Anticoags

For the client taking clopidogrel, the nurse will monitor for which adverse effect? Nausea Epistaxis Chest pain Elevated temperature

Epistaxis Clopidogrel is a platelet aggregation inhibitor; therefore bleeding can occur as an adverse effect. The high vascularity of the nose, combined with its susceptibility to trauma (e.g., sneezing, nose blowing), makes it a frequent site of hemorrhage. Nausea, chest pain, and elevated temperature are not associated with anticoagulant therapy.

The health care provider has prescribed enoxaparin 1 mg/kg for a client who had a total knee replacement. The client weighs 85 kg (187 lb). This medication is available in a concentration of 30 mg/0.3 mL. Which dose will the nurse administer in milliliters? 0.8 mL 0.85 mL 0.9 mL 0.95 mL

0.85 mL The answer is calculated as follows: 1 kg = 2.2 lb (187 divided by 2.2 = 85 kg) 85 mg × 0.3 mL = 25.5 mg/mL25.5 mg divided by 30 = 0.85 mL

A health care provider prescribes enoxaparin 30 mg subcutaneously daily. Which measure would the nurse take when administering this medication? Push over 2 minutes. Administer in the abdomen. Massage site after administration. Remove air pocket from prepackaged syringe before administration.

Administer in the abdomen. Enoxaparin specifically targets blood clots throughout the body and carries a lower risk of hemorrhage than that associated with the medications heparin and warfarin. Enoxaparin is administered once a day through a subcutaneous injection site around the naval. Enoxaparin should be injected into the fatty tissue only, which is why the abdomen is the recommended injection site. Avoid administering in a muscle. Manufacturer recommendations indicate the air pocket from prepackaged syringes not be removed before administration. Rubbing the site is contraindicated, because it can cause bruising. There are no recommendations to push this subcutaneous medication over 2 minutes.

To prevent excessive bruising when administering subcutaneous heparin, which technique will the nurse employ? Administer the injection via the Z-track technique. Avoid massaging the injection site after the injection. Use 2 mL of sterile normal saline to dilute the heparin. Inject the medication into the vastus lateralis muscle in the thigh.

Avoid massaging the injection site after the injection. The site of the injection should not be massaged to avoid dispersion of the heparin around the site and subsequent bleeding into the area. The Z-track technique and the intramuscular route are not used with heparin; subcutaneous injection and intravenous administration are the routes appropriate for heparin administration. The medication should be injected into the subcutaneous tissue slowly, not quickly. Diluting heparin with normal saline is unnecessary. Generally, heparin is provided by the pharmacy department in single-dose syringes.

Which foods will the nurse discuss when teaching a client who has a new prescription for warfarin? Dairy products High-fiber fruits Green leafy vegetables Whole-grain breads and cereals

Green leafy vegetables Green leafy vegetable are high in vitamin K, which will affect the effectiveness of warfarin because warfarin works by reducing the synthesis of vitamin K-dependent clotting factors. Clients taking warfarin are taught to try to eat about the same amount of vitamin K-rich foods daily to help stabilize the needed warfarin dose. Dairy products do not affect warfarin effectiveness. High-fiber fruits do not affect warfarin effectiveness. Whole-grain foods do not affect warfarin effectiveness.

The nurse identifies which anticoagulant medications as safe to administer during pregnancy for treatment of thrombophlebitis? Select all that apply. One, some, or all responses may be correct. A. Heparin B. Warfarin C. Enoxaparin D. Clopidogrel E. Acetylsalicylic acid

A,C Heparin may be used during pregnancy because it does not cross the placental barrier and will not cause hemorrhage in the fetus. Enoxaparin does not cross the placental barrier (formerly classified for pregnancy as category B). Warfarin crosses the placental barrier, causing hemorrhage in the fetus. Clopidogrel is a platelet aggregation inhibitor. It is not used for thrombophlebitis; it is used to reduce the risk of brain attack, transient ischemic attack, unstable angina, and myocardial infarction. Acetylsalicylic acid is a platelet aggregation inhibitor and is not recommended during pregnancy (formerly classified as category D).

Which statements are accurate regarding chronic aspirin poisoning? Select all that apply. One, some, or all responses may be correct. A. Chronic aspirin poisoning is often mistaken for viral illness. B. Acute ingestion of aspirin is always more serious than chronic ingestion. C. Peritoneal dialysis is used in the treatment of severe cases of aspirin poisoning. D. Acute ingestion of aspirin causes severe toxicity when the dosage is 200 to 250 mg/kg. E. Chronic ingestion of aspirin occurs when an amount greater than 100 mg/kg per day is ingested for more than 2 days.

A,E Chronic aspirin poisoning is characterized by subtle onset and nonspecific symptoms and is often mistaken for viral illness. Chronic ingestion of aspirin occurs when an amount greater than 100 mg/kg per day is ingested for more than 2 days. Chronic ingestion of aspirin can be more serious than acute ingestion. Hemodialysis, and not peritoneal dialysis, is used in the treatment of severe cases of aspirin poisoning. Acute ingestion of aspirin causes severe toxicity when the dosage is 300 to 500 mg/kg.

A client who has atrial fibrillation with rapid ventricular response is started on a continuous heparin infusion. Which clinical finding enables the nurse to conclude that the heparin therapy is effective? Atrial fibrillation converts to a sinus rhythm. The heart rate is stabilized at 70 to 90 beats per minute. The international normalized ratio (INR) is within normal range. An activated partial thromboplastin time (aPTT) is twice the usual value.

An activated partial thromboplastin time (aPTT) is twice the usual value. Heparin is an anticoagulant administered to clients with atrial fibrillation to prevent formation of mural thrombi. The desired anticoagulant effect is achieved when the activated partial thromboplastin time is 1.5 to 2 times normal. Medications other than heparin are administered to convert the rhythm and control the rate. The INR is not used to determine heparin effectiveness.

A client with a partial occlusion of the left common carotid artery is to be discharged while still receiving warfarin. Which adverse effect will the nurse identify as a reason for the client to seek medical consultation? Select all that apply. One, some, or all responses may be correct. A. Hematuria B. Hemoptysis C. Delayed clotting from minor cuts and scrapes D. Bleeding from gums when brushing teeth E. Vomiting coffee-ground emesis

C,D Warfarin causes an increase in the prothrombin time and International Normalized Ratio (INR) level, leading to an increased risk for bleeding. Any abnormal or prolonged bleeding must be reported, because it may indicate an excessive level of the medication. Common side effects including bruising, delayed clotting and bleeding gums do not require immediate intervention. However, hematuria and hemoptysis are evidence of more serious bleeding and require immediate attention. Coffee-ground emesis is a sign of gastric bleeding.

When a staff nurse is instructed by the charge nurse to give the scheduled warfarin dose to a client whose current international normalized ratio (INR) is 6, which action would the staff nurse take first? Refuse to give the unsafe medication dose. Remind the charge nurse of the INR result. Ask the hospital pharmacist to talk with the nurse manager. Ask the health care provider whether to give the medication.

Remind the charge nurse of the INR result. Because the INR is at an unsafe level, the warfarin would not be given. Professional communication would include first clarifying concerns with the charge nurse, by discussing the abnormal INR result and reasons for not administering another dose of warfarin. Although the nurse could refuse to give the medication as the first action, this is not likely to foster professional communication or workplace relationships. Direct communication with coworkers about concerns is more professional and fosters better relationships than having a third party (such as the pharmacist) address concerns. Because the INR is prolonged and the warfarin would be unsafe to give, the nurse does not need to ask the health care provider about giving the warfarin, but would notify the provider about the INR result.