Ph. Ch 26 Drugs used to Treat Thromboembolic Disorders Flashcards
drug class that inhibits platelet aggregation
Platelet inhibitors
drug class that is active against factor Xa and thrombin
anticoagulants
triggered by sources outside the blood vessels, such as tissue extract or thromboplastin
extrinsic clotting pathway
drug class that inhibits thrombin, preventing the conversion of fibrinogen to fibrin
Thrombin inhibitors
drug class that acts by blocking receptors on platelets,
preventing clot formation
glycoprotein Ilb/Illainhibitors
a small fragment of a thrombus that breaks off
Embolus
drug class that causes the dissolution of fibrin clots
fibrinolytic agents
a fibrin blood clot
Thrombus
activated when a blood vessel is injured and collagen in the
vessel wall is exposed
intrinsic clotting pathway
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
2 Certain types of cancers
3 Pregnancy and oral contraceptives
4 Immobilization or trauma of the lower limbs
5 Surgery and postoperative period
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
2 Certain types of cancers
3 Pregnancy and oral contraceptives
4 Immobilization or trauma of the lower limbs
5 Surgery and postoperative period
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)
- The patient is noncompliant with medications.
- The patient is taking medications on a regular
basis. - The patient has atrial fibrillation, which is known to cause blood clots.
- The patient walks slowly because of advanced
age and it slows the blood flow. - The healthcare provider had not prescribed the
correct medications to prevent a blood clot.
- The patient is noncompliant with medications.
- The patient has atrial fibrillation, which is known to cause blood clots.
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)
- Restrict fluid intake to 1 liter/day.
- Assess perfusion of extremities.
- Flex the patient’s knees when on bedrest.
- Administering anticoagulants as ordered
- Apply sequential compression devices as prescribed by the healthcare provider.
1 Restrict fluid intake to 1 liter/day.
2 Assess perfusion of extremities.
4 Administering anticoagulants as ordered
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)
- Anticoagulant
- Thrombin inhibitor
- Platelet inhibitor
- Fibrinolytic agent
Fibrinolytic agent
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?
- aspirin
- clopidogrel
- prasugrel
- apixaban
- dalteparin
- warfarin
clopidogrel
apixaban
warfarin
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)
- Regular ambulation
- Not to flex the knees
- Active or passive leg exercises
- Placing pressure against the popliteal space
behind the knees - Standing or sitting motionless for prolonged
periods of time
Regular ambulation
Not to flex the knees
Active or passive leg exercises
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)
- When metabolized, it takes the form of four active metabolites
- The capsules are taken two times daily with or without food
- 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
The drug does not require monitoring of blood tests to adjust the dosage
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)
- Monitor serum potassium levels
- Perform a neurologic assessment
- Observe for any gastrointestinal symptoms
- Determine any concurrent use of antihypertensives
- Get a baseline serum glucose if on oral hypoglycemic
Perform a neurologic assessment
Observe for any gastrointestinal symptoms
Get a baseline serum glucose if on oral hypoglycemic
NCLEX item type: multiple choice
Cognitive skill: interpret
What therapeutic response does the nurse need to
monitor when patients are on warfarin (Jantoven)?
(432)
- Occult blood will be evident in stools.
- Urine may appear red, smoke-colored, or
brownish. - The prothrombin time (PT) or INR results will
be within the recommended range. - The skin and mucous membranes will have
petechiae, ecchymosis, or hematomas.
The prothrombin time (PT) or INR results will be within the recommended range.
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)
- Anemia
- Petechiae
- Hematuria
- Thrombocytopenia
Petechiae
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)
- Plan to use the abdominal area.
- 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.
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.
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)
- Paresthesias
- Increasing pulse
- Cold, clammy skin
- Decreasing blood pressure
- Disoriented sensorium
Increasing pulse
Cold, clammy skin
Decreasing blood pressure
Disoriented sensorium
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
Subcutaneously, IV
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)
- Protime
- Platelets
- PTT
- Anti-factor Xa
- Hematocrit
PTT
Anti-factor Xa
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)
- Black tarry stools
- Nosebleeds
- Claudication
- Petechiae
- Coffee-ground or blood-tinged vomitus
Black tarry stools
Nosebleeds
Petechiae
Coffee-ground or blood-tinged vomitu
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)
- Ataxia
- Nystagmus
- Hematuria
- Easy bruising
- Black tarry stools
Hematuria
Easy bruising
Black tarry stools
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)
- 15-2.0
- 2.0-3.0
- 2.5-3.5
- 3.0-3.5
2.5 - 3.5
