My Lab Quiz 31 (Exam 2)
The nurse notes the blood pressure and red blood cell (RBC) count of a client receiving heparin is low. Which should the nurse suspect has occurred? a. Dehydration b. Internal bleeding c. Decreased activated partial thromboplastin time (aPTT) d. Clot formation
b. Internal bleeding Rationale: low bp & red blood cell (RBC) count in patient could indicate internal bleeding.
The nurse is preparing to assess a client with von Willebrand's disease (vWD). Which priority question should the nurse ask the client? a. "Have you ever been pregnant?" b. "What are you currently using for birth control?" c. "Do you have heavy menstrual periods?" d. "Do you have any other medical conditions?"
c. "Do you have heavy menstrual periods?" Rationale: Common bleeding disorder in women= von Willebrand's disease. Women w/ vWBD are at risk for anemia, menstrual pain, & limitations of daily activities.
The nurse has provided a client education about enoxaparin (Lovenox). Which statement made by a client indicates an understanding of the information? a. "Enoxaparin increases the time it takes for me to form a clot." b. "Enoxaparin inhibits the synthesis of prostaglandins." c. "Enoxaparin dissolves small clots so I won't have a stroke." d. "Enoxaparin increases the flexibility of my blood cells."
a. "Enoxaparin increases the time it takes for me to form a clot." Rationale: All anticoagulant drugs will increase normal time body takes to form clots.
Which statements should the nurse include in the teaching for a client prescribed warfarin (Coumadin) therapy? Select all that apply. a. "Inform your dentist you are taking warfarin prior to any procedures." b. "Report to the lab for testing of activated partial thromboplastin time (APTT)." c. "Avoid strenuous activities." d. "Place ice at the injection site if stinging or burning occurs." e. "Take nonsteroidal anti-inflammatories (NSAIDs) for minor pain relief."
a. "Inform your dentist you are taking warfarin prior to any procedures." c. "Avoid strenuous activities." Rationale: Warfarin increases risk of bleeding from dental procedures. Strenuous/risky activities place patient at risk for injury & bleeding.
The nurse notes a client's warfarin (Coumadin) level is 7 mcg/mL. Which action should the nurse take? a. Administer protamine sulfate and hold the next dose of warfarin (Coumadin). b. Hold the next dose of warfarin (Coumadin) and request an international normalized ratio (INR). c. Hold the next dose of warfarin (Coumadin) and contact the healthcare provider. d. Continue the treatment and monitor the client.
b. Hold the next dose of warfarin (Coumadin) and request an international normalized ratio (INR). Rationale: warfarin level of 7 mcg/mL is w/in a therapeutic range. Protamine sulfate= antidote for heparin, not warfarin. NOT necessary to hold next dose of warfarin or notify the HC provider.
The nurse has provided education for a client prescribed pentoxifylline (Trental). Which statements made by the client indicate an understanding of the information? Select all that apply. a. "The prescription will soften the red blood cells (RBCs) so they can fit through the smaller blood vessels." b. "The prescription decreases the platelets so the blood is less likely to clot." c. "The prescription decreases the "stickiness" of the blood." d. "The prescription affects how the liver makes clotting factors." e. "The prescription destroys some of the clotting factors."
a. "The prescription will soften the red blood cells (RBCs) so they can fit through the smaller blood vessels." b. "The prescription decreases the platelets so the blood is less likely to clot." c. "The prescription decreases the "stickiness" of the blood." Rationale: Pentoxifylline acts on RBCs to reduce their viscosity & increase their flexibility to allow them to enter partially occluded vessels. Pentoxifylline has an antiplatelet action.
Which adverse effect should the nurse instruct the client to monitor for while receiving warfarin sodium? a. Bleeding b. Rash c. Headache d. Pain
a. Bleeding Rationale: Clients receiving warfarin sodium are at risk for bleeding.
Which describes the action of thrombolytic prescriptions? a. Digest and remove preexisting clots. b. Prevent the liver from making fibrin. c. Convert plasmin to plasminogen. d. Prevent thrombus formation.
a. Digest and remove preexisting clots. Rationale: Thrombolytics digest & remove preexisting clots.
Which describes the mechanism of action of anticoagulant prescriptions? a. Inhibition of thrombi formation. b. Conversion of plasminogen to plasmin c. Alteration of plasma membrane and platelets d. Prevention of fibrin from dissolving
a. Inhibition of thrombi formation. Rationale: Anticoagulants are used to prolong bleeding time & thereby prevent thrombi from forming or enlarging.
Which describes the primary action of anticoagulant therapy? a. Prevent the formation of blood clots b. Dissolve blood clots c. Decrease the prothrombin time d. Increase the number of platelets
a. Prevent the formation of blood clots Rationale: Anticoagulants decrease the formation of new clots.
Which describes the purpose of fibrinolysis? a. Remove a blood clot b. Stop blood flow c. Produce enzymes d. Increase blood flow
a. Remove a blood clot Rationale: Fibrinolysis is removal of a clot in order to release plasminogen.
Which information should the nurse include the teaching for a client prescribed heparin? Select all that apply. a. Self-administration of subcutaneous injections. b. Symptoms of deep vein thrombosis. c. Required laboratory tests. d. Signs of abnormal bleeding. e. Scheduled administration times with meals.
a. Self-administration of subcutaneous injections. b. Symptoms of deep vein thrombosis. c. Required laboratory tests. d. Signs of abnormal bleeding. Rationale: Clients should be: taught how to self-administer their subcutaneous injections, informed of symptoms associated w/ deep vein thrombosis, informed of periodic laboratory monitoring, & informed of signs of abnormal or excessive bleeding.
The nurse is reviewing the process of hemostasis after an injury with a client. Which should the nurse identify as the initial event in this process? a. The vessel spasms. b. Von Willebrand's factor is activated. c. Platelets become sticky. d. Plasma proteins convert to active forms.
a. The vessel spasms. Rationale: Blood vessel spasms, causing constriction during initial event in the hemostasis process
Which prescription should the nurse prepare to administer for a client experiencing a warfarin sodium overdose? a. Vitamin K b. Aspirin c. Protamine sulfate d. Heparin
a. Vitamin K Rationale: Vitamin K used to treat client experiencing warfarin sodium overdose. Vitamin K helps reverse anticoagulant effects of vitamin K.
The nurse is preparing to provide education for a client prescribed Clopidogrel (Plavix) after a myocardial infarction and stent placement. Which statements should the nurse use to explain the action of Clopidogrel? Select all that apply. a. "Clopidogrel will dissolve any clots that might form in your stent." b. "Clopidogrel will make the platelets in your blood less sticky." c. "Clopidogrel will change the way your platelets work." d. "Clopidogrel decreases your blood's ability to clot." e. "Clopidogrel works just like the heparin you were prescribed when in the hospital."
b. "Clopidogrel will make the platelets in your blood less sticky." c. "Clopidogrel will change the way your platelets work." d. "Clopidogrel decreases your blood's ability to clot." Rationale: Clopidogrel =ADP receptor blocker that- renders platelets unable to aggregate making them less "sticky", causes irreversible changes in platelet plasma membranes, & decrease blood's ability to clot.
The nurse notes that a client receiving warfarin (Coumadin) has a high international normalized ratio (INR). Which question should the nurse include in the assessment? a. "Do you drink a lot of milk?" b. "Do you eat a lot of garlic?" c. "Are you restricting your fluids?" d. "Have you been eating a lot of salads and vegetables?"
b. "Do you eat a lot of garlic?" Rationale: Garlic has been shown to decrease aggregation of platelets, thus producing an anticoagulant effect. Clients taking anticoagulant meds should limit their intake of garlic.
A client with cirrhosis of the liver asks the nurse why they are at risk for bleeding. Which response should the nurse provide the client? a. "The liver thickens your blood so it is less likely to clot." b. "The liver is injured and cannot make clotting factors." c. "The liver is injured and unable to manufacture platelets." d. "The liver is breaking down your clotting factors too quickly."
b. "The liver is injured and cannot make clotting factors." Rationale: Liver is responsible for production of essential clotting factors necessary to prevent bleeding.
Which should the client be instructed to avoid when prescribed an anticoagulant? Select all that apply. a. Citrus fruits b. Alcohol c. Contact sports d. Prolonged sitting e. Hard toothbrush
b. Alcohol c. Contact sports d. Prolonged sitting e. Hard toothbrush Rationale: Alcohol should be limited/ eliminated in client prescribed anticoagulant. On anticoagulant- at risk for bleeding & should avoid contact sports. Prolonged sitting puts client at risk for formation of thrombi. Client instructed to use soft toothbrush to avoid trauma & bleeding in gums.
Which priority question should the nurse ask a client suspected of experiencing a stroke that is prescribed alteplase(Activase). a. "Do you take any other prescriptions?" b. "Do you have any other medical conditions?" c. "Do you know what time the stroke occurred?" d. "Are you currently being treated for hypertension?"
c. "Do you know what time the stroke occurred?" Rationale: Alteplase must be given w/in 3 hrs of a thrombotic stroke for max effectiveness, so it is important to ascertain the time stroke occurred.
Which classification of prescriptions does the nurse anticipate for the client being treated for a thromboembolic disorder? Select all that apply. a. Hemostatics b. Thrombolytics c. Anticoagulants d. Antiplatelet agents e. Clotting factor concentrates
c. Anticoagulants d. Antiplatelet agents Rationale: Anticoagulants inhibit specific clotting factors, thereby preventing clot formation. Antiplatelet agents inhibit action of platelets, preventing clot formation.
Which laboratory test is used to measure the effectiveness of warfarin sodium therapy? a. Platelet count b. aPtt c. International normalized ratio (INR) d. Complete blood count
c. International normalized ratio (INR) Rationale: INR is most effective test to measure effectiveness of warfarin therapy.
Which additional prescribed treatment should the nurse anticipate for the client prescribed heparin therapy? a. Advil as needed (PRN) for headaches b. Low vitamin K diet c. Obtaining an aPTT d. Weekly weights
c. Obtaining an aPTT Rationale: dosing for heparin nomogram system calculates appropriate heparin dose using weight, aPTT value, & clinical indication for prescription.
Which anatomical area should the nurse display a client when providing education about the point of origin of a pulmonaryembolism? a. Right ventricle b. Left atrium c. Right atrium d. Left ventricle
c. Right atrium Rationale: An embolus from right atrium will cause pulmonary emboli whereas an embolus from left atrium will cause a stroke or an arterial infarction elsewhere in body.
The nurse is caring for a client with a DVT (deep vein thrombosis) receiving heparin intravenously (IV). Which is the priority outcome for the client? a. The client will comply with dietary restrictions. b. The client will not disturb the intravenous infusion. c. The client will not experience bleeding. d. The client will keep the right leg elevated on two pillows.
c. The client will not experience bleeding. Rationale: Absence of bleeding is a priority outcome for any patient receiving anticoagulant therapy.
Which laboratory study is used to evaluate the proper dosage for heparin therapy? a. Sedimentation rate b. Complete blood count c. aPtt d. Serum heparin levels
c. aPtt Rationale: aPtt is used to help ID the correct dosage of heparin therapy for the client.
The nurse has provided discharge education for a client prescribed an anticoagulant. Which statement made by the client indicates an understanding of the information? a. "I can take enteric-coated aspirin but not plain aspirin for my arthritis." b. "I need to eat more protein while I am taking this medication." c. "I must limit my intake of vitamin C while I'm on warfarin (Coumadin)." d. "I should wear a medical alert bracelet that says I'm on an anticoagulant."
d. "I should wear a medical alert bracelet that says I'm on an anticoagulant." Rationale: Clients on anticoagulant therapy should wear a medical alert bracelet.
Which route of administration should the nurse anticipate to use for a client's prescribed enoxaparin (Lovenox)? a. Administer the prescription via slow intravenous (IV) push. b. Administer the prescription orally. c. Administer the prescription intramuscularly into the thigh. d. Administer the prescription into the abdomen, subcutaneously.
d. Administer the prescription into the abdomen, subcutaneously. Rationale: Administering prescription into abdomen, subcutaneously, is correct method of administration for enoxaparin.
Which prescription should the nurse anticipate for a client that has overdosed on Clopidogrel (Plavix)? a. Protamine sulfate b. Vitamin K c. Whole blood transfusion d. Platelet transfusion
d. Platelet transfusion Rationale: platelet transfusion may be necessary to treat a client that has overdosed on Clopidogrel to prevent hemorrhage.
Which describes the mechanism of action for Clopidogrel (Plavix)? a. Decreases platelet production b. Prevents platelets from adhering to the injured tissue c. Stimulates platelet production d. Prevents the platelets from sticking together
d. Prevents the platelets from sticking together Rationale: Clopidogrel is an antiplatelet prescription use to prevent platelet formation.
Which food should the nurse instruct the client prescribed warfarin (Coumadin) to avoid? a. Salt substitute b. Fettuccine Alfredo c. Whole-wheat bread with margarine d. Tomato salad with kale and basil
d. Tomato salad with kale and basil Rationale: Kale is high in vitamin K & must be avoided when a client receives warfarin.