chapter 20-agents affecting blood clotting

Question 1

The client is receiving heparin by continuous intravenous infusion. While getting out of bed, the client lacerates her arm on the bed rail. The laceration begins to bleed profusely. What is the first action of the nurse?

Answer 1

Apply pressure to the site.

This is the nurse’s first action as basic application of first aid.

Question 2

The nurse is preparing to administer aminocaproic acid to a client. The nurse understands that this agent:

Answer 2

stops the flow of blood. Aminocaproic acid is a hemostatic agent used to stop the flow of blood.

Question 3

The nurse is preparing to instill which agent to clear fibrin from the client’s central venous catheters?

Answer 3

Urokinase- is a thrombolytic agent used to clear fibrin from CVADs.

Question 4

The client is prescribed warfarin 7.5 mg daily. The medication is supplied as 5 mg tablets. How many tablet(s) should the client receive?

Answer 4

1 1/2-7.5 mg divided by 5 mg = 1.5 tablets = 1 1/2 tablets

Question 5

Alteplase is administered to a client following the diagnosis of acute myocardial infarction. The nurse realizes that for effectiveness the alteplase treatment begins within:

Answer 5

4 to 6 hours

For the most benefit, alteplase should be administered within 4 to 6 hours.

Question 6

The client was prescribed both heparin and warfarin sodium (Coumadin). What is the rationale for using both of these anticoagulants?

Answer 6

It takes time before the action of oral anticoagulants is evident.
For rapid effects, heparin is needed because it takes time for oral hypocoagulants to produce results.

Question 7

The client who is experiencing an overdose of heparin overdosage may be treated by:

Answer 7

protamine sulfate.

Question 8

Heparin is prescribed in:

Answer 8

USP units.

Question 9

A client is prescribed heparin injections. Which route should the nurse question?

Answer 9

IM injections should not be given, because of the risk of hematoma formation.

Question 10

A desirable end point for oral anticoagulant therapy is a prothrombin time that is what multiple of the control value?

Answer 10

2- The desirable end point is two times the control value.

Question 11

To assess the effectiveness of heparin therapy, the nurse looks up what lab value?

Answer 11

partial thromboplastin time (PTT)

Question 12

A new graduate in orientation prepares to administer heparin subcutaneous. Which action of this nurse would indicate a need for further instruction?

Answer 12

aspirating to be certain the needle is not in a blood vessel

Question 13

A client has experienced a toxic ingestion of warfarin. The nurse anticipates what antidote to be prescribed?

Answer 13

vitamin K1

Question 14

The nurse evaluates the understanding of the predischarge client receiving warfarin. Which comment indicates further teaching is needed?

Answer 14

“I should eat lots of dark green, leafy vegetables to increase my vitamin K1.”

Question 15

A client is receiving an oral anticoagulant. Before the next dose of an oral anticoagulant, the nurse notes that the prothrombin time (PT) is 32 seconds. The nurse should

Answer 15

notify the health care provider.

Question 16

In assessing for indications of excessive use of anticoagulants by the client, the nurse monitors for:

Answer 16

headache and vertigo. These indicate changes in neurologic status, a sign of increased bleeding.

Question 17

The nursing student asks if there is a concern related to administration of vitamin K1. The nurse replies that:

Answer 17

“Yes, because it can exert prolonged undesirable effects on future anticoagulation.”

This is the reason for concern about the administration of vitamin K1 for oral anticoagulant toxicity.

Question 18

The client asks the nurse about drug interactions with oral anticoagulants. The nurse indicates which of the following is known to interact with oral anticoagulants?

Answer 18

Aspirin- increases the activity of oral anticoagulants.

Question 19

The client asks the nurse if clopidogrel bisulfate works like heparin. The nurse replies:

Answer 19

“No, clopidogrel acts by decreasing platelets’ ability to form clots.”

Clopidogrel decreases the platelets’ ability to aggregate, while heparin acts by interfering with prothrombin conversion to thrombin.

Question 20

The nurse understands that desmopressin acetate (DDAVP) is a natural hormone produced by the:

Answer 20

posterior pituitary. DDAVP is produced by the posterior pituitary.

Question 21

The nurse understands that enoxaparin is frequently used for:

Answer 21

prophylaxis for DVT in clients undergoing hip replacements.
Correct: Deep vein thrombosis (DVT) is the most common complication associated with joint replacement, so enoxaparin is used as DVT prophylaxis.

Question 22

The nurse notes that the client understands information given about thrombolytic therapy when the client makes which of the following statements?

Answer 22

“These drugs can break down clots to help reestablish blood flow in a vessel.”

Question 23

The nurse wants to avoid administering a subcutaneous dose of heparin intramuscularly. Which of the following actions by the nurse will most effectively reduce the chances of IM administration?

Answer 23

The nurse should administer the drug in the abdomen.

Question 24

The nurse is providing client education about anticoagulant therapy prior to the client’s discharge. Which of the following statements by the client indicates a need for further teaching?

Answer 24

“I will still be able to use my grandfather’s straightedge razor if I’m careful.”

Clients on anticoagulant therapy should use electric razors.

Question 25

The nurse is preparing to administer heparin via a saline lock. The nurse should perform all of the following actions EXCEPT:

Answer 25

remove the saline lock cap before administration.

Question 26

The lab test to evaluate the effectiveness of heparin therapy is used because it demonstrates the action of heparin in interfering with the conversion of:

Answer 26

prothrombin to thrombin
The actual partial thromboplastin time measures how effectively heparin interferes with the conversion of prothrombin to thrombin.

Question 27

The nurse would question which of the following prescriptions for a client receiving subcutaneous heparin?

Answer 27

discontinue digoxin- Because of digoxin’s positive inotropic action in treating heart failure, this drug should not be discontinued, even though it may decrease the effects of heparin. The heparin dose should be increased to compensate.

Question 28

The nurse is preparing to administer enoxaparin 30 mg to a client following a total knee replacement. The nurse should:

Answer 28

administer at a 90-degree angle.

Question 29

A child with hemophilia A is having surgery. The nurse would anticipate what medication to be prescribed for this child?

Answer 29

desmopressin acetate ( DDAVP has been shown to increase factor VIII within 30 minutes after IV administration.

Question 30

The nurse is preparing to initiate continuous infusion heparin. The nurse should:

Answer 30

set up a volumetric infusion pump.

Question 31

Which of the following is NOT true of the parenteral anticoagulant heparin?

Answer 31

The client should be instructed to continue to take NSAIDs as prior to heparin therapy.

Question 32

Which of the following statements by the client indicates a need for further education concerning Aggrastat?

Answer 32

“I can continue to smoke if I do not exceed one-half pack per day.”

Question 33

Which of the following client comments would indicate a need for further teaching about oral anticoagulant therapy? Select all that apply.

Answer 33

a. “I take only 81 mg of aspirin a day.”
b. “I should take my pills before meals.”
f. “I can continue taking my garlic tablets.”

Question 34

The client receiving Arixtra would be monitored for which of the following? Select all that apply.

Answer 34

b. nausea and vomiting
e. insomnia
f. headache

Question 35

The client is receiving tPA. Which of the following indicate correct procedure during this medication regimen? Select all that apply.

Answer 35

c. A baseline ECG is obtained.
d. The client’s urine is monitored for blood.
e. Assess for history of hypertension.
f. Assess neuro status every hour until clotting times are WDL.

Question 36

Prescribed is heparin 5,000 units SC every 12 hours. The pharmacy sends a prefilled syringe of 10,000 units of heparin per mL. The nurse should administer what volume of medication?

Answer 36

0.5 mL

10,000 units/1 mL = 5,000 units/0.5 mL