question

A client who uses St. Johns wort is receiving warfarin. The nurse would be alert for which of the following?

answer

Increased risk of bleeding

question

For optimal therapeutic effect a thrombolytic medication should be administered as soon as possible after the formation of a thrombus, preferably w/n how many hours?

answer

4-6 hour

question

why thin blood?

answer

DVT Stroke PE MI

question

T or F Bleeding time is usually unaffected by Heparin

answer

True clotting time is prolonged by full therapeutic doses

question

How does one administer Enoxaparin (Lovenox)?

answer

Subcutaneous Injection

question

For a client prescribed warfarin, which herbal remedy may be problematic?

answer

Garlic Ginger Gingko Biloba Ginseng Green Tea

question

Client is prescribed warfarin for venous thrombosis. The nurse suspects overdose d/t what?

answer

Melena -blood in the stool

question

Assessment of a client receiving an anticoagulant reveals abdominal pain, coffee ground stools, black tarry stool, hematuria, joint pain and is coughing up blood. What may be happening?

answer

Internal bleeding

question

What inhibits the synthesis of Vit. K - dependent coagulation factors VII, IX, X and II

answer

Coumadin

question

What is administered for a overdose of warfarin?

answer

Phytonadione (Vitamin K)

question

What are used to precent the formation and extension of a thrombus?

answer

Anticoagulants

question

Do anticoagulants thin blood?

answer

No!!!! They prevent additional clots from forming.

question

People with PEs will be put on what?

answer

Coumadin

question

what is the most common oral anticoagulant?

answer

Warfarin

question

When is the peak activity reached with warfarin?

answer

1.5-3 days after therapy is started

question

What is a mixture of high and low molecular weight drugs?

answer

Heparin such as? Dalteparin (Fragmin) Enoxaparin (Lovenox)

question

What is used to prevent DVT in pts. undergoing hip, knee, or abdominal surgery?

answer

Desirudin (Iprivask) Fondaparinux (Arixtra)

question

A client is receiving anticoagulant therapy and has an INR done. Which result would indicate as being therapeutic?

answer

2.4 When anticoagulant therapy is used, INR between 2-3 is maintained.

question

A client receiving warfarin therapy. The nurse instructs the client and family certain foods must be ingested consistently bc of the possible interference with the effect of which therapy. Which food must be taken in limited quantity?

answer

food rich in Vit K

question

If someone is taking warfarin, and also uses Chamomile... what may happen?

answer

Increased risk for bleeding

question

The nurse would anticipate administering fondaparinux to a client with which of the following?

answer

DVT Prophylaxis

question

Someone receiving subcutaneous heparin at 8am, and is scheduled for the next dose at 8pm. When would the nurse obtain a specimen for an aPTT test at what time?

answer

2pm you want to do it 4-6 hours after the injection

question

When preparing to administer a thrombolytic drug to a pt. The nurse understands that this class of drugs would be contraindicated in clients with which of the following?

answer

Active bleeding HX of aneurysm HX of stroke Pregnancy

question

AR of thrombolytics?

answer

cardiac arrhythmias bleeding (Most common)

question

What would a nurse administer as an antiplatlet drug?

answer

Clopidogrel (Plavix)

question

When are vitals taken for Thrombolytics?

answer

q 15 mins, and q 30 mins in the following 6 hrs and fianlly q 60 mins for 16 hrs

question

Thrombolytic drugs?

answer

Ateplase Reteplase (END IN ASE)

question

A nurse is educating a group of clients about the contraindications of warfarin (Coumadin) therapy. Which of the following statements is appropriate to include in the teaching?

answer

Clients who are pregnant should not take Coumadin.

question

A nurse is caring for a client diagnosed with thrombophlebitis who has a swollen and inflamed right calf. The client is started on a continuous heparin infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give?

answer

"Heparin does not dissolve clots, it stops new clots from forming."

question

Most common side effect of anticoagulants?

answer

Bleeding is the most common side effect, and may present in a variety of ways: epistaxis, gum bleeding, hemoptysis, hematuria, melena or hemorrhage

question

Heparin CI?

answer

Contraindications: • Severe thrombocytopenia • Uncontrollable active bleeding state • Pregnancy, Nursing Mothers

question

Heparin Nursing intervention?

answer

•Nursing: Monitor for bleeding. •Check color of urine, occult blood in stool, • Check for changes in vital signs.

question

Factor Xa Inhibitor does what?

answer

Inhibits factor Xa in clotting cascade which prevents the conversion of prothrombin to thrombin

question

Factor Xa Inhibitor drugs

answer

rivaroxaban, apixaban, dabigatran

question

Factor Xa Inhibitor does what? prevents what?

answer

Prevents deep vein thrombosis (DVT) and pulmonary embolus (PE)

question

Factor Xa Inhibitor CI?

answer

Contraindications • Active pathological bleeding • Pregnancy • Patients taking other anticoagulant, antiplatelet, thrombolytic drugs

question

Thrombolytics indications?~

answer

Treatment of acute MI, pulmonary embolism, and acute ischemic stroke.

question

Thrombolyics CI?

answer

Contraindications • Known bleeding disorder Recent trauma/surgery • Acute liver disease • Cerebrovascular accident within 2mo. • GI ulcers. • Pregnancy

question

when should thrombolytics be given?

answer

Time frame for administration: treatment within 3 hours of onset is crucial

question

Thrombolytics Nursing....

answer

Nursing: • Status is assessed every 15 minutes, and every 30 minutes in the following 6 hours, and finally every 60 minutes for 16 hours • Essential not to give anticoagulants or antiplatelet agents for 24 hours.

question

What is Erythropoietin?

answer

•Erythropoietin (EPO) is a hormone produced by the kidney. •Erythropoietin promotes the formation of red blood cells by the bone marrow.

question

Protamine is used to treat overdose of which of the following medications? Select all that apply.

answer

Heparin Enoxaparin (Lovenox)

question

After teaching a group of nursing students about heparins, the instructor determines that the teaching was successful when the students identify which of the following as an example of a low-molecular-weight heparin (LMWH)? Select all that apply.

answer

Dalteparin Enoxaparin Tinzaparin

question

when discussing anticoagulants to a client, which of the following would the nurse include?

answer

Anticoagulants prevent formation of a thrombus Anticoagulants prevent extension of a thrombus

question

When reviewing the medical records of several clients, the nurse understands that the use of anticoagulants is contraindicated in clients with which of the following medical conditions? Select all that apply.

answer

Leukemia TB GI ulcers

question

A client is being discharged from the hospital with a prescription for clopidogrel. The nurse would instruct the client about which of the following as a possible adverse reaction? Select all that apply.

answer

Bleeding Heart palipatations Constipation Skin rash

question

Which assessment would the nurse obtain before administering an anticoagulant to a client with DVT? Select all that apply.

answer

Test for a pos. Homans sign Examine extremity for skin temp. Assess pain check for pedal pulse

question

When teaching a class about parenterally administered heparin, which of the following would the nurse include? Select all that apply.

answer

Onset of action is almost immediate Max effect occurs within 10 mins. Clotting time returns to NL within 4 hours

question

8. A client is receiving a heparin infusion. The nurse should check the needle site for the heparin infusion for signs of which of the following? Select all that apply.

answer

pain inflammation tenderness

question

When teaching a client how to inject heparin subcutaneously, which of the following would the nurse include? Select all that apply.

answer

Pinch a fold of skin Apply firm pressure after inj. Change sites for ea. dose hold the needle at 90 degrees

question

Which of the following may be ordered periodically during therapy with anticoagulants? Select all that apply.

answer

platelet count blood count stool analysis

question

11. A client is prescribed an anticoagulant. In which of the following situations would the nurse hold the drug and notify the physician? Select all that apply.

answer

PT exceeds 1.5 times the control value. Evidence of bleeding INR greater than 3.0

question

A client is being discharged on warfarin therapy. Which of the following would the nurse include in the teaching plan for the client? Select all that apply.

answer

Be consistent with your intake of foods containing vitamin K. Do not change brands of warfarin without consulting the physician. Take the drug at the same time every evening. Do not take or stop taking other medications except on the advice of the physician. Inform the dentist of therapy with warfarin prior to any treatment or procedure.

question

A client is receiving streptokinase. The nurse understands that which of the following would occur? Select all that apply.

answer

Breakdown of existing thrombi Reopening of occluded blood vessels Prevention of tissue necrosis

question

The nurse instructs a client receiving warfarin about the importance of consistent intake of dietary vitamin K to decrease fluctuations in PT/INR. The nurse determines that the client understands the instructions when he identifies which foods as containing vitamin K? Select all that apply.

answer

Broccoli Cauliflower Fish Yogurt

question

A female client is prescribed warfarin. The client also uses oral contraceptives. The nurse would assess the client closely for which of the following? Select all that apply.

answer

Subtherapeutic INR Calf pain and warmth

question

A nurse is conducting a seminar on thrombosis. What information would the nurse include about the cause of arterial thrombosis?

answer

arrhythmias

question

A client with thrombotic stroke is administered ticlopidine. The nurse would assess the client for which of the following?

answer

Dyspepsia

question

What is an AR of protamine?

answer

Bradycardia Dyspnea

question

A client with intermittent claudication is prescribed cilostazol by the primary health care provider. The nurse would expect to administer this drug cautiously if the client's history reveals which of the following?

answer

Pancytopenia

question

Anticoagulants are used for the prevention and treatment of ?

answer

pulmonary emboli the adjuvant treatment of myocardial infarction and the treatment of intermittent claudication.

question

A client is prescribed warfarin. The client also takes a diuretic for the treatment of cardiac problems. The nurse would anticipate which of the following?

answer

Decreased effectiveness of the anticoagulant

question

A client is receiving heparin by continuous IV infusion. Which of the following would be most appropriate for the nurse to do?

answer

Perform blood coagulation tests every 4 hours.

question

When administering heparin by the subcutaneous route what is done?

answer

an APTT test is performed 4 to 6 hours after the injection.

question

A nurse is caring for a client receiving the anticoagulant drug warfarin. Which assessment would be most appropriate before administering the drug?

answer

Assess prothrombin time (PT) and INR.

question

A female client is receiving an anticoagulant to prevent the formation and extension of blood clots. What instruction should the nurse include in the teaching plan for the client?

answer

use a reliable contraceptive

question

A client in a health care facility is receiving the thrombolytic drug reteplase. Which nursing diagnosis would be most likely?

answer

Anxiety

question

A nurse is caring for a client prescribed warfarin. The nurse would instruct the client that which of the following foods are high in vitamin K?

answer

Green leafy vegetables

question

A nurse is conducting an in-service presentation about hemostasis. The nurse determines that the teaching was successful when the class identifies a thrombus as which of the following?

answer

Formation of a blood clot

question

A nurse is reviewing a journal article about antiplatelet agents. Which of the following would the nurse expect to be discussed? Select all that apply.

answer

Abciximab Anagrelide Dipyridamole

question

A client is experiencing an overdosage of heparin. The nurse would expect to administer which of the following?

answer

Protamine

question

Clients on blood-thinning meds should be monitored for bleeding. Which of the following may indicate internal bleeding?

answer

Decreased BP Red spots on skin black, tarry stools

question

Why would dalteparin be prescribed?

answer

to prevent a DVT

question

hemostasis is best described as what?

answer

Events forming a clot, stopping bleeding

question

Evaluating a client who is taking an antocoagulant for blood loss would usually include assessing for which of the following?

answer

1. The presence of petechiae 2. Bleeding gums while brushing the teeth 3.Dark colored urine 4.The presence of ecchymotic areas 5. Loss of hair

question

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 has developed a rash. What is the nurse's highest priority action?

answer

Notify the provider; the medication will need to be discontinued.

question

Cilostazol (Pletal) belongs to which drug class?

answer

antiplatelet

question

A patient who is on enoxaparin (Lovenox) therapy has hematuria, melena, petechiae, and bleeding from the gums. Which treatment strategy will be most beneficial for the patient?

answer

Administering protamine sulfate (Protamine sulfate)

question

The nurse is administering tenecteplase (TNKase) therapy to a patient experiencing an acute myocardial infarction. What will the nurse teach the patient about this therapy?

answer

"This therapy will dissolve the clot that caused the heart attack."

question

What are glycoproteins that stimulate and regulate the production of erythrocytes?

answer

Erythropoiesis- Stimulating agents

question

two drugs to tx anemia associated with chronic illness are?

answer

Epoetin alfa (Epogen) Darbepoetin (Aranesp)

question

AR of erythropoietin drugs?

answer

Hypertension HA N/V/D Rashes Fatigue Arthralgia and skin reaction at Inj. site.

question

Epoetin alfa is CI in who?

answer

uncontrolled hypertension emergency transfusion hypersensitivity to human albumin

question

Darbepoetin alfa is CI in who?

answer

uncontrolled HBP

question

What can occur if the hemoglobin is not carefully monitored and the dosage is too high?

answer

polycythemia

question

what is the component in hemoglobin that picks up oxygen from lungs and delivers to body tissues?

answer

Iron

question

What may happen if Iron is delivered as IM?

answer

Brownish color on skin

question

When monitoring a patient taking epoetin alfa, which of the following laboratory results would be most important for the nurse to report immediately?

answer

any increase in hematocrit of 4 points within a 2 wk period

question

When teaching a patient about the use of vitamin b 12, the nurse would include which of the following statements?

answer

you will require vitamin b12 injections monthly for life

question

which drug can be used to treat ITP?

answer

Romiplostim

question

most common type of anemia?

answer

Iron deficiency anemia

question

Which substance would decrease the absorption of oral iron?

answer

antacids

question

Filgrastim is CI in which condition?

answer

hypothyroidism

question

Fluid and electrolytes make up what percentage of the body?

answer

50%

question

Which is the following of fluid overload?

answer

Behavioral changes

question

What may indicate hypocalcemia?

answer

tetany

question

What may indicate Hypernatremia?

answer

fever increased thirst

question

Common metabolic complication of TPN?

answer

hyperglycemia

question

When monitoring a client with an IV line, the nurse observes that the area around the needle insertion site is swollen and red. the first action would be to what?

answer

check for further possible extravastion

question

Which of the following IV solutions must be typed and crossmatched for administration?

answer

whole blood

question

a nurse administers calcium IV slowly based on the understanding that rapid IV administration of calcium can lead to which AR?

answer

Hypotension Bradycardia Cardiac arrest

question

A nurse caring for a client prescribed fat emulsions. The nurse would be alert for the development of which of the following?

answer

Increased body temp. chest and back pain slight pressure over eyes

question

What is a major intracellular fluid electrolyte?

answer

Potassium

question

Preparing to administer plasma protein fraction to a pt. The nurse understands that that drug is used to treat which of the following?

answer

hypovolemic shock

question

What is a major extracellular fluid electrolyte?

answer

Sodium

question

What may happen if Total parenteral nutrition (TPN) is being infused too rapidly?

answer

Hyperglycemia

question

If one has hypercalcemic syndrome, which of the following would support suspicion?

answer

Weakness Severe vomiting lethargy

question

What electrolyte is necessary for the transmission of impulses and contraction of smooth, cardiac, and skeletal muscles?

answer

Potassium

question

A pt. w/ chronic renal failure is prescribed darbepoetin alfa. After administration of the drug, the RN would assess for which AR?

answer

Arthragia Hypertension Rashes

question

Filgrastim (Neupogen) should be cautiously used in which people?

answer

Those with hypothyroidism

question

Oprelvekin (Neumega) is a drug that stimulates the process of making which following blood cell?

answer

platelets

question

What drug stimulates thrombopoiesis?

answer

Oprelvekin (Neumega)

question

Pt. with iron deficiency anemia who is prescribed iron. Which of the following should the nurse confirm to ensure that iron compunds are not contraindicated in this client?

answer

The pt. does not have hemochromatosis.

question

pt. dev. neutropenia secondary to chemotherapy. the RN would identify that this pt. is at risk for what?

answer

Infection

question

A pt. diagnosed with anemia. The nurse understands that anemia can result is which of the following?

answer

Decreased platelet production

question

Epoetin afla (Epoetin) is CI in which medical condition?

answer

Uncontrolled hypertension

question

A pt. suffering from anemia resulting from chronic kidney disease might be treated with which drug?

answer

Epoetin alfa (Epogen)

question

a client is prescribed which drug that acts on the hematopoietic cells to stimulate proliferation, differentiation, and maturation of WBC?

answer

Filgrastim (Neupogen)

question

A patient has been administered iron preparation for treating iron deficiency anemia. The patient has informed the nurse that she has also been taking ascorbic acid. Which of the following conditions should the nurse monitor for as a result of the interaction between iron and ascorbic acid?

answer

increased absorption of iron

question

A patient with megaloblastic anemia is to be administered leucovorin. For which of the following conditions is leucovorin contraindicated in this patient?

answer

pernicious anemia

question

A nurse is caring for a patient with hypertension who is prescribed epoetin for anemia. Which of the following interventions should the nurse perform when administering epoetin to this patient?

answer

Note the hematocrit value before each dose during therapy

question

A patient who was treated for anemia is being discharged. The patient has been instructed to continue with epoetin alfa for a week. Which of the following points should the nurse include in the teaching plan for therapy on an outpatient basis?

answer

Report to the primary health care provider on experiencing signs of joint pain

question

A patient is receiving folic acid for the treatment of megaloblastic anemia. The patient also tells the nurse she is takes hydantions. What does the nurse monitor for interactions of these two drugs

answer

increased seizure activity

question

a patient with chronic renal failure is prescribed darbepoetin alfa. What are the adverse effects.

answer

Rash, hypertension, arthralgia, headache, nausea, vomiting, fatigue, diarrhea

question

A patient with iron deficiency is prescribed Iron Dextan, the nurse should administer it cautiously under what conditions

answer

if the patient has asthma, allergies

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