ATI Practice Test (Anticoagulants)

A nurse is preparing to administer heparin 2,000 units by IV bolus. Available is heparin injection 5,000 units/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

0.4 mL

A nurse is preparing to administer heparin 3,000 units by IV bolus. Available is heparin injection 5,000 units/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

0.6 mL

A client is to receive enoxaparin 30 mg subcutaneously. Available is enoxaparin 40 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

0.8 mL

A nurse is caring for a client who is receiving heparin 3,800 units subcutaneous daily. Available is heparin 5,000 units/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth.)

0.8 mL

A nurse is caring for a client who has a pulmonary embolism and has a new prescription for enoxaparin 1.5mg/kg/dose subcutaneous every 12 hr. The client weighs 245 lbs. How many mg should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

167

A nurse is educating a group of clients about the contraindications of warfarin therapy. Which of the following statements should the nurse include in the teaching? "Clients who have glaucoma should not take warfarin." "Clients who have rheumatoid arthritis should not take warfarin." "Clients who are pregnant should not take warfarin." "Clients who have hyperthyroidism should not take warfarin."

"Clients who are pregnant should not take warfarin." Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk for bleeding.

A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide? "Crushing the medication might cause you to have a stomachache or indigestion." "Crushing the medication is a good idea, and I can mix it in some ice cream for you." "Crushing the medication would release all the medication at once, rather than over time." "Crushing is unsafe, as it destroys the ingredients in the medication."

"Crushing the medication might cause you to have a stomachache or indigestion." The pill is enteric-coated to prevent breakdown in the stomach and decrease the possibility of GI distress. Crushing the pill destroys that protection.

A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give? - "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level." - "A pharmacist is the person to answer that question." - "Heparin does not dissolve clots. It stops new clots from forming." - "The oral medication you will take after this IV will dissolve the clot."

"Heparin does not dissolve clots. It stops new clots from forming." Rationale: This statement accurately answers the client's question.

A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching? "I have started taking ginger root to treat my joint stiffness." "I take this medication at the same time each day." "I eat a green salad every night with dinner." "I had my INR checked three weeks ago."

"I have started taking ginger root to treat my joint stiffness." Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching.

A nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which of the following statements by the client indicates an understanding of the teaching? "It's okay to have a couple of glasses of wine with dinner each evening." "I'll be sure to eat more foods with vitamin K." "I'll take aspirin for my headaches." "I'll use my electric razor for shaving."

"I'll use my electric razor for shaving." Because this medication prolongs clotting times, the client should avoid situations that put him at high risk for bleeding, such as shaving with a straight razor or a razor blade.

A nurse is providing teaching to a client who is taking warfarin about monitoring its therapeutic effects. Which of the following explanations should the nurse provide about the international normalized ratio (INR) test? "The INR also monitors heparin therapy if the provider switches the medication prescription." "The INR is the only test available for anticoagulant therapy monitoring." "You will only need the test twice per month." "The INR is a standardized test that eliminates the variations between laboratories reports in prothrombin times."

"The INR is a standardized test that eliminates the variations between laboratories reports in prothrombin times." The INR is a standardized test, which means that the result will be the same, no matter which laboratory performs it.

A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make? "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." "I will call the provider to get a prescription for discontinuing the IV heparin today." "Both heparin and warfarin work together to dissolve the clots." "The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay."

"Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." Heparin and warfarin are both anticoagulants that decrease the clotting ability of the blood and help prevent thrombosis formation in the blood vessels. However, these medications work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which is usually within 1 to 5 days. When the client's PT and INR are within therapeutic range, the heparin can be discontinued.

A nurse is teaching a client who has a new prescription for clopidogrel. Which of the following instructions should the nurse include? - "Take this medication with food." - "You might have to stop taking this medication 5 days before any planned surgeries." - "Take this medication three times daily." - "Expect to have black-colored stools while taking this medication."

"You might have to stop taking this medication 5 days before any planned surgeries." Rationale: Clopidogrel inhibits platelet aggregation and can cause bleeding. The client should report taking this medication to providers to determine whether to discontinue the medication prior to elective procedures to reduce the risk for bleeding.

A nurse in an emergency department is preparing to administer alteplase accelerated therapy to a client who is having a myocardial infarction. Which of the following actions should the nurse plan to take? (Select all that apply.) Administer the medication within 30 min of the client's arrival to the department. - Reconstitute the medication with sterile water. - Administer a 15 mg IV bolus. - Tell the client that the purpose of the medication is to keep a new clot from forming. - Assess the client for back pain.

- Reconstitute the medication with sterile water - Administer a 15 mg IV bolus - Assess the client for back pain.

A nurse is caring for a male client who has peripheral vascular disease (PVD), is taking dietary supplements, and has a new prescription for warfarin. The nurse should instruct the client to stop which of the following supplements prior to starting the warfarin? (Select all that apply.) Saw palmetto Flaxseed oil Glucosamine Black cohosh Gingko biloba

- Saw palmetto - Glucosamine - Gingko biloba

A nurse is preparing to administer aspirin 650 mg PO every 12 hr. The amount available is aspirin 325 mg tablets. How many tablets should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

2 tablets

A nurse is preparing to administer a continuous heparin infusion at 1600 units/hr. Available is heparin 25,000 units in dextrose 5% in water (D5W) 500 mL. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

32 mL/hr

A nurse is caring for a client who is postoperative hip arthroplasty and has a new prescription for enoxaparin 1 mg/kg/dose subcutaneous every 12 hr. The client weighs 95 lbs. How many mg should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

43.2

A nurse is caring for a client who is postoperative following knee arthroplasty and has a new prescription for enoxaparin 1mg/kg/dose subcutaneous every 12 hr. The client weighs 185 lb. How many mg should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

84.1 mg

A nurse is teaching a client who has a new prescription for aspirin to treat rheumatoid arthritis. The nurse should include to monitor for which of the following adverse effects of this medication? Constipation Bleeding Blurred vision Insomnia

Bleeding Aspirin can cause bleeding, tinnitus, gastric ulceration, nausea, and heartburn. The client should monitor and report manifestations of bleeding, such as black tarry stools.

A nurse is caring for a client who is receiving a continuous IV infusion of heparin. Which of the following actions should the nurse take? Administer 50,000 units of heparin by IV bolus every 12 hr. Check the activated partial thromboplastin time (aPTT) every 4 hr. Have vitamin K available on the nursing unit. Use IV tubing specific for heparin sodium when administering the infusion.

Check the activated partial thromboplastin time (aPTT) every 4 hr. Heparin is an anticoagulant. The activated partial thromboplastin time (aPTT) should be monitored every 4 hr and the infusion rate should be adjusted accordingly until the effective dose has been determined.

A nurse is preparing to administer heparin subcutaneously to a client who has a deep vein thrombosis. Which of the following techniques should the nurse use? Cleanse the skin with an alcohol swab, insert the needle, aspirate, and inject the heparin. Cleanse the skin with an alcohol swab, insert the needle, aspirate, inject the heparin, and massage the site. Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, and observe for bleeding. Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, aspirate, and observe for bleeding.

Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, and observe for bleeding. This is the correct technique for the nurse to use to inject heparin.

FLAG A nurse is caring for an older adult client who has rheumatoid arthritis (RA) and is taking aspirin 650 mg every 4 hours. Which of the following diagnostic tests should the nurse monitor to evaluate the effectiveness of this medication? White blood cell (WBC) count Rheumatoid factor (RF) Antinuclear antibody (ANA) Erythrocyte sedimentation rate (ESR)

Erythrocyte sedimentation rate (ESR) Rheumatoid arthritis is a chronic inflammatory disease. ESR is useful in detecting and monitoring tissue inflammation in clients with RA. As the disease improves the ESR decreases.

FLAG A nurse is preparing an in-service about the various supplements clients might use. Which of the following herbal supplements should the nurse include as potentially increasing the anticoagulant effects of aspirin and other oral anticoagulants? Valerian Feverfew Milk thistle Saw palmetto

Feverfew Feverfew can increase the risk of bleeding due to the suppression of platelet aggregation.

A nurse is teaching a client who takes aspirin daily for coronary artery disease about herbal supplements. The nurse should instruct the client that which of the following herbal supplements may interact adversely with aspirin? Cranberry juice Aloe vera Feverfew Flaxseed

Feverfew Rationale: The nurse should instruct the client to avoid taking feverfew with aspirin because it suppresses platelet aggregation and places the client at risk for bleeding when taken with aspirin.

A nurse is obtaining a medical history from a client who is to start warfarin therapy and currently uses herbal supplements at home. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin? Feverfew Black cohosh Echinacea Flaxseed

Feverfew The nurse should instruct the client to avoid taking feverfew while taking warfarin because it will increase the anticoagulant effect.

A nurse is caring for a female client who has rheumatoid arthritis and asks the nurse if it is safe for her to take aspirin. The nurse should recognize which of the following findings in the client's history is a contraindication to this medication? Report of recent migraine headaches History of gastric ulcers Current diagnosis of glaucoma Prior reports of amenorrhea

History of gastric ulcers Aspirin is contraindicated for clients who have a history of gastrointestinal bleeding and peptic ulcer disease because it impedes platelet aggregation. An adverse effect of aspirin is gastric bleeding.

A nurse is preparing to administer heparin to a client. Which of the following actions should the nurse plan to take? Use a 22-gauge needle to inject the medication. Use a 1-inch needle to inject the medication. Inject the medication into the abdomen above the level of the iliac crest. Massage the injection site after administration of the medication.

Inject the medication into the abdomen above the level of the iliac crest. The nurse should inject the medication into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus.

A nurse is teaching a client who has a new prescription for aspirin to prevent cardiovascular disease. Which of the following instructions should the nurse include in the teaching? Take the tablets on an empty stomach. Expect stools to turn black. Anticipate the tablets to smell like vinegar. Monitor for tinnitus.

Monitor for tinnitus. Tinnitus is a manifestation of salicylism, or aspirin toxicity. Other manifestations include sweating, headache, and dizziness.

A nurse is reviewing laboratory results of a client who has atrial fibrillation and is taking warfarin. For which of the following results should the nurse notify the provider? PT 45 seconds Hgb 16 g/dL Hct 44% Platelets 190,000/mm3

PT 45 seconds The expected reference range for PT is 11 to 12.5 seconds. During therapy, the nurse should expect to see the values increase 1.5 to 2.5 times the baseline. Therefore, the nurse should withhold the warfarin and notify the provider.

A nurse is reviewing the laboratory data on a client who has a new prescription for heparin for treatment of a pulmonary embolism. Which of the following data should the nurse report to the provider? Hematocrit 45% Partial thromboplastin time (PTT) 65 seconds White blood cell count 8,000/mm3 Platelets 74,000/mm3

Platelets 74,000/mm3 Heparin-induced thrombocytopenia is a disorder characterized by low platelet counts. It is an adverse effect of heparin that causes the activation of platelets, resulting in widespread clot formation and depletion of platelets. The expected reference range for platelets is 150,000-400,000/mm3.

A nurse is caring for a client who is receiving heparin by continuous IV infusion. Which of the following medications should the nurse plan to administer in the event of an overdose? Iron Glucagon Protamine Vitamin K

Protamine Protamine reverses the effects of heparin and is used in the event of an overdose.

A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects? Vitamin K Protamine sulfate Acetylcysteine Deferasirox

Protamine sulfate Protamine sulfate reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties.

A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin? Hemoglobin (Hgb) Prothrombin time (PT) Bleeding time Activated partial thromboplastin time (aPTT)

Prothrombin time (PT) This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation.

A nurse in a clinic is caring for a client who has recently begun taking warfarin. The nurse is reviewing potential drug and food interaction risks and should instruct the client to avoid which of the following? Cabbage Cantaloupe Green beans White beans

Rationale: Cabbage should be limited in the diet when taking warfarin, because it is rich in vitamin K.

A nurse is teaching a client who is to start taking warfarin about herbal supplements. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin? Valerian Black cohosh Echinacea St. John's wort

St. John's wort The nurse should instruct the client that St. John's wort can decrease anticoagulation when taking warfarin.

A nurse is caring for a client who has atrial fibrillation and is receiving heparin. Which of the following findings is the nurse's priority? - The client's ECG tracing shows irregular heart rate without P waves. - The client has an aPTT of 80 seconds. - The client experiences sudden weakness of one arm and leg. - The client's urine output is cloudy and odorous.

The client experiences sudden weakness of one arm and leg. Rationale: Sudden weakness or numbness of the face and one arm or leg and can indicate that the client is at greatest risk for stroke; therefore, this is the nurse's priority finding. In addition to these findings, the client may appear confused, have slurred speech, loss of balance, dizziness, or sudden severe headache.

A nurse is preparing to administer warfarin to a client. Which of the following information should the nurse recognize prior to administering the medication? Warfarin is compatible with heparin. The client's aPTT should be monitored. The client should be observed for manifestations of hemorrhage. Warfarin can be administered along with NSAIDS.

The client should be observed for manifestations of hemorrhage. The nurse should observe for manifestations of hemorrhage because it is an adverse side effect of warfarin, which has anticoagulant and anti-inflammatory actions.

A nurse is completing a medical interview with a client who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin? The client follows a low-fat diet to reduce cholesterol. The client drinks a glass of grapefruit juice every day. The client sprinkles flax seeds on food 1 hr before taking the anticoagulant. The client uses garlic to lower cholesterol levels.

The client uses garlic to lower cholesterol levels. The nurse should recognize that garlic can potentiate the action of the warfarin.

A nurse is preparing to administer enoxaparin to a client. Which of the following actions should the nurse plan to take? - Insert the needle at a 45º angle. - Aspirate for a blood return before depressing the plunger. - The nurse should not expel the air bubble in the prefilled syringe. - Administer the medication 2.54 cm (1 in) from the umbilicus.

The nurse should not expel the air bubble in the prefilled syringe. The nurse should not expel the air bubble that is in the pre-filled syringe prior to administering the medication.

A nurse is caring for a client who is taking aspirin for arthritis. The nurse should identify which of the following findings as an adverse effect of this medication? - Tinnitus - Clay colored stools - Nystagmus Respiratory depression

Tinnitus Rationale: The nurse should identify tinnitus, or ringing in the ears, as an adverse effect of aspirin that indicates salicylism.

A nurse is preparing to administer dabigatran to a client who has atrial fibrillation. The nurse should explain that the purpose of this medication is which of the following? - To convert atrial fibrillation to sinus rhythm - To dissolve clots in the bloodstream - To slow the response of the ventricles to the fast atrial impulses - To reduce the risk of stroke in clients who have atrial fibrillation

To reduce the risk of stroke in clients who have atrial fibrillation Rationale: Clients who have atrial fibrillation are at an increased risk for thrombus formation and subsequent embolization to the brain. Anticoagulants, such as dabigatran, help prevent thrombus formation.

A nurse is providing discharge teaching for a client who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching? - Mild nosebleeds are common during initial treatment. - Use an electric razor while on this medication. If a dose of the medication is missed, double the dose at the next scheduled time. Increase fiber intake to reduce the adverse effect of constipation.

Use an electric razor while on this medication - Warfarin, an anticoagulant, increases the client's risk for bleeding. The nurse should teach the client safety measures, such as using an electric razor, to decrease the risk for injury and bleeding.

A nurse is reviewing the medication list for a client who has a new prescription for warfarin. The nurse should recognize that which of the following medications is incompatible with warfarin? Furosemide Alprazolam Vitamin K Vitamin A

Vitamin K These two medications are not compatible. Vitamin K antagonizes the action of warfarin and is the antidote for warfarin toxicity.

A nurse is caring for a client who is on warfarin therapy for atrial fibrillation. The client's INR is 5.2. Which of the following medications should the nurse prepare to administer?

Vitamin K Rationale: Vitamin K reverses the effects of warfarin.

A client who has a history of myocardial infarction (MI) is prescribed aspirin 325 mg. The nurse recognizes that the aspirin is given due to which of the following actions of the medication? - analgesic - anti-inflammatory - antiplatelet aggregate - antipyretic

antiplatelet aggregate Rationale: Aspirin is used to decrease the likelihood of blood clotting. It also is used to reduce the risk of a second heart attack or stroke by inhibiting platelet aggregation and reducing thrombus formation in an artery, a vein, or the heart.