Ph. Ch 26 Drugs used to Treat Thromboembolic Disorders

Question 1

drug class that inhibits platelet aggregation

Answer 1

Platelet inhibitors

Question 2

drug class that is active against factor Xa and thrombin

Answer 2

anticoagulants

Question 3

triggered by sources outside the blood vessels, such as tissue extract or thromboplastin

Answer 3

extrinsic clotting pathway

Question 4

drug class that inhibits thrombin, preventing the conversion of fibrinogen to fibrin

Answer 4

Thrombin inhibitors

Question 5

drug class that acts by blocking receptors on platelets,
preventing clot formation

Answer 5

glycoprotein Ilb/Illainhibitors

Question 6

a small fragment of a thrombus that breaks off

Answer 6

Embolus

Question 7

drug class that causes the dissolution of fibrin clots

Answer 7

fibrinolytic agents

Question 8

a fibrin blood clot

Answer 8

Thrombus

Question 9

activated when a blood vessel is injured and collagen in the
vessel wall is exposed

Answer 9

intrinsic clotting pathway

Question 10

Scenario #1: An 82-year-old patient was admitted to the
hospital with a stroke. The patient has a history of atrial
fibrillation and noncompliance with medications.

Objective: Describe conditions that place an
individual at risk for developing blood clots and
nursing interventions used to prevent these
conditions.

NCLEX item type: multiple response
Cognitive skill: application

The nurse recognizes that certain conditions put
patients at risk for developing blood clots. Which
patient conditions will the nurse recognize as potential risks? (Select all that apply.) (417)

1.Pulmonary embolism
2. Certain types of cancers
3. Pregnancy and oral contraceptives
4. Immobilization or trauma of the lower limbs
5. Surgery and postoperative period

Answer 10

2 Certain types of cancers
3 Pregnancy and oral contraceptives
4 Immobilization or trauma of the lower limbs
5 Surgery and postoperative period

Question 10

Scenario #1: An 82-year-old patient was admitted to the
hospital with a stroke. The patient has a history of atrial
fibrillation and noncompliance with medications.

Objective: Describe conditions that place an
individual at risk for developing blood clots and
nursing interventions used to prevent these
conditions.

NCLEX item type: multiple response
Cognitive skill: application

The nurse recognizes that certain conditions put
patients at risk for developing blood clots. Which
patient conditions will the nurse recognize as potential risks? (Select all that apply.) (417)

1.Pulmonary embolism
2. Certain types of cancers
3. Pregnancy and oral contraceptives
4. Immobilization or trauma of the lower limbs
5. Surgery and postoperative period

Answer 10

2 Certain types of cancers
3 Pregnancy and oral contraceptives
4 Immobilization or trauma of the lower limbs
5 Surgery and postoperative period

Question 11

NCLEX item type: multiple response
Cognitive skill: interpret

The nurse recognizes that the patient in scenario #1 is at risk for developing a clot that breaks off and
creates a pulmonary embolism because of what factors? (Select all that apply.) (419)

1. The patient is noncompliant with medications.
2. The patient is taking medications on a regular
   basis.
3. The patient has atrial fibrillation, which is known to cause blood clots.
4. The patient walks slowly because of advanced
   age and it slows the blood flow.
5. The healthcare provider had not prescribed the
   correct medications to prevent a blood clot.

Answer 11

1. The patient is noncompliant with medications.
2. The patient has atrial fibrillation, which is known to cause blood clots.

Question 12

NCLEX item type: multiple response
Cognitive skill: application

The nurse will perform which nursing actions to help prevent the formation of a clot in those patients who are at risk for developing blood clots? (Select all that apply.) (418)

1. Restrict fluid intake to 1 liter/day.
2. Assess perfusion of extremities.
3. Flex the patient’s knees when on bedrest.
4. Administering anticoagulants as ordered
5. Apply sequential compression devices as prescribed by the healthcare provider.

Answer 12

1 Restrict fluid intake to 1 liter/day.
2 Assess perfusion of extremities.
4 Administering anticoagulants as ordered

Question 13

NCLEX item type: multiple choice
Cognitive skill: knowledge

The nurse knows that when a small fragment of a thrombus breaks off and circulates until it becomes trapped causing a cerebral embolism, the treatment of choice would be to use what class of drug? (424)

1. Anticoagulant
2. Thrombin inhibitor
3. Platelet inhibitor
4. Fibrinolytic agent

Answer 13

Fibrinolytic agent

Question 14

NCLEX item type: extended multiple response
Cognitive skill: recognize cues

The nurse explains to the patient in scenario #1 that there are medications used to prevent clot formation for patients with atrial fibrillation. Which drugs would the nurse expect the patient to be prescribed?

1. aspirin
2. clopidogrel
3. prasugrel
4. apixaban
5. dalteparin
6. warfarin

Answer 14

clopidogrel
apixaban
warfarin

Question 15

NCLEX item type: multiple response
Cognitive skill: generate solutions

When patients are receiving anticoagulant therapy, the nurse should instruct them on which measures to prevent clot formation? (Select all that apply.) (420)

1. Regular ambulation
2. Not to flex the knees
3. Active or passive leg exercises
4. Placing pressure against the popliteal space
   behind the knees
5. Standing or sitting motionless for prolonged
   periods of time

Answer 15

Regular ambulation
Not to flex the knees
Active or passive leg exercises

Question 16

NCLEX item type: multiple choice
Cognitive skill: compare

The nurse recognizes that the thrombin inhibitor dabigatran (Pradaxa) has which major advantage over anticoagulants used for reducing the risk of stroke or systemic embolism? (434)

1. When metabolized, it takes the form of four active metabolites
2. The capsules are taken two times daily with or without food
3. The drug does not require monitoring of blood tests to adjust the dosage
   4.Baseline blood pressure readings need to be obtained supine and standing

Answer 16

The drug does not require monitoring of blood tests to adjust the dosage

Question 17

Scenario # 2: A patient on the surgical floor recovering from orthopedic surgery was prescribed bedrest for two days. The nurse caring for the patient implemented nursing cares to prevent post-operative complications.

Objective: Describe specific monitoring procedures and laboratory data used to detect hemorrhage in the patient taking anticoagulants.

NCLEX item type: multiple response
Cognitive skill: take action

Which premedication assessments should be performed by the nurse before administering aspirin as a platelet inhibitor? (Select all that apply.) (421)

1. Monitor serum potassium levels
2. Perform a neurologic assessment
3. Observe for any gastrointestinal symptoms
4. Determine any concurrent use of antihypertensives
5. Get a baseline serum glucose if on oral hypoglycemic

Answer 17

Perform a neurologic assessment
Observe for any gastrointestinal symptoms
Get a baseline serum glucose if on oral hypoglycemic

Question 18

NCLEX item type: multiple choice
Cognitive skill: interpret

What therapeutic response does the nurse need to
monitor when patients are on warfarin (Jantoven)?
(432)

1. Occult blood will be evident in stools.
2. Urine may appear red, smoke-colored, or
   brownish.
3. The prothrombin time (PT) or INR results will
   be within the recommended range.
4. The skin and mucous membranes will have
   petechiae, ecchymosis, or hematomas.

Answer 18

The prothrombin time (PT) or INR results will be within the recommended range.

Question 19

NCLEX item type: multiple choice
Cognitive skill: illustrate

Which adverse effect from warfarin (antoven) does the nurse monitor for that indicates the patient is bleeding under the skin? (433)

1. Anemia
2. Petechiae
3. Hematuria
4. Thrombocytopenia

Answer 19

Petechiae

Question 20

NCLEX item type: multiple response
Cognitive skill: application

A prescription for subcutaneous heparin for the patient in scenario #2 was received by the nurse, who will prepare and administer the drug after reviewing which precautions? (Select all that apply.) (428)

1. Plan to use the abdominal area.
2. Avoid rotating sites of injection.
3. Obtain the correct needle length–usually 1/2 inch.
4. Avoid an area of 2 inches around the umbilicus.
5. After injecting the drug, massage the area for 10 seconds.

Answer 20

Avoid rotating sites of injection.
Obtain the correct needle length–usually 1/2 inch.
Avoid an area of 2 inches around the umbilicus.
After injecting the drug, massage the area for 10 seconds.

Question 21

NCLEX item type: multiple response
Cognitive skill: evaluate outcomes

The nurse will observe for which specific events to detect for internal bleeding in patients on IV heparin? (Select all that apply.) (429)

1. Paresthesias
2. Increasing pulse
3. Cold, clammy skin
4. Decreasing blood pressure
5. Disoriented sensorium

Answer 21

Increasing pulse
Cold, clammy skin
Decreasing blood pressure
Disoriented sensorium

Question 22

NCLEX item type: multiple choice
Cognitive skill: knowledge

When administering heparin, the nurse knows that this drug can be administered by which routes? (428)
1. Orally, IM, IV
2. Subcutaneously, IV
3. IM, subcutaneously, IV
4. Orally, subcutaneously, IV

Answer 22

Subcutaneously, IV

Question 23

Objective: Describe the nursing assessments needed to monitor therapeutic response and adverse effects
from anticoagulant therapy.

NCLEX item type: multiple response
Cognitive skill: application

The therapeutic effect of heparin is monitored by the nurse with which laboratory tests? (Select all that apply.) (428)

1. Protime
2. Platelets
3. PTT
4. Anti-factor Xa
5. Hematocrit

Answer 23

PTT
Anti-factor Xa

Question 24

NCLEX item type: multiple response
Cognitive skill: take action

Nurses will educate the patient in scenario #1 on what to report when on Jantoven therapy and include which symptoms, which may indicate a need to check the INR? (Select all that apply.) (433)

1. Black tarry stools
2. Nosebleeds
3. Claudication
4. Petechiae
5. Coffee-ground or blood-tinged vomitus

Answer 24

Black tarry stools
Nosebleeds
Petechiae
Coffee-ground or blood-tinged vomitu

Question 25

NCLEX item type: multiple response
Cognitive skill: application

The nurse educates the patient taking apixaban (Eliquis) on which adverse effects that need to be reported? (Select all that apply.) (426)

1. Ataxia
2. Nystagmus
3. Hematuria
4. Easy bruising
5. Black tarry stools

Answer 25

Hematuria
Easy bruising
Black tarry stools

Question 26

NCLEX item type: multiple choice
Cognitive skill: knowledge

What is the normal therapeutic range of INR that the nurse will monitor for warfarin Jantoven) therapy on a patient with a mechanical prosthetic heart valve? (432)

1. 15-2.0
2. 2.0-3.0
3. 2.5-3.5
4. 3.0-3.5

Answer 26

2.5 - 3.5