N-283 Ch. 40-41 Practice Questions

A patient is prescribed aspirin, 81 mg, and clopidogrel. The nurse identifies the drug classification of clopidogrel as A.anticoagulant. B.thrombotic inhibitor. C.antiplatelet. D.thrombolytic.

C Rationale: Clopidogrel is an antiplatelet drug.

A patient is scheduled to receive gemfibrozil. It is most important for the nurse to assess for concurrent use of which medication? A.Acetaminophen B.Ibuprofen C.Warfarin D.Folic acid

C Rationale: Gemfibrozil (Lopid) is highly protein-bound and should not be taken with anticoagulants, because they compete for protein sites. Anticoagulant dose should be reduced during antihyperlipidemic therapy, and the international normalized ratio (INR) should be closely monitored.

A nurse who is administering atorvastatin calcium realizes the importance of monitoring for which serious adverse reaction? A.Pharyngitis B.Rash/pruritus C.Rhabdomyolysis D.Agranulocytosis

C Rationale: Serious adverse reactions of atorvastatin include rhabdomyolysis, myalgia, photosensitivity, and cataracts. Less serious side effects include headache, rash, pruritus, constipation, diarrhea, sinusitis, and pharyngitis.

A patient visits an outpatient clinic. The patient has been noncompliant with anticoagulation therapy and states, "I don't like having to have blood work all of the time." The nurse anticipates prescription of which medication? A.Abciximab B.Tirofiban C.Eptifibatide D.Rivaroxaban

D Rationale: Two oral anticoagulants form a new anticoagulant category called Xa inhibitors. Rivaroxaban (Xarelto) was FDA-approved in July 2011, and apixaban (Eliquis) was FDA-approved in December 2012. These drugs do not require routine coagulation monitoring and are given q.d. or b.i.d. The other medications are administered intravenously.

A patient is recovering from surgery to replace her right hip. In the early postoperative phase, the nurse anticipates administration of which drug to prevent deep vein thrombosis? A.Dipyridamole B.Low-molecular-weight heparin C.Abciximab D.Anagrelide

B Rationale: Low-molecular-weight heparins are derivatives of standard heparin and were introduced to prevent venous thromboembolism. The other drugs are platelet inhibitors. Antiplatelets are used to prevent thrombosis in the arteries by suppressing platelet aggregation

A patient will be taking niacin as part of antilipemic therapy. The best way to avoid problems with flushing or pruritus would be to A.take the medication at bedtime. B.take the medication with a small dose of a steroid. C.take the medication with a full glass of water on an empty stomach. D.start with a low initial dose and then increase it gradually.

Correct answer: D Rationale: Cutaneous flushing may be minimized if the niacin is started at a smaller dose and gradually increased. Premedication with a small dose of aspirin or a nonsteroidal antiinflammatory drug 30 minutes before taking the niacin, as well as taking the niacin with meals, may help to minimize these undesirable effects.

When converting from IV heparin to oral warfarin (Coumadin) therapy, the prescriber monitors which of the following to determine the next appropriate dose of warfarin? A.Platelet levels B.aPTT C.Red blood cell count D.PT/INR

Correct answer: D Rationale: For conversion from heparin to an oral anticoagulant such as warfarin, the dose of the oral drug is the usual initial dosage amount, with the prescriber using the PT/INR levels to determine the next appropriate dosage of warfarin. When there is continuous therapeutic anticoagulation coverage and warfarin has reached therapeutic levels, the heparin or LMWH may be discontinued without tapering.

A patient wants to take garlic tablets to improve his cholesterol levels. Which condition would be a contraindication? A.Hypertension B.Bowel obstruction C.Sinus infection D.Scheduled surgery

Correct answer: D Rationale: Garlic has antiplatelet activity and is contraindicated in patients who will undergo surgery within 2 weeks and in patients with human immunodeficiency virus infection or diabetes.

The patient accidentally takes too much of the prescribed warfarin (Coumadin) and is readmitted to the hospital with bleeding. The nurse anticipates administration of A.protamine sulfate. B.alteplase (Activase, Cathflo Activase). C.reteplase (Retavase). D.vitamin K.

Correct answer: D Rationale: High doses of vitamin K (10 mg) given IV will reverse the anticoagulation of warfarin within 6 hours. Protamine sulfate is used to reverse heparin. Alteplase, and reteplase are thrombolytics.

Which patient would benefit from administration of simvastatin (Zocor) 80 mg? A.A patient newly diagnosed with hyperlipidemia B.A patient with muscle aches who was taking another antilipidemic drug C.A patient who is taking verapamil D.A patient who has already been taking simvastatin (Zocor) for 12 months with no evidence of myopathy

Correct answer: D Rationale: In 2011, the Food and Drug Administration imposed new prescribing restrictions on simvastatin, stating: "Physicians should limit using the 80-mg dose unless the patient has already been taking the drug for 12 months and there is no evidence of myopathy. Simvastatin 80 mg should not be started in new patients, including patients already taking lower doses of the drug." In patients taking verapamil, the dose of simvastatin is not to exceed 10 mg.

The nurse is caring for a patient who received alteplase tPA for treatment of acute coronary syndrome. The patient starts to bleed. The nurse anticipates administration of which medication? A.Protamine sulfate B.Vitamin K C.Warfarin D.Aminocaproic acid

D Rationale: Aminocaproic acid (Amicar) is used to stop bleeding by inhibiting plasminogen activation, which inhibits thrombolysis.

Which herb is most often associated with the treatment of intermittent claudication? A.Ginseng B.Valerian C.St. John's wort D.Ginkgobiloba

D Rationale: The herb Ginkgo biloba, taken with an antiplatelet drug, has been used to treat intermittent claudication, because of its vasodilating and antioxidant effects, although this herb has not been approved by the FDA.

Which of the following should the nurse include when providing dietary teaching for the patient receiving warfarin (Coumadin) therapy? A.Avoid drinking large amounts of green tea. B.Cranberry juice will provide you with needed nutrients while taking Coumadin. C.You must never eat spinach. D.You can only eat lettuce once a month.

Correct answer: A Rationale: For patients taking warfarin therapy, it is recommended to avoid eating or drinking large amounts of kale, spinach, Brussels sprouts, collard or mustard greens, lettuce, chard, and green tea. Beverages that may increase the effect of warfarin and to be avoided include cranberry juice and alcohol.

Four patients are considered as potential candidates for thrombolytic therapy. Which patient is most likely to receive thrombolytic therapy? A.The patient who recently used acetaminophen B.The patient with a history of severe hypertension C.The patient who recently had spinal surgery D.The patient with a history of warfarin use

A Rationale: Acetaminophen (Tylenol) does not interfere with the coagulation system. Contraindications for use of thrombolytics include a recent CVA, active bleeding, severe hypertension, recent history of traumatic injury, especially head injury, and anticoagulant therapy. The nurse should report if the patient takes aspirin or NSAIDs.

The patient develops a deep vein thrombosis. The nurse anticipates administration of which medication? A.Intravenous heparin B.Clopidogrel C.Vitamin K D.Protamine sulfate

A Rationale: Intravenous heparin is indicated for rapid anticoagulant effect when a thrombosis occurs because of a deep vein thrombosis (DVT), pulmonary embolism (PE), or an evolving stroke. The effects of subcutaneous heparin take longer to occur. Clopidogrel (Plavix) is an antiplatelet drug that is mainly for prophylactic use in prevention of myocardial infarction or stroke. Vitamin K is the antidote for warfarin, and protamine is the antidote for heparin.

A patient arrived in the emergency department 2 hours after an acute ischemic stroke. The patient is given an intravenous (IV) injection of alteplase tPA. It is most important for the nurse to monitor what? (Select all that apply.) A.Bleeding B.Vital signs C.PT levels D.Allergic reactions E.Electrocardiogram

A,B,D,E Rationale: The nurse should monitor the patient receiving thrombolytics for adverse effects, such as bleeding, allergic reactions, and cardiac dysrhythmias. An increased heart rate with a decreased BP usually indicates blood loss from bleeding.

A patient's serum lipids are cholesterol 197 mg/dL, low-density lipoprotein (LDL) 110 mg/dL, and high-density lipoprotein (HDL) 35 mg/dL. The nurse knows what about these values? A.Serum lipids are within desirable values. B.Cholesterol is within desirable value, but LDL and HDL are not. C.Cholesterol is not within desirable value, though LDL and HDL are. D.Cholesterol, LDL, and HDL are not within desirable values.

B Rationale: The normal range for cholesterol is 150 to 200. The normal range for LDL is less than 100. The normal range for HDL is 45 to 60.

The patient is being discharged home on warfarin therapy. Which information will the nurse include when teaching the patient? A.Results of activated partial thromboplastin time (aPTT) will determine if the medication is effective. B.International normalized ratio (INR) results should be between 2 and 3. C.A normal response to warfarin is for your stools to look tarry. D.Increase the amount of green leafy vegetables in your diet.

B Rationale: Today, the international normalized ratio (INR) is the laboratory test most frequently used to report PT results; a value of 2 to 3 is considered acceptable. Partial thromboplastin time (PTT) and activated partial thromboplastin time (aPTT) are laboratory tests to detect deficiencies of certain clotting factors, and these tests are used to monitor heparin therapy. Tarry stools indicate GI bleeding. Green leafy vegetables contain vitamin K, which is the antidote for warfarin (Coumadin).

A patient is on heparin therapy secondary to deep vein thromboses. The nurse has which medication on hand as an antidote in case it is needed? A.Vitamin K B.Protamine sulfate C.Warfarin D.Aminocaproic acid

B Rationale: Vitamin K is the antidote for warfarin (Coumadin), not heparin, therapy; warfarin (Coumadin) is an anticoagulant, and aminocaproic acid (Amicar) is a plasminogen inactivator used to control excessive bleeding from hyperfibrinolysis.

Which information will the nurse include when teaching a patient about warfarin therapy? A.Increase the amount of green, leafy vegetables in your diet. B.Rinse your mouth instead of brushing your teeth. C.Follow up with laboratory tests such as PT or INR to regulate warfarin dose. D.Use a new razor blade each time you shave.

C Rationale: Laboratory tests such as PT or INR are performed to regulate warfarin (Coumadin) dose. The patient should avoid consuming large amounts of green, leafy vegetables; broccoli; legumes; soybean oil; coffee; tea; cola; excessive alcohol, and certain nutritional supplements such as coenzyme Q10. Patients are encouraged to perform oral hygiene and use a soft tooth brush to prevent gums from bleeding. Patients should be instructed to use an electric razor when shaving.

A patient with a new prescription for a HMG-CoA (statin) drug is instructed to take the medication with the evening meal or at bedtime. The patient asks why it must be taken at this time of day. The reason is A.the medication is better absorbed at this time. B.this timeframe correlates better with the natural diurnal rhythm of cholesterol production. C.there will be fewer adverse effects if taken at night instead of with the morning meal. D.this timing reduces the incidence of myopathy.

Correct answer: B Rationale: All statins are generally dosed once daily, usually with the evening meal or at bedtime to best coincide with the body's natural diurnal rhythm of cholesterol production.

A patient is receiving an IV infusion of a thrombolytic drug during treatment for an acute MI. The nurse notices that there is a slight amount of bleeding from the antecubital area where venous lab work was drawn. What will the nurse do first? A.Monitor the site for further bleeding. B.Apply pressure to the site with a gauze pad. C.Slow the rate of infusion of the thrombolytic drug. D.Stop the infusion of the thrombolytic drug.

Correct answer: B Rationale: The most common undesirable effect of thrombolytic therapy is internal, intracranial, and superficial bleeding. If invasive procedures must be performed or injections given, appropriate pressure should be applied to bleeding sites, and all areas of venous or arterial catheter insertion should be closely watched for bleeding. This type of superficial bleeding is to be expected and does not warrant cessation of the thrombolytic therapy.

Nursing considerations for conversion of IV heparin to oral warfarin (Coumadin) therapy will include: A.immediate discontinuation of IV heparin and administration of oral warfarin (Coumadin) therapy only. B.overlapping therapy of IV heparin and warfarin are for at least 5 days. C.monitoring the INR and stopping the IV heparin when the INR is 1.0.

Correct answer: B Rationale: When the oral anticoagulant warfarin is prescribed, therapy is often initiated while the patient is still receiving heparin. This overlapping is done purposefully to allow time for the blood levels of warfarin to rise so that when the heparin is eventually discontinued, therapeutic anticoagulation levels of warfarin will have been achieved. Recommendations for overlapping therapy of heparin and warfarin are for at least 5 days; the heparin is stopped after 5 days when the INR is above 2.

A 75-year-old man fell at home and hit his head against a table. His wife reports to their daughter that he does not have cuts or scratches, but there is a small lump on his upper scalp. She does not see any blood. He is taking warfarin and an antidysrhythmic as part of his treatment for chronic atrial fibrillation. What is the main concern at this time? A.Pressure should be applied to the lump for 3 to 5 minutes. B.He will need to take two doses of warfarin tonight to prevent blood clotting. C.He needs to be examined for possible internal bleeding from the fall. D.As long as there is no bleeding, there is no concern.

Correct answer: C Rationale: Careful examination will be needed to ensure that there is no hematoma or other internal bleeding as a result of the fall even if superficial bleeding is not noted.

A 72-year-old woman is taking an over-the-counter multivitamin that contains ginkgo. Her physician has recommended that she start taking low-dose aspirin therapy as part of her treatment for transient ischemic attacks. The concern with taking these two drugs together is A.increased risk of gastric ulcer. B.decreased action of the aspirin because of the interaction with the ginkgo. C.increased risk of bleeding because of the ginkgo. D.antagonism of the action of the aspirin because of the multivitamins.

Correct answer: C Rationale: Ginkgo may cause some increased bleeding times, so taking aspirin with ginkgo may put the patient at a higher risk for bleeding episodes.

A patient is receiving an IV infusion of heparin and was started on warfarin therapy the night before. Which statement is most correct? A.The patient is receiving a double dose of anticoagulants. B.The heparin therapy was ineffective, so the warfarin was started. C.The heparin provides anticoagulation until therapeutic levels of warfarin are reached. D.The heparin and warfarin work together synergistically to provide anticoagulation.

Correct answer: C Rationale: Heparin has a faster onset and therefore is used to provide anticoagulation until therapeutic levels of warfarin are reached.