Ch 37 Anticoagulant and Thrombolytics

A client is prescribed warfarin. The client also takes a diuretic for the treatment of cardiac problems. The nurse would anticipate which of the following? A) Decreased effectiveness of the anticoagulant B) Increased effectiveness of the diuretic C) Increased absorption of the anticoagulant D) Increased absorption of the diuretic

Ans: A Feedback: The nurse should monitor for decreased effectiveness of warfarin as an effect of the interaction between the anticoagulant and the diuretic. The nurse need not monitor for the increased effectiveness of the diuretic, the increased absorption of the anticoagulant, or the increased absorption of the diuretic in the client.

A client with thrombotic stroke is administered ticlopidine. The nurse would assess the client for which of the following? A) Dyspepsia B) Dyspnea C) Hematoma D) Bradycardia

Ans: A Feedback: The nurse should monitor for dyspepsia in the client who has been administered ticlopidine. Hematoma is an adverse reaction to heparin. Dyspnea is an adverse reaction to protamine sulfate and treprostinil. Bradycardia is an adverse reaction to protamine sulfate.

A client in a health care facility is receiving the thrombolytic drug reteplase. Which nursing diagnosis would be most likely? A) Anxiety B) Constipation C) Disturbed Sensory Perception D) Ineffective Tissue Perfusion

Ans: A Feedback: The nursing diagnoses for a client receiving the thrombolytic drug reteplase should include Anxiety. Constipation, disturbed sensory perception, and ineffective tissue perfusion would be unlikely for the client receiving reteplase.

When describing anticoagulants to a client, which of the following would the nurse expect to include? Select all that apply. A) Anticoagulants prevent formation of a thrombus. B) Anticoagulants prevent extension of a thrombus. C) Anticoagulants dissolve existing thrombi. D) Anticoagulants thin the blood. E) Anticoagulants can reverse the damage caused by a thrombus.

Ans: A, B Feedback: Anticoagulants can prevent the formation and extension of a thrombus but have no direct effect on an existing thrombus and do not reverse any of the damage from that thrombus. Although clients often refer to anticoagulants as blood thinners, they do not actually thin the blood.

A client is receiving streptokinase. The nurse understands that which of the following would occur? Select all that apply. A) Breakdown of existing thrombi B) Reopening of occluded blood vessels C) Prevention of tissue necrosis D) Decreased risk of internal bleeding E) Prevention of formation of a thrombus

Ans: A, B, C Feedback: Streptokinase is a thrombolytic drug. Thrombolytic drugs break down existing thrombi, reopen blood vessels after occlusion, and prevent tissue necrosis.

A client is receiving a heparin infusion. The nurse should check the needle site for the heparin infusion for signs of which of the following? Select all that apply. A) Inflammation B) Pain C) Tenderness D) Clot formation E) Itching

Ans: A, B, C Feedback: The nurse inspects the needle site for signs of inflammation, pain, and tenderness along the pathway of the vein. If these occur the infusion is discontinued and restarted in another vein.

The nurse instructs a client receiving warfarin about the importance of consistent intake of dietary vitamin K to decrease fluctuations in PT/INR. The nurse determines that the client understands the instructions when he identifies which foods as containing vitamin K? Select all that apply. A) Broccoli B) Cauliflower C) Fish D) Yogurt E) Chicken

Ans: A, B, C, D Feedback: Foods high in vitamin K include leafy green vegetables, beans, broccoli, cabbage, cauliflower, cheese, fish, and yogurt.

A client is being discharged on warfarin therapy. Which of the following would the nurse include in the teaching plan for the client? Select all that apply. A) Be consistent with your intake of foods containing vitamin K. B) Do not change brands of warfarin without consulting the physician. C) Take the drug at the same time every evening. D) Do not take or stop taking other medications except on the advice of the physician. E) Inform the dentist of therapy with warfarin prior to any treatment or procedure.

Ans: A, B, C, D, E Feedback: Instructions would include being consistent with intake of foods containing vitamin K, not changing brands of the drug, taking the drug at the same time each evening, not taking or stopping other medications, and informing the dentist about the use of warfarin.

A client taking warfarin asks the nurse about using herbal remedies. Which of the following would the nurse instruct the client to avoid? Select all that apply. A) Chamomile B) St. John's wort C) Ginkgo biloba D) Ginger E) Ginseng

Ans: A, B, C, D, E Feedback: Warfarin, a drug with a narrow therapeutic index, has the potential to interact with many herbal remedies. For example, warfarin should not be combined with any of the following substances, because they may have additive or synergistic activity and increase the risk for bleeding: celery, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo biloba, ginseng, green tea, onion, passionflower, red clover, St. John's wort, and turmeric.

Which assessment would the nurse obtain before administering an anticoagulant to a client with DVT? Select all that apply. A) Test for a positive Homans' sign. B) Examine extremity for skin temperature. C) Assess pain. D) Assess blood pressure. E) Check for pedal pulse.

Ans: A, B, C, E Feedback: Preadministration assessment for a client with a DVT should include checking for a pedal pulse, examining the extremity for color and skin temperature, assessing for pain, and checking for a positive Homans' sign.

A client is being discharged from the hospital with a prescription for clopidogrel. The nurse would instruct the client about which of the following as a possible adverse reaction? Select all that apply. A) Skin rash B) Bleeding C) Heart palpitations D) Nausea E) Constipation

Ans: A, B, C, E Feedback: The most common adverse reactions associated with clopidogrel are skin rash, dizziness, bleeding, palpitations, and constipation.

When teaching a class about parenterally administered heparin, which of the following would the nurse include? Select all that apply. A) Onset of action is almost immediate. B) Maximum effect occurs within 10 minutes. C) It is preferably given intramuscularly. D) Clotting time returns to normal within 4 hours. E) It causes fewer adverse reactions than the oral form.

Ans: A, B, D Feedback: Parenteral heparin results in an almost immediate onset of action with a maximum effect within 10 minutes, but clotting returns to normal within 4 hours unless subsequent doses are given. It is preferably given subcutaneously or intravenously.

After teaching a group of nursing students about heparins, the instructor determines that the teaching was successful when the students identify which of the following as an example of a low-molecular-weight heparin (LMWH)? Select all that apply. A) Dalteparin B) Streptokinase C) Enoxaparin D) Warfarin E) Tinzaparin

Ans: A, C, E Feedback: Dalteparin, enoxaparin, and tinzaparin are all examples of LMWHs. Streptokinase is a thrombolytic; warfarin is an oral anticoagulant.

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Ans: A, C, E Feedback: The nurse should withhold the drug and contact the physician if any of the following occur: the PT exceeds

When reviewing the medical records of several clients, the nurse understands that the use of anticoagulants is contraindicated in clients with which of the following medical conditions? Select all that apply. A) Leukemia B) Hypotension C) Atrial fibrillation D) GI ulcers E) Tuberculosis

Ans: A, D, E Feedback: Anticoagulants are contraindicated in clients with known sensitivity to the drug, active bleeding, hemorrhagic disease, tuberculosis, leukemia, uncontrolled hypertension, GI ulcers, recent eye or CNS surgery, aneurysms, and severe renal and hepatic disease and during pregnancy and lactation.

A nurse is conducting an in-service presentation about hemostasis. The nurse determines that the teaching was successful when the class identifies a thrombus as which of the following? A) Damage to a blood vessel B) Formation of a blood clot C) Cessation of bleeding D) Coagulation cascade

Ans: B Feedback: A thrombus refers to the formation of a blood clot, sometimes from damage, in a vessel that impedes blood flow. Cessation of bleeding refers to hemostasis. The coagulation cascade is the series of events that occur in the formation of a blood clot to stop bleeding.

A client is experiencing an overdosage of heparin. The nurse would expect to administer which of the following? A) Vitamin K1 B) Protamine C) Ticlopidine D) Tenecteplase

Ans: B Feedback: Heparin overdosage is treated with protamine. Vitamin K1 is used to treat overdoses of warfarin. Ticlopidine, an antiplatelet drug, and tenecteplase, a thrombolytic, would have no effect on counteracting the effects of warfarin.

A nurse is caring for a client receiving the anticoagulant drug warfarin. Which assessment would be most appropriate before administering the drug? A) Observe for signs of thrombus formation. B) Assess prothrombin time (PT) and INR. C) Assess for signs of bleeding. D) Monitor for hypersensitivity reaction.

Ans: B Feedback: The nurse should assess the prothrombin time (PT) and INR before administering the anticoagulant drug warfarin to the client. Observing for signs of thrombus formation, assessing for signs of bleeding, and monitoring for hypersensitivity reaction are the ongoing assessments performed in clients who are administered warfarin.

Protamine is used to treat overdose of which of the following medications? Select all that apply. A) Clopidogrel (Plavix) B) Heparin C) Enoxaparin (Lovenox) D) Alteplase (Activase) E) Warfarin (Coumadin)

Ans: B, C Feedback: Protamine is used to treat overdose of heparin and low-molecular-weight heparins (LMWHs).

Which of the following may be ordered periodically during therapy with anticoagulants? Select all that apply. A) Urinalysis B) Platelet count C) Blood count D) Stool analysis E) Ultrasound

Ans: B, C, D Feedback: A complete blood count, platelet count, and stool analysis for occult blood may be ordered periodically throughout anticoagulant therapy.

When teaching a client how to inject heparin subcutaneously, which of the following would the nurse include? Select all that apply. A) Holding the needle at a 45-degree angle B) Pinching a fold of skin C) Aspirating before injecting the drug D) Applying firm pressure after injection E) Changing sites for each dose

Ans: B, D, E Feedback: When administering a subcutaneous dose of heparin, the nurse picks a site that has not been use previously, pinches a fold of skin, holds the needle at a 90-degree angle, does not aspirate before injecting, and then applies firm pressure to the area after injection.

A nurse is caring for a client prescribed warfarin. The nurse would instruct the client that which of the following foods are high in vitamin K? A) Dairy products B) Root vegetables C) Green leafy vegetables D) Fruits and cereals

Ans: C Feedback: The nurse should inform the client that green leafy vegetables are high in vitamin K. Increased amounts of vitamin K could decrease the PT/INR and increase the risk of clot formation. Dairy products, root vegetables, fruits, and cereals are generally low in vitamin K. A diet that is very low in vitamin K may prolong the PT/INR and increase the risk of hemorrhage. The key to vitamin K management for clients receiving warfarin is maintaining a consistent daily intake of vitamin K. To avoid large fluctuations in vitamin K intake, clients receiving warfarin should be aware of the vitamin K content of food.

A female client is receiving an anticoagulant to prevent the formation and extension of blood clots. What instruction should the nurse include in the teaching plan for the client? A) Avoid caffeinated drinks. B) Take the drug on an empty stomach. C) Use a reliable contraceptive. D) Take the drug with a glass of milk.

Ans: C Feedback: The nurse should instruct the female client to use a reliable contraceptive to prevent pregnancy. The nurse need not instruct the client to avoid caffeinated drinks, take the drug on an empty stomach, or take the drug with a glass of milk.

A nurse is conducting a seminar on thrombosis. What information would the nurse include about the cause of arterial thrombosis? A) Decreased blood flow B) Injury to the vessel wall C) Arrhythmias D) Altered blood coagulation

Ans: C Feedback: The nurse should mention that arterial thrombosis is caused by atherosclerosis and arrhythmias. Decreased blood flow, injury to the vessel wall, and altered blood flow are causes of venous thrombosis.

A nurse is reviewing a journal article about antiplatelet agents. Which of the following would the nurse expect to be discussed? Select all that apply. A) Heparin B) Warfarin C) Abciximab D) Anagrelide E) Dipyridamole

Ans: C, D, E Feedback: Abciximab, anagrelide, and dipyridamole are antiplatelet agents. Heparin and warfarin are anticoagulants.

A female client is prescribed warfarin. The client also uses oral contraceptives. The nurse would assess the client closely for which of the following? Select all that apply. A) Bruising B) Blood in the stool C) Subtherapeutic INR D) Supratherapeutic INR E) Calf pain and warmth

Ans: C, E Feedback: Coadministration of warfarin and oral contraceptives can result in a decreased anticoagulant effect, leading to subtherapeutic INR and increased chance of clotting (signs and symptoms of DVT or PE).

A client with intermittent claudication is prescribed cilostazol by the primary health care provider. The nurse would expect to administer this drug cautiously if the client's history reveals which of the following? A) Intermittent claudication B) Pulmonary emboli C) Myocardial infarction D) Pancytopenia

Ans: D Feedback: The nurse should administer cilostazol with caution to clients with pancytopenia. Anticoagulants are used for the prevention and treatment of pulmonary emboli, the adjuvant treatment of myocardial infarction, and the treatment of intermittent claudication.

A client is receiving heparin by continuous IV infusion. Which of the following would be most appropriate for the nurse to do? A) Perform a complete blood count. B) Perform baseline PT/INR. C) Perform APTT test 4 to 6 hours after injection. D) Perform blood coagulation tests every 4 hours.

Ans: D Feedback: The nurse should perform blood coagulation tests every 4 hours for the client receiving heparin by continuous IV infusion. A blood count test or the baseline PT/INR test is not the right intervention for this client. When administering heparin by the subcutaneous route, an APTT test is performed 4 to 6 hours after the injection.