Lilley Chapter 27: Coagulation Modifier Drugs Flashcards
The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin?
A. Blood urea nitrogen
B. Complete blood count
C. Activated partial thromboplastin time (aPTT)
D. Prothrombin time (PT)
C. Activated partial thromboplastin time (aPTT)
Heparin dosing is based on aPTT results. The PT is reflective of warfarin’s anticoagulant effect.
The nurse is caring for a patient admitted with gastrointestinal bleeding who is anticoagulated with warfarin (Coumadin®). Which medication should the nurse anticipate administering?
A. Vitamin E
B. Calcium gluconate
C. Vitamin K (phytonadione)
D. Protamine
C. Vitamin K (phytonadione)
Vitamin K is the antagonist for warfarin.
The nurse notes a patient’s international normalized ratio (INR) value of 2.5. Which of the following is the meaning of this reported value?
A. The patient’s warfarin dose is within the therapeutic range.
B. The patient is not receiving enough warfarin for a therapeutic effect.
C. The patient needs the subcutaneous heparin dose increased.
D. The patient is receiving too much heparin and is at risk for bleeding.
A. The patient’s warfarin dose is within the therapeutic range.
INR determination is a routine test to evaluate coagulation while patients are taking warfarin, not heparin. A therapeutic INR is 2 to 3.
The nurse is giving discharge instructions to a patient prescribed warfarin for atrial fibrillation. Which statement by the patient indicates a need for further instruction from the nurse?
A. “I will take my medication in the early evening each day.”
B. “I will avoid activities that have a risk for injury, such as contact sports.”
C. “I will contact my health care provider if I develop excessive bruising.”
D. “I will increase the dark green leafy vegetables in my diet.”
D. “I will increase the dark green leafy vegetables in my diet.”
Dark green leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Therefore, it is important to maintain a consistent daily intake of vitamin K and avoid eating large amounts of these foods.
Which medication is an antiplatelet drug?
A. clopidogrel (Plavix®)
B. enoxaparin (Lovenox®)
C. alteplase (Activase®)
D. Heparin
A. clopidogrel (Plavix®)
Clopidogrel (Plavix) is an antiplatelet drug. Enoxaparin and heparin are anticoagulants. Alteplase is a thrombolytic drug.
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?
A. tirofiban (Aggrastat®)
B. Aminocaproic acid
C. warfarin (Coumadin)
D. Protamine (protamine sulphate)
A. tirofiban (Aggrastat®)
Tirofiban is a glycoprotein IIb/IIIa inhibitor that blocks the enzyme essential for platelet aggregation. It is given to prevent the formation of further clots and is faster-acting than warfarin. Protamine sulphate is the antagonist for heparin, not an anticoagulant. Aminocaproic acid is an antifibrinolytic, the opposite of what is needed in this situation.
Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. What type of drug is this medication?
A. A low-molecular-weight heparin
B. A thrombolytic drug
C. An oral anticoagulant
D. A glycoprotein IIb/IIIa inhibitor
A. A low-molecular-weight heparin
Enoxaparin is a low-molecular-weight heparin.
The patient asks the nurse, “What is the difference between dalteparin and heparin?” What is the nurse’s best response?
A. “There is really no difference, but dalteparin is preferred because it is less expensive.”
B. “Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect.”
C. “The only difference is that the heparin dosage calculation is based on the patient’s weight.”
D. “I’m not really sure why some health care providers choose dalteparin and some choose heparin.”
B. “Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect.”
A low-molecular-weight heparin is more predictable in its effect than regular heparin. Dalteparin is more expensive than heparin and is dosed based on the patient’s weight.
Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin?
A. Phenytoin
B. Vitamin E
C. Protamine (protamine sulphate)
D. Vitamin K (phytonadione)
C. Protamine (protamine sulphate)
Protamine sulphate binds with heparin in the bloodstream to inactivate it and thus reverse its effect.
A patient who is prescribed an anticoagulant requests an aspirin (acetylsalicylic acid) for headache relief. What is the nurse’s best action?
A. Explain that a common initial adverse effect of this drug is headache.
B. Explain that acetylsalicylic acid is contraindicated, and administer ibuprofen.
C. Inform the patient of potential drug interactions with anticoagulants.
D. Administer 650 mg of acetylsalicylic acid and reassess pain in 30 minutes.
C. Inform the patient of potential drug interactions with anticoagulants.
Patients taking an anticoagulant should not use medications that would further increase the risk of bleeding.
A patient is prescribed oral anticoagulant therapy (Warfarin) while still receiving intravenous (IV) heparin infusion. The patient is concerned about the risk for bleeding. What is the nurse’s best response?
A. “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.”
B. “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.”
C. “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. “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.”
C. “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.”
Warfarin works by decreasing the production of clotting factors. However, it takes 4 to 5 days for the body to use up the present clotting factors and thus achieve a full therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved.
Which statement of the patient tells the nurse that the patient has a good understanding of the discharge instructions regarding warfarin?
A. “I will double my dose if I forget to take it the day before.”
B. “I should use a soft toothbrush for dental hygiene.”
C. “I should keep taking ibuprofen for my arthritis.”
D. “I should decrease the dose if I start bruising easily.”
B. “I should use a soft toothbrush for dental hygiene.”
The patient should reduce the risk of bleeding by using, for example, a soft toothbrush. The other choices are inaccurate.
While observing a patient self-administer enoxaparin (Lovenox), the nurse identifies the need for further teaching when the patient does which of the following?
A. Massages the site after administering the medication
B. Does not aspirate before injecting the medication
C. Administers the medication into subcutaneous (fatty) tissue
D. Injects the medication more than 2 inches away from the umbilicus
A. Massages the site after administering the medication
It is not recommended to massage the area of injection of anticoagulants because of the increased risk of hematoma formation.
