PrepU Chapter 48

A nurse is preparing to administer an antiplatelet drug. Which medication would the nurse most likely administer? Phytonadione Alteplase Enoxaparin Clopidogrel

Clopidogrel Clopidogrel is an antiplatelet agent. Alteplase is a thrombolytic agent. Phytonadione is an anticoagulant antagonist. Enoxaparin is an LMWH anticoagulant.

A nurse is caring for a client receiving warfarin drug therapy. The client informs the nurse that he is also taking chamomile, which is an herbal remedy. The nurse would alert the client to which adverse effects?

Increased risk for bleeding The nurse should inform the client about the increased risk for bleeding, which is an effect of the interaction between warfarin and the herb. Decreased effectiveness of chamomile, increased absorption of warfarin, and increased risk for hypertension are not effects of the interaction between warfarin and chamomile.

A client is receiving warfarin. The nurse would expect to administer this drug by which route?

Oral Warfarin is administered orally.

What values are used to monitor the effectiveness of warfarin therapy?

PT and INR Warfarin dose is regulated according to the international normalized ratio (INR), which is based on prothrombin time (PT). PT and INR are assessed daily until a stable daily dose is reached. Thereafter, PT and INR are determined every few weeks for the duration of warfarin therapy.

A client is being sent home with subcutaneous heparin after a total hip replacement. The nurse understands what symptom would indicate a serious drug reaction? Hypotension Headache Tarry stools Stomach pain

Tarry stools Tarry stools would be an indication of gastrointestinal bleeds. The most common adverse effect of heparin is bleeding.

The nurse is reviewing the coagulation studies of a client who is receiving a heparin infusion. The client's baseline partial thromboplastin time is 32 seconds. Which result would indicate therapeutic effectiveness? 96 seconds 32 seconds 40 seconds 64 seconds

64 seconds Therapeutic range for heparin would be 1.5 to 2.5 times the client's baseline. For a baseline value of 32 seconds, this would range from 48 to 80 seconds. A value of 64 seconds would be considered therapeutic.

A 55-year-old man has been diagnosed with coronary artery disease and begun antiplatelet therapy. The man has asked the nurse why he is not taking a "blood thinner like warfarin." What is the most likely rationale for the clinician's use of an antiplatelet agent rather than an anticoagulant? Antiplatelet agents have fewer adverse effects than anticoagulants. Antiplatelet agents are more effective against arterial thrombosis; anticoagulants are more effective against venous thrombosis. Antiplatelet agents do not require the man to undergo frequent blood work; anticoagulants require constant blood work to ensure safety. Antiplatelet agents are most effective in large vessels; anticoagulants are most effective in the small vessels of the peripheral circulation.

Antiplatelet agents are more effective against arterial thrombosis; anticoagulants are more effective against venous thrombosis. Anticoagulants are more effective in preventing venous thrombosis than arterial thrombosis. Antiplatelet drugs are used to prevent arterial thrombosis. CAD has an arterial rather than venous etiology. The rationale for the use of antiplatelet agents in CAD is not likely related to the need for blood work or the presence of adverse effects.

A client is receiving heparin. Which would the nurse use to monitor the effects of the drug? Vitamin K level International normalized ratio Prothrombin time Partial thromboplastin time

Partial thromboplastin time Heparin's effectiveness is monitored by the results of the partial thromboplastin time. The INR and PT are used to monitor warfarin. Vitamin K is the antidote for warfarin, and levels are not monitored to evaluate the effects of any anticoagulant.

While preparing a client for discharge, the nurse teaches about the proper use of warfarin, which has been prescribed by the physician. Which statement by the client indicates that additional teaching is required?

"I should use aspirin to control my arthritis pain." Aspirin is an antiplatelet agent that can increase the effect of warfarin. Clients taking warfarin should check with a health care professional before taking any analgesic. The other statements suggest that the client understands important aspects of warfarin therapy.

A client asks the nurse what dose of acetylsalicylic acid is needed for antiplatelet effects to prevent heart attacks. What dose is most appropriate to reduce platelet aggregation? 1000 mg 30 mg 625 mg 10 mg

30 mg A single dose of 300 to 600 mg or multiple doses of 30 mg inhibit cyclooxygenase in circulating platelets almost completely. The dose of 100 mg is too small. The doses of 625 mg and 1000 mg are too large.

A male client who is experiencing the signs and symptoms of an acute myocardial infarction says that his symptoms started at 10:00 AM this morning. It is now 11:15 AM. The nurse understands that the latest time that the client could receive a thrombolytic agent would be: 4:00 PM 1:00 PM 2:00 PM 3:00 PM

4:00 PM Treatment with a thrombolytic must be instituted within 6 hours of the onset of symptoms of an acute myocardial infarction to achieve maximum therapeutic effectiveness. In this case, 4 PM would be the latest.

A nurse will use extreme caution when administering heparin to which patient?

A 38-year-old male with peptic ulcer disease Heparin should be administered with extreme caution to patients with peptic ulcer or liver disease or after surgery because those patients would have greater risk for hemorrhage or excessive blood loss. Urticaria is a listed adverse effect of taking heparin and would therefore be expected. A patient who takes heparin would be advised to not drink heavily or smoke, but neither would have the safety risk posed by a patient with peptic ulcer. A patient with an accelerated heart rate and on heparin therapy would be at no special risk.

The health care provider orders thrombolytic agents when treating a client diagnosed with acute myocardial infarction. When specifically considering this client, which drug should the nurse keep readily available when blood flow is reestablished?

Antidysrhythmics When the thrombolytic agents are used in acute myocardial infarction, cardiac dysrhythmias may occur when blood flow is reestablished; antidysrhythmic drugs should be readily available.

A nurse is caring for a patient receiving the anticoagulant drug warfarin. What pre-administration assessments should the nurse perform before administering the drug to the patient?

Assess prothrombin time (PT) and INR. The nurse should assess the prothrombin time (PT) and INR before administering the anticoagulant drug warfarin to the patient. Observing for signs of thrombus formation, assessing for signs of bleeding, and monitoring for hypersensitivity reaction are the ongoing assessments performed in patients who are administered warfarin.

A nurse would anticipate the need for an increased dosage of warfarin if the patient was also receiving: Carbamazepine Amiodarone Danazol Clofibrate

Carbamazepine Carbamazepine decreases the anticoagulant effects of warfarin necessitating an increased dose of warfarin. Clofibrate, amiodarone, and danazol increase the bleeding effects of warfarin, necessitating a decreased dosage of warfarin.

A client is to receive clopidogrel. The nurse would expect to administer this agent by which route?

Oral

A client is to receive clopidogrel. The nurse would expect to administer this agent by which route? Intravenous Intramuscular Subcutaneous Oral

Oral Clopidogrel is administered orally.

A 50-year-old man has undergone a bunionectomy and has been admitted to the postsurgical unit. What aspect of the man's medical history would contraindicate the use of heparin for deep vein thrombosis (DVT) prophylaxis?

The man has a diagnosis of ulcerative colitis (UC). GI ulcerations contraindicate the use of heparin since it is a frequent site of heparin-induced bleeding. Obesity, diabetes, and previous MI do not rule out the safe use of heparin.

A 59-year-old client is on warfarin therapy. On follow-up visits to the clinic, the nurse will assess the client's:

intake of vitamin K. It is important to assess the client's usual vitamin K intake because warfarin interferes with the synthesis of vitamin K-derived clotting factors. Increases in vitamin K intake will interfere with the action of warfarin if the increase in intake occurs after the warfarin dosage has been titrated. In addition, a deficiency of vitamin K can increase the risk of bleeding. The client's sugar intake or the presence of a skin-related or breathing disorder does not affect the administration of warfarin.

A client who is receiving warfarin has blood in his urinary drainage bag. What medication will likely be prescribed by the health care provider?

vitamin K Vitamin K is the antidote for warfarin overdose. Aminocaproic acid is used to control excessive bleeding from systemic hyperfibrinolysis. Platelets are a blood product, not a medication. Protamine sulfate is the antidote for heparin therapy.

A client is receiving low-molecular-weight heparin to prevent thromboembolic complications. The nursing student asks the instructor the reason why this treatment is given instead of heparin. What is the instructor's best explanation of the rationale for LMWH over heparin?

"LMWH is associated with less thrombocytopenia than standard heparin." Low-molecular-weight heparins are associated with less thrombocytopenia than standard heparin. Low-molecular-weight heparin is not stronger than standard heparin. Low-molecular-weight heparin is administered cautiously in clients with blood dyscrasia and hypertension.

A 61-year-old man is prescribed alteplase for an acute myocardial infarction. A priority nursing intervention will be to monitor for what during and after drug therapy? A drop in blood pressure Arrhythmias Liver failure Gastrointestinal distress

Arrhythmias A patient who is on alteplase therapy to treat a myocardial infarction should be monitored for arrhythmias using a cardiac monitor. Reperfusion arrhythmias are common when blood flow to the heart has been reestablished. The patient's blood pressure should also be monitored but would not be the priority intervention. Gastrointestinal distress and liver failure are not associated with alteplase therapy.

Mr. Hon has been admitted to the hospital and placed on anticoagulant therapy. For what blood-related disorder is this therapy used? Blood cancer Hemostasis Hemophilia Hypercoagulation

Hypercoagulation Anticoagulants are used to treat hypercoagulation, or excessive coagulation. They prevent the blood from clotting unexpectedly and maintain the flow of blood. Hemophilia is treated with human factor IX complex. Blood cancer is treated with therapies such as chemotherapy or radiation treatment. On the other hand, hemostasis is the process by which the body prevents excessive blood flow during an injury.

Which would a nurse identify as inhibiting factor Xa? Argatroban Heparin Fondaparinux Warfarin

Fondaparinux Fondaparinux inhibits factor Xa and blocks the clotting cascade to prevent clot formation. Heparin and argatroban block the formation of thrombin from prothrombin. Warfarin decreases the production of vitamin K-depending clotting factors in the liver.

The client is currently receiving a continuous IV infusion of heparin. Which procedure should the nurse avoid when possible?

Giving intramuscular injections When caring for clients who are receiving anticoagulation therapy, nurses should, when possible, avoid procedures that present the risk of trauma or bleeding. Nursing procedures to avoid include intramuscular injections, venipuncture, and arterial puncture.

The nurse is preparing to administer protamine emergently to a client per instructions from the health care provider. The nurse concludes this is necessary due to an adverse reaction to which drug?

Heparin An overdosage of any anticoagulant may result in uncontrolled bleeding in the client. In most cases, discontinuation of the drug is usually sufficient to correct overdosage; however, if the bleeding is severe there are antidotes. Protamine is used to treat overdose of heparin and low-molecular-weight heparins (LMWHs). Vitamin K is used to treat the overdosage of warfarin. Alteplase and clopidogrel do not require antidotes.

During a cardiac catheterization and concurrent GP IIb/IIIa receptor antagonist administration, a client begins to bleed from the arterial access site of the catheterization. In what, if any, specific circumstance can the infusion continue? It can continue when the client can tolerate Trendelenburg's position. It can't; it must be stopped. It can continue when the procedure is within 15 minutes of completion. It can continue when bleeding can be controlled by pressure application.

It can continue when bleeding can be controlled by pressure application. If bleeding occurs and cannot be controlled with pressure, the procedure must be terminated. No other options are accurately good practice under the described situation.

A 75-year-old client presents to the health care provider's office with bleeding gums and multiple bruises. When the nurse reviews the client's drug history, the nurse finds that the client is prescribed aspirin 81 mg/d. What drug may cause increased bleeding when used in conjunction with the aspirin?

NSAIDs NSAIDs, which are commonly used by older adults, also have antiplatelet effects. Clients who take an NSAID daily may not need low-dose aspirin for antithrombotic effects.

The health care provider discovers a clot in the client's left lower leg. Anticoagulant drugs are prescribed to prevent formation of new clots and to achieve which other effect?

Prevent extension of clots already present Anticoagulant drugs are given to prevent formation of new clots and extension of clots already present.

The health care provider discovers a clot in the client's left lower leg. Anticoagulant drugs are prescribed to prevent formation of new clots and to achieve which other effect? Regulate PT, INR Prevent extension of clots already present Regulate PTT Increase coagulation

Prevent extension of clots already present Anticoagulant drugs are given to prevent formation of new clots and extension of clots already present.

A client is to receive enoxaparin (Lovenox). The nurse would administer this drug by which route?

Subcutaneous injection Enoxaparin (Lovenox) is administered via subcutaneous injection. Intramuscular (IM) administration is avoided because of the possibility of the development of local irritation, pain, or hematoma (a collection of blood in the tissue). Intravenous infusions are used with several anticoagulants such as heparin. Warfarin is given orally.

A client is being sent home with subcutaneous heparin after a total hip replacement. The nurse understands what symptom would indicate a serious drug reaction?

Tarry stools Tarry stools would be an indication of gastrointestinal bleeds. The most common adverse effect of heparin is bleeding.

The client is diagnosed with hepatitis A, diabetes type 1, and portal hypertension. The client develops a DVT, and the health care provider prescribes warfarin. The nurse is concerned for what reason? The client is at risk for hyperglycemic episodes. The client is less likely to achieve a therapeutic dose. The client is more likely to experience bleeding. The client is at risk for further liver impairment.

The client is more likely to experience bleeding. Warfarin is more likely to cause bleeding in clients with liver disease because of decreased synthesis of vitamin K. In addition, warfarin is eliminated only by hepatic metabolism and may accumulate with liver impairment.

Which would the nurse identify as the end of the intrinsic pathway? Thrombin formation Vasoconstriction Platelet aggregation Release of factor XI

Thrombin formation Thrombin formation occurs at the end of the intrinsic pathway. The first reaction to a blood vessel injury is local vasoconstriction. In addition, injury then exposes blood to the collagen and other substances under the endothelial lining of the vessel causing platelet aggregation. Release of factor XI occurs in response to activation of the Hageman factor.

The nurse is caring for a 73-year-old client receiving warfarin. When the nurse performs the initial shift assessment, the nurse observes blood in the client's urinary drainage bag. After reporting the observation to the physician, which substance will the nurse likely administer?

Vitamin K Genitourinary bleeding is an adverse effect of warfarin. Vitamin K, a hemostatic agent that controls bleeding caused by warfarin overdose, will likely be administered to this patient.

A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the client's:

aPTT Before initiating therapy, it is important to review the client's aPTT, hematocrit, and platelet count. These tests provide baseline information on the client's blood clotting abilities and identify conditions that may cause heparin therapy to be contraindicated. The client's heart rate and pulse, electrolyte levels, and blood sugar levels would not be priority nursing assessments.

The provider orders heparin for a 35-year-old female client. The nurse administers the drug only after confirming that the client:

does not have peptic ulcer disease. Contraindications of heparin include GI ulcerations (e.g., peptic ulcer disease, ulcerative colitis), active bleeding, severe kidney or liver disease, severe hypertension, and recent surgery of the eye, spinal cord, or brain. The drug should be used cautiously in clients with non-severe hypertension.

A postsurgical client possesses numerous risk factors for venous thromboembolism, including a previous deep vein thrombosis. What drug would the nurse anticipate administering while this client recovers in the hospital?

heparin Heparin is frequently used to prevent postsurgical venous thromboembolism. Antiplatelet drugs do not have this indication, and vitamin K would increase the client's risks.

A client with a history of clot formation is scheduled for bowel resection due to colorectal cancer. What anticoagulant agent will be administered prophylactically? streptokinase warfarin acetylsalicylic acid heparin

heparin Prophylactically, low doses of heparin are given to prevent thrombus formation in clients having major abdominal surgery. Acetylsalicylic acid is not used to prevent thrombus in clients having major abdominal surgery. Warfarin takes several days for therapeutic effects to occur; thus it is not used prophylactically to prevent thrombus in a client with abdominal surgery. Streptokinase promotes thrombolysis and is not used to prevent thrombus.

A nurse at a long-term care facility is conducting a medication reconciliation for a man who has just moved into the facility. The man is currently taking clopidogrel. The nurse is most justified suspecting that this man has a history of:

myocardial infarction. Indications for use of clopidogrel include reduction of myocardial infarction, stroke, and vascular death in clients with atherosclerosis and in those after placement of coronary stents. It is not indicated in the treatment of ITP, CVA, or hemophilia.

A client exhibits signs and symptoms of heparin overdose. The nurse would anticipate administering:

Protamine sulfate Protamine sulfate is the antidote for heparin overdose. Vitamin K is the antidote for warfarin overdose. Urokinase is a thrombolytic. Drotrecogin alfa is a C-reactive protein that has anticoagulant effects.

A stable daily dose of warfarin is reached when which parameter is achieved?

The PT and INR are within their therapeutic ranges, and the dose does not cause bleeding. When warfarin is started, PT and INR should be assessed daily until a stable daily dose is reached (the dose that maintains PT and INR within therapeutic ranges and does not cause bleeding).

A 50-year-old man has undergone a bunionectomy and has been admitted to the postsurgical unit. What aspect of the man's medical history would contraindicate the use of heparin for deep vein thrombosis (DVT) prophylaxis? The man had a myocardial infarction (MI) 18 months ago. The man has a diagnosis of type 2 diabetes mellitus (DM). The man has a diagnosis of ulcerative colitis (UC). The man is morbidly obese.

The man has a diagnosis of ulcerative colitis (UC). GI ulcerations contraindicate the use of heparin since it is a frequent site of heparin-induced bleeding. Obesity, diabetes, and previous MI do not rule out the safe use of heparin.

Which client statement demonstrates an accurate understanding of the action of a prescribed anticoagulant? "Anticoagulants thin the blood so clots can't get as big." "This medication will keep unnecessary clots from forming in my blood." "If I have another stroke, this medication will bust up the clot before too much damage is done." "If a big clot starts to form, this medication will help break it up."

"This medication will keep unnecessary clots from forming in my blood." An anticoagulant slows the body's normal blood-clotting processes to prevent harmful blood clots from forming. This type of drug is often called a "blood thinner"; however, it cannot dissolve any clots that have already formed and does not make your blood thin.

A client is receiving anticoagulant therapy and has an INR done. Which result would the nurse interpret as being therapeutic? 1.0 1.4 1.8 2.4

2.4 When anticoagulant therapy is used, the INR is maintained between 2 and 3. The other values are not therapeutic.

A client is started on enoxaparin immediately after hip surgery. The nurse would explain to the client that this drug will be continued for how long? 7 to 10 days 1 to 3 days 10 to 14 days 3 to 7 days

7 to 10 days When used for hip surgery, enoxaparin typically is administered for 7 to 10 days to prevent deep vein thrombosis that may lead to pulmonary embolism after hip replacement.

The nurse is preparing to administer a thrombolytic drug to a client. The nurse understands that this class of drugs would be contraindicated in clients with which conditions? Select all that apply.

Active bleeding History of aneurysm History of stroke The use of thrombolytic drugs is contraindicated in a client with known hypersensitivity to the medication, active bleeding, and a history of stroke, aneurysm, and recent intracranial surgery. Active infection does not affect the use of thrombolytics. Recent abdominal surgery, although watched depending on postop time, is not a contraindication.

A 60-year-old client experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The client has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect?

By inactivating clotting factors and thus stopping the coagulation cascade Heparin, along with antithrombin, rapidly promotes the inactivation of factor X, which, in turn, prevents the conversion of prothrombin to thrombin. Heparin does not achieve its therapeutic effect through the excretion or inhibition of vitamin K or by inhibiting platelet aggregation.

The black box warning associated with warfarin concerns its risk of causing what condition?

Major or fatal bleeding The FDA has issued a black box warning for warfarin due to its risk of causing major or fatal bleeding.

A client, taking warfarin after open heart surgery, tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the report of pain, what should the nurse suspect is the cause of the pain? joint thrombosis bleeding degenerative joint disease caused by her medication torn medial meniscus

bleeding The main adverse effect of warfarin is bleeding. The sudden onset of pain in the knees alerts the nurse to assess the client for bleeding. Arthritis, torn medical meniscus, and degenerative joint disease could all be symptoms of knee pain, but the onset and combination of anticoagulant therapy is not an etiology of these types of injuries and disease.

A client, taking warfarin after open heart surgery, tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the report of pain, what should the nurse suspect is the cause of the pain? torn medial meniscus joint thrombosis bleeding degenerative joint disease caused by her medication

bleeding The main adverse effect of warfarin is bleeding. The sudden onset of pain in the knees alerts the nurse to assess the client for bleeding. Arthritis, torn medical meniscus, and degenerative joint disease could all be symptoms of knee pain, but the onset and combination of anticoagulant therapy is not an etiology of these types of injuries and disease.

The nurse is caring for a 76-year-old client who is receiving IV heparin 5000 units q4h. At the initiation of therapy, the client's control activated thromboplastin time (aPTT) was found to be 35 seconds. One hour prior to the next scheduled dose, aPTT is determined to be 92 seconds. Based on this result, the nurse will:

hold the dose and contact the provider. During heparin therapy, aPTT values are typically maintained between 1.5 to 2.5 times the control value. Since an aPTT value of 92 seconds is greater than 2.5 times this client's control value, the anticoagulation effect is too great, and the health care provider should be notified.

A 60-year-old client experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The client has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect? By inactivating clotting factors and thus stopping the coagulation cascade By inhibiting the action of vitamin K at its sites of action By promoting the rapid excretion of vitamin K by the gastrointestinal mucosa By inhibiting platelet aggregation on vessel walls and promoting fibrinolysis

By inactivating clotting factors and thus stopping the coagulation cascade Heparin, along with antithrombin, rapidly promotes the inactivation of factor X, which, in turn, prevents the conversion of prothrombin to thrombin. Heparin does not achieve its therapeutic effect through the excretion or inhibition of vitamin K or by inhibiting platelet aggregation.

The nurse is preparing to administer protamine emergently to a client per instructions from the health care provider. The nurse concludes this is necessary due to an adverse reaction to which drug? Warfarin Alteplase Heparin Clopidogrel

Heparin An overdosage of any anticoagulant may result in uncontrolled bleeding in the client. In most cases, discontinuation of the drug is usually sufficient to correct overdosage; however, if the bleeding is severe there are antidotes. Protamine is used to treat overdose of heparin and low-molecular-weight heparins (LMWHs). Vitamin K is used to treat the overdosage of warfarin. Alteplase and clopidogrel do not require antidotes.

A nurse at a long-term care facility is conducting a medication reconciliation for a man who has just moved into the facility. The man is currently taking clopidogrel. The nurse is most justified suspecting that this man has a history of: hemophilia A. idiopathic thrombocytopenic purpura (ITP). hemorrhagic cerebrovascular accident. myocardial infarction.

myocardial infarction. Indications for use of clopidogrel include reduction of myocardial infarction, stroke, and vascular death in clients with atherosclerosis and in those after placement of coronary stents. It is not indicated in the treatment of ITP, CVA, or hemophilia.

A nurse is caring for a patient receiving the anticoagulant drug warfarin. What pre-administration assessments should the nurse perform before administering the drug to the patient? Assess prothrombin time (PT) and INR. Observe for signs of thrombus formation. Monitor for hypersensitivity reaction. Assess for signs of bleeding.

Assess prothrombin time (PT) and INR. The nurse should assess the prothrombin time (PT) and INR before administering the anticoagulant drug warfarin to the patient. Observing for signs of thrombus formation, assessing for signs of bleeding, and monitoring for hypersensitivity reaction are the ongoing assessments performed in patients who are administered warfarin.

Mr. Hon has been admitted to the hospital and placed on anticoagulant therapy. For what blood-related disorder is this therapy used?

Hypercoagulation Anticoagulants are used to treat hypercoagulation, or excessive coagulation. They prevent the blood from clotting unexpectedly and maintain the flow of blood. Hemophilia is treated with human factor IX complex. Blood cancer is treated with therapies such as chemotherapy or radiation treatment. On the other hand, hemostasis is the process by which the body prevents excessive blood flow during an injury.

A client is discharged from the hospital with a prescription of warfarin. Which statement indicates successful client teaching?

"I will avoid herbal remedies." Most commonly used herbs and supplements have a profound effect on drugs for anticoagulation. The client should never double up on dosing related to a missed dose. The client should avoid green leafy vegetables due to vitamin K. The client should not discontinue his or her medications without first consulting with the primary health care provider.

After teaching a group of students about antiplatelet agents, the instructor determines that the teaching was successful when the students identify which drug as blocking the production of platelets in the bone marrow? Anagrelide Ticlopidine Cilostazol Clopidogrel

Anagrelide Anagrelide blocks the production of platelets in the bone marrow. Cilostazol inhibits platelet aggregation and adhesion by blocking receptor sites on the platelet membrane preventing platelet-platelet interaction or the interaction of platelets with other clotting chemicals. Clopidogrel inhibits platelet aggregation and adhesion by blocking receptor sites on the platelet membrane preventing platelet-platelet interaction or the interaction of platelets with other clotting chemicals. Ticlopidine inhibits platelet aggregation and adhesion by blocking receptor sites on the platelet membrane preventing platelet-platelet interaction or the interaction of platelets with other clotting chemicals.

To compensate for clopidogrel's slow onset of action, the nurse should anticipate implementing which intervention? temporarily supplementing the client's medication regimen with low molecular weight heparin administering the first two to three doses of clopidogrel intravenously simultaneously administrating warfarin and clopidogrel administering a one-time loading dose that is higher than the maintenance dose

administering a one-time loading dose that is higher than the maintenance dose Effective dose-dependent prevention of platelet aggregation can be seen within 2 hours of a single oral dose of clopidogrel, but the onset of action is slow, so a loading dose of 300 to 600 mg is usually administered. None of the other options effectively addresses the drug's slow onset of action.

A client with a history unstable angina is being prepared for percutaneous transluminal coronary angioplasty (PTCA). The nurse assessing the client should focus on identifying a history of which conditions/situations that are considered contraindications to this procedure? Select all that apply.

major trauma within the last 6 weeks uncontrolled hypertension thrombocytopenia A PTCA involves the administration of abciximab. Contraindications for abciximab administration include active bleeding, thrombocytopenia, history of a serious stroke, surgery or major trauma within the previous 6 weeks, uncontrolled hypertension, or hypersensitivity to drug components. Abciximab is contraindicated in clients who have recently received an oral anticoagulant but not heparin. Diabetes is not considered a contraindication for the use of abciximab.

A client who has been treated with warfarin after cardiac surgery is found to have an INR of 9.0. Which medication will be administered to assist in the development of clotting factors?

vitamin K Vitamin K is the antidote for warfarin overdosage. In this case, the client may be at the therapeutic level to control thrombus formation, but, due to the injury, it is important to control bleeding. Vitamin E is not used as an antidote for warfarin overdosage. Protamine sulfate is used as an antidote to heparin or low-molecular-weight heparin. Acetylsalicylic acid (aspirin) is used to decrease coagulation as a preventive measure for myocardial infarction.

The health care provider reorders dalteparin for the client. The pharmacy states that the drug is not available. The nurse calls the health care provider and asks if dalteparin can be replaced with another LMWH. What does the nurse expect to be the response? "The drugs are not interchangeable; have the pharmacy obtain the drug ordered." "I'll change the drug to Lovenox." "The drugs are interchangeable; the pharmacy can substitute another LMWH." "I'll change the order to enoxaparin."

"The drugs are not interchangeable; have the pharmacy obtain the drug ordered." Currently available LMWHs (dalteparin, enoxaparin) differ from standard heparin and each other and are not interchangeable.

The nurse is teaching a client and caregiver about the warfarin which has been prescribed to continue at home. The nurse determines the teaching session is successful when the client and caregiver correctly choose which instructions to follow? Select all that apply.

Be consistent with your intake of foods containing vitamin K. Do not change brands of warfarin without consulting the health care provider. Take the drug at the same time every evening. Do not take or stop taking other medications except on the advice of the health care provider. Instructions would include being consistent with intake of foods containing vitamin K, not changing brands of the drug, taking the drug at the same time each evening, and not taking or stopping other medications. Individuals taking anticoagulants are at a greater risk of infection during the first 3 months of treatment, however, the use of prophylactic antibiotics is not recommended.

A female client is started on warfarin therapy. The client asks the nurse why she is no longer on heparin therapy. What differentiates heparin from warfarin?

Heparin is administered parenterally, while warfarin is administered orally. Heparin is administered parenterally, while warfarin is administered orally. Warfarin is administered after heparin therapy to complete treating a thrombus or embolism. Clients receiving heparin therapy will begin taking warfarin before they discontinue heparin. This overlap allows the warfarin to reach a therapeutic level before heparin is discontinued. However, both drugs are used to treat thrombosis and thromboembolic disorders and have equally serious adverse effects, such as bleeding. Anticoagulants, such as warfarin and heparin, prevent new clot formation or extension of an existing clot, while thrombolytics dissolve existing blood clots.

A female client is started on warfarin therapy. The client asks the nurse why she is no longer on heparin therapy. What differentiates heparin from warfarin? Heparin is an anticoagulant, while warfarin is a thrombolytic. Heparin causes more serious adverse effects than warfarin. Heparin is administered parenterally, while warfarin is administered orally. Heparin is used to treat thrombosis, while warfarin treats heart attacks.

Heparin is administered parenterally, while warfarin is administered orally. Heparin is administered parenterally, while warfarin is administered orally. Warfarin is administered after heparin therapy to complete treating a thrombus or embolism. Clients receiving heparin therapy will begin taking warfarin before they discontinue heparin. This overlap allows the warfarin to reach a therapeutic level before heparin is discontinued. However, both drugs are used to treat thrombosis and thromboembolic disorders and have equally serious adverse effects, such as bleeding. Anticoagulants, such as warfarin and heparin, prevent new clot formation or extension of an existing clot, while thrombolytics dissolve existing blood clots.

A 50-year-old man has undergone a bunionectomy and has been admitted to the postsurgical unit. What aspect of the man's medical history would contraindicate the use of heparin for deep vein thrombosis (DVT) prophylaxis? The man has a diagnosis of type 2 diabetes mellitus (DM). The man has a diagnosis of ulcerative colitis (UC). The man is morbidly obese. The man had a myocardial infarction (MI) 18 months ago.

The man has a diagnosis of ulcerative colitis (UC). GI ulcerations contraindicate the use of heparin since it is a frequent site of heparin-induced bleeding. Obesity, diabetes, and previous MI do not rule out the safe use of heparin.

What laboratory value will the nurse prioritize when providing care for a client prescribed intravenous heparin?

aPTT Prescribers use the activated partial thromboplastin time (aPTT), which is sensitive to changes in blood clotting factors, except factor VII, to regulate heparin dosage. D-dimer test is used to help rule out deep vein thrombosis (DVT) and pulmonary embolism (PE). A platelet count measures how many platelets are present in the blood. Platelets are parts of the blood that help the blood clot. Factor XIII levels are assessed when diagnosing/managing hemophilia A.

A client, taking warfarin after open heart surgery, tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the report of pain, what should the nurse suspect is the cause of the pain?

bleeding The main adverse effect of warfarin is bleeding. The sudden onset of pain in the knees alerts the nurse to assess the client for bleeding. Arthritis, torn medical meniscus, and degenerative joint disease could all be symptoms of knee pain, but the onset and combination of anticoagulant therapy is not an etiology of these types of injuries and disease.

Which client statement demonstrates an accurate understanding of the action of a prescribed anticoagulant?

"This medication will keep unnecessary clots from forming in my blood." An anticoagulant slows the body's normal blood-clotting processes to prevent harmful blood clots from forming. This type of drug is often called a "blood thinner"; however, it cannot dissolve any clots that have already formed and does not make your blood thin.

When describing the clotting process, which step would the nurse identify as the first reaction to occur with injury to a blood vessel?

Vasoconstriction The first reaction to a blood vessel injury is local vasoconstriction. In addition, injury then exposes blood to the collagen and other substances under the endothelial lining of the vessel, causing platelet aggregation. Release of factor XI occurs in response to activation of the Hageman factor. Thrombin formation occurs at the end of the intrinsic pathway.

The nurse educates a client diagnosed with atrial fibrillation about the prescribed warfarin. Which client statements establish the need for further clarification? "I will not drink alcohol unless it is all right with my primary care provider." "I will keep my lab appointments for prothrombin and INR levels." "I will take the warfarin at the same time each day." "I will not eat green leafy vegetables, broccoli, yogurt, or cheese."

"I will not eat green leafy vegetables, broccoli, yogurt, or cheese." The nurse needs to clarify teaching regarding the intake of foods rich in Vitamin K. The client should not avoid eating foods with Vitamin K, but eat consistent amounts every day so therapeutic levels for the warfarin may be maintained. The client has an adequate understanding of the importance of keeping lab appointments for PT and INR levels used to monitor and regulate the warfarin dosage. The client should take the warfarin the same tie each day to maintain consistent blood levels of the drug. The client should not drink alcohol unless the primary care provider approves it, and instructs the client as to how much and how often. Alcohol will increase the risk for bleeding.

A 55-year-old man has been diagnosed with coronary artery disease and begun antiplatelet therapy. The man has asked the nurse why he is not taking a "blood thinner like warfarin." What is the most likely rationale for the clinician's use of an antiplatelet agent rather than an anticoagulant?

Antiplatelet agents are more effective against arterial thrombosis; anticoagulants are more effective against venous thrombosis. Anticoagulants are more effective in preventing venous thrombosis than arterial thrombosis. Antiplatelet drugs are used to prevent arterial thrombosis. CAD has an arterial rather than venous etiology. The rationale for the use of antiplatelet agents in CAD is not likely related to the need for blood work or the presence of adverse effects.

The nurse is preparing to administer protamine emergently to a client per instructions from the health care provider. The nurse concludes this is necessary due to an adverse reaction to which drug? Clopidogrel Warfarin Heparin Alteplase

Heparin An overdosage of any anticoagulant may result in uncontrolled bleeding in the client. In most cases, discontinuation of the drug is usually sufficient to correct overdosage; however, if the bleeding is severe there are antidotes. Protamine is used to treat overdose of heparin and low-molecular-weight heparins (LMWHs). Vitamin K is used to treat the overdosage of warfarin. Alteplase and clopidogrel do not require antidotes.

An older adult client has been admitted to the emergency department with severe chest pain. Onset of symptoms is within the last 60 minutes. What medication would the nurse expect the health care provider to prescribe for this acute disorder? antiplatelet drugs anticoagulant drugs thrombolytic drugs direct thrombin inhibitor drugs

thrombolytic drugs The scenario suggests that the client's chest pain may be a result of a thromboembolism. The main use of thrombolytic agents is for management of acute, severe thromboembolic disease, such as myocardial infarction or pulmonary embolism since they dissolve blood clots. None of the other options can dissolve an existing blood clot.

A 61-year-old man is prescribed alteplase for an acute myocardial infarction. A priority nursing intervention will be to monitor for what during and after drug therapy? A drop in blood pressure Gastrointestinal distress Arrhythmias Liver failure

Arrhythmias A patient who is on alteplase therapy to treat a myocardial infarction should be monitored for arrhythmias using a cardiac monitor. Reperfusion arrhythmias are common when blood flow to the heart has been reestablished. The patient's blood pressure should also be monitored but would not be the priority intervention. Gastrointestinal distress and liver failure are not associated with alteplase therapy.

A client is receiving anticoagulant therapy and has an INR done. Which result would the nurse interpret as being therapeutic? 1.8 2.4 1.0 1.4

2.4 When anticoagulant therapy is used, the INR is maintained between 2 and 3. The other values are not therapeutic.

A client is started on enoxaparin immediately after hip surgery. The nurse would explain to the client that this drug will be continued for how long? 3 to 7 days 7 to 10 days 1 to 3 days 10 to 14 days

7 to 10 days When used for hip surgery, enoxaparin typically is administered for 7 to 10 days to prevent deep vein thrombosis that may lead to pulmonary embolism after hip replacement.

The client is diagnosed with hepatitis A, diabetes type 1, and portal hypertension. The client develops a DVT, and the health care provider prescribes warfarin. The nurse is concerned for what reason? The client is at risk for hyperglycemic episodes. The client is more likely to experience bleeding. The client is less likely to achieve a therapeutic dose. The client is at risk for further liver impairment.

The client is more likely to experience bleeding. Warfarin is more likely to cause bleeding in clients with liver disease because of decreased synthesis of vitamin K. In addition, warfarin is eliminated only by hepatic metabolism and may accumulate with liver impairment.