EAQ 25-27

When the nurse finds that a patient has an obstructed central venous catheter, which drug would be prescribed to reopen the catheter? Alteplase (Activase) Warfarin (Coumadin) Eptifbatide (Integrilin) Aminocaproic acid (Amicar) Rationale Alteplase (Activase) is a fibrinolytic agent used to dissolve clots and may be used to reopen intravenous catheters and central venous catheters. Aminocaproic acid (Amicar i inhibitor fibrinolysis and is used for the treatment of fibrinolytic bleeding. Eptifbatide (Integrilin)is glycoproteinlbll inhibitor used during percutaneous coronary intervention procedures. Warfarin (Coumadin isan anticoagulant used to treat or prophylactically prevent venous thrombosis, embolism associated with atril fibrillation or heart valve replacement, pulmonary embolism, and coronary occlusion.

Alteplase (Activase)

Which adverse effects of pentoxiflline (Trental) are mild and tend to resolve with continued therapy? Select all that apply. Flatus Belching Dyspepsia Chest pain Shortness of breath Rationale Flatus, belching, and dyspepsia are gastrointestinal adverse effects of pentoxifylline (Trental); these effects are mild and tend to resolve with continued therapy. Chest pain and shortness of breath are neurologic adverse effects of pentoxifylline (Trental) that should be reported to the healthcare provider for further evaluation.

Flatus Belching Dyspepsia- It is a pain or an uncomfortable feeling in the upper middle part of your stomach area.

Which instruction from the healthcare provider is most beneficial for a patient who has been prescribed cilostazol ( Pletal)for the treatment of intermittent claudication ? " Take the medication 2 hours before dinner ." " Avoiddrinking grapefruit juice while taking the medication ." " Discontinuethe medication if you experience nausea and vomiting ." " Chestpain and shortness of breath are common adverse effects of cilostazol ( Pletal)." Rationale Grapefruit juice inhibits the metabolism of cilostazol (Pletal). Therefore the healthcare provider should tell the patient to avoid drinking grapefruit juice while taking the medication .Cilostazol ( Pletal)should be taken 2 hours after (not before )dinner for maximum efficacy.Nausea and vomiting are common adverse effects of cilostazol ( Pletal)therapy.The patient should not discontinue the medication without consulting the healthcare provider first .Chest pain and shortness of breath are serious adverse effects of cilostazol ( Pletal)that should be reported to the healthcare provider immediately .

" Avoiddrinking grapefruit juice while taking the medication ."

Which statements are true regarding the pharmacodynamics of pentoxifylline (Trental)? Select all that apply. " Pentoxifylline( Trental)should not be given to patients taking sertraline Zoloft)." " Pentoxifylline(Trentalshouldnot be given to patients ingesting caffeine ." " Pentoxifylline( Trental)should not be given to patients taking fluoxetine Prozac)." " Pententoxifylline(Trental)should not be given to patients taking fluvoxamine (Luvox)." " Pentoxifylline( Trental)should not be given to patients taking theophylline Asbron)." Rationale Pentoxifylline (Trental)a hemorheologic agent that is used to treat peripheral vascular disease. It should not be given to patients taking caffeine and ( Asbron).Pentoxifylline Trental) can be given to patients taking ( Zoloft),fluoxetine (Prozac), or fluvoxamine (Luvox).

" Pentoxifylline(Trentalshouldnot be given to patients ingesting caffeine ." " Pentoxifylline( Trental)should not be given to patients taking theophylline Asbron)."

Which statement is true regarding cilostazol (Pletal)? "Cilostazol (letal) is used to treat patients with heart failure." "Cilostazol (Pletal) therapy is an adjunct to surgical bypass." "Cilostazo Pltal) metabolism is inhibited by theophylline (Asbron).' "Cilostazol Pletal) is approved for the treatment of peripheral arterial disease." Rationale Cilostazol (Pletal) is a platelet aggregation inhibitor that is used in the treatment of peripheral vascular disease. It is used as an adjunct to surgical bypass. Cilostazol (Pletal) is contraindicated in patients with heart failure because the medication may worsen the condition. The metabolism o cilostazol (Pletal is inhibited by diltiazem (Cardizem). Cilostazol Pletal) is approved for the treatment of intermittent claudication.

"Cilostazol (Pletal) therapy is an adjunct to surgical bypass."

When a patient who was prescribed clopidogrel (Plavix) to reduce the risk of atherosclerotic events reports nausea, vomiting, and anorexia, which information should the healthcare provider give the patient? "You are allergic to this medication." "Take the medication before eating." "Discontinue the medication if you notice these symptoms again." "Continue with the drug therapy and your symptom will resolve after 2 weeks." Rationale Common adverse fects of clopidogrel (Plavix) are nausea, vomiting, and anoreia. These effects tend to occur most frequently with early dosages and tend to resolve with continued therapy over the next 2 weeks. Nausea, vomiting, and anorexia do not indicate an allergic reaction, and they can be minimized when taken with food. The patient should not stop taking the medication, because these symptoms will resolve in a short time.

"Continue with the drug therapy and your symptom will resolve after 2 weeks."

Which statement made by a patient with peripheral vascular disease indicates a need for further education regarding the dosage and administration of pentoifyline (Trental)? "I should take a 400-mg dose three times a day." "I should take the medication for at least 8 weeks." O "I should reduce the dosage to 400 mg twice a day if gastrointestinal effects occur." "I should reduce the dosage to 400 mg once a day if gastrointestinal effects persist." Rationale Pentoifyline (Trental) is a hemorheologic agent used to treat peripheral vascular disease. If gastrointestinal effects persist, the patient should discontinue the medication rather than reducing the dosage. The medication should be taken in 400-mg doses three times a day. Even after symptomatic relief, the medication should be continued for at least 8 weeks to achieve maximum efficacy. The dosage should be reduced to 400 mg twice a day in the presence of gastrointestinal effects.

"I should reduce the dosage to 400 mg once a day ifgastrointestinal effects persist."

Which instructions would be given to the patient with nonvalvular atrial fibrillation who has been prescribed dabigatran (Pradaxa)? Select all that apply. "Swallow the capsule whole." "Once the bottle is opened, use within 30 days." "Crush the capsule and sprinkle the pellets on food." "Reseal the bottle quickly after taking a capsule from it." "If you forget to take a dose, take two doses when you are next scheduled to take the medication." Rationale Dabigatran (Pradaxa) is used to reduce the risk of strokes and systemic embolisms in patients with nonvalvular atrial filling. Dabigatran (Pradaxa) capsules should be swallowed whole to prevent change in the dosage. Dabigatran (Pradaxa) capsules are sensitive to moisture. Once the bottle is opened it should be used within 30 days and resealed quickly after taking a capsule from it. Crushing the capsule and sprinkling the pellets on the food may lead to a severe overdose. lf the dose is missed, dabigatran Pradaxa should be taken 6 hours before the next dose, not added along with the next dose.

"Swallow the capsule whole." "Once the bottle is opened, use within 30 days." "Reseal the bottle quickly after taking a capsule from it."

When the healthcare provider prescribes warfarin (Coumadin) fora thromboembolic disorder, which instructions should be given to the patient? Select all thatapply. "Reduce the dosage once you are feeling better." "Take the dosage exactly as prescribed." "Start a new schedule ifone dose ofwarfarin (Coumadin) is missed." "Report to your healthcare provider immediately if you feel weak and have moist, clammy skin.' "Consult a healthcare provider before taking any over-the-counter medication." Rationale Warfarin (Coumadin) is a potent anticoagulant that should be taken as prescribed to prevent complications. Weakness and moist, clammy skin are indicators of internal bleeding; the patient should immediately report these findings to the healthcare provider. Because many drugs interact with warfarin (Coumadin) to increase or decrease its effectiveness, the patient should consult the healthcare provider before taking any over-the- counter medication. The dosage should never be reduced without consulting the healthcare provider. The patient should resume a regular schedule if one dose of warfarin (Coumadin) is missed.

"Take the dosage exactly as prescribed." "Report to your healthcare provider immediately if you feel weak and have moist, clammy skin.' "Consult a healthcare provider before taking any over-the-counter medication."

Which instruction would be beneficial to a patient with a myocardial infarction who is prescribed clopidogrel (Plavix)? Select all that apply. "Take this medication with food." "Avoid taking this medication if anorexia occurs.' "Stop taking the medication if diarrhea occurs.' "Report symptoms of fever and excessive fatigue immediately.' "Discontinue the therapy if nosebleeds and dark tarry stools are observed." Rationale Clopidogrel (Plavix) is a second-generation thienopyridine used to treat myocardialinfarction. Nausea, vomiting, anorexia, and diarrhea are common adverse effects of the medication. These adverse effects can be minimized by taking the medication with food. Fever and excessive fatigue are symptoms of infection that should be reported immediately to the healthcare provider. Anorexia and diarrhea are common adverse effects that tend to resolve within 2 weeks. The patient should not discontinue the therapy without frst consulting the healthcare provider. Nosebleeds and dar tarry stools indicate thrombotic thrombocytopenic purpura; these findings should be reported immediately to the healthcare provider without discontinuing the medication.

"Take this medication with food." "Report symptoms of fever and excessive fatigue immediately.'

Which statement is true regarding the use of calcium channel blockers? "Calcium channel blockers cause an increase in bradykinins.' "The calcium channel blocker nifedipine greatly reduces vasospastic attacks." "Calcium channel blockers are used as an adjunctive therapy to treat peripheral vascular diseases." "Calcium channel blockers have not been successful in the management of Raynaud's disease." Rationale The calcium channel blocker nifedipine greatly reduces vasospastic attacks. Calcium channel blockers do not increase the level of bradykinins; angiotensin-converting enzyme inhibitors do. Calcium channel blockers are not used as an adjunctive therapy to treat peripheral vascular diseases. Calcium channel blockers are successful in treating Raynaud's disease.

"The calcium channel blocke nifedipine greatly reduces vasospastic attacks."

Which statement by the patient indicates the need for further education concerning self-management of peripheral vascular disease? "Tighter-fitting socks will help improve my circulation by helping return the blood to the heart." "I shouldn't elevate my arms or legs above the level of my heart unless my healthcare provider says it is ok.' "Itis dangerous to go barefoot, sol should always make sure have footwear on when am up walking." "When lam outside during the winter months, I need to wear several layers of lightweight clothing to avoid frostbite." Rationale A tight sock will constrict peripheral blood flow and should be avoided. Extremities should not be elevated above the level of the heart unless the patient is told to do so by the healthcare provider. Going barefoot can be dangerous because of the potential for injuries to the feet. Several layers of lightweight clothing should be worn when exposed to cold weather to avoid frostbite, which can occur without the patient's awareness because of the decreased sensation in the extremities.

"Tighter-itting socks will help improve my circulation by helping return the blood to the heart."

Which instruction included in the care plan of a patient who is on pentoifyline (Trental) therapy needs correction? "You should stop taking the medication if nausea and vomiting occur." "You should continue the therapy for at least 8 weeks to achieve maximal efficacy." "You should rise slowly from a sitting position and flex your leg muscles before moving." "You should take the medication with food or milk to avoid gastrointestinal discomfort.' Rationale Pentoiflline (Trental) therapy should not be discontinued without first consulting the healthcare provider. Nausea and vomiting are common adverse effects of the medication and tend to resolve with continued therapy. The patient should continue pentoifyline (Trental) therapy for at least 8 weeks to achieve maximal efficacy. Pentoiflline (Trental) therapy has the potential to cause orthostatic hypotension; therefore the patient should rise slowly from the sitting position, flex the leg muscles and adjust the balance for stability before moving. The patient should take the medication with food or milk to avoid gastrointestinal adverse effects such as nausea, vomiting, and dyspepsia.

"You should stop taking the medication if nausea and vomiting occur."

Which instruction should be given to a patient with peripheral vascular disease prescribed cilostazol (Pletal)? "You should discontinue the medication if you experience dyspepsia." "You should continue the medication for at least 4 weeks." "You should tell your healthcare physician if you begin experiencing diarrhea." "You should take the medication twice daily, 30 minutes before breakfast and dinner." Rationale Cilostazol (Pletal) is a platelet aggregation inhibitor that is used to treat peripheral vascular disease. Cilostazol (Pletal) should be taken orally twice daily, 30 minutes before breakfast and dinner. The patient should not discontinue the medication without consulting the healthcare provider. The medication should be continued for at least l2 weeks to achieve maximum efficacy. Diarrhea is a common gastrointestinal adverse effect that resolves with continued therapy. Diarrhea should be reported only if it persists over a long period.

"You should take the medication twice daily, 30 minutes before breakfast and dinner."

When the healthcare provider prescribes medication to a patient newly diagnosed with peripheral vascular disease, which instruction is beneficial to the patient? "You should wear garters." "You should avoid elevating the head of your bed." "You should avoid heat." "You should wear properly fitting shoes." Rationale Peripheral vascular disease refers to a disease of the blood vessels in the arms and legs. This disease is caused by obstructions of blood flow through the arteries, which results in ischemia in the tissues supplied by those arteries. The patient should wear propel-fitting shoes to prevent ulcerative complications associated with peripheral vascular disease. The patient should avoid wearing garters because they may cause vasoconstriction. The head of the bed should be elevated by l2 to 16 inches. The patient should avoid cold conditions to prevent further blood fow obstructions.

"You should wear properl ftting shoes."

When a patient on pentoiflline (Trental) therapy reports dyspepsia and vomiting, which instruction would the healthcare provider give to the patient? "You should discontinue the medication.' "You should reduce the dosage of the medication." "You should take the medication without food to avoid these effects." 'These are common adverse effects that will disappear with therapy." Rationale Dyspepsia and vomiting are common gastrointestinal adverse effects of pentoiflline (Trental) therapy. These effects resolve with continued therapy. The patient should not be instructed to discontinue the therapy. Reducing the dosage is not appropriate. The medication should be taken with food to reduce discomfort.

'These are common adverse effects that will disappear with therapy."

Which patient taking clopidogrel (Plavix) would the nurse suspect will develop an infection? A patient with renal impairment A patient who reports anorexia and vomiting A patient experiencing hematuria who has excreted dark tarry stools A patient who reports sore throat and excessive fatigue Rationale Adverse effects of clopidogrel (Plavix) include neutropenia and infection. The symptoms of infection are sore throat, fever, and excessive fatigue. A patient who has a renal impairment and is taking clopidogrel (Plavix) may develop thrombotic thrombocytopenic purpura. Anorexia and vomiting are common adverse effects of clopidogre| (Plavix), which resolve after 2 weeks of treatment and do not indicate infection. The normal physiologic effect of clopidogrel (Plavix) is prolonged of bleeding time;this condition manifests as hematuria and dark tarry stools.

) A patient who reports sore throat and excessive fatigue

Which patient can be safely prescribed ticagrelor(rilinta)? A patient with severe liver damage A patient with acute myocardial infarction A patient who is on 125 mg of aspirin daily A patient who has a history of intracranial hemorrhage Rationale Ticagrelor (Brilita) is a platelet aggregation inhibitor that binds to the platelet P2Yl2 receptors and inhibits the adenosine 5'-diphosphate pathway required for platelet aggregation. This drug can be prescribed to a patient with myocardial infarction to reduce the frequency of thrombotic events. Ticagrelor (Brilinta) is contraindicated in a patient with severe liver damage because metabolism of the drug will be decreased and therapeutic activity will be altered. Large doses of aspirin reduce the effectiveness of ticagrelor (rilinta). Ticagrelor (Brilinta) is contraindicated in a patient who has a history of intracranial hemorrhage because of the risk of a hemorrhagic stroke.

A patient with acute myocardial infarction

Which glycoproteinlbllla inhibitors are used to prevent clot formation during percutaneous coronary intervention (PCl procedures? Select all that apply. Alteplase (Activase) Abciximab (ReoPro) Tirofban (Aggrastat) Dabigatran (Pradaxa) Eptifbatide (Integrilin) Rationale Abciximab (ReoPro) tirofban (Aggrastat), and eptifbatide (Integrilin are glycoprotein lb/ll inhibitors that prevent clot formation during PCl procedures. Alteplase (Activase) is a fibrinolytic agent that dissolves arterial thromboemboli once they are formed. Dabigatran (Pradaxa)is an oral direct thrombin inhibitor used to prevent strokes and systemic emboli in patients with atrial fibrillation.

Abciximab (ReoPro) Tirofban (Aggrastat) Eptifbatide (Integrilin)

Which class of drugs used to treat Raynaud's disease causes an increase in bradykinins? Direct vasodilators Adrenergic antagonists Calcium channel blockers Angiotensin-converting enzyme inhibitors Rationale Angiotensin-converting enzyme inhibitors cause an increase in bradykinins, a potent vasodilator. Direct vasodilators such as nitroglycerin (Nitrostat) are used to reduce the frequency and severity of attacks in patients with Raynaud's disease. Adrenergic antagonists are used in moderation to treat Raynaud's disease because of adverse effects associated with these drugs Calcium channel blockers reduce the frequency of vasospastic attacks in patients with Raynaud's disease.

Angiotensin-converting enzyme inhibitors

Which class of medication may cause Raynaud's disease? Beta blockers Adrenergic blockers Calcium channel blockers Angiotensin-converting enzyme inhibitors Rationale Beta-blockers cause Raynaud's disease. Adrenergic blockers, calcium channel blockers, and angiotensin-converting enzyme inhibitors are used to treat Raynaud's disease.

Beta blockers

The nurse is caring for a patient who weighs 37 kg with a deep vein thrombosis who is prescribed 40 mg of enoxaparin (Lovenox) to be taken once a day. Which complication should the nurse monitor for in this patient? Systemiclotting Bleeding Renal impairment Altered prothrombin time Rationale Enoxaparin (Lovenox) is a low-molecular-weight heparin used to treat deep vein thrombosis patient that weighs less than 57 kg receiving 30 mg to 40 mg of the medication either once or twice a day should be carefully monitored for signs and symptoms of bleeding. Systemic clotting and renal impairment are very rare in the patient. Enoxaparin (Lovenox) affects neither the prothrombin time nor the activated partial thromboplastin time.

Bleeding

Which phrase describes the mechanism ofaction o eptifbatide (Integrilin)? Inhibits the activity of vitamin K Prevents the conversion of fbrinogen to fbrin Blocks the glycoproteinllla receptor on platelets Stimulates the body's own clot-dissolving mechanism Rationale Eptifbatid (Integrilin) acts by blocking the glycoprtein lllla receptor on platelets, which prevents platelet aggregation and clot formation. Warfarin (Coumadin is a potent anticoagulant that inhibits the activity of vitamin K. Dabigatran (Pradaxa) is a direct thrombin inhibitor that prevents the conversion of fibrinogen to fibrin, which is required for the formation of a thrombus. Fibrinolytic agents such as reteplase (Retavase) stimulate the body's own clot-dissolving mechanism.

Blocks the glycoproteinllla receptor on platelets

How does pentoxifylline Trental) halt intermittent claudication? By increasing blood viscosity By increasing the bradykinin level By increasing red blood cell flexibility By increasing the concentration of fibrinogen in the blood Rationale ( Trental)an agent that increases red blood cell flexibility. This action reduces blood viscosity and provides better oxygenation to muscle tissues to stop intermittent claudication. Pentoxifylline ( Trental)decreases blood viscosity. Angiotensin -converting enzyme inhibitors increase bradykinin levels .( Trental)decreases the concentration of fibrinogen in the blood.

By increasing red blood cell flexibility

How does cilostazol (Pletal) inhibit platelet aggregation in patients with peripheral vascular disease? By increasing erythrocyte feibility By decreasing blood viscosity By improving the flow properties of the blood By suppressing cyclic adenosine monophosphate phosphodiesteras III Rationale Cilostao (Plta) is a platelet aggregation inhibitor that is a selective inhibitor of cellular cyclic adenosine monophosphate phosphodiesteraslll. This action results in vasodilation and inhibits platelet aggregation. Pentoiflline (Trental) is a hemorheologic agent that increases erythrocyte flexibility, decreases blood viscosity, and improves the flow properties of the blood.

By suppressing cyclic adenosine monophosphate phosphodiesteras III

Which food and herbal supplements inhibit the therapeutic activity of warfarin (Coumadin)? Select all that apply. Papaya Fish oil Cabbage Devil's claw Green leaf vegetables Rationale Food and herbal supplements such as cabbage and green leafy vegetables are rich in vitamin Cand K.These vitamins inhibit the therapeutic activity of warfarin (Coumadin) Papaya fish oil, and devil's claw stimulate the therapeutic effect of warfarin (Coumadin).

Cabbage Green leaf vegetables

Which medication reduces the frequency and severity of attacks in patients with peripheral vascular disease? Clopidogrel (Plavix) Captopril (Capoten) Vorapaxar (Zontivity) Clonidine (Catapres) Rationale Captopril (Capoten) is an angiotensin-converting enzyme (ACE) inhibitor that reduces the frequency and severity of attacks in patients with peripheral vascular disease. Clopidogrel (Plavix and vorapaxar (Zontivity) are platelet aggregation inhibitors that are used to treat peripheral arterial disease. Clonidine (Catapres) is an alpha agonist that causes Raynaud's disease.

Captopril (Capoten)

Which medications should be used with caution in patients on pentoiflline (Trental) therapy? Select all that apply. Cilostazol (Pletal) Captopril (Capoten) Prazosin (Minipress) Vorapaxar (Zontivity) Theophylline (Asbron) Rationale Concurrent use of pentoxiflline (Trental and antihypertensive agents such as captopril Capoten) or prazosin (Minipress) may cause hypotension. Concurrent use of pentoiflline (Trental) and theophylline (Asbron) leads to theophylline (Asbron) toxicity, which results in tachycardia Cilostazol Pltal) is a platelet aggregation inhibitor that treats peripheral vascular disease;this drug does not interact with pentosiflline Trental). Vorapaxar (Zontivit) I a newer platelet aggregation inhibitor used to treat peripheral arterial disease; this drug does not interact with pentoiflline (Trental).

Captopril (Capoten) Prazosin (Minipress) Theophylline (Asbron)

Which phrase correctly describes the drug interactions of pentoilline Trental)? Does not have the potential to cause dizziness and headaches Increases systemic blood pressure Decreases theophylline (Asbron) levels Causes theophylline (Asbron) toxicity Rationale When taken concurrently with theophylline (Asbron) pentoxiflline (Trental) causes theophylline (Asbron) toxicity. diverse effects of pentoiflline (Trental) indeed include dizziness and headaches. Pentoifylline (Trental) decreases systemic blood pressure. Pentoiflline (Trental) increases theophylline (Asbron) levels.

Causes theophylline (Asbron) toxicity

A patient who is diagnosed with a bacterial infection is prescribed erythromycin (Erythrocin), and the healthcare provider discovers the patient is also on cilostazo| (Pletal) therapy. Which intervention would be beneficial for the patient? Increasing the dose of cilostazol (Pletal) Discontinuing cilostazol Pltal) therapy Changing the medication used to treat the bacterial infection Increasing the dosage of erythromycin (Erythrocin) Rationale Erythromycin (Erythrocin) inhibits the metabolism of cilostazol Pltal), resulting in an increased incidence of adverse effects. Therefore the medication prescribed to treat the bacterial infection should be changed to minimize the adverse effects. Increasing the dosage of cilostazol (Pletal) may result in the accumulation of the drug, which can cause severe adverse effects. The patient should not discontinue cilostazol Pletal) therapy, but he or she can reduce the dosage after consulting the healthcare provider. Increasing the dosage of erythromycin (Erythrocin) increases the inhibition of metabolism of cilostazol (Pltal), resulting in adverse effects.

Changing the medication used to treat the bacterial infection

Which symptoms are serious adverse effects of pentoiflline? Select all that apply. Diarrhea Dizziness Dyspepsia Chest pain Shortness of breath Rationale Pentoxifyline is a hemorheologic agent that is used to treat peripheral vascular disease. Chest pain and shortness of breath are serious adverse effects of pentoiflline. Diarrhea is a common adverse effect of cilostazol Dizziness and dyspepsia are common but no serious adverse effects of pentoiflline.

Chest pain Shortness of breath

A patient with intermittent claudication takes a platelet aggregation inhibitor and reports shortness of breath accompanied by chest pain. Which medication is responsible for the patient's condition? Cilostazol (Pletal) Vorapaxar (Zontivity) Pentoxifylline (Trental) Bromocriptine (Cycloset) Rationale Cilostazol ( Pletal) and aggregation inhibitor are used to treat intermittent claudication. Shortness of breath aggregation inhibitor is used to treat peripheral arterial disease; it does not cause shortness of breath or chest pain. Pentoxifylline ( Trental) is a hemorheology agent used to treat intermittent claudication; it may cause chest pain and shortness of breath, but this medication is not the most likely to cause these symptoms. Bromocriptine (Cycloset)is a dopamine receptor agonist that is not used to treat intermittent claudication.

Cilostazol (Pletal)

Which statement regarding drug therapy for peripheral vascular disease is true? Pentoxifylline is a platelet aggregation inhibitor. Cilostazol is approved for the treatment of intermittent claudication. Pentoxifylline has great success in the treatment of peripheral vascular disease. Clopidogrel and vorapaxar are used to treat Raynaud 'sdisease . Rationale Cilostazol is a platel aggregation inhibitor that is approved for the treatment of intermittent claudication. Pentoxifylline is a hemorheological agent that is used to treat peripheral vascular disease. Pentoxifylline has modest success in the treatment of peripheral vascular disease . Clopidogrel and vorapaxar are used to treat peripheral arterial disease.

Cilostazol is approved for the treatment of intermittent claudication .

When a patient with chronic occlusive arterial disease of the limbs reports aches, cramps, and numbness in the legs, which medication would be beneficial for the patient? Select all that apply. Cilostazo| (Pletal) Verapamil (Calan) Diltiazem (Cardizem) Pentoxifulline (Trental) Nitroglycerin Nitrostat) Rationale Aches, cramps, and numbness in the legs indicate intermittent claudication. This condition is caused by poor blood circulation because of narrowing of the arteries of the legs in patients with chronic occlusive arterial disease of the limbs. Cilostazol (Pletal) and pentoifline (Trental) are the only two medications that are approved by the US Food and Drug Administration to treat intermittent claudication caused by chronic occlusive arterial disease of the limbs. Verapamil (Calan) and diltiazem (Cardizem) are calcium ion antagonists used to treat Raynaud's disease. Nitroglycerin (Nitrostat is a vasodilator that is used to treat Raynaud's disease.

Cilostazo| (Pletal) Pentoxifulline (Trental)

Which medications may cause Raynaud's disease? Select all that apply. Cilostazol (Pletal) Clonidine (Catapres) Vorapaxar (Zontivity) Imipramine (Tofranil) Bromocriptine (Cycloset) Rationale Clonidine (Catapres) imipramine (Tofanil), and bromocriptine (Cycloset) are secondary causes of Raynaud's disease. Cilostazol Pletal) is a platelet aggregation inhibitor used to treat intermittent claudication. Vorapaxar (Zontivity) is a platelet aggregation inhibitor that treats peripheral arterial disease.

Clonidine (Catapres) Imipramine (Tofranil) Bromocriptine (Cycloset)

Which medications are used to treat peripheral arterial disease? Select all that apply. Clopidogrel Prazosin Vorapaxar Reserpine Nifedipine Rationale Clopidogrel and vorapaxar are platelet aggregation inhibitors used to treat peripheral arterial disease. Adrenergic antagonists such as prazosin and reserpine are used to treat Raynaud's disease, but they are moderately successful because of the adverse effects associated with these medications. Calcium ion antagonists such as nifedipine are most effective in patients with Raynaud's disease.

Clopidogrel Vorapaxar

Before administering dalteparin (Fragmin), the nurse would monitor which laboratory values? Homocysteine (HCY) Erythropoieti (EPO) C-reactive protein (CRP) Complete blood count (CBC) Rationale Dalteparin (Fragmin) is indicated for prophylaxis of deep vein thrombosis ischemic complications in unstable angina, and non-Q-wave myocardilinfarction (Ml). A CBC, platelet count, and stoo occult blood test should be performed and monitored before starting dalteparin (Fragmin) therapy because an adverse effect of the drug is bleeding. A CRP testis used to diagnose inflammatory disorders. An EPO testis used t asst in differentiating the cause of anemia or polycythemia.An HCY test is used as a predictor of cerebral, coronary, and peripheral vascular disease and is also used for the detection of malnutrition. None of these latter three tests is necessary for dalteparin (Fragmin) therapy, which is used for prophylaxis of deep vein thrombosis, ischemic complications in unstable angina, and non-Q-wave Ml.

Complete blood count (CBC)

The nurse is caring for a patient with heart failure who is receiving digoxin (Lanoxin), and the serum digoxin (Lanoxin) level is found to be0.3ng/mL. Which intervention would be appropriate in this patient? Withhold digoxin (Lanoxin). Administer verapamil (Verelan), Contact the provider to increase the dose of digoxin (Lanoxin). Advise to avoid potassium supplements. Rationale Normal serum digoxin (Lanoxin) levels are 0.5ng/mLto2.1ng/mL.Avalue of0.3ng/mL may indicate subtherapeutic dose; thus the dose of digoxin (Lanoxin) should be increased. Digoxin (Lanoxin) should be withdrawn if there is digoxin Lanoxin) toxicity Verapamil should be not be administered to patients with heart failure because it may aggravate the patient's condition. Potassium supplements should be advised because digoxin (Lanoxin) may cause hypokalemia.

Contact the provider to increase the dose of digoxin (Lanoxin).

Which method of heparin (Heparin Sodium) administration provides the advantage of steady heparin (Heparin Sodium) levels in the blood Continuous infusion of heparin (Heparin Sodium) Intramuscular injection of heparin (Heparin Sodium) Subcutaneous injection of heparin (Heparin Sodium) Intermittent administration of heparin (Heparin Sodium) Rationale A continuous heparin (Heparin Sodium) infusion provides steady heparin (Heparin Sodium) levels in the blood. Intramuscular injections are not recommended because of the risk of hematomas. Subcutaneous injections and intermittent administration do not lead to steady heparin (Heparin Sodium) levels in the blood.

Continuous infusion of heparin (Heparin Sodium)

Which medication would likely be responsible for a patient with nonvalvular atrial fibrillation reporting dark tarry stools? Reteplase (Retavase) Tirofban (Aggrastat) Dabigatran (Pradaxa) Dipyridamole (Persantine) Rationale Dabigatran (Pradaxa) is a direct thrombin inhibitor that reduces the risk of strokes and systemic embolisms in a patient with nonvalvular atrial fibrillation. This medication may lead to gastrointestinal (Gl bleeding, which manifests as dark tarry stools. Reteplase Retavase) is a fibrinolytic agent that is more clot-specific and lowers the potential for hemorrhage in the body. Tirofban (Aggrastat is a glycoprotetinlll inhibitor that does not cause GI bleeding. Dipyridamole (Persantine) is a platelet adhesiveness inhibitor that causes abdominal discomfort; this condition disappears with continued therapy.

Dabigatran (Pradaxa)

A patient with a deep vein thrombosis underwent hip replacement surgery and is prescribed drug therapy. During the assessment, the nurse finds decreased blood pressure, increased pulse, cold and clammy skin,and disoriented sensorium. Which medication is responsible for the patient's condition? Apixaban (Eliquis) Prasugrel (Effient) Ticagrelor (Brilinta) Dalteparin (Fragmin) Rationale Dalteparin (Fragmin) is a low-molecular-weight heparin that acts as the active components of the heparin (Heparinol) protein molecule. This medication is used to prevent and treat deep vein thrombosis after hip replacement surgey. Decreased blood pressure, increased pulse, cold and clammy skin and disoriented sensorium are the signs and symptoms ofinternal bleeding. Internal bleeding is a serious adverse effect of dalteparin (Fragmin) Nosebleeds, easy bruising bright red or coffee-ground emesis, hematuria, and dark trr stoos are associated with apixaban (Eliquis) Prasugrel (Efent is not used to treat deep vein thromboses in patients who underwent hip replacement surgery. Ticagrelor (Brilinta) reduces the frequency of thrombotic events associated with patients suffering an acute myocardial infarction, but it is not used to treat deep vein thromboses in patients who underwent hip replacement surgery.

Dalteparin (Fragmin)

The magnetic resonance imaging reports ofa patient scheduled for hip replacement surgery show deep vein thrombosis. Which medications are beneficial for the patient? Select all that apply. Prasugrel (Effient) Alteplase (Activase) Tirofiban (Aggrastat) Dalteparin (Fragmin) Rivaroxaban (Xarelto) Rationale Dalteparin (Fragmin) is a low-molecular-weight heparin that has less potential for hemorrhage and longer duration of action. Therefore this medication is used to prevent and treat deep vein thrombosis after hip replacement surgery. Rivaroxaban (Xarelto) is a selective factor Xa inhibitor used in the prophylaxis of deep vein thrombosis in a patient scheduled for hip replacement surgery. Prasugrel (Efient is a third-generation thienopyridine used to prevent blood clot formation in patients with myocardial infarctions. Alteplase (Activase) is a fbrinolytic agent used to treat cerebral embolisms (stroke). Tirofban (Aggrastat) is a glycoprotein l/ll inhibitor used to reduce the risk of acute myocardial infarctions and death.

Dalteparin (Fragmin) Rivaroxaban (Xarelto)

Which medication combination should be prescribed for a patient with a non-ST segment elevation myocardial infarction who has a history of unstable angina? Aspirin and clopidogrel (Plavix) Dalteparin (Fragmin) and aspirin Aspirin and dipyridamole (Persantine) Dipyridamole (Persantine) and warfarin (Coumadin) Rationale A combination of dalteparin (Fragmin) and aspirin is used to prevent clot formation in a patient with unstable angina pectoris and a non-ST segment elevation myocardial infarction. Aspirin and clopidogrel Plavix) are used to treat an acute myocardial infarction. Aspirin and dipyridamole (Persantine) are prescribed to prevent myocardial infarctions, transient ischemic attacks, and strokes. combination of dipyridamole (Persantine) and warfarin (Coumadin) is used to prevent thromboembolism in a patient who underwent a cardiac valve replacement.

Dalteparin (Fragmin) and aspirin

Which common adverse effects are anticipated in a patient prescribed cilostaol (letal)? Select all that apply. Diarrhea Dizziness Dyspepsia Chest pain Palpitations Rationale Diarrhea, dizziness and dyspepsia are common adverse effects of cilostazol (Pletal). Chest pain and palpitations are serious adverse effects associated with cilostazol (Pletal).

Diarrhea Dizziness Dyspepsia

Which adverse effects are associated with nitroglycerin (Nitrostat when it is used to treat peripheral vascular disease? Select all that apply. Diarrhea Dizziness Headaches Chest pain Postural hypotension Rationale Nitroglycerin (Nitrostat) is a direct vasodilator that is applied to the hands as an ointment base for patients with Raynaud's disease. Adverse effects of nitroglycerin (Nitrostat) include dizziness, headaches, and postural hypotension. Diarrheais a common adverse effect of cilostazol (Pletal). Chest pain is a serious adverse effect of pentoiflline (Trental) and cilostazo| (Pletal).

Dizziness Headaches Postural hypotension

The nurse is preparing to administer an initial dose of cilostazol to a patient with intermittent claudication. While reviewing the patient's record the nurse notes the patient has heart failure. Which action does the nurse take next? Administer the initial dose as prescribed. Contact the healthcare provider to receive an order for half the normal starting dose. Administer the initial dose and monitor the patient closely for signs of worsening heart failure. Do not administer the initial dose and contact the healthcare provider to inform him or her of the patient's diagnosis. Rationale Cilostazol should not be administered to patients with heart failure because it can significantly worsen heart failure; the nurse would not administer the dose and would contact the healthcare provider to inform him or her of the patient's diagnosis. The nurse should not administer the dose as prescribed nor ask the healthcare provider for a reduced starting dose. The nurse should not administer the dose and monitor for worsening heart failure symptoms because they could significantly worsen.

Do not administer the initial dose and contact the healthcare provider to inform him or her of the patient's diagnosis.

Which phrase is true regarding dalteparin (Fragmin)? Has a short duration of action Has a high potential for hemorrhage Does not affect the coagulation cascade Does not affect activated thromboplastin time Rationale Dalteparin (Fragmin) is a low-molecular-weight heparin that has no effect on thrombin; this drug will not affect activated thromboplastin time. Dalteparin (Fragmin) affects specific actions at certain steps of the coagulation pathway, which results in along duration of action and a low potential for hemorrhage. Dalteparin (Fragmin) enhances antithrombin activity primarily against factor Xa;this effect prevents the completion of the coagulation cascade.

Does not affect activated thromboplastin time

The nurse instructs a patient who has been prescribed pentoiflline (Trental) to take the medication with milk to reduce which adverse effect? Dizziness Dyspepsia Headache Chest pain Rationale Dyspepsi is a common gastrointestinal adverse effect of pentoifyline (Trental); this condition occurs in l% to 3% of patients. Taking the medication with milk or food helps reduce dyspepsia. Sitting or lying down if a feeling of faintness occurs will help reduce dizziness and headache. Taking the medication with milk will not help reduce chest pain.

Dyspepsia

Which physical findings in the lower extremities noted in a patient's history and physical does the nurse identify as characteristic of arteriosclerosis obliterans? Select all that apply. Edema Numbness to sensation Reduced arterial pulsations Systolic bruits over the involved arteries A higher temperature of the skin of the extremity Rationale Edema, numbness to sensation, reduced arterial pulsations, and systolic bruits over the involved arteries are physical findings in the lower extremities of a patient with arteriosclerosis obliterans. The skin of the extremity would have a lower temperature.

Edema Numbness to sensation Reduced arterial pulsations Systolic bruits over the involved arteries

Which physical findings in the lower extremities noted in a patient's history and physical does the nurse identify as characteristic of arteriosclerosis obliterans? Select all that apply. Edema Numbness to sensation Reduced arterial pulsations Systolic bruits over the involved arteries A higher temperature of the skin of the extremity Rationale Edema, numbness to sensation, reduced arterial pulsations, and systolic bruits over the involved arteries are physical findings in the lower extremities ofa patient with arteriosclerosis obliterans. The skin of the extremity would have a lower temperature.

Edema Numbness to sensation Reduced arterial pulsations Systolic bruits over the involved arteries

Which medications should be used with caution in patients who are on cilostazol ( Pletal)therapy? Select all that apply. Fluoxetine (Prozac) Clopidogrel (Plavix) Fluvoxamine (Luvox) Omeprazole (Prilosec) Pentoxifylline (Trental) Rationale Fluoxetine Prozac), fluvoxamine (Luvox), and omeprazole (Prilosec)inhibit the metabolism of cilostazol ( Pletal); these medications should be used with caution. Clopidogrel ( Plavix)used to treat peripheral arterial does not interact with cilostazol ( Pletal). Pentoxifylline Trental)is used to treat peripheral vascular disease and does not show any interaction with cilostazol ( Pletal).

Fluoxetine (Prozac) Fluvoxamine (Luvox) Omeprazole (Prilosec)

Which medication would be appropriate fora patient with a deep vein thrombosis who has a known food allergy to pork? Heparin (Heparinol) Dalteparin (Fragmin) Enoxaparin (Lovenox) Fondaparinux (Arixtra) Rationale Fondaparinux (Arixtra) is a selective factor Xa inhibitor used to treat acute deep vein thrombosis in a patient who underwent a hip replacement. This drug can be safely given to a patient with a pork allergy because it is manufactured synthetically. Heparin (Heparinol and low-molecular-weight heparin such as dalteparin (Fragmin) and enoxaparin (Lovenox are extracted from pig and cow gut and lung tissues.

Fondaparinux (Arixtra)

Which statement about the action of fondaparinux (Arixtra) is true? Vitamin K activity is inhibited. Fondaparinux (Arixtra) is a selective factor Xa inhibitor. The adenosine 5'-diphosphate (ADP) pathway is inhibited. Cyclic adenosine monophosphate (cAMP) in platelets is increased. Rationale Fondaparinux (Arixtra) is a selective factor Xa inhibitor, binding to antithrombinll potentiating its action against factor Xa, and therefore preventing completion of the coagulation cascade. Clopidogrel (Plavix) is thought to act by inhibiting the ADP pathway. Warfarin (Coumadin) inhibits vitamin Kactity. Dipyridamole (Persantine) inhibits thromboxane As, increasing cAMP in platelets.

Fondaparinux (Arixtra) is a selective factor Xa inhibitor.

The nurse would alert the healthcare provider when a patient who has been prescribed warfarin (Coumadin) is also taking which agent? Niacin Folic acid Ginkgo biloba Saw palmetto Rationale Ginkgo biloba and danshen increase the risk for bleeding as a result of decreased platelet aggregation, and they are contraindicated with warfarin (Coumadin) Folic acid, niacin, and saw palmetto do not increase the risk of bleeding and are therefore not contraindicated with warfarin (Coumadin).

Ginkgo biloba

Which substance should be restricted in patients who are on cilostazol (Pletal) therapy? Milk Grapefruit juice Protein supplements Vitamin supplements Rationale Grapefruit juice should be restricted in patients who are on cilostazol (Pletal) therapy because it inhibits the metabolism of cilostazol (Pletal), resulting in decreased efficacy and therapeutic effect. Milk can be taken along with the medication to reduce abdominal discomfort. The patient should take protein and vitamin supplements to promote the healing process.

Grapefruit juice

Which adverse effect of cilostazol ( Pletal)may lead to discontinuation of the therapy? Diarrhea Dizziness Headache Dyspepsia Rationale headache is a central system adverse effect that occurs in 3 4%of patients who are on cilostazol ( Pletaltherapy; this problem may be severe enough to cause the discontinuation of therapy. Diarrhea occurs in 1 9%of patient on cilostazol ( Pletal)therapy; this condition can be resolved with continued therapy. Dizziness occurs in about 1 0%of patient who is on cilostazol ( Pletal)therapy and can be resolved with continued therapy. Dyspepsia occurs in 6 %of patients who are on cilostazol ( Pletal)therapy and can be resolved with continued therapy .

Headache

Cilostazol (Pletal) therapy is contraindicated in a patient with which condition? Select all that apply. Heart failure Fungal infection Peptic ulcer disease On exercise therapy On therapy for smoking cessation Rationale Cilostazol (ltl)is a selective inhibito of cellular cyclic adenosine monophosphate phosphodiesteras ll This drug is used to treat intermittent claudication. Cilostazol Pletal) is contraindicated in patients with heart failure because phosphodiesterase inhibitors significantly worsen heart failure. Medications used to treat fungal infections and peptic ulcer disease inhibit the metabolism of cilostazol (Pletal). Cilostazo| (Pletal) therapy is an adjunct to exercise therapy and smoking cessation.

Heart filure Fungal infection Peptic ulcer disease

Which mechanism of action is true of aspirin? Inhibits platelet aggregation Reduces thrombus formation Blocks the glycoprotein llla receptors Prevents completion of coagulation cascade Rationale Aspirin is a salicylate, which acetylates the cyclooxygenase enzyme and inhibits the synthesis of thromboxane A2. This action inhibits platelet aggregation Apixaban is a reversible and selective factor Xa inhibitor, which reduces thrombin generation and thrombus formation. Eptifbatide blocks glycoprotein llla receptors. Enoxaparin is low-molecular-weight heparin that acts against factor Xa and thrombin, and prevents completion of the coagulation cascade.

Inhibits platelet aggregation

When a patient with peripheral vascular disease is prescribed hemorheologic agents, which information will best help the patient? Select all that apply. Suggest that the patient drink eight 8-ounce glasses of water each day. Instruct the patient to adopt a high-protein diet. Instruct the patient to rise slowly from a sitting or lying position. Teach the patient to take and record his or her own blood pressure. Instruct the patient to discontinue the therapy if any adverse effects occur. Rationale Hemorheologic agents such as pentoiflline (Trental are used to treat peripheral vascular diseases. These medications cause vasodilatation of blood vessels, resulting in orthostatic hypotension. Because of this effect, the patient should rise slowly from sitting or lying positions, adjust the balance for stability, and then proceed with movement. The patient should be instructed to monitor his or her own blood pressure to prevent adverse effects of the medication, which may occur because of vasodilatation. Drinking eight 8-ounce glasses of water a day promotes adequate hydration of body tissues; however, this is not included in the medication regimen. Adopting a high-protein diet with adequate vitamin intake promotes the healing of ulcers, but this action is not included in the medication regime. any adverse effects occur, the patient should not discontinue the therapy without first consulting the healthcare provider.

Instruct the patient to rise slowly from a sitting or lying position. Teach the patient to take and record his or her own blood pressure.

Which statement regarding intermittent claudication is correct? Intermittent claudication is characterized by cramping and weakness. Intermittent claudication is treated using calcium ion antagonists. Intermittent claudication is characterized by pain that often occurs during exercise in the beginning. Intermittent claudication results when oxygen demand is lower than oxygen supply. Rationale Intermittent claudication is defined as obstruction of blood flow through the arteries that result in ischemia to the tissues supplied by those arteries. This condition manifests as pain that often occurs with exercise during the early episodes, but it progresses to occur during rest and accompanies numbness and paresthesias. Arteriosclerosis obliterans is characterized by cramping and weakness. Raynaud's disease can be treated with calcium ion antagonists. Intermittent claudication occurs because of a lack of oxygen to the muscles during exercise.

Intermittent claudication is characterized by pain that often occurs during exercise in the beginning.

Which description of prasugrel (Efient) is incorrect? Is a prodrug Is a second-generation low-molecular-weight heparin Shows a greater platelet inhibitory effect than clopidogrel (Plavix) Prevents blood clot formation in patients with myocardial infarction Rationale Prasugrel (ffient) is a third-generation, not second-generation, thienopyridine that is similar to clopidogrel (Plavix) and ticlopidin (Ticid) ti a prodrug that metabolizes to form an active drug that inhibits platelet aggregation. It shows a greater platelet inhibitor effect and onset ofaction than clopidogrel (Plavix) It prevents blood clot formation in patients with a myocardial infarction who are undergoing a percutaneous coronary intervention.

Is a second-generation low-molecular-weight heparin

Which phrases describe the advantages of reteplase (Retavase)? Select all that apply. Is nonantigenic Needs a concurrent heparin (Heparinol) therapy Has a low potential to cause a hemorrhage Is administered as a single bolus to dissolve clots Is clinically proven to be effective in dissolving clots Rationale Reteplase (Retavase) is a fibrinolytic agent that works by stimulating the body's clot-dissolving mechanism.It is nonantigenic and more clot specific, and it has a low potential to cause hemorrhaging The disadvantage of reteplase (Retavase) is the need for concurrent heparin (Heparinol) therapy. Reteplase (Retavase) is administered as two boluses to dissolve clots.

Is nonantigenic- relating to or having the properties of an antigen nonantigenic materials. Has a low potential to cause a hemorrhage Is clinically proven to be effective in dissolving clots

Which medication used to treat Raynaud's disease is also used as an adjunctive therapy to treat peripheral vascular diseases? Captopril (Capoten) Prazosin (Minipress) Verapamil (Calan) Isoxsuprine (Vasodilan) Rationale ( Vasodilan) is a medication extensively used to treat Raynaud disease; it can also be an adjunctive therapy to treat peripheral vascular diseases. Captopril ( Capoten)is an angiotensin-converting enzyme inhibitor used to reduce the frequency and severity of vasospastic attacks . Prazosin (Minipress)is an adrenergic antagonist used in the treatment of Raynaud disease.Verapamil ( Calan)a calcium ion antagonist used to treat Raynaud's disease.

Isoxsuprine (Vasodilan)

Which method is safest or administering dalteparin (Fragmin)? Inject the medication at the same ste every day. Insert the needle intramuscularly at an angle of 90 degrees. Rub the injection site after completion of the injection. Leave the needle in the injection site for lO seconds after injection. Rationale Dalteparin (Fragmin is a low-molecular-weight heparin (LMWH that is injected slowly; the needle should be left in place for l0 seconds after injection. injecting the medication at the same site regularly may lead to tissue fibrosis; the injection site should be alternated every 24 hours. The medication should not be used intramuscularly because this action may result in a delayed and prolonged therapeutic effect. The injection site should not be rubbed after administration because the action may cause bruising.

Leave the needle in the injection site for lO seconds after injection.

The registered nurse is evaluating the actions ofa licensed practical nursing student who is injecting heparin (Heparin Sodium) into a patient. Which action of the student indicates a need for correction? Rotating the injection site after each dose Massaging the injection site after injection Injecting heparin (Heparin Sodium) into the tissue in the abdomen Injecting heparin (Heparin Sodium 4 inches away from the umbilicus Rationale The injection site should not be massaged either before or after administering heparin (Heparin Sodium) because massaging bruises the skin and may cause a hematoma.The injection site should be rotated for each dose to prevent the development ofa massive hematoma. Heparin Heparin Sodium) is usually administered subcutaneously into the tissue over the abdomen. A subcutaneous injection of heparin (Heparin Sodium) should not be administered within 2inches of the umbilicus.

Massaging the injection site after injection

Which action would the healthcare provider take before prescribing apixaban (Eliquis) to a patient with an embolism caused by atril fbrillation? Selet all that apply. Monitor for bleeding. Check the renal function test reports. Inspect the skin and mucous membranes. Ask whether the patient is likely to become pregnant. Check the most recent activated partial thromboplastin time (aPTT) report. Rationale The healthcare provider should monitor for hematuria, bleeding gums and melena before administering apixaban (Eliquis) to a patient with an embolism caused by atrial fbilltion. Assessment of renal function tests such as blood urea nitrogen, serum creatinine, stool occult blood, and complete blood pictures serve as a baseline for future comparison. Inspecting skin and mucous membranes helps asss initial bleeding and prevent further complications. The healthcare provider should ask whether the patientis likely to become pregnant before nitiating dabigatran (Pradaxa) to prevent complications. Checking the most recent aPTT report should be done before the patient receives heparin (Heparinol).

Monitor for bleeding. Check the renal function test reports. Inspect the skin and mucous membranes.

Does the healthcare provider suspect theophylline (Asbron) toxicity in a patient taking pentosiflline (Trental)? Which symptoms support this suspicion? Select all that apply. Tremor Nausea Diarrhea Tachycardia Reduction in systemic blood pressure So close! Rationale When taken concurrently with theophyline (Asbron) pentoiflline (Trental) causes theophylline (Asbron) toxicity in some patients. Symptoms of theophylline (Asbron) toxicity include nausea and tachycardia. Tremors are common adverse effects of pentoxifylline (Trental). Diarrhea is a common adverse effect of pentoxifylline (Trental). Reduction in systemic blood pressure is a serious adverse effect associated with pentoxifylline

Nausea Tachycardia

Which medication is most beneficial for the patient newly diagnosed with Raynaud's disease? Prazosin Reserpine Nifedipine Methyldopa Rationale Calcium channel blockers and adrenergic antagonists are used to treat Raynaud's disease. Calcium ion antagonists such as nifedipine are most beneficial in patients with Raynaud's disease because they greatly reduce vasospastic attack Adrenergic antagonists such as prazosin, reserpine, and methyldopa are also used to treat Raynaud's disease, but they are only moderately successful because of the adverse effects associated with these medications.

Nifedipine

A patient receiving therapy for Raynaud's disease reports a headache and dizziness, and the nurse notes postural hypotension. Which medication would the nurse suspect is responsible for the patient's condition? O Diltiazem (Cardizem) O Verapamil (Calan) Nitroglycerin (Rectiv) Methyldopa (Aldopam) Rationale Nitroglycerin (Rectiv) is a direct vasodilator that may cause headaches dizziness and postural hypotension. Diltiazem (Cardizem) and verapamil (Calan) are calcium ion antagonists used to treat Raynaud's disease; these medications do not cause dizziness and headache. Methyldopa (Aldopam) is an adrenergic antagonist used to treat Raynaud's disease; this medication does not cause dizziness, postural hypotension, and headache.

Nitroglycerin (Rectiv)

Which medication should be used with caution in a patient diagnosed with intermittent claudication who also has hypotension? Cilostazol (Pletal) Nitroglycerin (Rectiv) Pentoiflline (Trental) Methyldopa (Aldopam) Rationale Cilostazo| (Pletal) should be used with caution in clients with hypotension because this medication has the potential to reduce blood pressure because of its vasodilating property. Nitroglycerin (Recti) is a direct vasodilator used to treat Raynaud's disease. Pentoifylline (Trental) is used to treat intermittent claudication and is contraindicated in patients with hypotension. Methyldopa (Aldopam)is an adrenergic antagonist used to treat Raynaud's disease.

O Cilostazol (Pletal)

Which medication decreases the concentration of fibrinogen in blood and increases erythrocyte flexibility? Cilostazol Pletal) O Clopidogrel (Plavix) Captopril (Capoten) Pentoifyline (Trental) Rationale Pentoxifyline (Trental) is a hemorheologic agent that decreases the concentration of fibrinogen in blood and increases erythrocyte flexibility. Cilostazol (Pletal i a platelet aggregation inhibitor used to treat intermittent claudication. Captopril (Capoten is an angiotensin-converting enzyme inhibitor used to reduce the frequency and severity of vasospastic attacks. Clopidogrel (Plavix) is a platelet aggregation inhibitor that treats peripheral arterial disease.

Pentoifyline (Trental)

The healthcare provider reduces the dosage of pentoifyline (Trental) in a patient with intermittent claudication who complained ofdizziness and headache. During the follow-up visit, the nurse finds that the symptoms persist. Which intervention would the healthcare provider take next? Instruct the patient to discontinue the therapy. Encourage the patient to take the medication with food. Instruct the patient to avoid dairy products. Suggest that the patient adopt a high-protein diet. Rationale Pentoxifyline (Trental) is a hemorheologic agent used in the treatment of intermittent claudication. Dizziness and headache are the central nervous system (CNS) adverse effects of this medication. If the CNS adverse effects persist even after reducing the dosage,the therapy should be discontinued. Encouraging the patient to take the medication with food will only minimize the patient's discomfort caused by gastrointestinal adverse effects. Instructing the patient to avoid dairy products will not help the patient treat the condition. Suggesting that the patient adopt a high-protein diet will help promote the healing process but does not reduce the CNS adverse effects.

O Instruct the patient to discontinue the therapy.

When evaluating a patient's response to pentoxiflline (Trental), which sign/symptom does the nurse assess? Leg pain Urinary output Allergy symptoms Motor coordination Rationale Pentosilline (Trental) is used to treat intermittent claudication, which is characterized by leg pain on walking. Urinary output, allergy symptoms, and motor coordination are not associated with the use of pentoxifylline (Trental).

O Leg pain

What is the primary therapeutic outcome of fbrinolytic therapy? Reperfusion of the tissues obstructed by the thrombus Prevention of clot formation during a percutaneous intervention procedure Reduction of the risk of thromboembolism in patients with atrial fbrillation Prevention of deep vein thrombosis in patients undergoing hip or knee replacement Rationale Fibrinolytic agents are used to dissolve clots secondary to a coronary artery occlusion. The primary therapeutic outcome of fibrinoltic therapy is reperfusion of the tissues obstructed by the thrombus. The primary therapeutic outcome of glycoproteinll/lla inhibitor therapyis prevention of clot formation during percutaneous intervention procedures. The primary therapeutic outcome ofapixaban (Eliquis) is reduction of the risk of thromboembolism in patients wit atrial fbilltion. The primary therapeutic outcome of rivaroxaban (Xarelto) therapy is the prevention ofa deep vein thrombosis in patients undergoing hip or knee replacement surgery.

O Reperfusion of the tissues obstructed by the thrombus

Which premedication assessments should be performed in a patient with a pulmonary embolism who has been prescribed apixaban (Eliquis) Selec all that apply. Obtaining baseline vital signs Performing renal function tests Checking activated partial thromboplastin time Checking if the patient has a history of liver disease Inspecting the skin and mucous membrane for petechiae Rationale Apixaban (Eliquis) is a reversible and selective factor Xa inhibitor used to treat deep vein thrombosis and pulmonary embolisms. The premedication assessments forapixaban (Eliquis) include obtaining baseline vital signs, performing renal function tests (such as blood urea nitrogen and creatinine), and inspecting the skin and mucous membrane for petechiae. Checking activated partial thromboplastin time is a premedication assessment for a patient who is prescribed heparin Heparin Sodium) Checking if the patient has a history of liver disease is a premedication assessment for a patient wh will take dipyridamole Persantine).

Obtaining baseline vital signs Performing renal function tests Inspecting the skin and mucous membrane for petechiae

Which serious adverse effect of cilostazol (Pletal) must be evaluated further by the healthcare provider? Palpitations Constipation Increased urine output Tingling of the hands and feet Rationale Palpitations, along with angina dysrhythmias, and shortness of breath, should be reported to, and further evaluated by, healthcare professional. Cilostazol (Pletal does not affect urine output and may cause diarrhea, but not constipation. Tingling of the hand and feet is nota side effect of cilostazol (Pletal).

Palpitations

Which medication causes theophylline (Asbron) toxicity when taken concurrently? Cilostazol (Pletal) Diltiazem (Cardizem) Pentoifyline (Trental) Nitroglycerin (Nitrostat) Rationale Pentoifyline (Trental) is a hemorheologic agent that is used to treat peripheral vascular disease; this medication causes theophylline (Asbron) toxicity when taken concurrently with theophylline (Asbron) Cilostazol (Pletal is a platelet inhibitor that does not cause theophylline (Asbron) toxicity. Diltiazem (Cardizem) inhibits the metabolism of cilostazol (Pletal) Nitroglycerin (Nitrostat) is a vasodilator that causes a headache, dizziness, and postural hypotension.

Pentoifyline (Trental)

Which statement is true regarding platelet aggregation inhibitor therapy used in the treatment of peripheral vascular diseases? Platelet aggregation inhibitors show maximum efficacy if used for at least 18 weeks. Platelet aggregation inhibitors are used as a replacement for weight loss in treating peripheral vascular diseases. Platelet aggregation inhibitors are used with caution in patients with intermittent claudication. Platelet aggregation inhibitors are used as an adjunct to surgical bypass in treating peripheral vascular diseases. Rationale Cilostazol Pletal) is a platelet aggregation inhibitor used to treat peripheral vascular diseases. This therapy is used as an adjunct to surgical bypass and exercise therapy. Platelet aggregation inhibitor therapy shows maximum efficacy if used for at least l2 weeks. Platelet aggregation inhibitor therapy acts as an adjunct to weight loss;it does not replace weight loss. Platelet aggregation inhibitor therapy is used in the treatment of intermittent claudication.

Platelet aggregation inhibitors are used as an adjunct to surgical bypass in treating peripheral vascular diseases.

Which medications act by inhibiting the adenosine 5'-diphosphate (ADP) pathway required for platelet aggregation. Select all that apply. Apixaban (Eliquis) Prasugrel (ffent) Ticagrelor Brilinta) Clopidogrel (Plavix) Dabigatran (Pradaxa) Rationale Prasugrel (fent irreversibly binds to the platelet P2Y12 receptors and inhibits the ADP pathway required for platelet aggregation. Ticagrelor (Brilinta) is a platelet aggregation inhibitor that binds to the platelet P2Y12 receptors, inhibiting the ADP pathway required for platelet aggregation. Clopidogrel (Plavix) acts by inhibiting the ADP pathway required for platelet aggregation. Apixaban (Eliquis) is a reversible and selective factor Xa inhibitor, which reduces thrombin generation and thrombus formation. Dabigatran (Pradaxa)is a direct thrombin inhibitor, which inhibits thrombin and prevents the conversion fibrinogen to fibrin, which is required for blood clot formation.

Prasugrel (ffent) Ticagrelor Brilinta) Clopidogrel (Plavix)

Which outcome is expected when heparin (Heparinol) is used to treat deep vein thrombosis? Increase prothrombin time Prevent clot formation Dissolve existing thrombin Inhibit platelet coagulation Rationale Heparin (Heparinol) prevents the formation of thrombi by speeding the action of antithrombin ll, which neutralizes thrombin; activated factors IXa, Xa,Xl, and Xll;and plasmin. it also inhibits activation of factor Vll, preventing soluble fibrin clots from becoming insoluble. Heparin (Heparinol) does not inhibit platelet coagulation, and it has no fibrinolytic activity and cannot lyse thrombi. Heparin (Heparinol) does not inhibit platelet coagulation or increase prothrombin time.

Prevent clot formation

Which therapeutic outcome is expected for a patient taking abciximab (ReoPro)? Reperfusion of the tissues obstructed by the thrombus Prevention of embolus formations and nonvalvular atrial fbrillations Prevention of a deep vein thrombosis after hip, knee, or abdominal surgery Prevention of clot formation during percutaneous intervention procedures Rationale The primary therapeutic outcome of glycoprotein llla inhibitors such as abciximab (ReoPro) is to prevent clot formation during percutaneous intervention procedures. The primary therapeutic outcome of fibrinolytic agents is reperfusion of the tissues obstructed by the thrombus. The primary therapeutic outcome of dabigatran Pradaxa) is to prevent embolus formations and nonvalvular atrial fbilltions. The primary therapeutic outcome of fondaparinux (Arixtra) is the prevention of a deep vein thrombosis in patients who have underwent hip, knee, orabdominal surgery.

Prevention of clot formation during percutaneous intervention procedures

A patient with a fungal infection and receiving ketoconazole is newly diagnosed with intermittent claudication. The healthcare provider finds that cilostazol therapy is necessary. Which action would be the healthcare provider take next? 0 Increase the dosage of ketoconazole for a few days. Instruct the patient to take cilostazol only at bedtime. Suggest that the patient discontinue ketoconazole therapy. Reduce the starting dose of cilostazol to half the normal starting dose. Rationale Ketoconazole inhibits the metabolism of cilostazol. Because cilostazol therapy is necessary, the healthcare provider should reduce the starting dose o cilostazol to half the normal starting dose. Increasing the dosage of ketoconazole for a few days will increase its inhibitory effect on cilostazol. Instructing the patient to take cilostazol only at bedtime will not have a significant effect. Discontinuing ketoconazole therapy will aggravate the patient's fungal infection.

Reduce the starting dose of cilostazol to half the normal starting dose.

A patient with peripheral vascular disease is prescribed pentoiflline (Trental) and is also taking antihypertensive therapy. Which intervention would be beneficial for this patient? Reducing the dosage of antihypertensive medication Increasing the dosage of pentoiflline (Trental) Concurrent administration of both medications 2 hours after dinner Discontinuing the antihypertensive medication while taking pentoxiflline (Trental) Rationale Patients receiving pentoifyline (Trental) therapy frequently display a small reduction in systemic blood pressure. Concurrent use of antihypertensives and pentoifyline (Trental may result in hypotension, which can cause serious adverse effects. Therefore the dosage of antihypertensive medication should be reduced in patients who are prescribed pentoiflline (Trental) to minimize the adverse effects. Increasing the pentoifyline (Trental) dosage may further aggravate the patient's condition by lowering his or her blood pressure. Concurrent administration of both medications hours after dinner may reduce the patient's blood pressure and lead to adverse effects Antihypertensive medications should not be discontinued but should be used in small doses to minimize the adverse effects.

Reducing the dosage of antihypertensive medication

A patient with peripheral vascular disease is prescribed pentoifyline (Trental) and a medical history check reveals that the patient is also on theophylline (Asbron) therapy. Which condition would the patient be instructed to report? Diarrhea Tachycardia Hypotension Shortness of breath Rationale Concurrent use of pentoiflline(Trental) and theophyline (Asbron) can lead to theophlline (Asbron) toxicity, which results in tachycardia. Diarrhea may not occur because of the concurrent use of pentoiflline (Trental) and theophylline (Asbron) Hypotension may be caused by the concurrent use of pentoiflline (Trental) and other antihypertensive agents. Shortness of breath is an adverse effect of pentoiflline (Trental) therapy; this condition can be treated with theophlline (Asbron).

Tachycardia

The healthcare provider prescribes pentoiflline Trental to a patient diagnosed with intermittent claudication, and the patient later reports headache and dyspepsia. Which action of the healthcare provider would best help this patient? Prescribing pain medications to the patient Asking the patient to discontinue the therapy Reducing the dosage of pentoifyline (Trental) Instructing the patient to take the medication on an empty stomach Rationale Pentoiflline (Trental)is a hemorheologic agent that treats intermittent claudication by increasing erythrocyte flexibility Headache and dyspepsia are common neurologic and gastrointestinal adverse effects of this medication. if the patient develops neurologic or gastrointestinal adverse effects, the dosage should be reduced. Prescribing pain medications will not reduce the adverse affects. The healthcare provider should instruct the patient to discontinue the therapy adverse effects persist even after reducing the dosage of the prescribed medication. Encouraging the patient to take the medication with food can minimize the patient's discomfort caused by gastrointestinal adverse effects.

Reducing the dosage of pentoifyline (Trental)

Which medications decrease the therapeutic effectiveness of warfarin (Coumadin)? Select all that apply. Rifampin (Rifadin) Terbinafne (Lamisil) Azathioprine (Azasan) Omeprazole (Prilosec) Sulfinpyrazone (Anturane) Rationale Rifampin (Rifadin), terbinafne (Lamisil) and azathioprine (Azasan) decrease the therapeutic activity of warfarin (Coumadin). Omeprazole (Prilosec) and sulfnpyrazone (Anturane) enhance the activity of warfarin (Coumadin).

Rifampin (Rifadin) Terbinafne (Lamisil) Azathioprine (Azasan)

Which medications reduce the metabolism of ticagrelor (Brilinta)? Select all that apply. Ritonavir (Norvir) Lepirudin (Refludan) Telithromycin (Ketek) Ketoconazole (Nizoral) Fondaparinux (Arixtra) Rationale Ritonavir (Norvir) telithromycin (Ketek), and ketoconazole (Nizoral) inhibit the metabolism of ticagrelor (Brilinta), which increases the likelihood of bleeding and increases the therapeutic effect of the medication. Lepirudin Refudan) and fondaparinux (Arixtra) increase the therapeutic effect of ticagrelor (rilinta) via a combined pharmacologic effect.

Ritonavir (Norvir) Telithromycin (Ketek) Ketoconazole (Nizoral)

Which medication acts by prolonging prothrombin time (PT) and activated partial thromboplastin time (aPTT)? Ticagrelor (Brilinta) Abciximab (ReoPro) Rivaroxaban (Xarelto) Tenecteplase (TNKase) Rationale Rivaroxaban (Xarelto) is a selective factor Xa inhibitor that prolongs PTand aPTT, but it has no effect on platelet activity. Ticagrelor (Brilinta)is a platelet aggregation inhibitor that binds to the platelet P2Y12 receptors and inhibits the adenosine diphosphate pathway required for platelet aggregation. Abciximab (ReoPro) is a glycoprotein lll inhibitor that blocks the glycoprotein llla receptor, thereby preventing platelet aggregation and clot formation. Tenecteplase (TNKase) is a fibrinolytic agent that converts plasminogen to plasmin, thereby degrading fibrin and preventing clot formation.

Rivaroxaban (Xarelto)

A patient is prescribed medication for Raynaud's disease and in a follow-up visit reports a decrease in symptoms Which symptoms would the healthcare provider teach the patient to report immediately after an attack occurs and subsides? Select all that apply. Rubor Edema Redness Pale skin Waxy skin Rationale Raynaud's disease is defined as peripheral vascular disease caused by arterial vasospasm. It is characterized by numbness tingling, a sense of skin tightness in the affected area, and blanching of the skin. Once the attack subsides, vasodilation occurs, which causes rubor, redness, and pale skin. Edema and waxy skin are symptoms of peripheral vascular disease.

Rubor Redness Pale skin

Which medications taken concurrently with cilostazol (Pletal will inhibit the metabolism of cilostazol Pletal)? Select all that apply. Sertraline (Zoloft) Caffeine (Abalgin) Fluvoxamine (Luvox) Erythromycin (Erythrocin) Theophylline (Asbron) Rationale Cilostazol Pletal) is a platelet aggregation inhibitor that is used in the treatment of peripheral vascular disease. Sertraline (Zoloft) fluvoxamine (Luvox), and erythromycin (Erythrocin) are medications that, when taken concurrently with cilostazol (plural , I inhibit the metabolism of cilostazol (Pletal). affeine (Abalgin) has no effect on the metabolism o cilostazol (Pletal). Pentoxifylline (Trental) increases theophylline (Asbron) levels.

Sertraline (Zoloft) Fluvoxamine (Luvox) Erythromycin (Erythrocin)

During a premedication assessment, which healthcare issues does the nurse assess for in the patient with a pending prescription of pentoifyline for treatment of intermittent claudication? Select all that apply. Stroke Lung cancer Recent surgery Kidney problems Peptic ulcer disease Rationale Pentoxiflline decreases the viscosity of blood and improves its flow properties; thus it is important to assess for past history of stroke, recent surgery, kidney problems, and peptic ulcer disease Although it is important to review the patient's entire medical history, lung cancer is not directly relevant to administration of this medication.

Stroke Recent surgery Kidney problems Peptic ulcer disease

A patient with a coronary artery occlusion collapsed on the road and is being transferred to a cardiovascular center. Which fbrinolytic agent would the nurse anticipate will be prescribed? 0 Alteplase (Activase) 0 Reteplase (Retavase) Tenecteplase (TNKase) Streptokinase (Streptase) Rationale Tenecteplase (TNKase) is a potentially lifesaving fbrinolytic agent used to treat clots in a patient with a coronary artery occlusion. This medication is easy to administer and offers an emergent treatment. Alteplase (Activase) is clot specific but itis costly and has a prolonged administration time. Reteplase (Retavase) should be concurrently administered with heparin (Heparinol) which may take too much time. Streptokinase (Streptase) is rarely used and is usually replaced by newer medications.

Tenecteplase (TNKase)

Which situation could cause a hematoma to form at the injection site of enoxaparin (Lovenox) for a patient with deep vein thrombosis? The patient is on aspirin therapy. The patient has prolonged prothrombin time. The administration technique is inappropriate. The air bubble from the syringe is expelled before injection. Rationale inappropriate administration techniques of enoxaparin (Lovenox) may lead to hematoma formation at the site of injection. Enoxaparin (Lovenox) can be safely coadministered with aspirin, and the prothrombin time will not be affected. Expelling the air bubble from the syringe may cause loss of the drug.

The administration technique is inappropriate.

A patient is prescribed cilostazol for peripheral vascular disease and is also receiving diltiazem. Which dosing adjustment would the licensed practical nurse expect from the healthcare provider? The maintenance dose of diltiazem will be reduced by half. Dosage for either drug will not be affected. The cilostazol will be started at half the normal dose. The prescription for diltiazem therapy will be stopped before starting cilostazol. Rationale lf a patient prescribed cilostazol is already on diltiazem, the starting dose of cilostazol should be reduced to half the normal starting dose. The dosage of diltiazem should not be reduced. Diltiazem therapy should not be discontinued before starting the medication.

The cilostazol will be started at half the normal dose.

The healthcare provider prescribes cilostazol Pletal to a patient with peripheral vascular disease. Which points should the patient understand to increase medical compliance? Select all that apply. Drug interactions Times of administration Name of the medication Common adverse effects Pharmacokinetics of the medication Rationale Medical compliance can be increased by seeking cooperation and ensuring the patient understands the times of administration, name of the medication, and common adverse effects of the medication. The patient's understanding of drug interactions or the pharmacokinetics of the medication does not necessrily increase medical compliance.

Times of administration Name of the medication Common adverse effects

While performing a percutaneous coronary intervention (PCl), the healthcare provider finds the patient's blood clots frequently. Which medication would the nurse expect the healthcare provider to prescribe? Tirofban (Aggrastat) Reteplase Retavase) Dabigatran (Pradaxa) Rivaroxaban (Xarelto) Rationale Glycoprotein l/lla inhibitors such as tirofban (Aggrastat) are administered intravenously during a PCl to signifcantly reduce the risk of acute myocardial infarctions and death. Reteplase (Retavase) is a fibrinolytic agent used to dissolve clots secondary to coronary artery occlusions, pulmonary emboli, and strokes. Dabigatran (Pradaxa) is a direct thrombin inhibitor used to reduce the risk of strokes and systemic embolisms in patients with nonvalvular atrial fibrillation. Rivaroxaban (Xarelto) is a selective factor Xa inhibitor used for the prophylaxis of deep vein thrombosis in patients undergoing knee or hip replacement surgeries.

Tirofban (Aggrastat)

Which action would be effective in controlling bleeding induced by warfarin (Coumadin)? Select all that apply. Transfusing plasma Administering aspirin Administering vitamin K Discontinuing warfarin (Coumadin) therapy Administering protamine sulfate Rationale Bleeding induced by warfarin (Coumadin) can be controlled by transfusing plasma. Vitamin K is an antidote for warfarin-induced hemorrhage. In addition, most cases of warfarin-induced bleeding can be controlled by discontinuing warfarin (Coumadin) therapy. Aspirin enhances the therapeutic and toxic effects of warfarin (Coumadin) Protamine sulfate is an antidote for heparin (Heparin Sodium).

Transfusing plasma Administering vitamin K Discontinuing warfarin (Coumadin) therapy

Which medication would help a patient who reports numbness, prickling, and a sense of skin tightness in the hand? Verapamil (Calan) Vinblastine (Velban) Imipramine (Tofranil) Bromocriptine (Cycloset) Rationale Numbness, prickling, and a sense of skin tightness in the hand are characteristics of Raynaud's disease. Verapamil (Calan) is an angiotensin-converting enzyme inhibitor that is used to treat this condition. Vinblastine (Velban), imipramine (Tofranil), and bromocriptine (Cycloset) may cause Raynaud's disease.

Verapamil (Calan)

Which medication's dosage is adjusted based on the international normalized ratio (INR)? Apixaban (Eliquis) Dabigatran (Pradaxa) Warfarin (Coumadin) Rivaroxaban (Xarelto) Rationale The dosage of warfarin (Coumadin) is adjusted based on prolonging the lNR.The dosages ofapixaban (Eliquis and rivaroxaban (Xarelto) are notadjusted based on the INR. Dabigatran (Pradaxa) does not require blood test monitoring with resultant dosage adjustments.

Warfarin (Coumadin)

Which symptoms support the healthcare provider's suspicion that a patient prescribed dalteparin (Fragmin) has internal bleeding? Selec all that apply. Decreased pulse Dry and wrinkled skin Weakness and fatigue Disoriented sensorium Decreased blood pressure Rationale Dalteparin (Fragmin) may cause bleeding as an adverse effect. The signs and symptoms of internal bleeding are feelings of weakness and fatigue, disoriented sensorium, decreased blood pressure, increased pulse, and cold clammy skin.

Weakness and fatigue Disoriented sensorium Decreased blood pressure