Unit4:Chapter 48 (Karch 7th Ed) - Drugs Affecting Blood Coagulation

Question 1

A patient is admitted to the hospital with deep vein thrombosis. A 10,000-unit dose of heparin is
administered subcutaneously. What drug does the nurse keep on hand to reverse the effects of heparin
if the patient begins to bleed?
A) Antithrombin (Thrombate III)
B) Desirudin (Iprivask)
C) Protamine sulfate
D) Vitamin K

Answer 1

Ans: C
Feedback:
The antidote for heparin is protamine sulfate. This drug forms stable salts as soon as it comes in contact
with heparin. The reaction immediately reverses heparin’s anticoagulation effects. Vitamin K reverses
the effect of warfarin. Antithrombin and desirudin are anticoagulants that would not be administered
with heparin.

Question 2

Prior to beginning anticoagulant therapy, the nurse will question the female patient about what?
A) Last menstrual period
B) Peptic ulcers
C) Urinary tract infection
D) Weight

Answer 2

Ans: B
Feedback:
The nurse should screen for conditions that could be exacerbated by increased bleeding tendencies,
including hemorrhagic disorders, recent trauma, spinal puncture, gastrointestinal (GI) ulcers, recent
surgery, intrauterine device placement, tuberculosis, presence of indwelling catheters, and threatened
abortion. Beginning anticoagulant therapy with active peptic ulcers could result in severe bleeding. Last
menstrual period, urinary tract infection, and weight should not impact anticoagulant therapy.

Question 3

The nurse is caring for a female patient who is nursing her 3-month-old infant. What will the nurse instruct the patient to do prior to starting heparin to treat venous thrombosis?
A) Wait an hour after taking the anticoagulant before feeding the infant.
B) Push fluids to clear the drug from her system before feeding the infant.
C) Find another method of feeding the infant while taking this drug.
D) Continue breast-feeding because heparin does not enter breast milk.

Answer 3

Ans: D
Feedback:
Although some adverse fetal effects have been reported with its use during pregnancy, heparin does not
enter breast milk, and so it is the anticoagulant of choice if one is needed during lactation. As a result,
there is no need to wait an hour, push fluids, or find another method of feeding the baby.

Question 4

The nurse receives a patient having an acute myocardial infarction (MI) to the emergency department.
What drug will the nurse administer before transferring the patient to a larger facility?
A) Anagrelide (Agrylin)
B) Clopidogrel (Plavix)
C) Ticlopidine (Ticlid)
D) Tenecteplase (TNKase)

Answer 4

Ans: D
Feedback:
Arrange to administer tenecteplase to reduce mortality associated with acute MI as soon as possible
after the onset of symptoms because the timing for the administration of tenecteplase is critical to
resolve the clot before permanent damage occurs to the myocardial cells. Anagrelide is used to treat
essential thrombocytopenia. Clopidogrel is used to treat patients who are at risk for ischemic events;
ticlopidine is used to reduce the risk of thrombotic stroke.

Question 5

A nurse is preparing to discharge a patient newly prescribed warfarin (Coumadin). While assessing the
patient’s knowledge of the drug, what would indicate that the patient needs further instruction
concerning drug therapy?
A) I love to eat homegrown tomatoes in the summer.
B) I take aspirin for my arthritis.
C) I walk 2 miles a day.
D) I drink a glass of wine about once a week.

Answer 5

Ans: B
Feedback:
Increased bleeding can occur if a salicylate is taken in combination with warfarin. The nurse will
instruct the patient to stop taking aspirin. Walking, eating tomatoes, and drinking an occasional glass of
wine should not interfere with the therapeutic effects of warfarin.

Question 6

The nurse is caring for a patient with a fever and severe diarrhea in addition to thrombophlebitis. How
will this patient’s condition impact the clotting process?
A) Depleted production of Hageman factor
B) Increased production of thrombin
C) Activation of plasminogen
D) Reduced production of fibrinolysin

Answer 6

Ans: C
Feedback:
Plasminogen is the basis for the clot-dissolving system. It is converted to plasmin (fibrinolysin) by
several factors including Hageman’s factor, which is factor XII found in circulating blood. Activated
thrombin breaks down fibrinogen to form fibrin threads, which form a clot inside the blood vessel.
Patients with diarrhea or fever could alter the normal clotting process by, respectively, loss of vitamin
K from the intestine or activation of plasminogen.

Question 7

The nurse is caring for a patient who received protamine sulfate in error. The patient is not receiving,
and has never received, heparin. What effect does the nurse assess for in this patient?
A) Coagulation effects
B) No effect
C) Anticoagulant effects
D) Antiplatelet effects

Answer 7

Ans: C
Feedback:
Paradoxically, if protamine is given to a patient who has not received heparin, it has anticoagulant
effects. Protamine is normally used as an antidote to heparin overdose but if heparin was not
administered, it does not have coagulation or antiplatelet effects. Since it has anticoagulant effects it
cannot be said to have no effect.

Question 8

A patient is being discharged home on warfarin. The discharge teaching by the nurse should include a
warning to avoid what?
A) St. John’s wort
B) Tarragon
C) Ginkgo
D) Saw palmetto

Answer 8

Ans: C
Feedback:
Many of the herbal remedies are known to alter blood coagulation and should be avoided when taking
anticoagulants. Patients taking these drugs should be cautioned to avoid angelica, cat’s claw,
chamomile, chondroitin, feverfew, garlic, Ginkgo, goldenseal, grape seed extract, green leaf tea, horse
chestnut seed, psyllium, and turmeric. If a patient who is taking an anticoagulant presents with
increased bleeding and no other interaction or cause is found, question the patient about the possibility
of use of herbal therapies. St. John’s wort, tarragon, and saw palmetto are not implicated as having an
interaction with anticoagulants.

Question 9

The nurse administers clopidogrel (Plavix) appropriately to the patient with what condition?
A) Maintaining the patency of grafts
B) Treating peripheral artery disease
C) Preventing emboli from valve replacements
D) Dissolving a pulmonary embolus and improving oxygenation

Answer 9

Ans: B
Feedback:
Clopidogrel is used to inhibit platelet aggregation, decreasing the formation of clots in narrowed or
injured blood vessels like those found in peripheral artery disease. Maintaining the patency of grafts or
preventing emboli from valve replacements would be accomplished using an anticoagulant. Dissolving
emboli would be accomplished using streptokinase or a similar enzyme to stimulate the conversion of
plasminogen to plasmin.

Question 10

The nurse is caring for a patient who is going home on warfarin (Coumadin). What lab test will the
patient require to evaluate therapeutic effects of the drug?
A) Activated partial thromboplastin time (APTT) only
B) International normalized ratio (INR) only
C) Prothrombin time (PT) and INR
D) PT and APTT

Answer 10

Ans: C
Feedback:
PT and INR are ordered to evaluate for therapeutic effects of warfarin. Normal values of PT is 1.3 to
1.5 times the control value and the ratio of PT to INR is 2 to 3.5.

Question 11

What drug would the nurse administer for its antiplatelet effects? (Select all that apply.)
A) Ticlid
B) Iprivask
C) Arixtra
D) ReoPro
E) Activase

Answer 11

Ans: A, D
Feedback:
Antiplatelet agents available for use include abciximab (ReoPro), anagrelide (Agrylin), aspirin,
cilostazol (Pletal), clopidogrel (Plavix), dipyridamole (Persantine), eptifibatide (Integrilin), ticlopidine
(Ticlid), ticagrelor (Brilinta), and tirofiban (Aggrastat). Iprivask and Arixtra are anticoagulants, and
Actuvase is a thrombolytic agent.

Question 12

A 76-year-old patient is receiving IV heparin 5,000 units every 8 hours. An activated thromboplastin
time (aPTT) is drawn 1 hour before the 8:00 AM dose; the aPTT is at 3.5 times the control value. What
is the nurse’s priority action?
A) Give a larger dose to increase the aPTT.
B) Give the dose as ordered and chart the results.
C) Check the patient’s vital signs prior to administering the dose.
D) Hold the dose and call the result to the physician

Answer 12

Ans: D
Feedback:
The therapeutic level of heparin is demonstrated by an activated partial thromboplastin time (aPTT)
that is 1.5 to 3 times the control value. The patient’s value is 3.5 times control, which indicates clotting
time is a bit too delayed and the dosage will likely either be reduced or a dosage may be held according
to the order received from the physician. It would be inappropriate to give two doses at once, give the
dose and chart the results, or simply check the vital signs without holding the dose and calling the
physician

Question 13

The nurse evaluates the effects of warfarin (Coumadin) by monitoring what laboratory test?
A) Red blood cell count (RBC)
B) Activated thromboplastin time (APT)
C) Prothrombin time (PT) and international normalized ratio (INR)
D) Platelet count

Answer 13

Ans: C
Feedback:
The warfarin dose is regulated according to the INR. INR is based upon the PT. The other options are
incorrect.

Question 14

The nurse discovers a patient receiving warfarin is bleeding. What drug would the nurse prepare to
counteract this drug?
A) Vitamin E
B) Vitamin K
C) Protamine sulfate
D) Calcium gluconate

Answer 14

Ans: C
Feedback:
Injectable vitamin K is used to reverse the effects of warfarin. Protamine sulfate is used to reverse the
effects of heparin. Vitamin E reduces effects of warfarin but is not used for that purpose. Calcium
gluconate would not be indicated for this patient.

Question 15

The nurse evaluates that additional patient teaching is needed regarding anticoagulants when the patient
states that he will do what?
A) Carry a Medic Alert card with him.
B) Report to the lab once a month.
C) Use acetaminophen for arthritis pain.
D) Use a disposable safety razor to shave

Answer 15

Ans: D
Feedback:
The patient should use an electric razor to shave rather than a disposable razor that could nick his skin
and increase risk of bleeding. Carrying a MedicAlert card, getting regular follow-up lab work, and use
of acetaminophen would all be appropriate actions that would not indicate the need for further teaching.

Question 16

The nurse teaches the patient taking warfarin (Coumadin) to minimize foods high in vitamin K
including what type of food?
A) Eggs
B) Dairy products
C) Citrus fruits
D) Green leafy vegetables

Answer 16

Ans: D
Feedback:
Injectable vitamin K is used to reverse the effects of warfarin. Vitamin K is responsible for promoting
the liver synthesis of several clotting factors. When these pathways have been inhibited by warfarin,
clotting time is increased. If an increased level of vitamin K is provided, more of these factors are
produced, and the clotting time can be brought back within a normal range. Green leafy vegetables are
high in vitamin K and should be avoided or minimized in the diet to prevent reversal of warfarin
effects. The other food options are not high in vitamin K.

Question 17

The nurse evaluates teaching about warfarin (Coumadin) is successful when the patient makes what
statement?
A) If I miss a dose, I will take two pills the next day.
B) I will check with the pharmacist before taking any herbal supplements.
C) I will increase the dark-green leafy vegetables in my diet.
D) I will take a multivitamin daily

Answer 17

Ans: B
Feedback:
Warfarin is involved in many drug drug and drug herb interactions so the patients statement about
checking with the doctor before starting any new drugs or supplements would be correct. The other
statements made by the patient indicate the need for further teaching because he or she should not take
two pills after missing a dose, there is no need to increase green leafy vegetables containing vitamin K,
and multivitamin use is contraindicated.

Question 18

The nurse assesses blood in the urine of the 73-year-old patient receiving warfarin (Coumadin) this
morning. What actions will the nurse take? (Select all that apply.)
A) Assess prothrombin time (PT).
B) Assess international normalized ratio (INR).
C) Expect to administer protamine sulfate.
D) Expect to administer vitamin K.
E) Assess partial thromboplastin time (PTT).

Answer 18

Ans: A, B, D
Feedback:
Vitamin K is the antidote for warfarin. PT and INR are used to assess therapeutic levels of warfarin.
PTT is used to assess therapeutic levels of heparin. Protamine sulfate is given as an antidote for
heparin.

Question 19

The nurse is caring for a patient following repeat coronary artery bypass grafting who has excessive
bleeding. What systemic hemostatic drug will the nurse expect to administer?
A) Thrombin recombinant
B) Microfibrillar collagen
C) Human fibrin sealant
D) Aminocaproic acid (Amicar)

Answer 19

Ans: D
Feedback:
The hemostatic drug that is used systemically is aminocaproic acid (Amicar). Topical hemostatic agents
include absorbable gelatin (Gelfoam), human fibrin sealant (Artiss, Evicel), microfibrillar collagen
(Avitene), thrombin (Thrombinar, Thrombostat), and thrombin recombinant (Recothrom).

Question 20

The 86-year-old patient, admitted with thrombophlebitis, is being sent home on enoxaparin (Lovenox).
The nurse evaluates that he understands why enoxaparin is being used if he states that it will do what?
A) Inhibit the formation of additional clots
B) Stimulate production of certain clotting factors
C) Prevent the blood from clotting
D) Dissolve the clot

Answer 20

Ans: A
Feedback:
Low-molecular-weight heparins inhibit thrombus and clot formation by blocking factors Xa and IIa.
Because of the size and nature of the molecules, these drugs do not greatly affect thrombin, clotting, or
the PT; therefore, they cause fewer systemic adverse effects.

Question 21

What intervention does the nurse include in the plan of care for a patient receiving a continuous
intravenous infusion of heparin?
A) Avoiding intramuscular injections
B) Assessing for symptoms of respiratory depression
C) Measuring hourly urinary outputs
D) Monitoring BP hourly

Answer 21

Ans: A
Feedback:
The most commonly encountered adverse effect of the anticoagulants is bleeding, ranging from
bleeding gums during toothbrushing to severe internal hemorrhage. Avoid all invasive procedures,
including giving IM injections, while the patient is on heparin therapy. It would not be necessary to
assess for respiratory depression, measure hourly output, or monitor the BP hourly as related because
of heparin administration.

Question 22

The nurse is sending a patient home who will remain on anticoagulant therapy. What teaching point
does the nurse make when teaching the patient about the drug? (Select all that apply.)
A) Brush teeth gently with soft bristle brush.
B) Wear or carry a MedicAlert notification.
C) Warning signs of bleeding include fatigue, pallor, and increased heart rate.
D) Treat minor side effects with over-the-counter (OTC) medications.
E) Obtain follow-up lab work regularly as ordered

Answer 22

Ans: A, B, C, E
Feedback:
Patients should be taught to avoid bleeding risk by brushing teeth gently, using electric razors, and
avoiding dangerous activities or falls that could cause bleeding. The patient should have a MedicAlert
to notify other health care providers of anticoagulant therapy. Teach patients to recognize the signs of
blood loss and stress the importance of follow-up lab work. Patients should be taught to avoid adding
any new medication, prescription or OTC, without first talking to the health care provider or pharmacist
to ensure safety.

Question 23

Indications for the nurse to administer heparin include what? (Select all that apply.)
A) Treatment of hemophilia
B) Prevention and treatment of pulmonary emboli
C) Treatment of atrial fibrillation with embolization
D) Prevention and treatment of venous thrombosis
E) Diagnosis and treatment of disseminated intravascular coagulation (DIC)

Answer 23

Ans: B, C, D, E
Feedback:
Indications include prevention and treatment of venous thrombosis and pulmonary emboli, treatment of
atrial fibrillation with embolization, and diagnosis and treatment of DIC. Heparin is not given to
patients with hemophilia because the drug would worsen bleeding.

Question 24

The nurse is caring for a child who needs anticoagulation therapy. What drug is approved for pediatric
use?
A) Heparin
B) Dabigatran
C) Rivaroxaban
D) Low-molecular-weight heparins

Answer 24

Ans: A
Feedback:
Heparin is approved for pediatric use. If heparin is used, the dosage should be carefully calculated
based on weight and age. It should be verified by another person before the drug is administered.
Dabigatran and rivaroxaban are not approved for use in children. The safety of low-molecular-weight
heparins has not been established in children

Question 25

When the nurse administers warfarin it is expected that the drug will have what effect on the body?
A) Decrease in production of vitamin K dependentt clotting factors
B) Increase in prothrombin
C) Increase in vitamin K dependent factors in the liver
D) Increase in procoagulation factors

Answer 25

Ans: A
Feedback:
Warfarin, an oral anticoagulant drug, causes a decrease in the production ovitamin K dependent clotting
factors in the liver. The eventual effect is a depletion of these clotting factors and a prolongation of
clotting times. It is used to maintain a state of anticoagulation in situations in which the patient is
susceptible to potentially dangerous clot formation. It does not increase prothrombin, vitamin
K dependent factors in the liver, or procoagulation factors.

Question 26

When the nurse administers heparin it is anticipated the drug will have what action on the patient’s
body?
A) Binds to factor X
B) Blocks the formation of thrombin
C) Binds to factor Xa
D) Promotes the inactivation of factor VIII

Answer 26

Ans: B
Feedback:
Heparin blocks the formation of thrombin from prothrombin. Heparin does not bind to factors X and
Xa. Heparin does not inactivate factor VIII

Question 27

A young man has been diagnosed with hemophilia and the nurse is planning his discharge teaching and
includes what teaching point?
A) Using nonsteroidal anti-inflammatory drugs (NSAIDs) for mild pain
B) Preventing trauma to the body
C) Receiving IV factor VIII therapy at home
D) Understanding the condition is an X-linked recessive disorder

Answer 27

Ans: B
Feedback:
The nurse’s thorough patient teaching must include the name of the drug, dosage prescribed, measures
to avoid adverse effects, warning signs of problems, and the need for periodic monitoring and
evaluation. Hemophilia A is an X-linked recessive disorder that primarily affects males. Approximately
90% of persons with hemophilia produce insufficient quantities of the factor VIII. The prevention of
trauma is important in people with hemophilia. The other options are incorrect.

Question 28

The nurse admits a 32-year-old woman who takes oral contraceptives; she is expected to need
aminocaproic acid postoperatively. The nurse recognizes this patient is at risk for what?
A) Hypercoagulation
B) Bleeding
C) Pregnancy
D) Infertility

Answer 28

Ans: A
Feedback:
Aminocaproic acid is associated with the development of hypercoagulation states if it is combined with
oral contraceptives or estrogens. Oral contraceptives do not increase the risk of pregnancy, bleeding, or
infertility.

Question 29

The nurse reviews the patient’s lab values and determines warfarin therapy is at therapeutic levels with
what lab result?
A) Partial thromboplastin time (PTT) 1.5 to 2.5 times the control
B) Prothrombin time (PT) 1.3 to 1.5 times the control
C) International normalized ratio (INR) of 3 to 4
D) Activated partial thromboplastin time (aPTT) 3 to 4 times the control

Answer 29

Ans: B
Feedback:
Warfarin is at therapeutic level when the INR is 2 to 3.5 and the PT is 1.3 to 1.5 times control. PTT and
aPTT should be 1.5 to 2.5 to indicate heparin dosage is at therapeutic level.

Question 30

The patient receives a new diagnosis of peripheral artery disease and the nurse anticipates an order for
what drug?
A) Clopidogrel
B) Persantine
C) Aspirin
D) Warfarin

Answer 30

Ans: A
Feedback:
Clopidogrel (Plavix) is indicated for the treatment of patients who are at risk for ischemic events;
patients with a history of myocardial infarction, peripheral artery disease, or ischemic stroke; and
patients with acute coronary syndrome. Persantine, aspirin, and warfarin would not be indicated for this
patient.

Question 31

The nurse admits a patient in acute respiratory distress secondary to pulmonary emboli. What drug will
the nurse administer to lyse the clots?
A) Urokinase
B) Tenecteplase
C) Rivaroxaban
D) Fondaparinux

Answer 31

Ans: A
Feedback:
Urokinase is used for lysis of pulmonary emboli and treatment of coronary thrombosis. Reteplase is
used to treat coronary artery thrombosis associated with an acute myocardial infarction. Rivaroxaban is
used to prevent deep vein thromboses that may lead to pulmonary emboli. Fondaparinux is used to treat
and prevent venous thromboembolic events.

Question 32

The nurse is caring for a postpartum patient admitted to the intensive care unit with a diagnosis of
disseminated intravascular coagulation (DIC). What is the drug of choice to treat this problem?
A) Heparin
B) Urokinase
C) Aspirin
D) Warfarin

Answer 32

Ans: A
Feedback:
The treatment of choice for DIC is heparin, an anticoagulant. It prevents the clotting phase from being
completed, thus inhibiting the breakdown of fibrinogen. It may also help avoid hemorrhage by
preventing the body from depleting its entire store of coagulation factors. None of the other
medications listed in this question are indicated for treatment of DIC and may, in fact, make the
condition worse.

Question 33

By what route will the nurse administer the antihemophilic agent to the patient with hemophilia
following a car accident?
A) Oral
B) Topical
C) IV
D) Sublingual

Answer 33

Ans: C
Feedback:
All antihemophilic agents are administered IV and are not available for administration by any other
route.

Question 34

The nurse administers agents that control bleeding to patients with hemophilia and what other
condition?
A) Liver disease
B) Lyme s disease
C) Disseminated intravascular coagulation (DIC)
D) Pheochromocytoma

Answer 34

Ans: A
Feedback:
Drugs to control bleeding are also given to patients with liver disease because liver disease prohibits
clotting factors and proteins needed for clotting from being produced in adequate quantities. Lyme s
disease, DIC, and pheochromocytoma are not indications for administration of agents to control
bleeding.

Question 35

The nurse is caring for a pediatric patient with hemophilia who receives antihemophilic factor several
times a year. What should this patient be regularly screened for? (Select all that apply.)
A) HIV
B) Hepatitis
C) Anemia
D) Infection
E) Cardiomyopathy

Answer 35

Ans: A, B, C
Feedback:
The most common adverse effects associated with antihemophilic agents involve risks associated with
the use of blood products (e.g., in a patient with hepatitis or AIDS). Patients with hemophilia should
also be monitored for anemia secondary to blood loss. There is no associated risk for infection or
cardiomyopathy.