PrepU Chapter 9: Drug Therapy for Coagulation Disorders
Which would a nurse identify as inhibiting factor Xa?
Fondaparinux
A patient is receiving heparin by continuous IV infusion. What interventions should the nurse perform for the patient?
Perform blood coagulation tests every four hours.
A male client is receiving heparin by continuous intravenous infusion. The nurse will instruct the client and family members to report what should it occur?
Presence of blood in urine or stools
The nurse is caring for a postoperative client receiving dalteparin prophylactically to prevent deep vein thrombosis. The nurse should perform which ongoing assessment(s) for safe administration of the drug? Select all that apply.
Presence of dark tarry stools, or melena Presence of pain, edema, redness in leg Nasogastric drainage for presence of blood
The health care provider discovers a clot in the client's left lower leg. Anticoagulant drugs are prescribed to prevent formation of new clots and to achieve which other effect?
Prevent extension of clots already present
The pharmacology instructor is discussing heparin with the students. How would the instructor explain the action of heparin?
Promotes the inactivation of clotting factors
A client exhibits signs and symptoms of heparin overdose. The nurse would anticipate administering:
Protamine sulfate
A nurse is caring for a 64-year-old female client who is receiving IV heparin and reports bleeding from her gums. The nurse checks the client's laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which drug may be ordered?
Protamine sulfate
The nursing instructor is talking about anticoagulant therapy. The instructor explains that when administering warfarin (Coumadin) to a client with deep vein thrombophlebitis, the nurse monitors the PTT, PT, INR, and hematocrit. Which laboratory value would the instructor say indicates warfarin is at therapeutic levels?
Prothrombin time (PT) 1.2 to 1.5 times the control
The nurse is caring for a client who is going home on warfarin. What lab test(s) will the client require to evaluate therapeutic effects of the drug?
Prothrombin time (PT) and international normalized ration (INR)
Antiplatelet agents decrease the formation of the platelet plug by decreasing the responsiveness of the platelets to stimuli that would cause them to stick and aggregate on a vessel wall. The nurse knows that which drug is an antiplatelet agent? (Select all that apply.)
ReoPro Ticlopidine
A client has presented to the emergency department with a new onset of unilateral weakness and visual disturbances. The care team suspects that the client has had a cerebrovascular accident and the administration of alteplase is being considered. What is the care priority prior to administering alteplase?
Ruling out a hemorrhagic stroke
The FDA has issued a black box warning for the use of protamine sulfate due to the risk of which conditions? (Select all that apply.)
Severe hypotension Cardiovascular collapse Pulmonary vasodilation
A client is to receive enoxaparin. The nurse would administer this drug by which route?
Subcutaneous injection
A client with acute coronary syndrome is prescribed clopidogrel. Which additional medication will the nurse expect to be prescribed for this client?
aspirin
By what means does warfarin achieve the desired anticoagulant effects?
preventing synthesis of clotting factors in the liver
The client is learning to self-administer heparin daily. The home care nurse draws blood every 2 to 3 days to monitor the client's platelet levels. What platelet count would the nurse report to the health care provider as a critical laboratory result?
90,000
A nurse is preparing to discharge a client who has been prescribed warfarin. While assessing the client's knowledge of the drug, what statement should the nurse address?
"I take aspirin to help with the pain of my arthritis."
The nurse instructs a client with a history of atrial fibrillation on warfarin. Which client statement indicates that teaching about the medication has been effective?
"I will avoid walking barefoot in the house and outdoors."
The nurse determines that teaching about warfarin is successful when the client makes what statement?
"I will check with my provider before taking any herbal supplements."
The nurse educates a client diagnosed with atrial fibrillation about the prescribed warfarin. Which client statements establish the need for further clarification?
"I will stop eating green leafy vegetables, broccoli, yogurt, or cheese."
A client recovering from joint replacement surgery is prescribed subcutaneous heparin injections. Which response will the nurse make when the client asks if the medication can be taken orally?
"The gastrointestinal tract does not absorb the drug, so it cannot be given by mouth."
An older client has been prescribed an anticoagulant. What statement made by the client assures the nurse that the discharge information was understood correctly? (Select all that apply.)
"They may need to increase the dosage of this medication." "It's really important that I have my blood tested on a regular basis." "Starting or stopping any of my other medications could cause me to bleed."
Which client statement demonstrates an accurate understanding of the action of a prescribed anticoagulant?
"This medication will keep unnecessary clots from forming in my blood."
A client receiving heparin has a baseline aPTT of 28 seconds. Which result would the nurse interpret as suggesting too much heparin?
98 seconds
A client receives subcutaneous heparin at 8 am and is scheduled for the next dose at 8 pm. The nurse would expect to obtain a specimen for an aPTT test at which time?
1400
A nurse will use extreme caution when administering heparin to which patient?
A 38-year-old male with peptic ulcer disease
Heparin therapy is prescribed to a client with deep vein thrombosis. Which client would be at greatest risk of bleeding from this therapy?
A 45-year-old corporate executive with peptic ulcer disease
A client is receiving anticoagulant therapy and has an INR done. Which result would the nurse interpret as being therapeutic?
2.4
When administering tirofiban, the nurse would administer the drug intravenously over which time frame?
30 minutes
The nurse is reviewing the coagulation studies of a client who is receiving a heparin infusion. The client's baseline partial thromboplastin time is 32 seconds. Which result would indicate therapeutic effectiveness?
64 seconds
The nurse is caring for a client with a fever and severe diarrhea in addition to thrombophlebitis. How will this client's condition impact the clotting process?
Activation of plasminogen
A hospital patient in a critical care setting is currently receiving an intravenous infusion of aminocaproic acid. What desired outcome is paramount in the care of this patient?
Adequate tissue perfusion will be maintained
A female client is admitted to the hospital for treatment of a pulmonary embolism. Forty-eight hours after therapy has started, the client reports bleeding from her gums when she brushes her teeth. What orders can the nurse anticipate receiving from the health care provider to reverse the effects of the heparin?
Administer protamine sulfate, at a dosage of 1 mg per 100 units of heparin, for a maximum dose of 100 mg.
The nurse is working in the Emergency Department (ED) of a small rural hospital. A 54-year-old man arrives in your ED and it is determined that he is having an acute myocardial infarction. Before transferring the client to a larger facility that has a heart catheterization laboratory, what drug will the nurse administer?
Alteplase
After teaching a group of students about antiplatelet agents, the instructor determines that the teaching was successful when the students identify which drug as blocking the production of platelets in the bone marrow?
Anagrelide
A client prescribed an anticoagulant demonstrates an understanding of their condition by implementing which interventions to manage an episode of bleeding? Select all that apply.
Apply firm, constant pressure to the bleeding site. Notify a health care provider immediately.
The nurse is teaching a client and caregiver about the warfarin that has been prescribed to continue at home. The nurse determines the teaching session is successful when the client and caregiver correctly choose which instruction(s) to follow? Select all that apply.
Be consistent with your intake of foods containing vitamin K. Do not change brands of warfarin without consulting the health care provider. Take the drug at the same time every evening. Do not take or stop taking other medications except on the advice of the health care provider.
A 60-year-old client experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The client has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect?
By inactivating clotting factors and thus stopping the coagulation cascade
A nurse is preparing to administer an antiplatelet drug. Which medication would the nurse likely administer?
Clopidogrel
An older adult client with a history of mild renal failure has experienced two different transient ischemic attacks (TIAs) and has been prescribed clopidogrel therapy. What statement should be the basis of the nurse's response when asked why aspirin (ASA) wasn't prescribed as the drug of choice?
Clopidogrel is believed to be more effective than aspirin in treating TIAs.
The nurse would anticipate administering fondaparinux to a client with which condition?
DVT prophylaxis
When the nurse administers warfarin, it is expected that the drug will have what effect on the body?
Decrease in production of vitamin K-dependent clotting factors
A patient is prescribed warfarin to prevent the formation and extension of thrombus. The patient also takes a diuretic for the treatment of cardiac problems. What effect of interaction between the two drugs should the nurse monitor in the patient?
Decreased effectiveness of the anticoagulant
The client is prescribed a thrombolytic agent. The nurse understands that the purpose of this order may be to achieve which effects? (Select all that apply.)
Dissolve thrombi Limit tissue damage Reestablish blood flow
The client is prescribed warfarin. His INR is 5.2. At what level is this dose?
Elevated
A client is admitted to the hospital with deep vein thrombosis. An infusion of heparin is established. What action best protects the client's safety?
Ensure that protamine sulfate is readily available
There are two pathways that can be activated by the coagulation process. One pathway begins when factor XII is activated. The other pathway begins when there is trauma to a blood vessel. What are these pathways?
Extrinsic and intrinsic pathways
A client taking an anticoagulant drug tells the nurse she is having bleeding in the gums and teeth. When reviewing client history, the client states she has decided to try an herbal remedy. Which of the following is most likely the cause of increased bleeding?
Ginger
A nurse is caring for a patient prescribed warfarin. Which of the following foods should the nurse inform the patient as having high vitamin K content?
Green leafy vegetables
While preparing a client for discharge, the nurse is teaching the client about the proper use of warfarin. Which food should the nurse tell the client to avoid consuming in excess?
Green leafy vegetables
The nurse is caring for a postpartum client admitted to the intensive care unit with a diagnosis of disseminated intravascular coagulation (DIC). What is the drug of choice to treat this problem?
Heparin
The nurse is preparing to administer protamine emergently to a client per instructions from the health care provider. The nurse concludes this is necessary due to an adverse reaction to which drug?
Heparin
An instructor describes the action of some anticoagulants as blocking the formation of thrombin from prothrombin. Which drugs would the instructor use as examples for this action? (Select all that apply.)
Heparin Argatroban Bivalirudin
Protamine is used to treat overdose of which medications? (Select all that apply.)
Heparin Enoxaparin (Lovenox)
A female client is started on warfarin therapy. The client asks the nurse why she is no longer on heparin therapy. What differentiates heparin from warfarin?
Heparin is administered parenterally, while warfarin is administered orally.
A client is receiving subcutaneous heparin 5,000 units every 8 hours. An activated thromboplastin time (aPTT) is drawn 1 hour before the 8:00 AM dose; the aPTT is at 3.5 times the control value. What is the nurse's priority action?
Hold the dose and call the result to the prescriber.
A 59-year-old client with vascular disorders is prescribed cilostazol. The nurse instructs the client that it is for the treatment of what condition?
Intermittent claudication
A client is to receive abciximab. The nurse would expect to administer the drug by which route?
Intravenous
The primary health care provider orders a 300-mg dose of clopidogrel for a client. The client then is to receive 75 mg/day. The nurse interprets the 300-mg dose to be which type of dose?
Loading dose
The black box warning associated with warfarin concerns its risk of causing what condition?
Major or fatal bleeding
A 75-year-old client presents to the health care provider's office with bleeding gums and multiple bruises. When the nurse reviews the client's drug history, the nurse finds that the client is prescribed aspirin 81 mg/d. What drug may cause increased bleeding when used in conjunction with the aspirin?
NSAIDs
A client is receiving warfarin. The nurse would expect to administer this drug by which route?
Oral
A client is to receive clopidogrel. The nurse would expect to administer this agent by which route?
Oral
What values are used to monitor the effectiveness of warfarin therapy?
PT and INR
A client is receiving heparin. Which would the nurse use to monitor the effects of the drug?
Partial thromboplastin time
A client is being sent home with subcutaneous heparin after a total hip replacement. The nurse understands what symptom would indicate a serious drug reaction?
Tarry stools
A stable daily dose of warfarin is reached when which parameter is achieved?
The PT and INR are within their therapeutic ranges, and the dose does not cause bleeding.
The client is diagnosed with hepatitis A, diabetes type 1, and portal hypertension. The client develops a DVT, and the health care provider prescribes warfarin. The nurse is concerned for what reason?
The client is more likely to experience bleeding.
Which would the nurse identify as the end of the intrinsic pathway?
Thrombin formation
When describing the clotting process, which step would the nurse identify as the first reaction to occur with injury to a blood vessel?
Vasosconstriction
A 73-year-old client receiving warfarin (Coumadin) has blood in the urinary drainage bag this morning. After reporting these observations to the health care provider, the nurse will expect to administer what substance?
Vitamin K
A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the client's:
aPTT.
To compensate for clopidogrel's slow onset of action, the nurse should anticipate implementing which intervention?
administering a one-time loading dose that is higher than the maintenance dose
A 70-year-old resident of a long-term care facility has experienced increasing pain, swelling, and redness to her lower leg over the past 12 hours, prompting the care providers at the facility to have the woman brought to the local emergency department. Diagnostic testing has confirmed deep vein thrombosis (DVT) and an IV infusion of alteplase (Activase) has been initiated. Unlike anticoagulants, a thrombolytic such as alteplase can
break down existing clots.
A client with pneumonia develops deep vein thrombosis and is prescribed intravenous heparin. When reviewing the client's current medications, the nurse will alert the health care provider to what drug that could increase the effectiveness of the heparin?
cephalosporin
The provider orders heparin for a 35-year-old female client. The nurse administers the drug only after confirming that the client:
does not have peptic ulcer disease.
A client is prescribed warfarin. Before administering the drug, the nurse checks the client's history for use of herbal remedies. Which herbal remedy if used by the client would present a problem? Select all that apply.
garlic chamomile gingko biloba feverfew green tea
A postsurgical client possesses numerous risk factors for venous thromboembolism, including a previous deep vein thrombosis. What drug would the nurse anticipate administering while this client recovers in the hospital?
heparin
The nurse is caring for a 76-year-old client who is receiving IV heparin 5000 units q4h. At the initiation of therapy, the client's control activated thromboplastin time (aPTT) was found to be 35 seconds. One hour prior to the next scheduled dose, aPTT is determined to be 92 seconds. Based on this result, the nurse will:
hold the dose and contact the provider.
A client accidentally ingested extra doses of warfarin at home and now presents with an elevated INR and bleeding. Which medication will the nurse prepare as prescribed to administer along with vitamin K?
prothrombin complex concentrate
The nurse explains to a client that angina can be caused by a thrombus forming in which anatomical location?
the heart
To monitor possible intermittent claudication, the nurse will assess for a thrombus lodging in what specific location?
the legs
An older adult client has been admitted to the emergency department with severe chest pain. Onset of symptoms is within the last 60 minutes. What medication would the nurse expect the health care provider to prescribe for this acute disorder?
thrombolytic drugs
