Chapter 31 Review
What patient education should be included for a patient receiving enoxaparin (Lovenox)? (Select all that apply.) A: Teach the patient or family to give subcutaneous injections at home. B: Teach the patient or family not to take any over-the-counter drugs without first consulting with the health care provider. C: Teach the patient to observe for unexplained bleeding such as pink, red, or dark brown urine or bloody gums. D: Teach the patient to monitor for the development of deep vein thrombosis. E: Teach the patient about the importance of drinking grapefruit juice daily.
A, B, C, D. Enoxaparin is an LMWH. Patients and family can be taught to give subcutaneous injections at home. Teaching should include instructions to not take any other medications without first consulting the health care provider and recognizing the signs and symptoms of bleeding. Enoxaparin is given to prevent development of DVT. Patients should be taught signs and symptoms of DVT to observe for and should contact their health care provider immediately if these develop or worsen while on enoxaparin therapy. Option E is incorrect. Grapefruit juice is known to alter the metabolism of many drugs in the liver. Even though the enoxaparin is given parenterally, it is metabolized in the liver and may be affected by compounds in the grapefruit juice.
A patient with a congenital coagulation disorder is given aminocaproic acid (Amicar) to stop bleeding following surgery. The nurse will carefully monitor this patient for development of which of the following adverse effects? (Select all that apply.) A: Anaphylaxis B: Hypertension C: Hemorrhage D: Headache E: Hypotension
A, D, E. Adverse effects of aminocaproic acid (Amicar) include headache, anaphylaxis, and hypotension. Options B and C are incorrect. Aminocaproic acid is given to prevent excessive bleeding and hemorrhage in patients with clotting disorders. It may cause hypotension, not HTN.
A patient is receiving a thrombolytic drug, alteplase (Activase), following an acute myocardial infarction. Which of the following effects is most likely attributed to this drug? A: Skin rash with urticaria B: Wheezing with labored respirations C: Bruising and epistaxis D: Temperature elevation of 38.2°C (100.8°F)
C. Thrombolytic agents such as alteplase (Activase) dissolve existing clots rapidly and continue to have effects for 2 to 4 days. All forms of bleeding must be monitored and reported immediately. Options A, B, and D are incorrect. Skin rash, urticaria, labored respirations with wheezing, or temperature elevation are not directly associated with alteplase, and other causes should be investigated.
A patient with deep vein thrombosis is receiving an infusion of heparin and will be started on warfarin (Coumadin) soon. While the patient is receiving heparin, what laboratory test will provide the nurse with information about its therapeutic effects? A: Prothrombin time (PT) B: International Normalized Ratio (INR) C: Activated partial thromboplastin time (aPTT) D:Platelet count
C: Therapeutic effects of heparin are monitored by the aPTT. While the patient is receiving heparin, the aPTT should be 1.5 to 2 times the patient's baseline, or 60 to 80 seconds. Options A, B, and D are incorrect. A PT or INR is used to monitor the effectiveness of warfarin (Coumadin). Platelets are not affected by anticoagulant therapy and are not useful in monitoring the therapeutic effects of the drug.
A patient has started clopidogrel (Plavix) after experiencing a transient ischemic attack. What is the desired therapeutic effect of this drug? A: Anti-inflammatory and antipyretic effects B: To reduce the risk of a stroke from a blood clot C: Analgesic as well as clot-dissolving effects D: To stop clots from becoming emboli
B. Antiplatelet drugs such as clopidogrel are given to inhibit platelet aggregation and, thus, reduce the risk of thrombus formation. Options A, C, and D are incorrect. Antiplatelet drugs do not exert anti-inflammatory, antipyretic, or analgesic effects. The antiplatelet and anticoagulant drugs do not prevent emboli formation. Thrombolytics dissolve existing blood clots.
The patient receiving heparin therapy asks how the "blood thinner" works. What is the best response by the nurse? A: "Heparin makes the blood less thick." B: "Heparin does not thin the blood but prevents clots from forming as easily in the blood vessels." C: "Heparin decreases the number of platelets so that blood clots more slowly." D: "Heparin dissolves the clot."
B: Anticoagulants do not change the viscosity (thickness) of the blood. Instead, anticoagulants modify the mechanisms by which clotting occurs. Options A, C, and D are incorrect. Heparin does not make the blood less viscous or actually thinner and does not decrease the number of platelets or dissolve existing clots.
