Chapter 40 - Anticoagulants, Antiplatelets, & Thrombolytics
In which organ is clopidogrel activated for its drug effects? a. Kidney b. Stomach c. Liver d. Small intestines
c. Liver
(oral) anticoagulants Xa Inhibitors
Rivaroxaban (Xarelto) Apixaban (Eliquis) - Do not require routine coagulation monitoring - Administered once a day or twice a day - More expensive than warfarin (Coumadin) - No antidote
case study Which products, if taken by Ms. Wang, would concern the nurse because they increase the effects of warfarin? Select all that apply. a. Garlic b. Ibuprofen c. Ginseng d. Allopurinol e. Broccol f. Gingko
a. Garlic b. Ibuprofen d. Allopurinol f. Gingko
anticoagulants low-molecular-weight heparin (LMWH)
- Inactivates factor Xa - More predictable effect - Less risk of bleeding - aPTT monitoring not necessary Enoxaparin sodium (Lovenox) - Hip & knee replacement Dalteparin sodium (Fragmin) - Abdominal surgery Contraindications - Stroke, peptic ulcer, blood anomalies administration Subcutaneously - Abdomen - Prefilled syringes with attached needles Average treatment period 7 to 10 days - Started in hospital within 24 hours after surgery Longer half-life than heparin - Patients at home should not take antiplatelet drugs when on LMWH Protamine sulfate for bleeding - 1 mg per 100 units of LMWH
case study Mr. Dibecki, a 57-year-old man, has sustained a recent stroke for which he was hospitalized 3 months ago. Mr. Dibecki's wife tells the nurse that the patient had a brain scan during his hospitalization for a stroke; the results confirmed a stroke but were negative for any other conditions. The patient has a history of coronary artery disease. Mr. Dibecki is a nonsmoker (quit 5 years ago), drinks socially, and denies recreational drug use. He takes a daily (81-mg) oral aspirin and has no known drug allergies. Family history includes a deceased mother (age 75, stroke) and a deceased father (age 58, myocardial infarction). The nurse's assessment of Mr. Dibecki reveals subtle right-sided hemiparesis, hyperactive reflexes, and slight neglect of his right side. Vital signs include BP 150/99 mm Hg, HR 85 beats/min, RR 18, T 98.7°F. Mr. Dibecki is 72" tall and weighs 205 lb (93 kg).
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case study Ms. Turner, a 45-year-old female patient, is being discharged following a diagnosis of atrial fibrillation not related to valvular heart disease. She has been prescribed 150 mg of dabigatran by mouth twice daily with a recheck appointment scheduled in 2 weeks. She has no history of major trauma within the last 3 months. Ms. Turner does not take any regular drugs but occasionally takes aspirin for headaches.
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case study Ms. Wang, a 65-year-old woman, is started on warfarin therapy for atrial fibrillation. She also takes allopurinol for gout. Ms. Wang mentions to the nurse that she usually takes ibuprofen for her "aches and pains." The nurse notices some bruising to the arms. A bottle of an herbal supplement is at the patient's bedside.
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case study Ms. Williams, a 38-year-old woman, was admitted for acute deep vein thrombosis and multiple small pulmonary emboli. The patient tells the nurse she had a baby 6 weeks ago. Ms. Williams is 5'7" tall and weighs 161 lb (73 kg). Vital signs are as follows: ● Blood pressure 142/84 mm Hg ● Pulse 114 beats/min ● Respiration 32 breaths/min ● Temp 99.2°F ● SpO2 92% on room air IV fluids of 0.9% saline solution at 30 mL/hr and continuous IV heparin were prescribed. Twelve hours after starting heparin infusion, the patient reported some bruising to the legs, bleeding of the gums, a hematoma to the right groin, blood in the urine, and irritation at the injection site. Patient is noted to have fever and chills.
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thrombolytics
- Dissolve clots (fibrinolytic mechanism) - Plasminogen to plasmin destroys fibrin - Natural Process takes 2 weeks
anticoagulant meds
- Heparin - Low Molecular Weight Heparin (LMWH) - Warfarin (Coumadin) - Selective Factor Xa Inhibitors
thrombolytics treat what?
Myocardial infarction - Thrombus, or blood clot, disintegrates when a thrombolytic drug is administered within 3-4 hours. Ischemic stroke - Thrombolytic drug should be administered within 3 hours. - Pulmonary embolism - Deep Vein Thrombosis - Arterial occlusion from an acute thromboembolism
(oral) anticoagulants warfarin (Coumadin)
- Oral anticoagulant; days to take effect - Prolongs clotting time Inhibits hepatic synthesis of vitamin K - Affects clotting factors II, VII, IX, X - Prevents thrombophlebitis, pulmonary embolism, and embolism formation caused by atrial fibrillation, which can lead to a stroke (CVA) - Potential drug interactions with antiplatelets & other anticoagulants - Takes 10 days to clear from the plasma Highly protein-bound - Drug interactions > antiinflammatory agents & oral hypoglycemics (more free/active warfarin) - Long half-life (1 to 7 days) - Assess for signs of bleeding - Monitor therapeutic range Lab specimen drawn before next dose - PT 1.25 to 2.5 times control value (11 to 15 seconds) - INR 2 to 3 (normal 1.3 to 2) antagonists Vitamin K - Low dose orally for INR 5.5 - 24 to 48 hours to be effective Bleeding - 1 to 10 mg IM or subcutaneously Uncontrolled bleeding - Fresh frozen plasma - Whole blood - Platelets interventions/teaching - Inform dentist, Soft toothbrush - Electric shaver Lab testing - INR 2-3 - Medic Alert bracelet / necklace Stop smoking - Increases metabolism of drug Do not take aspirin - Increases action of warfarin - Avoid large quantities of dark, leafy vegetables
Anticoagulants
- Prevent formation of clots - Prevent venous thrombosis
antiplatelets
- Prevent thrombosis in the arteries - Suppress platelet aggregation - Prevent MI/stroke
antiplatelets Aspirin
- Suppresses platelet aggregation - Long-term, low-dose therapy - 81, 162, 325 mg - Inhibits cyclooxygenase, an enzyme needed by platelets to synthesize thromboxane A2 (TxA2) - Stop 7 days before surgery
thrombolytics nursing interventions
- Vital signs Assess for bleeding - 24 hours; q 15 minutes X 1 hour; q30 minutes X 7 hours then q 1 hour - Have Aminocaproic acid available Allergic reaction - Itching hives, flushing, dyspnea, bronchospasm, hypotension Avoid aspirin/NSAIDs - Substitute acetaminophen - Reperfusion dysrhythmias - Avoid venipuncture / arterial sticks
After administration, when would the nurse expect clopidogrel to start having its effect? _______ - _______ hours
1-2 hrs
How many minutes after infusion is most alteplase eliminated? _______ minutes.
10
A patient receiving unfractionated heparin has a baseline activated thromboplastin time (aPTT) of 30 seconds. What is the therapeutic aPTT level for this patient?
45-60 secs
How many days does it take for platelet aggregation to return to baseline once clopidogrel is discontinued? ______ days
5
A total dose of alteplase 80 mg is prescribed to a patient with an acute ischemic stroke. How many milligrams would the nurse initially administer? ______ mg
8
What percentage of warfarin is bound to protein? _____ %
91%
Warfarin is appropriate for patients with which conditions? Select all that apply. a. Deep vein thrombus b. Mechanical heart valve c. Heart failure d. Pulmonary embolus e. Chronic pulmonary disease f. Thromboembolic stroke
a. Deep vein thrombus b. Mechanical heart valve d. Pulmonary embolus f. Thromboembolic stroke
anticoagulants Heparin
Prevents - Deep vein thrombosis (DVT) - acute pulmonary embolism Laboratory test - aPTT - Detect deficiencies of clotting factors - Monitor heparin therapy Side effect - Bleeding Antidote - Protamine sulfate 1mg / 100 units of heparin administration High risk medication - Verification by 2 licensed nurses before administering - Monitor aPTT - Give subcutaneously or intravenously Dose ordered in units - Do not abbreviate the word units SubQ injection - Tuberculin syringe - 5/8-inch needle - Abdomen - Avoid area 2 inches around the umbilicus - Do not aspirate before - Do not massage after
Alteplase directly decreases the action of which blood products? Select all that apply. a. Fibrinogen b. Red blood cells c. Clotting factors d. Fibrin e. Platelets
a. Fibrinogen c. Clotting factors d. Fibrin
antiplatelets Adenosine diphosphate (ADP) antagonists
Dipyridamole (Persantine) Clopidogrel (Plavix) - Synergistic with ASA - Once a day - Stop 7 days before surgery - History of peptic ulcer: Proton pump Inhibitor Side-effects - Flu-like symptoms, dizziness, headache, fatigue, diarrhea
thrombolytics complications
Hemorrhage - Cerebral bleed - Antidote: aminocaproic acid (Amicar) Allergic reactions - Anaphylaxis (streptokinase) Intracoronary catheter - Reperfusion dysrhythmia - Hemorrhagic infarction
thrombolytics meds *do not memorize*
Systemic Streptokinase (Streptase) Urokinase (Abbokinase) Tissue plasminogen activator (tPA): clot-specific Alteplase tPA (Activase) - 3 doses: bolus, 30-minute IVPB, 60-minute IVPB - Assess: bleeding, allergic reactions, cardiac dysrhythmias, & vital signs Tenecteplase TNK-tPA (TNKase) - Single dose - Insert IVs before administering Derivative of tPA Reteplase rPA (Retavase)
antiplatelets Platelet glycoprotein IIb/IIIa receptor antagonists
Ticagrelor (Brilinta) - Taken with aspirin
The nurse is preparing to administer heparin intravenously (IV). Which response by the nurse would be appropriate when the patient asks when the medication will start working? a. "Heparin will start working in about 5 to 10 minutes." b. "It depends on the dose of heparin." c. "Heparin will start working in about 20 minutes." d. "You will need several doses before it affects you."
a. "Heparin will start working in about 5 to 10 minutes."
A patient is being discharged 2 days after being treated with alteplase for acute myocardial infarction (MI). Which statement made by the patient indicates a need for additional teaching? a. "I will need to continue to shave with an electric razor." b. "I should not be seeing any red in my urine." c. "I will call my doctor if I experience more chest pain." d. "I will notify my doctor if I start having dark, tarry stool."
a. "I will need to continue to shave with an electric razor."
While obtaining a medical history, the nurse finds that the patient taking warfarin eats a spinach salad for lunch every day. Which teaching point would the nurse provide for this patient? a. "The salad may decrease warfarin's effectiveness." b. "The salad may increase your risk for bleeding." c. "You are at a greater risk for hypersensitivity reaction to warfarin." d. "Taking warfarin with food can increase gastrointestinal (GI) distress."
a. "The salad may decrease warfarin's effectiveness."
Heparin and warfarin are started simultaneously in a patient who is diagnosed with a deep vein thrombosis. The nurse would anticipate that the heparin will most likely be discontinued at which time? a. 3 days after being on warfarin b. 24 hours after being on warfarin c. After 4 doses of heparin have been given d. 5 days after heparin was started
a. 3 days after being on warfarin
Routine medications were prescribed to resume for a patient who returned from major knee surgery 1 hour ago. The nurse is preparing to administer these medications, including clopidogrel. Which action would the nurse take? a. Administer the clopidogrel. b. Hold the clopidogrel for 24 hours. c. Notify the surgeon. d. Discontinue the clopidogrel.
a. Administer the clopidogrel.
A nurse is preparing to administer clopidogrel to a patient who has previously complained of dyspepsia 2 hours after taking the drug. Which action would the nurse take? a. Administer the drug with a small amount of food. b. Hold the drug. c. Notify the health care provider of the patient's complaint. d. Keep the head of the bed elevated for 2 hours after administering the drug.
a. Administer the drug with a small amount of food.
A patient on thrombolytic therapy experiences severe bleeding. The nurse anticipates the administration of which medication? a. Aminocoproic acid b. Protamine sulfate c. Vitamin K d. Clopidogrel
a. Aminocoproic acid
The nurse is preparing warfarin for several patients. For which patient would the nurse be most concerned in administering warfarin? a. An alcoholic patient with liver disease b. A postoperative patient following knee surgery c. An older adult with atrial fibrillation d. A pregnant patient with mechanical heart valve
a. An alcoholic patient with liver disease
case study Given Mr. Dibecki's history, which condition is he at risk for if he starts taking clopidogrel? a. Bleeding b. Thrombus c. Confusion d. Hypertension
a. Bleeding
A patient arrived in the emergency department 2 hours after an acute ischemic stroke. The patient is given an intravenous (IV) injection of alteplase tPA. It is most important for the nurse to monitor what? (Select all that apply.) a. Bleeding b. Vital signs c. PT levels d. Allergic reactions e. Electrocardiogram
a. Bleeding b. Vital signs d. Allergic reactions e. Electrocardiogram
Alteplase is contraindicated with which conditions? Select all that apply. a. Cerebrovascular accident (CVA) 2 months ago b. History of intracranial hemorrhage c. Uncontrolled diabetes d. Brain tumor e. Blood pressure (BP) of 152/90 mm Hg
a. Cerebrovascular accident (CVA) 2 months ago b. History of intracranial hemorrhage d. Brain tumor
A patient with acute pulmonary embolus is started on dabigatran. Which laboratory test results are most appropriate for the nurse to assess before administering the drug? Select all that apply. a. Complete blood count (CBC) b. Prothrombin time (PT) c. Protein levels d. Partial thromboplastin time (PTT) e. Arterial blood gas
a. Complete blood count (CBC) b. Prothrombin time (PT) d. Partial thromboplastin time (PTT)
The nurse is preparing to administer dabigatran. Dabigatran would be mostappropriate for a patient with which medical condition? a. Hepatic dysfunction b. Renal dysfunction c. A mechanical heart valve d. Hemorrhagic stroke
a. Hepatic dysfunction
The nurse is preparing to administer warfarin to a patient whose international normalized ratio (INR) is 5.2. Which action would the nurse take? a. Hold the warfarin. b. Give the warfarin. c. Administer half the regular dose of warfarin. d. Administer vitamin K.
a. Hold the warfarin.
Which time frame describes the onset of action for intravenous (IV) heparin? a. Immediate b. 5 to 10 minutes c. 20 minutes d. 2 hours
a. Immediate
Which laboratory value is used to adjust the dosage of warfarin? a. International normalized ratio (INR) b. Partial thromboplastin time (PTT) c. Complete blood count (CBC) d. Platelets
a. International normalized ratio (INR)
The patient develops a deep vein thrombosis. The nurse anticipates administration of which medication? a. Intravenous heparin b. Clopidogrel c. Vitamin K d. Protamine sulfate
a. Intravenous heparin
For which patient would the nurse anticipate administering heparin? a. Patient diagnosed with atrial fibrillation b. Patient with hemorrhagic cerebrovascular accident (CVA) c. Patient with large blood clots in the urine d. Patient with thrombocytopenia
a. Patient diagnosed with atrial fibrillation
The nurse is preparing to administer unfractionated heparin to three patients. Which patient would the nurse be most concerned about when administering heparin? a. Patient with activated thromboplastin time (aPTT) value of 98 seconds b. Patient with a platelet value of 135,000/mm3 c. Patient with a hemoglobin value of 14 g/dL d. Patient with prothrombin time (PT) greater than 2 seconds
a. Patient with activated thromboplastin time (aPTT) value of 98 seconds
Which drug classes have an additive effect of anticoagulation when administered with heparin? Select all that apply. a. Penicillins b. Tetracyclines c. Platelet inhibitors d. Nonsteroidal antiinflammatory drugs (NSAIDs) e. Aminoglycosides f. Cephalosporins
a. Penicillins c. Platelet inhibitors d. Nonsteroidal antiinflammatory drugs (NSAIDs) f. Cephalosporins
A nurse is preparing clopidogrel for several patients. Patients with which conditions should receive the drug? Select all that apply. a. Prevention of thrombosis b. Acute coronary syndrome c. Coronary artery stents d. Hemorrhagic stroke e. Chronic renal disease
a. Prevention of thrombosis b. Acute coronary syndrome c. Coronary artery stents
Which adverse effects would the nurse teach the patient to report during thrombolytic therapy? Select all that apply. a. Rapid heartbeat b. Rashes c. Lightheadedness d. Dizziness e. Blurred vision
a. Rapid heartbeat b. Rashes c. Lightheadedness d. Dizziness
Through which route would the nurse expect to administer enoxaparin? a. Subcutaneous (SQ) injection b. Intermittent intravenous (IV) administration c. Continuous IV infusion d. Intramuscular (IM) injection
a. Subcutaneous (SQ) injection
Four patients are considered as potential candidates for thrombolytic therapy. Which patient is most likely to receive thrombolytic therapy? a. The patient who recently used acetaminophen b. The patient with a history of severe hypertension c. The patient who recently had spinal surgery d. The patient with a history of warfarin use
a. The patient who recently used acetaminophen
A nurse is preparing to administer alteplase. The nurse would gather equipment knowing that alteplase would be administered by which route? a. Orally b. Intramuscularly (IM) c. Intravenously (IV) d. Intraosseously
c. Intravenously (IV)
A patient who was found unconscious was found to have a large, acute pulmonary embolism and was given alteplase. The patient's family asks the nurse why alteplase was given rather than warfarin. Which response would the nurse make? a. "Alteplase is safer to give than warfarin." b. "Alteplase is a thrombolytic that is used to dissolve large clots to restore circulation. Warfarin only prevents clots from forming." c. "Alteplase is safer to use than warfarin because it has a slower onset of action." d. "Alteplase will prevent thrombus formation after discharge, whereas warfarin will only destroy the existing clot."
b. "Alteplase is a thrombolytic that is used to dissolve large clots to restore circulation. Warfarin only prevents clots from forming."
case study Which teaching would the nurse provide to Ms. Turner regarding concomitant use of aspirin and dabigatran? a. "You should take ibuprofen instead of aspirin for your headache to decrease your risk for bleeding." b. "NSAIDs, including aspirin, can increase the risk for bleeding." c. "NSAIDs, including aspirin, reduce the effectiveness of dabigatran." d. "Dabigatran reduces the effects of NSAIDs, including aspirin, so you will need to take something else for your headaches."
b. "NSAIDs, including aspirin, can increase the risk for bleeding."
A patient states that clopidogrel is causing an upset stomach. Which instruction would the nurse provide? a. "Take the clopidogrel with grapefruit juice." b. "Take the clopidogrel with food." c. "Ask your health care provider about prescribing omeprazole." d. "Ask your health care provider about stopping the clopidogrel."
b. "Take the clopidogrel with food."
A patient taking dabigatran complains of dyspepsia. Which instruction would the nurse provide to the patient? a. "Take an antacid with the dabigatran." b. "Take the drug with food." c. "Drink green tea." d. "Drink cranberry juice."
b. "Take the drug with food."
A patient who recently started taking warfarin asks the nurse why laboratory work needs to be obtained every 3 to 4 days. Which response would the nurse provide? a. "To ensure no bleeding is occurring, complete blood count (CBC) is checked every 3 to 4 days." b. "To ensure adequate dosing of warfarin, the INR needs to be checked every 3 to 4 days." c. "To ensure you are taking the medication, aPTT is checked every 3 to 4 days." d. "To determine whether blood clots are developing, platelets must be checked every 3 to 4 days."
b. "To ensure adequate dosing of warfarin, the INR needs to be checked every 3 to 4 days."
Alteplase is indicated for which emergent conditions? Select all that apply. a. Acute deep vein thrombosis b. Acute ischemic stroke c. Acute large pulmonary embolus d. Acute renal stenosis e. Acute ST-elevated myocardial infarction
b. Acute ischemic stroke c. Acute large pulmonary embolus e. Acute ST-elevated myocardial infarction
Oral clopidogrel 300-mg one-time dose is prescribed to a patient with acute coronary syndrome. Which action would the nurse take? a. Reduce the dose to 75 mg. b. Administer the dose. c. Call the health care provider for clarification. d. Give the dose intravenously.
b. Administer the dose.
A nurse is preparing to administer enoxaparin, a heparin derivative. Which action by the nurse demonstrates the correct technique for administering the medication? a. Inject enoxaparin slowly by intravenous (IV) route. b. Administer the drug at least 2 inches from the umbilicus. c. Dilute enoxaparin with normal saline for IV administration. d. Obtain an IV pump to administer the drug.
b. Administer the drug at least 2 inches from the umbilicus.
A patient on subcutaneous anticoagulant calls the clinic about a cut received on the hand. Which initial action would the nurse tell the patient to take? a. Call 911 for an ambulance. b. Apply direct pressure to the cut for 5 to 10 minutes. c. Apply a belt above the cut. d. Eat several servings of spinach.
b. Apply direct pressure to the cut for 5 to 10 minutes.
For which reasons would the nurse monitor older adults taking heparin more closely for bleeding? Select all that apply. a. There is reduced production of red blood cells. b. Capillary walls are more fragile. c. Platelets are of poor quality. d. Skin is thinner. e. Red blood cells are smaller.
b. Capillary walls are more fragile. d. Skin is thinner.
A patient who has been taking warfarin for chronic atrial fibrillation was advised by a friend to consume a low-protein diet. Which change in warfarin dosage would the nurse anticipate? a. Increase b. Decrease c. No change d. Discontinue
b. Decrease
Which phrases describe the main functions of antiplatelet drugs? Select all that apply. a. Suppress the production of clotting factors b. Decrease platelet aggregation c. Prevent the conversion of fibrinogen to fibrin d. Inhibit thrombus formation e. Prevent antithrombin from converting to thrombin
b. Decrease platelet aggregation d. Inhibit thrombus formation
case study Which signs and symptoms experienced by Ms. Williams would prompt the nurse to immediately notify the health care provider? Select all that apply. a. Minor bruising to the legs b. Hematoma under the skin c. Blood in the urine d. Bleeding from the gums e. Irritation at the injection site f. Chills and fever
b. Hematoma under the skin c. Blood in the urine d. Bleeding from the gums f. Chills and fever
Which time frame describes the onset of action of alteplase when administered intravenously? a. 5 to 10 minutes b. Immediately c. 35 minutes d. 3 hours
b. Immediately
The patient is being discharged home on warfarin therapy. Which information will the nurse include when teaching the patient? a. Results of activated partial thromboplastin time (aPTT) will determine if the medication is effective. b. International normalized ratio (INR) results should be between 2 and 3. c. A normal response to warfarin is for your stools to look tarry. d. Increase the amount of green leafy vegetables in your diet.
b. International normalized ratio (INR) results should be between 2 and 3.
A patient is recovering from surgery to replace her right hip. In the early postoperative phase, the nurse anticipates administration of which drug to prevent deep vein thrombosis? a. Dipyridamole b. Low-molecular-weight heparin c. Abciximab d. Anagrelide
b. Low-molecular-weight heparin
A patient has been receiving subcutaneous heparin every 12 hours. The patient is scheduled to have a lumbar puncture at 0900. Which action is the nurse's priority? a. Ensure that the patient understands and has consented for the procedure. b. Notify the health care provider the patient is receiving heparin. c. Give the heparin early, just before the lumbar puncture. d. Prepare the patient for the lumbar puncture.
b. Notify the health care provider the patient is receiving heparin.
A patient who has a pulmonary embolism is prescribed alteplase. The review of the patient history reveals an ischemic stroke 4 months ago. Which action would the nurse take? a. Administer the medication. b. Notify the health care provider. c. Conduct a thorough skin assessment for ecchymosis. d. Make sure the patient eats before giving the drug.
b. Notify the health care provider.
A patient is on heparin therapy secondary to deep vein thromboses. The nurse has which medication on hand as an antidote in case it is needed? a. Vitamin K b. Protamine sulfate c. Warfarin d. Aminocaproic acid
b. Protamine sulfate
Which substance would the nurse ensure is readily available to stop active bleeding before administering heparin? a. Platelets b. Protamine sulfate c. Plasma d. Packed red blood cells
b. Protamine sulfate
Prophylactic therapy with antiplatelet drugs is indicated in patients with a history of which conditions? Select all that apply. a. Peptic ulcers b. Transient ischemic attacks (TIAs) c. History of myocardial infarction (MI) d. Intracranial bleed e. Factor V Leiden deficiency f. History of ischemic stroke
b. Transient ischemic attacks (TIAs) c. History of myocardial infarction (MI) e. Factor V Leiden deficiency f. History of ischemic stroke
In which time frame does warfarin reach its peak level? a. 20 to 60 hours b. 36 to 48 hours c. 1.5 to 3 days d. 2 to 5 days
c. 1.5 to 3 days
A patient was started on intravenous (IV) heparin at 1200 pm. When will the nurse assess the activated thromboplastin time (aPTT)? a. 0000 (midnight) b. 0600 next day c. 1800 d. 1200 next day
c. 1800
A patient is prescribed clopidogrel and aspirin at 9:00 a.m. Which action would the nurse take? a. Administer clopidogrel at 9:00 a.m. and aspirin 4 hours later. b. Notify the health care provider. c. Administer both drugs at 9:00 a.m. d. Hold aspirin but administer clopidogrel.
c. Administer both drugs at 9:00 a.m.
A patient with healing stab wounds to the arms and legs is brought to the emergency department with complaints of chest pain. The patient was diagnosed with acute myocardial infarction, and alteplase was prescribed. The nurse would closely monitor the patient for which complications following the administration of alteplase? a. Hypertension b. Diarrhea c. Bleeding d. Blood clots
c. Bleeding
Which information will the nurse include when teaching a patient about warfarin therapy? a. Increase the amount of green, leafy vegetables in your diet. b. Rinse your mouth instead of brushing your teeth. c. Follow up with laboratory tests such as PT/INR to regulate warfarin dose. d. Use a new razor blade each time you shave.
c. Follow up with laboratory tests such as PT/INR to regulate warfarin dose.
The patient continues to bleed after receiving vitamin K for warfarin toxicity. The nurse anticipates administering which product to a patient who is not responding to vitamin K? a. Protamine sulfate b. Dabigatran c. Fresh-frozen plasma d. Heparin
c. Fresh-frozen plasma
Which treatment for reversing the anticoagulant effects of clopidogrel would the nurse anticipate administering if a patient develops thrombotic thrombocytopenic purpura (TTP)? a. Whole blood b. Vitamin K c. Fresh-frozen plasma d. Idarucizumab
c. Fresh-frozen plasma
Clopidogrel is an example of which class of antiplatelets? a. Cyclooxygenase inhibitors b. Anticoagulants c. P2Y12 adenosine diphosphate (ADP) receptor blockers d. Glycoprotein IIb/IIIa receptor blockers
c. P2Y12 adenosine diphosphate (ADP) receptor blockers
For which patient is rivaroxaban contraindicated? a. Patient with decreased renal function b. Patient with hepatic impairment c. Patient with mechanical prosthetic heart valve d. Older adult patient
c. Patient with mechanical prosthetic heart valve
Which teaching is appropriate for a patient being discharged with a prescription for subcutaneous heparin? a. Inject heparin in the same spot every day. b. Dispose of used syringes in the regular garbage. c. Shave with an electric razor. d. Use your preferred type of toothbrush.
c. Shave with an electric razor.
A patient is on the tenth day of a clopidogrel regimen and presents with a temperature of 102.1oF and total urine output of 200 mL over 24 hours. The patient is disoriented. Which adverse effect would the nurse suspect? a. Bleeding ulcer b. Acute renal impairment c. Thrombotic thrombocytopenia purpura (TTP) reaction d. Myocardial infarction (MI)
c. Thrombotic thrombocytopenia purpura (TTP) reaction
Before administering warfarin, the nurse would ensure that which antidote is on hand in case of an overdose? a. Potassium b. Protamine sulfate c. Vitamin K d. Naloxone
c. Vitamin K
A patient is prescribed aspirin, 81 mg, and clopidogrel. The nurse identifies the drug classification of clopidogrel as a. anticoagulant. b. thrombotic inhibitor. c. antiplatelet. d. thrombolytic.
c. antiplatelet.
A patient taking warfarin asks the nurse what should be done first if bleeding occurs from a small laceration on the arm. Which response would the nurse make? a. "Call 911 for emergency health care." b. "Place a tourniquet above the cut." c. "Take over-the-counter vitamin K." d. "Apply firm, direct pressure to the cut."
d. "Apply firm, direct pressure to the cut."
The nurse is providing teaching education to a patient who is being discharged with prescriptions for clopidogrel and aspirin. The patient tells the nurse that fresh garlic is used to season many of the foods eaten. Which response would the nurse make? a. "Continue to use garlic. It is good for you." b. "Decrease your garlic intake by half." c. "Instead of garlic, use ginger to flavor the food." d. "Avoid garlic. It can increase chance of bleeding."
d. "Avoid garlic. It can increase chance of bleeding."
A patient is started on clopidogrel and reports hematuria to the nurse before receiving the morning dose. The nurse has placed a call to the health care provider and is waiting for a response. Which action would the nurse take next? a. Provide a snack to be taken with the medication. b. Hold the dose. c. Administer half the prescribed dose of the medication. d. Administer the medication.
d. Administer the medication.
The nurse is caring for a patient who received alteplase tPA for treatment of acute coronary syndrome. The patient starts to bleed. The nurse anticipates administration of which medication? a. Protamine sulfate b. Vitamin K c. Warfarin d. Aminocaproic acid
d. Aminocaproic acid
Parenteral anticoagulants prevent the formation of which product as the final step of clotting? a. Antithrombin III b. Thrombin c. Fibrinogen d. Fibrin
d. Fibrin
A nurse is preparing to administer heparin intravenously (IV) to a patient who was admitted with an acute pulmonary embolus. Which response by the nurse is appropriate when the patient asks why the drug is given IV rather than orally? a. IV heparin dissolves the clot. b. IV heparin lasts longer. c. Laboratory work is not needed for IV heparin. d. Heparin is poorly absorbed by the gastrointestinal (GI) tract.
d. Heparin is poorly absorbed by the gastrointestinal (GI) tract.
A patient who was started on continuous intravenous heparin for a pulmonary embolus complains of "a lot of bruises" and "pink urine." Laboratory values show that platelets have decreased from 225,000 mm3 to 75,000 mm3. Which condition would the nurse most likely consider with these signs and symptoms? a. Expected response from heparin b. Hypersensitivity reaction from heparin c. Spleen reacting to heparin d. Heparin-induced thrombocytopenia (HIT) from heparin
d. Heparin-induced thrombocytopenia (HIT) from heparin
A patient with a mechanical heart valve has been taking warfarin. The patient tells the nurse that vegetables and fruits have been added to the diet. Which effect will most likely occur with the increase in fruit and vegetable intake? a. International normalized ratio (INR) will increase. b. Bleeding will increase. c. Renal function will decrease. d. INR will decrease.
d. INR will decrease.
A patient is admitted for bleeding caused by an overdose of dabigatran. Which drug will the nurse anticipate administering? a. Protamine sulfate b. Vitamin K c. Atropine sulfate d. Idarucizumab
d. Idarucizumab
A nurse is preparing to administer clopidogrel and aspirin to a patient who has an altered CYP2C19 gene. Which action would the nurse take? a. Administer aspirin and clopidogrel. b. Assess for ecchymosis. c. Administer clopidogrel only. d. Notify the health care provider.
d. Notify the health care provider.
A patient visits an outpatient clinic. The patient has been noncompliant with anticoagulation therapy and states, "I don't like having to have blood work all of the time." The nurse anticipates prescription of which medication? a. Heparin b. Lovenox (enoxaparin) c. Plavix (clopidogrel) d. Rivaroxaban (Xarelto)
d. Rivaroxaban (Xarelto)
By which route is unfractionated heparin primarily excreted? a. Liver b. Feces c. Respirations d. Urine
d. Urine
