Chapter 45 and 46
A client is receiving warfarin sodium (Coumadin) for prevention of a thromboembolic event. The nurse determines that the client's latest International Normalized Ratio(INR) is optimal if which of the following values is noted?
2.5
How many minutes after a unit of packed red blood cells is checked out of the blood bank should it be hung for client use?
30 minutes
After receiving a first dose of warfarin (Coumadin) the client receiving IV heparin may expect the infusion to be discontinued in
48-72 hours
Which of the following laboratory studies will the doctor order to monitor the therapeutic effects of heparin?
APTT
An allergic reaction to urokinase may manifest itself through which of the following?
Dyspnea
Pravastatin is a
HMG-CoA reductase inhibitor
Discharge instructions about the Coumadin should include instructions to:
Use a soft toothbrush
Clopidogrel is
an antiplatelet
Fibrinolytics
degrade fibrin strands
Which agent below is a reductase enzyme inhibitor, which reduces cholesterol?
lovastatin
Nursing care for a client who received streptokinase include all of the following, EXCEPT
monitor liver enzymes
All of the following are correct regarding anticoagulant therapy, except
therapy poses a life threatening risk in clients with a DVT
Alteplase is a (an)
thrombolytic
Clients receiving warfarin therapy have their INR maintained at
2-3
A client who is taking anticoagulants requests an aspirin for his headache. As his nurse, you:
Contact the physician for an analgesic that does not contain aspirin
Heparin is given
IV
Enoxaparin belongs to which of the following drug group?
LMWH
Tinzaparin is a (an)
LMWH
Which of the following drugs does NOT alter the action of heparin?
Maalox
An example of an antiplatelet agent for angioplasty and acute coronary syndrome is
abciximab
A client on clopidogrel (Plavix) can take which of the following over the counter analgesics when needed?
acetaminophen (Tylenol)
Cholestyramine is a
bile acid sequestering agent
Anticoagulants
interfere with the clotting factors in the clotting cascade
Warfarin (Coumadin) exerts its anticoagulant effect by
interfering with the production of vitamin-K dependent clotting factors
Before discharge, a client begins oral anticoagulant therapy while he is still taking heparin. He questions you about being on both of the medications. Your best response would be:
"It takes a few days for the Coumadin to work, so we need to keep you on the heparin."
The nurse is preparing to hang a unit of blood on an assigned client. The nurse asks another nurse to monitor the other clients, because the nurse will need to remain with the client receiving the transfusion for at least how long after the unit is hung?
15 minutes
A client taking warfarin (Coumadin) is expected to have the international normalized ratio (INR) laboratory result within which of the following values?
2 to 3
The occurrence of hematuria and petechiae is most likely attributed to the concurrent use of heparin and:
Ibuprofen (Motrin)
Which of the following is an appropriate nursing diagnosis for the client who is taking heparin?
Impaired tissue perfusion
During streptokinase administration, it is important to carry out which of the following nursing interventions?
Monitor for any signs of blood loss
Which of the following tests is used for monitoring therapy with oral anticoagulants?
PT and INR
Which of the following lab test(s) must be done for a client receiving heparin?
PTT and APTT
Heparin primarily interferes with
Prothrombin
For which condition would the use of anticoagulants be contraindicated?
Recent childbirth
A client who is receiving a continuous heparin infusion is complaining of a chill and low back pain. The most appropriate nursing action would be to:
Stop the heparin infusion
Warfarin primarily interferes with
Vitamin K
A client who needs a blood transfusion has a history of having a febrile nonhemolytic reaction to a transfusion in the past. The nurse questions the physician about an order for which of the following, which the client should receive to prevent this from occurring with this transfusion?
acetaminophen(Tylenol)
The nurse advises a client taking anticoagulant therapy that which of the following drugs would be best to use for self-treatment of occasional headaches?
acetaminophen(Tylenol)
All of the following statements are correct regarding special consideration for the older adult, except
alcohol consumption and diet will not interfere with anticoagulant effects
Which agent below is used to hasten clot formation to help manage care for clients at high risk for bleeding, such as in hemophilia?
aminocaproic
Which agent below is used to treat bleeding disorders, such as hemophilia
aminocaproic
Which of the following drugs is an antidote for streptokinase?
aminocaproic acid
Cilostazol is a (an)
antiplatelet
Dipyridamole is a (an)
antiplatelet
Ticlopidine is a (an)
antiplatelet
Clopidogrel (Plavix) and ASA are examples of
antiplatelets
Which drug class below inhibits cholesterol absorption at the brush border of the small intestine?
azetidinones
Colesevelam is a
bile acid sequestering agent
Colestipol is a
bile acid sequestering agent
Colestipol (Colestid) reduces serum cholesterol by
binding to bile salts in the GI tract to prevent reabsorption
Heparin can cause
bleeding
The nurse would notify the physician prior to beginning an IV infusion of alteplase(Activase) if which of the following vital signs were measured as part of the admission to the emergency department?
blood pressure 194/112 mmHg
Expected risks for antiplatelets, anticoagulants and fibrinolytics are all of the following, except
cancer
Of the list below which one of the following is NOT a LMWH?
clopidogrel
Which agent below is an antiplatelet?
clopidogrel
Which agent below is a bile acid sequestering agent?
colestipol
All of the following are instructions for clients with altered platelet or clotting factors, except
discontinue your medication at first sign of bleeding and contact the prescriber
Fibrinolytic drugs
dissolve clots
A client is a candidate for alteplase (Activase). This drug will
dissolve the blood clot that has already formed
_______ is a mass of undissolved matter that breaks off from the blood clot.
embolus
A low molecular weight heparin is
enoxaparin
Parenteral anticoagulants include
enoxaparin
Clofibrate is a
fibric acid derivative
Which agent below is a fibric acid derivative?
gemfibrozil
A client taking warfarin (Coumadin) should limit intake of _______ to avoid a drug-food interaction.
green, leafy vegetables
Which agent below is a parenteral anticoagulant
heparin
Upon nearing completion of intravenous infusion of alteplase (Activase), the client will be started on _________ as part of the protocol.
heparin (Liquaemin)
If a client receives the drug therapy simvastatin (Zocor), they should NOT have which of the following health problems?
hepatitis
Risk factors for coronary heart disease include all of the following, except
high HDL
Intravenous heparin therapy exerts its effect by
inactivating clotting factors circulating in the bloodstream
The most serious drug interaction that occurs with oral anticoagulants (OAC) are those that
increase OAC effect and increase bleed risk
Antiplatelet drugs
inhibit platelet aggregation
A client has just completed intravenous thrombolytic therapy. A sign above the client's bed reads do not give drugs by which route for at least 24 hours?
intramuscular
Ticlopidine (Ticlid) is contraindicated in which of the following?
liver disease
An allergic reaction to streptokinase includes all of the following, EXCEPT
nausea
Which agent below is a vitamin shown to reduce cholesterol?
niacin
Which of the following vitamins has a lipid-lowering effect?
nicotinic acid
Warfarin is a (an)
oral anticoagulant
Vitamin K is a (an)
oral anticoagulant antidote
Heparin is a (an)
parenteral anticoagulant
Protamine sulfate is a (an)
parenteral anticoagulant antidote
In the case of the administration of too much warfarin, which agent below would be the appropriate antidote?
phytonadione
A client taking warfarin sodium(Coumadin) who is experiencing small episodes of bleeding visits the urgent care clinic and has an INR level drawn. After noting that the level is critically high, what medication should the nurse have readily available for use if ordered?
phytonadione(Mephyton)
A dose of warfarin (Coumadin) would be contraindicated in
pregnancy
Anticoagulants will
prevent new clot formation
The primary goal of anticoagulant therapy is to
prevent the formation of new thrombi
In the case of the administration of too much heparin, which agent below would be the appropriate antidote?
protamine sulfate
In the event of a hemorrhage, which of the following medications is most likely to be administered intravenously?
protamine sulfate
A client receiving heparin has an activated partial thromboplastin time in the critically high range. Which of the following drugs should be on hand to use as an antidote?
protamine sulfate (Protamine)
Fluvastatin is a
reductase enzyme inhibitor
The nurse is preparing to administer a scheduled dose of heparin to a client. Which of the following actions should the nurse take as part of routine procedures?
rotate sites on the lower abdomen
A client is being discharged on anticoagulant therapy. Which of the following is an acceptable item for self-care?
soft toothbrush
Which agent below is a thrombolytic?
streptokinase
Health teachings for a client receiving warfarin therapy would include all of the following, EXCEPT
take an aspirin for a headache
Which statement below is correct regarding Clopidogrel?
the combination of clopidogrel and ASA is appropriate
Urokinase is a (an)
thrombolytic
Which of the following is the antidote for warfarin overdose?
vitamin K
The oral anticoagulant commonly used is
warfarin
Which agent below is an oral anticoagulant?
warfarin
Which of the following agent(s) is pregnancy safety category X?
warfarin