Chapter 52: Anticoagulant, Antiplatelet, and Thrombolytic Drugs

Which instruction about clopidogrel [Plavix] should the nurse include in the discharge teaching for a patient who has received a drug-eluting coronary stent? "Constipation is a common side effect of clopidogrel, so take a stool softener daily." "If you see blood in your urine or black stools, stop the clopidogrel immediately." "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." "Keep the amount of food containing vitamin K, such as mayonnaise, canola and soybean oil, and green, leafy vegetables, consistent in your diet."

"Check with your healthcare provider before taking any over-the-counter medications for gastric acidity."

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." "Once a new bottle is opened, the capsules maintain efficacy for 90 days." "If you have difficulty swallowing the capsule, you can open it and mix it with food." "You will need to learn how to give yourself a subcutaneous injection in your abdomen."

"The medication must be stored in the manufacturer-supplied bottle."

A patient with an acute myocardial infarction is prescribed an intravenous (IV) bolus of tenecteplase [TNKase]. The patient weighs 160 lb. The nurse will administer what dosage? 30 mg 35 mg 40 mg 45 mg

40 mg

The nurse is caring for a group of patients taking warfarin [Coumadin]. Which patients are at moderate to high risk for harm as a result of warfarin therapy? (Select all that apply.) A patient with variant genes that code for VKORC1 and CYP2CP A patient with a current INR of 2.2 treated for deep vein thrombosis A woman with a new onset of symptoms of a pulmonary embolus A patient on day 4 after hip replacement with a new order for warfarin A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen

A patient with variant genes that code for VKORC1 and CYP2CP A woman with a new onset of symptoms of a pulmonary embolus A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen

The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin? Heart rate of 60 beats/min Blood pressure of 160/88 mm Hg Discolored urine Inspiratory wheezing

Discolored urine

A patient with deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response? Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting factors. Heparin suppresses coagulation by helping antithrombin perform its natural functions. Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot matrix. Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels.

Heparin suppresses coagulation by helping antithrombin perform its natural functions.

The laboratory calls 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? Notify the healthcare provider to discuss the reduction or withdrawal of heparin. Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level. Obtain vitamin K and prepare to administer it by intramuscular (IM) injection. Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated.

Notify the healthcare provider to discuss the reduction or withdrawal of heparin.

A patient is receiving continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor? (Select all that apply.) Platelets Vitamin K Prothrombin time (PT) International normalized ratio (INR) Activated partial thromboplastin time (aPTT)

Platelets Activated partial thromboplastin time (aPTT)

Fondaparinux [Arixtra] is not approved for use in which circumstance? Prevention of deep vein thrombosis (DVT) after knee replacement Treatment of acute pulmonary embolism (PE) (in conjunction with warfarin) Prevention of deep vein thrombosis (DVT) after abdominal surgery Prevention of ischemic complications in patients with unstable angina

Prevention of ischemic complications in patients with unstable angina

A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. Of which findings should the nurse immediately notify the healthcare provider? (Select all that apply.) aPTT of 65 seconds aPTT of 40 seconds Nosebleeds aPTT of 100 seconds Platelet count of 300,000/mcL

aPTT of 40 seconds Nosebleeds aPTT of 100 seconds

Which needle length and gauge should the nurse choose to administer subcutaneous heparin? ½ inch; 20 gauge ⅝ inch; 25 gauge 1½ inch; 18 gauge 1 inch; 26 gauge

⅝ inch; 25 gauge

A nursing student who is preparing to care for a postoperative patient with deep vein thrombosis asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct? a. "Heparin has a longer half-life." b. "Heparin has fewer adverse effects." c. "The onset of warfarin is delayed." d. "Warfarin prevents platelet aggregation."

c. "The onset of warfarin is delayed."

A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication? a. Aspirin b. Clopidogrel [Plavix] c. Enoxaparin [Lovenox] d. Warfarin [Coumadin]

c. Enoxaparin [Lovenox]

A patient who is taking clopidogrel [Plavix] calls the nurse to report black, tarry stools and coffee-ground emesis. The nurse will tell the patient to: a. ask the provider about using aspirin instead of clopidogrel. b. consume a diet high in vitamin K. c. continue taking the clopidogrel until talking to the provider. d. stop taking the clopidogrel immediately.

c. continue taking the clopidogrel until talking to the provider.

A patient has been taking warfarin [Coumadin] for atrial fibrillation. The provider has ordered dabigatran etexilate [Pradaxa] to replace the warfarin. The nurse teaches the patient about the change in drug regimen. Which statement by the patient indicates understanding of the teaching? a. "I may need to adjust the dose of dabigatran after weaning off the warfarin." b. "I should continue to take the warfarin after beginning the dabigatran until my INR is greater than 3." c. "I should stop taking the warfarin 3 days before starting the dabigatran." d. "I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2."

d. "I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2."

A 50-year-old female patient asks a nurse about taking aspirin to prevent heart disease. The patient does not have a history of myocardial infarction. Her cholesterol and blood pressure are normal, and she does not smoke. What will the nurse tell the patient? a. Aspirin is useful only for preventing a second myocardial infarction. b. She should ask her provider about using a P2Y12 ADP receptor antagonist. c. She should take one 81-mg tablet per day to prevent myocardial infarction. d. There is most likely no protective benefit for patients her age.

d. There is most likely no protective benefit for patients her age.

A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats per minute. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The nurse will request an order for: a. a repeat aPTT to be drawn immediately. b. analgesic medication. c. changing heparin to aspirin. d. protamine sulfate.

d. protamine sulfate.

The nurse is ready to begin 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? 50 70 90 110

70

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? Administer intravenous (IV) push protamine sulfate. Continue with the current prescription. Prepare to administer vitamin K. Call the healthcare provider to increase the dose.

Call the healthcare provider to increase the dose.

A 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, which finding by the nurse most likely indicates an adverse reaction to this drug? Urticaria, itching, and flushing Blood pressure of 90/50 mm Hg Decreasing level of consciousness Potassium level of 5.5 mEq/L

Decreasing level of consciousness

A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. What medication would be appropriate for this patient who has a history of heparin-induced thrombocytopenia (HIT)? Warfarin [Coumadin] Lepirudin [Refludan] Bivalirudin [Angiomax] Eptifibatide [Integrilin]

Lepirudin [Refludan]

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? Aspirin [Bayer] Omeprazole [Prilosec] Acetaminophen [Tylenol] Warfarin [Coumadin]

Omeprazole [Prilosec]

A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein thrombosis 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 stool for discoloration. Do not start any new medication without first talking to your healthcare provider. Enteric-coated aspirin and any aspirin products can be used unless they cause a gastrointestinal ulcer. No laboratory or home monitoring of international normalized ratio (INR) is required after the first 6 months.

Wear a medical alert bracelet. Check all urine and stool for discoloration. Do not start any new medication without first talking to your healthcare provider.

A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the patient's INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider and: a. administer the dose as ordered. b. request an order to decrease the dose. c. request an order to give vitamin K (phytonadione). d. request an order to increase the dose.

a. administer the dose as ordered.

The nurse has just received an order for tenecteplase [TNKase] for a patient experiencing an acute myocardial infarction. The nurse should administer this drug: a. by bolus injection. b. by infusion pump over 24 hours. c. slowly over 90 minutes. d. via monitored, prolonged infusion.

a. by bolus injection.

A patient who is taking warfarin [Coumadin] has just vomited blood. The nurse notifies the provider, who orders lab work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer: a. phytonadione (vitamin K1) 1 mg IV over 1 hour. b. phytonadione (vitamin K1) 2.5 mg PO. c. protamine sulfate 20 mg PO. d. protamine sulfate 20 mg slow IV push.

a. phytonadione (vitamin K1) 1 mg IV over 1 hour.

A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this patient? a. Aspirin, clopidogrel, omeprazole b. Aspirin, heparin, abciximab [ReoPro] c. Enoxaparin [Lovenox], prasugrel [Effient], warfarin [Coumadin] d. Heparin, alteplase, abciximab [ReoPro]

b. Aspirin, heparin, abciximab [ReoPro]

A patient will begin taking dabigatran etexilate [Pradaxa] to prevent stroke. The nurse will include which statement when teaching this patient? a. Dabigatran should be taken on an empty stomach to improve absorption. b. It is important not to crush, chew, or open capsules of dabigatran. c. The risk of bleeding with dabigatran is less than that with warfarin [Coumadin]. d. To remember to take dabigatran twice daily, a pill organizer can be useful.

b. It is important not to crush, chew, or open capsules of dabigatran.

A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats per minute and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color. A stat CBC shows a platelet count of less than 100,000 mm3. The nurse will: a. administer oxygen and notify the provider. b. discontinue the heparin and notify the provider. c. request an order for protamine sulfate. d. request an order for vitamin K (phytonadione).

b. discontinue the heparin and notify the provider.

A patient is admitted to the emergency department with chest pain. An electrocardiogram shows changes consistent with an evolving myocardial infarction. The patient's cardiac enzymes are pending. The nurse caring for this patient will expect to: a. administer aspirin when cardiac enzymes are completed. b. give alteplase [Activase] within 2 hours. c. give tenecteplase [TNKase] immediately. d. obtain an order for an INR.

b. give alteplase [Activase] within 2 hours.

A patient who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The nurse will anticipate an order to: a. decrease the dose of carbamazepine. b. increase the dose of warfarin. c. perform more frequent aPTT monitoring. d. provide extra dietary vitamin K.

b. increase the dose of warfarin.

A postoperative patient will begin anticoagulant therapy with rivaroxaban [Xarelto] after knee replacement surgery. The nurse performs a history and learns that the patient is taking erythromycin. The patient's creatinine clearance is 50 mL/min. The nurse will: a. administer the first dose of rivaroxaban as ordered. b. notify the provider to discuss changing the patient's antibiotic. c. request an order for a different anticoagulant medication. d. request an order to increase the dose of rivaroxaban.

b. notify the provider to discuss changing the patient's antibiotic.

A patient has been receiving heparin while in the hospital to treat deep vein thromboses and will be discharged home with a prescription for enoxaparin [Lovenox]. The nurse provides teaching for the nursing student who asks about the advantages of enoxaparin over heparin. Which statement by the student indicates a need for further teaching? a. "Enoxaparin does not require coagulation monitoring." b. "Enoxaparin has greater bioavailability than heparin." c. "Enoxaparin is more cost-effective than heparin." d. "Enoxaparin may be given using a fixed dosage."

c. "Enoxaparin is more cost-effective than heparin."

A patient who takes warfarin [Coumadin] is brought to the emergency department after accidentally taking too much warfarin. The patient's heart rate is 78 beats per minute and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any obvious hematoma or petechiae and does not complain of pain. The nurse will anticipate an order for: a. vitamin K (phytonadione). b. protamine sulfate. c. a PTT. d. a PT and an INR.

d. a PT and an INR.

A patient who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the second postoperative day, the nurse assesses the patient and notes an oxygen saturation of 83%, pleuritic chest pain, shortness of breath, and hemoptysis. The nurse will contact the provider to report possible ____ and request an order for ____. a. congestive heart failure; furosemide [Lasix] b. hemorrhage; vitamin K (phytonadione) c. myocardial infarction; tissue plasminogen activator (tPA) d. pulmonary embolism; heparin

d. pulmonary embolism; heparin