Module 3 practice questions
Which of the following blood thinners is safe to administer to a woman that is pregnant? A. heparin B. clopidogrel C. warfarin D. dabigatran
A
A patient with increased cholesterol takes lovastatin. Which is a possible adverse effect of this drug? A. Muscle pain and tenderness B. Platelet count of 100 × 103/mm3 C. Blood pressure of 140/90 mm Hg D. Wheezing and shortness of breath
A
A patient taking an ACE inhibitor develops a persistent cough. What should the nurse do? A. Notify the provider of the new development B. Tell the patient that the cough will subside in a few days. C. Assess for other symptoms of upper respiratory infection. D. Give the the patient a PRN medication for cough.
A
Which of the following would be a contraindication for the administration of alteplase? A. Hemorrhagic stroke B. Pulmonary emboli C. Myocardial infarction D. Ischemic stroke
A
A client is taking enoxaparin (Lovenox) daily. Which client statement requires additional monitoring? A. "I take aspirin daily for headaches." B. "I take ibuprofen (Motrin) at least once a week for joint pain." C. "Whenever I have a fever, I take acetaminophen (Tylenol)." D. "I take my medicine first thing in the morning."
A Rationale: Aspirin is an antiplatelet medication. A client taking both aspirin and Lovenox could cause excessive bleeding.
A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein thrombosis prevention. Which instructions should the nurse include in the patient's discharge teaching plan? (Select all that apply.) A. Wear a medical alert bracelet. B. Check all urine and stool for discoloration. C. Do not start any new medication without first talking to your healthcare provider. D. Enteric-coated aspirin and any aspirin products can be used unless they cause a gastrointestinal ulcer. E. No laboratory or home monitoring of international normalized ratio (INR) is required after the first 6 months.
ABC Advise the patient to wear some form of identification (eg, Medic Alert bracelet) to alert emergency personnel to warfarin use. Bleeding is a major complication of warfarin therapy. Inform patients about the signs of bleeding, which include discolored urine or stools. Inform patients that warfarin is subject to a large number of potentially dangerous drug interactions. Instruct them to avoid all prescription and nonprescription drugs that have not been specifically approved by the prescriber. Aspirin and aspirin products should be avoided because aspirin can increase the effects of warfarin to promote bleeding and on the gastrointestinal tract to cause ulcers, thereby initiating bleeding. The INR should be determined frequently: daily during the first 5 days, twice a week for the next 1 to 2 weeks, once a week for the next 1 to 2 months, and every 2 to 4 weeks thereafter.
A client is started on warfarin (Coumadin) therapy while still receiving intravenous heparin. The client questions the nurse about the risk for bleeding. How should the nurse respond? A. "Your concern is valid. I will call the doctor to discontinue the heparin." B. "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." C. "Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than one alone." D. "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."
B
A client who is taking warfarin (Coumadin) requests an aspirin for headache relief. What is the nurse's best response? A. Administer 650 mg of acetylsalicylic acid (ASA) and reassess pain in 30 minutes. B. Teach the client of potential drug interactions with anticoagulants. C. Explain to the client that ASA is contraindicated and administer ibuprofen as ordered. D. Explain that the headache is an expected side effect and will subside shortly.
B
A patient is receiving an IV infusion of heparin and was started on warfarin therapy the night before. Which statement is most correct?A. The patient is receiving a double dose of anticoagulants. B. The heparin therapy was ineffective, so the warfarin was started. C. The heparin provides anticoagulation until therapeutic levels of warfarin are reached. D. The heparin and warfarin work together synergistically to provide anticoagulation.
C Rationale: Heparin has a faster onset and therefore is used to provide anticoagulation until therapeutic levels of warfarin are reached.
A patient is receiving a thrombolytic agent, alteplase (Activase), follwing an acute myocardial infraction. Which condition is most likely attributed to thrombolytic therapy with this agent? A. Skin rash with urticaria B. Wheezing with labored respirations C. Brusing and epistaxis D. Temperature elevation of 100.8F
C Rationale: Thrombolytic agents dissolve existing clots rapidly and continue to have effects for 2 to 4 days. All forms of bleeding must be monitored and reported immediately. Skin rash with urticara, wheezing with labored respirations, and temperature elevation of 100.8F are not symptoms of adverse effects directly attributed to thrombolytic therapy.
The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin? A. Heart rate of 60 beats/min B. Blood pressure of 160/88 mm Hg C. Discolored urine D. Inspiratory wheezing
C The primary and most serious adverse effect of heparin is bleeding. Bleeding can occur from any site and may be manifested in various ways, including reduced blood pressure, increased heart rate, bruises, petechiae, hematomas, red or black stools, cloudy or discolored urine, pelvic pain, headache, and lumbar pain.
What is the most appropriate nursing consideration for a patient who is prescribed verapamil [Calan] and digoxin [Lanoxin]? A. Restrict intake of oral fluids and high-fiber food. B. Take an apical pulse for 30 seconds before administration. C. Notify the healthcare provider of nausea, vomiting, and visual changes. D. Hold the medications if the heart rate is greater than 110 beats/min.
C Verapamil can raise digoxin blood serum levels, increasing the risk of digoxin toxicity. Symptoms of digoxin toxicity may include nausea, vomiting, and visual changes. Increase intake of oral fluids and high-fiber food to decrease the adverse effect of constipation. An apical pulse should be taken for a full minute prior to administering digoxin. Verapamil and digoxin can cause bradycardia not tachycardia.
What is the antidote for Heparin? A. Protamine sulfate B. Vitamin K C. Flumazenil D. Narcan
A
A client has been taking atorvastatin for cholesterol. Which laboratory value is important to monitor? A. ALT/AST B. BUN/Creatinine C. Platelets D. Potassium
A
A client is prescribed diltiazem for atrial fibrillation. What is the relationship between diltiazem and grapefruit juice? A. Grapefruit juice increases the effects of diltiazem. B. Grapefruit juice decreases the effects of diltiazem.
A
a nurse suspects that client receiving antihyperlipidemic therapy is experiencing rhabdomyolysis based on assessment of which of the following (select all that apply) A. unexplained muscle pain B. fever C. malaise D. cough E. nasal congestion
ABC
A client is taking amiodarone for atrial fibrillation. Which nursing intervention would be priority? A. Assisting the client out of bed B. Encouraging increased oral fluids C. Limiting high potassium foods D. Limiting high sodium foods
A
A client is taking propranolol for heart rate control. Which of the following teaching is a priority? A. "Do not stop taking without consulting your physician." B. "Monitor your blood pressure daily." C. "Limit foods high in potassium." D. "Do not take this medication with grapefruit juice."
A
A nurse notices that a client that is receiving heparin is profusely bleeding from his nose. What would the nurse anticipate the physician to order? A. Protamine Sulfate B. Narcan C. Vitamin K D. Ferrous Sulfate
A
What is the action of alteplase? A. It dissolves the clot. B. It prevents platelet aggregation. C. It decreases clot formation.
A
What is the antidote for warfarin? A. Vitamin K B. Protamine Sulfate C. Narcan D. Flumazenil
A
The nurse is preparing to administer a daily dose of digoxin [Lanoxin]. What is the priority nursing intervention? A. Analyze heart rate and rhythm. B. Assess for Homans' sign. C. Check blood pressure. D. Palpate the pedal pulses.
A Before giving digoxin, the nurse will assess the heart rate and rhythm. The dosage will be held and the prescriber notified if the heart rate is below 60 beats per minute or if the cardiac rhythm has changed. Digoxin can cause bradycardia and electrical changes in the heart.
The nurse is preparing to administer an oral dose of digoxin [Lanoxin]. The apical pulse rate is 64. What nursing action is most appropriate? A. Give the medication. B. Obtain a serum digoxin level. C. Notify the healthcare provider. D. Assess for signs of digoxin toxicity
A Determine heart rate and rhythm prior to administration. If heart rate is less than 60 beats/min or if a change in rhythm is detected, withhold digoxin and notify the healthcare provider.
A client is receiving heparin and starts to bleed. The nurse administers Protamine Sulfate to stop the bleeding. What type of effect occurs when this happens? A. Adverse Effect B. Antagonist Effect C. Synergistic Effect D. Additive Effect
B
A client is receiving heparin, which laboratory test will the nurse need to monitor? A. ProThrombin time (PT) B. Activated partial thromboplastin time (aPTT) C. Platelet count D. White blood cells
B
The nurse is teaching a patient about self-administration of enoxaparin. Which statement will be included in this teaching session? A. "We will need to teach a family member how to give this drug in your arm." B. "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel." C. "This drug needs to be taken at the same time every day with a full glass of water." D. "Be sure to massage the injection site thoroughly after giving the drug
B
What teaching will the nurse provide to the patient who needs to apply nitroglycerin ointment? A. Massage the ointment into the skin. B. Apply the ointment to a nonhairy part of the upper torso. C. Spread the ointment evenly over a 3-inch area. D. The ointment should be taken sublingually.
B
A patient with deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response? A. Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting factors. B. Heparin suppresses coagulation by helping antithrombin perform its natural functions. C. Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot matrix. D. Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels.
B Heparin is an anticoagulant that works by helping antithrombin inactivate thrombin and factor Xa, reducing the production of fibrin and thus decreasing the formation of clots
The healthcare provider prescribes an intravenous dose of diltiazem [Cardizem] for treatment of a patient with atrial fibrillation. What is the priority nursing intervention? A. Assist with cardioversion. B. Monitor electrocardiogram. C. Obtain baseline coagulation studies. D. Assess for increased urinary output.
B Monitor the electrocardiogram (ECG) continuously during IV administration of diltiazem for AV block, sudden reduction in heart rate, and prolongation of the PR or QT interval. Cardioversion is not necessary; however, have equipment for cardioversion available. Baseline laboratory studies are needed for liver and kidney function. Increased urinary output is not an adverse effect of diltiazem.
The nurse is caring for a patient receiving amiodarone [Cordarone]. Which body system should the nurse assess for serious adverse effects of this medication? A. Musculoskeletal B. Respiratory C. Integumentary D. Gastrointestinal
B Pulmonary toxicity is the most serious potential adverse effect of amiodarone. It may manifest as pneumonitis or pulmonary fibrosis, with symptoms such as dyspnea, cough, and chest pain.
A nursing student who is preparing to care for a postoperative patient with deep vein thrombosis asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct? A. "Heparin has a longer half-life." B. "Heparin has fewer adverse effects." C. "The onset of warfarin is delayed." D. "Warfarin prevents platelet aggregation.
C
The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? A. "I can take this medication in the morning to reduce nighttime urination." B. "I will rise slowly when changing from a sitting to a standing position." C. "My heart rate may slow down with this drug. I will call if my pulse is below 60." D. "I need to increase my intake of fluids and foods that are high in fiber."
B Vasodilators may cause postural hypotension and reflex tachycardia. Patients should be taught to move slowly when changing positions to prevent dizziness.
An RN had administered Alteplase IV. The IV starts to ooze, which is the most appropriate action for the nurse? A. Assess the patient's vital sign B. Discontinue the IV and start another one C. Call and notify the physician D. Administer direct pressure over the puncture site
B if its bleeding bad D if its just a little
A client is receiving amiodarone to control their rate for atrial fibrillation. Which assessment would be a priority? A. abdominal B. neurological C. respiratory D. genitourinary
C
A client is receiving nitroglycerin for chest pain. What would the nurse inform the client of a common side effect from this medication? A. nausea B. rash C. headache D. diaphoresis
C
A client is taking warfarin for the maintenance of their mechanical heart valve. Which laboratory value is important to monitor? A. BUN/Creatinine B. PTT C. PT/INR D. ALT/AST
C
A nurse is administering metoprolol to help decrease the blood pressure in a client. What would not be a priority for the nurse to check prior to administering the medication? A. Heart rate B. Blood pressure C. Last oral intake D. Name and date of birth
C
A patient is receiving instructions regarding warfarin therapy and asks the nurse about what medications she can take for headaches. The nurse will tell her to avoid which type of medications? A. Opioids B. Acetaminophen C. NSAIDs D. There are no restrictions while taking warfarin
C
What a client does the nurse identify as most likely needing an increased dose of warfarin? A. A client taking acetaminophen for pain B. A client taking predisone for arthritis C. A client taking oral contraceptives D. A client taking famotidine
C
A client is receiving warfarin (Coumadin) for a chronic condition. Which client statement requires immediate action by the nurse? A. "I will avoid contact sports." B. "I will take my medication in the early evening each day." C. "I will increase dark-green, leafy vegetables in my diet." D. "I will contact my health care provider if I develop excessive bruising."
C Rationale: Dark green, leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Rather than increase the intake of these, it is important to maintain a consistent daily intake of vitamin K.
The nurse is caring for a patient prescribed digoxin [Lanoxin] for heart failure. Which finding would require immediate attention by the nurse? A. Potassium level of 3.7 mEq/L B. Digoxin level of 0.7 ng/mL C. Vomiting and diarrhea D. Heart rate of 68 beats/min
C Vomiting and diarrhea can lead to hypokalemia, which increases the risk of digoxin toxicity. These symptoms, along with nausea, fatigue, and visual disturbances, also may precede digoxin toxicity and warrant further attention. The heart rate, potassium level, and digoxin level are within the normal range.
A client has been taking lovastatin for their cholesterol and starts to complain of leg pain. Which of the following statements would be appropriate from the nurse? A. "This is a normal finding, so no further treatment is needed." B. "You are dehydrated, so increase your water intake." C. "This means the medication is affecting your liver, so we need to check your liver." D. "You need to go see your physician because the medication can cause rhabdomylysis."
D
A client is receiving digoxin to control their heart rate. How would the nurse assess the client's heart rate? A. radial B. carotid C. femoral D. apical
D
A father presents to the emergency department with his 4-year-old son. The father explains that his son had a fever, so he gave the child baby aspirin to decrease the fever and it has not worked. What should concern the nurse about the 4-year-old receiving aspirin? A. Aspirin has the potential to cause gastrointestinal (GI) bleeding in children B. Aspirin has the potential to cause ringing in the ears in children C. Aspirin has the potential to cause hyperglycemia in children D. Aspirin has the potential to cause Reye's syndrome in children
D
Which safety precautions would you need to take when administering anticoagulants SATA? A. Use an electric razor B. Minimize needle sticks C. Use a soft toothbrush D. Keep toenails cut E. Report signs of bleeding
ABCE
A client's digoxin level is 1.1 ng/ml. Which electrolyte imbalance would you anticipate? A. hyperkalemia B. hypokalemia C. hyponatremia D. hypernatremia
B
A patient is receiving continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor? (Select all that apply.) A. Platelets B. Vitamin K C. Prothrombin time (PT) D. International normalized ratio (INR) E. Activated partial thromboplastin time (aPTT
AE To reduce the risk of heparin-induced thrombocytopenia (HIT), platelet counts should be monitored. Heparin therapy is monitored by measuring the laboratory test activated partial thromboplastin time (aPTT). Warfarin therapy is monitored by measuring prothrombin time (PT) and results are expressed as an international normalized ratio (INR). Vitamin K is not monitored for a heparin infusion.
A patient with cardiovascular disease is taking rosuvastatin [Crestor]. The nurse is monitoring for potential adverse effects. Which finding indicates a potential adverse effect of this drug? A. Blood pressure of 140/90 mm Hg B. Wheezing and shortness of breath C. Platelet count of 100 × 103/mm3 D. Muscle pain and tenderness
D The statins typically are well tolerated; however, in rare cases they can cause the serious adverse effect of myopathy and rhabdomyolysis. If unexplained muscle pain and tenderness develop, the prescriber should be notified. The other effects would not likely be caused by rosuvastatin.
A client is taking captopril for hypertension. Which laboratory value would be important for the nurse to monitor? A. Sodium B. Potassium C. Magnesium D. Chloride
B
Which nursing diagnosis would be possible for a client receiving intravenous heparin therapy? A. Potential for fluid volume excess B. Potential for pain C. Risk for injury D. Potential for body image disturbance
C Rationale: The client receiving heparin is at risk for injury secondary to increased risk of bleeding.
A client who has been taking warfarin (Coumadin) is admitted with coffee-ground emesis. What is the nurse's primary action? A. Administer vitamin E. B. Administer vitamin K. C. Administer protamine sulfate. D. Administer calcium gluconate.
B
A nurse tells a patient, "This drug increases the contractions of your heart." Which drug is this? A. Carvedilol B. Lisinopril C. Digoxin D. Verapamil
C
What should the nurse include in the discharge teaching for a patient prescribed amiodarone [Cordarone]? (Select all that apply.) A. "Take amiodarone with grapefruit juice." B. "Take the medication on an empty stomach." C. "Wear sunblock and protective clothing when you are outdoors." D. "Check your pulse daily and report excessive slowing to your healthcare provider immediately." E. "Immediately notify your healthcare provider of shortness of breath, cough, or chest pain
CDE Patients frequently experience photosensitivity reactions while taking amiodarone. To reduce this risk, patients should avoid sunlamps and wear sunblock and protective clothing when outdoors. Excessive slowing of the heart rate may indicate that the patient is experiencing sinus bradycardia or an AV block. Dyspnea, cough, and chest pain may indicate pulmonary toxicity. Grapefruit juice should be avoided, because it may increase amiodarone levels and thus the risk of toxicity. Gastrointestinal side effects of amiodarone can be reduced by taking the drug on a full stomach.
A nurse notices that the physician has ordered warfarin while the client is still receiving heparin. What should the nurse do? A. Not give the warfarin until the heparin is discontinued B. Call the physician to clarify the order C. Discontinue the heparin and start the warfarin D. Continue the heparin and administer the warfarin
D
Which behavior by a patient indicates more teaching is needed about taking diltiazem? A. Takes with a full glass of water. B. Takes in the morning with breakfast. C. Checks blood pressure at home. D. Takes with grapefruit juice
D
The nurse evaluates that the client understood discharge teaching regarding warfarin (Coumadin) based on which statement? A. "I will double my dose if I forget to take it the day before." B. "I should keep taking ibuprofen for my arthritis." C. "I should decrease the dose if I start bruising easily." D. "I should use a soft toothbrush for dental hygiene."
D Rationale: This statement is accurate and will reduce the risk of bleeding. Ibuprofen will potentiate bleeding. The client should call the health care provider if experiencing excessive bruising.
A nurse is teaching a child care class to prospective grandparents. Which of the following medications is contraindicated in children? A. ibuprofen B. acetaminophen C. amoxicillin D. aspirin
D The nurse should instruct the grandparents that aspirin increases children's risk of developing Reye's syndrome, and they should not give the drug to children.
A patient who takes warfarin (Coumadin) is brought to the emergency department after accidentally taking too much warfarin. The patient's heart rate is 78 beats per minute and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any obvious hematoma or petechiae and does not complain of pain. The nurse will anticipate an order for: A. vitamin K (phytonadione). B. protamine sulfate. C. a PTT. D. a PT and an INR.
D This patient does not exhibit any signs of bleeding from a warfarin overdose. The vital signs are stable, there are no hematomas or petechiae, and the patient does not have pain. A PT and INR should be drawn to evaluate the anticoagulant effects. Vitamin K may be given if laboratory values indicate overdose. Protamine sulfate is given for heparin overdose. PTT evaluation is used to monitor heparin therapy.
