Pharm Exam 3: Ch. 52 - Anticoagulant, Antiplatelet, Thrombolytic Drugs, Enoxaprin, Warfarin, Aspirin & Clopidogrel, Alteplase Drugs (Key Bank & Elsevier Q's)

The healthcare provider prescribes heparin 2500 units subcutaneous daily. The drug is available in 10,000 units per mL. How may milliliters will the nurse give? (Fill in the blank and record your answer using one decimal place.) __________________________

0.25 mL

The patient's heparin is infusing at 28 mL/hr. The bag of fluid is mixed 20,000 units of heparin in 500 mL D5W. What hourly dose is the patient receiving? (Fill in the blank and record your answer.) _________________________

1120 units/hr

The patient's heparin is infusing at 11 mL/hr. The bag of fluid is mixed 25,000 units of heparin in 250 mL D5W. What hourly dose is the patient receiving? (Fill in the blank and record your answer.) __________________________

1100 units/hr

The healthcare provider prescribes heparin 900 units/hr. The label on the IV bag reads Heparin 10,000 units in 500 mL D5W. How many mL/hr will deliver the correct dose? (Fill in the blank and record your answer.) _________________________

45 mL

Which instruction about clopidogrel [Plavix] should the nurse include in the discharge teaching for a patient who has received a drug-eluting coronary stent? "Constipation is a common side effect of clopidogrel, so take a stool softener daily." "If you see blood in your urine or black stools, stop the clopidogrel immediately." "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." "Keep the amount of food containing vitamin K, such as mayonnaise, canola and soybean oil, and green, leafy vegetables, consistent in your diet."

Correct: "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." Reason: Proton pump inhibitors (PPIs), such as omeprazole [Prilosec], and CYP2C1 inhibitors, such as cimetidine [Tagamet], can be purchased over the counter to treat heartburn. However, patients taking clopidogrel should consult their healthcare provider before using them. PPIs and CYP2C1 inhibitors can reduce the antiplatelet effects of clopidogrel. Diarrhea (5% incidence), not constipation, is a side effect of clopidogrel. Patients should immediately contact their healthcare provider if signs of bleeding occur, such as bloody urine, stool, or emesis. The drug should not be stopped until the prescriber advises it, because this could lead to coronary stent restenosis. Consistency of vitamin K intake is indicated while taking warfarin [Coumadin].

A patient has been receiving heparin while in the hospital to treat deep vein thromboses and will be discharged home with a prescription for enoxaparin [Lovenox]. The nurse provides teaching for the nursing student who asks about the advantages of enoxaparin over heparin. Which statement by the student indicates a need for further teaching? "Enoxaparin does not require coagulation monitoring." "Enoxaparin has greater bioavailability than heparin." "Enoxaparin is more cost-effective than heparin." "Enoxaparin may be given using a fixed dosage.

Correct: "Enoxaparin is more cost effective than heparin." Reason: Low-molecular-weight (LMW) heparins have higher bioavailability and longer half-lives, so routine coagulation monitoring is not necessary and fixed dosing is possible. LMW heparins are more expensive, however, so this statement indicates a need for further teaching.

A patient has been taking warfarin [Coumadin] for atrial fibrillation. The provider has ordered dabigatran etexilate [Pradaxa] to replace the warfarin. The nurse teaches the patient about the change in drug regimen. Which statement by the patient indicates understanding of the teaching? "I may need to adjust the dose of dabigatran after weaning off the warfarin." "I should continue to take the warfarin after beginning the dabigatran until my INR is greater than 3." "I should stop taking the warfarin 3 days before starting the dabigatran." "I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2."

Correct: "I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2." Reason: When switching from warfarin to dabigatran, patients should stop taking the warfarin and begin taking the dabigatran when the INR is less than 2. It is not correct to begin taking the dabigatran before stopping the warfarin. While warfarin is stopped before beginning the dabigatran, the decision to start taking the dabigatran is based on the patient's INR and not on the amount of time that has elapsed.

A patient with nonvalvular atrial fibrillation is to be discharged on dabigatran etexilate [Pradaxa]. Which statement should the nurse include in the discharge teaching? "The medication must be stored in the manufacturer-supplied bottle." "Once a new bottle is opened, the capsules maintain efficacy for 90 days." "If you have difficulty swallowing the capsule, you can open it and mix it with food." "You will need to learn how to give yourself a subcutaneous injection in your abdomen."

Correct: "The medication must be stored in the manufacturer-supplied bottle." Correct Dabigatran is unstable, especially when exposed to moisture, and should be stored in the manufacturer-supplied bottle, which has a desiccant cap. Current labeling of the pill bottle indicates that once the bottle is opened, the pills should be used within 30 days. However, recent evidence indicates that they maintain efficacy for 60 days, provided they have been stored in the original container. Capsules should be swallowed intact, because chewing, crushing, or opening enhances absorption by 75% and increases the risk of bleeding. The medication is administered orally, not subcutaneously.

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? "Heparin has a longer half-life." "Heparin has fewer adverse effects." "The onset of warfarin is delayed." "Warfarin prevents platelet aggregation."

Correct: "The onset of warfarin is delayed." Reason: Warfarin is not useful for treating existing thromboses or for emergencies because the onset of action is delayed. Heparin has a shorter half-life and has more side effects. Warfarin does not prevent platelet aggregation.

A 50-year-old female patient asks a nurse about taking aspirin to prevent heart disease. The patient does not have a history of myocardial infarction. Her cholesterol and blood pressure are normal, and she does not smoke. What will the nurse tell the patient? Aspirin is useful only for preventing a second myocardial infarction. She should ask her provider about using a P2Y12 ADP receptor antagonist. She should take one 81-mg tablet per day to prevent myocardial infarction. There is most likely no protective benefit for patients her age.

Correct: "There is most likely no protective benefit for patients her age." Reason: ASA is used for primary prevention of myocardial infarction (MI) in men and in women older than 65 years. Aspirin for primary prevention may be used in women ages 55 to 79 years when the potential benefit of a reduction in MI outweighs the potential harm of increased GI hemorrhage. This patient has no previous history of MI, so the use of ASA is not indicated. ASA is useful for primary prevention, but only when indicated by cardiovascular risk, based on age, gender, cholesterol levels, blood pressure, and smoking status. A P2Y12 ADP receptor antagonist is used as secondary prevention. This patient should not begin taking ASA unless her risk factors change, or until she is 65 years old.5

The nurse is caring for a group of patients taking warfarin [Coumadin]. Which patients are at moderate to high risk for harm as a result of warfarin therapy? (Select all that apply.) A patient with variant genes that code for VKORC1 and CYP2CP A patient with a current INR of 2.2 treated for deep vein thrombosis A woman with a new onset of symptoms of a pulmonary embolus A patient on day 4 after hip replacement with a new order for warfarin A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen

Correct: 40 mg Reason: 160 lb is 72.72 kg. Body weight of 70 to 79.9 kg is prescribed 40 mg of tenecteplase as a single IV bolus.

The nurse is ready to begin a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved? 50 70 90 110

Correct: 70 Reason: The therapeutic level of heparin is achieved when the aPTT reaches 1.5 to 2 times normal. Thus, a range of 60 to 80 seconds would be appropriate for this patient.

A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. Of which findings should the nurse immediately notify the healthcare provider? (Select all that apply.) aPTT of 65 seconds aPTT of 40 seconds Nosebleeds aPTT of 100 seconds Platelet count of 300,000/mcL

Correct: A patient with variant genes that code for VKORC1 and CYP2CP A woman with a new onset of symptoms of a pulmonary embolus A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen Reason: Patients with genetic alterations in VKORC1 and CYP2CP are at increased risk of warfarin-induced bleeding. An INR of 2.2 indicates a therapeutic warfarin level. Warfarin can cause fetal hemorrhage and is listed as Pregnancy Risk Category X. Warfarin could be prescribed for the prevention of deep vein thrombosis after hip replacement surgery. The day of prescription would not likely be a day to expect a dangerous adverse effect from warfarin, because its half-life is 1.5 to 2 days. Warfarin interacts with many other agents. The greatest risk for harm is when an interacting drug is being added to or deleted from the regimen.

A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this patient? Aspirin, clopidogrel, omeprazole Aspirin, heparin, abciximab [ReoPro] Enoxaparin [Lovenox], prasugrel [Effient], warfarin [Coumadin] Heparin, alteplase, abciximab [ReoPro]

Correct: Aspirin, heparin, abciximab [ReoPro] Reason: Abciximab, combined with ASA and heparin, is approved for IV therapy for patients undergoing PCI.

The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate? Administer intravenous (IV) push protamine sulfate. Continue with the current prescription. Prepare to administer vitamin K. Call the healthcare provider to increase the dose.

Correct: Call the healthcare provider to increase the dose. Reason: An INR in the range of 2 to 3 is considered the level for warfarin therapy. For a level of 1.2, the nurse should contact the healthcare provider to discuss an order for an increased dose.

A patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which finding by the nurse most likely indicates an adverse reaction to this drug? Urticaria, itching, and flushing Blood pressure of 90/50 mm Hg Decreasing level of consciousness Potassium level of 5.5 mEq/L

Correct: Decreasing level of consciousness Reason: The greatest risk with this drug is bleeding, with intracranial bleeding being the greatest concern. A decreasing level of consciousness indicates intracranial bleeding. Alteplase does not cause an allergic reaction or hypotension. Thrombolytic agents, such as alteplase, do not typically cause an elevated potassium level.

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? Heart rate of 60 beats/min Blood pressure of 160/88 mm Hg Discolored urine Inspiratory wheezing

Correct: Discolored urine Reason: 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.

A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication? Aspirin Clopidogrel [Plavix] Enoxaparin [Lovenox] Warfarin [Coumadin]

Correct: Enoxaparin [Lovenox] Reason: Enoxaparin is a low-molecular-weight heparin and is used in situations requiring rapid onset of anticoagulant effects, such as massive DVT. Aspirin, clopidogrel, and warfarin are useful for primary prevention but are not used when rapid anticoagulation is required.

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? Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting factors. Heparin suppresses coagulation by helping antithrombin perform its natural functions. Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot matrix. Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels.

Correct: Heparin suppresses coagulation by helping antithrombin perform its natural functions. Reason: 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.

A patient will begin taking dabigatran etexilate [Pradaxa] to prevent stroke. The nurse will include which statement when teaching this patient? Dabigatran should be taken on an empty stomach to improve absorption. It is important not to crush, chew, or open capsules of dabigatran. The risk of bleeding with dabigatran is less than that with warfarin [Coumadin]. To remember to take dabigatran twice daily, a pill organizer can be useful.

Correct: It is important not to crush, chew, or open capsules of dabigatran. Reason: Patients should be taught to swallow capsules of dabigatran intact; absorption may be increased as much as 75%, increasing the risk of bleeding, if the capsules are crushed, chewed, or opened. Dabigatran may be taken with or without food. The risk of bleeding is not less than that of warfarin. Dabigatran is unstable when exposed to moisture, so using a pill organizer is not recommended.

The nurse knows that which statement is accurate for enoxaparin [Lovenox]? It equally reduces the activity of thrombin and factor Xa. It has selective inhibition of factor Xa and no effect on thrombin. It reduces the activity of factor Xa more than the activity of thrombin. It has a lower bioavailability and shorter half-life than unfractionated heparin.

Correct: It reduces the activity of factor Xa more than the activity of thrombin. Reason: Enoxaparin acts primarily on factor Xa and also, but to a lesser degree, on thrombin. Unfractionated heparin equally reduces the action of thrombin and factor Xa. Fondaparinux [Arixtra] causes selective inhibition of factor Xa. Low-molecular-weight (LMW) heparins, such as enoxaparin, have greater bioavailability and a longer half-life than unfractionated heparin.

A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. What medication would be appropriate for this patient who has a history of heparin-induced thrombocytopenia (HIT)? Warfarin [Coumadin] Lepirudin [Refludan] Bivalirudin [Angiomax] Eptifibatide [Integrilin]

Correct: Lepirudin [Refludan] Reason: Lepirudin [Refludan] and argatroban are indicated for the treatment of thrombosis in patients with a history of HIT. Because these medications are given as an initial IV bolus followed by a continuous infusion, the desired effect of direct thrombin inhibition is achieved more quickly. Because of warfarin's delayed onset of effects, it is not useful in emergency situations, such as pulmonary embolism (PE). Intravenous bivalirudin given in combination with aspirin helps prevent clot formation in patients undergoing coronary angioplasty. Eptifibatide [Integrilin], a glycoprotein IIb/IIIa receptor inhibitor, is an antiplatelet drug that is used short term to prevent ischemic events in patients who have acute coronary syndrome or who are undergoing percutaneous coronary intervention.

The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate? Notify the healthcare provider to discuss the reduction or withdrawal of heparin. Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level. Obtain vitamin K and prepare to administer it by intramuscular (IM) injection. Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated.

Correct: Notify the healthcare provider to discuss the reduction or withdrawal of heparin. Reason: Heparin-induced thrombocytopenia (HIT) is a potential immune-mediated adverse effect of heparin infusions that can prove fatal. HIT is suspected when the platelet counts fall significantly. A platelet count below 100,000/mm3 would warrant discontinuation of the heparin.

The nurse is caring for a patient receiving clopidogrel [Plavix] to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel? Aspirin [Bayer] Omeprazole [Prilosec] Acetaminophen [Tylenol] Warfarin [Coumadin]

Correct: Omeprazole [Prilosec] Reason: Omeprazole and other proton pump inhibitors may reduce the antiplatelet effects of clopidogrel. Patients sometimes take them to reduce gastric acidity and the risk of gastrointestinal (GI) bleeding.

A patient is receiving continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor? (Select all that apply.) Platelets Vitamin K Prothrombin time (PT) International normalized ratio (INR) Activated partial thromboplastin time (aPTT)

Correct: Platelets Activated partial thromboplastin time (aPTT) Reason: 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.

Fondaparinux [Arixtra] is not approved for use in which circumstance? Prevention of deep vein thrombosis (DVT) after knee replacement Treatment of acute pulmonary embolism (PE) (in conjunction with warfarin) Prevention of deep vein thrombosis (DVT) after abdominal surgery Prevention of ischemic complications in patients with unstable angina

Correct: Prevention of ischemic complications in patients with unstable angina Reason: Enoxaparin [Lovenox], not Arixtra, is approved for use in preventing ischemic complications in patients with unstable angina, non-Q-wave myocardial infarction (MI), and ST-segment elevation myocardial infarction (STEMI). Arixtra is approved for (1) preventing DVT after hip surgery, knee replacement, and abdominal surgery and (2) treating acute PE and acute DVT in conjunction with warfarin.

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: vitamin K (phytonadione). protamine sulfate. a PTT. a PT and an INR.

Correct: a PT and an INR Reason: 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.

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.) Wear a medical alert bracelet. Check all urine and stool for discoloration. Do not start any new medication without first talking to your healthcare provider. Enteric-coated aspirin and any aspirin products can be used unless they cause a gastrointestinal ulcer. No laboratory or home monitoring of international normalized ratio (INR) is required after the first 6 months.

Correct: aPTT of 40 seconds Nosebleeds aPTT of 100 seconds Reason: Measurement of the aPTT is essential to determine whether the heparin infusion is having the desired effect. If the normal value of the aPTT is 40 seconds, the goal is to achieve a therapeutic range of a factor of 1.5 to 2 (60 to 80 seconds). Because 40 seconds is too short (increases the risk for clotting) and 100 seconds is too long (increases the risk for bleeding), the physician requires notification for adjustment of the infusion rate. Evidence of bleeding, such as nosebleeds, hematuria, and red or tarry stools, warrant a call to the physician. An aPTT of 65 seconds indicates that a therapeutic effect has been achieved, and a platelet count of 300,000/mcL is within normal limits, indicating no evidence of thrombocytopenia. Awarded 0.0 points out of 3.0 possible points.

A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the patient's INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider and: administer the dose as ordered. request an order to decrease the dose. request an order to give vitamin K (phytonadione). request an order to increase the dose.

Correct: administer the dose as ordered Reason: This patient has an INR in the appropriate range, which is 2 to 3 for most patients and 2.5 to 3.5 for some, so no change in warfarin dosing is necessary. It is not correct to request an order to either decrease or increase the dose of warfarin. It is not necessary to give vitamin K, which is an antidote for warfarin toxicity.

The nurse has just received an order for tenecteplase [TNKase] for a patient experiencing an acute myocardial infarction. The nurse should administer this drug: by bolus injection. by infusion pump over 24 hours. slowly over 90 minutes. via monitored, prolonged infusion.

Correct: by bolus injection Reason: Tenecteplase [TNKase] is given by bolus injection. Tissue plasminogen activator (tPA) must be infused over 90 minutes. Because tenecteplase [TNKase] is given by bolus injection, an infusion pump is not required. Although the patient should be monitored, tenecteplase [TNKase] does not require a prolonged infusion time.

A patient who is taking clopidogrel [Plavix] calls the nurse to report black, tarry stools and coffee-ground emesis. The nurse will tell the patient to: ask the provider about using aspirin instead of clopidogrel. consume a diet high in vitamin K. continue taking the clopidogrel until talking to the provider. stop taking the clopidogrel immediately.

Correct: continue taking the clopidogrel until talking to the provider. Reason: Patients who experience bleeding should be warned not to stop taking the clopidogrel until the prescriber says they should, since abrupt withdrawal may precipitate a thrombotic event. Taking aspirin with an active GI bleed is contraindicated. Warfarin is a vitamin K inhibitor; consuming extra vitamin K will not reverse the effects of clopidogrel.

A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats per minute and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color. A stat CBC shows a platelet count of less than 100,000 mm3 . The nurse will: administer oxygen and notify the provider. discontinue the heparin and notify the provider. request an order for protamine sulfate. request an order for vitamin K (phytonadione).

Correct: discontinue the heparin and notify the provider. Reason: This patient is showing signs of heparin-induced thrombocytopenia, so the heparin should be discontinued immediately and the provider should be notified. The purplish color of the fingertips is caused by thrombosis, not hypoxia, so oxygen is not indicated. This patient may need continued anticoagulation therapy, so a request for protamine sulfate is not correct. Heparin is not a vitamin K inhibitor.

A patient is admitted to the emergency department with chest pain. An electrocardiogram shows changes consistent with an evolving myocardial infarction. The patient's cardiac enzymes are pending. The nurse caring for this patient will expect to: administer aspirin when cardiac enzymes are completed. give alteplase [Activase] within 2 hours. give tenecteplase [TNKase] immediately. obtain an order for an INR.

Correct: give alteplase [Activase] within 2 hours. Reason: When alteplase is given within 2 hours after symptom onset, the death rate for MI has been shown to be 5.4%, compared with 9.4% if given 4 to 6 hours after symptom onset. ASA may be given at the first sign of MI; it is not necessary to wait for cardiac enzyme results. Tenecteplase may be given more than 2 hours after onset of symptoms. Obtaining an order for an INR is not indicated.

A patient who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The nurse will anticipate an order to: decrease the dose of carbamazepine. increase the dose of warfarin. perform more frequent aPTT monitoring. provide extra dietary vitamin K

Correct: increase the dose of warfarin Reason: Carbamazepine is a powerful inducer of hepatic drug-metabolizing enzymes and can accelerate warfarin degradation. The warfarin dose should be increased if the patient begins taking carbamazepine. Decreasing the dose of carbamazepine is not indicated. It is not necessary to perform more frequent aPTT monitoring or to add extra vitamin K.

A postoperative patient will begin anticoagulant therapy with rivaroxaban [Xarelto] after knee replacement surgery. The nurse performs a history and learns that the patient is taking erythromycin. The patient's creatinine clearance is 50 mL/min. The nurse will: administer the first dose of rivaroxaban as ordered. notify the provider to discuss changing the patient's antibiotic. request an order for a different anticoagulant medication. request an order to increase the dose of rivaroxaban.

Correct: notify the provider to discuss changing the patient's antibiotic Reason: Patients with impaired renal function who are taking macrolide antibiotics will experience increased levels of rivaroxaban, increasing the risk of bleeding. It is correct to discuss using a different antibiotic if possible. The nurse should not administer the dose without discussing the situation with the provider. The patient's renal impairment is minor; if it were more severe, using a different anticoagulant might be appropriate. It is not correct to increase the dose of rivaroxaban.

A patient who is taking warfarin [Coumadin] has just vomited blood. The nurse notifies the provider, who orders lab work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer: phytonadione (vitamin K1) 1 mg IV over 1 hour. phytonadione (vitamin K1) 2.5 mg PO. protamine sulfate 20 mg PO. protamine sulfate 20 mg slow IV push.

Correct: phytonadione (vitamin K1) 1 mg IV over 1 hour. Reason: Vitamin K1 is given for warfarin overdose and may be given IV in an emergency. To reduce the incidence of an anaphylactoid reaction, it should be infused slowly. In a nonemergency situation, it would be appropriate to give vitamin K1 orally. Protamine sulfate is used for heparin overdose.

A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats per minute. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The nurse will request an order for: a repeat aPTT to be drawn immediately. analgesic medication. changing heparin to aspirin. protamine sulfate.

Correct: protamine suflate Reason: Heparin overdose may cause hemorrhage, which can be characterized by low blood pressure, tachycardia, and lumbar pain. Protamine sulfate should be given, and the heparin should be discontinued. An aPTT may be drawn later to monitor the effectiveness of protamine sulfate. Analgesics are not indicated because the lumbar pain is likely caused by adrenal hemorrhage. Aspirin will only increase the risk of hemorrhage.

A patient who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the second postoperative day, the nurse assesses the patient and notes an oxygen saturation of 83%, pleuritic chest pain, shortness of breath, and hemoptysis. The nurse will contact the provider to report possible ____ and request an order for ____. congestive heart failure; furosemide [Lasix] hemorrhage; vitamin K (phytonadione) myocardial infarction; tissue plasminogen activator (tPA) pulmonary embolism; heparin

Correct: pulmonary embolism; heparin7 Reason: This patient is exhibiting signs of pulmonary embolism. Heparin is used when rapid onset of anticoagulants is needed, as with pulmonary embolism. The patient would have respiratory cracks and a cough with congestive heart failure. Hemorrhage involves a decrease in blood pressure, bruising, and lumbar pain. The patient has pleuritic pain, which is not consistent with the chest pain of a myocardial infarction.

Which needle length and gauge should the nurse choose to administer subcutaneous heparin? ½ inch; 20 gauge ⅝ inch; 25 gauge 1½ inch; 18 gauge 1 inch; 26 gauge

Correct: ⅝ inch; 25 gauge Reason: Heparin should be administered subcutaneously into the fatty layer of the abdomen with a ½- to ⅝-inch needle, 25 or 26 gauge. The only appropriate option for injection in the list shown is the ⅝-inch, 25-gauge needle.