Question 1

A 70-year-old resident of a long-term care facility has experienced increasing pain, swelling, and redness to her lower leg over the past 12 hours, prompting the care providers at the facility to have the woman brought to the local emergency department. Diagnostic testing has confirmed deep vein thrombosis (DVT) and an IV infusion of alteplase (Activase) has been initiated? Unlike anticoagulants, a thrombolytic such as alteplase can

Accepted Answer

break down existing clots.

Question 2

Blood coagulation results from the activation of one of two pathways: one pathway occurs in tissue, and the other occurs in the vascular system. What are the names of these pathways?

Accepted Answer

Extrinsic and intrinsic pathways

Question 3

A client taking warfarin (Coumadin) tells the nurse she is having bleeding in the gums and teeth. When reviewing client history, the client states she has decided to try an herbal remedy. Which of the following is most likely the cause of increased bleeding?

Accepted Answer

Ginger

Question 4

Many commonly used herbs and supplements alter the effects of anticoagulant drugs. Which of the following substances presents an additive bleeding effect when taken concomitantly with warfarin?

Accepted Answer

Ginger

Question 5

While preparing a patient for discharge, you teach her about the proper use of warfarin, which has been prescribed by the physician. Which of the following statements by the patient indicates that additional teaching is required?

Accepted Answer

\"I should use aspirin to control my arthritis pain.\"

Question 6

For optimal therapeutic effect a thrombolytic medication should be administered as soon as possible after the formation of a thrombus, preferably within how many hours? (Choose one)

Accepted Answer

4 to 6 hours

Question 7

What values are used to monitor the effectiveness of warfarin therapy?

Accepted Answer

PT and INR

Question 8

A nurse is caring for a patient receiving warfarin drug therapy. The patient informs the nurse that he is also taking chamomile, which is an herbal remedy. What effect of the interaction between warfarin and the herb should the nurse inform the patient about?

Accepted Answer

Increased risk for bleeding

Question 9

Antiplatelet agents decrease the formation of the platelet plug by decreasing the responsiveness of the platelets to stimuli that would cause them to stick and aggregate on a vessel wall. The nurse knows that which drug is an antiplatelet agent? Select all that apply.

Accepted Answer

ReoPro Ticlopidine

Question 10

A patient is being discharged from the hospital with warfarin (Coumadin) to be taken at home. Which of the following foods should the patient be instructed to avoid in his diet?

Accepted Answer

Spinach

Question 11

A male patient is receiving heparin by continuous intravenous infusion. The nurse will instruct the patient and family members to report which of the following should it occur?

Accepted Answer

Presence of blood in urine or stools

Question 12

A 76-year-old client is receiving IV heparin 5,000 U qh. An activated thromboplastin time (aPTT) is drawn 1 hour before the 8:00 AM dose; the aPTT is at 3.5 times the control value. What would be the most appropriate action?

Accepted Answer

Hold the dose and call the result to the physician

Question 13

You know that your 48-year-old patient needs additional teaching regarding anticoagulants if he states that he will what?

Accepted Answer

Use aspirin for arthritis pain

Question 14

Anticoagulant drugs prevent thromboembolic disorders. How does warfarin, one of the anticoagulant drugs, act on the body?

Accepted Answer

Alters vitamin K reducing its ability to participate in the coagulation of the blood

Question 15

Your newest admit to your cardiac-monitored floor is being readied for cardiac catheterization. After you obtain a complete history and complete your nursing assessment, you notify the cardiac surgeon of your patient\'s contraindication to abciximab administration. What are the contraindications to percutaneous transluminal coronary angioplasty? Select all that apply.

Accepted Answer

Major trauma within last 6 weeks Uncontrolled hypertension

Question 16

Your client is currently receiving a continuous IV infusion of heparin. Which of the following procedures should you avoid when possible?

Accepted Answer

Giving intramuscular injections

Question 17

A nurse is caring for a 64-year-old female patient who is receiving IV heparin and reports bleeding from her gums. The nurse checks the patient\'s laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which of the following drugs may be ordered?

Accepted Answer

Protamine sulfate

Question 18

There are two pathways that can be activated by the coagulation process.One pathway begins when factor XII is activated.The other pathway begins when there is trauma to a blood vessel. What are these pathways?

Accepted Answer

Extrinsic and intrinsic pathways

Question 19

A patient has a history of clot formation in the past. She is scheduled for bowel resection due to an obstruction. What anticoagulant agent will be administered prophylactically?

Accepted Answer

Heparin

Question 20

A patient is taking warfarin (Coumadin) to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin (Coumadin) monitored?

Accepted Answer

PT and INR

Question 21

The physiology instructor is discussing blood clots. What would the instructor tell the students is the basis for the clot-dissolving system?

Accepted Answer

Plasminogen

Question 22

While preparing a patient for discharge, you teach her about the proper use of warfarin, which has been prescribed by the physician. Which of the following foods should you tell her to avoid?

Accepted Answer

Green leafy vegetables

Question 23

You are caring for a patient who is going home on warfarin (Coumadin). You will schedule the patient for what following laboratory tests to help evaluate therapeutic effects of the drug?

Accepted Answer

Prothrombin time (PT) and international normalized ratio (INR)

Question 24

A nurse is caring for a patient receiving heparin therapy. The nurse instructs the patient and family that certain foods must be taken in limited quantity as they interfere with the effect of the therapy. Which of the following foods must be taken in limited quantity?

Accepted Answer

Foods rich in vitamin K

Question 25

Which of the following is classified as an antiplatelet agent? (Choose one)

Accepted Answer

Clopidogrel (Plavix)

Question 26

A patient who has been treated with warfarin (Coumadin) after open heart surgery is involved in a car accident and has a laceration on her head. Which medication will be administered to assist in the development of clotting factors?

Accepted Answer

Vitamin K

Question 27

A patient is discharged from the hospital with a prescription of warfarin (Coumadin). Which of the following statements indicates successful patient teaching?

Accepted Answer

\"I will avoid herbal remedies.\"

Question 28

A 59-year-old patient is on warfarin therapy. On follow-up visits to the clinic, the nurse will assess the patient for which of the following?

Accepted Answer

Intake of vitamin K

Question 29

The nursing instructor is discussing the indications for using heparin with their students. What are the indications for using heparin? (Mark all that apply.)

Accepted Answer

Prevention and treatment of pulmonary emboli Treatment of atrial fibrillation with embolization Prevention and treatment of venous thrombosis Diagnosis and treatment of DIC

Question 30

Abdominal pain, coffee-ground emesis, black, tarry stool, hematuria, joint pain, spitting or coughing up blood are signs of which of the following? (Select all that apply)

Accepted Answer

Internal bleeding

Question 31

Bleeding resulting from the administration of heparin is treated with which of the following substances?

Accepted Answer

Protamine sulfate

Question 32

A nurse is preparing to discharge a patient newly prescribed warfarin (Coumadin). While assessing the patient\'s knowledge of their drug, what would indicate that the patient needs further instruction concerning her drug therapy?

Accepted Answer

\"I take aspirin for my arthritis.\"

Question 33

You are caring for a 73-year-old client receiving warfarin. When you perform your initial shift assessment, you observe blood in the client\'s urinary drainage bag. After reporting your observation to the physician, which of the following substances will you likely administer?

Accepted Answer

Vitamin K

Question 34

You know that your teaching about warfarin (Coumadin) is successful if your client makes what statement?

Accepted Answer

\"I will ask my doctor about herbal supplements.\"

Question 35

The physician orders heparin for a 35-year-old female client. The nurse administers the drug only after confirming that the client

Accepted Answer

does not have peptic ulcer disease.

Question 36

Warfarin typically takes 3 days to achieve its onset of action.

Accepted Answer

True

Question 37

A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the patient\'s

Accepted Answer

aPTT.

Question 38

Ms. Kern is treated with heparin therapy for a pulmonary embolism. As the nurse caring for Ms. Kern, you understand that heparin acts by which mechanism?

Accepted Answer

Prevents the extension of the clot that has formed in lungs

Question 39

Your 86-year-old client, who was admitted earlier in the week with thrombophlebitis, is being sent home on enoxaparin. Which of the following statements by your client suggests that he understands proper management of his condition and proper use of the drug?

Accepted Answer

\"The medication will increase my risk of bleeding.\"

Question 40

Enoxaparin (Lovenox) should be administered via which route? (Choose one)

Accepted Answer

Subcutaneous injection

Question 41

A patient who is receiving warfarin (Coumadin) has blood in his urinary drainage bag. What medication will likely be ordered by the physician?

Accepted Answer

Vitamin K

Question 42

Which of the following patients would likely be the best candidate to receive alteplase recombinant therapy?

Accepted Answer

A 68-year-old male who has had an ischemic stroke that resulted in neurological deficits

Question 43

A patient is to receive abciximab. The nurse would expect to administer the drug by which route?

Accepted Answer

Intravenous

Question 44

Which of the following is used to treat a warfarin (Coumadin) overdose? (Choose one)

Accepted Answer

Phytonadione

Question 45

Ms. Main is sent home with subcutaneous heparin after a total hip replacement. What symptom would indicate a serious drug reaction?

Accepted Answer

Tarry stools

Question 46

Prior to beginning anticoagulant therapy the nurse will question their female patient about what?

Accepted Answer

Peptic ulcers

Question 47

Your 73-year-old client receiving warfarin (Coumadin) has blood in his urinary drainage bag this morning. After reporting your observations to the physician, you will expect to administer what substance?

Accepted Answer

Vitamin K

Question 48

Use of St. John\'s wort during warfarin therapy can result in which of the following? (Choose one)

Accepted Answer

Increased risk of bleeding

Question 49

A nurse is caring for a patient undergoing warfarin therapy for the treatment of venous thrombosis. What symptom of warfarin overdose should the nurse be aware of?

Accepted Answer

Melena

Question 50

A 60-year-old patient experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The patient has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect?

Accepted Answer

By inactivating clotting factors and thus stopping the coagulation cascade

Question 51

Heparin therapy is prescribed to a patient with deep vein thrombosis. Which patient would be at greatest risk of bleeding from this therapy?

Accepted Answer

A 45-year-old corporate executive with peptic ulcer disease

Question 52

You are sending a patient home on heparin therapy. What is important when you teach a patient to administer heparin subcutaneously?

Accepted Answer

Insert the needle at a 45- to 90-degree angle

Question 53

You are caring for a patient who is taking warfarin (Coumadin). When providing patient education on Coumadin you should include information about minimizing foods high in vitamin K. What are these foods?

Accepted Answer

Green leafy vegetables

Question 54

A patient is admitted to the hospital with deep vein thrombosis. Heparin 10,000 units is administered Sub-Q. Which of the following drugs should always be available in the pharmacy if the patient begins to bleed?

Accepted Answer

Protamine sulfate

Question 55

A patient is to receive desirudin to prevent deep vein thrombosis with an elective hip surgery. The nurse would expect this drug to be administered by which route?

Accepted Answer

Subcutaneous

Question 56

The pharmacology instructor is discussing heparin with their students. How would the instructor explain the action of heparin?

Accepted Answer

Promotes the inactivation of clotting factors

Question 57

When should the nurse administer a 300 mg dose of clopidogrel (Plavix) to a patient, instead of the 75 mg dose? (Choose one)

Accepted Answer

Loading dose

Question 58

Ms. Adams is started on warfarin therapy. The patient asks you why she is not on heparin therapy any longer. What differentiates heparin from warfarin?

Accepted Answer

Heparin is administered parenterally, while warfarin is administered orally.

Question 59

The nursing instructor is talking about anticoagulant therapy. The instructor explains that when administering warfarin (Coumadin) to a client with deep vein thrombophlebitis, the nurse monitors the PTT, PT, INR, and hematocrit. Which laboratory value would the instructor say indicates warfarin is at therapeutic levels?

Accepted Answer

Prothrombin time (PT) 1.2 to 1.5 times the control

Question 60

A patient is to receive eptifibatide. The nurse would expect to administer this drug by which route?

Accepted Answer

Intravenous

Question 61

A patient receiving heparin has a baseline aPTT of 28 seconds. Which result would the nurse interpret as suggesting too much heparin?

Accepted Answer

98 seconds

Question 62

A patient has been prescribed 300 mg of anisindione daily for the treatment of venous thrombosis. The drug is available as 50 mg tablets. How many tablets should the nurse administer to the patient per day?

Accepted Answer

6

Question 63

The squad just delivered to your ED a 73-year-old man with crushing chest pain. He has a history of cardiovascular disease. Onset of symptoms is within the last 60 minutes. What medication would you expect the physician to order for his thromboembolic disorder?

Accepted Answer

Thrombolytic drugs

Question 64

Ms. Kim is admitted to the hospital for treatment of a pulmonary embolism. Forty-eight hours after therapy has started, Ms. Kim reports bleeding from her gums when she brushes her teeth. The nurse notes this to be an adverse effect of the medication and contacts the physician. What orders can the nurse anticipate receiving from the physician to reverse the effects of the heparin?

Accepted Answer

Administer protamine sulfate, at a dosage of 1 mg per 100 units of heparin, for a maximum dose of 100 mg.

Pharm Chp 37 – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards