Perfusion Clotting EAQ Quiz Elsevier
A nurse administers several vitamins as part of a client's medical regimen. Which prescribed vitamin is essential for the synthesis of prothrombin by the liver?
K Prothrombin, which is present in the plasma, is synthesized in the liver in the presence of vitamin K from the amino acid glutamine; vitamin K initiates the vital process of coagulation. Vitamin B12 is needed for hemoglobin synthesis Vitamin C plays a role in collagen formation. Vitamin D is involved in calcium absorption and metabolism.
The parent of a child with hemophilia asks the nurse, "If my son hurts himself, is it all right if I give him 2 baby aspirins?" What is the best response by the nurse?
"Aspirin may cause more bleeding. Give him acetaminophen instead." Aspirin, which has an anticoagulant effect, is contraindicated because it may harm a child with bleeding problems; in addition, aspirin is contraindicated for all children because of its relationship to Reye syndrome. Stating that the parent seems concerned about giving drugs to the child does not answer the mother's question and may cause the mother to feel defensive. Acetaminophen cannot prevent bleeding episodes; it is an analgesic.
A client who had a transurethral resection of the prostate is to be discharged from the outpatient surgical department. Which client statement indicates to the nurse that discharge teaching about self-care is understood?
"I will notify my health care provider if persistent bleeding occurs." Intermittent bleeding is expected; however, the health care provider should be notified if bleeding persists. The client driving themselves home after the surgery is unsafe; immediately after surgery, the client should avoid strenuous activities to prevent injury. The client should avoid spicy food or should use spices in moderation to prevent irritation of remaining prostatic tissue. Four to five glasses of water will not provide sufficient fluid; 3 to 4 L of fluid are needed to keep urine flowing freely and to prevent formation of clots.
A client develops severe bone marrow suppression related to cancer treatment. What is important for the nurse to include in the client's teaching?
Use a soft toothbrush for oral hygiene Thrombocytopenia occurs with several cancer treatment programs; using a soft toothbrush helps prevent bleeding gums. Although alopecia does occur, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. Monitoring intake and output of fluids is not related to bone marrow suppression.
To prevent thrombus formation after most surgeries, the nurse should plan to:
Encourage the client to ambulate with assistance every few hours. Ambulation is essential to promote venous return and prevent thrombus formation. Keeping the client's bed gatched to elevate the knees causes increased popliteal pressure and impairs venous return. Having the client dangle the legs off the side of the bed causes increased popliteal pressure and impairs venous return. Having the client use an incentive spirometer every hour helps prevent atelectasis, not thrombi.
A client is admitted to the emergency department with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. The nurse expects that the client's initial treatment will include which medication?
Aspirin (ASA) Early administration of aspirin in the setting of acute myocardial infarction (MI) has been demonstrated to significantly reduce mortality. Aspirin inhibits the action of platelets, preventing their ability to clump together and form clots. The mechanism of acute coronary syndrome usually is ruptured plaque in one of the coronary arteries with clot formation obstructing blood flow. Prompt administration of an antiplatelet agent, such as aspirin, significantly reduces damage and can be lifesaving, the earlier the better, hence the reason why it is part of emergency management treatment. Gabapentin is an anticonvulsant and is not the drug of choice to relieve the pain associated with an MI. Midazolam HCl is a sedative-hypnotic that is used for its calming effect, but it will not relieve the pain of an MI. Alprazolam is an anxiolytic that is used for its calming effect, but it will not relieve the pain of an MI.
A nurse is reviewing a list of current medications with an 80-year-old client who has developed gastrointestinal bleeding. Which medication prescription should the nurse discuss with the health care provider because it is contraindicated for a person who is experiencing gastrointestinal bleeding?
Ibuprofen (Advil) Ibuprofen (Advil) is a nonsteroidal anti-inflammatory drug (NSAID) that can cause bleeding in the gastrointestinal (GI) tract; clients with a history of GI bleeding should not take NSAIDs. Digoxin is an antidysrhythmic used to slow and strengthen the heart rate; it does not contribute to GI bleeding. Furosemide, a commonly used diuretic, is not contraindicated with GI bleeding. Spironolactone is a diuretic that often causes potassium retention; it does not cause GI bleeding.
A client with liver dysfunction states, "My gums have been bleeding spontaneously." The nurse identifies small hemorrhagic lesions on the client's face. The nurse concludes that the client needs additional Vitamin:
K Petechiae are evidence of capillary bleeding; the diseased liver is no longer able to metabolize vitamin K, which is necessary to activate blood clotting factors. Vitamin D is not involved in the clotting process. Vitamin E is not involved in the clotting process. Vitamin A is not involved in the clotting process, even though the transformation of carotene to vitamin A takes place in the liver.
A client who has had right upper quadrant pain for several months now experiences clay-colored stools. Laboratory results reveal elevated liver enzymes and a needle biopsy of the liver is scheduled. What should the nurse include in the client's teaching about the procedure?
Lying on the right side after the procedure is required because it will decrease the risk of hemorrhage. Because of the vascularity of the liver, compression of the needle insertion site limits the risk of hemorrhage; also, it decreases the risk of bile leakage. The procedure is performed under local anesthesia and some discomfort may be felt during instillation of the anesthetic as well as when the needle enters the liver. There is no scarring because a surgical incision is not necessary for a needle biopsy. The client is kept nothing by mouth for at least six hours before the procedure to prevent nausea and vomiting.
When obtaining an admission history of a preoperative client, the nurse learns that the client is taking several herbal supplements. What is the priority nursing action?
Notify the health care provider because some herbs can cause hemorrhage. The patient is preoperative, so notifying the health care provider is a priority because some herbs can cause hemorrhage and the health care provider may need to postpone the surgery until the client has been free of herbal supplements for a period of time. Although some herbs are dangerous, others have proved beneficial. Although the client may be interested in the usefulness of the herbal therapies being taken, this is not the appropriate time for this teaching. STUDY TIP: Record the information you find to be most difficult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traffic or for an appointment, just pull out the cards and review again. This "found" time may add points to your test scores that you have lost in the past.
Enoxaparin (Lovenox) 40 mg subcutaneously daily is prescribed for a client who had abdominal surgery. The nurse explains that the medication is given to:
Provide prophylaxis against postoperative thrombus formation Enoxaparin (Lovenox), a low-molecular-weight heparin, prevents the conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing the inhibitory effects of antithrombin III. Enoxaparin is not an antipyretic. Enoxaparin is not an analgesic. Enoxaparin is not an anti-inflammatory drug.
A client who had a femoropopliteal bypass graft is receiving clopidogrel (Plavix) postoperatively. What should the nurse teach the client related to the medication?
Report multiple bruises on the extremities. Clopidogrel is a platelet aggregation inhibitor that decreases the probability of clots forming where the graft was placed, but it also increases bleeding tendencies when the dosage is excessive. Clopidogrel does not interact with oranges and it is permitted on the diet. Diarrhea, not constipation, is more likely to occur with clopidogrel. Clopidogrel should be taken with food to decrease the side effects of gastric discomfort, diarrhea, and gastrointestinal bleeding.
To prepare a client for surgery, which explanation by a nurse would be accurate related to pneumatic compression devices?
They help the venous blood return to the heart. Deep vein thrombosis (DVT) is a potential complication of any surgery lasting longer than 30 minutes. The purpose of pneumatic compression devices is to increase venous return. Clients often complain about pneumatic compression devices being hot and itchy. In addition to the pneumatic compression devices, a mechanical form of DVT prophylaxis, pharmaceutical prophylaxis is often required. Pneumatic compression devices are continued until the client is up ambulating frequently throughout the day.
A client with chronic liver disease reports, "My gums have been bleeding spontaneously." The nurse identifies small hemorrhagic lesions on the client's face. The nurse concludes that the client needs additional:
Vitamin K Fat-soluble vitamin K is essential for synthesis of prothrombin by the liver; a lack results in hypoprothrombinemia, inadequate coagulation, and hemorrhage. Although cirrhosis may interfere with production of bile, which contains the bilirubin needed for optimum absorption of vitamin K, the best and quickest manner to counteract the bleeding is to provide vitamin K intramuscularly. Folic acid is a coenzyme with vitamins B12 and C in the formation of nucleic acids and heme; thus, a deficiency may lead to anemia, not bleeding. Vitamin A deficiency contributes to development of polyneuritis and beriberi, not hemorrhage.
A client is taking administering warfarin (Coumadin). The nurse recalls that the antidote for this medication is:
Vitamin K Warfarin sodium inhibits vitamin K; therefore, vitamin K is the antidote for warfarin sodium. Fibrinogen and prothrombin are blood-clotting factors, not the antidotes for warfarin sodium. Protamine sulfate is the antidote for heparin, not warfarin sodium.
