Pharm Cardio - Coagulation Modifiers (ch 26)

warfarin: therapeutic PT levels

18-24 seconds (1.5 times the control value)

Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit? 1. Vitamin K 2. Protamine sulfate 3. Potassium chloride 4. Aminocaproic acid (Amicar)

2. Protamine sulfate NCLEX

The nurse is caring for a patient admitted with gastrointestinal bleeding who is anticoagulated with warfarin (Coumadin). Which medication should the nurse anticipate administering? 1. Vitamin E 2. Vitamin K (Phytonadione) 3. Protamine (Protamine sulfate) 4. Calcium gluconate

2. Vitamin K (Phytonadione) Pharm text ch 26

A client is receiving a heparin infusion. The nurse determines that the client is receiving the therapeutic effects based on which results? 1. PT time of 12.5 seconds 2. aPTT of 60 seconds 3. aPTT of 28 seconds 4. aPTT longer than 120 seconds

2. aPTT of 60 seconds -PT is for warfarin -60-80 seconds is normal for heparin therapy NCLEX

A client with atrial fibrillation who is receiving maintenance therapy of warfarin sodium has a PT of 35 sec and an INR of 3.5. On the basis of these laboratory values, the nurse anticipates which prescription? 1. adding a dose of heparin sodium 2. holding the next dose of warfarin 3. increasing the next dose of warfarin 4. administering the next dose of warfarin

2. holding the next dose of warfarin -PT = 18-24 sec (pt's value of 35 is high) -INR = 2-3.5 sec (pt's value of 3.5 is on the high end) NCLEX

While preparing a patient with acute chest pain for an emergency angioplasty, the nurse would anticipate administering which medication to prevent platelet aggregation? A. tirofiban (Aggrastat) B. protamine sulfate C. warfarin (Coumadin) D. aminocaproic acid (Amicar)

A. tirofiban (Aggrastat) (tirofiban = antiplatelet)

While observing a patient self-administer enoxaparin (Lovenox), the nurse identifies the need for further teaching when the patient completes which action? A. Does not aspirate prior to injecting the medication B. Massages the site after administration of the medication C. Administers the medication greater than 2 inches away from the umbilicus D. Injects the medication and then waits 10 seconds before withdrawing the needle

B. Massages the site after administration of the medication

Which statement when made by the patient indicates deficient knowledge regarding warfarin? A. "I will avoid contact sports." B. "I will take my medication in the early evening each day." C. "I will increase the dark green leafy vegetables in my diet." D. "I will contact my physician if I develop excessive bruising."

C. "I will increase the dark green leafy vegetables in my diet."

alteplase: routes

IV

warfarin: routes

PO

warfarin: initiate bleeding precautions if the PT value is longer than ___ seconds and the INR is greater than ___

PT longer than 30 seconds and INR greater than 3.0 (NCLEX)

The nurse is assessing a pt who has a new prescription for vorapraxar (Zontivity). Which of these conditions are considered contraindications to the use of vorapaxar? (Select all that apply) a. impaired renal function b. impaired liver function c. history of myocardial infarction d. peripheral artery disease e. history of stroke

a. impaired renal function b. impaired liver function e. history of stroke (vorapraxar = antiplatelet) Pharm

During teaching of a pt who will be taking warfarin sodium (Coumadin) at home, which statement by the nurse is correct regarding OTC drug use? a. "Choose nonsteroidal antiinflammatory drugs as need for pain relief." b. "Aspirin products may result in increased bleeding." c. "Vitamin E therapy is recommended to improve the effect of warfarin." d. "Mineral oil is the laxative of choice while taking anticoagulants."

b. "Aspirin products may result in increased bleeding." workbook

The nurse determines the patient has a good understanding of the discharge instructions regarding warfarin (Coumadin) with which patient statement? a. "I should keep taking ibuprofen for my arthritis." b. "I should use a soft toothbrush for dental hygiene." c. "I should decrease the dose if I start bruising easily." d. "I will double my dose if I forget to take it the day before."

b. "I should use a soft toothbrush for dental hygiene." Pharm text ch 26

The nurse is teaching a pt about self-administration of enoxaparin (Lovenox). Which statement will be included in this teaching session? a. "We will need to teach a family member how to give this drug in your arm." b. "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel." c. "This drug needs to be taken at the same time every day with a full glass of water." d. "Be sure to massage the injection site thoroughly after giving the drug."

b. "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel." Pharm

A nurse is caring for a patient with a diagnosis of deep venous thrombosis (DVT). The patient has an order to receive 30 mg enoxaparin (Lovenox). Which injection site should the nurse use to administer this medication safely? a. Buttock, upper outer quadrant b. Abdomen, anterior-lateral aspect c. Back of the arm, 2 inches away from a mole d. Anterolateral thigh, with no scar tissue nearby

b. Abdomen, anterior-lateral aspect MS ch 37

The nurse is reviewing the laboratory test results for a 68-yr-old patient whose warfarin (Coumadin) therapy was terminated during the preoperative period. On postoperative day 2, the international normalized ratio (INR) result is 2.7. Which action by the nurse is most appropriate? a. Hold the daily dose of warfarin. b. Administer the daily dose of warfarin. c. Teach the patient signs and symptoms of bleeding. d. Call the physician to request an increased dose of warfarin.

b. Administer the daily dose of warfarin. (therapeutic INR = 2-3 or 2-3.5) MS ch 37

The nurse is caring for a patient with a recent history of deep vein thrombosis (DVT) who is scheduled for an emergency appendectomy. Vitamin K is ordered for immediate administration. The international normalized ratio (INR) value is 1.0. Which nursing action is most appropriate? a. Administer the medication as ordered. b. Hold the medication and record in the electronic medical record. c. Hold the medication until the lab result is repeated to verify results. d. Administer the medication and seek an increased dose from the health care provider.

b. Hold the medication and record in the electronic medical record. (Warfarin impairs the ability of the blood to clot. Therefore, it may be necessary to give vitamin K before surgery to reduce the risk of hemorrhage. However, the INR value is normal, and vitamin K is not required, so the medication would be held and recorded in the electronic medical record.) MS ch 37

The nurse is caring for a newly admitted patient with vascular insufficiency. The patient has a new order for enoxaparin (Lovenox) 30 mg subcutaneously. What should the nurse do to correctly administer this medication? a. Spread the skin before inserting the needle. b. Leave the air bubble in the prefilled syringe. c. Use the back of the arm as the preferred site. d. Sit the patient at a 30-degree angle before administration.

b. Leave the air bubble in the prefilled syringe. (The nurse should not expel the air bubble from the prefilled syringe because it should be injected to clear the needle of medication and avoid leaving medication in the needle track in the tissue.) MS ch 37

Which assessment finding would alert the nurse that a postoperative patient is not receiving the beneficial effects of enoxaparin (Lovenox)? a. Crackles bilaterally in the lung bases b. Pain and swelling in a lower extremity c. Absence of arterial pulse in a lower extremity d. Abdominal pain with decreased bowel sounds

b. Pain and swelling in a lower extremity (enoxaparin is used to prevent DVT postoperatively) MS ch 37

A pt is starting warfarin (Coumadin) therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? (Select all that apply) a. teach proper subcutaneous injection b. administer the oral dose at the same time every day c. assess carefully for excessive bruising or unusual bleeding d. monitor laboratory results for a target INR of 2 to 3 e. monitor laboratory results from a therapeutic aPTT value of 1.5 to 2.5 times the control value

b. administer the oral dose at the same time every day c. assess carefully for excessive bruising or unusual bleeding d. monitor laboratory results for a target INR of 2 to 3 -warfarin = PO -aPTT = heparin Pharm

A nurse is planning to administer IV alteplase to a client who is demonstrating manifestations of a massive pulmonary embolism. Which of the following interventions should the nurse plan to take? a. administer IM enoxaparin along with the alteplase dose b. hold direct pressure on puncture sites for up to 30 min c. administer aminocaproic acid IV prior to alteplase infusion d. prepare to administer alteplase within 8 hr of manifestation onset

b. hold direct pressure on puncture sites for up to 30 min ATI

The nurse is preparing a pt's morning medications and, upon reviewing the list of drugs, notes that the pt is to receive heparin 5000 units and enoxaparin (Lovenox), both subcutaneously. What is the nurse's priority action? a. administer the drugs in separate sites b. hold the drugs and clarify the order with the prescriber c. administer the enoxaparin and hold the heparin d. check the pt's aPTT

b. hold the drugs and clarify the order with the prescriber workbook

A nurse is planning to administer subcutaneous enoxaparin 40 mg using a prefilled syringe of enoxaparin 40 mg/0.4 mL to an adult client following hip arthroplasty. Which of the following actions should the nurse plan to take? a. expel the air bubble from the prefilled syringe before injecting b. insert the needle completely into the client's tissue c. administer injections in the client's thigh d. aspirate carefully after inserting the needle into the client's skin

b. insert the needle completely into the client's tissue ATI

A nurse is preparing to inject heparin subcutaneously for a client who is postoperative. Which of the following actions should the nurse take? a. use a 22-gauge needle b. select a site on the client's abdomen c. spread the skin with the thumb and index finger d. observe for bleb formation to confirm proper placement

b. select a site on the client's abdomen ATI Fund

Which statement is true regarding enoxaparin (Lovenox) and dalteparin (Fragmin)? a. their MOA is to interrupt vitamin K-dependent clotting factors b. they do not require clotting time monitoring c. they are administered deep IM d. they have thrombolytic properties

b. they do not require clotting time monitoring workbook

A patient tells the nurse that he likes to eat large amounts of garlic "to help lower his cholesterol levels naturally." The nurse reviews his medication history and notes that which drug has a potential interaction with the garlic? a. acetaminophen (Tylenol) b. warfarin (Coumadin) c. digoxin (Lanoxin) d. phenytoin (Dilantin)

b. warfarin (Coumadin)

A postoperative patient asks the nurse why the physician ordered daily administration of enoxaparin (Lovenox). Which reply by the nurse is most appropriate? a. "This medication will help prevent breathing problems after surgery, such as pneumonia." b. "This medication will help lower your blood pressure to a safer level, which is very important after surgery." c. "This medication will help prevent blood clots from forming in your legs until your level of activity, such as walking, returns to normal." d. "This medication is a narcotic pain medication that will help take away any muscle aches caused by positioning on the operating room table."

c. "This medication will help prevent blood clots from forming in your legs until your level of activity, such as walking, returns to normal." MS ch 37

A patient is receiving instructions regarding warfarin therapy and asks the nurse about what medications she can take for headaches. The nurse will tell her to avoid which type of medication? a. opioids b. acetaminophen (Tylenol) c. NSAIDs d. there are no restrictions while taking warfarin

c. NSAIDs Pharm text ch 26

The nurse is caring for a preoperative patient who has an order for vitamin K by subcutaneous injection. The nurse should verify that which laboratory study is abnormal before administering the dose? a. Hematocrit (Hct) b. Hemoglobin (Hgb) c. Prothrombin time (PT) d. Partial thromboplastin time (PTT)

c. Prothrombin time (PT) (vitamin K = antidote for warfarin, PT = lab test for warfarin) MS ch 37

When administering subcutaneous heparin, the nurse will remember to perform which action? a. use the same sites for injection to reduce trauma b. use a 1-inch needle for subcutaneous injections c. inject the medication without aspirating for blood return d. massage the site after the injection to increase absorption

c. inject the medication without aspirating for blood return workbook

A nurse is caring for a client who has atrial fibrillation and a new prescription for dabigatran to prevent development of thrombosis. Which of the following medications is prescribed concurrently to treat an adverse effect of dabigatran? a. vitamin K b. protamine c. omeprazole d. probenecid

c. omeprazole -dabigatran = direct thrombin inhibitor -omeprazole = proton pump inhibitor, for pts taking dabigatran who have abdominal pain and other GI adverse effects ATI

A pt is receiving dabigatran (Pradaza), 150 mg twice daily, as part of treatment for atrial fibrillation. Which condition, if present, would be a concern if the pt were to receive this dose? a. asthma b. elevated liver enzymes c. renal impairment d. history of myocardial infarction

c. renal impairment (dabigatran = anticoagulant) Pharm

what to do if aPTT is >90 seconds?

↓ dosage of heparin

warfarin and heparin MOA/drug class

-anticoagulant -prevent or delay coagulation

aspirin MOA/drug class

-antiplatelet -prevent platelet plugs from forming

alteplase adverse effects (2)

-bleeding -dysrhythmias

symptoms of hemorrhage/overdose (5)

-bleeding gums -bruising/petechiae/hematomas -black, tarry stools (GI bleed) -tachycardia -hypotension

anticoagulant adverse effects (2)

-hemorrhage -thrombocytopenia (↓ platelets)

pt teaching: how to prevent bleeding (2)

-shave with an electric razor -use a soft-bristle toothbrush to prevent gum bleeding

heparin: routes

-subcutaneous injection -IV infusion (can't be absorbed by the intestinal tract)

pt teaching: taking warfarin (2)

-take at the same time every day -monitor for symptoms of bleeding: nosebleeds, bruising, black tarry stools

alteplase MOA/drug class

-thrombolytic -dissolve thrombi that have already formed

A nurse is monitoring a client who takes aspirin 81 mg PO daily. The nurse should identify which of the following manifestations as adverse effects of daily aspirin therapy? Select all that apply: 1. Hypertension 2. Coffee-ground emesis 3. Tinnitus 4. Paresthesias of the extremities 5. Nausea

2. Coffee-ground emesis 3. Tinnitus 5. Nausea ATI Pharm ch 25

anticoagulant indications (5)

-MI -atrial fibrillation -unstable angina -mechanical heart valve -DVT prophylaxis

heparin interactions (2)

-NSAIDs -aspirin

warfarin interactions (4)

-NSAIDs -aspirin -acetaminophen -foods high in vitamin K (green leafy vegetables)

laboratory test(s) to measure the effectiveness of warfarin therapy

-PT (prothrombin time) -INR (international normalized ratio)

alteplase indications (3)

-acute MI -ischemic stroke -pulmonary embolism

nursing interventions: heparin injections (5)

-administer injections in the abdomen at least 2" from the umbilicus -do not aspirate before injection -apply gentle pressure for 1-2 min after injection -do not massage site after injection -rotate injection sites

For a patient receiving an IV infusion of alteplase (Activase), which nursing actions should be taken? (Select all that apply.) 1. Assess for cardiac dysrhythmias. 2. Administer injections intramuscularly. 3. Record vital signs and report changes. 4. Monitor for an increase in liver enzymes. 5. Observe for signs and symptoms of bleeding.

1. Assess for cardiac dysrhythmias. 3. Record vital signs and report changes. 5. Observe for signs and symptoms of bleeding. Pharm text ch 26

Anticoagulant therapy is appropriate for which conditions? Select all that apply: 1. Atrial fibrillation 2. Thrombocytopenia 3. Myocardial infarction 4. Presence of mechanical heart valve 5. Aneurysm 6. Leukemia

1. Atrial fibrillation 3. Myocardial infarction 4. Presence of mechanical heart valve workbook

Which medication is an antiplatelet drug? 1. Clopidogrel (Plavix) 2. Alteplase (Activase) 3. Heparin (Hemochron) 4. Enoxaparin (Lovenox)

1. Clopidogrel (Plavix) -alteplase = thrombolytic -heparin = anticoagulant -enoxaparin = anticoagulant Pharm text ch 26

The nurse recognizes that the patient understands the teaching about warfarin (Coumadin) when the patient verbalizes an increased risk of bleeding with concurrent use of which herbal product? (Select all that apply.) 1. Garlic 2. Ginkgo 3. Dong quai 4. Glucosamine 5. St. John's wort

1. Garlic 2. Ginkgo 3. Dong quai 5. St. John's wort Pharm text ch 26

The nurse notes a patient's international normalized ratio (INR) value of 2.5. What is the meaning of this reported value? 1. The patient's warfarin dose is within the therapeutic range. 2. The patient needs the subcutaneous heparin dose increased. 3. The patient is not receiving enough warfarin for a therapeutic effect. 4. The patient is receiving too much heparin and is at risk for bleeding.

1. The patient's warfarin dose is within the therapeutic range. (INR of 2-3.5 is therapeutic) Pharm text ch 26

warfarin: therapeutic INR levels

2-3

A client who had surgery 3 days earlier is receiving heparin sulfate by subcutaneous injection every 12 hours. In planning for the client's morning care, the priority nursing intervention is which action? 1. Allow the client to sit only at the bedside. 2. Assist the client to shave using an electric razor. 3. Monitor the prothrombin time (PT) every 4 hours. 4. Tell the client that brushing the teeth is not allowed.

2. Assist the client to shave using an electric razor.

A client with atrial fibrillation secondary to mitral stenosis is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium 7.5 mg at 5:00 pm daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT) = 32 seconds; internationalized normalized ratio (INR) = 1.3. The nurse should plan to take which action based on the client's laboratory results? 1. Collaborate with the health care provider (HCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed. 2. Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed. 3. Collaborate with the HCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range. 4. Collaborate with the HCP to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate (Pradaxa) in place of warfarin sodium.

2. Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed. -When a pt is taking warfarin for clot prevention due to atrial fibrillation, an INR of 2-3 is appropriate. Until the INR has achieved a therapeutic range, the pt should be maintained on a continuous heparin infusion with the aPTT ranging between 60-80 sec. -heparin = aPTT (aPTT = 60-80 sec) -warfarin = PT and INR (INR = 2-3.5) NCLEX

A patient has received a double dose of heparin during surgery and is bleeding through the incision site. While the surgeons are working to stop the bleeding, the nurse will prepare to take what action at this time? 1. Give IV vitamin K as an antidote 2. Give IV protamine sulfate as an antidote 3. Call the blood bank for an immediate platelet infusion 4. Obtain an order for packed red blood cells

2. Give IV protamine sulfate as an antidote Pharm text ch 26

During thrombolytic therapy, the nurse monitors for bleeding. Which symptoms may indicate a serious bleeding problem? Select all that apply: 1. Hypertension 2. Hypotension 3. Decreased LOC 4. Increased pulse rate 5. Restlessness

2. Hypotension 3. Decreased LOC 4. Increased pulse rate 5. Restlessness workbook

The home care nurse instructs a client on how to administer enoxaparin subcutaneously. Which statement, if made by the client, indicates an understanding of how to administer this medication? 1. "I need to hold my skin flat before I put the needle into my skin." 2. "I need to massage the skin with the alcohol wipe after I give the injection." 3. "A syringe that has a small ⅝-inch (1.5 cm) needle is used to administer the injection." 4. "I need to pull back on the syringe and aspirate before pushing the medication into my skin."

3. "A syringe that has a small ⅝-inch (1.5 cm) needle is used to administer the injection." NCLEX

A client is diagnosed with an ST-segment elevation myocardial infarction (STEMI) and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention? 1. Monitor for kidney failure. 2. Monitor psychosocial status. 3. Monitor for signs of bleeding. 4. Have heparin sodium available.

3. Monitor for signs of bleeding. (alteplase = thrombolytic - hemorrhage is a complication) NCLEX

Which of the findings would the nurse expect to observe in the patient experiencing heparin-induced thrombocytopenia? 1. RBC count of 3.0/mL 2. WBC count of less than 5000/mL 3. Platelet count of 50,000/mL 4. Creatine kinase of 230 U/L

3. Platelet count of 50,000/mL workbook

A nurse is caring for a hospitalized patient who is receiving IV heparin for a deep-vein thrombosis. The client begins vomiting blood. After the heparin has been stopped, which medication should the nurse prepare to administer? 1. Vitamin K 2. Atropine 3. Protamine 4. Calcium gluconate

3. Protamine ATI Pharm ch 25

A thrombolytic is administered in the hospital emergency department to a client who has had a myocardial infarction. The client's spouse asks the nurse about the purpose of the medication. The nurse bases the response on which fact regarding this medication? 1. Thrombolytics suppress the production of fibrin. 2. Thrombolytics act to prevent thrombus formation. 3. Thrombolytics act to dissolve thrombi that have already formed. 4. Thrombolytics have been proved to reverse all detrimental effects of heart attacks.

3. Thrombolytics act to dissolve thrombi that have already formed. NCLEX

The nurse should report which assessment findings to the health care provider (HCP) before initiating thrombolytic therapy in a client with pulmonary embolism? 1. adventitious breath sounds 2. temperature of 99.4 F (37.4 C) orally 3. blood pressure of 198/110 4. respiratory rate of 28 breaths/min

3. blood pressure of 198/110 (thrombolytic therapy is contraindicated in severe hypertension because of the risk of cerebral hemorrhage) NCLEX

A client receiving thrombolytic therapy with a continuous infusion of alteplase suddenly becomes extremely anxious and complains of itching. The nurse hears stridor and notes generalized urticaria and hypotension. Which nursing action is the priority? 1. administer oxygen and protamine sulfate 2. cut the infusion rate in half and sit the client up in bed 3. stop the infusion and call for the Rapid Response Team (RRT) 4. administer diphenhydramine and epinephrine and continue the infusion

3. stop the infusion and call for the Rapid Response Team (RRT) (the pt is experiencing an anaphylactic reaction) NCLEX

The nurse provides discharge instructions to a client who is taking warfarin sodium. Which statement, by the client, reflects the need for further teaching? 1. "I will avoid alcohol consumption." 2. "I will take my pills every day at the same time." 3. "I have already called my family to pick up a MedicAlert bracelet." 4. "I will take coated aspirin for my headaches because it will coat my stomach."

4. "I will take coated aspirin for my headaches because it will coat my stomach." (aspirin-containing products need to be avoided when a pt is taking warfarin) NCLEX

The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin (Hemochron)? 1. Prothrombin time (PT) 2. Blood urea nitrogen 3. Complete blood count 4. Activated partial thromboplastin time (aPTT)

4. Activated partial thromboplastin time (aPTT) Pharm text ch 26

Which drug is most often used for deep vein thrombosis prevention after major orthopedic surgery, even after the patient has gone home? 1. Antiplatelet drugs, such as aspirin 2. Adenosine diphosphate (ADP) inhibitors, such as clopidogrel (Plavix) 3. Anticoagulants, such as warfarin sodium (Coumadin) 4. Low-molecular-weight heparins, such as enoxaparin (Loxenox)

4. Low-molecular-weight heparins, such as enoxaparin (Loxenox) workbook

A client brought into the emergency department states that he has accidentally been taking 2 times his prescribed dose of warfarin for the past week. After noticing that the client has no evidence of obvious bleeding, the nurse plans to take which action? 1. prepare to administer an antidote 2. draw a sample for type and crossmatch and transfuse the client 3. draw a sample for an aPTT level 4. draw a sample for PT and INR

4. draw a sample for PT and INR (to determine the pt's coagulation status and risk of bleeding, will determine how to best treat the pt) NCLEX

A client is receiving a continuous intravenous infusion of heparin sodium to treat deep vein thrombosis. The client's aPTT is 65 sec. The nurse anticipates that which action is needed? 1. discontinuing the heparin infusion 2. increasing the rate of the heparin infusion 3. decreasing the rate of the heparin infusion 4. leaving the rate of the heparin infusion as is

4. leaving the rate of the heparin infusion as is (aPTT for a pt on heparin is 60-80 sec) NCLEX

A nurse is caring for a client receiving continuous heparin infusion. What lab test should the nurse review prior to adjusting the client's heparin? A) aPTT B) PT C) INR D) WBC count

A) aPTT ATI

heparin: therapeutic aPTT levels

NCLEX, ATI: 60-80 seconds Pharm text: 45-70 seconds (1.5 to 2.5 times the control or baseline value)

laboratory test(s) to measure the effectiveness of heparin therapy

aPTT (activated partial thromboplastin time)

What drug is recommended to prevent platelet aggregation for stroke prevention by the American Stroke Society?

aspirin

A patient is prescribed oral anticoagulant therapy while still receiving IV heparin infusion. The patient is concerned about risk for bleeding. What is the nurse's best response? a. "Bleeding is a common adverse effect of taking warfarin. If bleeding occurs, your health care provider will prescribe an injection of medication to stop the bleeding." b. "Because you are now getting out of bed and walking around, you have a higher risk of blood clot formation and therefore need to be on both medications." c. "Because of your mechanical valve replacement, it is especially important for you to be fully anticoagulated, and the heparin and warfarin together are more effective than one alone." d. "It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin infusion is continued to help prevent blood clots until the warfarin reaches its therapeutic effect."

d. "It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin infusion is continued to help prevent blood clots until the warfarin reaches its therapeutic effect." Pharm text ch 26

Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This medication is in which drug class? a. Thrombolytic drug b. Oral anticoagulant c. Glycoprotein IIb/IIIa inhibitor d. Low-molecular-weight heparin

d. Low-molecular-weight heparin Pharm text ch 26

The nurse is preparing to administer a scheduled dose of enoxaparin (Lovenox) 30 mg subcutaneously. What should the nurse do to administer this medication correctly? a. Remove the air bubble in the prefilled syringe. b. Aspirate before injection to prevent IV administration. c. Rub the injection site after administration to enhance absorption. d. Pinch the skin between the thumb and forefinger before inserting the needle.

d. Pinch the skin between the thumb and forefinger before inserting the needle. MS ch 37

The nurse is monitoring a pt who is receiving antithrombolytic therapy in the emergency department because of a possible MI. Which adverse effect would be of the greatest concern at this time? a. dizziness b. blood pressure of 130/98 c. slightly bloody oozing from the IV insertion site d. irregular heart rhythm

d. irregular heart rhythm Pharm

A nurse is reviewing laboratory results for a patient who is receiving heparin via continuous IV infusion for deep-vein thrombosis. The nurse should discontinue the medication infusion for what patient finding? a. potassium 5.0 mEq/L b. aPTT 2 times the control c. hemoglobin 15 g/dL d. platelets 96,000/mm³

d. platelets 96,000/mm³ (normal platelets = 100,000/mm³ - heparin-induced thrombocytopenia) ATI

nursing interventions: administering IV alteplase

hold direct pressure on puncture site for 20-30 min

antidote for heparin

protamine sulfate

exnoxaparin: routes

subcutaneous injection

antidote for warfarin

vitamin K / phytonadione (NCLEX)

what to do if aPTT is <60 seconds?

↑ dosage of heparin