Evolve Pharm Chapter 26

A patient who is on enoxaparin (Lovenox) therapy has hematuria, melena, petechiae, and bleeding from the gums. Which treatment strategy will be most beneficial for the patient?

Administering protamine sulfate (Protamine sulfate)

A patient is diagnosed with hemophilia. Which is an essential intervention?

Administration of recombinant factors

Cilostazol (Pletal) belongs to which drug class?

Antiplatelet

The nurse is monitoring a patient receiving reteplase (Retavase) therapy. Which assessment finding requires the most immediate action?

Change in mental status

A registered nurse is teaching a student nurse about safe and effective administration of heparin. Which action by the student nurse is appropriate?

Checking if the patient's prescription contains enaxoparin

The nurse is caring for a patient who is being treated with dabigatran (Pradaxa) who is scheduled to be placed on phenytoin. The nurse anticipates which effect will occur when the phenytoin is administered?

Decreased effect of the dabigatran

A patient who has been receiving an infusion of heparin has an aPTT of 120 seconds. What is the nurse's first action?

Shut off the heparin drip.

The nurse is caring for a patient who is undergoing treatment with heparin therapy. The nurse assesses the patient's aPTT level and finds it to be 98 seconds. How will the nurse interpret this finding?

The level is outside the expected target therapeutic level of anticoagulation; it is too high.

The patient is receiving warfarin therapy, and the nurse finds the INR to be 4.0. How will the nurse interpret this finding?

The level is outside the expected target therapeutic level of anticoagulation; it is too high.

The nurse is preparing to administer an anticoagulant to a patient. Which action, if observed, is in error?

The nurse administers enoxaparin (Lovenox) intramuscularly to a patient.

The nurse will include which instructions in the plan of care for a patient receiving warfarin therapy?

"Do not take aspirin for pain."

Which statement reflects a patient's accurate understanding of dietary restrictions while taking an anticoagulant?

"I should be consistent in my intake of green vegetables once a maintenance dose of my medication has been established."

The nurse is teaching a patient who is receiving aminocaproic acid (Amicar) the measures to prevent adverse effects. Which statement made by the patient indicates the need for further teaching?

"I should take oral contraceptives during the therapy."

The nurse is caring for a patient who has recently been placed on dabigatran (Pradaxa). Which instruction will the nurse provide to the patient regarding storing the drug for home use?

"Store the drug with the desiccant-drying agent in the packing cap."

The nurse is administering tenecteplase (TNKase) therapy to a patient experiencing an acute myocardial infarction. What will the nurse teach the patient about this therapy?

"This therapy will dissolve the clot that caused the heart attack."

A patient is receiving an intravenous heparin drip. Which laboratory value requires immediate action by the nurse?

Activated partial thromboplastin time (aPTT) of 120 seconds

The patient is receiving anticoagulant therapy. The international normalized ratio (INR) value for the patient today is 1.5. In response to this, the nurse could anticipate the health care provider placing which order?

Administer an additional dose of warfarin (Coumadin).

A patient who has been receiving intravenous heparin as treatment for a deep vein thrombosis requires immediate surgery for a suspected bowel perforation. Which intervention is essential at this time?

Administer protamine sulfate.

Which nursing intervention is essential for the patient receiving alteplase (Activase)?

Assess for dysrhythmias.

The patient is being treated with dabigatran (Pradaxa) and opens a new bottle of the medication on July 1. The nurse will instruct the patient to discard any unused medication by which date?

August 29

The patient is being treated with a continuous intravenous infusion of heparin. What is the nurse's highest priority?

Ensure that protamine sulfate is readily available at all times.

The patient is scheduled to receive argatroban (Argatroban). Which is the correct route by which to administer the drug?

Intravenous

The nurse is caring for a newly admitted patient who will begin heparin therapy. While documenting the patient history, the nurse notes that the patient is currently undergoing treatment with enoxaparin. What is the nurse's highest priority?

Notify the provider that heparin should not be started on the patient.

The nurse is caring for a patient who is being treated with one of the coagulation modifier drugs. The patient tells the nurse that he has developed a rash. What is the nurse's highest priority action?

Notify the provider; the medication will need to be discontinued.

A patient who is receiving heparin therapy has bruises covering the abdomen as well as red-colored urine. What does the nurse need to assess?

Platelet level

Which is a National Patient Safety Goal associated with anticoagulation therapy?

Preventing adverse events associated with anticoagulant drugs

The nurse is caring for a patient who is scheduled to begin warfarin treatment and is currently being treated with amiodarone. Based on this information, the nurse anticipates which change will be made to the medication regimen?

The dosage of the warfarin will be decreased by half.

The nurse is screening a patient for candidacy for treatment with fondaparinux (Arixtra). The nurse reviews the patient's laboratory test results and finds a creatinine clearance of 20 mL/min and a body weight of 48 kg. How will the nurse interpret these findings?

The patient is not a candidate for treatment with the medication based on both an insufficient creatinine clearance and an inadequate body weight.

A patient with deep vein thrombosis is receiving fondaparinux (Arixtra) therapy. After reviewing the patient's laboratory reports, the nurse believes that discontinuing the therapy will be beneficial for the patient. Which finding supports the nurse's suspicion?

The patient's platelet count is 75,000 cell/μL.

A patient has overdosed on warfarin (Coumadin). Which substance will the nurse administer to reverse the effect of warfarin?

Vitamin K

The patient asks the nurse to explain the difference between dalteparin (Fragmin) and heparin. Which response by the nurse is accurate?

"Dalteparin is a low-molecular-weight heparin that is more predictable in its effect and has a lower risk of bleeding."

The nurse evaluates that the patient has understood discharge teaching regarding warfarin (Coumadin) based on which statement by the patient?

"I should use a soft toothbrush for dental hygiene."

After talking with a patient who is receiving warfarin sodium (Coumadin) therapy, the nurse believes that the patient is at increased risk for bleeding. Which statement made by the patient supports the nurse's conclusion?

"I take ginkgo supplements for memory enhancement."

A patient is receiving warfarin (Coumadin) for a chronic condition. Which patient statement requires immediate action by the nurse?

"I will increase dark-green, leafy vegetables in my diet."

A nurse is providing care to a patient who is at risk for deep vein thrombosis (DVT). The health care provider prescribes aspirin therapy. Which statement from the patient supports this prescription?

"I've been on prolonged bedrest."

A patient is started on warfarin (Coumadin) therapy while also receiving intravenous heparin. The patient is concerned about the risk for bleeding. What will the nurse tell the patient?

"It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic."