Anti-Clotting

A patient with warfarin [Coumadin] toxicity is prescribed vitamin K (phytonadione). Which nursing assessment ensures patient safety? 1 Assess the prothrombin time. 2 Assess the amount of blood lost. 3 Assess the white blood cell count. 4 Assess the partial thromboplastin time.

1

The nurse is caring for a patient who is being treated with fondaparinux [Arixtra] and notes a platelet count of 80,000/mm3. Based on this information, the nurse anticipates which change to the medication regimen? 1 The medication will be stopped completely. 2 The dose of the medication will be increased. 3 The dose of the medication will be decreased. 4 The dose of the medication will be unchanged.

1

The nurse is caring for a patient who is being treated with one of the coagulation modifier drugs. The patient tells the nurse that he has developed a rash. What is the nurse's highest priority action? 1 Notify the provider; the medication will need to be discontinued. 2 Monitor the area of the rash; this is an expected side effect of the medication. 3 Notify the provider to obtain an order for a topical medication to apply to the rash. 4 Instruct the patient to wash the area with mild soap and water and leave open to the air.

1

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? 1 Discolored urine 2 Inspiratory wheezing 3 Heart rate of 60 beats/min 4 Blood pressure of 160/88 mm Hg

1

The nurse is reviewing laboratory data before initiating a patient's heparin infusion. Which finding requires immediate action? 1 Platelets 95,000/mm3 2 Potassium 3.5 mEq/L 3 International normalized ratio (INR) of 1 4 Activated partial thromboplastin time (aPTT) of 37 seconds

1

The patient is being treated with a continuous intravenous infusion of heparin. What is the nurse's highest priority? 1 Ensure that protamine sulfate is readily available at all times. 2 Ensure that the patient's laboratory values are monitored correctly. 3 Ensure that a loading dose was initially administered when treatment began. 4 Ensure that the patient is taught dietary restrictions while on the medication.

1

A patient who has been receiving intravenous heparin as treatment for a deep vein thrombosis requires immediate surgery for a suspected bowel perforation. Which intervention is essential at this time? 1 Administer vitamin K. 2 Administer protamine sulfate. 3 Provide patient teaching about the heparin. 4 Assess the international normalized ratio (INR) before surgery.

2

A patient who has been taking warfarin [Coumadin] is admitted with coffee-ground emesis. What can the nurse anticipate being prescribed for this patient? 1 Vitamin E 2 Vitamin K 3 Protamine sulfate 4 Calcium gluconate

2

The nurse assesses the patient's prothrombin (PT) time to determine the effectiveness of anticoagulant therapy and notes that it is 32 seconds. How will the nurse interpret this value? 1 The PT is within normal limits. 2 The PT is significantly elevated. 3 The PT is significantly decreased. 4 The PT is inadequate to evaluate treatment.

2

The nurse determines that the patient has understood the discharge teaching regarding warfarin [Coumadin] based on which of the patient's statements? 1 "I should keep taking ibuprofen for my arthritis." 2 "I should use a soft toothbrush for dental hygiene." 3 "I should decrease the dose if I start bruising easily." 4 "I will double my dose if I forget to take it the day before."

2

The nurse is caring for a patient who is being treated with warfarin [Coumadin] and who is scheduled to be placed on phenytoin. The nurse anticipates which effect will occur when the phenytoin is administered? 1 Increased effect of the warfarin 2 Decreased effect of the warfarin 3 Therapeutic effect of the warfarin 4 Anaphylactic reaction to the warfarin

2

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? 1 50 2 70 3 90 4 110

2

The patient is scheduled to receive argatroban. Which is the correct route by which to administer the drug? 1 Intradermal 2 Intravenous 3 Intramuscular 4 Subcutaneous

2

Which needle length and gauge should the nurse choose to administer subcutaneous heparin? 1 1½ inch; 20 gauge 2 ⅝ inch; 25 gauge 3 1½ inch; 18 gauge 4 1 inch; 26 gauge

2

A nurse is preparing to administer enoxaparin sodium [Lovenox] to a patient for prevention of deep vein thrombosis. Which is an essential nursing intervention? 1 Rub the administration site after injecting. 2 Utilize the Z-track method to inject the medication. 3 Administer the medication into subcutaneous tissue of the abdomen. 4 Draw up the medication in a syringe with a 22-gauge, 1½-inch needle.

3

A patient is receiving warfarin [Coumadin] for a chronic condition. Which patient statement requires immediate action by the nurse? 1 "I will avoid contact sports." 2 "I will take my medication at the same time each day." 3 "I will increase dark green, leafy vegetables in my diet." 4 "I will contact my healthcare provider if I develop excessive bruising."

3

A patient who was admitted with deep vein thrombophlebitis is complaining of difficulty breathing and chest pain. What is the most likely cause of these symptoms? 1 Anxiety 2 Medication reaction 3 Embolus to the lungs 4 Fatigue from the extra work of walking with pain

3

In which patient would a low-dose aspirin be contraindicated? 1 A patient with thrombosis 2 A patient with a heart problem 3 A patient with a hemorrhagic stroke 4 A patient with a deep vein thrombosis

3

The nurse assesses the patient's activated partial thromboplastin time (aPTT) to determine the effectiveness of the heparin regimen and notes that it is 35 seconds. How will the nurse interpret this value? 1 The aPTT is within normal limits. 2 The aPTT is significantly elevated. 3 The aPTT is significantly decreased. 4 The aPTT is inadequate to evaluate treatment.

3

The patient is receiving warfarin therapy, and the nurse finds the international normalized ratio (INR) to be 4.0. How will the nurse interpret this finding? 1 The level is within the expected target therapeutic level of anticoagulation. 2 The level is outside the expected target therapeutic level of anticoagulation; it is too low. 3 The level is outside the expected target therapeutic level of anticoagulation; it is too high. 4 The level cannot be interpreted without knowing the prothrombin time and the activated partial thromboplastin time (aPTT) value.

3

A bleeding patient receiving warfarin [Coumadin] has an international normalized ratio (INR) of 6. What is the nurse's best course of action? 1 Stop the IV drip. 2 Wait for the INR to decrease. 3 Administer protamine sulfate. 4 Administer vitamin K1 (phytonadione).

4

The nurse is administering tenecteplase (TNKase) therapy to a patient experiencing an acute myocardial infarction. What will the nurse teach the patient about this therapy? 1 "This therapy will quickly decrease your pain." 2 "This therapy will prevent new clots from forming." 3 "This therapy will reverse damage from the infarction." 4 "This therapy will dissolve the clot that caused the heart attack."

4

The nurse is monitoring a patient receiving alteplase [Activase] for treatment of a massive pulmonary embolism. Which finding indicates that the therapy is effective? 1 +2 pitting edema 2 Numbness in left leg 3 Faint posterior tibial pulse 4 Pulse oxygen saturation increased

4

The nurse is preparing to administer an anticoagulant to a patient. Which action, if observed, is in error? 1 The nurse administers heparin subcutaneously to a patient. 2 The nurse administers warfarin [Coumadin] orally to a patient. 3 The nurse administers dabigatran [Pradaxa] orally to a patient. 4 The nurse administers enoxaparin [Lovenox] intramuscularly to a patient.

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