Heparin and Warfarin
A 30-year-old woman taking warfarin has a hematocrit of 22. Which questions would be important for the nurse to ask? Select all that apply. "Do you have tar-colored stools?" "How heavy is your menstrual bleeding?" "Do you experience headaches frequently?" "Are you eating a lot of aged cheeses and meats?" "Are you taking any over-the-counter medications?"
"Do you have tar-colored stools?" Tar-colored stools may indicate a reason for the low hematocrit (GI bleeding). Correct "How heavy is your menstrual bleeding?" Menstrual bleeding may indicate a reason for the low hematocrit. "Are you taking any over-the-counter medications?" Over-the-counter medications interact with warfarin and may cause bleeding, which is a reason for the low hematocrit.
A patient asks if it is safe to take heparin while pregnant. How should the nurse respond? "Heparin will dissolve the blood clot, and it is safe to use this during pregnancy." "Heparin can be administered safely during pregnancy because it does not cross the placenta." "Warfarin is a better choice, and I will speak with the health care provider about this." "Heparin is safe because it will ensure you and the fetus do not develop further blood clots."
"Heparin can be administered safely during pregnancy because it does not cross the placenta." Heparin does not cross the placenta; therefore, it is safe to administer heparin during pregnancy.
A patient is overheard telling a family member, "I am receiving heparin intravenously to dissolve the blood clot in my lung." What would be an appropriate response to this patient's statement? "Heparin will help dissolve your current blood clot." "You are taking warfarin, not heparin, to dissolve your blood clot." "Heparin does not dissolve clots but prevents new clots from forming." "You are receiving heparin subcutaneously, not intravenously, for your lung blood clot."
"Heparin does not dissolve clots but prevents new clots from forming." This statement accurately describes the pharmacodynamics of IV heparin therapy.
Which statement would indicate that a patient needs more discharge teaching related to warfarin? Select all that apply. "I'll increase my intake of green leafy vegetables." "This medication will break up blood clots I have in my legs." "I'll take this medication whenever I don't take my baby aspirin." "I'll look for blood in my urine and stool and notify my health care provider if I see this." "I'll notify my health care provider if I'm considering taking a new over-the-counter vitamin."
"I'll increase my intake of green leafy vegetables." Warfarin interacts with caffeine and green leafy vegetables; intake of these should be kept consistent and not increased. Correct "This medication will break up blood clots I have in my legs." Warfarin does not break up blood clots. It prevents them from becoming larger and prevents from new clots forming. Correct "I'll take this medication whenever I don't take my baby aspirin." Warfarin needs to be taken consistently (every day) and, unless directed by the health care provider, should not be taken with aspirin.
The nurse is giving discharge teaching regarding warfarin to a Chinese patient. The patient uses coining (rubbing a coin vigorously along the back) to help decrease fever. Which teaching will be especially important for this patient? "It is okay to use coining as long as you do it only once a week." "You should not use coining because it may increase your INR levels." "You can continue coining daily and taking aspirin until the fever is gone." "Warfarin causes an increased risk for bruising; coining can lead to bruising and would not be advised."
"Warfarin causes an increased risk for bruising; coining can lead to bruising and would not be advised." Coining can lead to bruising and is not recommended with warfarin therapy.
A patient is started on a continuous infusion of heparin at 0900. What time should an aPTT be checked? 1000-1200 1300-1500 1700-1900 2100-2300
1300-1500 The time to check aPTT after the initial infusion is started is 4-6 hours.
Warfarin binds with which molecule in the body? Keratin Ferritin Albumin Platelets
Albumin Ninety-nine percent of warfarin binds to albumin.
For which patient would warfarin be contraindicated? An alcoholic patient with liver disease A patient on hemodialysis at high risk for thrombosis A patient 24 hours post-operative for total knee replacement A patient with new onset atrial fibrillation who has a mechanical heart valve
An alcoholic patient with liver disease Patients with liver disease do not produce clotting factors and are at high risk for bleeding.
A patient is receiving a continuous heparin infusion. What is the appropriate aPTT response? An increase in INR 1.5-2.5 times above baseline. A decrease of 1.5-2.5 times below baseline aPTT. An increase of 1.5-2.5 times above baseline aPTT. No response. This is not the lab value monitored for continuous heparin infusion.
An increase of 1.5-2.5 times above baseline aPTT. An increase of 1.5-2.5 times above baseline aPTT is an appropriate aPTT response.
Heparin combines with which factor to inhibit thrombus formation? Factor I Factor VII Antithrombin III Prothrombin Factor II
Antithrombin III Antithrombin III leads to inactivation of thrombin and prevents thrombus formation.
What is the initial intervention for a patient taking an anticoagulant who cuts him- or herself? Apply a tourniquet above the cut. Stop the anticoagulant immediately. Call 911 and discuss the situation with the operator. Apply direct pressure with a clean cloth to the cut for 5-10 minutes.
Apply direct pressure with a clean cloth to the cut for 5-10 minutes. Applying pressure to the wound should be performed initially for a patient on an anticoagulant who cuts him- or herself.
During the patient interview, the nurse finds that the patient taking warfarin eats a salad for lunch every day. What is a concern for this patient? Increase in GI upset Allergic reaction to warfarin Increase in warfarin's action Decrease in warfarin's effectiveness
Decrease in warfarin's effectiveness Foods high in vitamin K, such as green, leafy vegetables, can decrease the effectiveness of warfarin.
What is important to teach Ms. Wang about nutrition while she is taking warfarin? Avoid broccoli. Eat a lot of grapes. Avoid eating pasta. Drink a lot of green tea.
Avoid broccoli. The patient should avoid broccoli because it can inhibit the action of warfarin due its vitamin K content. Green leafy vegetables should be eaten sparingly for this reason.
Which teaching is important for a patient taking warfarin? Select all that apply. Avoid smoking. Avoid exercise. Wear support hose. Avoid herbal products. Take the warfarin dose at any time.
Avoid smoking. Smoking increases the metabolism of warfarin, which may interfere with the drug's effectiveness. Wear support hose. Wearing support hose will reduce venous stasis, which will reduce the risk of thrombosis. Avoid herbal products. Herbal products interact with anticoagulants and could cause an increase in bleeding.
A patient who only speaks Spanish is being discharged home on an anticoagulant. How can the nurse best ensure the patient understands discharge instructions? By giving the patient written instructions By teaching the patient and using their family member as the interpreter By providing discharge teaching instructions in the patient's preferred language By speaking to the patient slowly in English and enunciating the discharge instructions
By providing discharge teaching instructions in the patient's preferred language This will better ensure the patient understands the discharge instructions.
The nurse is hanging a new bag of intravenous heparin and sees the dose is prescribed in milligrams. What is the nurse's next action? Discuss the situation with the charge nurse. Hang the new bag of heparin, per hospital policy. Contact the prescriber for a change in prescription. Convert milligrams to grams and hang the new bag, per hospital policy.
Contact the prescriber for a change in prescription. Heparin is always dosed in units. This is a medication error and needs to be corrected before the medication is administered to the patient.
A patient taking warfarin states that she is having trouble falling asleep at night. Which advice would be contraindicated for this patient? Drink a cup of warm milk at bedtime. Drink hot water with honey before bedtime. Drink a cup of chamomile tea before bedtime. Try gentle yoga or meditation two hours before bedtime.
Drink a cup of chamomile tea before bedtime. Chamomile can affect the INR.
A patient is admitted with an acute pulmonary embolism (PE). Heparin intravenous (IV) is prescribed. Why is the prescription for IV rather than subcutaneous heparin? Better absorption. Ease of administration. Immediate onset of action. IV heparin will dissolve the PE.
Immediate onset of action. IV heparin has an immediate onset of action.
Why is heparin administered parenterally rather than orally? Heparin is destroyed by gastric secretions. One of heparin's adverse effects is oral lesions. Heparin is poorly tolerated and causes nausea. Heparin causes bleeding in the GI tract after oral administration.
Heparin is destroyed by gastric secretions. Heparin can only be given intravenously or subcutaneously because it is destroyed by gastric secretions.
A patient with recurrent blood clots is taking warfarin at home. During an office visit, which lab work would indicate a high risk for thrombus formation? INR of 5 INR of 1.5 aPTT of 70 Platelets 200,000/microL
INR of 1.5 INR of 1.5 indicates the INR is sub-therapeutic and that the patient is at risk for thrombus.
A patient is taking an anticoagulant at home. In which situation should the health care provider be contacted immediately? If the patient has dark, tarry stools If the patient has a sore throat and nasal drainage If a small bruise appears on the patient's knee after the patient bumps it on a table If the patient has a cut from knife but is able to stop the bleeding after putting pressure on the cut
If the patient has dark, tarry stools Dark, tarry stool is a sign of bleeding when a patient is taking an anticoagulant.
Which result is possible if a patient takes St. John's wort and heparin simultaneously? Hemorrhage Blood clotting Increased bleeding Myocardial infarction
Increased bleeding Many herbal products interact with anticoagulants and may increase bleeding.
A patient taking warfarin is profusely bleeding. The patient received vitamin K 2 hours ago but continues to bleed. Which prescription should the nurse anticipate? Infusion of heparin Administration of aspirin Infusion of fresh frozen plasma Administration of protamine sulfate
Infusion of fresh frozen plasma Infusing fresh frozen plasma is the next step in stopping the bleeding.
What is a critical nursing assessment for a patient receiving a continuous heparin infusion? Monitoring the patient's platelet count Assessing for bruising or bleeding after a fall Monitoring the aPTT and notifying the provider of the need to make changes Monitoring the INR and notifying the provider of the need to make changes
Monitoring the aPTT and notifying the provider of the need to make changes This is the highest priority when monitoring a patient on a heparin infusion.
A hospitalized patient has been receiving subcutaneous heparin every 12 hours. The patient is scheduled to have a lumbar puncture at 0900. What is the nurse's priority action? Anticipating what supplies are needed for the 0900 lumbar puncture Notifying the health care provider that the patient is receiving heparin Ensuring that the patient understand and has signed a consent for the procedure Giving the 0900 dose at 0830 to ensure that the patient receives heparin before the lumbar procedure
Notifying the health care provider that the patient is receiving heparin The health care provider needs to know when the patient last received heparin because the patient is at increased risk for bleeding and hematoma development during the puncture if receiving heparin.
Why should patients inform their dentist if they are taking an anticoagulant? Patients are at an increased risk for bleeding. Dentists cannot work on patients taking anticoagulants. The dentist should know about every medical condition. Anticoagulants may influence the anesthetic the dentist may use.
Patients are at an increased risk for bleeding. Dental procedures can cause trauma in the oral cavity and lead to bleeding.
For which patients is warfarin contraindicated? Select all that apply. Patients on hemodialysis Patients who are pregnant Patients with vitamin K deficiency Patients scheduled for brain surgery Patients with a mechanical heart valve
Patients who are pregnant Pregnancy is a contraindication for warfarin therapy. Correct Patients with vitamin K deficiency Vitamin K deficiency is a contraindication for warfarin therapy. Correct Patients scheduled for brain surgery Surgery is a contraindication for warfarin therapy.
When a patient is taking warfarin, which manifestation could indicate bleeding? Petechiae on arms Clay-colored stools Elevated blood pressure Pain and burning with urination
Petechiae on arms Petechiae (small red spots on the skin) are a sign of bleeding.
A patient is receiving heparin infusions for several days after major surgery. In reviewing lab data, the nurse finds that the platelet count is 130,000/microL, when previously it had been 300,000/microL. What might this decrease in platelets signify? Bleeding at the surgical site Decrease in vitamin K activity An expected response to heparin therapy Possible heparin induced thrombocytopenia (HIT)
Possible heparin induced thrombocytopenia (HIT) Possible signs of HIT include a decrease in platelets 5-10 days after heparin therapy, a decrease in platelet count 30-50% from baseline, and new onset thrombosis.
What is the primary use for subcutaneous heparin therapy? Preventing thrombosis Treating deep vein thrombosis Managing hepatitis side effects Treating myocardial infarction (MI)
Preventing thrombosis Subcutaneous heparin therapy is used to prevent thrombosis.
What is the antidote to heparin? Vitamin K Whole blood Protamine sulfate Packed red blood cells
Protamine sulfate Protamine sulfate is the antidote to heparin.
Which laboratory value should the nurse monitor related to warfarin therapy? White blood cell count (WBC) Activated prothrombin time (aPTT) Hematocrit (Hct) and hemoglobin (Hgb) Prothrombin time reported in international normalized ratio (INR)
Prothrombin time reported in international normalized ratio (INR) Prothrombin time reported in INR is how warfarin is monitored.
A patient is administering subcutaneous heparin at home. Which teaching point is appropriate for this patient? Shave with an electric razor. Use a hard-bristled toothbrush. Inject heparin in the same spot every day. Dispose of used syringes in the regular garbage.
Shave with an electric razor. An electric razor should be used because there is less risk of the patient for cutting himself than when using a straight razor.
Which laboratory value should the nurse monitor related to intravenous (IV) heparin therapy? INR CBC aPTT Platelets
aPTT
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aPTT aPTT is the priority lab value and guides IV heparin therapy decisions.
Which discharge teaching is appropriate to give a patient who has been prescribed warfarin? Select all that apply. The medication may cause dizziness. There are no dietary restrictions while taking warfarin. Use a soft toothbrush when taking this medication. Wear a medical alert ID that states you are taking warfarin. Notify the health care provider for excessive bruising, abdominal pain, or tar-colored stools.
Use a soft toothbrush when taking this medication. Use of soft toothbrush will help to prevent bleeding of gums during oral hygiene. Wear a medical alert ID that states you are taking warfarin. In case of an accident, it is important for medical providers to know if a patient is taking warfarin. Notify the health care provider for excessive bruising, abdominal pain, or tar-colored stools. These are signs of bleeding.
Which teaching is appropriate for a patient taking warfarin? Select all that apply. Use an electric razor. Use a soft-bristled toothbrush. Notify your dentist you are taking warfarin. Use over-the-counter supplements as needed. Take aspirin whenever you need for a headache.
Use an electric razor. Using an electric razor decreases the risk of bleeding. Correct Use a soft-bristled toothbrush. Using a soft-bristled toothbrush decreases the risk of bleeding. Correct Notify your dentist you are taking warfarin. Notifying the dentist of warfarin use is appropriate teaching.
