Chapter 45 and 46

A client is receiving warfarin sodium (Coumadin) for prevention of a thromboembolic event. The nurse determines that the client's latest International Normalized Ratio(INR) is optimal if which of the following values is noted?

2.5

How many minutes after a unit of packed red blood cells is checked out of the blood bank should it be hung for client use?

30 minutes

After receiving a first dose of warfarin (Coumadin) the client receiving IV heparin may expect the infusion to be discontinued in

48-72 hours

Which of the following laboratory studies will the doctor order to monitor the therapeutic effects of heparin?

APTT

An allergic reaction to urokinase may manifest itself through which of the following?

Dyspnea

Pravastatin is a

HMG-CoA reductase inhibitor

Discharge instructions about the Coumadin should include instructions to:

Use a soft toothbrush

Clopidogrel is

an antiplatelet

Fibrinolytics

degrade fibrin strands

Which agent below is a reductase enzyme inhibitor, which reduces cholesterol?

lovastatin

Nursing care for a client who received streptokinase include all of the following, EXCEPT

monitor liver enzymes

All of the following are correct regarding anticoagulant therapy, except

therapy poses a life threatening risk in clients with a DVT

Alteplase is a (an)

thrombolytic

Clients receiving warfarin therapy have their INR maintained at

2-3

A client who is taking anticoagulants requests an aspirin for his headache. As his nurse, you:

Contact the physician for an analgesic that does not contain aspirin

Heparin is given

IV

Enoxaparin belongs to which of the following drug group?

LMWH

Tinzaparin is a (an)

LMWH

Which of the following drugs does NOT alter the action of heparin?

Maalox

An example of an antiplatelet agent for angioplasty and acute coronary syndrome is

abciximab

A client on clopidogrel (Plavix) can take which of the following over the counter analgesics when needed?

acetaminophen (Tylenol)

Cholestyramine is a

bile acid sequestering agent

Anticoagulants

interfere with the clotting factors in the clotting cascade

Warfarin (Coumadin) exerts its anticoagulant effect by

interfering with the production of vitamin-K dependent clotting factors

Before discharge, a client begins oral anticoagulant therapy while he is still taking heparin. He questions you about being on both of the medications. Your best response would be:

"It takes a few days for the Coumadin to work, so we need to keep you on the heparin."

The nurse is preparing to hang a unit of blood on an assigned client. The nurse asks another nurse to monitor the other clients, because the nurse will need to remain with the client receiving the transfusion for at least how long after the unit is hung?

15 minutes

A client taking warfarin (Coumadin) is expected to have the international normalized ratio (INR) laboratory result within which of the following values?

2 to 3

The occurrence of hematuria and petechiae is most likely attributed to the concurrent use of heparin and:

Ibuprofen (Motrin)

Which of the following is an appropriate nursing diagnosis for the client who is taking heparin?

Impaired tissue perfusion

During streptokinase administration, it is important to carry out which of the following nursing interventions?

Monitor for any signs of blood loss

Which of the following tests is used for monitoring therapy with oral anticoagulants?

PT and INR

Which of the following lab test(s) must be done for a client receiving heparin?

PTT and APTT

Heparin primarily interferes with

Prothrombin

For which condition would the use of anticoagulants be contraindicated?

Recent childbirth

A client who is receiving a continuous heparin infusion is complaining of a chill and low back pain. The most appropriate nursing action would be to:

Stop the heparin infusion

Warfarin primarily interferes with

Vitamin K

A client who needs a blood transfusion has a history of having a febrile nonhemolytic reaction to a transfusion in the past. The nurse questions the physician about an order for which of the following, which the client should receive to prevent this from occurring with this transfusion?

acetaminophen(Tylenol)

The nurse advises a client taking anticoagulant therapy that which of the following drugs would be best to use for self-treatment of occasional headaches?

acetaminophen(Tylenol)

All of the following statements are correct regarding special consideration for the older adult, except

alcohol consumption and diet will not interfere with anticoagulant effects

Which agent below is used to hasten clot formation to help manage care for clients at high risk for bleeding, such as in hemophilia?

aminocaproic

Which agent below is used to treat bleeding disorders, such as hemophilia

aminocaproic

Which of the following drugs is an antidote for streptokinase?

aminocaproic acid

Cilostazol is a (an)

antiplatelet

Dipyridamole is a (an)

antiplatelet

Ticlopidine is a (an)

antiplatelet

Clopidogrel (Plavix) and ASA are examples of

antiplatelets

Which drug class below inhibits cholesterol absorption at the brush border of the small intestine?

azetidinones

Colesevelam is a

bile acid sequestering agent

Colestipol is a

bile acid sequestering agent

Colestipol (Colestid) reduces serum cholesterol by

binding to bile salts in the GI tract to prevent reabsorption

Heparin can cause

bleeding

The nurse would notify the physician prior to beginning an IV infusion of alteplase(Activase) if which of the following vital signs were measured as part of the admission to the emergency department?

blood pressure 194/112 mmHg

Expected risks for antiplatelets, anticoagulants and fibrinolytics are all of the following, except

cancer

Of the list below which one of the following is NOT a LMWH?

clopidogrel

Which agent below is an antiplatelet?

clopidogrel

Which agent below is a bile acid sequestering agent?

colestipol

All of the following are instructions for clients with altered platelet or clotting factors, except

discontinue your medication at first sign of bleeding and contact the prescriber

Fibrinolytic drugs

dissolve clots

A client is a candidate for alteplase (Activase). This drug will

dissolve the blood clot that has already formed

_______ is a mass of undissolved matter that breaks off from the blood clot.

embolus

A low molecular weight heparin is

enoxaparin

Parenteral anticoagulants include

enoxaparin

Clofibrate is a

fibric acid derivative

Which agent below is a fibric acid derivative?

gemfibrozil

A client taking warfarin (Coumadin) should limit intake of _______ to avoid a drug-food interaction.

green, leafy vegetables

Which agent below is a parenteral anticoagulant

heparin

Upon nearing completion of intravenous infusion of alteplase (Activase), the client will be started on _________ as part of the protocol.

heparin (Liquaemin)

If a client receives the drug therapy simvastatin (Zocor), they should NOT have which of the following health problems?

hepatitis

Risk factors for coronary heart disease include all of the following, except

high HDL

Intravenous heparin therapy exerts its effect by

inactivating clotting factors circulating in the bloodstream

The most serious drug interaction that occurs with oral anticoagulants (OAC) are those that

increase OAC effect and increase bleed risk

Antiplatelet drugs

inhibit platelet aggregation

A client has just completed intravenous thrombolytic therapy. A sign above the client's bed reads do not give drugs by which route for at least 24 hours?

intramuscular

Ticlopidine (Ticlid) is contraindicated in which of the following?

liver disease

An allergic reaction to streptokinase includes all of the following, EXCEPT

nausea

Which agent below is a vitamin shown to reduce cholesterol?

niacin

Which of the following vitamins has a lipid-lowering effect?

nicotinic acid

Warfarin is a (an)

oral anticoagulant

Vitamin K is a (an)

oral anticoagulant antidote

Heparin is a (an)

parenteral anticoagulant

Protamine sulfate is a (an)

parenteral anticoagulant antidote

In the case of the administration of too much warfarin, which agent below would be the appropriate antidote?

phytonadione

A client taking warfarin sodium(Coumadin) who is experiencing small episodes of bleeding visits the urgent care clinic and has an INR level drawn. After noting that the level is critically high, what medication should the nurse have readily available for use if ordered?

phytonadione(Mephyton)

A dose of warfarin (Coumadin) would be contraindicated in

pregnancy

Anticoagulants will

prevent new clot formation

The primary goal of anticoagulant therapy is to

prevent the formation of new thrombi

In the case of the administration of too much heparin, which agent below would be the appropriate antidote?

protamine sulfate

In the event of a hemorrhage, which of the following medications is most likely to be administered intravenously?

protamine sulfate

A client receiving heparin has an activated partial thromboplastin time in the critically high range. Which of the following drugs should be on hand to use as an antidote?

protamine sulfate (Protamine)

Fluvastatin is a

reductase enzyme inhibitor

The nurse is preparing to administer a scheduled dose of heparin to a client. Which of the following actions should the nurse take as part of routine procedures?

rotate sites on the lower abdomen

A client is being discharged on anticoagulant therapy. Which of the following is an acceptable item for self-care?

soft toothbrush

Which agent below is a thrombolytic?

streptokinase

Health teachings for a client receiving warfarin therapy would include all of the following, EXCEPT

take an aspirin for a headache

Which statement below is correct regarding Clopidogrel?

the combination of clopidogrel and ASA is appropriate

Urokinase is a (an)

thrombolytic

Which of the following is the antidote for warfarin overdose?

vitamin K

The oral anticoagulant commonly used is

warfarin

Which agent below is an oral anticoagulant?

warfarin

Which of the following agent(s) is pregnancy safety category X?

warfarin