Ch 52

A patient with nonvalvular atrial fibrillation is to be discharged on dabigatran etexilate [Pradaxa]. Which statement should the nurse include in the discharge teaching? A "The medication must be stored in the manufacturer-supplied bottle." B "Once a new bottle is opened, the capsules maintain efficacy for 90 days." C "If you have difficulty swallowing the capsule, you can open it and mix it with food." D "You will need to learn how to give yourself a subcutaneous injection in your abdomen."

A

The nurse is caring for a group of patients taking warfarin [Coumadin]. Which patients are at moderate to high risk for harm as a result of warfarin therapy? (Select all that apply.) A A patient with variant genes that code for VKORC1 and CYP2CP B A patient with a current INR of 2.2 treated for deep vein thrombosis C A woman with a new onset of symptoms of a pulmonary embolus D A patient on day 4 after hip replacement with a new order for warfarin E A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen

ACE

A patient is receiving continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor? (Select all that apply.) A Platelets B Vitamin K C Prothrombin time (PT) D International normalized ratio (INR) E Activated partial thromboplastin time (aPTT)

AE

A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. What medication would be appropriate for this patient who has a history of heparin-induced thrombocytopenia (HIT)? A Warfarin [Coumadin] B Lepirudin [Refludan] C Bivalirudin [Angiomax] D Eptifibatide [Integrilin]

B

The nurse is caring for a patient receiving clopidogrel [Plavix] to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel? A Aspirin [Bayer] B Omeprazole [Prilosec] C Acetaminophen [Tylenol] D Warfarin [Coumadin]

B

Which needle length and gauge should the nurse choose to administer subcutaneous heparin? A ½ inch; 20 gauge B ⅝ inch; 25 gauge C 1½ inch; 18 gauge D 1 inch; 26 gauge

B

A patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which finding by the nurse most likely indicates an adverse reaction to this drug? A Urticaria, itching, and flushing B Blood pressure of 90/50 mm Hg C Decreasing level of consciousness D Potassium level of 5.5 mEq/L

C

A patient with an acute myocardial infarction is prescribed an intravenous (IV) bolus of tenecteplase [TNKase]. The patient weighs 160 lb. The nurse will administer what dosage? A 30 mg B 35 mg C 40 mg D 45 mg

C

The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin? A Heart rate of 60 beats/min B Blood pressure of 160/88 mm Hg C Discolored urine D Inspiratory wheezing

C

The nurse knows that which statement is accurate for enoxaparin [Lovenox]? A It equally reduces the activity of thrombin and factor Xa. B It has selective inhibition of factor Xa and no effect on thrombin. C It reduces the activity of factor Xa more than the activity of thrombin. D It has a lower bioavailability and shorter half-life than unfractionated heparin.

C

Which instruction about clopidogrel [Plavix] should the nurse include in the discharge teaching for a patient who has received a drug-eluting coronary stent? A "Constipation is a common side effect of clopidogrel, so take a stool softener daily." B "If you see blood in your urine or black stools, stop the clopidogrel immediately." C "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." D "Keep the amount of food containing vitamin K, such as mayonnaise, canola and soybean oil, and green, leafy vegetables, consistent in your diet."

C

Fondaparinux [Arixtra] is not approved for use in which circumstance? A Prevention of deep vein thrombosis (DVT) after knee replacement B Treatment of acute pulmonary embolism (PE) (in conjunction with warfarin) C Prevention of deep vein thrombosis (DVT) after abdominal surgery D Prevention of ischemic complications in patients with unstable angina

D

The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate? A Administer intravenous (IV) push protamine sulfate. B Continue with the current prescription. C Prepare to administer vitamin K. D Call the healthcare provider to increase the dose.

D

A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein thrombosis prevention. Which instructions should the nurse include in the patient's discharge teaching plan? (Select all that apply.) A Wear a medical alert bracelet. B Check all urine and stool for discoloration. C Do not start any new medication without first talking to your healthcare provider. D Enteric-coated aspirin and any aspirin products can be used unless they cause a gastrointestinal ulcer. E No laboratory or home monitoring of international normalized ratio (INR) is required after the first 6 months.

ABC

The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate? A Notify the healthcare provider to discuss the reduction or withdrawal of heparin. B Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level. C Obtain vitamin K and prepare to administer it by intramuscular (IM) injection. D Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated.

A

A patient with deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response? A Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting factors. B Heparin suppresses coagulation by helping antithrombin perform its natural functions. C Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot matrix. D Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels.

B

The nurse is ready to begin a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved? A 50 B 70 C 90 D 110

B

A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. Of which findings should the nurse immediately notify the healthcare provider? (Select all that apply.) A aPTT of 65 seconds B aPTT of 40 seconds C Nosebleeds D aPTT of 100 seconds E Platelet count of 300,000/mcL

BCD