Chapter 26 - Coagulation Modifier Drugs

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Chapter 26 - Coagulation Modifier Drugs
updated 1 year ago by mens05
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1

The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin (Hemochron)?

  1. Complete blood count
  2. Activated partial thromboplastin time (aPTT)
  3. Blood urea nitrogen
  4. Prothrombin time (PT)

B. Activated partial thromboplastin time (aPTT)

2

The nurse is caring for a patient admitted with gastrointestinal bleeding who is anticoagulated with warfarin (Coumadin). Which medication should the nurse anticipate administering?

  1. Vitamin E
  2. Vitamin K (Phytonadione)
  3. Protamine (Protamine sulfate)
  4. Calcium gluconate

B. Vitamin K (Phytonadione)

3

The nurse notes a patient’s international normalized ratio (INR) value of 2.5. What is the meaning of this reported value?

  1. The patient’s warfarin dose is within the therapeutic range.
  2. The patient needs the subcutaneous heparin dose increased.
  3. The patient is not receiving enough warfarin for a therapeutic effect.
  4. The patient is receiving too much heparin and is at risk for bleeding.

A. The patient’s warfarin dose is within the therapeutic range.

4

The nurse is giving discharge instructions to a patient prescribed warfarin (Coumadin) for atrial fibrillation. Which statement by the patient indicates a need for further instruction from the nurse?

  1. “I will take my medication in the early evening each day.”
  2. “I will contact my health care provider if I develop excessive bruising.”
  3. “I will increase the dark green leafy vegetables in my diet.”
  4. “I will avoid activities that have a risk for injury such as contact sports.”

C. “I will increase the dark green leafy vegetables in my diet.”

5

Which medication is an antiplatelet drug?

  1. Clopidogrel (Plavix)
  2. Alteplase (Activase)
  3. Enoxaparin (Lovenox)
  4. Heparin (Hemochron)

A. Clopidogrel (Plavix)

6

The nurse is preparing a patient with acute chest pain for an emergency angioplasty. The nurse would anticipate administering which medication to prevent platelet aggregation?

  1. Warfarin (Coumadin)
  2. Aminocaproic acid (Amicar)
  3. Protamine (Protamine sulfate)
  4. Tirofiban (Aggrastat)

D. Tirofiban (Aggrastat)

7

Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This medication is in which drug class?

  1. Oral anticoagulant
  2. Glycoprotein IIb/IIIa inhibitor
  3. Low-molecular-weight heparin
  4. Thrombolytic drug

C. Low-molecular-weight heparin

8

The patient asks the nurse, “What is the difference between dalteparin (Fragmin) and heparin?” What is the nurse’s best response?

  1. “Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect.”
  2. “The only difference is that the heparin dosage calculation is based on the patient’s weight.”
  3. “There is really no difference, but dalteparin is preferred because it is less expensive.”
  4. “I’m not really sure why some health care providers choose dalteparin and some heparin.”

A. “Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect.”

9

Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin?

  1. Vitamin K (Phytonadione)
  2. Protamine (Protamine sulfate)
  3. Phenytoin (Dilantin)
  4. Vitamin E

B. Protamine (Protamine sulfate)

10

A patient who is prescribed an anticoagulant requests an aspirin (acetylsalicylic acid) for headache relief. What is the nurse’s best action?

  1. Administer 650 mg of acetylsalicylic acid and reassess pain in 30 minutes.
  2. Inform the patient of potential drug interactions with anticoagulants.
  3. Explain that a common initial adverse effect is a headache for this drug.
  4. Explain that acetylsalicylic acid is contraindicated and administer ibuprofen.

B. Inform the patient of potential drug interactions with anticoagulants.

11

A patient is prescribed oral anticoagulant therapy while still receiving IV heparin infusion. The patient is concerned about risk for bleeding. What is the nurse’s best response?

  1. “Bleeding is a common adverse effect of taking warfarin. If bleeding occurs, your health care provider will prescribe an injection of medication to stop the bleeding.”
  2. “Because of your mechanical valve replacement, it is especially important for you to be fully anticoagulated, and the heparin and warfarin together are more effective than one alone.”
  3. “Because you are now getting out of bed and walking around, you have a higher risk of blood clot formation and therefore need to be on both medications.”
  4. “It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin infusion is continued to help prevent blood clots until the warfarin reaches its therapeutic effect.”

D. “It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin infusion is continued to help prevent blood clots until the warfarin reaches its therapeutic effect.”

12

The nurse determines the patient has a good understanding of the discharge instructions regarding warfarin (Coumadin) with which patient statement?

  1. “I will double my dose if I forget to take it the day before.”
  2. “I should keep taking ibuprofen for my arthritis.”
  3. “I should use a soft toothbrush for dental hygiene.”
  4. “I should decrease the dose if I start bruising easily.”

C. “I should use a soft toothbrush for dental hygiene.”

13

While observing a patient self-administer enoxaparin (Lovenox), the nurse identifies the need for further teaching when the patient performs which self-injection action?

  1. Massages the site after administration of the medication
  2. Does not aspirate before injecting the medication
  3. Administers the medication into subcutaneous (fatty) tissue
  4. Injects the medication greater than 2 inches away from the umbilicus

A. Massages the site after administration of the medication

14

The nurse recognizes that the patient understands the teaching about warfarin (Coumadin) when the patient verbalizes an increased risk of bleeding with concurrent use of which herbal product? Select all that apply.

  1. Garlic
  2. St. John’s wort
  3. Glucosamine
  4. Dong quai
  5. Ginkgo

A. Garlic

B. St. John’s wort

D. Dong quai

E. Ginkgo

15

For a patient receiving an IV infusion of alteplase (Activase), which nursing actions should be taken? Select all that apply.

  1. Record vital signs and report changes.
  2. Assess for cardiac dysrhythmias.
  3. Observe for signs and symptoms of bleeding.
  4. Administer injections intramuscularly.
  5. Monitor for an increase in liver enzymes.

A. Record vital signs and report changes.

B. Assess for cardiac dysrhythmias.

C. Observe for signs and symptoms of bleeding.