Chapter 20: Review Qs, Evolve, Study Guide

Question 1

1. What is the main purpose of anticoagulation therapy?

A. To dissolve existing clots and improve blood flow B. To prevent a thrombus from becoming an embolus C. To prevent an embolus from becoming a thrombus D. To prevent clots from forming where they are not needed

Answer 1

D

Question 2

2. Which condition is a common indication for the use of an anticoagulant drug?

A. Pregnancy B. Brain surgery C. Atrial fibrillation D. Excessive bruising in an extremity after trauma

Answer 2

C

Question 3

3. Which of the following drugs or supplements makes the risk for bleeding worse when a patient is also taking an anticoagulant drug? Select all that apply.

A. Aspirin B. Caffeine C. Gingko biloba D. Nicotine E. Oral contraceptives F. St. John’s wort G. Vitamin C H. Vitamin K

Answer 3

A C F

Question 4

4. What agent is used as an antidote for a warfarin (Coumadin) overdose?

A. Phytonadione B. Protamine sulfate C. Vitamin C D. Vitamin K

Answer 4

D

Question 5

5. After bleeding, what is the most common adverse effect of most antiplatelet drugs?

A. Decreased platelet count B. Lowered seizure threshold C. Pulmonary embolism D. Formation of stomach ulcers

Answer 5

A

Question 6

6. What agent is used as an antidote for a heparin overdose?

A. Phytonadione B. Protamine sulfate C. Vitamin C D. Vitamin K

Answer 6

B

Question 7

7. Which action is essential before beginning continuous IV heparin therapy?

A. Have the laboratory draw an INR blood test. B. Get an accurate baseline patient weight. C. Make a sign that states, “No IM or subcutaneous injections.” D. Instruct the patient to remain on bed rest and use the call light.

Answer 7

B

Question 8

8. Which anticoagulant drug must be avoided during pregnancy because it can cause birth defects in the fetus?

A. Alteplase (Activase) B. Heparin (Hepalean) C. Warfarin (Coumadin) D. Rivaroxaban (Xarelto)

Answer 8

C

Question 9

9. Which laboratory test result indicates that an antiplatelet drug is effective?

A. International normalized ratio (INR) is increasing. B. Total red blood cell count is increasing. C. Platelet count is increasing. D. Platelet count is decreasing.

Answer 9

A

Question 10

10. Which action is important to prevent losing any part of the drug dose when administering low molecular weight heparin?

A. Not using dextrose in water to flush the IV line B. Not rubbing the injection site after injecting the drug C. Not expelling the air bubble before injecting the drug D. Not aspirating after inserting the needle into the injection site and before injecting the drug

Answer 10

C

Question 11

11. Why is the antiplatelet effect of aspirin longer lasting than that of other nonsteroidal anti-inflammatory drugs (NSAIDs)?

A. Aspirin irreversibly inhibits the production of TXA2, whereas NSAIDs cause reversible inhibition of this substance. B. Aspirin can be taken up to 6 times per day, and most NSAIDs can only be taken twice per day. C. Other NSAIDs have more effects on other tissues, but aspirin targets platelets specifically. D. Other NSAIDs are more rapidly metabolized and eliminated than is aspirin.

Answer 11

A

Question 12

12. Why is it important to teach the patient starting on the anticoagulant warfarin (Coumadin) to limit his or her intake of leafy green vegetables?

A. These foods contain vitamin K, which can increase the effects of warfarin. B. These foods contain vitamin K, which can reduce the effects of warfarin. C. These foods enhance aspirin activity and increase the risk for bleeding in the person who also takes warfarin. D. These foods reduce aspirin activity and increase the risk for pulmonary

Answer 12

B

Question 13

13. What is the major mechanism of action that allows thrombolytic drugs to dissolve clots?

A. Increasing the blood level of the enzyme plasmin B. Decreasing the blood level of the enzyme plasmin C. Increasing the blood level of antithrombin III D. Decreasing the blood level of antithrombin III

Answer 13

A

Question 14

14. Which problems, conditions, or drugs are absolute contraindications for thrombolytic therapy? Select all that apply.

A. Previous heart attack 5 years before B. Chronic use of oral contraceptives C. Recent head trauma D. Undergoing cancer chemotherapy E. Delivering a baby within the past 24 hours F. Received a blood transfusion within the past 2 weeks G. Receiving low-molecular-weight heparin within the past 24 hours H. Taking aspirin 81mg daily for the past 2 years

Answer 14

C E

Question 15

15. What is an intended response when a patient is prescribed epoetin alfa (Epogen)?

A. Red blood cell levels normalize. B. New blood clots do not form. C. Clotting time is increased. D. Thrombolytic events are prevented.

Answer 15

A

Question 16

A patient who has had a heart valve replacement takes warfarin (Coumadin) daily. The patient would require additional teaching if he or she selected which food items for lunch?

Spinach salad with bacon

Steak and baked potato

Beans and rice in a tortilla

Fried chicken and potato salad

Answer 16

Spinach salad with bacon

Some vegetables are rich in vitamin K (such as liver, green leafy vegetables, broccoli, and cauliflower) because vitamin K interferes with the action of warfarin. Steak and baked potato; beans, rice and tortillas; and fried chicken and potato salad do not contain large amounts of vitamin K and are acceptable to eat while taking warfarin.

Question 17

The nurse is caring for a patient admitted after a thrombolytic event. What patient is most at risk for this type of event?

Patient with an infection

Bedridden patient

Patient playing contact sports

Patient with liver disease

Answer 17

Bedridden patient

A patient most at risk for a thrombolytic event is one who has been on bed rest for a long period. Other patients at increased risk of thrombolytic events are those who have had surgery for knee or hip replacement, general abdominal surgery, and dialysis. A patient with an infection or with liver disease is not at increased risk for a thrombolytic event. A patient playing contact sports would be at risk for hemorrhage if he or she were on anticoagulant therapy, but not for a thrombolytic event.

Question 18

The nurse is performing an admission assessment on a patient admitted for thrombolytic therapy. The nurse knows that which condition is an absolute contraindication for thrombolytic therapy?

Endocarditis

Recent delivery of a baby

Active peptic ulcer disease

Pulmonary embolism

Answer 18

Recent delivery of a baby

Pregnancy or recent delivery (24 hours) is an absolute contraindication for thrombolytic therapy. Ask female patients of childbearing age if they are pregnant, breastfeeding, or planning to become pregnant. Also determine whether the patient has had a baby, a miscarriage, or an abortion within the past 24 hours. These bleeding conditions are made worse by drugs that disrupt blood clotting, which can lead to serious hemorrhage. Endocarditis, active peptic ulcer disease, and pulmonary embolism are not contraindications for thrombolytic therapy.

Question 19

The nurse is monitoring a patient who is receiving high-dose heparin therapy. What antidote must the nurse be sure is readily available?

Warfarin (Coumadin)

Vitamin K

Protamine sulfate

Aspirin

Answer 19

Protamine sulfate

The antidote to heparin therapy is IV protamine sulfate and should always be readily available for use. Warfarin and aspirin are anticoagulants and would increase any bleeding problems caused by heparin. Vitamin K is the antidote to the clotting factor synthesis inhibitor warfarin (Coumadin).

Question 20

The nurse has an order to administer a thrombopoiesis-stimulating agent oprelvekin (Neumega). How should this medication be administered?

Subcutaneously

Intravenously

Intradermally

Intramuscularly

Answer 20

Subcutaneously

Oprelvekin 50 mcg/kg is given subcutaneously once daily until the platelet count is greater than 50,000/mm3. Oprelvekin should never be administered intravenously, intradermally, or intramuscularly.

Question 21

The prescriber has ordered low-molecular-weight (LMW) heparin to be given to a patient. How is this drug administered?

Orally

Intramuscularly

Intravenously

Subcutaneously

Answer 21

Subcutaneously

LMW heparin should be given by deep subcutaneous injection with the patient lying down. To avoid losing any of the drug, do not expel the air bubble before injection. The needle should be inserted into a skinfold held between the thumb and forefinger. Remember to not aspirate before injection to avoid tissue damage. The skinfold should be held until the injection is completed. To avoid bruising, do not rub the injection site. Heparin is not administered orally or intramuscularly. Although heparin is often given intravenously, LMW heparin is administered subcutaneously.

Question 22

A patient who is taking warfarin (Coumadin) has an international normalized ratio (INR) of 1.0. What change in the warfarin dosage, if any, would the nurse expect?

The dose will increase.

The dose will decrease.

The dose will remain the same.

The therapy will stop.

Answer 22

The dose will increase.

This patient’s dose will need to be increased because the normal range for the INR is 0.8 to 1.2. A therapeutic range for a patient on Coumadin is generally considered to be 2.0 to 3.0. The international normalized ratio (INR) is a blood test used to monitor the effects of warfarin and determine an appropriate dose. Some patients may require higher or lower doses, depending on other medical conditions. An INR level of 1.0 is not too high, so the dose does not need to decrease. Although a level of 1.0 is normal for the average person, it is not normal for a patient who is on warfarin. There is no need to stop therapy for this patient.

Question 23

The nurse is caring for a patient who has been diagnosed with coronary artery disease. What is the most common antiplatelet drug the nurse would expect to see ordered for this patient?

Aspirin (Ecotrin)

Ticlopidine (Ticlid)

Clopidogrel (Plavix)

Tirofiban (Aggrastat)

Answer 23

Aspirin (Ecotrin)

Aspirin is the most commonly prescribed antiplatelet drug and comes in tablet, capsule, gum, and suppository forms. After a single dose of aspirin, clotting is reduced for at least 36 hours until fresh platelets that have not been exposed to aspirin are released into circulation from the spleen. Ticlopidine, Clopidogrel, and Tirofiban are not the most commonly prescribed antiplatelet drugs.

Question 24

During pregnancy, a woman requires anticoagulation therapy. Which drug is likely to be prescribed?

Warfarin (Coumadin)

Clopidogrel (Plavix)

Enoxaparin (Lovenox)

Epoetin alfa (Epogen)

Answer 24

Enoxaparin (Lovenox)

Warfarin is a clotting factor synthesis inhibitor. It is pregnancy category X and can cause birth defects and bleeding in an unborn child. Clopidogrel is an antiplatelet drug. Antiplatelet drugs should not be taken during the last 2 weeks of pregnancy because of the risk for bleeding before and after delivery. Enoxaparin is a low-molecular-weight heparin. Heparin does not cause birth defects and does not pass into breast milk. Heparin is the drug of choice when anticoagulant therapy is required during pregnancy. Epoetin alfa is a colony-stimulating factor. This drug improves blood clotting.