Anticoagulants, Antiplatelets, & Thrombolytics – Flashcards
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A client is receiving an intravenous heparin drip. Which laboratory value will require immediate action by the nurse? A. Platelet count of 150,000 B. Activated partial thromboplastin time (aPTT) of 120 seconds C. INR of 1.0 D. Blood urea nitrogen (BUN) level of 12 mg/dL
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Rationale: This aPTT value is too prolonged. The heparin drip should be shut off for an hour.
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A client who has been taking warfarin (Coumadin) is admitted with coffee-ground emesis. What is the nurse's primary action? A. Administer vitamin E. B. Administer vitamin K. C. Administer protamine sulfate. D. Administer calcium gluconate.
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Answer: B Rationale: Vitamin K is the antagonist for warfarin.
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The client has an international normalized ratio (INR) value of 1.5. What action will the nurse take? A. Administer an additional dose of warfarin (Coumadin). B. Hold the next dose of warfarin (Coumadin). C. Increase the heparin drip rate. D. Administer protamine sulfate.
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Answer: A Rationale: A therapeutic INR is 2 to 3. The client needs more Coumadin to reach a therapeutic level.
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A client is receiving warfarin (Coumadin) for a chronic condition. Which client statement requires immediate action by the nurse? A. "I will avoid contact sports." B. "I will take my medication in the early evening each day." C. "I will increase dark-green, leafy vegetables in my diet." D. "I will contact my health care provider if I develop excessive bruising."
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Answer: C Rationale: 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.
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A client is taking enoxaparin (Lovenox) daily. Which client statement requires additional monitoring? A. "I take aspirin daily for headaches." B. "I take ibuprofen (Motrin) at least once a week for joint pain." C. "Whenever I have a fever, I take acetaminophen (Tylenol)." D. "I take my medicine first thing in the morning."
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Answer: A Rationale: Aspirin is an antiplatelet medication. A client taking both aspirin and Lovenox could cause excessive bleeding.
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The client is receiving tirofiban (Aggrastat). What is an essential nursing intervention for this client? A. Have protamine sulfate available in case of an overdose. B. Weigh the client before administration. C. Have vitamin K available in case of an overdose. D. Assess intake and output.
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Answer: B Rationale: Tirofiban (Aggrastat) is a glycoprotein IIb/IIIa inhibitor that blocks the enzyme essential for platelet aggregation. This is given to prevent the formation of further clots and is faster acting than warfarin. The medication is administered in mcg per kg of body weight per minute. Weighing the client is essential. Protamine sulfate is the antagonist for heparin. Vitamin K is not the antidote to overdose.
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A nurse is preparing to administer enoxaparin sodium (Lovenox) to a client for prevention of deep vein thrombosis. What is an essential nursing intervention? A. Draw up the medication in a syringe with a 22-gauge, 1-½ inch needle. B. Utilize the Z-track method to inject the medication. C. Administer the medication into subcutaneous tissue. D. Rub the administration site after injecting.
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Answer: C Rationale: Enoxaparin (Lovenox) is a low-molecular-weight heparin that is administered subcutaneously.
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The client asks what the difference is between dalteparin (Fragmin) and heparin. What is the nurse's best response? A. "There is no real difference. Dalteparin is preferred because it is less expensive." B. "Dalteparin is a low-molecular-weight heparin that is more predictable in its effect and has a lower risk of bleeding." C. "I'm not sure why some health care providers choose dalteparin and some heparin. You should ask your doctor." D. "The only difference is that heparin dosing is based on the client's weight."
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Answer: B Rationale: A low-molecular-weight heparin is more predictable in its effect than regular heparin. Dalteparin (Fragmin) is more expensive than heparin and is dosed based on the client's weight.
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A client has been admitted through the emergency department and requires emergency surgery. The client has been receiving heparin. What nursing intervention is essential? A. Teach the client about the phenytoin. B. Administer protamine sulfate. C. Assess the INR before surgery. D. Administer vitamin K.
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Answer: B Rationale: Protamine sulfate binds with heparin in the bloodstream to inactivate it and thus reverse its effect.
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What nursing intervention is essential for the client receiving alteplase? A. Assess for reperfusion dysrhythmias. B. Monitor liver enzymes. C. Administer vitamin K if bruising is observed. D. Monitor blood pressure and stop the medication if blood pressure drops below 110 systolic.
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Answer: A Rationale: Alteplase (Activase) can cause bleeding as well as reperfusion dysrhythmias. Alteplase does not directly affect liver enzymes. Vitamin K will not reverse the effects of Activase. Vital sign changes can alert the nurse to complications; however, a blood pressure below 110 systolic is not, in itself, cause for alarm.
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A client who is taking warfarin (Coumadin) requests an aspirin for headache relief. What is the nurse's best response? A. Administer 650 mg of acetylsalicylic acid (ASA) and reassess pain in 30 minutes. B. Teach the client of potential drug interactions with anticoagulants. C. Explain to the client that ASA is contraindicated and administer ibuprofen as ordered. D. Explain that the headache is an expected side effect and will subside shortly.
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Answer: B Rationale: Clients taking an anticoagulant should not use medications that would further increase the risk of bleeding, which includes aspirin as well as ibuprofen. Aspirin should not be administered to the client taking other anticoagulants, unless it is ordered specifically as a low dose daily therapy. Ibuprofen is not the best choice of medication for the client receiving Coumadin. Tylenol (acetaminophen) would be preferred for pain relief. Headache is not an expected side effect of Coumadin therapy.
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A client is started on warfarin (Coumadin) therapy while still receiving intravenous heparin. The client questions the nurse about the risk for bleeding. How should the nurse respond? A. "Your concern is valid. I will call the doctor to discontinue the heparin." B. "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." C. "Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than one alone." D. "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."
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Answer: B Rationale: 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.
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The nurse evaluates that the client understood discharge teaching regarding warfarin (Coumadin) based on which statement? A. "I will double my dose if I forget to take it the day before." B. "I should keep taking ibuprofen for my arthritis." C. "I should decrease the dose if I start bruising easily." D. "I should use a soft toothbrush for dental hygiene."
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Answer: D Rationale: This statement is accurate and will reduce the risk of bleeding. Ibuprofen will potentiate bleeding. The client should call the health care provider if experiencing excessive bruising.
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What intervention is essential before the nurse administers tenecteplase (TNKase)? A. Perform all necessary venipunctures. B. Administer aminocaproic acid (Amicar). C. Have the client void. D. Assess for allergies to iodine.
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Answer: A Rationale: TNKase is a thrombolytic agent that can interfere with the body's clotting ability. Therefore, all invasive procedures should be completed before administering this drug.
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Which nursing diagnosis would be possible for a client receiving intravenous heparin therapy? A. Potential for fluid volume excess B. Potential for pain C. Risk for injury D. Potential for body image disturbance
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Answer: C Rationale: The client receiving heparin is at risk for injury secondary to increased risk of bleeding.
