Pharmacology Homework #3
A healthcare provider orders Heparin sodium 6000 units subcutaneously daily. The pharmacy dispenses a vial containing 10,000 units per milliliters. How many milliliters of heparin should the nurse administer? include a leading zero if applicable.
0.6
A client with a thromboembolic disorder is receiving a continuous intravenous infusion of heparin 1000 units per hour. There are 25,000 units of heparin in 500 mL of 5% dextrose solution. At how many milliliters per hour should the nurse set the rate on the electronic infusion control device? Record your answer using a whole number. ___ mL/hr
20ml
A client is receiving heparin sodium intravenously at 1500 units/hour. The concentration in the bag is 25,000 units/500 milliliters. The nurse determines that how many milliliters will infuse during the 8-hour shift?
240ml
The laboratory international normalized ratio (INR) results of a client receiving warfarin have been variable. The nurse interviews the client to determine factors contributing to the problem. Which is most important for the nurse to identify? A) Adherence to the prescribed drug regimen B) Use of analgesics C) Serum potassium levels D) Serum glucose level
ANSWER: A) Adherence to the prescribed drug regimen. The dosage of warfarin is adjusted according to INR results; if the client fails to take the drug as prescribed, test results will not be reliable in monitoring the client's response to therapy. Although some medications can affect the absorption or metabolism of warfarin and should be investigated, this is less likely to be a cause of fluctuations in laboratory values. Serum glucose level and serum potassium levels do not affect the absorption of warfarin.
A healthcare provider prescribes enoxaparin 30 mg subcutaneously daily. Which measure would the nurse take when administering this medication? A) Push over 2 minutes. B) Administer in the abdomen C) Rub site after administration D) Remove air pocket from prepackaged syringe before administration.
ANSWER: B) Administer in the abdomen
A client is taking warfarin. If an antidote is needed, which agent will the nurse anticipate being prescribed? A) Prothrombin B) Vitamin K C) Fibrinogen D) Protamine sulfate
ANSWER: B) Vitamin K
Warfarin is prescribed for a client who has been receiving intravenous (IV) heparin for a partial occlusion of the left common carotid artery. The client expresses concern about why both drugs are needed at the same time. What rationale does the nurse include to address the client's concern? A) Giving both drugs allows clot dissolution while preventing new clot formation B) Heparin provides anticoagulant effects until warfarin reaches therapeutic levels. C) This permits the administration of sma
ANSWER: B) Warfarin is administered orally for two or three days to achieve the desired effect on the international normalized ratio (INR) level before heparin is discontinued. These drugs do not dissolve clots already present. Because each drug affects a different part of the coagulation mechanism, dosages must be adjusted separately. That this approach immediately provides maximum protection against clot formation does not account for the reason for the administration of both drugs; warfarin will not exert an immediate therapeutic effect.
A client with a history of pulmonary emboli is taking warfarin (Coumadin) daily. The nurse teaches the client about foods that are appropriate to consume when taking this medication. The nurse evaluates that the client needs further teaching when the client states: A) " Yellow vegetables are high in vitamin A and should be included in the diet." B) "Milk and other high calcium dairy products are necessary to counteract bone loss." C) "Dark green leafy vegetables are high in vitamin K so I shoul
ANSWER: C) "Dark green leafy vegetables are high in vitamin K so I should eat them more often."
After teaching a family member how to administer subcutaneous enoxaparin sodium, how should a nurse evaluate the effectiveness of the training? A) Return demonstration on a manakin B) Observing the family member administering enoxaparin sodium to the client C) Verbalization of the side effects of the medication D) Correctly verbalizing all the necessary steps in enoxaparin sodium administration
ANSWER:B) Observing the family member administering enoxaparin sodium to the client
A nurse is caring for a client who is receiving aspirin therapy. which clinical indicator would be related to this therapy. A) Urinary calculi B) Atrophy of the liver C) Prolonged bleeding time D)Premature erythrocyte destruction
C) Prolonged bleeding time
After surgery a client develops a deep vein thrombosis and a pulmonary embolus. Heparin via a continuous drip at 1200 units/hr is prescribed. Several hours later, vancomycin (Vancocin) 500 mg intravenously every 12 hours is prescribed. The client has one intravenous (IV) site: a peripheral line in the left forearm. What action should the nurse take? A) Stop the heparin, flush the line, and administer the vancomycin. B)Use a piggyback setup to administer the vancomycin into the heparin. C)Start
ANSWER: Start another IV line for vancomycin and continue the heparin as prescribed (These drugs are incompatible in the same IV)
An older adult with cerebral arteriosclerosis is admitted with atrial fibrillation and is started on a continuous heparin infusion. What clinical finding enables the nurse to conclude that the anticoagulant therapy is effective? A) An activated partial thromboplastin twice the usual value B) A reduction of confusion C) A decreased viscosity of the blood D) an absence of ecchymotic areas
ANSWER: A) An activated partial thromboplastin (APTT) twice the usual value
A client develops thrombophlebitis in the right calf. Bed rest is prescribed, and an IV of heparin is initiated. When describing the purpose of this drug to the client, the nurse explains that it: A) Prevents extension of the clot B) Reduces the size of the thrombus C) Dissolves the blood clot in the vein D) Facilitates absorption of red blood cells
ANSWER: A) Prevents extension of the clot.Heparin interferes with activation of prothrombin to thrombin and inhibits aggregation of platelets. Heparin does not reduce the size of a thrombus. Heparin does not dissolve blood clots in the veins. Heparin does not facilitate the absorption of red blood cells.
A primary healthcare provider prescribes three stool specimens for occult blood for a client who complains of blood-streaked stools and a 10-pound (4.5 kg) weight loss in one month. To ensure valid test results, what instructions should the nurse give the client? A) Avoid eating red meat before testing B) Keep the specimen war, C) Discard the first specimen D) Test three different areas of the same specimen
ANSWER: Avoid eating red meat before testing R:Red meat can react with reagents used in the test to cause false-positive results. Testing the specimen while it is still warm may apply for testing for ova and parasites, but not for occult blood. If the correct procedure is followed, discarding the first specimen is unnecessary. Random stool testing can be done but must be on three different bowel movements during the screening period.
To prevent excessive bruising when administering subcutaneous heparin, what technique would the nurse employ? A) Administer the injection via the Z-track technique B) Avoid massaging the injection site after the injection C) Inject the drug into the vastus lateralis muscle in the thigh D) Use 2 mL of sterile normal saline to dilute the heparin
ANSWER: B) Avoid massaging the injection site after the injection
A client is admitted to the hospital with a diagnosis of deep vein thrombosis, and intravenous (IV) heparin sodium is prescribed. If the client experiences excessive bleeding, what should the nurse be prepared to administer? A) Vitamin K B) Protamine sulfate C) Oprelvekin D) Warfarin sodium
ANSWER: B) Protamine sulfate-Protamine sulfate binds with heparin sodium to form a physiologically inert complex; it corrects clotting deficits. Vitamin K counteracts the effects of drugs like warfarin sodium (Coumadin). Panheparin is an alternate name for heparin sodium. Warfarin sodium is an oral anticoagulant that interferes with the synthesis of prothrombin.
Before a cholecystectomy, vitamin K is prescribed. The nurse recognizes that this is ordered because vitamin K contributes to the formation of which substance? A) Bilirubin B) Prothrombin C) Thromboplastin D) Cholecystokinin
ANSWER: B) Prothrombin Vitamin K is necessary in the formation of prothrombin to prevent bleeding. It is a fat-soluble vitamin and is not absorbed from the gastrointestinal (GI) tract in the absence of bile. Bilirubin is the bile pigment formed by the breakdown of erythrocytes. Thromboplastin converts prothrombin into thrombin during the process of coagulation. Cholecystokinin is the hormone that stimulates contraction of the gallbladder.
A client who had a femoropopliteal bypass graft is receiving clopidogrel postoperatively. what should the nurse teach the client related to the medication? A) Eliminate grapefruit from the diet B) Report any occurrences of multiple bruises C) Eat more roughage if constipation occurs D) Take the medication on an empty stomach
ANSWER: B) Report any occurrences of multiple bruises Clopidogrel is a platelet aggregation inhibitor that decreases the probability of clots forming where the graft was placed, but it also increases bleeding tendencies when the dosage is excessive. Clopidogrel does not interact with grapefruit and it is permitted on the diet. Diarrhea, not constipation, is more likely to occur with clopidogrel. Clopidogrel should be taken with food to decrease the side effects of gastric discomfort, diarrhea, and gastrointestinal bleeding.
After a deep vein thrombosis developed in a postpartum client, an intravenous (IV) infusion of heparin therapy was instituted 2 days ago. The client's activated partial thromboplastin time (aPTT) is now 98 seconds. What should the nurse do next? A) Document the result on the medical record and recheck the aPTT in 4 hours B) Interrupt the infusion and notify the primary healthcare provider of the aPTT result. C) Call the primary healthcare provider to obtain a prescription for a low-molecular wei
ANSWER: Interrupt the infusion and notify the primary healthcare provider of the aPTT result.The heparin should be withheld, because 98 seconds is almost three times the normal time it takes a fibrin clot to form (25 to 36 seconds), and prolonged bleeding may result; the therapeutic range for heparin is one-and-a-half to two times the normal range. The primary healthcare provider should be notified. The dosage of heparin must not be increased, because the client already has received too much. Documenting the result on the medical record and rechecking the aPTT in 4 hours is an unsafe option. Continuing the infusion could result in hemorrhage. The medication does not have to be changed; it should be stopped temporarily until the aPTT is within the therapeutic range.