Study Guide- Pharm. Ch. 38

Which of the following should the nurse include in the teaching plan for a patient receiving subcutaneous heparin? Select all that apply. 1. Inject medication in the deep fatty layer of the abdomen 2. When brushing your teeth, use a soft toothbrush. 3. Hold direct pressure on any puncture sites for 15 mins. 4. Use dental floss daily after brushing 5. Take a daily aspirin tablet tablet, 325 mg, to prevent inflammation at the injection site.

1,2,3 Rationale: The patient should be taught proper injection technique, including the need to inject the heparin into subcutaneous fat layer. A soft toothbrush should be used for oral hygiene. Puncture wounds or cuts will require long than normal pressure held at the site to stop bleeding- 15 mins. or longer. Avoid flossing when using anticoagulant. Aspirin has anti platelet effects and concurrent use may increase the risk for bleeding or hemorrhage

A patient will be receiving dabigatram (Pradaxa). Which of the following is true concerning this drug therapy? Select all that apply. 1. Ginger, garlic, and green tea may increase the risk of bleeding 2. Vit. B12 is used to augment this drug's response 3. Pradaxa is used for DVT 4. Activated partial thromboplatin time may be monitored to determine effectiveness. 5. This drug is contraindicated for patients with gastritis

1,3,4,5

The nurse is addressing a group of clients who have experienced thromboembolic disorders. One of the clients states, "My dad had a problem with clotting too much and so does my brother." Before responding to this comment, the nurse considers which information? 1. A genetic deficiency of protein C can produce hypercoagulability. 2. Familial eating habits can result in deficiency of vitamin C that would increase clotting. 3. Genetic deficiency of C peptide is implicated in clotting disorders. 4. If there is a genetic tendency to decreased C reactive protein (CRP) the clotting cascade is enhanced.

1. A genetic deficiency of protein C can produce hypercoagulability. Global Rationale: Protein C is a natural anticoagulant. Too little would cause increased clotting. Vitamin C is not involved in clotting. C peptide is created in the process of insulin synthesis and is not associated with clotting. Deficiency of the inflammatory protein CRP would not cause increased clotting.

A patient who is taking clopidogrel (Plavix), to prevent another stroke asks the nurse how the medication works. The nurse response should be based on an understanding that Plavix: 1. Inhibits platelet aggregation to prevent clot formation 2. Activates antithrombin III and subsequently inhibits thrombin. 3. Inhibits enzymes involved in the formation of Vit. K 4. Converts plasminogen to plasmin to dissolve fibrin clots.

1. Inhibits platelet aggregation to prevent clot formation

A patient who is taking warfarin (Cuomadin) states, "I wake up every morning with arthritis pain and I always take aspirin or ibuprofen." The nurse's response would be based on which physiologic concepts? 1. aspirin and ibuprofen (Motrin) will counteract the therapeutic effects of many anticoagulants. 2. Anticogulants will reduce the half-life of drugs such as apirin and ibuprofen. 3. many substances such as aspirin and ibuprofen will increase the risk for bleeding 4. The combination of aspirin products with anticoagulants will worsen arthritis pain.

3.

Assessment for deep vein thrombosis (DVT) is a priority for which client? 1. A client with a gastric ulcer 2. A client with hypertension 3. A client recovering from a knee replacement 4. A client with pneumonia

3. A client recovering from a knee replacement Global Rationale: Surgery of the lower extremities, especially knee and hip replacements, are common causes of DVT. A gastric ulcer does not increase the risk of DVT. Hypertension does not significantly increase a client's risk of DVT. Pneumonia is not a risk factor for the development of DVT.

A nurse assessing a client on a heparin drip notes bloody drainage in the nasogastric tube and indwelling urinary catheter. A stat partial thromboplastin time (PTT) is drawn according to heparin protocol. The result is 224 seconds. Which action by the nurse is the most appropriate? 1. Notify the health care provider and prepare to administer protamine sulfate. 2. Stop the infusion, increase the IV rate, and prepare to administer aminocaproic acid (Amicar). 3. Notify the supervisor and obtain a unit of clotting factors. 4. Call the health care provider and prepare to administer vitamin K.

Correct Answer 1 Global Rationale: Bleeding accompanied by a PTT of 224 indicates dangerously high overheparinization. Notification of the health care provider is essential. Protamine sulfate is administered to neutralize the anticoagulant activity of heparin. Amicar is indicated for bleeding from conditions such as aplastic anemia, hepatic cirrhosis, postoperative cardiac surgery, and in certain cancers. It is not given if the client has urinary tract bleeding. Clotting factors and vitamin K would not immediately lower the elevated PTT, and would not stop the bleeding the client is experiencing.

The baseline international normalized ratio (INR) of a client started on warfarin (Coumadin) for atrial fibrillation was 1.2. The nurse notes that the INR value is 2.5 prior to administration of the next dose of medication. Which action by the nurse is the most appropriate? 1. Administer the antidote and observe for bleeding. 2. Notify the health care provider so that the dose can be increased. 3. Administer the medication as ordered. 4. Hold medication and contact the health care provider.

Correct Answer 3 Global Rationale: INR values averaging 2.5 are considered therapeutic for most indications. The INR is in the therapeutic range, and the warfarin does not need to be increased

As the nurse is completing the physical assessment of a client receiving heparin therapy for deep vein thrombosis (DVT), the client complains of severe lumbar pain. Which is the nurse's priority action? 1. Evaluate further because this could indicate a complication of drug therapy. 2. Reposition the client to promote comfort. 3. Administer pain medication. 4. Document the finding and report it to the next shift.

Correct Answer: 1 Global Rationale: A major side effect of heparin is bleeding. Lumbar pain and unilateral abdominal wall bulges or swelling could indicate retroperitoneal hemorrhage. Only providing comfort measures is not appropriate. Administering pain medication might be appropriate, but it is not the priority action. Documenting and reporting the pain to the next shift could allow any adverse effects to worsen.

The nurse is providing care for a client who developed heparin-induced thrombocytopenia (HIT) during heparin therapy. The nurse is aware that lepirudin (Refludan) is often given to clients with this condition. Which assessment findings should the nurse report to the medical team? Standard Text: Select all that apply. 1. The most recent aPTT is 2.8. 2. The client's last stool tested positive for blood. 3. The client is allergic to eggs. 4. The client's spleen was removed after a motor vehicle accident 3 years ago. 5. The client drinks 5-6 cups of coffee daily.

Correct Answer: 1,2 Rationale 1: Lepirudin is contraindicated if the aPTT is above 2.5. Rationale 2: Lepirudin is contraindicated in clients who are actively bleeding. Rationale 3: There is no contraindication to the use of lepirudin in clients with egg allergy. Rationale 4: A surgery 3 years ago is not a contraindication to the use of lepirudin, nor is absence

The nurse is planning care for a client prescribed enoxaparin (Lovenox). Which interventions should be included? 1. Teach the client or family to give subcutaneous injections at home. 2. Monitor for development of deep vein thrombosis. 3. Monitor multiple lab tests. 4. Teach the client signs of excessive bleeding. 5. Schedule administration times right before breakfast and the evening meal.

Correct Answer: 1,2,4 Global Rationale: Family and clients can be taught to give subcutaneous injections at home. Lovenox is used to prevent DVTs. The nurse should observe for the development of DVTs. Although Lovenox is more predictable than are other anticoagulants and has fewer adverse effects, bleeding is still a possibility. Lovenox is a low-molecular-weight heparin (LMWH), and does not require multiple lab tests. Lovenox is generally administered once daily, and administration time is not tied to mealtimes.

A clinic nurse is developing a teaching handout for clients who are prescribed warfarin (Coumadin) therapy. Which statements should be included in this information? Select all that apply. 1. "Tell your dentist you are taking warfarin prior to any procedures." 2. "Report to the lab for testing of activated partial thromboplastin time (APTT)." 3. "Avoid strenuous activities." 4. "Place ice at the injection site if stinging or burning occurs." 5. "Take nonsteroidal anti-inflammatories (NSAIDs) for minor pain relief."

Correct Answer: 1,3 Rationale 1: Warfarin increases the risk of bleeding from dental procedures. Rationale 2: APTT is not used to monitor warfarin. Rationale 3: Strenuous or risky activities place the client at risk for injury and bleeding. Rationale 4: Warfarin is not administered by injection. Rationale 5: NSAIDs can cause bleeding if taken concurrently with warfarin.

During health history assessment, an adult client says, "I've been told I have some sort of bleeding disorder, but I'm not certain." Which responses by the nurse are the most appropriate? Standard Text: Select all that apply. 1. "Did the health care provider mention von Willebrand disease?" 2. "None of the inherited bleeding disorders affect women." 3. "Is there a history of bleeding disorders in your family?" 4. "Have you ever experienced excessive bleeding or easy bruising?" 5. "If you had a true bleeding disorder you would have had symptoms earlier in your life."

Correct Answer: 1,3,4 Rationale 1: Von Willebrand disease is the most common inherited coagulation disorder. Rationale 2: Von Willebrand disease affects males and females equally. Rationale 3: Many bleeding disorders are inherited. Rationale 4: Excessive bleeding and easy bruising are signs of bleeding disorders. Rationale 5: Von Willebrand disease has both mild and severe forms. Symptoms may have been so mild as to be unnoticed by the client.

The nurse is monitoring for the development of thrombocytopenia in a client receiving heparin therapy. The nurse determines that thrombocytopenia has occurred when the platelet count drops below ______ mm3.

Correct Answer: 150,000 Rationale: Thrombocytopenia occurs when the platelet count falls below 150,000mm3.

A client's intravenous heparin drip rate will be increased at 1400. The nurse plans to draw an activated partial thromboplastin time (aPTT) at which time? 1. Immediately after increasing the rate 2. At 2000 3. At 1530 4. At 0800 the next morning

Correct Answer: 2 Global Rationale: The most accurate representation of aPTT from the new rate will occur at least 6 hours after a rate increase. If drawn immediately, the aPTT will reflect the level from the lower dosage. At 1530, the aPTT will reflect a mix of the old rate and the new rate. Waiting until 0800 the next morning is dangerous because the heparin dose may be too high.

Which class of drugs would the nurse expect to be prescribed to a client who is bleeding excessively at a surgical site? 1. Thrombolytics 2. Antifibrinolytics 3. Anticoagulants 4. Prothrombin activators

Correct Answer: 2 Rationale 1: Thombolytic drugs enhance the dissolving of clots. Rationale 2: Antifibrinolytic drugs inhibit normal removal of fibrin, resulting in a clot that remains intact longer. Rationale 3: Anticoagulants inhibit the clotting cascade, preventing clot formation. Rationale 4: Prothrombin activators are natural substances. There are currently no drugs based on this mechanism.

A client has been taking oral anticoagulant therapy for a number of years secondary to atrial fibrillation. Which client statement alerts the nurse to assess more closely for the development of drug-induced hepatitis Standard Text: Select all that apply. 1. "I seem to be making more urine that normal." 2. "My stools are a funny light yellow color." 3. "I need an ointment to keep my skin from itching so much." 4. "My legs hurt when I walk very far." 5. "I seem to be very thirsty most of the time."

Correct Answer: 2,3 Rationale 1: Increased urine output is not associated with drug-induced hepatitis. Rationale 2: Clay-colored stools are indicative of liver changes. Rationale 3: Itchy skin can be associated with hepatitis. Rationale 4: Intermittent claudication is not associated with hepatitis. Rationale 5: Increased thirst is not associated with hepatitis.

The client states, "I've never had such trouble breathing. What is a pulmonary embolus anyway?" Which response by the nurse is the most appropriate? 1. "A pulmonary embolus is a stationary blood clot that formed in your lung." 2. "An embolus is a piece of the injured blood vessel that is moving in your lung." 3. "A pulmonary embolus is a portion of a blood clot that has moved from its original location to your lung." 4. "A pulmonary embolus is an area of tissue in your lung that has lost its blood supply and has become necrotic."

Correct Answer: 3 Global Rationale: A thrombus that detaches and moves is called an embolus. Because the thrombus has moved to the lung, it is called a pulmonary embolus. A stationary blood clot is a thrombus. An embolus is not a portion of blood vessel. An embolus

A client is maintained on warfarin (Coumadin) therapy secondary to refractory atrial fibrillation. Which statement by the client would alert the nurse to a possible problem with this therapy? 1. "I have started taking a vitamin C supplement to prevent colds this winter." 2. "I am learning to use olive oil in my cooking." 3. "I've stopped drinking coffee and now drink decaffeinated green tea." 4. "I have a big glass of grapefruit juice with my breakfast every day."

Correct Answer: 3 Global Rationale: Drinking green tea while taking warfarin may increase the risk of bleeding. There is no adverse drug-drug interaction between warfarin and vitamin C, olive oil, or grapefruit juice.

An adult client is brought to the emergency department (ED) and diagnosed with a thrombotic stroke. The team plans to administer alteplase (Activase). The client makes the following comments to a nurse. Which information is critical for the nurse to relay to the health care provider? 1. "I can't believe this is happening. My baby is only a year old." 2. "I thought this was just my asthma acting up." 3. "I wonder if this was happening when I fell and hit my head last week." 4. "I had a blood clot in my leg last year after my baby was born."

Correct Answer: 3 Global Rationale: The use of alteplase (Activase) increases the risk of severe bleeding. Clients with head injury can experience intracranial bleeding, which can cause brain damage and is potentially fatal. Childbirth a year ago, a history of asthma, and DVT are not contraindications to alteplase (Activase).

A client is prescribed intermittent intravenous heparin therapy to treat deep vein thrombosis (DVT). Which laboratory value should the nurse review prior to administering this medication? 1. Prothrombin time (PT) 2. Fibrinogen level 3. Activated partial thromboplastin time (APTT) 4. Factor VIII level

Correct Answer: 3 Rationale 1: Prothrombin time (PT) measures the effectiveness of warfarin (Coumadin) therapy. Rationale 2: Fibrinogen level is not used to evaluate heparin therapy. Rationale 3: APTT measures the effectiveness of heparin therapy. Rationale 4: Factor VIII level is used to evaluate treatment for hemophilia.

A client is being treated for a thromboembolic disorder. If the goal is to prevent clot formation, the nurse anticipates the client will be treated with which classifications of drug? Standard Text: Select all that apply. 1. Hemostatics 2. Thrombolytics 3. Anticoagulants 4. Antiplatelet agents 5. Clotting factor concentrates

Correct Answer: 3,4 Rationale 1: Hemostatic drugs are given to inhibit fibrin destruction, thereby promoting clot formation. Rationale 2: Thrombolytic drugs are given to remove existing clots by dissolving them. Rationale 3: Anticoagulants inhibit specific clotting factors, thereby preventing clot formation. Rationale 4: Antiplatelet agents inhibit the action of platelets, thereby preventing clot formation. Rationale 5: Clotting factor concentrates replace missing clotting factors, thereby promoting clot formation.

The nurse is providing discharge teaching regarding anticoagulant therapy. Which statements by the client would the nurse evaluate as indicating the need for further instruction? Standard Text: Select all that apply. 1. "I'll ask for an electric razor for my birthday next week." 2. "I guess my trip to the amusement park is off for now." 3. "I won't be able to cook anymore." 4. "I'll get one of those new electric toothbrushes with the firm bristles." 5. "I should make an appointment for a B12 injection monthly."

Correct Answer: 3,4,5 Rationale 1: Use of an electric razor is preferred for clients on anticoagulant therapy. Rationale 2: The client should avoid situations in which jostling or violent bumping could occur. Rationale 3: The client should be cautious when cutting food for preparation, but cooking is not prohibited. Rationale 4: The client should use a soft-bristle toothbrush. Rationale 5: IM injections should be avoided.

A nurse manager is making nurse assignments for care of clients who have just received thrombolytic therapy. The nurse specifically tells a new nurse, "Be certain to hold pressure on any puncture sites for at least ____ minutes."

Correct Answer: 30 Rationale: Thrombolytic therapy increases the risk of bleeding from any invasive procedure. Pressure should be held on any puncture site for a minimum of 30 minutes.

A client has lost 50 pounds by following a diet that allows 1200 calories each day. Today's laboratory results reveal a significant decrease in platelets. Which foods should the nurse recommend the client add to the daily diet? 1. Moderate-carbohydrate foods 2. Foods high in vitamin C 3. Fiber-rich foods 4. Foods rich in folic acid

Correct Answer: 4 Global Rationale: A common cause of decreased platelet production is folic acid deficiency. Carbohydrates, increasing vitamin C, and increasing fiber will not increase platelets

A hospitalized client is prescribed warfarin (Coumadin). The nurse teaches the client to avoid which food on the lunch selection menu? 1. Whole-wheat bread with margarine 2. Roast beef 3. Salt substitute 4. Broccoli salad

Correct Answer: 4 Global Rationale: Broccoli is high in vitamin K, and must be avoided when a client receives warfarin (Coumadin). Whole-wheat bread with margarine, roast beef, and salt substitute are not high in vitamin K, and so these foods are not contraindicated when a client receives warfarin (Coumadin).

How would a nurse explain the action of pentoxifylline (Trental) to a client? 1. Pentoxifylline is given to dissolve clots. 2. Pentoxifylline acts by increasing platelet production. 3. Pentoxifylline increases fibrin production. 4. Pentoxifylline reduces the viscosity of red blood cells.

Correct Answer: 4 Global Rationale: Pentoxifylline acts on red blood cells to decrease their viscosity, increasing their flexibility and allowing them to enter vessels that are partially occluded and prevent thrombi formation. Pentoxifylline does not dissolve clots, increase platelet production, or increase fibrin production.

Alteplase (Activase) is prescribed for a client with an acute myocardial infarction. Which is the priority nursing intervention for this client? 1. Monitor APTT. 2. Monitor PT/INR. 3. Monitor injection sites. 4. Monitor level of consciousness (LOC).

Correct Answer: 4 Global Rationale: Thrombolytics dissolve any clots they encounter. Cerebral hemorrhage is a major concern, so the nurse must assess the level of consciousness and neurological status. Thrombolytics do not affect APTT or PT/INR. Thrombolytics can cause bleeding from the IV site, but that is not as important as is cerebral hemorrhage.

The client prescribed heparin therapy asks how the "blood thinner" works. Which response by the nurse is the most appropriate? 1. "Heparin dissolves the clot." 2. "Heparin makes the blood less viscous." 3. "Heparin decreases the number of platelets so that blood clots more slowly." 4. "Heparin prevents clots from forming."

Correct Answer: 4 Rationale 1: Anticoagulants do not dissolve clots. Rationale 2: Anticoagulants do not change the viscosity of the blood. Rationale 3: Anticoagulants do not decrease the number of platelets. Rationale 4: Heparin inhibits the clotting cascade, preventing clots from forming

A client with a newly placed prosthetic heart valve will be maintained on long-term anticoagulant therapy. Which medication does the nurse anticipate being used for this purpose? 1. Enoxaparin (Lovenox) 2. Dalteparin (Fragmin) 3. Heparin 4. Warfarin (Coumadin)

Correct Answer: 4 Rationale 1: Lovenox is used for short-term anticoagulation. Rationale 2: Fragmin is used for short-term anticoagulation. Rationale 3: Heparin is not used for long-term therapy. Rationale 4: Warfarin (Coumadin) is the drug of choice for long-term anticoagulation in a client with a prosthetic heart valve.

The nurse is providing discharge instruction to a client who is going home after a knee replacement. Which information regarding symptoms of deep vein thrombosis (DVT) should the nurse include? 1. "If you develop a DVT, you will know it." 2. "Watch for paleness or coolness in your toes." 3. "Report any swelling in your knee." 4. "Look for increased tenderness in your lower legs."

Correct Answer: 4 Rationale 1: Some DVTs produce no symptoms. Rationale 2: Pale toes would indicate arterial insufficiency. Rationale 3: Because this client just had a knee replacement, swelling is likely to be present and is an expected finding. Rationale 4: Tenderness, warmth, or swelling in the lower legs may indicate DVT.

A patient will be taking dabigatran (Pradaxa) as part of treatment for chronic atrial fibrillation. Which statements about dabigatran are true?

The dose of dabigatran is reduced in patients with decreased renal function. Bleeding is the most common adverse effect. This drug is a prodrug and becomes activated in the liver.