Parenteral Anticoagulant Therapy

Question 2 of 4 In which time frame does warfarin reach its peak level? 20 to 60 hours 36 to 48 hours 1.5 to 3 days 2 to 5 days

1.5 to 3 days Warfarin peaks in 1.5 to 3 days.

Question 4 of 11 The nurse is preparing to administer heparin intravenously (IV). Which response by the nurse would be appropriate when the patient asks when the medication will start working? "Heparin will start working in about 5 to 10 minutes." "It depends on the dose of heparin." "Heparin will start working in about 20 minutes." "You will need several doses before it affects you."

"Heparin will start working in about 5 to 10 minutes." The onset of action for IV heparin is 5 to 10 minutes.

CASE STUDY DETAILS Ms. Turner, a 45-year-old female patient, is being discharged following a diagnosis of atrial fibrillation not related to valvular heart disease. She has been prescribed 150 mg of dabigatran by mouth twice daily with a recheck appointment scheduled in 2 weeks. She has no history of major trauma within the last 3 months. Ms. Turner does not take any regular drugs but occasionally takes aspirin for headaches.

"NSAIDs, including aspirin, can increase the risk for bleeding." NSAIDs, such as aspirin, increase the risk for bleeding when taken with dabigatran.

Question 13 of 13 Which discharge teaching is appropriate to give a patient who has been prescribed warfarin? Select all that apply. "Obtain emergency care if you do not stop bleeding within 5 to 10 minutes." "Excessive bruising, abdominal pain, or tarry stools are expected side effects of warfarin." "Take the medication once daily regardless of the time of day." "Check with your health care provider before taking any new medications, including over-the-counter medications and herbals." "Notify your health care provider if you will be using tobacco products."

"Obtain emergency care if you do not stop bleeding within 5 to 10 minutes." "Check with your health care provider before taking any new medications, including over-the-counter medications and herbals." "Notify your health care provider if you will be using tobacco products."

Question 10 of 13 A patient taking dabigatran complains of dyspepsia. Which instruction would the nurse provide to the patient? "Take an antacid with the dabigatran." "Take the drug with food." "Drink green tea." "Drink cranberry juice."

"Take the drug with food." If gastrointestinal distress, such as dyspepsia, occurs, dabigatran can be taken with food to decrease the distress.

Question 7 of 13 While obtaining a medical history, the nurse finds that the patient taking warfarin eats a spinach salad for lunch every day. Which teaching point would the nurse provide for this patient? "The salad may decrease warfarin's effectiveness." "The salad may increase your risk for bleeding." "You are at a greater risk for hypersensitivity reaction to warfarin." "Taking warfarin with food can increase gastrointestinal (GI) distress."

"The salad may decrease warfarin's effectiveness." Foods high in vitamin K, such as green, leafy vegetables found in salads, can decrease the effectiveness of warfarin, which increases the risk for blood clots. Patients should be advised to avoid large amounts of food rich in vitamin K.

Question 1 of 13 A patient who recently started taking warfarin asks the nurse why laboratory work needs to be obtained every 3 to 4 days. Which response would the nurse provide? "To ensure no bleeding is occurring, complete blood count (CBC) is checked every 3 to 4 days." "To ensure adequate dosing of warfarin, the INR needs to be checked every 3 to 4 days." "To ensure you are taking the medication, aPTT is checked every 3 to 4 days." "To determine whether blood clots are developing, platelets must be checked every 3 to 4 days."

"To ensure adequate dosing of warfarin, the INR needs to be checked every 3 to 4 days." Dosage of warfarin depends on the international normalized ratio (INR) level. The steady state of warfarin may take 3 to 4 days. To ensure adequate dosing of warfarin, the INR is checked within 3 to 4 days of any changes to the warfarin dose.

Question 4 of 4 What percentage of warfarin is bound to protein? _______%

99 99% of warfarin is bound to protein.

Question 10 of 11 A patient on subcutaneous anticoagulant calls the clinic about a cut received on the hand. Which initial action would the nurse tell the patient to take? Call 911 for an ambulance. Apply direct pressure to the cut for 5 to 10 minutes. Apply a belt above the cut. Eat several servings of spinach.

Apply direct pressure to the cut for 5 to 10 minutes. Applying pressure to the wound for 5 to 10 minutes should be performed initially for a patient on an anticoagulant who is bleeding from a cut.

Question 1 of 5 Which signs and symptoms experienced by Ms. Williams would prompt the nurse to immediately notify the health care provider? Select all that apply. Minor bruising to the legs Hematoma under the skin Blood in the urine Bleeding from the gums Irritation at the injection site Chills and fever

Hematoma under the skin Blood in the urine Bleeding from the gums Chills and fever

Question 6 of 11 A patient who was started on continuous intravenous heparin for a pulmonary embolus complains of "a lot of bruises" and "pink urine." Laboratory values show that platelets have decreased from 225,000 mm3 to 75,000 mm3. Which condition would the nurse most likely consider with these signs and symptoms? Expected response from heparin Hypersensitivity reaction from heparin Spleen reacting to heparin Heparin-induced thrombocytopenia (HIT) from heparin

Heparin-induced thrombocytopenia (HIT) from heparin Significant decrease in platelets can indicate HIT. With decreased platelets, evidence of bleeding, such as multiple bruises and hematuria (blood in urine), can occur.

Question 3 of 4 The nurse is preparing to administer warfarin to a patient whose international normalized ratio (INR) is 5.2. Which action would the nurse take? Hold the warfarin. Give the warfarin. Administer half the regular dose of warfarin. Administer vitamin K.

Hold the warfarin. The therapeutic range for INR in a patient who is on warfarin is 2 to 3. Because 5.2 is above the therapeutic range, the nurse should hold the dose.

Question 8 of 11 A patient has been receiving subcutaneous heparin every 12 hours. The patient is scheduled to have a lumbar puncture at 0900. Which action is the nurse's priority? Ensure that the patient understands and has consented for the procedure. Notify the health care provider the patient is receiving heparin. Give the heparin early, just before the lumbar puncture. Prepare the patient for the lumbar puncture.

Notify the health care provider the patient is receiving heparin. The health care provider needs to know when the patient last received heparin. Heparin therapy is contraindicated in patients who will be undergoing a lumbar puncture. The patient is at increased risk for bleeding due to heparin, and hematoma can develop during or after the puncture.

Question 5 of 11 The nurse is preparing to administer unfractionated heparin to three patients. Which patient would the nurse be most concerned about when administering heparin? Patient with activated thromboplastin time (aPTT) value of 98 seconds Patient with a platelet value of 135,000/mm3 Patient with a hemoglobin value of 14 g/dL Patient with prothrombin time (PT) greater than 2 seconds

Patient with activated thromboplastin time (aPTT) value of 98 seconds The nurse will be concerned about this patient. An aPTT value of 98 seconds is above the therapeutic range. Normal aPTT value is 25 to 38 seconds. With heparin, the aPTT value should be 1.5 to 2 times the normal range. Ninety-eight seconds is more than twice of the upper limit of 76 seconds. The nurse should not administer heparin.

Question 2 of 3 For which patient is rivaroxaban contraindicated? Patient with decreased renal function Patient with hepatic impairment Patient with mechanical prosthetic heart valve Older adult patient

Patient with mechanical prosthetic heart valve Mechanical prosthetic heart valve would be a contraindication to rivaroxaban.

Question 4 of 5 Which drug classes have an additive effect of anticoagulation when administered with heparin? Select all that apply. Penicillins Tetracyclines Platelet inhibitors Nonsteroidal antiinflammatory drugs (NSAIDs) Aminoglycosides Cephalosporins

Penicillins Platelet inhibitors Nonsteroidal antiinflammatory drugs (NSAIDs) Cephalosporins

Question 3 of 5 Through which route would the nurse expect to administer enoxaparin? Subcutaneous (SQ) injection Intermittent intravenous (IV) administration Continuous IV infusion Intramuscular (IM) injection

Subcutaneous (SQ) injection Enoxaparin is a low-molecular-weight heparin derivative, which is administered deep SQ.

Question 4 of 4 A patient taking warfarin asks the nurse what should be done first if bleeding occurs from a small laceration on the arm. Which response would the nurse make? "Call 911 for emergency health care." "Place a tourniquet above the cut." "Take over-the-counter vitamin K." "Apply firm, direct pressure to the cut."

"Apply firm, direct pressure to the cut." If bleeding occurs on the body, firm, direct pressure should be applied to the cut for 5 to 10 minutes. If bleeding does not stop, then the patient should seek emergency health care

Question 2 of 11 A patient was started on intravenous (IV) heparin at 1200 pm. When will the nurse assess the activated thromboplastin time (aPTT)? 0000 (midnight) 0600 next day 1800 1200 next day

1800 aPTT should be assessed 4 to 6 hours after the initiation of heparin to ensure adequate dosing. Values should be 1.5 to 2 times that of the patient's baseline.

Question 4 of 13 Heparin and warfarin are started simultaneously in a patient who is diagnosed with a deep vein thrombosis. The nurse would anticipate that the heparin will most likely be discontinued at which time? 3 days after being on warfarin 24 hours after being on warfarin After 4 doses of heparin have been given 5 days after heparin was started

3 days after being on warfarin Warfarin peaks in 1.5 to 3 days of starting warfarin. Heparin is administered as a bridge until the international normalized ratio (INR) becomes therapeutic, which usually takes 3 to 4 days.

Question 5 of 5 A patient receiving unfractionated heparin has a baseline activated thromboplastin time (aPTT) of 30 seconds. What is the therapeutic aPTT level for this patient? _________-__________ seconds

45 Therapeutic aPTT should be 1.5 to 2 times the baseline. If a patient has a baseline aPTT of 30 seconds, then the therapeutic aPTT would be 45-60 seconds. 60 Therapeutic aPTT should be 1.5 to 2 times the baseline. If a patient has a baseline aPTT of 30 seconds, then the therapeutic aPTT would be 45-60 seconds.

Question 1 of 3 Parenteral anticoagulants prevent the formation of which product as the final step of clotting?Antithrombin IIIThrombinFibrinogenFibrin

Fibrin Fibrin is the final product during the clotting cascade. Anticoagulants prevent the conversion of fibrinogen to fibrin during the final step of clotting.

Question 7 of 11 A nurse is preparing to administer enoxaparin, a heparin derivative. Which action by the nurse demonstrates the correct technique for administering the medication? Inject enoxaparin slowly by intravenous (IV) route. Administer the drug at least 2 inches from the umbilicus. Dilute enoxaparin with normal saline for IV administration. Obtain an IV pump to administer the drug.

Administer the drug at least 2 inches from the umbilicus. Enoxaparin is a heparin derivative that is administered deep SQ. The nurse should administer the medication at least 2 inches from the umbilicus.

Question 6 of 13 The nurse is preparing warfarin for several patients. For which patient would the nurse be most concerned in administering warfarin? An alcoholic patient with liver disease A postoperative patient following knee surgery An older adult with atrial fibrillation A pregnant patient with mechanical heart valve

An alcoholic patient with liver disease Warfarin is contraindicated in alcoholic patients with liver disease. Alcohol and liver disease disrupt hepatic synthesis of clotting factors, which increases the risk for bleeding. Adding warfarin further increases the risk for bleeding.

Question 11 of 11 For which reasons would the nurse monitor older adults taking heparin more closely for bleeding? Select all that apply. There is reduced production of red blood cells. Capillary walls are more fragile. Platelets are of poor quality. Skin is thinner. Red blood cells are smaller.

Capillary walls are more fragile. Anticoagulants prevent the formation of fibrin (clots) which can promote bleeding. Older adults are at an increased risk for bleeding because of fragile capillaries. Skin is thinner. Anticoagulants prevent the formation of fibrin (clots), which can promote bleeding. Older adults are at an increased risk for bleeding because of their thin skin.

Question 3 of 3 A patient with acute pulmonary embolus is started on dabigatran. Which laboratory test results are most appropriate for the nurse to assess before administering the drug? Select all that apply. Complete blood count (CBC) Prothrombin time (PT) Protein levels Partial thromboplastin time (PTT) Arterial blood gas

Complete blood count (CBC) Because dabigatran increases the risk for bleeding, CBC should be assessed to determine if anemia is present before administering dabigatran. If the hemoglobin and hematocrit are low, the nurse should notify the health care provider. Prothrombin time (PT) Because dabigatran increases the risk for bleeding, PT should be assessed to ensure the patient does not have a bleeding disorder. Partial thromboplastin time (PTT) Because dabigatran increases the risk for bleeding, PTT should be assessed to ensure the patient does not have a bleeding disorder.

Question 2 of 13 A patient who has been taking warfarin for chronic atrial fibrillation was advised by a friend to consume a low-protein diet. Which change in warfarin dosage would the nurse anticipate? Increase Decrease No change Discontinue

Decrease Warfarin is 99% bound to protein. With a low-protein diet, less protein will be available for warfarin to bind with, which can increase the bioavailability of warfarin and require a decrease in warfarin dosage.

Question 11 of 13 Warfarin is appropriate for patients with which conditions? Select all that apply. Deep vein thrombus Mechanical heart valve Heart failure Pulmonary embolus Chronic pulmonary disease Thromboembolic stroke

Deep vein thrombus Mechanical heart valve Pulmonary embolus Thromboembolic stroke

Question 12 of 13 Which phrases describe reported benefits of prescribing novel oral anticoagulants (NOACs) instead of warfarin? Select all that apply. Frequent laboratory monitoring is not required for NOACs. NOACs have a delayed onset of action. Genetics do not alter the effectiveness of NOACs. Comorbid conditions do not affect the effectiveness of NOACs. Diet does not affect the effectiveness of NOACs.

Frequent laboratory monitoring is not required for NOACs. Genetics do not alter the effectiveness of NOACs. Comorbid conditions do not affect the effectiveness of NOACs. Diet does not affect the effectiveness of NOACs.

Question 8 of 13 The patient continues to bleed after receiving vitamin K for warfarin toxicity. The nurse anticipates administering which product to a patient who is not responding to vitamin K? Protamine sulfate Dabigatran Fresh-frozen plasma Heparin

Fresh-frozen plasma Fresh-frozen plasma can be given to patients who are actively bleeding and are unresponsive to vitamin K or need to rapidly increase clotting factors.

Question 1 of 4 Which products, if taken by Ms. Wang, would concern the nurse because they increase the effects of warfarin? Select all that apply. Garlic Ibuprofen Ginseng Allopurinol Broccol Gingko

Garlic Ibuprofen Allopurinol Gingko

Question 1 of 11 A nurse is preparing to administer heparin intravenously (IV) to a patient who was admitted with an acute pulmonary embolus. Which response by the nurse is appropriate when the patient asks why the drug is given IV rather than orally? IV heparin dissolves the clot. IV heparin lasts longer. Laboratory work is not needed for IV heparin. Heparin is poorly absorbed by the gastrointestinal (GI) tract.

Heparin is poorly absorbed by the gastrointestinal (GI) tract. Heparin is poorly absorbed by the GI tract and is therefore not available in an oral form. It is given parenterally (IV or SQ).

Question 5 of 13 The nurse is preparing to administer dabigatran. Dabigatran would be most appropriate for a patient with which medical condition? Hepatic dysfunction Renal dysfunction A mechanical heart valve Hemorrhagic stroke

Hepatic dysfunction Dabigatran is not metabolized by the hepatic enzyme system; therefore a patient with hepatic dysfunction can receive dabigatran.

Question 3 of 13 A patient with a mechanical heart valve has been taking warfarin. The patient tells the nurse that vegetables and fruits have been added to the diet. Which effect will most likely occur with the increase in fruit and vegetable intake? International normalized ratio (INR) will increase. Bleeding will increase. Renal function will decrease. INR will decrease.

INR will decrease. Fruits and vegetables can contain vitamin K-rich food. Vitamin K promotes the production of clotting factors, which increases the risk for blood clots.

Question 9 of 13 A patient is admitted for bleeding caused by an overdose of dabigatran. Which drug will the nurse anticipate administering? Protamine sulfate Vitamin K Atropine sulfate Idarucizumab

Idarucizumab Idarucizumab is the antidote to reverse the effects of dabigatran.

Question 2 of 3 Which time frame describes the onset of action for intravenous (IV) heparin? Immediate 5 to 10 minutes 20 minutes 2 hours

Immediate The onset of action for IV heparin is immediate.

Question 1 of 4 Which laboratory value is used to adjust the dosage of warfarin? International normalized ratio (INR) Partial thromboplastin time (PTT) Complete blood count (CBC) Platelets

International normalized ratio (INR) Patients taking warfarin should obtain frequent laboratory work assessing the INR. The dosage of warfarin is adjusted accordingly. The therapeutic range is 2 to 3 seconds.

Question 3 of 11 For which patient would the nurse anticipate administering heparin? Patient diagnosed with atrial fibrillation Patient with hemorrhagic cerebrovascular accident (CVA) Patient with large blood clots in the urine Patient with thrombocytopenia

Patient diagnosed with atrial fibrillation A patient with atrial fibrillation is a high risk for blood clots. An anticoagulant, such as heparin, prevents the formation of blood clots.

Question 9 of 11 Which teaching is appropriate for a patient being discharged with a prescription for subcutaneous heparin? Inject heparin in the same spot every day. Dispose of used syringes in the regular garbage. Shave with an electric razor. Use your preferred type of toothbrush.

Shave with an electric razor. Heparin, an anticoagulant, prevents the formation of clots and increases the risk for bleeding when the skin is broken. An electric razor should be used, because there is less risk of cutting oneself.

Question 2 of 5 Which substance would the nurse ensure is readily available to stop active bleeding before administering heparin? Platelets Protamine sulfate Plasma Packed red blood cells

Protamine sulfate Protamine sulfate is the antidote for heparin.

Question 3 of 3 By which route is unfractionated heparin primarily excreted? Liver Feces Respirations Urine

Urine Unfractionated heparin is primarily excreted in urine.

Question 2 of 4 Before administering warfarin, the nurse would ensure that which antidote is on hand in case of an overdose? Potassium Protamine sulfate Vitamin K Naloxone

Vitamin K Warfarin is a vitamin K antagonist; it decreases the synthesis of vitamin K, which is needed to make clotting factors, including prothrombin. Vitamin K is an antidote for warfarin overdose. Vitamin K can be administered by orally, subcutaneously, or intravenously.