Ch. 26 - Coagulation Modifiers

The patient asks the nurse to explain the difference between dalteparin and heparin. Which response by the nurse is accurate?

"Dalteparin is a low-molecular-weight heparin that is more predictable in its effect and has a lower risk of bleeding.

The nurse will include which instructions in the plan of care for a patient receiving warfarin therapy?

"Do not take aspirin for pain.

Which drug has antifibrinolytic properties?

Desmopressin

The patient is scheduled to receive argatroban. Which is the correct route by which to administer the drug?

IV

A patient who is receiving heparin therapy has bruises covering the abdomen as well as red-colored urine. What does the nurse need to assess?

Platelet level

Which statement reflects a patient's accurate understanding of dietary restrictions while taking an anticoagulant?

"I should be consistent in my intake of green vegetables once a maintenance dose of my medication has been established."

The nurse evaluates that the patient has understood discharge teaching regarding warfarin based on which statement by the patient?

"I should use a soft toothbrush for dental hygiene.

After talking with a patient who is receiving warfarin sodium therapy, the nurse believes that the patient is at increased risk for bleeding. Which statement made by the patient supports the nurse's conclusion?

"I take ginkgo supplements for memory enhancement."

A patient is receiving warfarin for a chronic condition. Which patient statement requires immediate action by the nurse?

"I will increase dark-green leafy vegetables in my diet."

A nurse is educating a patient on the safe use of dabigatran. Which patient statement indicates a need for additional teaching?

"I will place the pills in an organizer for easy use

The nurse is providing care to a patient who is experiencing adverse reactions related to the administration of 5000 units of heparin. What is the appropriate dose of protamine sulfate, the antidote? Record your answer using a whole number. _______ mg

1 mg of protamine sulfate can reverse the effects of 100 units of heparin; therefore, 5000 units of heparin effects can be reversed by 50 mg of protamine sulfate.

A patient is admitted to the emergency department experiencing symptoms of a thrombolytic stroke. Which medication should the nurse expect to be prescribed for the patient?

Alteplase Alteplase is a tissue plasminogen activator, which can be administered to treat a thrombolytic stroke within a specified time frame after symptom onset.

The nurse is teaching a patient about therapy with anticoagulants. What is essential information to include in the teaching plan?

Anticoagulants prevent clots from forming.

Cilostazol belongs to which drug class?

Antiplatelet

The patient is receiving anticoagulant therapy. The international normalized ratio (INR) value for the patient today is 1.5. In response to this, the nurse could anticipate the health care provider placing which order?

Administer an additional dose of warfarin

A nurse is preparing to administer enoxaparin sodium to a patient for prevention of deep vein thrombosis. Which is an essential nursing intervention?

Administer the medication into subcutaneous tissue of the abdomen

A patient who is on enoxaparin therapy has hematuria, melena, petechiae, and bleeding from the gums. Which treatment strategy will be most beneficial for the patient?

Administering protamine sulfate

A patient is experiencing chest pain, dyspnea, hemoptysis, and hypotension. The patient's arterial blood gas analysis indicates a decreased level of oxygen. Which medication prescription should the nurse expect for the patient based on the current assessment data?

Alteplase

Which nursing intervention is essential for the patient receiving alteplase?

Assess for dysrhythmias

The patient is being treated with dabigatran and opens a new bottle of the medication on July 1. The nurse will instruct the patient to discard any unused medication by which date?

August 29

The nurse is monitoring a patient receiving reteplase therapy. Which assessment finding requires the most immediate action?

Change in mental status

A registered nurse is teaching a student nurse about safe and effective administration of heparin. Which action by the student nurse is appropriate?

Checking if the patient's prescription contains enoxaparin

The nurse is caring for a patient who is being treated with dabigatran and who is scheduled to be placed on phenytoin. The nurse anticipates which effect will occur when the phenytoin is administered?

Decreased effect of the dabigatran Drug interactions include phenytoin (decreased effect) and amiodarone (increased effect). Concomitant use of phenytoin is most likely to result in a decreased effect of dabigatran, not an increased effect, therapeutic effect, or anaphylactic reaction.

A patient who was admitted with deep vein thrombophlebitis is complaining of difficulty breathing and chest pain. What is the most likely cause of these symptoms?

Embolus to the lungs

A patient with atrial fibrillation is admitted in the emergency unit for symptoms of warfarin toxicity. The primary health care provider instructs the nurse to administer 6 mg of vitamin K to the patient. Which medication should be included in the patient's prescription to provide safe and effective treatment?

Enoxaparin

A nurse is providing care to a patient who is at risk for deep vein thrombosis (DVT). The health care provider prescribes aspirin therapy. Which statement from the patient supports this prescription?

I've been on prolonged bed rest."

The patient is being treated with a continuous intravenous infusion of heparin. What is the nurse's highest priority?

Monitor the patient for increased action of the anticoagulant.

The patient has been placed on aspirin as an antiplatelet drug. Which side effect is the patient most likely to experience?

Nausea

The patient is being treated with abciximab. The nurse assesses the patent's laboratory test results and finds that the platelet count has dropped to 75,000/mm3. What action will the nurse perform next?

Notify the primary care provider of this finding. If at any time during treatment with this drug the platelet count drops below 90,000/mm3, the health care provider should be notified. Protamine sulfate is the antidote for an excessive amount of heparin.

Which is a National Patient Safety Goal associated with anticoagulation therapy?

Preventing adverse events associated with anticoagulant drugs

The nurse assesses the patient's activated partial thromboplastin time (aPTT) to determine the effectiveness of the heparin regimen and notes that it is 35 seconds. How will the nurse interpret this value?

The aPTT is significantly decreased

The nurse is caring for a patient who is undergoing treatment with heparin therapy. The nurse assesses the patient's activated partial thromboplastin time (aPTT) level and finds it to be 98 seconds. How will the nurse interpret this finding?

The level is outside the expected target therapeutic level of anticoagulation; it is too high

The patient is receiving warfarin therapy, and the nurse finds the international normalized ratio (INR) to be 4.0. How will the nurse interpret this finding?

The level is outside the expected target therapeutic level of anticoagulation; it is too high.

The nurse is preparing to administer an anticoagulant to a patient. Which action, if observed, is in error?

The nurse administers enoxaparin intramuscularly to a patient.

The nurse is screening a patient for candidacy for treatment with fondaparinux. The nurse reviews the patient's laboratory test results and finds a creatinine clearance of 20 mL/min and a body weight of 48 kg. How will the nurse interpret these findings?

The patient is not a candidate for treatment with the medication based on both an insufficient creatinine clearance and an inadequate body weight.

A patient with deep vein thrombosis is receiving fondaparinux therapy. After reviewing the patient's laboratory reports, the nurse believes that discontinuing the therapy will be beneficial for the patient. Which finding supports the nurse's suspicion?

The patient's platelet count is 75,000 cell/μL Fondaparinux is a selective inhibitor of factor Xa and reduces the risk of clotting

A patient who has been taking warfarin is admitted with coffee-ground emesis. What can the nurse anticipate being prescribed for this patient?

Vitamin K Vitamin K is the antagonist for warfarin