ATI Practice Test (Anticoagulants)

A nurse is educating a group of clients about the contraindications of warfarin therapy. Which of the following statements should the nurse include in the teaching? "Clients who have glaucoma should not take warfarin." "Clients who have rheumatoid arthritis should not take warfarin." "Clients who are pregnant should not take warfarin." "Clients who have hyperthyroidism should not take warfarin."

"Clients who are pregnant should not take warfarin." Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk for bleeding.

A nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which of the following statements by the client indicates an understanding of the teaching? "It's okay to have a couple of glasses of wine with dinner each evening." "I'll be sure to eat more foods with vitamin K." "I'll take aspirin for my headaches." "I'll use my electric razor for shaving."

"I'll use my electric razor for shaving." Because this medication prolongs clotting times, the client should avoid situations that put him at high risk for bleeding, such as shaving with a straight razor or a razor blade.

A nurse is providing teaching to a client who is taking warfarin about monitoring its therapeutic effects. Which of the following explanations should the nurse provide about the international normalized ratio (INR) test? "The INR also monitors heparin therapy if the provider switches the medication prescription." "The INR is the only test available for anticoagulant therapy monitoring." "You will only need the test twice per month." "The INR is a standardized test that eliminates the variations between laboratories reports in prothrombin times."

"The INR is a standardized test that eliminates the variations between laboratories reports in prothrombin times." The INR is a standardized test, which means that the result will be the same, no matter which laboratory performs it.

A nurse is preparing to administer heparin 3,000 units by IV bolus. Available is heparin injection 5,000 units/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

0.6 mL

A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin? Hemoglobin (Hgb) Prothrombin time (PT) Bleeding time Activated partial thromboplastin time (aPTT)

Prothrombin time (PT) This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation.

A nurse is providing discharge teaching for a client who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching? - Mild nosebleeds are common during initial treatment. - Use an electric razor while on this medication. If a dose of the medication is missed, double the dose at the next scheduled time. Increase fiber intake to reduce the adverse effect of constipation.

Use an electric razor while on this medication - Warfarin, an anticoagulant, increases the client's risk for bleeding. The nurse should teach the client safety measures, such as using an electric razor, to decrease the risk for injury and bleeding.

A nurse is caring for a client who is on warfarin therapy for atrial fibrillation. The client's INR is 5.2. Which of the following medications should the nurse prepare to administer?

Vitamin K Rationale: Vitamin K reverses the effects of warfarin.

A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give? - "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level." - "A pharmacist is the person to answer that question." - "Heparin does not dissolve clots. It stops new clots from forming." - "The oral medication you will take after this IV will dissolve the clot."

"Heparin does not dissolve clots. It stops new clots from forming." Rationale: This statement accurately answers the client's question.

A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching? "I have started taking ginger root to treat my joint stiffness." "I take this medication at the same time each day." "I eat a green salad every night with dinner." "I had my INR checked three weeks ago."

"I have started taking ginger root to treat my joint stiffness." Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching.

A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make? "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." "I will call the provider to get a prescription for discontinuing the IV heparin today." "Both heparin and warfarin work together to dissolve the clots." "The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay."

"Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." Heparin and warfarin are both anticoagulants that decrease the clotting ability of the blood and help prevent thrombosis formation in the blood vessels. However, these medications work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which is usually within 1 to 5 days. When the client's PT and INR are within therapeutic range, the heparin can be discontinued.

A nurse is preparing to administer heparin 2,000 units by IV bolus. Available is heparin injection 5,000 units/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

0.4 mL

A nurse is caring for a client who is receiving heparin 3,800 units subcutaneous daily. Available is heparin 5,000 units/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth.)

0.8 mL

A nurse is preparing to administer a continuous heparin infusion at 1600 units/hr. Available is heparin 25,000 units in dextrose 5% in water (D5W) 500 mL. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

32 mL/hr

A nurse is caring for a client who is receiving a continuous IV infusion of heparin. Which of the following actions should the nurse take? Administer 50,000 units of heparin by IV bolus every 12 hr. Check the activated partial thromboplastin time (aPTT) every 4 hr. Have vitamin K available on the nursing unit. Use IV tubing specific for heparin sodium when administering the infusion.

Check the activated partial thromboplastin time (aPTT) every 4 hr. Heparin is an anticoagulant. The activated partial thromboplastin time (aPTT) should be monitored every 4 hr and the infusion rate should be adjusted accordingly until the effective dose has been determined.

A nurse is preparing to administer heparin subcutaneously to a client who has a deep vein thrombosis. Which of the following techniques should the nurse use? Cleanse the skin with an alcohol swab, insert the needle, aspirate, and inject the heparin. Cleanse the skin with an alcohol swab, insert the needle, aspirate, inject the heparin, and massage the site. Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, and observe for bleeding. Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, aspirate, and observe for bleeding.

Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, and observe for bleeding. This is the correct technique for the nurse to use to inject heparin.

A nurse is obtaining a medical history from a client who is to start warfarin therapy and currently uses herbal supplements at home. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin? Feverfew Black cohosh Echinacea Flaxseed

Feverfew The nurse should instruct the client to avoid taking feverfew while taking warfarin because it will increase the anticoagulant effect.

A nurse is preparing to administer heparin to a client. Which of the following actions should the nurse plan to take? Use a 22-gauge needle to inject the medication. Use a 1-inch needle to inject the medication. Inject the medication into the abdomen above the level of the iliac crest. Massage the injection site after administration of the medication.

Inject the medication into the abdomen above the level of the iliac crest. The nurse should inject the medication into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus.

A nurse is reviewing laboratory results of a client who has atrial fibrillation and is taking warfarin. For which of the following results should the nurse notify the provider? PT 45 seconds Hgb 16 g/dL Hct 44% Platelets 190,000/mm3

PT 45 seconds The expected reference range for PT is 11 to 12.5 seconds. During therapy, the nurse should expect to see the values increase 1.5 to 2.5 times the baseline. Therefore, the nurse should withhold the warfarin and notify the provider.

A nurse is reviewing the laboratory data on a client who has a new prescription for heparin for treatment of a pulmonary embolism. Which of the following data should the nurse report to the provider? Hematocrit 45% Partial thromboplastin time (PTT) 65 seconds White blood cell count 8,000/mm3 Platelets 74,000/mm3

Platelets 74,000/mm3 Heparin-induced thrombocytopenia is a disorder characterized by low platelet counts. It is an adverse effect of heparin that causes the activation of platelets, resulting in widespread clot formation and depletion of platelets. The expected reference range for platelets is 150,000-400,000/mm3.

A nurse is caring for a client who is receiving heparin by continuous IV infusion. Which of the following medications should the nurse plan to administer in the event of an overdose? Iron Glucagon Protamine Vitamin K

Protamine Protamine reverses the effects of heparin and is used in the event of an overdose.

A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects? Vitamin K Protamine sulfate Acetylcysteine Deferasirox

Protamine sulfate Protamine sulfate reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties.

A nurse in a clinic is caring for a client who has recently begun taking warfarin. The nurse is reviewing potential drug and food interaction risks and should instruct the client to avoid which of the following? Cabbage Cantaloupe Green beans White beans

Rationale: Cabbage should be limited in the diet when taking warfarin, because it is rich in vitamin K.

A nurse is caring for a client who has atrial fibrillation and is receiving heparin. Which of the following findings is the nurse's priority? - The client's ECG tracing shows irregular heart rate without P waves. - The client has an aPTT of 80 seconds. - The client experiences sudden weakness of one arm and leg. - The client's urine output is cloudy and odorous.

The client experiences sudden weakness of one arm and leg. Rationale: Sudden weakness or numbness of the face and one arm or leg and can indicate that the client is at greatest risk for stroke; therefore, this is the nurse's priority finding. In addition to these findings, the client may appear confused, have slurred speech, loss of balance, dizziness, or sudden severe headache.

A nurse is preparing to administer warfarin to a client. Which of the following information should the nurse recognize prior to administering the medication? Warfarin is compatible with heparin. The client's aPTT should be monitored. The client should be observed for manifestations of hemorrhage. Warfarin can be administered along with NSAIDS.

The client should be observed for manifestations of hemorrhage. The nurse should observe for manifestations of hemorrhage because it is an adverse side effect of warfarin, which has anticoagulant and anti-inflammatory actions.

A nurse is completing a medical interview with a client who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin? The client follows a low-fat diet to reduce cholesterol. The client drinks a glass of grapefruit juice every day. The client sprinkles flax seeds on food 1 hr before taking the anticoagulant. The client uses garlic to lower cholesterol levels.

The client uses garlic to lower cholesterol levels. The nurse should recognize that garlic can potentiate the action of the warfarin.

A nurse is reviewing the medication list for a client who has a new prescription for warfarin. The nurse should recognize that which of the following medications is incompatible with warfarin? Furosemide Alprazolam Vitamin K Vitamin A

Vitamin K These two medications are not compatible. Vitamin K antagonizes the action of warfarin and is the antidote for warfarin toxicity.