PHARM EXAM 3A
A patient is ordered subcutaneous heparin every 8 hours. When the patient asks what this medication is for, what is the nurse's best answer?
"It is to prevent you from developing a blood clot." Rationale:Subcutaneous heparin every 8 hours is given to prevent clots. Intravenous (IV) heparin is administered to prevent clots and to keep current clots from getting bigger. It is not accurate that everyone is on heparin and saying so does not address the question. Activated partial thromboplastin clotting time (aPTT) is monitored with IV infusion only and not a reason for administering heparin.
A client is receiving low-molecular-weight heparin (LMWH) to prevent thromboembolic complications. The nursing student asks the instructor the reason why this treatment is given instead of heparin. What is the instructor's best explanation of the rationale for LMWH over heparin?
"LMWH is associated with less thrombocytopenia than standard heparin."
An 86-year-old male client who was admitted earlier in the week with thrombophlebitis is being sent home on enoxaparin. Which statement by the client suggests that he understands proper management of his condition and proper use of the drug?
"The medication will increase my risk of bleeding."
Which client statement demonstrates an accurate understanding of the action of a prescribed anticoagulant?
"This medication will keep unnecessary clots from forming in my blood."
What are contraindications for patients with hypoprothrombinemia?
(low clotting factors) hold the med
The RAAS is associated with which? 1Intense vasoconstriction and BP elevation 2Blood flow through the kidneys 3Production of surfactant in the lungs 4Release of aldosterone from the adrenal cortex 5Retention of sodium and water in the kidneys 6Liver production of fibrinogen
1,2,5,6
A client asks the nurse what dose of acetylsalicylic acid (aspirin) is needed for antiplatelet effects to prevent heart attacks.
300 mg
What is the initial treatment for salicylate/aspirin toxicity?
Activated Charcoal
A patient is on a heparin infusion. Which lab value is used to titrate this medication?
Activated partial thromboplastin clotting time (aPTT) Rationale:aPTT is used to guide titration in patients receiving heparin. PT and INR are monitored in patients receiving warfarin. Hemoglobin is monitored with all anticoagulants but does not impact titration.
What are contraindications for Alteplase?
Active bleeding (ex: peptic ulcer), recent surgery (within two weeks), previous cerebral vascular accident or seizure at onset, or uncontrolled hypertension
What is the purpose of aminocaproic acid
Aminocaproic acid is not an antidote. It is an intravenous medication used to reverse fibrinolysis, which is the breakdown of blood clots. It helps to prevent excessive bleeding by inhibiting the breakdown of clots.
What classification of medications does warfarin fall under?
Anticoagulant
A patient who is hypertensive becomes pregnant. Which is the safest medication for this patient? Angiotensin II receptor blocker ACE inhibitor Beta-blocker Calcium-channel blocker
Beta Blocker
Which medication is an example of an antiplatelet?
Clopidogrel Rationale:Clopidogrel is an example of an antiplatelet, as is aspirin. Atropine is for symptomatic bradycardia, warfarin is an anticoagulant, and alteplase is a thrombolytic.
A client is prescribed warfarin. The client also takes a diuretic for the treatment of cardiac problems. The nurse will monitor the client for which potential interaction?
Decreased effectiveness of the anticoagulant
The client is prescribed warfarin. His INR is 5.2. At what level is this dose?
Elevated
The client is currently receiving a continuous IV infusion of heparin. Which procedure should the nurse avoid when possible?
Giving intramuscular injections
What type of medication is heparin?
Heparin is an anticoagulant. It "thins" the blood to prevent new blood clots from forming and keeps current clots from getting bigger.
Mr. Hon has been admitted to the hospital and placed on anticoagulant therapy. For what blood-related disorder is this therapy used?
Hypercoagulation
common complaint of patients with left-sided heart failure?
Increased difficulty breathing when lying down
What should be avoided when a patient is on warfarin?
Intramuscular (IM) injections Rationale:IM injections should be avoided to decrease the risk for bleeding. Electric razors, pressure dressings, and deep breathing exercises are all safe for a patient on warfarin.
How does warfarin work?
It suppresses vitamin K and "thins" the blood.
The black box warning associated with warfarin concerns its risk of causing what condition?
Major or fatal bleeding
Which intervention should be implemented for patients on any medications that increase the risk of bleeding?
Monitor for dark stools. Rationale:For patients on medications that increase the risk for bleeding, the patient should be alert for signs of bleeding, which may include bleeding gums, bruising, dark stools. Other interventions include maintaining fall precautions, avoiding IM injections, and using electric razors.
A 75-year-old client presents to the health care provider's office with bleeding gums and multiple bruises. When the nurse reviews the client's drug history, the nurse finds that the client is prescribed aspirin 81 mg/d. What drug may cause increased bleeding when used in conjunction with the aspirin?
NSAIDs
How should intravenous (IV) heparin be administered?
On a pump with guardrails Rationale:Heparin is a high-alert drug that should be administered on a pump with guardrails. It should never be hung to gravity, does not need to be administered by an advanced practice nurse, and should never be administered on a pressure bag.
A client is taking warfarin to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin monitored?
PT and INR
What values are used to monitor the effectiveness of warfarin therapy?
PT and INR
What lab value should be monitored for a patient on warfarin?
PT and International normalized ratio (INR)
factor is an absolute contraindication to receiving a thrombolytic?
Pregnancy Rationale:Contraindications for thrombolytics include pregnancy, recent gastrointestinal bleed, hemorrhagic stroke, a known bleeding disorder, recent major surgery or trauma, history of intracranial vessel malformation, and uncontrolled hypertension. Ischemic stroke, appendectomy in the past, and controlled hypertension are not contraindications for thrombolytic administration.
A nurse is conducting an assessment on a client who has recently undergone exploratory laparotomy. The nurse notes the continued order for enoxaparin. The nurse predicts this is to accomplish which goal?
Prevent formation of a blood clot
A nurse is caring for a 64-year-old female client who is receiving IV heparin and reports bleeding from her gums. The nurse checks the client's laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which drug may be ordered?
Protamine sulfate
What is the antidote for heparin?
Protamine sulfate
A client is to receive enoxaparin. The nurse would administer this drug by which route?
Subcutaneous injection
A stable daily dose of warfarin is reached when which parameter is achieved?
The PT and INR are within their therapeutic ranges, and the dose does not cause bleeding.
A patient is on a heparin infusion. How does the nurse know if the medication is infusing at a therapeutic rate?
The activated partial thromboplastin clotting time (aPTT) is 1.5 to 2.5 times the normal time.
What lab test is used to monitor bleeding?
The lab test used to monitor bleeding is the CBC (Complete Blood Count). Rationale: The CBC measures various components of the blood, including platelet count, hemoglobin level, and hematocrit, which can indicate if there is a drop in these values that may suggest bleeding.
How do anticoagulants work?
Thin the blood to prevent clots and stop clots from getting bigger. Rationale: Anticoagulants work by thinning the blood to prevent clots and to stop them from getting bigger. Antiplatelets prevent platelets from sticking to stents, and thrombolytics dissolve clots.
What is the purpose of thrombolytics
Thrombolytics is a clot buster. It dissolves already formed blood clots.
T OR F Coagulation is the multistep process that changes blood from a fluid state to a solid state to help plug holes in the vascular system.
True
T OR F Digoxin (Lanoxin) improves cardiac output by increasing intracellular calcium in the heart, which improves the contractility of the ventricles.
True
T OR F Heparin is the drug of choice for breast or chestfeeding who have DVT (deep vein thrombosis) because it does not enter human milk.
True
What is the contraindication for Epoetin Alfa?
Uncontrolled Hypertension. It is not recommended to use Epoetin Alfa in patients with high blood pressure that is not well managed.
Digoxin (Lanoxin) is excreted in the:
Urine
A postsurgical client possesses numerous risk factors for venous thromboembolism, including a previous deep vein thrombosis. What drug would the nurse anticipate administering while this client recovers in the hospital?
heparin
When can alteplase be given?
must be given within a 3 hour time frame
A client exhibits signs and symptoms of heparin overdose. The nurse would anticipate administering:
Protamine sulfate
A patient taking an ACE inhibitor is scheduled for surgery. Because this medication may be dangerous in the setting of general anesthesia, the nurse should ... stop the drug without discussing with the providers. alert the provider caring for the patient and mark the patient's chart prominently. cancel the surgery and consult with the prescriber. monitor fluid levels and make sure the fluids are restricted before surgery.
alert the provider caring for the patient and mark the patient's chart prominently.
The nurse is caring for a 76-year-old client who is receiving IV heparin 5000 units q4h. At the initiation of therapy, the client's control activated thromboplastin time (aPTT) was found to be 35 seconds. One hour prior to the next scheduled dose, aPTT is determined to be 92 seconds. Based on this result, the nurse will:
hold the dose and contact the provider.
The stepped-care approach to the treatment of hypertension includes lifestyle modification, including exercise, diet, and decreased smoking and alcohol intake. use of a diuretic, beta-blocker, or ACE inhibitor to supplement lifestyle changes. a combination of antihypertensive drug classes to achieve desired control. all of the above.
all the above
Which of the following statements are true in regards to anticoagulants? Select all that apply: 1. Anticoagulants prevent formation of a thrombus. 2. Anticoagulants prevent extension of a thrombus. 3. Anticoagulants dissolve existing thrombi. 4. Anticoagulants thin the blood. 5. Anticoagulants can reverse the damage caused by a thrombus.
Anticoagulants prevent formation of a thrombus. Anticoagulants prevent extension of a thrombus.
Vitamin K is used to reverse the effects of which medication?
Warfarin
A client has been prescribed intravenous heparin. What laboratory value will the nurse prioritize when providing care for this client?
aPTT
Another name for aspirin
acetylsalicylic acid (ASA)
What is the purpose of growth factors?
- Growth factors stimulate red blood cell production. - They are used to help increase the production of red blood cells in conditions such as anemia.
What is the purpose of antiplatelet agents?
-The purpose of antiplatelet agents is to prevent platelet aggregation and clot formation. -These medications help to inhibit the clumping together of platelets, reducing the risk of clot formation.
ACE inhibitors work on the RAAS to prevent the conversion of angiotensin I to angiotensin II. Because this blocking occurs in the cells in the lung, which is usually the site of this conversion, the use of ACE inhibitors often results in ... spontaneous pneumothorax. pneumonia. unrelenting cough. respiratory depression.
unrelenting cough.
What is the purpose of clopidogrel
The purpose of clopidogrel is to inhibit platelet aggregation. It is an ADP inhibitor that helps prevent platelets from clumping together and forming clots
The pharmacology instructor is discussing heparin with the students. How would the instructor explain the action of heparin?
Promotes the inactivation of clotting factors
A 73-year-old client receiving warfarin (Coumadin) has blood in the urinary drainage bag this morning. After reporting these observations to the health care provider, the nurse will expect to administer what substance?
Vitamin K
A client who has been treated with warfarin after cardiac surgery is found to have an INR of 9.0. Which medication will be administered to assist in the development of clotting factors?
Vitamin K
What is thrombocytopenia?
low platelet count, indicates a huge rick for bleeding
