Ch 52 Lehne
Which needle length and gauge should the nurse choose to administer subcutaneous heparin?
5/8 inch; 25 gauge
Which instruction about clopidogrel (Plavix) should be included in the discharge teaching for a patient who has received a drug-eluting coronary stent?
"Check with your healthcare provider before taking any over-the-counter medications for gastric acidity."
The nurse determines that the patient has understood the discharge teaching regarding warfarin [Coumadin] based on which of the patient's statements?
"I should use a soft toothbrush for dental hygiene."
A patient with nonvalvular atrial fibrillation is to be discharged on dabigatran etexilate (Pradaxa). Which statement should the nurse include in the discharge teaching?
"The medication must be stored in the manufacturer-supplied bottle."
The nurse is administering tenecteplase (TNKase) therapy to a patient experiencing an acute myocardial infarction. What will the nurse teach the patient about this therapy?
"This therapy will dissolve the clot that caused the heart attack." *This drug is used when a blood clot in a coronary artery causes a myocardial infarction.
A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. The nurse will immediately notify the healthcare provider of which findings? Select all that apply.
*Nosebleeds *aPTT of 40 seconds *aPTT of 40 seconds
Fondaparinux [Arixtra] is approved for use in which circumstance? Select all that apply.
*Prevention of (DVT) after knee replacement *Prevention of (DVT) after abdominal surgery *Treatment of acute pulmonary embolism (PE) in conjunction with warfarin [Coumadin]
A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein thrombosis (DVT) prevention. Which instructions should the nurse include in the patient's discharge teaching plan? Select all that apply.
*Wear a medical alert bracelet. *Check all urine and stools for discoloration. *Do not start any new medication without first talking to the healthcare provider.
The patient's heparin is infusing at 28 mL/hr. The bag of fluid is mixed 20,000 units of heparin in 500 mL D5W. What hourly dose is the patient receiving? Record your answer using a whole number. _____ units/hr
1120 *20,000 units = X units; 500 mL 28 mL/hr; X = 1120 units/hr
A patient with an acute myocardial infarction is prescribed an intravenous (IV) bolus of tenecteplase [TNKase]. The patient weighs 160 pounds (approximately 73 kg). What dosage should the nurse administer?
40 mg *160 pounds is 72.72 kg. A patient with a body weight of 70 to 79.9 kg is prescribed 40 mg of tenecteplase [TNKase] as a single IV bolus.
The nurse is beginning a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved?
70
The nurse is caring for a group of patients taking warfarin (Coumadin). Which patient or patients is/are at moderate to high risk for harm as a result of warfarin therapy?
A 79-year-old man with variant genes that code for VKORC1 and CYP2CP. A 26-year-old pregnant woman with new onset of symptoms of a pulmonary embolus. A young adult with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen.
The nurse is caring for a patient who is being treated with warfarin [Coumadin]. The patient has just been ordered cimetidine [Tagamet]. What is the nurse's priority action?
Monitor the patient for increased action of the anticoagulant.
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 healthcare provider placing which order?
Administer an additional dose of warfarin [Coumadin]. *A therapeutic INR is 2 to 3.5. The patient needs more warfarin to reach a therapeutic level.
A bleeding patient receiving warfarin [Coumadin] has an international normalized ratio (INR) of 6. What is the nurse's best course of action?
Administer vitamin K1 (phytonadione).
A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. Which medication would be appropriate for initial therapy for this patient who has a history of heparin-induced thrombocytopenia (HIT)?
Argatroban [Acovan] *Argatroban [Acovan] is indicated for the treatment of thrombosis in patients with a history of heparin-induced thrombocytopenia (HIT).
A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. What would be appropriate in this situation, given that the patient has a history of heparin-induced thrombocytopenia (HIT)?
Lepirudin (Refludan)
The laboratory calls the nursing unit to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate?
Call the healthcare provider to discuss the reduction or withdrawal of heparin
The nurse is caring for a patient who takes warfarin (Coumadin) for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate?
Call the healthcare provider to increase the dose
A patient has been receiving intravenous heparin. The nurse notes that today's activated partial thromboplastin time (aPTT) result is elevated. What is the nurse's best action?
Monitor the patient and check the therapeutic range. *An elevated aPTT would be expected in a patient who is receiving heparin. The nurse should continue to monitor the patient.
The nurse is caring for a patient who is being treated with warfarin [Coumadin] 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 warfarin *Drug interactions include phenytoin (decreased effect) and amiodarone (increased effect).
A 52-year-old male patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, the nurse understands that which symptom, if present, indicates the most likely adverse reaction to this drug?
Decreasing level of consciousness
A 63-year-old male patient has been receiving a heparin infusion for 2 days for treatment of pulmonary embolism. Which symptom most clearly relates to an adverse effect of heparin?
Discolored urine
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
The patient is being treated with a continuous intravenous infusion of heparin. What is the nurse's highest priority?
Ensure that protamine sulfate is readily available at all times.
A patient with deep vein thrombosis is receiving an intravenous (IV) heparin infusion. He asks the nurse how this medication will help him. The nurse's response is accurately based on which concept?
Heparin suppresses coagulation by helping antithrombin perform its natural functions
The patient is scheduled to receive argatroban. Which is the correct route by which to administer the drug?
Intravenous
The nurse knows that which statement is accurate for enoxaparin (Lovenox)?
It reduces the activity of factor Xa more than the activity of thrombin
A patient admitted with atrial fibrillation is receiving a continuous heparin infusion as well as daily warfarin (Coumadin). What is an appropriate action by the nurse?
Notify the healthcare provider that the INR is 3 and anticipate that the heparin will be discontinued
The patient is being treated with abciximab [ReoPro]. 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 healthcare provider of this finding. *If at any time during treatment with this drug the platelet count drops below 90,000/mm3, the primary healthcare provider should be notified.
The nurse is caring for a newly admitted patient who will begin heparin therapy. While documenting the patient's history, the nurse notes that the patient is currently undergoing treatment with enoxaparin. What is the nurse's highest priority?
Notify the provider that the patient should not be started on heparin.
The nurse is caring for a patient who is being treated with one of the coagulation modifier drugs. The patient tells the nurse that he has developed a rash. What is the nurse's highest priority action?
Notify the provider; the medication will need to be discontinued.
The nurse is caring for a patient receiving clopidogrel (Plavix) to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel?
Omeprazole (Prilosec)
Fondaparinux (Arixtra) is NOT approved for use in which circumstance?
Prevention of ischemic complications in patients with unstable angina
The nurse assesses the patient's prothrombin (PT) time to determine the effectiveness of anticoagulant therapy and notes that it is 32 seconds. How will the nurse interpret this value?
The PT is significantly elevated. *The normal control PT value ranges from 11 to 13 seconds. The target therapeutic level of anticoagulation is 1.5 times the control value or about 18 seconds.
The nurse is caring for a patient who is being treated with dabigatran [Pradaxa]. The nurse is monitoring the patient's laboratory test results and notes that the creatinine clearance is 25 mL/min. Based on this information, the nurse anticipates which change to the medication regimen?
The dose of the medication will be decreased. *The normal dose of dabigatran [Pradaxa] is 150 mg twice daily, but it must be reduced to 75 mg daily if the creatinine clearance is less than 30 mL/min.
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 caring for a patient who is being treated with fondaparinux [Arixtra] and notes a platelet count of 80,000/mm3. Based on this information, the nurse anticipates which change to the medication regimen?
The medication will be stopped completely. *Thrombocytopenia can occur with the administration of Arixtra. Thrombocytopenia of any degree should be monitored closely. Discontinue Arixtra if the platelet count falls below 100,000/mm3.
The nurse is preparing to administer an anticoagulant to a patient. Which action, if observed, is in error?
The nurse administers enoxaparin [Lovenox] intramuscularly to a patient.
The nurse is screening a patient for candidacy for treatment with fondaparinux [Arixtra]. 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 has overdosed on warfarin [Coumadin]. Which substance will the nurse administer to reverse the effect of warfarin?
Vitamin K
A patient who has been taking warfarin [Coumadin] is admitted with coffee-ground emesis. What can the nurse anticipate being prescribed for this patient?
Vitamin K
A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. Which situation would warrant a call to the physician?
aPTT of 40 seconds, nosebleeds, and aPTT of 100 seconds