Exam 2 EAQs: Ch. 37 - Venous Disorders

A patient receives a prescription for 60 mg enoxaparin. Which injection site should the nurse use to administer the medication safely? Abdomen Thigh Deltoid Flank

Abdomen Enoxaparin is a low-molecular-weight heparin that is given as a subcutaneous injection. The preferred injection sites for this medication are the right and left anterolateral abdominal wall. All subcutaneous injections should be given away from scars, lesions, or moles. The thigh and flank are not appropriate sites for administering enoxaparin because of poorer absorption of the medication in the thigh or flank, and it should not be given intramuscularly in the deltoid because of risk of hematoma development.

The patient on bed rest is scheduled to receive a first dose of enoxaparin. For proper administration, which site should the nurse select for injection? Thigh Flank Abdomen Buttock

Abdomen Enoxaparin is a low-molecular-weight heparin that is given as a subcutaneous injection. The preferred injection sites for this medication are the right and left anterolateral abdominal walls. The thigh, flank, and buttock are not appropriate sites related to impaired drug absorption at these sites.

The nurse is performing a physical assessment on a patient with chronic venous insufficiency (CVI). Which manifestation involving the lower extremities should the nurse expect? Shiny skin Lack of sensation Brownish color Absent pulses

Brownish color Brownish or "brawny" is the characteristic skin color of the lower leg in chronic venous insufficiency. The brownish skin discoloration occurs when the red blood cells leak from the capillaries, break down, and release hemosiderin. Shiny skin and absent pulses are manifestations of peripheral artery disease. Itching is a common report by the patients with CVI.

When taking a patient's history, the 40-year-old patient tells the nurse, "I have a condition that makes me have pain in my feet and arms sometimes. They change color and temperature, get tingly, and are sensitive to cold. I was told that the primary treatment is for me to stop smoking and using marijuana." The nurse suspects that the patient is referring to what disorder? Buerger's disease Venous thrombosis Acute arterial ischemia Raynaud's phenomenon

Buerger's disease Buerger's disease is a nonatherosclerotic, segmental, recurrent inflammatory disorder of small and medium-sized vascular vessels of the upper and lower extremities, leading to color and temperature changes of the limbs, intermittent claudication, rest pain, and ischemic ulcerations. It primarily occurs in men younger than 45 years old with a long history of tobacco or marijuana use. Buerger's disease treatment includes smoking cessation, trauma and cold temperature avoidance, and a walking program. Venous thrombosis is the formation of a thrombus in association with inflammation of the vein. Acute arterial ischemia is a sudden interruption in arterial blood flow to a tissue caused by embolism, thrombosis, or trauma. Raynaud's phenomenon is characterized by vasospasm-induced color changes of the fingers, toes, ears, and nose.

The nurse reviews the medication profile of a patient and identifies that which type of medication predisposes the patient to thrombus formation? Antibiotics Corticosteroids β-adrenergic blockers Nonsteroidal antiinflammatory drugs (NSAIDs)

Corticosteroids Corticosteroids can inhibit the fibrinolytic activity of the blood and increase the risk of thrombus formation. Antibiotics do not inhibit the fibrinolytic activity of the blood. β-adrenergic blockers are used to treat aortic dissection; side effects include dizziness, depression, fatigue, and erectile dysfunction. Nonsteroidal antiinflammatory drugs (NSAIDs) are used to reduce inflammation and may cause gastric bleeding.

A 28-year-old female patient inquires about options for contraception. The nurse recognizes that if the patient takes an estrogen-based oral contraceptive, her risk for venous thromboembolism (VTE) doubles based on what statement that is made by the patient? "I smoke 1 ½ packs of cigarettes a day." "I have a job as a waitress." "I like to sit in my hot tub in the evenings." "It's been 3 years since my last child was born."

"I smoke 1 ½ packs of cigarettes a day." Women of childbearing age who take estrogen-based oral contraceptives or postmenopausal women on oral hormone therapy (HT) are at increased risk for VTE. Women who use oral contraceptives and tobacco double their risk. Smoking causes hypercoagulability by increasing plasma fibrinogen and homocysteine levels and activating the intrinsic coagulation pathway. Occupations in which a patient is mobile, hot tub use, and previous childbirth do not indicate increased risk of VTE.

The nurse provides discharge teaching to a patient with venous leg ulcers. Which statement made by the patient indicates the need for further education? "I will take a walk daily." "I will try to lose at least 20 pounds." "I will put on my stockings after I get out of bed each day." "I will not wear knee-high socks that are tight around my calf."

"I will put on my stockings after I get out of bed each day." The patient should apply stockings in bed before rising in the morning (not after rising). Emphasize the importance of periodic positioning of the legs above the heart. Prevention is a key factor related to varicose veins. Instruct the patient to avoid sitting or standing for long periods, maintain ideal body weight, take precautions against injury to the extremities, avoid wearing constrictive clothing, and walk daily. The overweight patient may need assistance with weight loss. The patient with a job that requires long periods of standing or sitting needs to frequently flex and extend the hips, legs, and ankles and change positions.

The registered nurse observes a new graduate nurse providing postoperative instructions to a patient with a history of cardiovascular disease. Which statement made by the new graduate nurse requires correction? "We will ambulate you in the halls four to six times a day." "It is important to flex and extend your hips, knees, and feet every eight hours." "You will need to wear an intermittent pneumatic compression device." "You will receive enoxaparin in your stomach twice a day until you are discharged."

"It is important to flex and extend your hips, knees, and feet every eight hours." The measures listed are to prevent postoperative venous thromboembolism. Hips, knees, and feet should be flexed at least every two to four hours while awake. The other statements indicate adequate understanding. Ambulation should take place four to six times a day. The patient should wear the compression devices at all times unless bathing, walking, or during the skin assessment. Enoxaparin will be given subcutaneously to the abdomen twice a day until the patient is discharged.

A postoperative patient asks the nurse why daily enoxaparin has been prescribed. How should the nurse respond? "It will help prevent breathing problems after surgery, such as pneumonia." "It will help lower your blood pressure to a safe level, which is very important after surgery." "It will help prevent blood clots from forming in your legs until your level of activity, such as walking, returns to normal." "It is a narcotic pain medication that will help take away any muscle aches caused by positioning on the operating room table."

"It will help prevent blood clots from forming in your legs until your level of activity, such as walking, returns to normal." Enoxaparin is an anticoagulant that is used to prevent deep vein thromboses (DVTs) postoperatively. Enoxaparin does not prevent breathing problems or pneumonia. Enoxaparin does not have hypotensive effects. Enoxaparin is not a medication used to treat pain.

A patient with varicose veins has been prescribed compression stockings. What information should the nurse provide to the patient? "Try to keep your stockings on 24 hours a day, as much as possible." "While you're still lying in bed in the morning, put on your stockings." "Dangle your feet at your bedside for 5 minutes before putting on your stockings." "Your stockings will be most effective if you can remove them for a few minutes several times a day."

"While you're still lying in bed in the morning, put on your stockings." The patient with varicose veins should apply stockings in bed, before rising in the morning. Stockings should not be worn continuously, but they should not be removed several times daily. Dangling feet at the bedside before application of stockings is likely to decrease their effectiveness.

The nurse reviews the coagulation profile results of a patient who is scheduled for surgery. The nurse concludes that the patient is stable for surgery after noting which international normalized ratio (INR) result? 1.0 1.8 2.7 3.4

1.0 The larger the INR number, the greater the amount of anticoagulation. For this reason, a level of 1.0 indicates that it is safe to proceed with the planned surgery.

A patient with venous thromboembolism (VTE) receives a prescription for dalteparin, a LMWH. The prescription is for 200 international units/kg daily for 30 days, subcutaneously. The medication is available in an injection solution, 10,000 international units per mL. The patient weighs 154 pounds. How many milliliters of dalteparin should the nurse give to the patient per dose? Record the answer using one decimal place.

1.4mL per dose 1) Calculate the daily dose in international units: a) Convert pounds to kilograms: 154 pounds = 70 kg. b) Calculate daily dosage per kilograms in international units: 200 international units/kg = 200 X 70 kg = 14,000 international units per dose. 2) Calculate daily dosage in milliliters: 10,000 international unit/1 mL = 14,000 international units/X mL (10,000)x = 14,000; x = 14,000 ÷ 10,000 = 1.4 mL per dose

The nurse reviews a patient's laboratory results before administering a prescribed dose of vitamin K 1. The nurse determines that the medication is both safe to give and is most needed when the international normalized ratio (INR) is at which level? 1.0 1.2 1.6 2.1

2.1 Phytonadione is the antidote to sodium warfarin (Coumadin), which the patient had been taking before admission. Warfarin is an anticoagulant that impairs the ability of the blood to clot. It is necessary to give phytonadione before surgery to reduce the risk of hemorrhage. The greatest value of the INR indicates the greatest impairment of clotting ability, making 2.1 the correct selection. Values of 1.0, 1.2, and 1.6 indicate lower INR results, which may not require vitamin K 1.

A patient has a 2-month history of taking warfarin as treatment for deep vein thrombosis (DVT). The patient is scheduled for an unrelated surgery. The nurse determines that it is safe and necessary to give vitamin K based on what international normalized ratio (INR) result? 1.0 1.2 2.0 3.4

3.4 Vitamin K is the antidote to warfarin. Warfarin is an anticoagulant that impairs the ability of the blood to clot; therefore, it is necessary to give vitamin K before surgery to reduce the risk of hemorrhage. The value of the INR indicates an impairment of clotting ability, making 3.4 the correct selection. For a patient with a history of VTE, a therapeutic INR is maintained between 2.0 and 3.0.

The nurse reviews the medical records of four patients and identifies that which patient is at risk for venous thromboembolism? A patient on hormone therapy A patient with hyperuricemia A patient receiving anticoagulant therapy as well as aspirin A patient with high C-reactive protein levels

A patient on hormone therapy Venous thromboembolism is a condition associated with both deep vein thrombosis (DVT) and pulmonary embolism (PE) in a patient. Hormone therapy decreases clotting factors (such as fibrinogen, protein S, protein C, tissue factor pathway inhibitor [TFPI], and antithrombin), which increases the risk of venous thromboembolism. Therefore, patient A is at a high risk for developing venous thromboembolism. Patient B, with hyperuricemia (excess uric acid in the blood), is at a high risk for developing peripheral artery disease. Nadroparin is an anticoagulant. Patient C, who is receiving anticoagulant therapy as well as aspirin, has a higher risk of bleeding. Patient D, with high C-reactive protein levels, is at a high risk for peripheral artery disease.

A nurse is caring for a patient with a diagnosis of deep venous thrombosis (DVT). The patient receives a prescription for 30 mg enoxaparin. Which injection site should the nurse use to administer this medication safely? Buttock, upper outer quadrant Abdomen, anterior-lateral aspect Back of the arm, 2 inches away from a mole Anterolateral thigh, with no scar tissue nearby

Abdomen, anterior-lateral aspect Enoxaparin is a low-molecular-weight (LMW) heparin that is given as a deep subcutaneous injection in the right and left anterolateral abdomen. Enoxaparin will not be given in the upper quadrant of the buttock. All subcutaneous injections should be given away from scars, lesions, or moles.

It is appropriate for the registered nurse (RN) to delegate which intervention to a licensed practical nurse (LPN) when providing care to a patient with venous thromboembolism? Monitoring for adverse effects of anticoagulant use Administering prescribed subcutaneous anticoagulants Providing instructions about the use of pressure to stop bleeding Teaching about the use of compression stockings during a hospital discharge

Administering prescribed subcutaneous anticoagulants The LPN can administer prescribed subcutaneous anticoagulants to the patient because it is within his or her scope of profession. The RN, not the LPN, should monitor for adverse effects of anticoagulant use, provide instructions to the patient about the use of pressure to stop bleeding, and teach the patient about the use of elastic compression stockings during a hospital discharge.

The nurse is caring for a patient with superficial vein thrombosis and expects what assessment findings? Tenderness to pressure over the involved vein Presence of edema with pain Induration of the overlying muscle Appearance of the vein as a palpable cord

Appearance of the vein as a palpable cord In superficial vein thrombosis, the vein appears as a palpable cord. Tenderness to palpation over the involved vein, presence of edema with pain, and induration of overlying muscle are noted in venous thromboembolism. Edema rarely occurs in superficial vein thrombosis.

The nurse is reviewing discharge instructions with a patient who is taking warfarin as treatment for venous thromboembolism (VTE). Which substances will the patient need to avoid while taking warfarin? Select all that apply. Aspirin Gingko biloba Black cohosh Acetaminophen Foods containing vitamin K

Aspirin Gingko biloba Black cohosh The patient receiving oral anticoagulants therapy needs to be taught to avoid taking antiplatelets (e.g., aspirin), nonsteroidal antiinflammatory drugs (NSAIDs), ginkgo biloba, black cohosh, and other dietary and herbal supplements. Acetaminophen can be taken with oral anticoagulants. Foods containing vitamin K can be eaten as long as the intake of these foods is consistent.

The primary health care provider prescribes warfarin for a patient with venous thromboembolism (VTE). Which information should the nurse include in the patient's discharge teaching plan? No routine laboratory monitoring is needed. Avoid contact sports and high-risk activities. Increase daily intake of dark leafy vegetables. Continue to use garlic as a dietary supplement.

Avoid contact sports and high-risk activities. Teaching for a patient prescribed warfarin includes avoiding any trauma or injury that might cause bleeding, such as contact sports. Routine laboratory monitoring is needed to assess the therapeutic effect of the medication and whether a change in drug dose is needed. Do not increase daily intake of dark leafy vegetables because these foods are high in vitamin K. Garlic may affect blood clotting. Instruct the patient to consult with the health care provider about the use of garlic supplements along with warfarin.

The nurse identifies that what interventions are appropriate to be included on the plan of care for a patient receiving anticoagulant therapy? Select all that apply. Checking the platelet count Administering stool softeners Utilizing the intramuscular route for medication administration Using large-gauge needles for venipunctures Applying manual pressure for at least 10 minutes on venipuncture sites

Checking the platelet count Administering stool softeners Applying manual pressure for at least 10 minutes on venipuncture sites The nurse should check the platelet count because anticoagulant therapy may induce thrombocytopenia. Stool softeners prevent hard stools, which reduces straining and the risk of bleeding. The nurse should apply manual pressure for at least 10 minutes on the venipuncture site to prevent bleeding. The nurse should avoid administering an intramuscular injection to the patient to prevent a hematoma formation. The nurse should use small-gauge needles for venipunctures to prevent bleeding.

The nurse prepares a home care plan for a patient diagnosed with venous thromboembolism (VTE) who is receiving anticoagulant therapy. The plan contains information such as: 1) Avoid injury or trauma that can cause bleeding. 2) Avoid all nonsteroidal antiinflammatory drugs. 3) Contact emergency services if there is blood in urine or stool. 4) Take correct doses of drugs (anticoagulants). 5) Take medication at the same time daily. Which important information was omitted from the plan? Take garlic supplements along with the anticoagulant. Avoid dairy products such as milk and yogurt. Avoid wearing sequential compression devices during the daytime. Contact emergency response services if cold, blue, or painful feet are noted.

Contact emergency response services if cold, blue, or painful feet are noted. The home care plan for a patient receiving anticoagulant therapy must include information regarding the possible adverse effects of the drug. Cold, blue, and painful feet may be indicative of severe lower extremity VTE, which, if untreated, may cause arterial occlusion and gangrene, and possibly lead to amputation. Garlic and other supplements, such as ginger and vitamins, can increase the risk of severe bleeding and hence should be avoided when a patient is on anticoagulant therapy. Dietary products are not prohibited unless the patient is allergic to them. For maximum benefits, sequential compression devices should be worn all the time, except during bathing, assessment, and ambulation.

A patient is receiving medication through an intravenous catheter. The nurse finds pain, tenderness, warmth, erythema, swelling, and a palpable cord at the site of catheter insertion. The nurse anticipates that what medication will be prescribed? Tamoxifen Diclofenac Metoprolol Epoetin alfa

Diclofenac Presence of pain, tenderness, warmth, erythema, swelling, and a palpable cord at the catheter insertion site indicates phlebitis. Nonsteroidal antiinflammatory drugs (NSAIDs), such as diclofenac, relieve pain and inflammation in patients with phlebitis. Tamoxifen is used to prevent the effects of estrogen on tissues. Metoprolol is used to decrease myocardial contractility. Epoetin alfa is used to stimulate erythropoiesis.

A patient with Raynaud's phenomenon is being discharged from the hospital. Which instructions should the nurse include in the patient's discharge teaching plan? Select all that apply. Do not smoke or use any tobacco products. Wear tight, warm clothing in the wintertime. Identify strategies to reduce emotional stress. Placing hands in cool water often decreases the vasospasm. Do not use drugs that contain pseudoephedrine.

Do not smoke or use any tobacco products. Identify strategies to reduce emotional stress. Do not use drugs that contain pseudoephedrine. Smoking or use of any tobacco products, emotional stress, and drugs containing pseudoephedrine often trigger an attack of Raynaud's phenomenon. Tight clothing should not be worn because it can reduce circulation. During an attack fingertips should be immersed in warm water to help decrease vasospasm.

The nurse provides teaching to a patient with Raynaud's phenomenon about how to prevent recurrent episodes. The nurse should instruct the patient to avoid what? Select all that apply. Wearing gloves Drinking caffeinated coffee Exposure to heat Emotional upsets Cigarette smoking

Drinking caffeinated coffee Emotional upsets Cigarette smoking Exposure to cold (not heat), emotional upsets, tobacco use, and caffeine often bring on symptoms of Raynaud's phenomenon. Wearing gloves often is recommended to protect the hands from exposure to cold.

A patient presents with symptoms of venous thromboembolism (VTE) in the calf. The nurse expects that what study will be performed, recalling that it is the most widely used test to diagnose VTE? Duplex ultrasound Contrast venography Magnetic resonance venography Computed tomography venography

Duplex ultrasound The duplex ultrasound is the most widely used test to diagnose VTE. Contrast venography rarely is used now. Magnetic resonance venography is less accurate for calf veins than pelvic and proximal veins. Computed tomography venography may be used but is invasive and much more expensive than the duplex ultrasound.

A patient has prosthetic heart valves and is being treated with warfarin to prevent blood clots. Which dietary supplements should the nurse teach the patient to avoid? Select all that apply. Fish oil Melatonin Garlic Soy Red yeast rice

Fish oil Melatonin Garlic Many dietary supplements may have adverse interactions with drugs and increase the risk of complications. Fish oil, melatonin, and garlic tend to increase the risk of bleeding and should be avoided in patients who are taking warfarin (Coumadin). Soy is used to treat high cholesterol. Red yeast rice is used to treat high cholesterol levels.

The nurse identifies that which treatment is beneficial for a patient with lower leg superficial vein thrombosis? Nifedipine Doxycycline Furosemide Fondaparinux

Fondaparinux Fondaparinux inhibits factor Xa and reduces thrombus formation; a prophylactic dose of fondaparinux is used to treat lower leg superficial vein thrombosis. Nifedipine is a calcium channel blocker used to reduce the severity of a vasospastic attack. Doxycycline is used to treat aortic aneurysms. Furosemide is a diuretic used to treat hypertension.

The nurse is preparing to administer a scheduled dose of enoxaparin 30 mg subcutaneously. What technique should the nurse use when administering the medication? Remove the air bubble in the prefilled syringe. Aspirate before injection to prevent intravenous (IV) administration. Rub the injection site after administration to enhance absorption. Hold skinfold during injection but release before removing needle.

Hold skinfold during injection but release before removing needle. The nurse should gather together or "bunch up" the skin between the thumb and the forefinger during the injection but should release it before removing the needle. The nurse should not remove the air bubble in the prefilled syringe, aspirate, or rub the site after injection.

The nurse is assessing a patient with Raynaud's phenomenon. What should the nurse teach the patient to prevent recurrent episodes? Wear thin, light clothing to allow better circulation. Drink small amounts of caffeine throughout the day to stimulate heartbeat and increase circulation. Immerse hands in warm water to decrease vasospasm and promote normal blood circulation. Use a cold compress or heating pad as needed for comfort.

Immerse hands in warm water to decrease vasospasm and promote normal blood circulation. Raynaud's phenomenon is triggered by stress and cold, and immersing hands in warm water often may decrease vasospasm. The patient should wear loose, warm clothing to protect from the cold, including gloves when handling cold objects. The patient should stop using all tobacco products and avoid caffeine and any drugs, such as cocaine, amphetamines, ergotamine, and pseudoephedrine, that have vasoconstrictive effects. The patient should avoid extreme temperatures at all times, so the use of a cold compress or heating pad would not be recommended.

A patient admitted to the health care facility with venous thromboembolism (VTE) is prescribed unfractionated heparin, to be administered subcutaneously. What technique should the nurse use when administering the medication? Select all that apply. Inject deep into abdominal fatty tissue. Hold skinfold during injection. Release skinfold after removing needle. Avoid aspiration. Rub site after injection.

Inject deep into abdominal fatty tissue. Hold skinfold during injection. Avoid aspiration. When administering unfractionated heparin subcutaneously, the nurse should inject deep into the abdominal fatty tissue, hold the skinfold during injection but release before removing the needle, and avoid aspiration. The nurse should not inject intramuscularly, rub the site after injection, or aspirate.

What is an appropriate nursing intervention for a patient following vein ligation surgery? Maintaining elastic compression stockings at all times Keeping the legs elevated at 15 degrees Reporting any bruising and discoloration Asking the patient to avoid deep breathing

Keeping the legs elevated at 15 degrees After vein ligation surgery, the nurse should ensure that the patient keeps his or her legs elevated at 15 degrees to reduce edema. Elastic compression stockings should be removed every 8 hours for short periods and reapplied. Some bruising and discoloration are normal. The patient should be encouraged to breathe deeply to promote venous return.

A patient develops postthrombotic syndrome. The nurse assesses lipodermatosclerosis, which has what hallmark characteristic? Leathery, brown-colored skin Swollen leg Blue-colored skin Presence of cordlike veins

Leathery, brown-colored skin In lipodermatosclerosis, the skin on the lower leg is scarred and leathery, with brown discoloration. A swollen, blue, painful leg, or phlegmasia cerulea dolens, is a rare complication that may develop in a patient in the advanced stages of cancer. The presence of cordlike veins is associated with superficial vein thrombosis.

The nurse is preparing to administer enoxaparin subcutaneously to a patient with vascular insufficiency. What technique should the nurse use when administering the medication? Spread the skin before inserting the needle. Leave the air bubble in the prefilled syringe. Use the back of the arm as the preferred site. Sit the patient at a 30-degree angle before administration.

Leave the air bubble in the prefilled syringe. The nurse should not expel the air bubble from the prefilled syringe because it should be injected to clear the needle of medication and to avoid leaving medication in the needle track in the tissue. The skin is not spread before inserting the needle. The abdomen is the preferred site of administration. The patient does not sit at a 30-degree angle for administration.

The nurse is caring for a patient with Buerger's disease and expects which clinical manifestation? Back pain when lying flat Chest pain when walking up stairs Leg pain with exercise and relief with rest Reddening of lower legs and feet when elevated

Leg pain with exercise and relief with rest Buerger's disease is characterized by inflammation of the arteries and veins of the upper and lower extremities. This causes pain in the legs and feet with exercise. Sensitivity to cold and paresthesias is also often seen with this condition. Buerger's disease is not associated with back pain when lying flat or vasodilation resulting in reddening of the lower legs or feet when elevated. Buerger's disease is not directly associated with chest pain.

Which diagnostic test can distinguish acute and chronic thrombus in a patient? Duplex ultrasound Contrast venography Venous compression ultrasound Magnetic resonance venography

Magnetic resonance venography Magnetic resonance venography involves the use of magnetic resonance imaging along with specialized software to evaluate blood flow through veins. This diagnostic test can identify acute and chronic thrombi. Duplex ultrasound is used to determine the location and extent of a thrombus. Contrast venography is used to determine the location and extent of a clot. Venous compression ultrasound is used to evaluate deep femoral, popliteal, and posterior tibial veins.

What interventions will decrease the likelihood of a patient developing varicose veins? Select all that apply. Maintaining ideal body weight Avoiding long periods of sitting Taking 325 mg of aspirin daily Applying hydrating lotions to the skin of legs daily Avoiding standing for long periods

Maintaining ideal body weight Avoiding long periods of sitting Avoiding standing for long periods Varicose veins are dilated, tortuous veins that occur mainly in the legs. Family history is thought to be a factor in the development of incompetent valves in the leg veins that become varicose veins. Strategies that promote competent veins in the legs include walking, avoiding standing and sitting for long periods of time, and keeping an ideal body weight. Aspirin therapy will not prevent varicose veins. Hydrating lotions will condition the skin but not prevent varicose veins.

The nurse is caring for a hospitalized patient who is receiving anticoagulant therapy for venous thromboembolism (VTE). Which interventions should the nurse perform for this patient? Select all that apply. Monitor platelet count. Use restraints as needed. Use small-gauge needle for venipunctures. Avoid manual pressure at venipuncture sites . Humidify O 2 source if supplemental O 2 is prescribed

Monitor platelet count. Use small-gauge needle for venipunctures. Humidify O 2 source if supplemental O 2 is prescribed Nursing interventions for the patient taking anticoagulant therapy include evaluation of platelet count for signs of heparin-induced thrombocytopenia. The nurse should preferably use a small-gauge needle for venipuncture. The nurse should humidify O 2 source if supplemental O 2 is prescribed; this will decrease the risk of nosebleed. Restraints should be avoided if possible, but if they are needed, the nurse should use soft, padded restraints. Manual pressure should be applied for 10 minutes or longer at venipuncture sites.

The nurse reviews the prescribed medications taken by a patient diagnosed with thromboangiitis obliterans (Buerger's Disease). Which medication is contraindicated and should be questioned by the nurse? Cilostazol Nifedipine Acetaminophen Nicotine transdermal patch

Nicotine transdermal patch Thromboangiitis obliterans (Buerger's Disease) is an inflammatory condition of small arteries and veins in the extremities that leads to tissue ischemia and ulcer development. The condition occurs mostly in young males with a history of heavy use of tobacco or marijuana. Treatment involves complete cessation of tobacco to stop the inflammation. A nicotine patch is contraindicated and should be questioned. The condition may be treated with antiplatelet medications such as cilostazol, or a calcium channel blocker agent such as nifedipine, for vasodilation effect. Acetaminophen may be used for pain relief.

The nurse reviews a patient's medical record and notes long-term use of heparin. The nurse identifies that the patient is at risk for what complication? Osteoporosis Erectile dysfunction Gastrointestinal bleeding Venous thromboembolism

Osteoporosis Long-term use of heparin decreases bone density and increases the risk of osteoporosis. Metoprolol can cause erectile dysfunction. Long-term use of aspirin causes gastrointestinal bleeding. Heparin is used to prevent venous thromboembolism.

A postoperative patient is receiving enoxaparin. The nurse identifies that the medication is not being effective when what assessment finding is noted? Generalized weakness and fatigue Crackles bilaterally in the lung bases Pain and swelling in the lower extremity Abdominal pain with decreased bowel sounds

Pain and swelling in the lower extremity Enoxaparin is a low-molecular-weight heparin used to prevent the development of deep vein thromboses (DVTs) in the postoperative period. Pain and swelling in the lower extremity can indicate development of DVT and therefore may signal ineffective medication therapy. Generalized weakness, fatigue, abdominal pain, and crackles in the bases of the lungs would not necessitate the use of enoxaparin.

Which description is characteristic of pain experienced by a patient diagnosed with Raynaud's phenomenon? Ripping type chest pain Leg pain with exercise that resolves with rest Leg pain that resolves when the leg is lowered Pain in fingers or toes with color changes in the skin

Pain in fingers or toes with color changes in the skin Pain associated with Raynaud's phenomenon is caused by vasospasm in small arteries, often in the fingers or toes. The vasospasm decreases circulation, starting with pallor (white), worsening to cyanosis (bluish) and then moving to redness as the blood flow returns to the digit. The pain occurs with the vasospasm and is throbbing in nature. Chest pain that is ripping in nature occurs with aortic dissection. Pain of intermittent claudication occurs with peripheral vascular disease in the lower extremities. This severe leg pain occurs with exercise and is relieved by rest. Rest pain occurs in patients with critical limb ischemia (advanced peripheral vascular disease) and is relieved by lowering the limb because gravity improves circulation.

The nurse understands that venous ulcers are characterized by which assessment findings? Select all that apply. Bluish tinge of the extremities Capillary refill greater than 3 seconds Pain worse with leg in a dependent position Well-defined edges along the ulcer Located above the medial malleolus

Pain worse with leg in a dependent position Located above the medial malleolus Venous ulcers are often quite painful. Pain may be worse when the leg is in a dependent position. Venous ulcers classically are located above the medial malleolus. A blue tinge to the skin is associated with decreased arterial oxygenation to the tissue. Venous ulcers have a bronze-brown pigmentation, and the capillary refill of the extremity is less than 3 seconds with venous disease. Well-defined edges are seen with arterial ulcers.

The nurse assesses four patients and identifies that which patient is at risk for venous stasis? A: Diabetes mellitus B: Spinal cord injury C: Glaucoma D: Hyperhomocysteinemia

Patient B Venous stasis occurs because of reduced action of the muscles in the extremities and the functional inadequacy of venous valves. A spinal cord injury causes muscle inactivity and prolonged immobilization, which can lead to venous stasis. Thus, Patient B is most susceptible. Patients A and D are at a higher risk for peripheral arterial disease. Glaucoma does not lead to muscle inactivity or prolonged immobilization; Patient C is not at risk for venous stasis.

The nurse administers dalteparin to a patient as prescribed. During a follow-up visit, the patient reports bleeding from the gums and nose, stomach and chest pain, shortness of breath, and blood in the urine. The nurse should prepare to administer what medication? Bosentan Protamine Nifedipine Metoprolol

Protamine Dalteparin is an anticoagulant that prevents the risk of venous thromboembolism; side effects include bleeding from the gums and nose, stomach and chest pain, shortness of breath, and blood in urine. Protamine reverses the anticoagulant effects of dalteparin. Bosentan, nifedipine, and metaprolol do not act as antidotes for dalteparin toxicity.

The nurse reviews a patient's international normalized ratio (INR) level before administering warfarin to a patient. The nurse recognizes that the INR is a standardized system for reporting what blood coagulation test? Hematocrit (Hct) Hemoglobin (Hgb) Prothrombin time (PT) Partial thromboplastin time (PTT)

Prothrombin time (PT) The INR is a standardized system for reporting prothrombin time (PT). The normal value is 0.75 to 1.25. The therapeutic value is 2 to 3.

The nurse notes changes in a patient's assessment findings, including phlebitis at the patient's peripheral intravenous (IV) site. What action should the nurse take? Remove the patient's IV catheter Apply an ice pack directly to the affected area Decrease the IV rate to 20 to 30 mL/hr Administer prophylactic antibiotics

Remove the patient's IV catheter The priority intervention for superficial phlebitis is removal of the offending IV catheter. Ice should never be placed directly against the skin. Decreasing the IV rate is insufficient. Antibiotics normally are not required.

The nurse reviews a patient's medication profile and identifies that which medication may cause thrombocytopenia? Diclofenac Prednisone Metoprolol Rivaroxaban

Rivaroxaban Rivaroxaban acts as an anticoagulant by inhibiting the clotting factor Xa. Rivaroxaban may decrease the platelet count and may cause thrombocytopenia. Diclofenac is a nonsteroidal antiinflammatory agent (NSAID) that reduces pain. Corticosteroids, such as prednisone, increase the risk of thrombus formation in patients and may not cause thrombocytopenia. Metoprolol can cause depression and erectile dysfunction.

Which intervention should the nurse implement while administering heparin sodium to a patient? Aspirating while administering the medication Rubbing the site after administering the medication Rotating the medication administration site frequently Using the intramuscular route for medication administration

Rotating the medication administration site frequently Rotating the injection site while administering heparin sodium prevents tissue trauma and reduces pain. The nurse should avoid aspiration while administering heparin sodium to prevent tissue damage and hematoma formation. The nurse should avoid rubbing the site after administering heparin sodium to prevent hematoma formation in the patient. Heparin sodium should be administered by subcutaneous route to ensure effective therapeutic drug action.

A patient reports pain and itchiness in a lower extremity. Upon further assessment, a nurse observes that the extremity is reddened and warm. The patient's body temperature is 101° F. What complication does the nurse suspect? Aortic aneurysm Raynaud's phenomenon Peripheral artery disease Superficial vein thrombosis

Superficial vein thrombosis The presence of an itchy, reddened, painful, and warm lower extremity characterizes a superficial vein thrombosis. A patient with superficial vein thrombosis may also have an elevated body temperature. Altered bowel elimination, abdominal and chest pain are symptoms of an aortic aneurysm. Bluish fingers and toes, pallor, rubor, throbbing, and aching pain due to exposure to cold are symptoms of Raynaud's phenomenon. Atherosclerosis, arterial stenosis, and decreased Doppler pressures are symptoms of peripheral artery disease.

Which instructions should the nurse provide to a patient who is receiving anticoagulant therapy? Select all that apply. Take aspirin regularly. Increase the intake of kale. Add spinach to the diet. Take medication at the same time each day. Contact emergency response services (ERS) if there is blood in the stool.

Take medication at the same time each day. Contact emergency response services (ERS) if there is blood in the stool The nurse should instruct the patient to take medication at the same time each day to obtain the desired therapeutic effect. Presence of blood in stool indicates gastrointestinal bleeding; the patient should contact emergency medical services immediately. The patient should avoid taking aspirin while receiving anticoagulant therapy to prevent the risk of bleeding. Spinach and kale are rich in vitamin K; vitamin K-rich foods should be avoided to prevent the risk of bleeding.

The nurse reviews the admission history of patient who is hospitalized with deep venous thrombosis (VTE) in the left leg. Which findings from the health history increase the risk for the patient to develop this complication? Select all that apply. Takes simvastatin regularly Takes omeprazole regularly Takes conjugated estrogen regularly Left knee replacement 2 weeks prior to the current hospitalization Negative history for cigarette smoking Abdominal hysterectomy 10 years prior to the current hospitalization

Takes conjugated estrogen regularly Left knee replacement 2 weeks prior to the current hospitalization The risk for developing thromboembolic complications continues for several weeks postoperatively. The risk is related to possible vascular injury with the procedure, altered fluid status, increased coagulability, and lessened mobility during and after surgery. The recent left knee joint replacement surgery is significant. Estrogen, a hormone used for relief of menopausal discomfort, increases clotting factors and enhances coagulation. Medications such as lipid-lowering agents (simvastatin) and proton pump inhibitors (omeprazole) do not increase the risk for thrombosis. The patient does not smoke, thereby avoiding the risk factor of smoking. The abdominal hysterectomy performed 10 years earlier is not a current risk factor.

What is the priority nursing intervention in the care of a patient with a diagnosis of chronic venous insufficiency (CVI)? Application of topical antibiotics to venous ulcers Maintaining the patient's legs in a dependent position Administering oral or subcutaneous anticoagulants Teaching the patient the correct use of compression stockings

Teaching the patient the correct use of compression stockings CVI requires conscientious and consistent application of compression stockings. Anticoagulants are not necessarily indicated and antibiotics, if required, are typically oral or intravenous, not topical. The patient should avoid prolonged positioning with the limb in a dependent position.

The nurse is examining a female patient who experiences leg edema and pain. What history findings indicate that the patient is at a high risk for venous thromboembolism (VTE)? Select all that apply. The patient uses tobacco. The patient takes an estrogen-based oral contraceptive. The patient has been taking aspirin daily for 1 year. The patient has a family history of VTE. The patient lives in a high-altitude area.

The patient uses tobacco. The patient takes an estrogen-based oral contraceptive. The patient has a family history of VTE. The patient lives in a high-altitude area. A woman who uses an estrogen-based oral contraceptive and tobacco is at high risk for VTE. These compounds may cause hypercoagulability and may activate the intrinsic coagulation pathway that leads to deep vein thrombosis and pulmonary embolism. The risk increases if the patient has a family history of VTE because the patient may carry the mutated genes responsible for the disease. High altitude causes hypercoagulability of blood. Some medications, such as corticosteroids, may stimulate thrombus formation, but aspirin has shown no such tendency.

The nurse is examining a female patient who experiences leg edema and pain. What history findings indicate that the patient is at a high risk for venous thromboembolism (VTE)? Select all that apply. The patient uses tobacco. The patient takes an estrogen-based oral contraceptive. The patient has been taking aspirin daily for 1 year. The patient has a family history of VTE. The patient lives in a high-altitude area.

The patient uses tobacco. The patient takes an estrogen-based oral contraceptive. The patient has a family history of VTE. The patient lives in a high-altitude area. A woman who uses an estrogen-based oral contraceptive and tobacco is at high risk for VTE. These compounds may cause hypercoagulability and may activate the intrinsic coagulation pathway that leads to deep vein thrombosis and pulmonary embolism. The risk increases if the patient has a family history of VTE because the patient may carry the mutated genes responsible for the disease. High altitude causes hypercoagulability of blood. Some medications, such as corticosteroids, may stimulate thrombus formation, but aspirin has shown no such tendency.

A patient is prescribed warfarin following a deep venous thrombosis and pulmonary embolism. What information should the nurse include in the teaching plan? Select all that apply. Eliminate green vegetables from the diet. Use a soft toothbrush and observe the gums for bleeding. Wear a bracelet that identifies the patient is taking an anticoagulant. Blood coagulation testing is needed only for the first 4 to 6 weeks of therapy. Do not take ibuprofen (Motrin) or aspirin unless prescribed by the primary health care provider.

Use a soft toothbrush and observe the gums for bleeding. Wear a bracelet that identifies the patient is taking an anticoagulant. Do not take ibuprofen (Motrin) or aspirin unless prescribed by the primary health care provider. Warfarin acts as an anticoagulant by inhibiting liver production of vitamin K. Patients are at risk for bleeding and should use a soft toothbrush. Wearing an identification bracelet will alert emergency medical personnel in case the patient is unable to inform them about the medication. Nonsteroidal antiinflammatory medications, including aspirin, potentiate the anticoagulation effect and may cause problems with bleeding. Green vegetables, which are sources of vitamin K, should be taken in consistent amounts but need not be eliminated. The patient taking warfarin will continue to need coagulation laboratory testing (Protime/internationalized normal ratio [INR]) while taking the medication because the anticoagulant effect is influenced by many factors, including medications and diet.

The nurse provides postoperative care for a patient and should monitor the patient for what indications of venous thromboembolism (VTE)? Select all that apply. Venous distention Vein appears as a palpable cord Deep-reddish color over the affected area Itchiness and warmth over the affected area Tenderness with palpation

Venous distention Deep-reddish color over the affected area Tenderness with palpation Clinical findings for VTE include tenderness to pressure over involved vein, induration of overlying muscle, venous distention, edema, possible mild to moderate pain, and a deep reddish color to area caused by venous congestion. Itchiness and cordlike texture are characteristics of superficial venous thrombosis.

The patient reports a palpable, firm, and cordlike vein. The patient states that the area around the vein is itchy, painful to the touch, reddened, and warm. The nurse recognizes that the condition needs to be treated to prevent what complication? Pulmonary embolism Pulmonary hypertension Postthrombotic syndrome Venous thromboembolism

Venous thromboembolism The clinical manifestations are characteristic of a superficial vein thrombosis. If untreated, the clot may extend to deeper veins and venous thromboembolism may occur. Pulmonary embolism, pulmonary hypertension, and postthrombotic syndrome are the sequelae of venous thromboembolism.

While caring for a patient, the nurse observes indications of warfarin toxicity. The nurse expects that which medication will be prescribed? Vitamin K Lepirudin Protamine Argatroban

Vitamin K Vitamin K is an antidote for warfarin toxicity. Lepirudin, protamine, and argatroban do not reverse the anticoagulant properties of warfarin. Lepirudin, a hirudin derivative, is an anticoagulant. Protamine is an antidote for unfractionated heparin (UH). Argatroban, a synthetic thrombin inhibitor, is also an anticoagulant.

The nurse is providing preoperative care to a patient who is scheduled for an abdominal aortic aneurysm (AAA) repair surgery. The medication history reveals that the patient takes warfarin daily. The nurse should prepare to administer which medication? Vitamin K Cobalamin Heparin sodium Protamine sulfate

Vitamin K Warfarin is a vitamin K antagonist anticoagulant that could cause excessive bleeding during surgery if clotting times are not corrected before surgery. For this reason, vitamin K is given as the antidote for warfarin. Protamine sulfate is the antidote for heparin sodium and cobalamin is vitamin B 12. Heparin sodium is not the antidote for warfarin.