Concept of Clotting EAQ

What should the nurse teach a client who is taking Warfarin? a. Report episodes of spontaneous bleeding b. increase the dose with prolonged inactivity c. take antibiotics if injured to prevent infection d. eat a diet with increased quantity of green vegetables

Answer: A Warfarin is an anticoagulant therefore excessive bleeding especially that occurs spontaneously an unrelated to injury may require a dosage adjustment for safety reasons.

Which adverse effect can be seen in a female client with gonadotropin deficiency and undergoing hormone replacement therapy? a. Thrombosis b. Hypotension c. Dehydration d. Increased thirst

Answer: A: A female client with gonadotropin deficient is treated by replacement therapy of combined hormones, namely estrogen and progesterone. The side effect of this therapy is increased risk of thrombosis or formation of blood clots in deep veins.

The nurse is caring for a client with a possible pulmonary embolism. Which diagnostic test should the nurse initially anticipate will be prescribed for this client because it is the evidence-based gold standard for PE diagnosis? a. Spiral (helical) computed tomographic angiography (CTA) b. D-dimer and arterial blood gas (ABG0 laboratory tests c. Ventilation-perfusion (V/Q) scan d. Pulmonary angiography

Answer: A: A spiral (helical) computed tomographic angiography (CTA) is considered the gold standard for a pulmonary embolism (PE) medical diagnosis. The spiral CTA also has the added advantage of diagnosing other pulmonary abnormalities.

While caring for a client who had an open reduction an internal fixation of the hip, the nurse encourages active leg and foot exercises of the unaffected leg every two hours. What does the nurse explain that these exercises will help to do? a. Prevent clot formation b. reduce leg discomfort c. maintain muscle strength d. limit venous inflammation

Answer: A: Active range of motion exercises increase venous return in the unaffected leg, preventing complications of immobility, including thrombophlebitis.

1. A nurse is caring for a group of clients on a medical surgical unit. Which client has the highest risk for developing a pulmonary embolism? a. an obese client with leg trauma b. a pregnant client with acute asthma c. a client with diabetes who has cholecystitis d. a client with pneumonia who is immunocompromised

Answer: A: An obese client with leg trauma has two risk factors for the development of pulmonary embolism obesity and leg trauma.

What interventions should the nurse implement when caring for a client 24-hours post-thyroidectomy? a. Check the sides of the operative site dressing and the back of the neck b. Support the head during mild range of motion exercises c. Encourage the client to ventilate feelings about the surgery d. Advise the client that regular activities can be resumed immediately

Answer: A: Bleeding may occur and blood will pool in the back of the neck due to gravity.

To prepare a client for surgery, which explanation by a nurse would be accurate related to pneumatic compression devices? A. They help the venous blood return to the heart B. They will not cause discomfort but gently massage the legs C. They are used instead of anticoagulant therapy D. They must be worn until the first time the client gets out of bed

Answer: A: Deep vein thrombosis is a potential complication of any surgery lasting longer than 30 minutes. The purpose of pneumatic compression devices is to increase venous return.

1. Four days after the client's total hip arthroplasty the nurse is preparing to transfer the client to a rehabilitation center. Before admission the client took warfarin sodium daily for a history of pulmonary embolus. While hospitalized the client received subcutaneous heparin two times a day. The nurse does not see any anticoagulant therapy listed on the client's transfer prescriptions. What should the nurse do? a. Contact the health care provider to determine which anticoagulant therapy should be prescribed for this client b. arrange for a supply of heparin for the client to take to the rehab center c. explain to the client that anticoagulant therapy will no longer be needed d. instruct the client to talk about anticoagulant needs with the health care provider at the rehabilitation center

Answer: A: Failure to clarify this omission can be life threatening because of the potential for an embolus. Waiting until the client is in the new facility to discuss the administration of an anticoagulant may jeopardize the client status.

A nurse is caring for a client who just had a liver biopsy. After their procedure, the nurse should monitor for which common complication associated with the biopsy? a. Hemorrhage b. gastroparesis c. pulmonary embolism d. tension pneumothorax

Answer: A: In the impaired liver, blood clotting mechanisms are disrupted, and hemorrhage may occur from the trauma of this invasive procedure.

A client is admitted to the hospital with a history of cancer of the liver and jaundice. In relation to the jaundice, the nurse expects the client to report the presence of what symptom? a. Pruritus b. Diarrhea c. Blurred vison Bleeding gums

Answer: A: Itching associated with jaundice is believed to Be caused by accumulating bile salts in the skin.

A client is receiving warfarin. Which test should the nurse use to determine whether the daily dose of this anticoagulant is therapeutic? a. International normalized ratio (INR) b. accelerated partial thromboplastin time (APTT) c. bleeding time d. sedimentation rate

Answer: A: Warfarin initially is prescribed day by day, based on INR blood test results. This test provides a standard system to interpret prothrombin times.

A nurse receives a shift report on 4 adult clients who are between the ages of 25 and 55. Which client should the nurse assess first? a. Male client with a hemoglobin of 15.9 b. Female client on Warfarin with an international normalized ratio of 7.5 c. Female client taking daily calcium supplements with a serum calcium level of 9.4 d. Male client with a blood urea nitrogen of 20 and creatinine of 1

Answer: B: A client on warfarin with an INR of 7.5 should be assessed first by the nurse because this is an elevated result. Normal is considered between 2 and 3.

A nurse teaches a client about wearing thigh high anti embolism elastic stockings. What would be appropriate to include in the instructions? a. You do not need to wear them while you are awake, but it is important to wear them at night. b. You will need to apply them in the morning before you lower your legs from the bed to the floor c. if they bother you, you can roll them down to your knees while you are resting or sitting down d. you can apply them either in the morning or at bedtime, but only after the legs are lower to the floor

Answer: B: Applying anti embolism elastic stockings in the morning before the legs are lowered to the floor prevents excessive blood from collecting and being trapped in the lower extremities as a result of the force of gravity. Elastic stockings are worn to prevent the formation of emboli and thrombi, especially in clients who have had surgery or who have limited mobility, by applying constant compression.

A nurse is reviewing a list of current medications with a client who has developed gastrointestinal bleeding. Which medication prescription should the nurse discuss with the Primary Health care provider? a. Digoxin b. Ibuprofen c. Famotidine d. Atorvastatin

Answer: B: Ibuprofen is a nonsteroidal anti-inflammatory drug that can cause bleeding in the gastrointestinal tract clients with a history of GI bleeding should not take NSAIDs.

A nurse is caring for a client with a diagnosis of Polycythemia Vera. The client asks " Why do I have an increased tendency to develop blood clots?" Which effect of the polycythemia vera should the nurse include in the teaching session? a. Elevated blood pressure b. Increased blood viscosity c. Fragility of the blood cells d. Immaturity of red blood cells

Answer: B: Polycythemia vera results in pathologically high concentrations of erythrocytes in the blood; increased viscosity promotes thrombus formation.

Knee length elastic support stockings are prescribed for a client with varicose veins. What should the nurse teach the client about the elastic stockings? a. The stockings should reach the middle of the knee b. the stocking should be applied before getting out of bed c. the stocking should be applied at the first sign of discomfort d. the stockings may be substituted with loose elastic bandages

Answer: B: To prevent distention of the veins the stocking should be applied before the legs are placed in a dependent position.

Which client is at greatest risk for the development of a venous thrombosis? a. A 76-year-old female with a 100 pack per year smoking history and hypertension b. a 68-year-old male on bed rest following a left hip fracture c. a 59-year-old male who is an intravenous drug user with hyperlipidemia d. A 42-year-old female with Factor V Leiden mutation on warfarin

Answer: B: Venous thrombosis is the result of inflammation to a vein, hypercoagulability, venous stasis, or a combination of the three, known as Virchow triad. Bed rest and hip fracture are two major risk factors for the development of a thrombosis.

What should the nurse monitor when a client is receiving a platelet aggregation inhibitor such as clopidogrel? a. Nausea b. Epistaxis c. Chest pain d. Elevated temperature

Answer: B: the high vascularity of the nose, combined with its susceptibility to trauma, makes it a frequent site of hemorrhage.

Which diagnostic study is used to detect deep vein thrombosis in the client's lower extremities? a. Thermography b. Plethysmography c. Duplex venous doppler d. Somatosensory evoked potential

Answer: C: Duplex venous doppler records an ultrasound of the veins, including blood flow abnormalities of the lower extremities, aiding detection of deep vein thrombosis.

A client is admitted to the hospital with suspected liver disease, and a needle biopsy of the liver is performed. After the procedure, the nurse should maintain the client in what position? a. Supine b. Semi-Fowler c. Right side-lying d. Dorsal recumbent

Answer: C: The liver is on the right side of the body the right sidelying position provides pressure at the needle insertion site and promotes hemostasis.

What should the nurse do to prevent thrombus formation after most surgeries? a. Keep the clients gatched to elevate the knees b. Have the client dangle the legs off the side of the bed c. Have the client use an incentive spirometer every hour d. Encourage the client to ambulate with assistance every few hours

Answer: D: Ambulation is essential to promote venous return and prevent thrombus formation.

Enoxaparin 40 mg subcutaneously daily is prescribed for a client who had abdominal surgery. The nurse explains that the medication is given for what purpose? a. Control postoperative fever b. Provide a constant sources of mild analgesia c. Limit the postsurgical inflammatory response d. Provide prophylaxis against postoperative thrombus formation

Answer: D: Enoxaparin, a low- molecular-weight heparin, prevents the conversion of fibrinogen to fibrin, and of prothrombin to thrombin by enhancing the inhibitory effects of antithrombin III.

A client with a history of herniated nucleus pulposus is scheduled for total hip replacement surgery. To prevent the most common complication associated with this type of surgery, the nurse should instruct the client to perform which activity? A. Straight-leg raises B. Buerger-Allen exercises C. Deep breathing and coughing D. Plantar flexion and dorsiflexion exercises

Answer: D: Planter flexion and dorsiflexion exercises promote venous return, which helps prevent venous thrombus formation, the most common complication after hip surgery.

The day after surgery a client is encouraged to ambulate. The client angrily asks the nurse why am I being made to walk so soon after surgery? How should the nurse explain the primary purpose of early ambulation? a. To promote healing of the incision b. to decrease the incidence of urinary tract infections c. to use energy to help the client sleep better at night d. to keep blood from pooling in the legs to prevent clots

Answer: D: The muscular action during ambulation facilitates the return of venous blood to the heart this reduces venous stasis an minimizes the risk of postoperative thrombophlebitis.

After surgery a client reports sudden Severe chest pain and begins coughing. The nurse suspects that the client has a thromboembolism. What characteristic of the sputum supports the nurses suspicion that the client has a pulmonary embolus? a. Pink b. clear c. green d. yellow

answer: A: With a pulmonary embolus, there is partial or complete occlusion of pulmonary blood flow when infarcted areas or areas of atelectasis is produce alveolar damage, red blood cells move into the alveolar resulting in hemoptysis.