NCLEX-style hemostasis

The patient receives heparin. During the morning assessment of the patient, the nurse notes that the patient's blood pressure and red blood cell (RBC) count are low. There is no evidence of bleeding on the bed linen or the patient's gown. What will the best assessment of this patient reveal? 1. The patient is dehydrated. 2. The patient may be bleeding internally. 3. The patient's activated partial thromboplastin time (aPTT) is too low. 4. The patient has probably formed some clots

2. The patient may be bleeding internally. A low blood pressure and red blood cell (RBC) count in the patient could indicate internal bleeding.

The patient receives an appropriate dose of warfarin (Coumadin), but the international normalized ratio (INR) is in the high range. The patient denies taking any aspirin products. What is the best assessment question to ask the patient at this time? 1. "Have you been eating much garlic?" 2. "Have you been eating a lot of salads and vegetables?" 3. "Have you been drinking too much milk?" 4. "Are you restricting your fluids too much?"

1. "Have you been eating much garlic?" Garlic has been shown to decrease the aggregation of platelets, thus producing an anticoagulant effect. Patients taking anticoagulant medications should limit their intake of garlic.

The patient receives warfarin (Coumadin). The nurse plans to teach the patient to avoid which foods that are served for lunch? 1. Spinach and goats cheese salad with basil 2. Whole-wheat bread with margarine 3. Salt substitute 4. Fettuccine Alfred

1. Spinach and goats cheese salad with basil Spinach contains high levels of vitamin K, so patient's should be educated to limit consumption of dark leafy greens

The patient receives enoxaparin (Lovenox) postoperatively. The nurse teaches the patient about this medication and evaluates that learning has occurred when he makes which statement? 1. "It inhibits the synthesis of prostaglandins." 2. "It increases the time it takes for me to form a clot." 3. "It dissolves small clots so I won't have a stroke." 4. "It increases the flexibility of my blood cells."

2. "It increases the time it takes for me to form a clot." All anticoagulant drugs will increase the normal time the body takes to form clots.

The nurse is managing care for a patient with cirrhosis of the liver. The nurse teaches the patient about how to avoid injury that may result in bleeding. The patient asks the nurse why he is at risk to start bleeding. What is the best response by the nurse? 1. "Because your liver is injured and unable to manufacture platelets." 2. "Because your liver thickens your blood so it is less likely to clot." 3. "Because your liver is injured and cannot make clotting factors." 4. "Because your liver is breaking down your clotting factors too quickly."

3. "Because your liver is injured and cannot make clotting factors." The liver is responsible for the production of essential clotting factors necessary to prevent bleeding

The nursing instructor is teaching student nurses about the process of hemostasis after an injury. What does the nursing instructor include as the initial event in this process? 1. Platelets become sticky. 2. Plasma proteins convert to active forms. 3. The vessel spasms. 4. Von Willebrand's factor is activated.

3. The vessel spasms. The blood vessel spasms, causing constriction during the initial event in the hemostasis process.

The patient receives warfarin (Coumadin) and becomes pregnant. The physician changes her anticoagulant to enoxaparin (Lovenox). She asks the nurse, "Why did the doctor do that?" What is the best rationale by the nurse? 1. "Because it is easier to maintain your bleeding times in a therapeutic range." 2. "Because warfarin (Coumadin) is known to cause serious cardiac defects." 3. "Because you are less likely to have bleeding with enoxaparin (Lovenox)." 4. "Because enoxaparin (Lovenox) does not cross the placenta and will not affect your baby."

4. "Because enoxaparin (Lovenox) does not cross the placenta and will not affect your baby." Heparin and the low-molecular-weight heparin (LMWH) molecules are too large to cross the placental barrier.

The nurse is admitting a 68-year-old preoperative patient with a suspected abdominal aortic aneurysm (AAA). The medication history reveals that the patient has been taking warfarin (Coumadin) on a daily basis. Based on this history and the patient's admission diagnosis, the nurse should prepare to administer which medication? A. Vitamin K B. Cobalamin C. Heparin sodium D. Protamine sulfate

A. Vitamin K Coumadin 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 (Coumadin).

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

B. Abdomen, anterior-lateral aspect Enoxaparin (Lovenox) is a low-molecular-weight (LMW) heparin that is given as a deep subcutaneous injection in the right and left anterolateral abdomen. All subcutaneous injections should be given away from scars, lesions, or moles.

The nurse would determine that a postoperative patient is not receiving the beneficial effects of enoxaparin (Lovenox) after noting what during a routine shift assessment? A. Generalized weakness and fatigue B. Crackles bilaterally in the lung bases C. Pain and swelling in lower extremity D. Abdominal pain with decreased bowel sounds

C. Pain and swelling in 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.

The nurse is preparing to administer a scheduled dose of enoxaparin (Lovenox) 30 mg subcutaneously. What should the nurse do to administer this medication correctly? A. Remove the air bubble in the prefilled syringe. B. Aspirate before injection to prevent IV administration. C. Rub the injection site after administration to enhance absorption. D. Pinch the skin between the thumb and forefinger before inserting the needle.

D. Pinch the skin between the thumb and forefinger before inserting the needle. The nurse should gather together or "bunch up" the skin between the thumb and the forefinger before inserting the needle into the subcutaneous tissue. The nurse should not remove the air bubble in the prefilled syringe, aspirate, nor rub the site after injection.

The patient reports tenderness when she touches her leg over a vein. The nurse assesses warmth and a palpable cord in the area. The nurse knows the patient needs treatment to prevent which sequelae? A. Pulmonary embolism B. Pulmonary hypertension C. Post-thrombotic syndrome D. Venous thromboembolism

D. 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 post-thrombotic syndrome are the sequelae of venous thromboembolism.

The coagulation cascade is the third component of the hemostatic process. The other two are: a) Hematopoiesis b) Platelet aggregation c) Vessel spasm d) Agglutination

Vessel spasm Platelet aggregation

The father of a 2-year-old boy recently diagnosed with hemophilia A asks the nurse how to prevent complications for his son. The best response would be: a) "Avoid administering aspirin and nonsteroidal anti-inflammatory drugs." b) "Hemophilia A will no longer be a concern once treated with a blood transfusion." c) "Do not allow the child to play outside or with other children." d) "Small bleeding in the joints is to be expected and can be treated at home."

a) "Avoid administering aspirin and nonsteroidal anti-inflammatory drugs."

The nurse is reviewing hospital discharge instructions with a client who has been diagnosed with secondary thrombocytosis and who also suffers from chronic ulcerative colitis, making anticoagulation inadvisable. The nurse stresses that the client should avoid: Select all that apply. a) Smoking b) Low-fat diet c) Oral contraceptives d) Folate supplements e) Immobilization

a) smoking c) oral contraceptives e) immobilization

A client's chart indicates Virchow's triad. The client is at risk for which complication? a) thrombosis b) venous stasis c) altered blood coagulation d) postphlebitic syndrome

a) thrombosis

A patient is admitted to the ICU with a diagnosis of unstable angina. Which of the following medication(s) might the nurse expect the patient to receive (select all that apply)? a. Aspirin b. Glycoprotein IIb/IIIa inhibitor c. Heparin d. Prophylactic antibiotics

a. Aspirin b. Glycoprotein IIb/IIIa inhibitor c. Heparin Nitroglycerin, morphine, ACE inhibitors, and oxygen may also be given

How does low-dose aspirin therapy impact clot formation? a) Aspirin acts as a clot buster by damaging fibrin strands. b) Aspirin is a platelet aggregation inhibitor. c) Aspirin has a negative effect on the platelet's adhesion abilities. d) Aspirin increases capillary permeability.

b) Aspirin is a platelet aggregation inhibitor.

A 42-year-old male client recently diagnosed with liver cancer is noted as at high risk for bleeding abnormalities. The nurse recognizes this risk as a result of: a) increased amounts of vitamin K being produced in the liver. b) the reduction of clotting factors synthesized in the liver. c) a vitamin C deficiency in the diet. d) weakening of the organ walls as a result of inflammation.

b) the reduction of clotting factors synthesized in the liver.

The parents are ready to take home their child with newly diagnosed hemophilia A. Which teaching aspects should the nurse discuss with them prior to discharge? Select all that apply. a) Aspirin should only be given for severe pain in the joints. b) The signs of an MI related to bleeding in the heart vessels c) Give ibuprofen (an NSAID) if the child runs a fever. d) Keep the child away from contact sports like football and wrestling. e) Administration of factor VIII at home when bleeding occurs

d) Keep the child away from contact sports like football and wrestling e) Administration of factor VIII at home when bleeding occurs

A patient is experiencing heparin overdose. Which medication would the nurse prepare to administer? a) vitamin K b) factor VIII c) antihistamine d) protamine sulfate

d) protamine sulfate The antidote for heparin overdose, protamine sulfate, is indicated. Protamine immediately neutralizes the heparin, and the action lasts about 2 hours. After 2 hours, additional protamine may be indicated, depending on the aPTT levels.

A client refuses to take the 81 mg of aspirin ordered by the physician, stating, "I do not have any pain." The best response by the nurse would be: a) "This dose of aspirin will break apart the blood clot that you have in your leg." b) "The doctor wants you to take the medication to prevent you from experiencing pain." c) "The 81 mg of aspirin daily will help protect you from a stroke or a heart attack." d) "Low-dose aspirin will help prevent you from having increased bleeding after surgery."

c) "The 81 mg of aspirin daily will help protect you from a stroke or a heart attack."

Which medication is known to interfere with the body's ability to control bleeding? Select all that apply. a) Potassium chloride b) Hormone replacement therapies c) Warfarin d) Heparin e) Nonsteroidal anti-inflammatory drugs (NSAIDs)

c) Warfarin d) Heparin e) Nonsteroidal anti-inflammatory drugs (NSAIDs)

The mother of a newborn infant questions why her baby needs a vitamin K injection immediately after birth. The best response by the nurse would be: a) "Infants have a higher body fat content, which prohibits the absorption of vitamin K." b)"It is hospital policy to administer the injection to newborns." c) "The infant was exposed to high levels of heparin upon birth." d) "Infants are not born with the normal intestinal bacteria that synthesize vitamin K for clotting."

d) "Infants are not born with the normal intestinal bacteria that synthesize vitamin K for clotting."

Anticoagulant drugs prevent thromboembolic disorders. How does warfarin, one of the anticoagulant drugs, act on the body? a) Increases vitamin K-dependent factors in the liver b) Increases procoagulation factors- c) Increases prothrombin d) Alters vitamin K, reducing its ability to participate in the coagulation of the blood

d) Alters vitamin K, reducing its ability to participate in the coagulation of the blood

A neonatal nurse is caring for a newborn that has been prescribed an injection of vitamin K to prevent possible bleeding. Lack of which physiologic finding in a newborn makes it necessary for the neonate to be given vitamin K? a) Liver enzymes b) Coagulation factors c) Plasma fibrinogen d) Intestinal bacteria

d) Intestinal bacteria