PN119 PrepU Chapter 37
The pharmacology instructor is discussing clopidogrel. According to the instructor, this drug is frequently used for
reduction of myocardial infarction in patients with atherosclerosis.
A patient is being discharged from the hospital with warfarin (Coumadin) to be taken at home. Which of the following foods should the patient be instructed to avoid in his diet?
Spinach
You work in the emergency department (ED) of a small rural hospital. A 54-year-old man in your ED is determined to be experiencing acute myocardial infarction, so the physician decides to transfer him to a larger facility with a cardiac catheterization laboratory. Prior to the transfer, what drug might you administer?
Streptokinase
A patient is to receive desirudin to prevent deep vein thrombosis with an elective hip surgery. The nurse would expect this drug to be administered by which route?
Subcutaneous
Enoxaparin (Lovenox) should be administered via which route?
Subcutaneous injection
Ms. Main is sent home with subcutaneous heparin after a total hip replacement. What symptom would indicate a serious drug reaction?
Tarry stools
While preparing a patient for discharge, the nurse teaches about the proper use of warfarin, which has been prescribed by the physician. Which statement by the patient indicates that additional teaching is required?
"I should use aspirin to control my arthritis pain."
A nurse is preparing to discharge a female patient newly prescribed warfarin (Coumadin). While assessing the patient's knowledge of their drug, what would indicate that the patient needs further instruction concerning her drug therapy?
"I take aspirin for my arthritis."
The nurse knows that teaching about warfarin (Coumadin) is successful if the client states:
"I will ask my doctor about herbal supplements."
A patient is discharged from the hospital with a prescription of warfarin (Coumadin). Which statement indicates successful patient teaching?
"I will avoid herbal remedies."
A 48-year-old patient needs additional teaching regarding anticoagulants if the patient states:
"I'll use aspirin for arthritis pain."
An 86-year-old client who was admitted earlier in the week with thrombophlebitis is being sent home on enoxaparin. Which statement by the client suggests that he understands proper management of his condition and proper use of the drug?
"The medication will increase my risk of bleeding."
For optimal therapeutic effect a thrombolytic medication should be administered as soon as possible after the formation of a thrombus, preferably within how many hours? (Choose one)
4 to 6 hours
A patient receiving heparin has a baseline aPTT of 28 seconds. Which result would the nurse interpret as suggesting too much heparin?
98 seconds
Which patients would be the best candidate to receive alteplase recombinant therapy?
A 68-year-old male who has had an ischemic stroke that resulted in neurological deficits
When are thrombolytic drugs contraindicated? (Select all that apply.)
Active bleeding History of aneurysm History of stroke Recent abdominal surgery
Ms. Kim is admitted to the hospital for treatment of a pulmonary embolism. Forty-eight hours after therapy has started, Ms. Kim reports bleeding from her gums when she brushes her teeth. The nurse notes this to be an adverse effect of the medication and contacts the physician. What orders can the nurse anticipate receiving from the physician to reverse the effects of the heparin?
Administer protamine sulfate, at a dosage of 1 mg per 100 units of heparin, for a maximum dose of 100 mg.
Anticoagulant drugs prevent thromboembolic disorders. How does warfarin, one of the anticoagulant drugs, act on the body?
Alters vitamin K, reducing its ability to participate in the coagulation of the blood
Which is classified as an antiplatelet agent?
Clopidogrel (Plavix)
Fondaparinux (Arixtra) is indicated for:
DVT prophylaxis.
Blood coagulation results from the activation of one of two pathways: one pathway occurs in tissue, and the other occurs in the vascular system. What are the names of these pathways?
Extrinsic and intrinsic pathways
There are two pathways that can be activated by the coagulation process. One pathway begins when factor XII is activated. The other pathway begins when there is trauma to a blood vessel. What are these pathways?
Extrinsic and intrinsic pathways
A patient in the cardiac care unit is given streptokinase for a suspected acute myocardial infarction. During the administration of this drug, the nurse will monitor the patient for which of the following?
Fever and chills
A nurse is caring for a patient receiving heparin therapy. The nurse instructs the patient and family that certain foods must be taken in limited quantity as they interfere with the effect of the therapy. Which foods must be taken in limited quantity?
Foods rich in vitamin K
Which herbal products should not be used during warfarin therapy? (Select all that apply.)
Garlic Ginger Gingko biloba Ginseng Green tea
A client taking warfarin (Coumadin) tells the nurse she is having bleeding in the gums and teeth. When reviewing client history, the client states she has decided to try an herbal remedy. Which of the following is most likely the cause of increased bleeding?
Ginger
Many commonly used herbs and supplements alter the effects of anticoagulant drugs. Which of the following substances presents an additive bleeding effect when taken concomitantly with warfarin?
Ginger
The client is currently receiving a continuous IV infusion of heparin. Which procedure should the nurse avoid when possible?
Giving intramuscular injections
While preparing a patient for discharge, you teach her about the proper use of warfarin, which has been prescribed by the physician. Which of the following foods should you tell her to avoid?
Green leafy vegetables
A female patient has a history of clot formation in the past. She is scheduled for bowel resection due to an obstruction. What anticoagulant agent will be administered prophylactically?
Heparin
A patient has developed the formation of clots and has bruising. It is determined that there is a depletion of coagulation factors and widespread bleeding. Which medication will be administered?
Heparin
A 76-year-old client is receiving IV heparin 5,000 units qh. An activated thromboplastin time (aPTT) is drawn 1 hour before the 8:00 AM dose; the aPTT is at 3.5 times the control value. What would be the most appropriate action?
Hold the dose and call the result to the physician.
A nurse is caring for a male patient receiving warfarin drug therapy. The patient informs the nurse that he is also taking chamomile, which is an herbal remedy. What effect of the interaction between warfarin and the herb should the nurse inform the patient about?
Increased risk for bleeding
Use of St. John's wort during warfarin therapy can result in which of the following? (Choose one)
Increased risk of bleeding
Abdominal pain, coffee-ground emesis, black, tarry stool, hematuria, joint pain, spitting or coughing up blood are signs of which of the following?
Internal bleeding
A patient is receiving warfarin. Which would the nurse monitor to determine the effectiveness of therapy? (Select all that apply.)
International normalized ratio Prothrombin time
A patient is to receive abciximab. The nurse would expect to administer the drug by which route?
Intravenous
A patient is taking warfarin (Coumadin) to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin (Coumadin) monitored?
PT and INR
The effects of warfarin (Coumadin) are monitored by what laboratory test(s)?
PT and INR
What values are used to monitor the effectiveness of warfarin therapy?
PT and INR
During coronary artery angioplasty, a client is receiving abciximab. Which of the following findings during the assessment should be immediately reported to the care provider? Select all that apply.
Pain Bleeding
The physiology instructor is discussing blood clots. What would the instructor tell the students is the basis for the clot-dissolving system?
Plasminogen
A male patient is receiving heparin by continuous intravenous infusion. The nurse will instruct the patient and family members to report what should it occur?
Presence of blood in urine or stools
The pharmacology instructor is discussing heparin with the students. How would the instructor explain the action of heparin?
Promotes the inactivation of clotting factors
A nurse is caring for a 64-year-old female patient who is receiving IV heparin and reports bleeding from her gums. The nurse checks the patient's laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which drug may be ordered?
Protamine sulfate
A patient is admitted to the hospital with deep vein thrombosis. Heparin 10,000 units is administered Sub-Q. Which drug should always be available in the pharmacy if the patient begins to bleed?
Protamine sulfate
Bleeding resulting from the administration of heparin is treated with which substance?
Protamine sulfate
A nurse is caring for a patient who is going home on warfarin (Coumadin). The nurse will schedule the patient for what laboratory test to help evaluate therapeutic effects of the drug?
Prothrombin time (PT) and international normalized ratio (INR)
T/F: Warfarin typically takes 3 days to achieve its onset of action.
True
Ms. Arnold is prescribed warfarin to treat a recurrent deep vein thrombosis. The nurse teaches Ms. Arnold to take the medication at what time, to maximize its therapeutic effect?
Usually in the evening, at 6 PM
A 73-year-old client receiving warfarin (Coumadin) has blood in his urinary drainage bag this morning. After reporting these observations to the physician, the nurse will expect to administer what substance?
Vitamin K
A patient who has been treated with warfarin (Coumadin) after open heart surgery is involved in a car accident and has a laceration on her head. Which medication will be administered to assist in the development of clotting factors?
Vitamin K
A patient who is receiving warfarin (Coumadin) has blood in his urinary drainage bag. What medication will likely be ordered by the physician?
Vitamin K
The nurse is caring for a 73-year-old client receiving warfarin. When the nurse performs the initial shift assessment, the nurse observes blood in the client's urinary drainage bag. After reporting the observation to the physician, which substance will the nurse likely administer?
Vitamin K
During your patient's cardiac catheterization and concurrent GP IIb/IIIa receptor antagonist administration, he begins to bleed from the arterial access site of the catheterization. In what specific circumstance can the infusion continue?
When bleeding can be controlled by pressure application
A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the patient's
aPTT.
A 70-year-old resident of a long-term care facility has experienced increasing pain, swelling, and redness to her lower leg over the past 12 hours, prompting the care providers at the facility to have the woman brought to the local emergency department. Diagnostic testing has confirmed deep vein thrombosis (DVT) and an IV infusion of alteplase (Activase) has been initiated? Unlike anticoagulants, a thrombolytic such as alteplase can
break down existing clots.
A 51-year-old man is being discharged from the hospital following treatment with anticoagulants for a deep vein thrombosis. The nurse will instruct the patient to:
consider safety measures to prevent bleeding and be alert for signs of bleeding.
The physician orders heparin for a 35-year-old female client. The nurse administers the drug only after confirming that the client:
does not have peptic ulcer disease.
An 86-year-old client, admitted with thrombophlebitis, is being sent home on enoxaparin (Lovenox). The client has a good understanding of why enoxaparin is being used if he states that it will:
inhibit the formation of additional clots.
A 59-year-old patient is on warfarin therapy. On follow-up visits to the clinic, the nurse will assess the patient's:
intake of Vitamin K