Antiplatelet, Anticoagulants, and thrombilytics, and some other random topics

The patient's heparin is infusing at 28 ml/hr. The bag of fluid is mixed 20,000 units of heparin in 500 ml D5w. What hourly dose is the patient receiving? ______ units/hr

1120 units/hr Normal dimensional analysis

A bleeding patient receiving warfarin has an INR of 6. What is the nurse's best course of action? A. Administer phytonadione B. Stop the intravenous drip C. wait for the INR to decrease D. Administer protamine sulfate

A. Administer phytonadione This is the warfarin antidote, vitamin K. This is needed because the INR is too high, whereas the therapeutic range is 2-3.

The nurse is monitoring a patient receiving a heparin infusion for the treatment of PE. Which assessment finding most likely relates to an adverse effect of heparin? A. Discolored urine B. Heart rate of 60 beats/min C. Respiratory rate 14 breath/min D. Blood pressure of 160/88 mm Hg

A. Discolored The primary adverse effect of heparin is bleeding, so discolored urine would indicate blood.

The patient is being treated with a continuous IV infusion of heparin. What is the nurse's highest priority? A. Ensure that protamine sulfate is readily available at all times B. Ensure that the patient's lab values are monitored correctly C. ensure that a loading dose was initially administered when treatment began D. Ensure that the patient is taught dietary restrictions while on the medication.

A. Ensure that protamine sulfate is readily available at all times. The antidote for heparin would be needed on standby incase of overdose

Which patient symptoms should alert the nurse to e concerned about digoxin toxicity? Select All A. Fatigue B. Vomitting C. Constipation D. Blurred vision E. Muscle weakness

A. Fatigue B. Vomitting D. Blurred Vision

A nurse discovers that a patient has a cardiac output of 5 L/min. What else should the nurse assess to determine cardiac output besides stroke volume? A. Heart rate B. Blood pressure C. Cardiac Preload D. Cardiac Afterload

A. Heart rate

The patient is being treated with dabigatran and opens a new bottle of the medication on July 1. The nurse will instruct the patient to discard any unused medication by which date? A. July 31 B. October 1 C. August 29 D. September 15

A. July 31st. Use all of dibigatran within 30 days

A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. The nurse will immediately notify the healthcare provider of which findings? Select all that apply. A. Nosebleeds B. aPTT of 40 seconds C. aPTT of 100 seconds D. Platelet count of 300,000 E. aPTT of 65 seconds

A. Nosebleeds B. aPTT of 40 seconds C. aPTT of 100 seconds Nosebleeds would indicate that the heparin is causing bleeding in the body, and if there is bleeding in the nose, it can be assumed that there would be bleeding in more prominent places. The therapeutic range for aPTT on heparin would be 60-80 seconds, so 40 seconds is too low and 100 seconds is too high. A platelet count of 300,000 is acceptable as it is within normal limits, and an aPTT of 65 is within the therapeutic range

The nurse is caring for a patient who is being treated with one of the coagulation modifier drugs. The patient tells the nurse that he has developed a rash. What is the nurses highest priority action? A. Notify the provider; the medication will need to be discontinued B. Monitor the area of the rash. this is an expected side effect the medication C. Notify the provider to obtain an order for a topical medication to apply to the rash. D. Instruct the patient to wash the are with mild soap and water open to the air

A. Notify the provider; the medication will need to be discontinued. Self explanatory really lol

A patient Is receiving a continuous heparin infusion for venous thromboembolism treatment. Which lab result should the nurse monitor? Select all that apply A. Platelets B. Vitamin K C. Prothrombin Time (PT) D. INR E. Activated partial thromboplastin time (aPTT)

A. Platelets E. (aPTT) Heparin only should only warrant the monitoring of Platelets and aPTT. Vitamin K is the warfarin antidote, PT monitors warfarin, and the INR monitors warfarin

The nurse is reviewing laboratory data before initiating a patient's heparin infusion. Which finding requires immediate action? A. Platelets 95,000/ mm^3 B. Potassium 3.5 mEq/L C. INR of 1 D. aPTT of 37 seconds

A. Platelets 95,000/mm^3 a platelet count of less than 100,000/mm^3 would indicate thrombocytopenia

Which information from a patient indicated correct understanding about the systems that regulate arterial pressure? A. The kidneys are the slowest to respond B. The natriuretic peptides are the slowest to respond C. The autonomic nervous system is the slowest to respond D. The RAAS is the slowest to respond.

A. The kidneys are the slowest to respond

A patient with nonvalvular atrial fibrillation is to be discharged on dibigatran etexiate. Which statement should the nurse include in the discharge teaching? A. The medication must be stored in the manufacturer-supplied bottle B. Once a new bottle is opened, the capsules maintain efficacy for 90 days C. If you have difficulty swallowing the capsule, you can open it and mix it with food. D. You will need to learn how to give yourself a subQ injection in your abdomen

A. The medication must be stored in the manufacturer supplied bottle. Dibigatran is extremely unstable so it must be stored in a specific manner.

The nurse is caring for a patient who is being treated with fondaparinux and notes a platelet count of 80,000/mm^3. Based on this information, the nurse anticipates which change to the medication regimen? A. The medication will be stopped completely. B. The dose of the medication will be increased C. The dose of the medication will be decreased D. The dose of the medication will be unchanged.

A. The medication will be stopped completely.

A patient is being discharged from the hospital on warfarin for DVT prevention. Which instructions should the nurse include in the patient's discharge teaching plan? Select all that apply. A. Wear a medical alert bracelet. B. Check all urine and stools for discoloration C. Do not start any new medication without first talking to the healthcare provider. D. No lab or home monitoring of INR is required after the first 6 months E. Enteric coated aspirin and any aspirin products can be used unless they cause a GI ulcer.

A. Wear a medical alert bracelet B. Check all urine and stools for discoloration C. Do not start any new medication without first talking to the healthcare provider. Lab monitoring is required frequently with warfarin. And Aspirin products should be avoided

The nurse is caring for a newly admitted patient who will begin heparin therapy. While documenting the patient's history, the nurse notes that the patient is currently undergoing treatment with enoxaparin. What's the nurse's highest priority? A. Notify the provider that the patient is at risk for an allergic reaction B. Notify the provider that the patient should not be started on heparin C. Notify the provider that the dosage of heparin will need to be increased D. Notify the provider that the dosage of heparin will need to be decreased

B Notify the provider that the patient should not be started on heparin. Heparin and Enoxaparin would potentiate the effects of the other and would increase he risk of bleeding

A patient who has been receiving intravenous heparin as treatment for a deep vein thrombosis requires immediate surgery for a suspected bowel perforation. Which intervention is essential at this time? A. Administer vitamin K B. Administer protamine sulfate C. Provide patient teaching about the heparin D. Assess the INR before surgery.

B. Administer protamine sulfate Protamine sulfate is the antidote for heparin and would be needed to stop any unnecessary bleeding due to the bowel perforation.

A patient admitted with deep vein thrombosis and subsequent pulmonary embolism requires immediate anticoagulation. Which medication would be appropriate for initial therapy for this patient who has a history of heparin induced thrombocytopenia? A. Warfarin B. Argatroban C. Eptifibatide D. Bivalirudin

B. Argatroban This is the only drug whose indication is for those who have heparin induced thrombocytopenia

A patient with warfarin toxicity is toxicity is prescribed phytonadione. Which nursing assessment ensures patient safety? A. Assess the amount of blood lost B. Assess prothrombin time (PT) C. Assess the white blood cell (WBC) count. D. Assess the partial thromboplastin time (PTT)

B. Assess prothrombin time (PT) The assessment of warfarin is prothrombin time

An unlicensed assistive personnel staff member asks the nurse how the blood gets back to the heart. How should the nurse respond? A. By way of tow way valves B. By way of the venous pump C. By way of dilation in the venous walls D. By way of the positive pressure in the right atrium

B. By way of the venous pump

The nurse is caring for a patient who is being treated with warfarin and who is scheduled to be placed on phenytoin. The nurse anticipated which effect will occur when the phenytoin is administered? A. Increased effect of the warfarin B. Decreased effect of the warfarin C. Therapeutic effect of the warfarin D. Anaphylactic reaction to the warfarin

B. Decreased effect of the warfarin. Phenytoin decreases the effect, while amiodarone increases the effect.

A patient with deep vein thrombosis receiving an IV heparin infusion asks the nurse how this medication works. What is the nurse's best response? A. Heparin converts plasminogen to plasmin, which in turn dissolves the clot matrix B. Heparin suppresses coagulation by helping antithrombin perform its natural functions C. Heparin prevents activation of vitamin K and thus blocks synthesis of some clotting factors D. Heparin inhibits the enzyme responsible fo platelet activation and aggregation within vessels.

B. Heparin suppress coagulation by helping antithrombin perform its natural functions

The nurse determines that the patient has understood the discharge teaching regarding warfarin based on which of the patient's statements? 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. A soft toothbrush would protect the gingiva from bleeding

The patient is scheduled to receive argatroban. Which is the correct route by which to administer the drug? A. intradermal B. intravenous C. Intramuscular D. Subcutaneous

B. Intravenous Argatroban is only given via the Intravenous route

The laboratory calls to report a drop in the platelet count to 90,000/mm^3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate? A. Obtain vitamin k and prepare to administer it by intramuscular injection. B. Notify the healthcare provider to discuss the reduction or withdrawal of heparin C. Observe the patient and monitor the aPTT as indicated D. Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level.

B. Notify the healthcare provider to discuss the reduction or withdrawal of heparin. A low platelet count of less than 100,000/mm^3 is indicatory of thrombocytopenia, and heparin would need to be discontinued.

A patient who is receiving heparin therapy has bruises covering the abdomen as well as red colored urine. What does the nurse need to assess? A. Urine culture B. Platelet level C. Ingestion of acetaminophen D. Over the counter medications

B. Platelet level The patient may have thrombocytopenia, where the medication would need to be changed. This is all found out by assessing the patients platelet levels.

Which best decribes the mechanism of action of an anticoagulant? A. Decreases platelet production B. Reduces the formation of fibrin C. Suppress platelet aggregation D. Removes thrombi that have formed

B. Reduces the formation of fibrin

The nurse assesses the patient's prothrombin time (PT) to determine the effectiveness of anticoagulant therapy and notes that is is 32 seconds. How will the nurse interpret this value? A. the PT is within normal limits B. The PT is significantly elevated C. The PT is significantly decreased D. the PT is inadequate to evaluate treatment.

B. The PT is significantly elevated. normal PT ranges should be 11-13 seconds. The anticoagulant PT time should be about 18 seconds

The nurse is caring for a patient who is scheduled to begin warfarin treatment and is currently being treated with amiodarone. Based on this information, the nurse anticipates which change will be made to the medication regimen? A. The dosage of the warfarin will be increased B. The dosage of the warfarin will be decreased C. The dosage of the amiodarone will be increased D. The dosage of the amiodarone will be decreased.

B. The dosage of the warfarin will be decreased. When amiodarone is given along with warfarin therapy, it is recommended that the does be cut in half because amiodarone increased the effectiveness of warfarin

A patient with hypertension and left ventricular hypertrophy takes losartan 50 mg daily. What is a benefit of this therapy for a patient with hypertension? A. This medication has no side effects B. This medication decreases the risk of stroke C. This medication is less expensive D. This medication decreases blood pressure more effectively than others.

B. This medication decreases the risk of stroke.

Which nursing intervention is essential for a patient experiencing myocardial infarction who is receiving alteplase? A. Monitor liver enzymes B. Assess for dysrhythmias C. Administer prescribed vitmim K if bruising is observed D. Stop the med if the blood pressure drops below 110 systolic

B. assess for dysrhythmias

A patient who has been receiving an infusion of heparin has an activated partial thromboplastin time (aPTT) of 120 seconds. What is the nurse's first action? A. Assess for bleeding B. Shut off the heparin drip C. Call the healthcare provider D. Keep the patient on bed rest

B. shut off the heparin drip The aPTT is too high and the patient could have spontaneous bleeding. AFTER turning off the drip, the nurse should notify the provider.

The nurse is caring for a patient who has been recently placed dabigatran. Which instruction will the nurse provide to the patient regarding storing the drug for home use? A. Refridgerate and keep away from direct sunlight. B. Remove from original package and place in aluminum foil. C. Store the drug with the desiccant agent in the packing cap. D. Discard the drug 21 days after opening the original container

C. Store the drug with the desiccant agent in the packing cap. This is the storage recommendation for dabigatran so that the drug can avoid atmospheric moisture

A patient with an acute myocardial infarction is prescribed an iv bolus of tenecteplase. The patient weighs about 160 pounds (apron 73 kg). What dosage should the nurse administer? A. 30 mg B. 35 mg C. 40 mg D. 45 mg

C. 40 mg. Tenecteplase dosage is based off of body weight. Below 60kg: 30mg 60-69.9kg: 35mg 70-79.9kg: 40mg 80-89.9kg: 45mg Above 90kg: 50mg

The nurse is ready to begin a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved? A. 50 B. 70 C. 90 D. 110.

C. 70 The therapeutic level of heparin is reached when the aPTT is 1.5-2 times the normal time. So the therapeutic range for aPTT on heparin is 60-80 seconds

In which patient would a low dose aspirin be contraindicated? A. a patient with thrombosis B. A patient with a heart problem C. A patient with a hemorrhagic stroke D. A patient with a deep vein thrombosis.

C. A patient with a hemorrhagic stroke. Aspirin would increase the bleeding with a hemorrhagic stroke.

A patient is receiving warfarin for a chronic condition. Which patient statement requires immediate action by the nurse? A. I will avoid contact sports B. I will take my medications at the same time each day C. I will increase dark green, leafy vegetables in my diet. D. I will contact my health care provider if i develop excessive bruising

C. I will increase dark green, leafy vegetables in my diet Dark green, leafy vegetables are high in vitamin k, so the warfarin would become inactive

The nurse is caring for a patient who takes warfarin for prevention of deep vein thrombosis. The patient has an INR of 1.2. How should the nurse interpret this finding? A. INR is too high; Vitamin K may be needed B. INR is within normal limits; no action is indicated C. INR is too low; the dose may need to be increased D. INR is too high; IV protamine may be needed.

C. INR is too low; the dose may need to be increased. the therapeutic INR level should be 2-3. Protamine sulfate is for heparin, not warfarin

A patient is started on warfarin therapy while also receiving IV heparin. The patient is concerned about the risk for bleeding. What will the nurse tell the patient? A. Your concern is valid. I will call the doctor to discontinue the heparin. B. Because you are now up and walking, you have a greater risk fo blood clots and therefore need to be on both medications. C. It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic. D. Because of your valve replacement, it is especially important for you to be given anticoagulant therapy. The heparin and warfarin are more effective than one alone.

C. It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic.

The patient has been placed on aspiring as an anti platelet drug. Which side effect is the patient most likely to experience? A. Itching B. Edema C. Nausea D. Chest Pain

C. Nausea Nausea with vomiting is an expected side effect of treatment with aspirin.

The patient is being treated with heparin. The nurse assesses the patient't lab test results and finds that the platelet count has dropped to 75,000/mm^3. What action will the nurse perform next? A. Prepare to administer protamine sulfate B. No action is needed; this is a normal finding. C. Notify the primary healthcare provider of this finding D. Document the finding and continue to monitor the patient

C. Notify the primary healthcare provider of this finding. If at anytime the platelet count drops below 90,000/mm^3, the primary healthcare provider should be notified.

The nurse is caring for a patient receiving clopidogrel to prevent blockage of coronary stents. Which other drug on the patient's medication administration record may reduce the anti platelet effects of clopidogrel? A. Aspirin B. Warfarin C. Omeprazole D. Acetaminophen

C. Omeprazole Omeprazole and other proton pump inhibitors can reduce the anti platelet effects of both clopidogrel and aspirin. Patients would take omeprazole to reduce the risk of GI bleeding. The other choices would increase the anti platelet effects

The nurse is caring for a patient who is being treated with dabigatran. The nurse is monitoring the patient's laboratory test results and notes that the creatinine clearance is 25 ml/min. Based on this information, the nurse anticipates which change to the medication regimen? A. The medication will be stopped completely. B. The dose of the medication will be increased C. The dose of the medication will be decreased. D. The dose of the medication will be unchanged.

C. The dose of the medication will be decreased. The dose of dabigatran will be decreased by half if the creatinine clearance is less than 30 ml/min

The patient is receiving warfarin therapy, and the nurse fids the international normalized ratio (INR) to be 4.0. How will the nurse interpret this finding? A. The level is within the expected target therapeutic level of anticoagulation. B. The level Is outside the expected target therapeutic level of anticoagulation: it is too low. C. The level is outside the expected target therapeutic level of anticoagulation: it is too high D. the level cannot be interpreted without knowing the prothrombin time and the activated partial thromboplastin time (aPTT)

C. The level is outside the expected target therapeutic level of anticoagulation: it is too high. The therapeutic level for INR should be between 2-3

A patient is receiving an intravenous heparin drip. Which lab value requires immediate action by the nurse? A. Platelet count of 150,000 mm^3 B. International Normalized Ratio (INR) of 1.0 C. Blood urea nitrogen (BUN) level of 12 mg/dL D. Activated partial thromboplastin time (aPTT) of 120 seconds

D. Activated partial thromboplastin time (aPTT) of 120 seconds. An aPTT of 120 is too high as the normal level would be 60-80 or a 1.5-2 time increase.

The patient is receiving anticoagulant therapy. The INR value for the patient today is 1.5. In response to this, the nurse could anticipate the healthcare provider placing which order? A. Administer protamine sulfate B. Increase the heparin drip rate C. Hold the next dose of warfarin D. Administer an additional dose of warfarin.

D. Administer an additional dose of warfarin. The INR is too low, so to make warfarin therapeutic, more warfarin should be administered. INR has nothing to do with heparin.

The patient asks the nurse to explain the difference between dalteparin and heparin. Which response by the nurse is accurate? A. There is no real difference. Dalteparin is interchangeable with heparin. B, The only difference is that heparin is dosing based on the patient's weight C. Im not sure who some healthcare providers choose dalteparin and some heparin. You should ask your doctor. D. Dalteparin is a low molecular weight heparin and is more predictable in its effect and has a lower risk of bleeding.

D. Dalteparin is a low molecular weight heparin that is more predictable in its effect and has a Lower risk of bleeding. LMW heparin is more predictable than normal heparin, and dalteparin is a LMW heparin.

Which statement reflects a patient's accurate understanding of a dietary restriction while taking a vitamin K antagonist? A. I should avoid most green leafy vegetables to prevent an interaction with my medication. B. I should avoid most fatty or high cholesterol foods to prevent an interaction with my medication C. I should be consistent in my intake of high fat foods once a maintenance dose of my medication has been established. D. I should be consistent in my intake of green vegetables once a maintenance dose of my medication has been established

D. I should be consistent in my intake of green vegetables once a maintenance dose of my medication has been established

A patient has overdosed on warfarin. Which substance will the nurse administer to reverse the effect of warfarin? A. Aspirin B. Calcium C. Potassium D. Phytonadione

D. Phytonadione Warfarin's antidote is vitamin K, which is NOT potassium or K+.

The nurse is monitoring a patient receiving alteplase for treatment of a massive PE. Which finding indicated that the therapy is effective? A. +2 pitting edema B. Numbness in left leg C. Faint posterior tibial pulse D. Pulse oxygen saturation increased.

D. Pulse Oxygen saturation increased More O2 would indicate that the embolism is removed or dissolved as per the alteplase therapy

The nurse is preparing to administer an anticoagulant to a patient. Which action, if observed, is an error? A. The nurse administers warfarin orally to a patient B. The nurse administers dibigatran orally to a patient. C. The nurse administers heparin subQ to a patient D. The nurse administers enoxaparin intramuscularly to a patient.

D. The nurse administers enoxaparin intramuscularly to a patient. Anticoagulants should not be administered intramuscularly as it can cause intense bleeding

The nurse is screening a patient for candidacy for treatment with fondaparinux. The nurse reviews the patient's laboratory test results and finds a creatinine clearance of 20 ml/min and a body weight of 48kg. How will the nurse interpret these findings? A. The patient is not a candidate for treatment with the medication based only on an insufficient creatinine clearance. B. The patient is a candidate for treatment with the medication based on a sufficient creatinine clearance and adequate body weight C. The patient is a candidate for treatment with the medication based on sufficient creatinine clearance and after body weight attains an adequate level. D. The patient is not a candidate for treatment with the medication based on both an insufficient creatinine clearance and an adequate body weight.

D. The patient is not a candidate for treatment with the medication based on both an insufficient creatinine clearance and an inadequate body weight Moderate renal impairment is classified as a creatinine level of 30-50 while fondaparinux is contraindicated in those who have severe renal impairment which is classified as a creatinine level of less than 30. Also those who are less than 50kg should not have fondaparinux

The nurse administers tenecteplase therapy to a patient experiencing an acute myocardial infarction. What will the nurse teach the patient about this therapy? A. This therapy will quickly decrease your pain B. This therapy will prevent new clots from forming C. This therapy will reverse damage from the infarction D. This therapy will dissolve the clot that caused the heart attack.

D. This therapy will dissolve the clot that caused the heart attack. Tenecteplase is a thrombolytic drug that dissolved existing clots.