CH 36 Prep U

A client prescribed an anticoagulant demonstrates an understanding of their condition by implementing which intervention(s) to manage an episode of bleeding? Select all that apply.

-Applying firm, constant pressure to the bleeding site -Notifying a health care provider immediately

A client is prescribed warfarin. Before administering the drug, the nurse checks the client's history for use of herbal remedies. Which herbal remedy if used by the client would increase the effects of warfarin? Select all that apply.

-garlic -gingko biloba -green tea

A client is receiving anticoagulant therapy and has an INR done. Which result would the nurse interpret as being therapeutic?

2.4

The nurse is assessing several clients who are receiving heparin therapy and checking their recent lab results. The nurse anticipates maintaining the current heparin dose based on which activated partial thromboplastin (aPTT) time?

55 seconds

Heparin therapy is prescribed to a client with deep vein thrombosis. Which client would be at greatest risk of bleeding from this therapy?

A 45-year-old corporate executive with peptic ulcer disease

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

A client has been taking heparin therapy for several days and is now experiencing a gastrointestinal hemorrhage that did not respond to withdrawing heparin therapy. What is the priority action by the nurse?

Administer protamine sulfate as prescribed

A female client is admitted to the hospital for treatment of a pulmonary embolism. Forty-eight hours after therapy has started, the client reports bleeding from her gums when she brushes her teeth. What orders can the nurse anticipate receiving from the health care provider to reverse the effects of the heparin?

Administer protamine sulfate, at a dosage of 1 mg per 100 units of heparin, for a maximum dose of 100 mg.

A 55-year-old client has been diagnosed with coronary artery disease and begun antiplatelet therapy. The client has asked the nurse why a "blood thinner like warfarin" hasn't been prescribed. 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.

A client taking warfarin after open heart surgery reports pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of the medications and the report of pain, what should the nurse suspect is the cause of the pain?

Bleeding

A 60-year-old client experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The client has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect?

By inactivating clotting factors and thus stopping the coagulation cascade

A nurse is preparing to administer an antiplatelet drug. Which medication would the nurse likely administer?

Clopidogrel

A nurse is caring for a 55-year-old client diagnosed with deep vein thrombosis (DVT). The health care provider orders anticoagulant therapy to prevent further clot formation. The client's lab results indicate a platelet count of 68,000 mm3 (68 x 109/L). What is the priority action the nurse should take in this scenario?

Consult the health care provider to discuss alternative anticoagulant options.

A nurse is preparing to administer a heparin injection to a client with a history of deep vein thrombosis and diabetes who practices Judaism. This will be the first dose of heparin the client has ever received. What should be the nurse's priority action in this scenario?

Consult with the health care provider to explore alternative anticoagulant options.

The nurse would anticipate administering fondaparinux to a client with which condition?

DVT prophylaxis

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.

A client is admitted to the hospital with deep vein thrombosis (DVT). An infusion of heparin is established. What action best protects the client's safety?

Ensure that protamine sulfate is readily available.

There are two pathways that can be activated by the coagulation process. One pathway begins when factor XII is activated. The other pathway begins when there is trauma to a blood vessel. What are these pathways?

Extrinsic and intrinsic pathways

A client taking an anticoagulant drug tells the nurse she is having bleeding in the gums and teeth. When reviewing client history, the client states she has decided to try an herbal remedy. Which of the following is most likely the cause of increased bleeding?

Ginger

Many commonly used herbs and supplements alter the effects of anticoagulant drugs. Which of the following substances presents an additive bleeding effect when taken concomitantly with warfarin?

Ginger

The client is currently receiving a continuous IV infusion of heparin. Which procedure should the nurse avoid when possible?

Giving intramuscular injections

While preparing a client for discharge, the nurse is teaching the client about the proper use of warfarin. Which food should the nurse tell the client to avoid consuming in excess?

Green leafy vegetables

A female client is started on warfarin therapy. The client asks the nurse why she is no longer on heparin therapy. What differentiates heparin from warfarin?

Heparin is administered parenterally, while warfarin is administered orally.

A client is receiving subcutaneous heparin 5,000 units every 8 hours. An activated thromboplastin time (aPTT) is drawn 1 hour before the 0800 dose. The results show that the aPTT is at 3.5 times the control value. What is the nurse's priority action?

Hold the dose and call the primary health care provider.

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.

A nurse is preparing to discharge a client who has been prescribed warfarin. While assessing the client's knowledge of the drug, what statement by the client should the nurse address?

I take aspirin to help with the pain of my arthritis

A client is discharged from the hospital with a prescription for warfarin. Which statement by the client indicates successful client teaching?

I will avoid ginseng and St. John's wort

The nurse determines teaching about warfarin is successful when the client makes what statement?

I will check with my primary health care provider before taking any herbal supplements

The nurse is caring for a client in long term care who is receiving warfarin. Which assessment indicates a need to withhold the drug and consult with the client's primary health care provider?

INR exceeds 3

A nurse is caring for a client receiving warfarin drug therapy. The client informs the nurse that they are also taking chamomile, which is an herbal remedy. The nurse would alert the client to which adverse effects?

Increased risk for bleeding

A client who uses St. John's wort is receiving warfarin. The nurse would be alert for which deviation from normal findings?

Increased risk of bleeding

The primary health care provider orders a 300-mg dose of clopidogrel for a client. The client then is to receive 75 mg/day. The nurse interprets the 300-mg dose to be which type of dose?

Loading dose

A nurse is caring for a client undergoing warfarin therapy for the treatment of venous thrombosis. The nurse suspects that the client is experiencing an overdose based on which finding?

Melena

A nurse at a long-term care facility is conducting a medication reconciliation for a client who has just moved into the facility. The client is currently taking clopidogrel. The nurse is most justified suspecting that this client has a history of what condition?

Myocardial infarction

A nurse working on the acute-care medical surgical floor is caring for an older adullt client originally admitted for severe hypertension and stroke. The client has been inpatient for eight days and has now developed a deep vein thrombosis to the left lower extremity. The health care provider has placed orders to start anticoagulation therapy. While preparing the heparin drip, the nurse receives new lab results showing an international normalized ratio (INR) of 3.9. What should be the nurse's priority action in this scenario?

Notify the health care provider about the lab results.

The effects of warfarin (Coumadin) are monitored by what laboratory test(s)?

PT and INR

A client experiences an overdose of warfarin. Which would the nurse expect to administer?

Phytonadione

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 stools

The pharmacology instructor is discussing heparin with the students. How would the instructor explain the action of heparin?

Promotes the inactivation of clotting factors

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

A client is being discharged from the hospital with warfarin to be taken at home. Which food should the client be instructed to avoid?

Spinach

A client is to receive enoxaparin. The nurse would administer this drug by which route?

Subcutaneous injection

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

The nurse is assessing a client who is being considered for anticoagulant therapy. What aspect of the client's health history should the nurse follow up most closely?

The client has a history of gastrointestinal (GI) ulcers.

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

A client is on warfarin therapy for atrial fibrillation and the INR is 4.2 with no protocols for adjustment. What is the priority action by the nurse?

The nurse should hold the medication and notify the health care provider

Which client statement demonstrates an accurate understanding of the action of a prescribed anticoagulant?

This medication will keep unnecessary clots from forming in my blood

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

A client who is receiving warfarin has blood in the urinary drainage bag. What medication will likely be prescribed by the health care provider?

Vitamin K

A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the client's:

aPTT

A client presents to the emergency department with a new onset of unilateral weakness and visual disturbances. The primary health care provider suspects that the client has had a cerebrovascular accident (CVA) and prescribes alteplase. What is the nurse's priority prior to administering alteplase?

assessing the client for a hemorrhagic stroke

A 70-year-old resident of a long-term care facility has experienced increasing pain, swelling, and redness to her lower leg over the past 12 hours, prompting the care providers at the facility to have the woman brought to the local emergency department. Diagnostic testing has confirmed deep vein thrombosis (DVT) and an IV infusion of alteplase (Activase) has been initiated. Unlike anticoagulants, a thrombolytic such as alteplase can

break down existing clots.

The nurse administers warfarin to a client. Which expected effect should the drug have on the body?

decrease in production of vitamin K-dependent clotting factors

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.

A client is prescribed warfarin. Before administering the drug, the nurse checks the client's history for use of herbal remedies. Which herbal remedy, if used by the client, would present a problem? Select all that apply.

garlic chamomile gingko biloba feverfew green tea

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

The nurse is caring for a client who has been diagnosed with disseminated intravascular coagulation (DIC). What is the drug of choice to treat this problem?

heparin

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

By what route will the nurse administer the antihemophilic agent to a client with hemophilia following a car accident?

intravenous (IV)

The nurse is caring for a client who is going home on warfarin. What laboratory test will the nurse inform the client will be used to evaluate therapeutic effects of the drug?

prothrombin time (PT) and international normalized ratio (INR)

The pharmacology instructor is discussing clopidogrel (Plavix). According to the instructor, this drug is frequently used for:

reduction of myocardial infarction in clients with atherosclerosis.