis?

Hip arthroplasty

A nurse is preparing to administer heparin to a client. Which of the following actions should the nurse plan to take?

Inject the medication into the abdomen above the level of the iliac crest.

A nurse is planning care for a client who has deep vein thrombosis of the lower leg. Which of the following interventions should the nurse include in the plan of care?

Keep the client's affected leg elevated while in bed. (decreases edema)

A nurse is caring for a client who is postoperative and is at risk for developing venous thromboembolism (VTE). The nurse should instruct the client to avoid which of the following unsafe actions?

Massaging her legs

A nurse is caring for a client who has hemophilia and hemarthrosis of the left knee. Which of the following actions should the nurse take?

Obtain a stool specimen

A nurse is reviewing laboratory results of a client who has atrial fibrillation and is taking warfarin. For which of the following results should the nurse notify the provider?

PT 45 seconds (Expected range for PT is 11.5 to 12.5 seconds. During therapy, the nurse should expect to see the values increase 1.5 to 2.5 times the baseline. Therefore, the nurse should withhold the warfarin and notify the provider.)

A nurse is reviewing the laboratory findings for a client who has idiopathic thrombocytopenic purpura (ITP). Which of the following findings should the nurse expect to be decreased?

Platelets (The nurse should recognize the ITP results from the destruction of platelets by antibodies. Therefore, the nurse should expect a platelet level below the expected reference range.)

A nurse is caring for a client who is receiving heparin by continuous IV infusion. Which of the following medications should the nurse plan to administer in the event of an overdose?

Protamine

A nurse is teaching a client who is to start taking warfarin about herbal supplements. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin?

St. Johns wort (can decrease anticoagulation when taking warfarin)

A nurse is caring for a 7-year-old child. For each assessment finding, click to specify if the finding is consistent with leukemia, sickle cell anemia, or hemophilia. Each finding may support than one disease process. Assessment Finding:

Temp is consistent with leukemia and sickle cell anemia Bruising is consistent with leukemia and hemophilia Bleeding is consistent with leukemia and hemophilia WBC count is consistent with leukemia and sickle cell anemia Pain is a consistent with leukemia, sickle cell, and hemophilia

A nurse is caring for a client who has atrial fibrillation and is receiving heparin. Which of the following findings is the nurse's priority?

The client experiences sudden weakness of one arm and leg. (Sudden weakness or numbness of the face in one arm or leg can indicate that the client is at greatest risk for stroke. Therefore, this is the nurse's priority finding. In addition to these findings, the client may appear confused, have slurred speech, loss of balance, dizziness, or sudden severe headache.)

A nurse is caring for a client who is 2 hr postoperative after having a total abdominal hysterectomy. Drag words from the choices below to fill in each blank in the following sentence.

The client is at risk for developing pneumonia, deep vein thrombosis, and pressure injuries.

A nurse is assessing a 24-year-old female client. Drag words from the choices below to fill in each blank in the following sentence.

The client is exhibiting clinical manifestations of deep vein thrombosis and pulmonary embolism.

A nurse is preparing to administer warfarin to a client. Which of the following information should the nurse recognize prior to administering the medication?

The client should be observed for manifestations of hemorrhage.

A nurse is reviewing the medication list for a client who has a new prescription for warfarin. The nurse should recognize that which of the following medications is incompatible with warfarin?

Vitamin K (vitamin K antagonizes the action of warfarin and is the antidote for warfarin toxicity

A nurse is caring for an adolescent who has hemophilia A and is scheduled for wisdom teeth extractions. Prior to the procedure, the nurse should anticipate that the client will receive which of the following products?

Recombinant. (The underlying problem of hemophilia is a deficiency of clotting factors therefore clients who have hemophilia are given recombinant to replace the deficiency factor as a prophylactic measure before an invasive procedure, surgery, or when actively bleeding.)

A nurse is completing a medical intervention with a client who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin.

The client uses garlic to lower cholesterol levels.

A nurse is assessing a client who is postoperative following a vaginal hysterectomy. Which of the following findings is a manifestation of deep-vein thrombosis (DVT)?

Unilateral leg edema

A nurse is caring for a client who was on warfarin therapy for atrial fibrillation. The clients INR is 5.2. Which of the following medications should the nurse prepare to administer?

Vitamin K

A nurse is assessing a client who was at risk for deep vein thrombosis (DVT). Which of the following findings is a manifestation of DVT?

Growing tenderness.

A nurse is reviewing the laboratory data on a client who has a new prescription for heparin for treatment of a pulmonary embolism. Which of the following data should the nurse report to the provider?

Platelets 74,000/mm3 (Heparin induced thrombocytopenia is a disorder characterized by low platelet counts. It is an adverse effect of heparin that causes the activation of platelets, resulting in widespread clot formation and depletion of platelet. The expected reference range for platelets is 150,000 to 400,000/mm3).

A nurse is assessing a postpartum client. Drag words from the choices below to fill in. Each blank in the following sentence.

To confirm a diagnosis of DVT the nurse anticipates provider orders for venous duplex ultrasound and D-dimer.

A nurse is providing discharge teaching for a client who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching?

Use an electric razor while on this medication.

A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make?

Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level.

A nurse is caring for a male client who has peripheral vascular disease (PVD), is taking dietary supplements, and has a new prescription for warfarin. The nurse should instruct the client to stop which of the following supplements prior to starting warfarin. (SATA)

-Saw Palmetto. -Glucosamine. -Ginkgo biloba.

A nurse is preparing to administer a continuous heparin infusion at 1600 units/hr. Available is Heparin 25,000 units in dextrose 5% in water (D5W) 500 mL. The nurse should set the IV pump to deliver how many mL/hr? Round the answer to the nearest whole number.

32 mL/hr

A nurse is caring for a client who has a deep vein thrombosis and just receiving IV fluid that contains 10,000 units of heparin and in 500 mL infusing at 1,000 units/hr. When calculating the client's intake and output, how much should the nurse document as intake from this infusion in an 8-hr shift?

400 mL

A nurse is assigned to care for a client diagnosed with autoimmune or idiopathic thrombocytopenic purpura (ITP). When reviewing the clients plan of care prior to caring for the client, the nurse should recognize that the priority concern in caring for the client is to monitor for

Bleeding

A nurse is preparing to administer heparin subcutaneously to a client who has a deep vein thrombosis. Which of the following techniques should the nurse use?

Cleanse the skin with an alcohol swab, insert the needle, inject the heparin and observe for bleeding.

A nurse is teaching a client who has a family history of hemophilia A about manifestations of the disorder. The nurse should include which of the following manifestations in the teaching?

Disabling joint pain

A nurse is planning care for a client who has idiopathic thrombocytopenia purpura (ITP). Which of the following manifestations is most appropriate for the nurse to monitor?

Ecchymosis (client who has. ITP has a decreased number of circulating platelets, which are important for clotting. One of the first manifestations seen in clients who have an exacerbation of ITP is the development of bruises ecchymosis petechiae. The greatest risk of this client is bleeding. Therefore, the nurse's priority is to monitor for occult bleeding and the development of ecchymosis.)

A nurse is preparing to administer heparin 2,000 units by IV bolus. Available is heparin injection 5,000 units/mL. How many milliliters should the nurse administer? (Round to the nearest tenth)

0.4 mL

A nurse is preparing to administer heparin 3,000 units by IV Bolus. Available Is heparin injection 5,000 units/mL. How many mL should the nurse administer? Round to the nearest tenth.

0.6 mL

A nurse is caring for a client who is receiving heparin 3,800 units subcutaneous daily. Available is heparin 5,000 units/mL. How many mL should the nurse administer?

0.8 mL

A nurse is preparing to administer aspirin 650 mg PO every 12 hr. The amount available is aspirin 325 milligram tablets. How many tablets should the nurse administer? Round the answer to the nearest whole number.

2 tablets

A nurse is caring for a client who has deep vein thrombosis and is prescribed heparin by continuous IV infusion at 1,200 units/hr. Available is Heparin 25,000 units in 500 mL D5W. The nurse should set the IV pump to deliver how many mL/hour?

24 mL/hr

A nurse is planning care for a client who is 2 hours postpartum following a cesarean birth. The client has a history of thromboembolic disease. Which of the following nursing interventions should be included in the plan of care?

Have the client ambulate.

A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects?

Protamine sulfate (Reverses the effects of heparin by binding with it to form a heparin-protamine complex that has no anticoagulant properties.)

A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin?

Prothrombin time (PT)