CH 9 Drugs for Coagulation Disorders (E3)
A client being treated with warfarin after cardiac surgery is found to have an INR of 9.0. Which medication will be administered to assist in the development of clotting factors? A) vitamin K B) vitamin E C) protamine sulfate D) acetylsalicylic acid (aspirin)
A
A client has been administered heparin to prevent thromboembolism development status postmyocardial infarction. The client develops heparin-induced thrombocytopenia. Which medication will be administered? A) argatroban 9 B) vitamin K C) calcium gluconate D) aminocaproic acid
A
A client is admitted with thrombophlebitis and sent home on enoxaparin therapy. Which statement indicates a good understanding of why enoxaparin is being administered? A) Enoxaparin inhibits the formation of additional clots. B) Enoxaparin eliminates certain clotting factors. C) Enoxaparin decreases the viscosity of blood. D) Enoxaparin will dissolve the existing clots.
A
A client is receiving low molecular weight heparin to prevent thromboembolic complications. The nursing student asks the nursing instructor the reason why this treatment is given instead of heparin. What is the instructor's best explanation of the rationale for LMWH over heparin? A) "LMWH is associated with less thrombocytopenia than standard heparin." B) "LMWH is associated with stronger anticoagulant effects than standard heparin." C) "LMWH is given to clients who have a history of blood dyscrasia." D) "LMWH is more effective than standard heparin for clients with hypertension."
A
A client who is recovering in hospital from a bilateral mastectomy has developed minor bleeding at one of the incision sites. During the process of clot formation, plasminogen will become part of a clot by which means? A) by binding with fibrin B) by binding with platelets C) by activating plasmin D) by activating factor VII
A
Clopidogrel is indicated for which of the following? A) reduction of myocardial infarction, stroke, and vascular death in patients with atherosclerosis B) adjunctive therapy to warfarin for deep vein thrombosis C) heparin-induced thrombocytopenia D) patients in whom bleeding is a consideration
A
What is the action of anticoagulants? A) Decrease blood coagulability- no effect on existing thrombus B) Prevent platelet aggregation at the site of blood vessel injury C) Destroy thrombi that are blocking blood vessels D) Prevent destruction of fibrin- promote clot formation
A
In explaining the use of warfarin to a female patient, the nurse is correct in telling her which of the following regarding warfarin? SELECT ALL THAT APPLY. A) Warfarin is a vitamin K antagonist. B) Warfarin does not cross the placenta. C) Warfarin is used for long-term anticoagulation therapy. D) Warfarin is metabolized by the liver.
A, C, D
A 50-year-old man has undergone a bunionectomy and has been admitted to the postsurgical unit. What aspect of the man's medical history would contraindicate the use of heparin for deep vein thrombosis (DVT) prophylaxis? A) The man is morbidly obese. B) The man has a diagnosis of ulcerative colitis (UC). C) The man had a myocardial infarction (MI) 18 months ago. D) The man has a diagnosis of type 2 diabetes mellitus (DM).
B
A 55-year-old man has been diagnosed with coronary artery disease and begun antiplatelet therapy. The man has asked the nurse why he is not taking a "blood thinner like warfarin." What is the most likely rationale for the clinician's use of an antiplatelet agent rather than an anticoagulant? A) Antiplatelet agents do not require the man to undergo frequent blood work; anticoagulants require constant blood work to ensure safety. B) Antiplatelet agents are more effective against arterial thrombosis; anticoagulants are more effective against venous thrombosis. C) Antiplatelet agents are most effective in large vessels; anticoagulants are most effective in the small vessels of the peripheral circulation. D) Antiplatelet agents have fewer adverse effects than anticoagulants.
B
A client asks the nurse what dose of acetylsalicylic acid is needed each day for antiplatelet effects to prevent heart attacks. What dose is most appropriate to reduce platelet aggregation? A) 10 mg B) 30 mg C) 625 mg D) 1000 mg
B
A client has experienced the formation of clots and has bruising. It is determined that there is a depletion of the client's coagulation factors and widespread bleeding. Which medication will be administered? A) aminocaproic acid B) heparin C) warfarin D) protamine sulfate
B
A client is discharged from the hospital with a prescription of warfarin. Which statement indicates successful client teaching? A) "If I miss a dose, I will take two doses." B) "I will avoid herbal remedies." C) "I will eat spinach or broccoli daily." D) "I will discontinue my other medications."
B
A client with a history of clot formation is scheduled for bowel resection due to colorectal cancer. What anticoagulant agent will be administered prophylactically? A) acetylsalicylic acid B) heparin C) warfarin D) streptokinase
B
A nurse is planning to administer subq enoxaparin 40 mg using a prefilled syringe of 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 the injection in the client's thigh. D) Aspirate carefully after inserting the needle into the client's skin.
B
A nurse is preparing to administer IV alteplase to a client. Which of the following interventions should the nurse plan to take? A) Administer IM enoxaparin along with the alteplase dose. B) Obtain the client's weight. C) Administer aminocaproic acid IV prior to alteplase infusion. D) Prepare to administer alteplase within 8 hours of manifestation onset.
B
In developing a safe plan of care, the nurse should recognize that the antidote for warfarin is A) protamine zinc B) vitamin K C) protamine sulfate D) idarucizumab
B
What is the action of antiplatelets? A) Decrease blood coagulability- no effect on existing thrombus B) Prevent platelet aggregation at the site of blood vessel injury C) Destroy thrombi that are blocking blood vessels D) Prevent destruction of fibrin- promote clot formation
B
A nurse is monitoring a client who takes aspirin daily. The nurse should identify which of the following manifestations as adverse effects of aspirin? SELECT ALL THAT APPLY. A) Hypertension B) Coffee-ground emesis C) Tinnitus D) Paresthesias of the extremeties E) Nausea
B, C, E
A client is being administered heparin IV and has been started on warfarin. The client asks the nurse why she is taking both medications. What is the nurse's most accurate response? A) "After a certain period of time, you must start warfarin and heparin together." B) "You will need both warfarin and heparin for several days." C) "Warfarin takes 3 to 5 days to develop anticoagulant effects, and you still need heparin." D) "Warfarin cannot be given without heparin due to the amount of clotting you need."
C
A client is taking warfarin to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin monitored? A) RBC B) aPTT C) PT and INR D) platelet count
C
A nurse is caring for a client who has AFib and a new prescription for dabigatran. 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
A nurse is caring for a client who is receiving heparin by continuous IV infusion. The client begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer? A) Vitamin K B) Atropine C) Protamine D) Calcium gluconate
C
In developing a safe plan of care, the nurse recognizes that which of the following agents is the antidote for heparin? A) protamine zinc B) vitamin K C) protamine sulfate D) vitamin D
C
The nurse is reviewing the laboratory results of a hospitalized patient receiving intravenous heparin therapy for pulmonary embolism. The activated partial thromboplastin time (aPTT) is 38 seconds (control 28 seconds). The nurse should A) not give the next dose because the level is too high B) continue the present order because the level is appropriate C) notify the health care provider that the aPTT is low and anticipate orders to increase the dose D) request an order for warfarin now that the patient is heparinized
C
What is the action of thrombolytics? A) Decrease blood coagulability- no effect on existing thrombus B) Prevent platelet aggregation at the site of blood vessel injury C) Destroy thrombi that are blocking blood vessels D) Prevent destruction of fibrin- promote clot formation
C
A 79-year-old woman has been brought to the emergency department by ambulance with signs and symptoms of ischemic stroke. The care team would consider the immediate (STAT) administration of what drug? A) low molecular weight heparin B) vitamin K C) clopidogrel D) alteplase
D
A client is being discharged from the hospital with warfarin to be taken at home. Which food should the client be instructed to avoid in the diet? A) eggs B) dairy products C) apples D) spinach
D
A client is prescribed eptifibatide, which inhibits platelet aggregation by preventing activation of GP IIb/IIIa receptors on the platelet surface and the subsequent binding of fibrinogen and von Willebrand factor to platelets. Which syndrome is treated with eptifibatide? A) blocked carotid arteries B) intermittent claudication C) hypertension D) unstable angina
D
A client is receiving IV heparin every 6 hours. An activated partial thromboplastin time (aPTT) is drawn 1 hour before the 08:00 dose. The PTT is 92 seconds. What is the most appropriate action by the nurse? A) Give the next two doses at the same time. B) Give the dose and chart the client response. C) Check the client's vital signs and give the dose. D) Hold the dose and call the aPTT result to the health care provider's attention.
D
A client who is receiving warfarin has blood in his urinary catheter drainage bag. What medication will likely be ordered by the health care provider? A) aminocaproic acid B) platelets C) protamine sulfate D) vitamin K
D
A client, taking warfarin after open heart surgery, tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the report of pain, what should the nurse suspect is the cause of the pain? A) joint thrombosis B) torn medial meniscus C) degenerative joint disease caused by her medication D) bleeding
D
A nurse at a long-term care facility is conducting a medication reconciliation for a man who has just moved into the facility. The man is currently taking clopidogrel. The nurse is most justified suspecting that this man has a history of: A) hemorrhagic cerebrovascular accident. B) hemophilia A. C) idiopathic thrombocytopenic purpura (ITP). D) myocardial infarction.
D
The nurse explains to a patient that aspirin suppresses blood clotting by A) inactivating thrombin B) promoting fibrin degradation C) decreasing synthesis of clotting factors D) decreasing platelet aggregation
D
What is the action of antifibrinolytics? A) Decrease blood coagulability- no effect on existing thrombus B) Prevent platelet aggregation at the site of blood vessel injury C) Destroy thrombi that are blocking blood vessels D) Prevent destruction of fibrin- promote clot formation
D
