PHARM TEST Chapter 26

Dipyridamole (Persantine) has been used extensively in combination with warfarin to prevent the formation of thromboembolism after which type of event

Cardiac Valve replacement

A patient is receiving 1400 units of heparin/hr on an IV pump. The aPTT time is 54. The laboratory control is 25. Which action by the nurse is accurate?

Continue with the prescribed rate.

anticoagulant therapy may be used for which situation(s)? (Select all that apply.)

To prevent stroke in patients at high risk Following a myocardial infarction Following total hip or knee joint replacement surgery With DVT To prevent thrombosis in immobilized patients

The nurse is preparing discharge education for a patient who will be receiving warfarin (Coumadin) at home. Which important point(s) will the nurse include?

"Do not make any major changes to your diet without discussing it with your healthcare provider." "Keep outpatient laboratory appointments for monitoring of therapy." "Report signs of bleeding to your healthcare provider, including observing skin for bruising; petechiae; blood in emesis, urine, or stools; bleeding gums; cold, clammy skin; faintness; or altered sensorium." "Avoid aspirin products."

A patient receiving IV heparin therapy for a deep vein thrombosis (DVT) in his right calf remains painful edematous, and warm to touch after 2 days of anticoagulant therapy. Which response by the nurse is most accurate

"Heparin does not dissolve blood clots but neutralizes clotting factors, preventing extension of the clot and the possibly of it traveling eleswhere in body

The nurse is instructing a patient about the administration of fondaparinux (Arixtra). Which statement by the patient indicates a correct understanding about the administration of the drug?

"I should not rub the injection site after injecting the medication."

The nurse has provided instruction to a patient recently prescribed warfarin (Coumadin). Which statement by the patient indicates to the nurse the need for further teaching?

"I will rinse my mouth with mouthwash instead of brushing my teeth.

The patient is receiving warfarin (Coumadin) for the prevention of venous thrombosis. Which instruction with the nurse include in the patient's teaching plan?

"Use a soft-bristled toothbrush to brush teeth."

The nurse is caring for a 27-year-old woman on the postpartum unit one day following a C-section. To prevent clot formation, the nurse will:

implement deep breathing and coughing exercises

The nurse finds that a patient has an obstructed central venous catheter. Which drug does the nurse administer to reopen the catheter?

Alteplase (tPa)

A patient comes to the clinic reporting unexplained bruising and bloody appearing urine. Which type of medication is most important for the nurse to determine if the patient is taking?

Anticoagulants

Which laboratory values should the nurse assess before administering dalteparin (Fragmin) to a patient?

CBC

Which nursing intervention(s) would be accurate when administering heparin subcutaneously?

Documenting ecchymotic areas Monitoring of vital signs

Which action will the nurse implement to decrease the risk of clot formation in an older patient on bed rest

Encourage passive leg exercises.

Which signs and symptoms is a patient taking clopidogrel (Plavix) instructed to report to the healthcare provider immediately

Fever, sore throat, excessive fatigue

Which statement about the action of fondaparinux (Arixtra) is true?

Fondaparinux is a selective factor Xa inhibitor.

The nurse is reviewing the medication history of a patient who has been prescribed warfarin (Coumadin). Which agent taken by the patient would be contraindicated?

Ginkgo Biloba

What is the rationale for administering fibrinolytic agents, such as streptokinase, within hours of the onset of myocardial infarction?

Lyses the blood clot

Which symptoms are most suggestive of the need to adjust warfarin (Coumadin) dosage?

Nosebleeds, petechiae, menorrhagia

Which symptom is indicative of bleeding in a patient taking warfarin (Coumadin)?

Petechiae

Which is the expected action of heparin when used to treat deep vein thrombosis (DVT)

Prevent Clot formation

The pharmacologic agents used to treat DVT may act in which way(s)?

Prevent platelet aggregation. Prevent the extension of existing clots inhibit steps in the fibrin clot formation cascade. Prolong bleeding time.

What is the mechanism of action of drugs used to treat thromboembolic disease?

Preventing platelet aggregation and inhibiting clot formation

A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin

Protamine Sulfate

The patient undergoing heparin therapy has hematemesis, dark, tarry stools, tachycardia, and hypotension. Which drug would the nurse anticipate to be ordered?

Protamine Sulfate

The nurse is teaching a patient about dietary implications while on warfarin (Coumadin) therapy. Which salad is highest in vitamin K?

Spinach

A patient is receiving IV heparin therapy. The aPTT is 90; the laboratory control is 30 seconds. Which nursing intervention is most accurate?

Stop the heparin drip

Which instruction does the nurse give to a patient who is ordered aspirin 325 mg PO bid (twice per day) for the prevention of thrombi

Take Aspirin with breakfast and supper

The nurse is caring for a patient undergoing heparin therapy. Which laboratory test should be ordered to measure the effectiveness of the heparin therapy?

aPTT

Rivaroxaban (Xarelto) is ordered on a patient following knee replacement surgery. When providing education on this medication to the patient, the nurse conveys that treatment will continue

for 12 days postsurgically

The nurse is preparing to administer dalteparin (Fragmin) to a patient in order to prevent DVT following a hip replacement. When providing this medication to the patient, the nurse will

inject slowly alternate injection sites every 24 hours.

Which is an accurate nursing action when administering subcutaneous enoxaparin, a low-molecular-weight heparin product?

leave the needle in the place for 10 secs after injection

Which coexisting condition should be reported to the healthcare provider when reviewing the history of a patient taking heparin?

peptic ulcer disease