Chapter 26: Drugs Used to Treat Thromboembolic Disorders

The nurse is preparing discharge education for a patient who will be receiving warfarin (Coumadin) at home. Which important point(s) will the nurse include? (Select all that apply.) a. "Do not make any major changes to your diet without discussing it with your health care provider." b. "Keep outpatient laboratory appointments for monitoring of therapy." c. "Take the medication after meals." d. "Report signs of bleeding to your health care provider, including observing skin for bruising; petechiae; blood in emesis, urine, or stools; bleeding gums; cold, clammy skin; faintness; or altered sensorium." e. "Avoid aspirin products."

A. "Do not make any major changes to your diet without discussing it with your health care provider." B. "Keep outpatient laboratory appointments for monitoring of therapy." D. "Report signs of bleeding to your health care provider, including observing skin for bruising; petechiae; blood in emesis, urine, or stools; bleeding gums; cold, clammy skin; faintness; or altered sensorium." E. "Avoid aspirin products."

The pharmacologic agents used to treat DVT may act in which way(s)? (Select all that apply.) a. Prevent platelet aggregation. b. Prevent the extension of existing clots. c. Inhibit steps in the fibrin clot formation cascade. d. Prolong bleeding time. e. Lower serum triglycerides

A. Prevent platelet aggregation. B. Prevent the extension of existing clots. C. Inhibit steps in the fibrin clot formation cascade. D. Prolong bleeding time.

Anticoagulant therapy may be used for which situation(s)? (Select all that apply.) a. To prevent stroke in patients at high risk b. Following a myocardial infarction c. Following total hip or knee joint replacement surgery d. With DVT e. To prevent thrombosis in immobilized patients f. Peptic ulcer disease

A. To prevent stroke in patients at high risk B. Following a myocardial infarction C. Following total hip or knee joint replacement surgery D. With DVT E. To prevent thrombosis in immobilized patients

Which is an accurate nursing action when administering subcutaneous enoxaparin, a low-molecular-weight heparin product? a. Expel the air bubble from the prefilled syringe. b. Leave the needle in place for 10 seconds after injection. c. Administer the medication into the deltoid muscle. d. Massage the site after injection to increase absorption

ANS: B The needle is left in place for 10 seconds after injection.

What is the rationale for administering fibrinolytic agents, such as streptokinase, within hours of the onset of myocardial infarction? a. Enhances myocardial oxygenation b. Lyses the blood clot c. Promotes platelet aggregation d. Inhibits clotting mechanisms

ANS: B Fibrinolytic agents such as streptokinase dissolve or lyse recently formed thrombi. The goals of thrombolytic therapy are to lyse the thrombus during the early stages of clot formation, restore circulation to the areas distal to the thrombus, and reduce morbidity after thromboembolism formation.

A patient receiving IV heparin therapy for a deep vein thrombosis (DVT) in his right calf asks why his calf remains painful, edematous, and warm to touch after 2 days of anticoagulant therapy. Which response by the nurse is most accurate? a. "It takes at least 3 days for the symptoms to resolve once the clot dissolves." b. "Heparin does not dissolve blood clots but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body." c. "I will report this to your health care provider because there may be a need to look at alternative treatments." d. "You appear anxious. The health care provider will eventually put you on ticlopidine, which allows for an earlier discharge."

ANS: B Heparin is used to treat a thromboembolism and promote neutralization of activated clotting factors, preventing the extension of thrombi and the formation of emboli.

Which symptom is indicative of bleeding in a patient taking warfarin (Coumadin)? a. Bradycardia b. Petechiae c. Increased urinary output d. Dry skin

ANS: B Petechiae are indicative of bleeding. These pinpoint red spots on the skin indicate intradermal hemorrhage.

Which action will the nurse implement to decrease the risk of clot formation in an older patient on bed rest? a. Assess peripheral pulses. b. Encourage passive leg exercises. c. Limit fluid intake. d. Position pillows behind the knees.

ANS: B Using active or passive leg exercises for a patient on bed rest will prevent clot formation. Assessing pulses is not a preventive measure

Rivaroxaban (Xarelto) is ordered on a patient following knee replacement surgery. When providing education on this medication to the patient, the nurse conveys that treatment will continue a. only while hospitalized. b. for 35 days postsurgically. c. for 12 days postsurgically d. as long as creatinine clearance is less than 30

ANS: C It is recommended that patients undergoing knee replacement continue treatment with rivaroxaban for 12 days postsurgically. It is recommended that patients undergoing hip replacement surgery continue treatment for 35 days postsurgically

Dipyridamole (Persantine) has been used extensively in combination with warfarin to prevent the formation of thromboembolism after which type of event? a. Myocardial infarction b. Transient ischemic attack c. Cardiac valve replacement d. Heart transplant

ANS: C Dipyridamole has been used extensively in combination with warfarin to prevent the formation of thromboembolism after cardiac valve replacement.

A patient is receiving IV heparin therapy. The aPTT is 90; the laboratory control is 30 seconds. Which nursing intervention is most accurate? a. Document in the nursing notes that these results are within therapeutic range. b. Note the RBC count and wait for the health care provider to make the next round to discuss all laboratory values. c. Stop the heparin drip. d. Assess the patient for signs and symptoms of decreased sensorium.

ANS: C Heparin dosage is considered to be in the normal therapeutic range if the aPTT is 1.5 to 2.5 times the control value.

A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin? a. Warfarin sodium (Coumadin) b. Enoxaparin (Lovenox) c. Protamine sulfate d. Vitamin K

ANS: C Protamine sulfate is the antidote to heparin. With the patient's risk of fluid volume deficit as a result of trauma, the primary intervention would be to counteract the effects of heparin to prevent hemorrhage.

The nurse is caring for a 27-year-old woman on the postpartum unit one day following a C-section. To prevent clot formation, the nurse will a. position the patient with knees flexed. b. initiate use of fitted thromboembolic disease deterrent (TED) stockings. c. maintain complete bed rest. d. implement deep breathing and coughing exercises.

ANS: D Deep breathing and coughing exercises should be part of regular postoperative nursing care to prevent clot formation. Knees should not be flexed. TED stockings require a physician's order. Early, regular ambulation should be encouraged after surgery.

The nurse is teaching a patient about dietary implications while on warfarin (Coumadin) therapy. Which salad is highest in vitamin K? a. Fruit b. Pasta c. Potato d. Spinach

ANS: D Green leafy vegetables contain vitamin K.

The nurse has provided instruction to a patient recently prescribed warfarin (Coumadin). Which statement by the patient indicates to the nurse the need for further teaching? a. "I will always wear a medical alert bracelet." b. "I will check with my health care provider before I take any OTC medications." c. "I will be careful when I use a knife or other sharp objects." d. "I will rinse my mouth with mouthwash instead of brushing my teeth."

ANS: D Soft-bristled toothbrushes are acceptable to use for oral care. Medical alert bracelets should always be worn.

What is the mechanism of action of drugs used to treat thromboembolic disease? a. Dissolving clots and preventing formation of new clots b. Making platelets more flexible and preventing formation of new clots c. Causing vasodilation and increased blood flow d. Preventing platelet aggregation and inhibiting clot formation

ANS: D The pharmacologic agents used to treat thromboembolic disease act to prevent platelet aggregation or to inhibit a variety of steps in the fibrin clot formation cascade.

A patient is receiving 1400 units of heparin/hour on an IV pump. The aPTT time is 54. The laboratory control is 25. Which action by the nurse is accurate? a. Bolus the patient with an additional 5000 units of heparin. b. Stop the heparin immediately and notify the health care provider that the patient's blood level is toxic. c. Administer protamine sulfate stat. d. Continue with the prescribed rate.

ANS: D Therapeutic heparin values are 1.5 to 2.5 times the control value. The therapeutic range of heparin with a control of 25 is 37.5 to 62.5 units/hour.

The nurse is preparing to administer dalteparin (Fragmin) to a patient in order to prevent DVT following a hip replacement. When providing this medication to the patient, the nurse will (Select all that apply.) a. administer intramuscularly. b. inject slowly. c. remove needle immediately after injection. d. rub injection site following administration. e. alternate injection sites every 24 hours.

B. inject slowly. E. alternate injection sites every 24 hours.

Which nursing intervention(s) would be accurate when administering heparin subcutaneously? (Select all that apply.) a. Assessment of recent aPTT levels b. Massaging the site after injection of medication c. Aspirating after needle insertion d. Documenting ecchymotic areas e. Monitoring of vital signs

D. Documenting ecchymotic areas E. Monitoring of vital signs.