karch module 4

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 Explanation: Heparin is frequently used to prevent postsurgical venous thromboembolism. Antiplatelet drugs do not have this indication, and vitamin K would increase the client's risks.

The nurse is caring for a 76-year-old client who is receiving IV heparin 5000 units q4h. At the initiation of therapy, the client's control activated thromboplastin time (aPTT) was found to be 35 seconds. One hour prior to the next scheduled dose, aPTT is determined to be 92 seconds. Based on this result, the nurse will:

hold the dose and contact the provider. Explanation: During heparin therapy, aPTT values are typically maintained between 1.5 to 2.5 times the control value. Since an aPTT value of 92 seconds is greater than 2.5 times this client's control value, the anticoagulation effect is too great, and the health care provider should be notified.

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

myocardial infarction. Explanation: Indications for use of clopidogrel include reduction of myocardial infarction, stroke, and vascular death in clients with atherosclerosis and in those after placement of coronary stents. It is not indicated in the treatment of ITP, CVA, or hemophilia.

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

vitamin K Explanation: Vitamin K is the antidote for warfarin overdose. Aminocaproic acid is used to control excessive bleeding from systemic hyperfibrinolysis. Platelets are a blood product, not a medication. Protamine sulfate is the antidote for heparin therapy.

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." Explanation: Aspirin is an antiplatelet agent that can increase the effect of warfarin. Clients taking warfarin should check with a health care professional before taking any analgesic. The other statements suggest that the client understands important aspects of warfarin therapy.

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

"I will avoid herbal remedies." Explanation: Most commonly used herbs and supplements have a profound effect on drugs for anticoagulation. The client should never double up on dosing related to a missed dose. The client should avoid green leafy vegetables due to vitamin K. The client should not discontinue his or her medications without first consulting with the primary health care provider.

A client is receiving low-molecular-weight heparin to prevent thromboembolic complications. The nursing student asks the instructor the reason why this treatment is given instead of heparin. What is the instructor's best explanation of the rationale for LMWH over heparin?

"LMWH is associated with less thrombocytopenia than standard heparin." Explanation: Low-molecular-weight heparins are associated with less thrombocytopenia than standard heparin. Low-molecular-weight heparin is not stronger than standard heparin. Low-molecular-weight heparin is administered cautiously in clients with blood dyscrasia and hypertension.

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

2.4 Explanation: When anticoagulant therapy is used, the INR is maintained between 2 and 3. The other values are not therapeutic.

A nurse will use extreme caution when administering heparin to which patient?

A 38-year-old male with peptic ulcer disease Explanation: Heparin should be administered with extreme caution to patients with peptic ulcer or liver disease or after surgery because those patients would have greater risk for hemorrhage or excessive blood loss. Urticaria is a listed adverse effect of taking heparin and would therefore be expected. A patient who takes heparin would be advised to not drink heavily or smoke, but neither would have the safety risk posed by a patient with peptic ulcer. A patient with an accelerated heart rate and on heparin therapy would be at no special risk.

A client presenting with which clinical situation is a candidate for enoxaparin therapy?

A post-surgical hip replacement A post-surgical gastric resection History of unstable angina Post non-Q-wave myocardial infarction Explanation: Enoxaparin is prescribed for the prevention of deep vein thrombosis (DVT) that may lead to pulmonary embolism (PE) after hip replacement or abdominal surgery; prevention of ischemic complications of unstable angina or non-Q-wave MI; prevention of DVT in patients with severely restricted mobility due illness. Enoxaparin is not prescribed for the management of atrial fibrillation.

A nurse is caring for a patient receiving the anticoagulant drug warfarin. What pre-administration assessments should the nurse perform before administering the drug to the patient?

Assess prothrombin time (PT) and INR. Explanation: The nurse should assess the prothrombin time (PT) and INR before administering the anticoagulant drug warfarin to the patient. Observing for signs of thrombus formation, assessing for signs of bleeding, and monitoring for hypersensitivity reaction are the ongoing assessments performed in patients who are administered warfarin.

Which genetic clinical condition will likely, over the course of the client's lifetime, require the pharmaceutical introduction of clotting factors to assure the client's safety?

Hemophilia Explanation: Hemophilia is a genetic lack of clotting factors that leaves the patient vulnerable to excessive bleeding with any injury. Treatment of classic hemophilia with antihemophilic factor provides temporary replacement of clotting factors to correct or prevent bleeding episodes or to allow necessary surgery. Bone marrow disorders are disorders in which platelets are not formed in sufficient quantity to be effective. Neither diabetes nor cystic fibrosis is treated with antihemophilic agents.

The nurse is preparing to administer protamine emergently to a client per instructions from the health care provider. The nurse concludes this is necessary due to an adverse reaction to which drug?

Heparin Explanation: An overdosage of any anticoagulant may result in uncontrolled bleeding in the client. In most cases, discontinuation of the drug is usually sufficient to correct overdosage; however, if the bleeding is severe there are antidotes. Protamine is used to treat overdose of heparin and low-molecular-weight heparins (LMWHs). Vitamin K is used to treat the overdosage of warfarin. Alteplase and clopidogrel do not require antidotes.

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. Explanation: Heparin is administered parenterally, while warfarin is administered orally. Warfarin is administered after heparin therapy to complete treating a thrombus or embolism. Clients receiving heparin therapy will begin taking warfarin before they discontinue heparin. This overlap allows the warfarin to reach a therapeutic level before heparin is discontinued. However, both drugs are used to treat thrombosis and thromboembolic disorders and have equally serious adverse effects, such as bleeding. Anticoagulants, such as warfarin and heparin, prevent new clot formation or extension of an existing clot, while thrombolytics dissolve existing blood clots.

Mr. Hon has been admitted to the hospital and placed on anticoagulant therapy. For what blood-related disorder is this therapy used?

Hypercoagulation Explanation: Anticoagulants are used to treat hypercoagulation, or excessive coagulation. They prevent the blood from clotting unexpectedly and maintain the flow of blood. Hemophilia is treated with human factor IX complex. Blood cancer is treated with therapies such as chemotherapy or radiation treatment. On the other hand, hemostasis is the process by which the body prevents excessive blood flow during an injury.

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

Increased risk for bleeding Explanation: The nurse should inform the client about the increased risk for bleeding, which is an effect of the interaction between warfarin and the herb. Decreased effectiveness of chamomile, increased absorption of warfarin, and increased risk for hypertension are not effects of the interaction between warfarin and chamomile.

A client is receiving warfarin. Which would the nurse monitor to determine the effectiveness of therapy? (Select all that apply.)

International normalized ratio Prothrombin time Explanation: INR is used to monitor the effects of warfarin. Prothrombin time is used to monitor the effects of warfarin. Whole blood clotting time is used to monitor the effects of heparin. Partial thromboplastin time is used to monitor the effects of heparin. Vitamin K levels are not used to monitor the effects of anticoagulants.

A 75-year-old client presents to the health care provider's office with bleeding gums and multiple bruises. When the nurse reviews the client's drug history, the nurse finds that the client is prescribed aspirin 81 mg/d. What drug may cause increased bleeding when used in conjunction with the aspirin?

NSAIDs Explanation: NSAIDs, which are commonly used by older adults, also have antiplatelet effects. Clients who take an NSAID daily may not need low-dose aspirin for antithrombotic effects.

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 Explanation: The nurse should instruct the client and family members to report the presence of blood in urine or stools and any bleeding from the gums, nose, vagina, or wounds. The anticoagulation properties of heparin can sometimes result in abnormal bleeding. Sleepiness, drowsiness, skin rash, and dizziness are not commonly identified adverse effects of the drug.

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 Explanation: If a client who receives IV heparin is found to be highly anticoagulated, protamine sulfate may be prescribed. Protamine sulfate, which is a strong base, reacts with heparin, which is a strong acid, to form a stable salt, thereby neutralizing the anticoagulant effects of heparin. Protamine sulfate does not produce the same effects for coumadin, alteplase, or ticlopidine.

A client exhibits signs and symptoms of heparin overdose. The nurse would anticipate administering:

Protamine sulfate Explanation: Protamine sulfate is the antidote for heparin overdose. Vitamin K is the antidote for warfarin overdose. Urokinase is a thrombolytic. Drotrecogin alfa is a C-reactive protein that has anticoagulant effects.

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

Subcutaneous injection Explanation: Enoxaparin (Lovenox) is administered via subcutaneous injection. Intramuscular (IM) administration is avoided because of the possibility of the development of local irritation, pain, or hematoma (a collection of blood in the tissue). Intravenous infusions are used with several anticoagulants such as heparin. Warfarin is given orally.

A 50-year-old man has undergone a bunionectomy and has been admitted to the postsurgical unit. What aspect of the man's medical history would contraindicate the use of heparin for deep vein thrombosis (DVT) prophylaxis?

The man has a diagnosis of ulcerative colitis (UC). Explanation: GI ulcerations contraindicate the use of heparin since it is a frequent site of heparin-induced bleeding. Obesity, diabetes, and previous MI do not rule out the safe use of heparin.

What would be considered a topical hemostatic agent?

Thrombin Explanation: Thrombin is a topical hemostatic agent. Protamine sulfate is the antidote for heparin. Pentoxifylline is a hemorrheologic agent (one that can induce hemorrhage). Urokinase is a thrombolytic agent.

What laboratory value will the nurse prioritize when providing care for a client prescribed intravenous heparin?

aPTT Explanation: Prescribers use the activated partial thromboplastin time (aPTT), which is sensitive to changes in blood clotting factors, except factor VII, to regulate heparin dosage. D-dimer test is used to help rule out deep vein thrombosis (DVT) and pulmonary embolism (PE). A platelet count measures how many platelets are present in the blood. Platelets are parts of the blood that help the blood clot. Factor XIII levels are assessed when diagnosing/managing hemophilia A.

The nurse is concerned that the health care provider does not order routine aPTTs when the client is receiving LMWH for thromboembolism prophylaxis. When the nurse calls the provider with the nurse's concern, what will be the response?

aPTTs are not needed. Explanation: Monitoring of aPTT is not necessary with low-dose standard heparin given sub-Q for prophylaxis of thromboembolism or with the LMWHs.

A 79-year-old woman has been brought to the emergency department by ambulance with signs and symptoms of ischemic stroke. The care team would consider the immediate (STAT) administration of what drug?

alteplase Explanation: Alteplase is used as first-line therapy for the treatment of acute ischemic stroke in selected people. Vitamin K would exacerbate the woman's symptoms, and LMWH and clopidogrel would be ineffective