Anticoagulants and Thrombolytics

Diet instructions have been provided to a patient who will be taking warfarin (Coumadin) for several weeks. Which menu selection indicates the need for further instructions? A. Spinach salad with bacon dressing B. Orange and banana fruit salad C. Plate of assorted cheeses and grapes D. Pepperoni pizza and light beer

Answer: A

The nurse is teaching the client to administer enoxaparin following a total hip replacement. What should the nurse instruct the client to do? Select all that apply. A. Report promptly any difficulty breathing, rash, or itching. B. Notify the health care provider (HCP) of unusual bruising. C. Avoid all aspirin-containing medications. D. Wear or carry medical identification. E. Expel the air bubble from the syringe before the injection. F. Remove needle immediately after medication is injected.

Answer: A, B, C, D Client/family teaching should include advising the client to report any symptoms of unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing to HCP immediately. Instruct the client not to take aspirin or nonsteroidal anti-inflammatory drugs without consulting the HCP while on therapy. A low-molecular-weight heparin is considered to be a high-risk medication, and the client should wear or carry medical identification. The air bubble should not be expelled from the syringe because the bubble ensures the client receives the full dose of the medication. The client should allow 5 seconds to pass before withdrawing the needle to prevent seepage of the medication out of the site.

What are important lifespan considerations for an older adult who is taking warfarin (Coumadin)? (Select all that apply.) A. Aspirin increases the action of warfarin. B. Statin drugs decrease the action of warfarin. C. Older adults are more likely to develop bruises and bleeding. D. Sucralfate (Carafate) increases the effect of warfarin. E. Older adults need more frequent monitoring of the international normalized ratio (INR).

Answer: A, C, E

The nurse is caring for a client with a cerebral contusion who is moaning and reporting head pain. The family requests that aspirin be given to the client. What does the nurse do? Select all that apply. A. Explains that aspirin may cause GI upset. B. Explains that aspirin may cause increased intracranial pressure. C. Explains that aspirin may cause pupil constriction. D. Explains that aspirin may increase the potential for further bleeding. E. Explains that aspirin may cause the contusion to clot in his brain.

Answer: A, D Aspirin causes increased bleeding and GI upset. Aspirin does not cause the contusion to clot, cause pupil constriction, or cause increased intracranial pressure. The nurse may suggest other interventions for pain relief for the client if appropriate.

A patient has recently been given an intravenous injection of heparin. Which vital sign changes should be reported as signs of a hemorrhage? A. Increased blood pressure, decreased pulse B. Decreased blood pressure, increased pulse C. Decreased blood pressure, decreased pulse D. Increased blood pressure, increased pulse

Answer: B

Before administering a thrombolytic drug, the nurse assesses for which absolute contraindication? A. Chronic peptic ulcer disease B. Recent spinal or cerebral surgery C. Blood pressure of 150/92 mm Hg D. Current use of warfarin (Coumadin) or aspirin

Answer: B

Which statement best demonstrates a patient's understanding of how warfarin (Coumadin) works to help after heart valve replacement surgery? (Select all that apply.) A. "It will thin out my blood so that it won't clot anymore." B. "It will make me bruise and bleed more easily, so I must be careful." C. "It will dissolve the clots that have formed in my heart." D. "New clots will not form as easily in my heart valves." E. "Any clots that I still have will not get any bigger." F. "I will feel the cold weather more because my blood is thinner now."

Answer: B, D, E

A patient who is taking a clotting factor synthesis inhibitor such as warfarin (Coumadin) should be monitored for which serious adverse effect? A. Decreased clotting times B. Upset stomach, diarrhea, and fever C. Headaches that are severe and will not go away D. Increased viscosity of the blood

Answer: C

Which important instruction should be included when teaching patients about colony-stimulating factor therapy? A. Tell the patient that weight gain of more than 2 pounds a month should be reported to the prescriber. B. Teach the patient how to administer intramuscular injections correctly. C. Remind the patient to keep scheduled laboratory appointments for blood tests to monitor therapy. D. Instruct the patient to take this medication with adequate amounts of liquid.

Answer: C

Which lab tests are used to monitor the effectiveness of heparin administration to a patient who has had a venous thromboembolism (VTE)? A. Prothrombin time (PT) B. Activated partial prothrombin time (APPT) C. Activated partial thromboplastin time (aPTT) D. International normalized ratio (INR)

Answer: C

A patient who is taking warfarin (Coumadin) therapy is instructed to avoid which foods? (Select all that apply.) A. Grapefruit B. Fava beans C. Spinach D. Bananas E. Kale F. Oranges G. Broccoli

Answer: C, E, G

A patient on renal dialysis who is anemic is most likely to be administered which medication? A. Oprelvekin (Neumega) B. Alteplase/t-PA (Activase) C. Clopidogrel (Plavix) D. Epoetin alfa (Epogen, Procrit)

Answer: D

Several patients are receiving heparin. Which medication must be available on the unit to use as an antidote? A. Epoetin alfa (Epogen) B. Enoxaparin (Lovenox) C. Vitamin K (AquaMEPHYTON) D. Protamine sulfate

Answer: D

A client reports having crushing chest pain. The electrocardiogram shows ST elevations indicating an anterior myocardial infarction. The client takes captopril twice a day and nitroglycerin sublingual PRN. The nurse reviews the client's vital signs and blood tests to report to the health care provider. Which information indicates that the client cannot receive fibrinolytic therapy? Select all that apply. A. a blood urea nitrogen of 20 mg/dL (14.28 mmol/L) and creatinine 1.1 mg/dL (97.24 µmol/L) B. a diastolic blood pressure of 105 mm Hg C. a history of aspirin and enoxaparin use D. a hip replacement within the past 3 weeks E. a systolic blood pressure of 185 mm Hg

Answer: D, E The client would not be eligible to receive fibrinolytic therapy due to meeting exclusion criteria that include a diastolic blood pressure >115 mm Hg, a systolic blood pressure >180 mm Hg, decreased renal function as evidenced by elevated blood urea nitrogen or creatinine, and major surgery within the past 3 weeks. The client does not report current use of aspirin or enoxaparin.