Unit 4 Review
While preparing a client for discharge, the nurse teaches about the proper use of warfarin, which has been prescribed by the physician. Which statement by the client indicates that additional teaching is required?
"I should use aspirin to control my arthritis pain." Aspirin is an antiplatelet agent that can increase the effect of warfarin. Clients taking warfarin should check with a health care professional before taking any analgesic. The other statements suggest that the client understands important aspects of warfarin therapy.
A client is receiving low-molecular-weight heparin to prevent thromboembolic complications. The nursing student asks the instructor the reason why this treatment is given instead of heparin. What is the instructor's best explanation of the rationale for LMWH over heparin?
"LMWH is associated with less thrombocytopenia than standard heparin." Low-molecular-weight heparins are associated with less thrombocytopenia than standard heparin. Low-molecular-weight heparin is not stronger than standard heparin. Low-molecular-weight heparin is administered cautiously in clients with blood dyscrasia and hypertension.
An 86-year-old male client who was admitted earlier in the week with thrombophlebitis is being sent home on enoxaparin. Which statement by the client suggests that he understands proper management of his condition and proper use of the drug?
"The medication will increase my risk of bleeding." Since antiplatelet and anticoagulant drugs increase the risk of bleeding, clients taking such drugs should take precautions to avoid injury. Clients should report any sign of bleeding to a health care professional
A client is being prescribed fluvastatin. The nurse reviews the client's medical record to ensure that the client has attempted lifestyle changes for at least a minimum of which amount of time?
12 weeks To ensure the need for the drug therapy, the client needs to have attempted lifestyle modifications including a cholesterol-lowering diet and exercise program for at least 3 to 6 months.
A nurse will use extreme caution when administering heparin to which patient?
A 38-year-old male with peptic ulcer disease Heparin should be administered with extreme caution to patients with peptic ulcer or liver disease or after surgery because those patients would have greater risk for hemorrhage or excessive blood loss. Urticaria is a listed adverse effect of taking heparin and would therefore be expected. A patient who takes heparin would be advised to not drink heavily or smoke, but neither would have the safety risk posed by a patient with peptic ulcer. A patient with an accelerated heart rate and on heparin therapy would be at no special risk.
A nurse is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics. Treatment of high cholesterol using statins would be contraindicated in which client?
An obese male client who is a heavy alcohol user and who has cirrhosis of the liver Active liver disease is a contraindication to the use of statins. As well, heavy alcohol use increases the risk of liver dysfunction. Respiratory disease, recent surgery, and organic cognitive deficits do not preclude the use of statins for high cholesterol.
Which substance would a group of students identify as being responsible for breaking up dietary fats into smaller units?
Bile acids Bile acids act like a detergent in the small intestine and break up fats into small units. These small units are called micelles. High levels of cholesterol are part of bile acids. Chylomicrons are carriers for micelles.
A client with atrial fibrillation who is receiving oral anticoagulant therapy is receiving atorvastatin. The nurse would monitor this client for:
Bleeding Increased serum levels and resultant toxicity can occur if a statin is combined with warfarin, an oral anticoagulant. This would increase the client's risk for bleeding. Abdominal pain and cataract development are related to the use of atorvastatin alone. Liver failure also is associated with atorvastatin use alone.
Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived?
Diet Blood lipids, which include cholesterol, phospholipids, and triglycerides, are derived from the diet or synthesized by the liver and intestine.
The client is prescribed warfarin. His INR is 5.2. At what level is this dose?
Elevated Warfarin dosage is regulated according to the INR (derived from the prothrombin [PT] time), for which a therapeutic value is between 2.0 to 3.0 in most conditions. A therapeutic PT value is approximately 1.5 times the control, or 18 seconds.
After reviewing information about antihyperlipidemic drugs, a group of nursing students demonstrate understanding when they identify which medication as a fibric acid derivative (fibrate)?
Gemfibrozil Gemfibrozil is a fibric acid derivative. Colesevelam is a bile acid resin. Niacin is classified as a miscellaneous antihyperlipidemic. Ezetimibe is a miscellaneous antihyperlipidemic.
Mr. Hon has been admitted to the hospital and placed on anticoagulant therapy. For what blood-related disorder is this therapy used?
Hypercoagulation Anticoagulants are used to treat hypercoagulation, or excessive coagulation. They prevent the blood from clotting unexpectedly and maintain the flow of blood. Hemophilia is treated with human factor IX complex. Blood cancer is treated with therapies such as chemotherapy or radiation treatment. On the other hand, hemostasis is the process by which the body prevents excessive blood flow during an injury.
The black box warning associated with warfarin concerns its risk of causing what condition?
Major or fatal bleeding The FDA has issued a black box warning for warfarin due to its risk of causing major or fatal bleeding.
A client exhibits signs and symptoms of heparin overdose. The nurse would anticipate administering:
Protamine sulfate Protamine sulfate is the antidote for heparin overdose. Vitamin K is the antidote for warfarin overdose. Urokinase is a thrombolytic. Drotrecogin alfa is a C-reactive protein that has anticoagulant effects.
A client is being sent home with subcutaneous heparin after a total hip replacement. The nurse understands what symptom would indicate a serious drug reaction?
Tarry stools Tarry stools would be an indication of gastrointestinal bleeds. The most common adverse effect of heparin is bleeding.
Cholesterol is the base unit for the formation of steroid hormones.
True
A client, taking warfarin after open heart surgery, tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the report of pain, what should the nurse suspect is the cause of the pain?
bleeding The main adverse effect of warfarin is bleeding. The sudden onset of pain in the knees alerts the nurse to assess the client for bleeding. Arthritis, torn medical meniscus, and degenerative joint disease could all be symptoms of knee pain, but the onset and combination of anticoagulant therapy is not an etiology of these types of injuries and disease.
A client who has been taking a statin has seen an improvement in his cholesterol laboratory values; however, the low-density lipoprotein remains elevated. What medication will be added to the medical regime?
cholestyramine Cholestyramine is administered to clients to reduce LDL cholesterol in clients who are already taking a statin drug. Digoxin is not given to lower LDL cholesterol. Vitamin D is not given to lower LDL cholesterol. Calcium carbonate is not given to lower LDL cholesterol.
An elderly client with dyslipidemia has had fenofibrate added to the existing medication regimen. In addition to having the lipid profile drawn on a regular basis, the nurse should educate the client about the need for what ongoing laboratory testing during therapy?
liver panel Because of the risk for hepatotoxicity, clients taking fenofibrate require serial testing of liver enzyme levels. There is no specific need for follow-up with CBCs, coagulation tests, or reticulocyte counts.
A client will begin taking atorvastatin, and the nurse is conducting relevant health education. The nurse should emphasize the need to report any new onset of:
muscle pain. Myopathy is an important adverse effect of statins. Statins can injure muscle tissue, resulting in muscle ache or weakness; this should be reported promptly. Dry mouth, pruritus, and thirst are not reported adverse effects of statins.
A client is discharged from the hospital with a prescription of warfarin. Which statement indicates successful client teaching?
"I will avoid herbal remedies." Most commonly used herbs and supplements have a profound effect on drugs for anticoagulation. The client should never double up on dosing related to a missed dose. The client should avoid green leafy vegetables due to vitamin K. The client should not discontinue his or her medications without first consulting with the primary health care provider.
A client diagnosed with iron deficiency anemia is learning about her prescribed iron supplement. Which additional information would the nurse include in the client's teaching plan?
"If constipation or diarrhea become severe, call your primary care provider." The nurse knows to teach the client that if constipation or diarrhea become severe, to call the primary care doctor. Darkening of the stools is an expected outcome of iron administration. The nurse would teach the client to increase fluid for thirst (if not contraindicated) before calling the provider. Increased appetite is not an adverse reaction to iron; poor appetite would trigger a call to the provider.
Which client would be the best candidate to receive alteplase recombinant therapy?
A 68-year-old male who has had an ischemic stroke that resulted in neurological deficits Alteplase recombinant is the only drug approved for treating ischemic stroke. After a CT scan rules out intracranial bleeding or hemorrhagic stroke, treatment should be initiated within 3 hours after the onset of the stroke. The drug can be used only for patients who have a clinical diagnosis of stroke with clinically meaningful neurologic deficit because its adverse effects can be fatal. Alteplase recombinant may also be used to treat massive pulmonary embolism, but caution is necessary in patients with significant hepatic impairment.
A hospital patient in a critical care setting is currently receiving an intravenous infusion of aminocaproic acid. What desired outcome is paramount in the care of this patient?
Adequate tissue perfusion will be maintained Aminocaproic acid treats severe, life-threatening hemorrhage. As such, the goal of treatment is to preserve tissue perfusion and oxygenation. The goal of treatment is to prevent fibrinolysis. Aminocaproic acid is not used to treat intermittent claudication and ADLs are not an immediate priority in the critical care setting.
The female client is diagnosed with chronic renal insufficiency. Her vascular access site becomes incompetent and the health care provider orders urokinase to dissolve the clot. What should the nurse do?
Administer the drug as ordered. Most anticoagulant, antiplatelet, and thrombolytic drugs may be used in clients with impaired renal function. For example, heparin and warfarin may be used in usual dosages, and thrombolytic agents (e.g., streptokinase, urokinase) may be used to dissolve clots in IV catheters or vascular access sites for hemodialysis.
Which would be classified as a bile acid sequestrant?
Cholestyramine Cholestyramine is classified as a bile acid sequestrant. Lovastatin is a HMG-CoA reductase inhibitor. Ezetimibe is a cholesterol absorption inhibitor. Gemfibrozil is classified as a fibrate.
A nurse is preparing to administer an antiplatelet drug. Which medication would the nurse most likely administer?
Clopidogrel Clopidogrel is an antiplatelet agent. Alteplase is a thrombolytic agent. Phytonadione is an anticoagulant antagonist. Enoxaparin is an LMWH anticoagulant.
As part of a routine physical examination, a 60-year-old client's primary care provider has ordered blood work that includes cholesterol levels. What result would strongly suggest the need for an antihyperlipidemic drug?
Elevated LDL levels Elevated LDL levels are considered a risk factor for coronary artery disease. Elevated HDL levels, low VLDL levels, and a high ratio of HDL to LDL are associated with a decreased risk of heart disease.
After teaching a group of students about fats and biotransformation, the instructor determines that the teaching was successful when the students identify what as the storage location of bile acids?
Gallbladder The presence of fatty acids, lipids, and cholesterol in the duodenum stimulates contraction of the gallbladder and the release of bile, which contains bile acids. Once their action is completed, they are reabsorbed and recycled to the gallbladder, where they remain until the gallbladder is stimulated again
The three major classes of drugs used to control blood lipids are statins, bile acid resins (or sequestrants), and fibrates. Which is a fibrate?
Gemfibrozil Gemfibrozil is a fibrate. Colestipol, colesevelam, and cholestyramine are bile acid resins.
The pharmacology instructor is discussing medications used in the treatment of dyslipidemia. Which drug class would the instructor identify as the most widely used dyslipidemia drugs?
HMG-CoA reductase inhibitors HMG-CoA reductase inhibitors (or statins) are the most widely used dyslipidemia drugs. They are useful in treating most of the major types of dyslipidemia.
What might a client report of during treatment with an atorvastatin (Lipitor)? (Select all that apply.)
Headache Insomnia Constipation Lipitor is an HMG-CoA reductase inhibitor (statin). Adverse effects of statins include headache, dizziness, insomnia, flatulence, abdominal pain, cramping, constipation, and nausea.
A nurse is providing care to a client who has elevated levels of low-density lipoprotein (LDL). A review of the client's history reveals a sedentary lifestyle and a history of being overweight. The nurse understands that this combination of factors places the client at risk for which condition?
Heart disease Increased levels of LDL in combination with other risk factors, such as increased weight, diet high in saturated fats, and lack of physical activity, can lead to the development of atherosclerotic heart disease. In diabetes high levels of blood glucose as well as HbA1c are seen. In clients with glaucoma, increased eye pressure causes damage to the optic nerve. Clients with hypertension left untreated can lead to kidney failure and stroke.
A nurse is caring for a client receiving warfarin drug therapy. The client informs the nurse that he is also taking chamomile, which is an herbal remedy. The nurse would alert the client to which adverse effects?
Increased risk for bleeding The nurse should inform the client about the increased risk for bleeding, which is an effect of the interaction between warfarin and the herb. Decreased effectiveness of chamomile, increased absorption of warfarin, and increased risk for hypertension are not effects of the interaction between warfarin and chamomile.
During a cardiac catheterization and concurrent GP IIb/IIIa receptor antagonist administration, a client begins to bleed from the arterial access site of the catheterization. In what, if any, specific circumstance can the infusion continue?
It can continue when bleeding can be controlled by pressure application. If bleeding occurs and cannot be controlled with pressure, the procedure must be terminated. No other options are accurately good practice under the described situation.
A client is taking lovastatin (Mevacor). Which are noted as the most common adverse effects?
Nausea, flatulence, and constipation The most common adverse effects of statins are nausea, constipation, diarrhea, abdominal cramps or pain, headache, and skin rash. The client will not experience increased appetite and blood pressure as adverse effects of statins. The client will not experience fatigue and mental disorientation as adverse effects of statins. The client will not experience hiccups, nasal congestion, and dizziness as adverse effects of statins.
What values are used to monitor the effectiveness of warfarin therapy?
PT and INR Warfarin dose is regulated according to the international normalized ratio (INR), which is based on prothrombin time (PT). PT and INR are assessed daily until a stable daily dose is reached. Thereafter, PT and INR are determined every few weeks for the duration of warfarin therapy.
HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category?
Pregnancy Category X HMG-CoA reductase inhibitors (statins) are in pregnancy category X and contraindicated during any stage of pregnancy. Medications in pregnancy category A are considered safe. Medications classified as pregnancy category B, studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. For pregnancy category C studies have shown adverse effects to the fetus, however, benefit may outweigh the potential harm---the risk has not been ruled out.
A male client is receiving heparin by continuous intravenous infusion. The nurse will instruct the client and family members to report what should it occur?
Presence of blood in urine or stool The nurse should instruct the client and family members to report the presence of blood in urine or stools and any bleeding from the gums, nose, vagina, or wounds. The anticoagulation properties of heparin can sometimes result in abnormal bleeding. Sleepiness, drowsiness, skin rash, and dizziness are not commonly identified adverse effects of the drug.
A nurse is caring for a 64-year-old female client who is receiving IV heparin and reports bleeding from her gums. The nurse checks the client's laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which drug may be ordered?
Protamine sulfate If a client who receives IV heparin is found to be highly anticoagulated, protamine sulfate may be prescribed. Protamine sulfate, which is a strong base, reacts with heparin, which is a strong acid, to form a stable salt, thereby neutralizing the anticoagulant effects of heparin. Protamine sulfate does not produce the same effects for coumadin, alteplase, or ticlopidine.
A client's current medical condition is suggestive of impaired erythropoiesis. Which laboratory study would be most clinically relevant in diagnosing this health problem?
RBC, hemoglobin, and hematocrit Parameters used to measure erythropoiesis include RBC count, hemoglobin concentration and, hematocrit, and mean corpuscular volume. Tests related to immune function, hemostasis, and inflammation are not used to diagnose erythropoiesis.
A male client has been diagnosed with moderately increased LDL, and his primary care provider wishes to begin him on a statin. What is a potential disadvantage of statins that the care provider should consider? Select all that apply.
Statins are expensive. Statins require regularly scheduled blood work. Because liver enzymes may be elevated during atorvastatin use, clients need liver function tests and repeat lipid profile testing on a routine basis. These drugs are also expensive. They are not nephrotoxic and do not suppress the immune system. Previous MI is an indication for their use, not a contraindication.
A client is to receive enoxaparin (Lovenox). The nurse would administer this drug by which route?
Subcutaneous injection Enoxaparin (Lovenox) is administered via subcutaneous injection. Intramuscular (IM) administration is avoided because of the possibility of the development of local irritation, pain, or hematoma (a collection of blood in the tissue). Intravenous infusions are used with several anticoagulants such as heparin. Warfarin is given orally.
The administration of cholestyramine (Questran) with warfarin (Coumadin) would most likely cause a client to present with which issues? (Select all that apply.)
Subtherapeutic INR Calf pain and warmth Co-administration of warfarin and cholestyramine can result in decreased anticoagulant effect leading to subtherapeutic INR and increase chance of clotting (signs and symptoms of DVT or PE).
What is the basis for a nurse's recommendation of a period of intensive diet therapy and lifestyle modification before initiation of drug therapy for a client newly diagnosed with dyslipidemia?
Therapeutic lifestyle changes are the preferred method for lowering blood lipids. Nonpharmacologic interventions are always preferred to pharmacologic ones if there is potential for success. Appropriate lifestyle changes should be maintained, but there will not assure guaranteed success. Medications are to be used only when nonpharmacologic efforts have proven unsuccessful. While nonpharmacologic interventions may be less expensive, that is not the basis for the recommendation.
What information would be included in a lipoprotein profile? Select all that apply:
Total cholesterol Triglycerides LDL A lipoprotein profile is a laboratory test which reports total cholesterol, LDL, HDL, and triglycerides. AST and ALT are values that would be found reported from liver function test.
A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the client's:
aPTT Before initiating therapy, it is important to review the client's aPTT, hematocrit, and platelet count. These tests provide baseline information on the client's blood clotting abilities and identify conditions that may cause heparin therapy to be contraindicated. The client's heart rate and pulse, electrolyte levels, and blood sugar levels would not be priority nursing assessments.
A client has had cholestyramine added to his or her treatment plan for dyslipidemia. What effect will cholestyramine have on the pharmacokinetics of the thiazide diuretic that the client is currently prescribed?
decreased absorption Cholestyramine may decrease absorption of thiazide diuretics. None of the other options are associated with cholestyramine's effect on other medications.
A patient is taking cholestyramine to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which medication?
digoxin Bile acid sequestrants may decrease absorption of digoxin. Cholestyramine will not decrease the ibuprofen, aspirin, or acetaminophen.
The provider orders heparin for a 35-year-old female client. The nurse administers the drug only after confirming that the client:
does not have peptic ulcer disease. Contraindications of heparin include GI ulcerations (e.g., peptic ulcer disease, ulcerative colitis), active bleeding, severe kidney or liver disease, severe hypertension, and recent surgery of the eye, spinal cord, or brain. The drug should be used cautiously in clients with non-severe hypertension
A client is to receive clopidogrel. The nurse would expect to administer this agent by which route?
oral Clopidogrel is administered orally.
A client is receiving warfarin. The nurse would expect to administer this drug by which route?
oral Warfarin is administered orally.
The client has been taking rosuvastatin for hyperlipidemia. The client now presents with severe weakness and states barely being able to move the extremities. The nurse suspects the client has which?
rhabdomyolysis. An adverse reaction of rosuvastatin is muscle toxicity, which may cause rhabdomyolysis. Rhabdomyolysis is the breakdown of muscle that can cause pain, weakness, nausea, and even kidney damage. Gallbladder disorders are related to the use of fibric acid derivatives. Any medication can cause pruritis, however, it is not related to weakness manifested by the use of rosuvastatin.
Which single class drug is known to be most effective in reducing the major types of dyslipidemia?
statins For single-drug therapy, a statin is preferred for the treatment of dyslipidemia.To lower cholesterol and triglycerides, a statin, a cholesterol absorption inhibitor, gemfibrozil, a fibrate, or the vitamin niacin may be used. To lower triglycerides, gemfibrozil, ezetimibe, a cholesterol absorption inhibitor, or niacin may be given.
A client who has been treated with warfarin after cardiac surgery is found to have an INR of 9.0. Which medication will be administered to assist in the development of clotting factors?
vitamin K Vitamin K is the antidote for warfarin overdosage. In this case, the client may be at the therapeutic level to control thrombus formation, but, due to the injury, it is important to control bleeding. Vitamin E is not used as an antidote for warfarin overdosage. Protamine sulfate is used as an antidote to heparin or low-molecular-weight heparin. Acetylsalicylic acid (aspirin) is used to decrease coagulation as a preventive measure for myocardial infarction.
What should the nurse teach an older adult client about the potential adverse effects of atorvastatin?
"The most common side effects of atorvastatin involve some mild gastrointestinal upset." Statins like atorvastatin are usually well tolerated; the most common adverse effects (nausea, constipation, diarrhea, abdominal cramps or pain, headache, skin rash) are usually mild and transient.
A nurse is caring for a client receiving cholestyramine to improve his blood lipid profile at a home care setting. What adverse reactions to cholestyramine should the nurse monitor in the client?
Constipation The nurse should monitor for constipation in the client receiving cholestyramine. Rash, vertigo, and cholelithiasis should be monitored by the nurse when caring for a client receiving gemfibrozil
Which genetic clinical condition will likely, over the course of the client's lifetime, require the pharmaceutical introduction of clotting factors to assure the client's safety?
Hemophilia Hemophilia is a genetic lack of clotting factors that leaves the patient vulnerable to excessive bleeding with any injury. Treatment of classic hemophilia with antihemophilic factor provides temporary replacement of clotting factors to correct or prevent bleeding episodes or to allow necessary surgery. Bone marrow disorders are disorders in which platelets are not formed in sufficient quantity to be effective. Neither diabetes nor cystic fibrosis is treated with antihemophilic agents.
What is the most common reason for an elevated cholesterol level in a client who does not have a genetic disorder of lipid metabolism?
His dietary intake of saturated fat Unless a person has a genetic disorder of lipid metabolism, the amount of cholesterol in the blood is strongly related to dietary intake of saturated fat.
A 55-year-old man has been diagnosed with coronary artery disease and begun antiplatelet therapy. The man has asked the nurse why he is not taking a "blood thinner like warfarin." What is the most likely rationale for the clinician's use of an antiplatelet agent rather than an anticoagulant?
Antiplatelet agents are more effective against arterial thrombosis; anticoagulants are more effective against venous thrombosis. Anticoagulants are more effective in preventing venous thrombosis than arterial thrombosis. Antiplatelet drugs are used to prevent arterial thrombosis. CAD has an arterial rather than venous etiology. The rationale for the use of antiplatelet agents in CAD is not likely related to the need for blood work or the presence of adverse effects.
A client is admitted with thrombophlebitis and sent home on enoxaparin therapy. Which statement indicates a good understanding of why enoxaparin is being administered?
Enoxaparin inhibits the formation of additional clots. Low-molecular-weight heparins prevent the development of additional clots. They do not eliminate clotting factors. LMWHs do not prevent the blood from clotting. LMWHs do not dissolve the clot.
In acute coronary syndrome (unstable angina, MI), platelet aggregation must be inhibited before medical or surgical treatment begins. Which medication exhibits antiplatelet effects during infusion that ceases when the infusion is stopped?
Eptifibatide In eptifibatide infusion, antiplatelet effects occur during infusion and stop when the infusion is terminated.
The client is prescribed a thrombolytic agent. The nurse understands that the purpose of this order may be to achieve which effects? (Select all that apply.)
Limit tissue damage Reestablish blood flow Thrombolytic agents are used to reestablish blood flow and limit tissue damage in selected thromboembolic disorders.
What are the difficulties encountered when the physician orders lepirudin for management of atrial fibrillation? (Select all that apply.)
No antidote is available. Must be given IV Requires frequent lab tests This drug is not suitable for long-term treatment because it must be given IV and no antidote is available in the event of an overdose or if bleeding occurs. Its duration of action is 24 hours. It requires frequent lab tests that might not be readily available. It may cause anxiety, not depression.
After teaching a group of students about anticoagulants, the instructor determines that the teaching was successful when the students identify which agents as interacting with warfarin that increase the risk of bleeding? (Select all that apply.)
Salicylates Ranitidine Metronidazole Cefoxitin Salicylates, ranitidine, metronidazole, and cefoxitin interact with warfarin, resulting in the increased risk of bleeding. Barbiturates and carbamazepine interact with warfarin resulting in a decreased anticoagulant effect.
What should the nurse suggest to assist a client to improve his cholesterol levels?
Smoking cessation Lifestyle changes that can help improve cholesterol levels include a low-fat diet, regular aerobic exercise, losing weight, and not smoking.
A patient with metabolic syndrome usually has increased plasminogen activator levels
True
A patient with metabolic syndrome usually has increased plasminogen activator levels.
True
Heparin is the anticoagulant of choice during lactation.
True
A client receives subcutaneous heparin at 8 am and is scheduled for the next dose at 8 pm. The nurse would expect to obtain a specimen for an aPTT test at which time?
1400 When administering heparin by the subcutaneous route, an aPTT test is performed 4 to 6 hours after the injection. Less than 4 to 6 hours or more than 4 to 6 hours will not have the optimal peak value.
After teaching a group of students about antiplatelet agents, the instructor determines that the teaching was successful when the students identify which drug as blocking the production of platelets in the bone marrow?
Anagrelide Anagrelide blocks the production of platelets in the bone marrow. Cilostazol inhibits platelet aggregation and adhesion by blocking receptor sites on the platelet membrane preventing platelet-platelet interaction or the interaction of platelets with other clotting chemicals. Clopidogrel inhibits platelet aggregation and adhesion by blocking receptor sites on the platelet membrane preventing platelet-platelet interaction or the interaction of platelets with other clotting chemicals. Ticlopidine inhibits platelet aggregation and adhesion by blocking receptor sites on the platelet membrane preventing platelet-platelet interaction or the interaction of platelets with other clotting chemicals.
A nurse is caring for a patient receiving the anticoagulant drug warfarin. What pre-administration assessments should the nurse perform before administering the drug to the patient
Assess prothrombin time (PT) and INR. The nurse should assess the prothrombin time (PT) and INR before administering the anticoagulant drug warfarin to the patient. Observing for signs of thrombus formation, assessing for signs of bleeding, and monitoring for hypersensitivity reaction are the ongoing assessments performed in patients who are administered warfarin
When describing the action of atorvastatin, which would the nurse include?
Blocking the enzyme that is involved in cholesterol synthesis HMG-CoA reductase inhibitors, such as atorvastatin, block the enzyme involved in cholesterol synthesis. Bile acid sequestrants block bile acids to form insoluble complexes for excretion in the feces. Fibrates stimulate the breakdown of lipoproteins from the tissues and their removal from the plasma. Cholesterol absorption inhibitors work in the brush border of the small intestine to decrease absorption of dietary cholesterol from the small intestine.
Which agent would the nurse identify as inhibiting triglyceride synthesis in the liver, resulting in a reduction of LDL levels.
Fenofibrate Fenofibrate inhibits triglyceride synthesis in the liver resulting in a reduction of LDL levels. Gemfibrozil inhibits the peripheral breakdown of lipids, reduces production of triglycerides and LDLs, and increases HDL concentrations. Niacin acts to inhibit the release of free fatty acids from adipose tissue, increases the rate of triglyceride removal from the plasma, and generally reduces LDL and triglyceride levels and increases HDL levels. Fenofibric acid activates a specific hepatic receptor that results in increased breakdown of lipids, elimination of triglyceride-rich particles from the plasma, and reduction in the production to an enzyme that naturally inhibits lipid breakdown.
A nurse is caring for a client prescribed nicotinic acid for hyperlipidemia. The nurse would assess the client for which findings as a possibility?
Flushing of the skin The nurse should inform the client prescribed nicotinic acid that flushing of the skin is generally experienced by clients during this treatment. Weakness, tachycardia, and dyspnea are not adverse reactions associated with nicotinic acid.
After teaching a group of students about fats and biotransformation, the instructor determines that the teaching was successful when the students identify what as the storage location of bile acids?
Gallbladder The presence of fatty acids, lipids, and cholesterol in the duodenum stimulates contraction of the gallbladder and the release of bile, which contains bile acids. Once their action is completed, they are reabsorbed and recycled to the gallbladder, where they remain until the gallbladder is stimulated again.
A client asks how ezetimibe will help to treat high lipid levels. The nurse explains that:
It decreases the absorption of cholesterol in the small intestine. Ezetimibe inhibits the absorption of cholesterol by the small intestine. Fibric acid derivatives work by stimulating catabolism of triglyceride-rich proteins. Gemfibrozil reduces the production of triglycerides by the liver.
Which lipid level would the nurse interpret as being high?
LDL cholesterol of 190 mg/dL LDL level of 190 mg/dL would be considered high. A total cholesterol level of 200 mg/dL would be considered borderline high. A triglyceride level of 160 would be borderline high. HDL level of 48 would be considered low to optimal. Levels about 60 mg/dL would be considered high.
A 75-year-old client presents to the health care provider's office with bleeding gums and multiple bruises. When the nurse reviews the client's drug history, the nurse finds that the client is prescribed aspirin 81 mg/d. What drug may cause increased bleeding when used in conjunction with the aspirin?
NSAIDs NSAIDs, which are commonly used by older adults, also have antiplatelet effects. Clients who take an NSAID daily may not need low-dose aspirin for antithrombotic effects.
The component of the red blood cell that is not recycled is bilirubin.
True
Warfarin typically takes 3 days to achieve its onset of action.
True
A male client is prescribed interferon. What is his probable diagnosis?
Viral hepatitis Interferons are used mainly for viral hepatitis and certain types of cancer.
The nurse is caring for a 73-year-old client receiving warfarin. When the nurse performs the initial shift assessment, the nurse observes blood in the client's urinary drainage bag. After reporting the observation to the physician, which substance will the nurse likely administer?
Vitamin K Genitourinary bleeding is an adverse effect of warfarin. Vitamin K, a hemostatic agent that controls bleeding caused by warfarin overdose, will likely be administered to this patient.
A nurse is conducting a presentation for a local community group about hyperlipidemia. When discussing the factors that individuals can work on to reduce their risk, which information would the nurse include? Select all that apply.
Weight Diet Modifiable risk factors for hyperlipidemia are weight, diet, and physical inactivity. Nonmodifiable risk factors for hyperlipidemia are age, gender, and family history.
What laboratory value will the nurse prioritize when providing care for a client prescribed intravenous heparin?
aPTT Prescribers use the activated partial thromboplastin time (aPTT), which is sensitive to changes in blood clotting factors, except factor VII, to regulate heparin dosage. D-dimer test is used to help rule out deep vein thrombosis (DVT) and pulmonary embolism (PE). A platelet count measures how many platelets are present in the blood. Platelets are parts of the blood that help the blood clot. Factor XIII levels are assessed when diagnosing/managing hemophilia A.
A client is suspected of having impaired erythropoiesis. This client is most likely to exhibit signs and symptoms associated with what health problem?
anemia Clinical manifestations of inadequate erythropoiesis include anemia. This results in a decrease in the oxygen-carrying capacity of blood and consequently a decreased oxygen availability to the tissues. Signs of hypercoagulation (venous thromboembolism or DIC) or infection (sepsis) are not expected.
What health problems contraindicate the use of fibrates for the treatment of dyslipidemia? Select all that apply.
chronic renal failure liver disease Contraindications to the use of fibrates include a hypersensitivity to fibrates, hepatic or (severe) renal impairment, preexisting gallbladder disease, primary biliary cirrhosis, or persistent liver function abnormalities of unknown origin. Currently fibrate treatment is not contraindicated for clients with a history of venous thromboembolisms, ischemic heart disease, or diabetes mellitus.
A 51-year-old man is being discharged from the hospital following treatment with anticoagulants for a deep vein thrombosis. The nurse will instruct the client to:
consider safety measures to prevent bleeding and be alert for signs of bleeding. Client education on anticoagulant therapy should include safety measures to prevent bleeding, instructions to remain alert for signs of bleeding, and directions on what to do if bleeding occurs. Clients should be advised to eat small amounts of food when the drug is known to cause gastrointestinal distress. Clients should never alternate between similar types of drugs or change the route of drug administration at home without consulting the prescriber.
The provider orders heparin for a 35-year-old female client. The nurse administers the drug only after confirming that the client:
does not have peptic ulcer disease. Contraindications of heparin include GI ulcerations (e.g., peptic ulcer disease, ulcerative colitis), active bleeding, severe kidney or liver disease, severe hypertension, and recent surgery of the eye, spinal cord, or brain. The drug should be used cautiously in clients with non-severe hypertension.
The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin?
headache and flatulence. The most common adverse effects of statins include GI symptoms (including nausea, constipation, flatulence, and abdominal pain), headache, and muscle aches. These effects are usually mild and transient. Hiccups, sinus congestion, dizziness, fatigue, mental disorientation, increased appetite or hypertension are not common adverse effects of statin drugs.
A postsurgical client possesses numerous risk factors for venous thromboembolism, including a previous deep vein thrombosis. What drug would the nurse anticipate administering while this client recovers in the hospital?
heparin Heparin is frequently used to prevent postsurgical venous thromboembolism. Antiplatelet drugs do not have this indication, and vitamin K would increase the client's risks.
The nurse is caring for a 76-year-old client who is receiving IV heparin 5000 units q4h. At the initiation of therapy, the client's control activated thromboplastin time (aPTT) was found to be 35 seconds. One hour prior to the next scheduled dose, aPTT is determined to be 92 seconds. Based on this result, the nurse will:
hold the dose and contact the provider. During heparin therapy, aPTT values are typically maintained between 1.5 to 2.5 times the control value. Since an aPTT value of 92 seconds is greater than 2.5 times this client's control value, the anticoagulation effect is too great, and the health care provider should be notified.
A client has been prescribed lovastatin for high cholesterol. The nurse's teaching plan will include a basic explanation of how the drug produces its therapeutic effect. The nurse will explain that lovastatin lowers cholesterol levels in which manner?
inhibits cholesterol syntheses. Lovastatin belongs to a group of drugs classified as statins. These drugs work by inhibiting cholesterol synthesis in the liver. Fibric acid derivatives and bile-acid resins also decrease cholesterol levels but they work at different sites. Fibric acid derivatives work on lipoproteins and triglycerides to reduce cholesterol, and bile-acid resins work in the gastrointestinal tract and bind bile salts in the intestine. Lovastatin is not a hormone.
A 59-year-old client is on warfarin therapy. On follow-up visits to the clinic, the nurse will assess the client's:
intake of vitamin K. It is important to assess the client's usual vitamin K intake because warfarin interferes with the synthesis of vitamin K-derived clotting factors. Increases in vitamin K intake will interfere with the action of warfarin if the increase in intake occurs after the warfarin dosage has been titrated. In addition, a deficiency of vitamin K can increase the risk of bleeding. The client's sugar intake or the presence of a skin-related or breathing disorder does not affect the administration of warfarin.
How should the nurse instruct the client to take his lovastatin?
with food Lovastatin should be taken with food; fluvastatin, pravastatin, or simvastatin should be taken in the evening, with or without food; atorvastatin may be taken with or without food and without regard to time of day.
