Anticoagulants, Antiplatelets, and Thrombolytics 40

The nurse recognizes what absolute contraindication to the administration of a thrombolytic to a patient having an acute myocardial infarction? History of intracranial hemorrhage Active peptic ulcer disease Presenting BP of 180/110 mm Hg Pregnancy

History of intracranial hemorrhage Thrombolytics are absolutely contraindicated in patients with a history of intracranial hemorrhage, intracranial neoplasms, or intracerebral ischemic effect in the previous 3 months (unless occurring within the last 3 hours, when a thrombolytic would be considered). The other factors are relative contraindications and would require vigilant monitoring.

Which finding in the patient receiving heparin would require an immediate intervention by the nurse? aPTT of 45 WBC of 8.5 RBCs of 4.2 Platelet count of 80,00

Platelet count of 80,000 A platelet count of less than 100,000 indicates thrombocytopenia. Because the patient is receiving heparin, which interferes with normal coagulation, adequate platelets are necessary to prevent hemorrhage in the event of trauma or bleeding.

A patient who received heparin begins to bleed. The nurse anticipates that the health care provider will order which antidote?

Protamine sulfate

Cilostazol is being prescribed for a patient with coronary artery disease. The nurse understands that which of the following is the major purpose for antiplatelet drug therapy?

Suppress platelet aggregation

A patient has an orthopedic surgery and is prescribed enoxaparin. What would the nurse teach the patient and or family members about this low-molecular- weight heparin before discharge?

Watch for bleeding or excessive bruising

The nurse is teaching a patient about clopidigrel. Which information will the nurse include in the patient's teaching plan?

Bleeding may increase when taken with aspirin

A patient is taking warfarin. The nurse knows that this drug works by which mechanism? Decreased number of circulating clotting factors Blocking of vitamin K-dependent factors Decreased numbers of platelets Altered cellular permeability

Blocking of vitamin K-dependent factors Coagulation is suppressed by warfarin because of its ability to interfere with synthesis of vitamin K. Four clotting factors require vitamin K for synthesis, and without them, coagulation

A patient is prescribed enoxaparin. The nurse knows that low-molecular-weight heparin has what kind of half-life?

A longer half-life than heparin

A patient is to undergo a coronary angioplasty. The nurse acknowledges that which drugs is used primarily for preventing reocclusion of coronary arteries following coronary angioplasty?

Abciximab

A patient is admitted to the emergency department with an acute myocardial infarction. Which drug does the nurse expect the health care provider to order for prevention of tissue necrosis following blood clot blockage in a coronary artery?

Alteplase

The nurse understands that platelet aggregation is initiated when platelets come in contact with what on the surface of a damaged blood vessel? Albumin Collagen Antigens Histamine

Collagen When there is vessel injury, collagen on the exposed surface of the damaged blood vessel causes platelets to aggregate (clump).

A patient is placed on heparin, and the nurse acknowledges that heparin is effective for preventing clot formation in patients who have which disorder(s)?

Coronary thrombosis, Acute myocardial infarction, DVT, Hemorrhagic stroke, DIC

The nurse monitors the aPTT of a patient receiving heparin for a deep vein thrombosis. The nurse notes that the aPTT is 70. What is the most important action to be taken by the nurse? Notify the physician Document the result Increase the infusion rate Decrease the infusion rate

Document the result In a patient receiving intravenous heparin, monitoring the aPTT result is necessary to ensure adequate anticoagulation as well as to check for overmedication. Normal aPTT is 40 seconds, and when the patient is receiving heparin, therapeutic effects occur when the aPTT is 1½ to 2 times normal, or between 60 and 80. The patient in this situation has an aPTT of 70, which is in the therapeutic range. It would be appropriate to continue the infusion at the same rate and document the results.

A patient is taking warfarin 5 mg daily for atrial fibrillation. The patient's international normalized ration is 3.8. The nurse would consider the international normalized ratio to be what?

Elevated range

A patient is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally?

Warfarin

The nurse is caring for a patient who has received a thrombolytic and is experiencing excessive bleeding. Which medication would the nurse expect to administer? vitamin k factor VIII protamine sulfate aminocaporic acid

aminocaproic acid In the patient with excessive bleeding due to the use of a thrombolytic, the drug should be stopped and the patient given packed red blood cells and fresh-frozen plasma (because they contain clotting factors). If bleeding continues after these actions, then aminocaproic acid can be given to reverse the excessive fibrinolysis caused by the thrombolytic.

What does the nurse recognize as the major adverse effect of low-molecular-weight heparin? thrombocytosis anaphylaxis infection bleeding

bleeding Low-molecular-weight heparin interferes with the normal clotting cascade and may lead to bleeding. Additionally, these drugs can cause thrombocytopenia.

In understanding normal coagulation, the nurse recognizes ________________ as necessary to the degradation of a clot as healing occurs. fibrin plasmin fibrinogen factor VIII

plasmin Plasmin, produced from plasminogen, is an enzyme that digests the fibrin mesh found in clots. Plasmin is necessary for normal healing.

A patient is experiencing heparin overdose. Which medication would the nurse prepare to administer? vitamin K factor VIII antihistamine protamine sulfate

protamine sulfate The antidote for heparin overdose, protamine sulfate, is indicated. Protamine immediately neutralizes the heparin, and the action lasts about 2 hours. After 2 hours, additional protamine may be indicated, depending on the aPTT levels.

The nurse recognizes that ______________ is necessary for synthesis of specific coagulation factors. vitamin A vitamin D vitamin E vitamin K

vitamin K Vitamin K is essential to the formation of factors VII, IX, X, and prothrombin. These are all necessary for normal coagulation.