M-S CARDIO II

A 68-year-old patient is being admitted with a possible stroke. Which information from the assessment indicates that the nurse should consult with the health care provider before giving the prescribed aspirin? A The patient has dysphasia. B The patient has atrial fibrillation. C The patient reports that symptoms began with a severe headache. D The patient has a history of brief episodes of right-sided hemiplegia.

C

The nurse determines that the patient has stage 2 hypertension when the patient's average blood pressure is: 1. 155/88 mm Hg. 2. 172/92 mm Hg. 3. 160/110 mm Hg. 4. 182/106 mm Hg.

Answer: 4 Rationale: Stage 2 hypertension is diagnosed when systolic blood pressure is greater than or equal to 160 mm Hg, or diastolic blood pressure is greater than or equal to 100 mm Hg.

A client has undergone cardiac catheterization using the right femoral artery for access. The nurse determines that the client is experiencing a complication of the procedure if which of the following is(are) noted? 1 Urine output 40 mL/hour 2 Blood pressure 118/76 mm Hg 3 Pallor and coolness of the right leg 4 Respirations 18 breaths per minute

3 Pallor and coolness indicate thrombosis or hematoma and should be further assessed and reported.

What should the nurse monitor when a client is receiving a platelet aggregation inhibitor such as clopidogrel (Plavix)? A Nausea B Epistaxis C Chest pain D Elevated temperature

Answer: B The high vascularity of the nose, combined with its susceptibility to trauma (e.g., sneezing, nose blowing), makes it a frequent site of hemorrhage. Nausea, chest pain, and elevated temperature usually are not associated with anticoagulant therapy.

When teaching a patient with peripheral arterial disease, the nurse determines that further teaching is needed when the patient says, 1. "I should not use heating pads to warm my feet." 2. "I will examine my feet every day for any sores or red areas." 3. "I should cut back on my walks if they cause pain in my legs." 4. "I think I can quit smoking with the use of short-term nicotine replacement and support groups."

Answer: 3 Rationale:Patients should be taught to exercise to the point of discomfort, stop and rest, and then resume walking until the discomfort recurs.Smoking cessation and proper foot care are also important interventions for patients with peripheral arterial disease.

A patient returns to the cardiac observation area following a cardiac catheterization with coronary angiography. Which of the following assessments would require immediate action by the nurse? 1. Pedal pulses are 2+ bilaterally. 2. Apical pulse is 54 beats/minute. 3. Mean arterial pressure is 72 mm Hg. 4. ST-segment elevation develops on the ECG.

Answer: 4 Rationale: ST elevation on ECG indicates myocardial ischemia or injury with partial or total occlusion of a coronary artery. This assessment finding requires immediate action. Actions would include assessment for chest pain, 12-lead ECG, administration of nitroglycerin or morphine, and notification of the health care provider. Option 1 would need further assessment but is not critical unless the patient is symptomatic (chest pain, shortness of breath, hypotension, etc.). Options 2 and 3 are normal findings.

A nurse teaches a client about warfarin (Coumadin). Which information is essential for the nurse to include in the education plan? A Periodic blood testing is necessary. B Foods do not affect the medication. C Physical activities should be limited. D Daily doses should not be interrupted.

Answer: A Testing is essential to determine dosing; a therapeutic prothrombin time (PT) ranges from 1.3 to 1.5 times greater than the control and is equal to an international normalized ratio (INR) of 2 to 3 times control. Foods high in vitamin K may affect the medication if eaten in larger than usual amounts. Activities usually are not restricted. Doses may be withheld if the PT is prolonged excessively or minor bleeding occurs; warfarin may be stopped for dental, medical, and surgical procedures.

A client with a partial occlusion of the left common carotid artery is to be discharged while still receiving warfarin (Coumadin). Which clinical adverse effect should the nurse identify as a reason for the client to seek medical consultation? A Presence of blood in urine B Increased swelling of the ankles C Diminished ability to concentrate D Occurrence of transient ischemic attacks

Answer: A Warfarin causes an increase in the prothrombin time and international normalized ratio (INR) level, leading to an increased risk for bleeding. Any abnormal or prolonged bleeding must be reported, because it may indicate an excessive level of the drug. Increased swelling of the ankles, diminished ability to concentrate, and occurrence of transient ischemic attacks are not signs of bleeding, the primary concern with warfarin.

A client is receiving warfarin (Coumadin) for a pulmonary embolism. Which drug increases risk of bleeding when taking warfarin? A Ferrous sulfate B Acetylsalicylic acid (aspirin) C Atenolol (Tenormin) D Chlorpromazine (Thorazine)

Answer: B Acetylsalicylic acid can cause decreased platelet aggregation, increasing the risk for undesired bleeding that may occur with administration of anticoagulants. Ferrous sulfate does not affect warfarin; it is used for red blood cell synthesis. Atenolol is a beta blocker that reduces blood pressure; it does not affect bleeding. Chlorpromazine is a neuroleptic; it does not affect bleeding.

A patient with ST-segment elevation in three contiguous electrocardiographic (ECG) leads is admitted to the emergency department (ED) and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy? a "Do you have any allergies?" b "Do you take aspirin on a daily basis?" c "What time did your chest pain begin?" d "Can you rate your chest pain using a 0 to 10 scale?"

Answer: C Thrombolytic therapy should be started within 6 hours of the onset of the myocardial infarction (MI), so the time at which the chest pain started is a major determinant of the appropriateness of this treatment. The other information will also be needed, but it will not be a factor in the decision about thrombolytic therapy.

When assessing the cardiovascular system of a 79-year-old patient, you might expect to find a. a narrowed pulse pressure. b. diminished carotid artery pulses. c. difficulty in isolating the apical pulse. d. an increased heart rate in response to stress.

Answer: C (hard to find apical pulse)

A client is receiving Coumadin (warfarin). The nurse explains the need for careful regulation of dietary intake of vitamin K. What physiologic process does vitamin K promote that makes this instruction essential? A Platelet aggregation B Ionization of blood calcium C Fibrinogen formation by the liver D Prothrombin formation by the liver

Answer: D Vitamin K promotes the liver's synthesis of prothrombin, an important blood clotting factor, and will reverse the effects of warfarin. Platelet aggregation and fibrinogen formation by the liver are not promoted by vitamin K. Vitamin K does not affect calcium ionization.

Warfarin (Coumadin) is prescribed for a client who has been receiving intravenous (IV) heparin for a partial occlusion of the left common carotid artery. The client expresses concern about why both drugs are needed at the same time. The nurse explains that this approach: a Allows clot dissolution while preventing new clot formation. b Permits the administration of smaller doses of each medication. c Immediately provides maximum protection against clot formation. d Provides an anticoagulant intravenously until the oral drug reaches therapeutic levels.

Answer: D Warfarin is administered orally for two or three days to achieve the desired effect on the international normalized ratio (INR) level before heparin is discontinued. These drugs do not dissolve clots already present. Because each drug affects a different part of the coagulation mechanism, dosages must be adjusted separately. That this approach immediately provides maximum protection against clot formation does not account for the reason for the administration of both drugs; warfarin will not exert an immediate therapeutic effect.

A patient in the emergency department with sudden-onset right-sided weakness is diagnosed with an intracerebral hemorrhage. Which information about the patient is most important to communicate to the health care provider? A The patient's speech is difficult to understand. B The patient's blood pressure is 144/90 mm Hg. C The patient takes a diuretic because of a history of hypertension. D The patient has atrial fibrillation and takes warfarin (Coumadin).

D

While performing blood pressure screening at a health fair, the nurse counsels which of the following visitors as having the greatest risk for developing hypertension? 1. A 56-year-old man whose father died at age 62 from a stroke 2. A 30-year-old female advertising agent who is unmarried and lives alone 3. A 68-year-old man who uses herbal remedies to treat his enlarged prostate gland 4. A 43-year-old man who travels extensively with his job and exercises only on weekends

Answer: 1 Rationale: History of a close blood relative (e.g., father to son) with hypertension is associated with an increased risk for developing hypertension; atherosclerosis is the most common cause of cerebrovascular disease. Hypertension is the major risk factor for cerebral atherosclerosis and stroke.

A patient arrives at an urgent care center after experiencing unrelenting substernal and epigastric pain and pressure for about 12 hours. The nurse reviews laboratory results with the understanding that at this point in time, a myocardial infarction would by indicated by peak levels of: 1. Troponin T. 2. Homocysteine. 3. Creatine kinase-MB. 4. Type b natriuretic peptide.

Answer: 1 Rationale: Troponin is the biomarker of choice in the diagnosis of myocardial infarction. Troponin is a myocardial muscle protein released into the circulation after injury. Troponin levels peak at 10 to 12 hours.

A patient is receiving a drug that decreases afterload. To evaluate the effect of the drug, the nurse monitors the patient's: 1. Heart rate. 2. Lung sounds. 3. Blood pressure. 4. Jugular vein distention.

Answer: 3 Rationale: Afterload is affected by size of the ventricle, wall tension, and arterial blood pressure.

The laboratory international normalized ratio (INR) results of a client receiving warfarin (Coumadin) have been variable. The nurse interviews the client to determine factors contributing to the problem. Which is most important for the nurse to identify? a Use of analgesics b Serum glucose level c Serum potassium levels d Adherence to the prescribed drug regimen

Answer: D The dosage of warfarin is adjusted according to INR results; if the client fails to take the drug as prescribed, test results will not be reliable in monitoring the client's response to therapy. Although some medications can affect the absorption or metabolism of warfarin and should be investigated, this is less likely to be a cause of fluctuations in laboratory values. Serum glucose level and serum potassium levels do not affect the absorption of warfarin.

A 72-year-old patient who has a history of a transient ischemic attack (TIA) has an order for aspirin 160 mg daily. When the nurse is administering medications, the patient says, "I don't need the aspirin today. I don't have a fever." Which action should the nurse take? A Document that the aspirin was refused by the patient. B Tell the patient that the aspirin is used to prevent a fever. C Explain that the aspirin is ordered to decrease stroke risk. D Call the health care provider to clarify the medication order.

C

After a patient experienced a brief episode of tinnitus, diplopia, and dysarthria with no residual effects, the nurse anticipates teaching the patient about A cerebral aneurysm clipping. B heparin intravenous infusion. C oral low-dose aspirin therapy. D tissue plasminogen activator (tPA).

c

After receiving change-of-shift report on the following four patients, which patient should the nurse see first? A A 60-year-old patient with right-sided weakness who has an infusion of tPA prescribed B A 50-year-old patient who has atrial fibrillation and a new order for warfarin (Coumadin) C A 40-year-old patient who experienced a transient ischemic attack yesterday who has a dose of aspirin due D A 30-year-old patient with a subarachnoid hemorrhage 2 days ago who has nimodipine (Nimotop) scheduled

A

A patient with peripheral vascular disease has marked peripheral neuropathy. An appropriate nursing diagnosis for the patient is: 1. Risk for injury related to decreased sensation. 2. Impaired skin integrity related to decreased peripheral circulation. 3. Ineffective peripheral tissue perfusion related to decreased arterial blood flow. 4. Activity intolerance related to imbalance between oxygen supply and demand.

Answer: 1 Rationale:Peripheral neuropathy is caused by diminished perfusion to neurons and results in loss of both pressure and deep pain sensations.The patient may not notice lower extremity injuries.Neuropathy increases susceptibility to traumatic injury and results in delay in seeking treatment.

A patient's blood pressure has not responded consistently to prescribed medications for hypertension. The first cause of this lack of responsiveness the nurse should explore is: 1. Progressive target organ damage. 2. The possibility of drug interactions. 3. The patient not adhering to therapy. 4. The patient's possible use of recreational drugs.

Answer: 3 Rationale: Side effects of antihypertensive drugs are common and may be so severe or undesirable that the patient does not comply with therapy.

11. Which of the following nursing responsibilities are priorities when caring for a patient returning from a cardiac catheterization (select all that apply)? a. Monitoring vital signs and ECG b. Checking the catheter insertion site and distal pulses c. Assisting the patient to ambulate to the bathroom to void d. Informing the patient that he will be sleeping from the general anesthesia e. Instructing the patient about the risks of the radioactive isotope injection

Answer: A & B

A patient in the clinic reports a recent episode of dysphasia and left-sided weakness at home that resolved after 2 hours. The nurse will anticipate teaching the patient about A alteplase (tPA). B aspirin (Ecotrin). C warfarin (Coumadin). D nimodipine (Nimotop).

B

A client is admitted to the hospital after taking an overdose of aspirin. A nasogastric tube is inserted for lavage. Which solution should the nurse obtain for the gastric lavage? A Normal saline B Lactated Ringers C Citrate magnesium D Sodium bicarbonate

Answer: A A saline solution of 0.9% is considered a physiological or isotonic solution appropriate for gastric lavage because it will not detrimentally influence the client's acid-base balance. Lactated Ringers contains sodium chloride, potassium chloride, and calcium chloride in purified water; it is an intravenous solution. Citrate magnesium affects the lower bowel, not the stomach. Sodium bicarbonate is used to counteract acidosis in some instances of salicylate toxicity, but it is undesirable for lavage because as a systemic alkalinizer it can precipitate metabolic alkalosis.

The nurse provides discharge medication education to a client who has been switched from a prescription for heparin to a prescription for warfarin sodium (Coumadin). The nurse concludes that the teaching was effective when the client states, "I will: A ... take acetaminophen (Tylenol) for my occasional headaches." B ... spend most of the day working at my desk." C ... ask my health care provider for antibiotics before going to the dentist." D ... make an appointment to have a complete blood count drawn."

Answer: A Acetaminophen should be used when an analgesic is required because it does not interfere with platelet aggregation. Acetylsalicylic acid (aspirin) should be avoided because it interferes with platelet aggregation. Immobility causes venous pooling and can predispose the client to deep vein thrombosis. Antibiotics are not necessary when going to the dentist; this is done when clients have cardiac problems, such as rheumatic fever or cardiac surgery. A prothrombin time (PT) or international normalized ratio (INR), not a complete blood count, needs to be done periodically.

A health care provider prescribes acetylsalicylic acid (aspirin) to be continued at home for a client with severe arthritis. What should the nurse teach the client about taking aspirin? A Take the medicine with meals. B See a dentist if bleeding gums develop. C Switch to acetaminophen if tinnitus occurs. D Avoid spicy foods while taking the medication.

Answer: A Acetylsalicylic acid is irritating to the stomach lining and can cause ulceration; the presence of food, fluid, or antacids decreases this response. Bleeding gums should be reported to the health care provider, not the dentist. Acetaminophen does not contain the antiinflammatory properties present in aspirin; tinnitus should be reported to the health care provider. Avoiding spicy foods is unnecessary as long as aspirin is taken with food.

Four days after the client's total hip arthroplasty, the nurse is preparing to transfer the client to a rehabilitation center. Before admission the client took warfarin sodium (Coumadin) daily for a history of pulmonary embolus. While hospitalized, the client received subcutaneous heparin two times a day. The nurse does not see any anticoagulant therapy listed on the client's transfer prescriptions. The nurse should: A Contact the health care provider to determine what anticoagulant therapy should be prescribed for this client. B Arrange for a supply of heparin for the client to take to the rehab center. C Explain to the client that anticoagulant therapy will no longer be needed. D Instruct the client to talk about anticoagulant needs with the health care provider at the rehabilitation center.

Answer: A Failure to clarify this omission can be life threatening because of the potential for an embolus. Waiting until the client is in the new facility to discuss the administration of an anticoagulant may jeopardize the client's status. Because anticoagulant therapy was not included in the transfer prescriptions, the nurse cannot legally supply the client with medications to take to the rehabilitation center. It is unclear what the anticoagulant needs are for this client; it is unsafe to tell the client that anticoagulants are no longer required. It is the nurse's, not the client's, responsibility to discuss this situation with the health care provider.

A client develops thrombophlebitis in the right calf. Bed rest is prescribed, and an IV of heparin is initiated. When describing the purpose of this drug to the client, the nurse explains that it: A Prevents extension of the clot B Reduces the size of the thrombus C Dissolves the blood clot in the vein D Facilitates absorption of red blood cells

Answer: A Heparin interferes with activation of prothrombin to thrombin and inhibits aggregation of platelets. Heparin does not reduce the size of a thrombus. Heparin does not dissolve blood clots in the veins. Heparin does not facilitate the absorption of red blood cells.

The nurse is providing care for a client that had an endarterectomy one month ago. The nurse explains the reason that clopidogrel (Plavix) is being prescribed. The nurse concludes that the teaching is understood when the client says, "The medication will: A Limit inflammation around my incision." B Help prevent further clogging of my arteries." C Lower the slight fever I have had since surgery." D Reduce the discomfort I feel at the surgical incision."

Answer: B Clopidogrel interferes with platelet aggregation, which impedes the formation of thrombi. Clopidogrel is a platelet aggregation inhibitor, not an antiinflammatory. Clopidogrel is a platelet aggregation inhibitor, not an antipyretic. Clopidogrel is a platelet aggregation inhibitor, not an analgesic.

A client with a history of a pulmonary embolus is to receive 3 mg of warfarin (Coumadin) daily. The client has blood drawn twice weekly to ascertain that the international normalized ratio (INR) stays within a therapeutic range. The nurse provides dietary teaching. Which food selected by the client indicates that further teaching is necessary? A Poached eggs B Spinach salad C Sweet potatoes D Cheese sandwich

Answer: B Dark green, leafy vegetables are high in vitamin K. Influencing the level of vitamin K alters the activity of warfarin because vitamin K acts as a catalyst in the liver for the production of blood-clotting factors and prothrombin. The intake of foods containing vitamin K must be consistent to regulate the warfarin dose so that the INR remains within the therapeutic range. Eggs contain protein and are permitted on the diet. Yellow vegetables contain vitamin A and are permitted on the diet. Dairy products containing protein and bread supplying carbohydrates are permitted on the diet.

An older adult with cerebral arteriosclerosis is admitted with atrial fibrillation and is started on a continuous heparin infusion. What clinical finding enables the nurse to conclude that the anticoagulant therapy is effective? A A reduction of confusion B An activated partial thromboplastin (APTT) twice the usual value C An absence of ecchymotic areas D A decreased viscosity of the blood

Answer: B Desired anticoagulant effect is achieved when the activated partial thromboplastin time is 1.5 to 2 times normal. While anticoagulants help prevent thrombi that could block cerebral circulation, they do not increase cerebral perfusion, and so will not affect existing confusion. Although absence of bleeding suggests that the drug has not reached toxic levels, it does not indicate its effectiveness. This medication does not affect the viscosity of blood.

What should the nurse teach a client who is taking warfarin (Coumadin)? a Increase the dose with prolonged inactivity. b Have routine blood work to determine dosing. c Take antibiotics if injured to prevent infection. d Eat a diet with an increased quantity of green vegetables.

Answer: B International normalized ratio (INR) is a standardized system of reporting prothrombin time that is based on a referenced, calibrated model; clients should be maintained within a therapeutic range of 2 to 3. Activity or inactivity is unrelated to the need to alter the dose of warfarin. The dose should not be altered without health care supervision. The problem of bleeding is more significant than infection when a client is taking warfarin. Green vegetables that contain vitamin K, which is necessary for the synthesis of clotting factors VII, IX, and X, should be kept consistent in the diet from week to week; increased consumption will decrease the action of warfarin, and a decreased consumption will increase the action of warfarin.

After a deep vein thrombosis developed in a postpartum client, an IV infusion of heparin therapy was instituted 2 days ago. The client's activated partial thromboplastin time (aPTT) is now 98 seconds. What should the nurse do? A Increase the intravenous rate of heparin. B Interrupt the infusion and notify the practitioner of the aPTT result. C Document the result on the medical record and recheck the aPTT in 4 hours. D Call the practitioner to obtain a prescription for a low-molecular-weight heparin.

Answer: B The heparin should be withheld, because 98 seconds is almost three times the normal time it takes a fibrin clot to form (25 to 36 seconds) and prolonged bleeding may result; the therapeutic range for heparin is one-and-a-half to two times the normal range. The primary health care provider should be notified. The dosage of heparin must not be increased, because the client already has received too much. Documenting the result on the medical record and rechecking the aPTT in 4 hours is an unsafe option. Continuing the infusion could result in hemorrhage. The medication does not have to be changed; it should be stopped temporarily until the aPTT is within the therapeutic range.

What should the nurse expect the health care provider to prescribe if a client exhibits clinical indicators of warfarin (Coumadin) overdose? A Heparin B Vitamin K C Iron dextran (Imferon) D Protamine sulfate

Answer: B Warfarin depresses prothrombin activity and inhibits formation of several clotting factors by the liver. Its antagonist is vitamin K, which is involved in prothrombin formation. Heparin is an anticoagulant. Iron dextran is an iron supplement, not an antidote for warfarin. Protamine sulfate is the antidote for heparin overdose.

A nurse is caring for a client who is receiving aspirin therapy. Which clinical indicator related to this therapy should be a matter of concern to the nurse? A Urinary calculi B Atrophy of the liver C Prolonged bleeding time D Premature erythrocyte destruction

Answer: C Aspirin interferes with platelet aggregation, thereby lengthening bleeding time. Urate excretion is enhanced by high doses of aspirin. Aspirin does not cause atrophy of the liver; it is readily broken down in the gastrointestinal tract and liver. Aspirin does not destroy erythrocytes.

Tissue plasminogen activator (t-PA) is to be administered to a client in the emergency department. Which is the priority nursing assessment? A Apical pulse rate B Electrolyte levels C Signs of bleeding D Tissue compatibility

Answer: C Assessment for bleeding is a priority when administering a thrombolytic agent because it may lead to hemorrhage. The heart rate is not affected. Electrolyte levels are not affected. Tissue compatibility is not necessary.

A client who had a femoropopliteal bypass graft is receiving clopidogrel (Plavix) postoperatively. What should the nurse teach the client related to the medication? A Eliminate grapefruit from the diet B Eat more roughage if constipation occurs C Report multiple bruises on the extremities D Take the medication on an empty stomach

Answer: C Clopidogrel is a platelet aggregation inhibitor that decreases the probability of clots forming where the graft was placed, but it also increases bleeding tendencies when the dosage is excessive. Clopidogrel does not interact with grapefruit and it is permitted on the diet. Diarrhea, not constipation, is more likely to occur with clopidogrel. Clopidogrel should be taken with food to decrease the side effects of gastric discomfort, diarrhea, and gastrointestinal bleeding.

Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI). What is the purpose of the heparin? A Heparin enhances platelet aggregation. B Heparin decreases coronary artery plaque size. C Heparin prevents the development of new clots in the coronary arteries. D Heparin dissolves clots that are blocking blood flow in the coronary arteries.

Answer: C Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary artery thrombosis. It does not change coronary artery plaque, dissolve already formed clots, or enhance platelet aggregation.

A nurse is planning care for a toddler who has ingested aspirin. What assessment warrants close monitoring because an increase can result in further complications? A Blood pressure B Abdominal girth C Body temperature D Serum glucose level

Answer: C Hyperpyrexia (increased temperature) is a manifestation of acute aspirin poisoning; this leads to increased oxygen consumption and heat loss. Blood pressure is not directly affected by aspirin ingestion. Ascites does not occur as a result of aspirin ingestion; it may occur if liver failure develops. Aspirin ingestion does not affect the serum glucose level.

A nurse is admitting a 2-year-old toddler who ingested half of a bottle of aspirin tablets to the emergency department. What is the origin of the metabolic acidosis caused by aspirin toxicity? A Deep rapid breathing B Higher pH of gastric contents C Rapid absorption of salicylate D Increased renal excretion of bicarbonate

Answer: C Rapid absorption of acetylsalicylic acid (aspirin) causes the stomach contents to become more acidic, leading to metabolic acidosis. Hyperventilation is the body's attempt to blow off excess hydrogen ions; carbon dioxide is converted to hydrogen ions by way of the carbonic anhydrase reaction. The pH of the stomach contents decreases with aspirin toxicity, becoming more acidic, resulting in metabolic acidosis. Although increased renal excretion of bicarbonate can contribute to metabolic acidosis, this is not the mechanism associated with aspirin toxicity. In metabolic acidosis associated with aspirin toxicity the kidneys attempt to decrease the renal excretion of bicarbonate.

When teaching about clopidogrel (Plavix), the nurse will tell the patient with cerebral atherosclerosis A to monitor and record the blood pressure daily. B that Plavix will dissolve clots in the cerebral arteries. C that Plavix will reduce cerebral artery plaque formation. D to call the health care provider if stools are bloody or tarry.

Answer: D

The nurse reviews the admission orders shown in the accompanying figure for a patient newly diagnosed with peripheral artery disease. Which admission order should the nurse question? A Use of treadmill for exercise B Referral for dietary instruction C Exercising to the point of discomfort D Combined clopidogrel and omeprazole therapy

Answer: D Because the antiplatelet effect of clopidogrel is reduced when it is used with omeprazole, the nurse should clarify this prescription with the health care provider. The other interventions are appropriate for a patient with peripheral artery disease.

A client is admitted to the hospital with a diagnosis of deep vein thrombosis, and intravenous (IV) heparin sodium is prescribed. If the client experiences excessive bleeding, the nurse should be prepared to administer: A Vitamin K B Panheparin C Warfarin sodium D Protamine sulfate

Answer: D Protamine sulfate binds with heparin sodium to form a physiologically inert complex; it corrects clotting deficits. Vitamin K counteracts the effects of drugs like warfarin sodium (Coumadin). Panheparin is an alternate name for heparin sodium. Warfarin sodium is an oral anticoagulant that interferes with the synthesis of prothrombin.

Which drug, if taken with warfarin, may decrease warfarin's anticoagulant effect? A Nonsteroidal antiinflammatory drug (NSAID) B Erythromycin C Amiodarone D Rifampin

Answer: D Rifampin, when taken with warfarin, reduces warfarin's anticoagulant effect. The other drugs may cause increased bleeding.