Pharm - Chapter 26 - Coagulation Modifier Drugs
The nurse is teaching a patient who is receiving aminocaproic acid the measures to prevent adverse effects. Which statement made by the patient indicates the need for further teaching? 1 "I should take oral contraceptives during the therapy." 2 "I should not use any acetaminophen during the therapy." 3 "I should refrain from eating broccoli during the therapy." 4 "I should follow a low-cholesterol diet during the therapy."
1 "I should take oral contraceptives during the therapy." Aminocaproic acid is an antifibrinolytic medication that interacts with oral contraceptives and increases the risk of clot formation. Therefore the nurse would instruct the patient not to take oral contraceptives during the therapy. Acetaminophen does not interact with aminocaproic acid, so the nurse would not instruct the patient to refrain from taking acetaminophen. Broccoli is rich in vitamin K. The consumption of vitamin K does not reduce the effectiveness of the aminocaproic acid. Following a low-cholesterol diet reduces the risk of hypertension in the patient.
A patient with atrial fibrillation is admitted to the emergency unit for symptoms of warfarin toxicity. The primary health care provider instructs the nurse to administer 6 mg of vitamin K to the patient. Which medication would be included in the patient's prescription to provide safe and effective treatment? 1 Enoxaparin 2 Furosemide 3 Amiodarone 4 Ketoconazole
1 Enoxaparin Vitamin K1 inhibits the anticoagulant effects of warfarin and reduces the symptoms of warfarin toxicity. After the administration of vitamin K1, the patient may develop warfarin resistance for 7 days. In these instances, low-molecular-weight heparins such as enoxaparin would be prescribed to the patient to reduce the symptoms of thrombus formation and to alleviate the symptoms of atrial fibrillation. Furosemide is a diuretic that interacts with warfarin and enhances its anticoagulant action. Amiodarone increases anticoagulant action of warfarin and increases risk of bleeding in the patient. Ketoconazole is an antifungal medication. It interacts with warfarin but does not alleviate symptoms of atrial fibrillation.
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 or she has developed a rash. Which is the nurse's priority action? 1 Notify the provider; the medication will need to be discontinued. 2 Monitor the area of the rash; this is an expected side effect of the medication. 3 Notify the provider to obtain an order for a topical medication to apply to the rash. 4 Instruct the patient to wash the area with mild soap and water and leave open to the air.
1 Notify the provider; the medication will need to be discontinued. If the patient develops a rash while taking one of the coagulation modifier drugs, the drug needs to be discontinued. A rash is not an expected side effect; the current recommendation is to discontinue the drug, not apply a topical medication. Soap may aggravate the rash and dry out the skin.
A patient who is receiving heparin therapy has bruises covering the abdomen as well as red-colored urine. Which assessment does the nurse need to address? 1 Platelet level 2 Urine culture 3 Ingestion of acetaminophen 4 Over-the-counter medications
1 Platelet level The patient's platelet level would be assessed when he or she receives heparin and then develops bruises and blood in the urine. The patient may have type II heparin-induced thrombocytopenia (HIT). The patient's medication would need to be changed. Urinary tract infections or acetaminophen would not cause these symptoms. Although over-the-counter medications may potentiate bleeding, they are not likely to cause these symptoms.
A patient is admitted to the emergency department experiencing symptoms of a thrombolytic stroke. Which medication would the nurse expect to be prescribed for the patient? 1 Heparin 2 Alteplase 3 Clopidogrel 4 Fondaparinux
2 Alteplase Alteplase is a tissue plasminogen activator, which can be administered to treat a thrombolytic stroke within a specified time frame after symptom onset. Heparin is an anticoagulant, which prevents clot formation by inhibiting clotting factors IIa and Xa. Clopidogrel is an antiplatelet medication that interferes with platelet function, thereby preventing platelet aggregation. Fondaparinux is an anticoagulant medication, which prevents clot formation by inhibiting factor Xa.
After talking with a patient who is receiving warfarin sodium therapy, the nurse believes that the patient is at increased risk for bleeding. Which statement made by the patient supports the nurse's conclusion? 1 "I do not take aspirin for pain relief." 2 "I eat 1 cup of green leafy vegetables daily." 3 "I take ginkgo supplements for memory enhancement." 4 "I refrain from drinking coffee and citrus fruit juices daily."
3 "I take ginkgo supplements for memory enhancement." Warfarin sodium is an anticoagulant medication that reduces the synthesis of vitamin-K dependent clotting factors and inhibits clot formation. Herbal supplements such as ginkgo interact with warfarin sodium and increase the risk of bleeding. Aspirin is a nonsteroidal antiinflammatory drug that prevents platelet aggregation and increases risk of bleeding. Therefore refraining from taking aspirin will reduce the risk of bleeding in the patient. Though green leafy vegetables are rich in vitamin K, consistent intake of green leafy vegetables does not result in food-drug interaction. Therefore the nurse would advise the patient to consume the same amount of green leafy vegetables daily. The intake of coffee and citrus fruit does not impair the clotting process and does not increase risk of bleeding.
A patient is receiving warfarin for a chronic condition. Which patient statement requires immediate action by the nurse? 1 "I will avoid contact sports." 2 "I will take my medication at the same time each day." 3 "I will increase dark green leafy vegetables in my diet." 4 "I will contact my health care provider if I develop excessive bruising."
3 "I will increase dark green leafy vegetables in my diet." Dark green leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Rather than increase the intake of these, it is important to maintain a consistent daily intake of vitamin K. The medication will usually be ordered to be taken at the same time each day. Due to the increased chance of bruising, avoiding contact sports is an appropriate patient statement. The patient should monitor incidence of bruising carefully.
A patient is started on warfarin therapy while also receiving intravenous heparin. The patient is concerned about the risk for bleeding. Which information will the nurse give the patient? 1 "Your concern is valid. I will call the doctor to discontinue the heparin." 2 "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications." 3 "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." 4 "Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than either one alone."
3 "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." Warfarin works by decreasing the production of clotting factors. However, it takes approximately 3 days for the body to metabolize present clotting factors and thus achieve a therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved. Ambulation reduces, not increases, the risk of blood clots. The patient will likely not continue on both medications, even for a valve replacement. A higher international normalized ratio (INR) is desired for valve replacement, but the patient should eventually take warfarin only on a daily basis; not both heparin and warfarin.
A registered nurse is teaching a student nurse about safe and effective administration of heparin. Which action by the student nurse is appropriate? 1 Massaging the site after the injection 2 Administering the medication when convenient 3 Checking if the patient's prescription contains enoxaparin 4 Administering the medication intramuscularly in the vastus lateralis
3 Checking if the patient's prescription contains enoxaparin It is appropriate for the student nurse to check the patient's medication records to determine if enoxaparin is prescribed because this medication should not be administered with heparin. The nurse would not massage the injection site because this can lead to tissue necrosis. The medication would be administered as per the prescribed order, not just when convenient. Heparin is administered as a subcutaneous injection, not as an intramuscular injection.
The patient has been placed on aspirin as an antiplatelet drug. Which is a side effect of aspirin therapy? 1 Edema 2 Itching 3 Nausea 4 Chest pain
3 Nausea Nausea is a most common side effect of treatment with aspirin. Edema, itching, and chest pain are side effects that are more likely to be seen with the use of clopidogrel.
The nurse is screening a patient for candidacy for treatment with fondaparinux. 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. Which interpretation of these findings is correct? 1 Not a candidate for fondaparinux based only on an insufficient creatinine clearance 2 Is a candidate for fondaparinux based on a sufficient creatinine clearance and adequate body weight 3 Not a candidate for fondaparinux based on both an insufficient creatinine clearance and an inadequate body weight 4 Is a candidate for fondaparinux based on sufficient creatinine clearance and after body weight attains an adequate level
3 Not a candidate for fondaparinux based on both an insufficient creatinine clearance and an inadequate body weight Fondaparinux is contraindicated with known allergy or in patients with a creatinine clearance less than 30 mL/min or a body weight of less than 50 kg.
A patient is prescribed dabigatran to treat atrial fibrillation. On a follow-up visit, the medication prescription is reduced by half. Which assessment finding supports the change in the prescribed dose? 1 Loss of 10 pounds 2 Diagnosis of diabetes mellitus 3 Platelet count of 80,000/mm3 4 Creatinine clearance of 25 mL/min
4 Creatinine clearance of 25 mL/min Dabigatran would be reduced by half if a patient's creatinine clearance is less than 30 mL/min. A weight loss of 10 pounds would not necessitate a change in the prescribed medication. The development of diabetes would not affect the prescribed dose of dabigatran. A platelet count of less than 1,000,000/mm3 indicates severe bleeding, and the patient's medication would be discontinued.
A patient has been receiving intravenous heparin. The nurse notes that today's activated partial thromboplastin time (aPTT) result is elevated. Which action would the nurse take? 1 Stop the medication. 2 Increase the dose of heparin. 3 Notify the health care provider immediately. 4 Monitor the patient and check the therapeutic range.
4 Monitor the patient and check the therapeutic range. An elevated aPTT would be expected in a patient who is receiving heparin. The nurse would continue to monitor the patient. The nurse would check the therapeutic range expected for the therapy. The medication would not be stopped because this is a therapeutic effect. The dose of heparin would not have to be increased. The health care provider would not have to be notified unless the aPTT is above the therapeutic range.
A patient is diagnosed with hemophilia. Which medication therapy is essential? 1 Warfarin daily 2 Vitamin K daily 3 Aspirin daily (i.e., 81 mg) 4 Recombinant factors
4 Recombinant factors Hemophilia is a rare genetic disorder in which the coagulation factors are absent. Factors need to be given as replacement therapy so the patient does not bleed to death. Patients with hemophilia cannot receive warfarin or aspirin because they increase bleeding. Vitamin K is not used to treat hemophilia.
A patient has overdosed on warfarin. Which substance will the nurse administer to reverse the effect of warfarin? 1 Aspirin 2 Calcium 3 Potassium 4 Vitamin K
4 Vitamin K The administration of vitamin K will help reverse the action of warfarin. Warfarin interferes with vitamin-K dependent clotting factors. Administration of vitamin K will reverse this action. Aspirin is an antiplatelet aggregator that can increase the risk of bleeding. Calcium and potassium do not reverse the effects of warfarin.
Cilostazol belongs to which drug class? 1 Antiplatelet 2 Thrombolytic 3 Anticoagulant 4 Antifibrinolytic
Antiplatelet Cilostazol is an antiplatelet drug that works through inhibition of type 3 phosphodiesterase in the platelets and primarily lower-extremity blood vessels. Thrombolytics break down blood clots. Anticoagulants prevent or delay coagulation of the blood. Antifibrinolytics prevent the lysis of fibrin, thereby promoting clot formation.
