Patho-Pharm: Exam 1 Practice Questions

A patient arrived in the emergency department 2 hours after an acute ischemic stroke. The patient is given an intravenous (IV) injection of alteplase tPA (Activase). It is most important for the nurse to monitor what? (Select all that apply.) A) Bleeding B) Vital signs C) PT levels D) Allergic reactions E) Electrocardiogram

A) Bleeding B) Vital signs D) Allergic reactions E) Electrocardiogram Rationale: The nurse should monitor the patient receiving thrombolytics for adverse effects, such as bleeding, allergic reactions, and cardiac dysrhythmias. An increased heart rate with a decreased BP usually indicates blood loss from bleeding.

The patient develops a deep vein thrombosis. The nurse anticipates administration of which medication? A) Intravenous heparin B) Clopidogrel (Plavix) C) Vitamin K D) Protamine sulfate (Protamine)

A) Intravenous heparin Rationale: Intravenous heparin is indicated for rapid anticoagulant effect when a thrombosis occurs because of a deep vein thrombosis (DVT), pulmonary embolism (PE), or an evolving stroke. The effects of subcutaneous heparin take longer to occur. Clopidogrel (Plavix) is an antiplatelet drug that is mainly for prophylactic use in prevention of myocardial infarction or stroke. Vitamin K is the antidote for warfarin, and protamine is the antidote for heparin.

Four patients are considered as potential candidates for thrombolytic therapy. Which patient is most likely to receive thrombolytic therapy? A) The patient who recently used acetaminophen (Tylenol) B) The patient with a history of severe hypertension C) The patient who recently had spinal surgery D) The patient with a history of warfarin (Coumadin) use

A) The patient who recently used acetaminophen (Tylenol) Rationale: Acetaminophen (Tylenol) does not interfere with the coagulation system. Contraindications for use of thrombolytics include a recent CVA, active bleeding, severe hypertension, recent history of traumatic injury, especially head injury, and anticoagulant therapy. The nurse should report if the patient takes aspirin or NSAIDs.

A patient manifests symptoms of a thrombolic stroke. The emergency department nurse is aware that thrombolytics need to be administered in this situation within how many hours of the onset of symptoms? A) 1 hour B) 2 hours C) 3 hours D) 4 hours

C) 3 hours Rationale: A thrombolytic drug should be administered within 3 hours of a thrombolic stroke.

A patient is on heparin therapy secondary to deep vein thromboses. The nurse has which medication on hand as an antidote in case it is needed? A) Vitamin K B) Protamine sulfate C) Warfarin (Coumadin) D) Aminocaproic acid (Amicar)

B) Protamine sulfate Rationale: Vitamin K is the antidote for warfarin (Coumadin), not heparin, therapy; warfarin (Coumadin) is an anticoagulant, and aminocaproic acid (Amicar) is a plasminogen inactivator used to control excessive bleeding from hyperfibrinolysis.

A patient is transitioning from IV heparin therapy to oral warfarin. The nurse recognizes which laboratory finding that indicates warfarin treatment efficacy? A) Bleeding time of 5 minutes B) Prothrombin time (PT) of 18 seconds C) International normalized ratio (INR) of 2.5 D) Partial thromboplastin time (PTT) of 24.3 seconds

C) International normalized ratio (INR) of 2.5 Rationale: INR is a more accurate measure of anticoagulation therapy because of variations in PT values across different laboratories. The goal of warfarin therapy is usually to maintain the patient's INR between 2.0 and 3.0 regardless of the actual PT in seconds.

A patient is prescribed aspirin, 81 mg, and clopidogrel (Plavix). The nurse identifies the drug classification of clopidogrel as A) anticoagulant. B) thrombotic inhibitor. C) antiplatelet. D) thrombolytic.

C) antiplatelet. Rationale: Clopidogrel is an antiplatelet drug.

The patient is being discharged home on warfarin (Coumadin) therapy. Which information will the nurse include when teaching the patient? A) Results of activated partial thromboplastin time (aPTT) will determine if the medication is effective. B) International normalized ratio (INR) results should be between 2 to 3. C) A normal response to warfarin (Coumadin) is for your stools to look tarry. D) Increase the amount of green leafy vegetables in your diet.

B) International normalized ratio (INR) results should be between 2 to 3. Rationale: Today, international normalized ratio (INR) is the laboratory test most frequently used to report PT results; a value of 2 to 3 is considered acceptable. Partial thromboplastin time (PTT) and activated partial thromboplastin time (aPTT) are laboratory tests to detect deficiencies of certain clotting factors, and these tests are used to monitor heparin therapy. Tarry stools indicate GI bleeding. Green leafy vegetables contain vitamin K, which is the antidote for warfarin (Coumadin).

A patient is recovering from surgery to replace her right hip. In the early postoperative phase, the nurse anticipates administration of which drug to prevent deep vein thrombosis? A) Dipyridamole (Persantine) B) Low-molecular-weight heparin C) Abciximab (ReoPro) D) Anagrelide HCl (Agrylin)

B) Low-molecular-weight heparin Rationale: Low-molecular-weight heparins are derivatives of standard heparin and were introduced to prevent venous thromboembolism. The other drugs are platelet inhibitors. Antiplatelets are used to prevent thrombosis in the arteries by suppressing platelet aggregation.

Which of the following is high priority for the nurse to include when teaching a patient about warfarin (Coumadin) therapy? A. Increase the amount of green, leafy vegetables in your diet. B. Rinse your mouth instead of brushing your teeth. C. Follow up with laboratory tests such as PT or INR to regulate warfarin (Coumadin) dose. D. Use a new razor blade each time you shave.

C. Follow up with laboratory tests such as PT or INR to regulate warfarin (Coumadin) dose. Rationale: Laboratory tests such as PT or INR are performed to regulate warfarin (Coumadin) dose. The patient should avoid consuming large amounts of green, leafy vegetables; broccoli; legumes; soybean oil; coffee; tea; cola; excessive alcohol, and certain nutritional supplements such as coenzyme Q10. Patients are encouraged to perform oral hygiene and use a soft tooth brush to prevent gums from bleeding. Patients should be instructed to use an electric razor when shaving.

The nurse is caring for a patient who received alteplase tPA (Activase) for treatment of acute coronary syndrome. The patient starts to bleed. The nurse anticipates administration of which medication? A) Protamine sulfate (protamine) B) Vitamin K (phytonadione) C) Warfarin (Coumadin) D) Aminocaproic acid (Amicar)

D) Aminocaproic acid (Amicar) Rationale: Aminocaproic acid (Amicar) is used to stop bleeding by inhibiting plasminogen activation, which inhibits thrombolysis.

A patient visits an outpatient clinic. The patient has been noncompliant with anticoagulation therapy and states, "I don't like having to have blood work all of the time." The nurse anticipates prescription of which medication? A) Abciximab (ReoPro) B) Tirofiban (Aggrastat) C) Eptifibatide (Integrilin) D) Rivaroxaban (Xarelto)

D) Rivaroxaban (Xarelto) Rationale: Two oral anticoagulants form a new anticoagulant category called Xa inhibitors. Rivaroxaban (Xarelto) was FDA-approved in July 2011, and apixaban (Eliquis) was FDA-approved in December 2012. These drugs do not require routine coagulation monitoring and are given q.d. or b.i.d. The other medications are administered intravenously.