Deck 30: Drugs for Coagulation Disorders

Question 1

The patient receives enoxaparin (Lovenox)postoperatively.The nurse teaches the patient about this medication and evaluates that learning has occurred when he makes which statement?
1)"It inhibits the synthesis of prostaglandins."
2)"It increases the time it takes for me to form a clot."
3)"It dissolves small clots so I won't have a stroke."
4)"It increases the flexibility of my blood cells."

Answer 1

2

Question 2

The physician orders enoxaparin (Lovenox)for the postoperative patient.What is the best administration technique by the nurse?
1)Administer the medication in the upper arm,subcutaneously.
2)Administer the medication in the abdomen,subcutaneously.
3)Administer the medication via slow intravenous (IV)push in the patient's Intravenous (IV)line.
4)Ask the patient where she would like the injection,and administer it subcutaneously.

Answer 2

2

Question 3

The patient receives warfarin (Coumadin).The nurse notes that the patient's morning international normalized ratio (INR)is 7-.What are the priority nursing interventions at this time?
1)Hold the next dose of warfarin (Coumadin)and repeat the international normalized ratio (INR).
2)Administer protamine sulfate and hold the next dose of warfarin (Coumadin).
3)Hold the next dose of warfarin (Coumadin)and contact the physician.
4)Administer vitamin K and hold the next dose of warfarin (Coumadin).

Answer 3

4

Question 4

The patient receives heparin.During the morning assessment of the patient,the nurse notes that the patient's blood pressure and red blood cell (RBC)count are low.There is no evidence of bleeding on the bed linen or the patient's gown.What will the best assessment of this patient reveal?
1)The patient is dehydrated.
2)The patient may be bleeding internally.
3)The patient's activated partial thromboplastin time (aPTT)is too low.
4)The patient has probably formed some clots.

Question 5

The patient is being discharged on warfarin (Coumadin)following a valve replacement.The nurse has completed medication education and determines that learning has occurred when the patient makes which statement?
1)"I must wear a MedicAlert bracelet that says I'm on warfarin (Coumadin)."
2)"If I notice any bruising or bleeding I will need to have lab work done."
3)"I can take enteric-coated aspirin,but not plain aspirin for my arthritis."
4)"I must limit my intake of vitamin C while I'm on warfarin (Coumadin)."

Question 6

Anticoagulants are used to
1)increase the number of platelets.
2)prevent the formation of blood clots.
3)shorten the prothrombin time.
4)dissolve blood clots.

Question 7

Laboratory studies related to heparin therapy include
1)aPtt.
2)serum heparin studies.
3)complete blood studies.
4)sedimentation rate.

Question 8

The nursing instructor is teaching student nurses about the process of hemostasis after an injury.What does the nursing instructor include as the initial event in this process?
1)Platelets become sticky.
2)Plasma proteins convert to active forms.
3)The vessel spasms.
4)Von Willebrand's factor is activated.

Question 9

The patient receives warfarin (Coumadin)and becomes pregnant.The physician changes her anticoagulant to enoxaparin (Lovenox).She asks the nurse,"Why did the doctor do that?" What is the best rationale by the nurse?
1)"Because it is easier to maintain your bleeding times in a therapeutic range."
2)"Because warfarin (Coumadin)is known to cause serious cardiac defects."
3)"Because you are less likely to have bleeding with enoxaparin (Lovenox)."
4)"Because enoxaparin (Lovenox)cannot get into your baby."

Question 10

The nurse is managing care for a patient with a DVT (deep vein thrombosis)of the right calf.The patient receives heparin intravenously (IV).What is the priority outcome for this patient?
1)The patient will comply with dietary restrictions.
2)The patient will keep the right leg elevated on two pillows.
3)The patient will not disturb the intravenous infusion.
4)The patient will not experience bleeding.

Question 11

The patient receives warfarin (Coumadin).The nurse plans to teach the patient to avoid which foods that are served for lunch?
1)Tomato salad with basil
2)Whole-wheat bread with margarine
3)Salt substitute
4)Fettuccine Alfredo

Question 12

The physician orders pentoxifylline (Trental)for the patient with peripheral vascular disease.The nurse has completed medication education and determines that learning has occurred when the patient makes which statement(s)? Credit will be given only if all correct choices and no incorrect choices are selected.
1)"It makes my red blood cells (RBCs)squishy so they can go into the little blood vessels."
2)"It decreases my platelets so my blood is less likely to clot."
3)"It decreases the "stickiness" of my blood."
4)"It changes how my liver makes clotting factors."
5)"It thins my blood so more can get to those little vessels."

Question 13

The process of fibrinolysis is to
1)stop blood flow.
2)remove a blood clot.
3)promote enzymes.
4)increase blood flow.

Question 14

The patient receives an appropriate dose of warfarin (Coumadin),but the international normalized ratio (INR)is in the high range.The patient denies taking any aspirin products.What is the best assessment to ask the patient at this time?
1)"Have you been eating much garlic?"
2)"Have you been eating a lot of salads and vegetables?"
3)"Have you been drinking too much milk?"
4)"Are you restricting your fluids too much?"

Question 15

A woman brings her husband to the emergency department and tells the nurse that her husband just had a stroke.The physician verifies a thrombotic cerebral vascular accident (CVA)occurred and plans to use alteplase (Activase).What priority assessment will the nurse ask the wife?
1)"What other medications does your husband take?"
2)"Does your husband have hypertension?"
3)"What other medical illnesses does your husband have?"
4)"What time did your husband have the stroke?"

Question 16

The nurse is managing care for a patient with cirrhosis of the liver.The nurse teaches the patient about how to avoid injury that may result in bleeding.The patient asks the nurse why he is at risk to start bleeding.What is the best response by the nurse?
1)"Because your liver is injured and unable to manufacture platelets."
2)"Because your liver thickens your blood so it is less likely to clot."
3)"Because your liver is injured and cannot make clotting factors."
4)"Because your liver is breaking down your clotting factors too quickly."

Question 17

The most important food for a patient taking anticoagulants to avoid is
1)citrus fruits.
2)garlic.
3)honey.
4)meat.

Question 18

A laboratory test used to best measure the effectiveness of warfarin sodium therapy is known as
1)complete blood count.
2)platelet count.
3)aPtt.
4)international normalized ratio (INR).

Question 19

The patient has a deep vein thrombosis (DVT)and is admitted for initial heparin therapy.Which order(s)would the nurse want to validate with the physician? Credit will be given only if all correct choices and no incorrect choices are selected.
1)Heparin 1,000 units intravenous (IV)every 6 hours
2)Tylenol as needed (PRN)for headaches
3)Obtaining a daily weight on the patient
4)Advil as needed (PRN)for headaches
5)Low vitamin K diet

Question 20

A new mother receives heparin.She asks the nurse if she can breastfeed her baby.What is the most therapeutic response by the nurse?
1)"No,because it would be too difficult to regulate your heparin dose."
2)"No,because this could cause your nipples to bleed."
3)"No,because this could alter your international normalized ratio (INR)times too much."
4)"No,because heparin will enter your breast milk."

Question 21

The nurse is providing discharge teaching regarding anticoagulant therapy.Which statements by the patient would the nurse evaluate as indicating the need for further instruction? Credit will be given only if all correct choices and no incorrect choices are selected.
1)"I'll ask for an electric razor for my birthday next week."
2)"I guess my trip to the amusement park is off for now."
3)"I won't be able to cook anymore."
4)"I'll get one of those new electric toothbrushes with the firm bristles."
5)"I should make an appointment for a B12 injection monthly."

Question 22

The nurse is aware that the mechanism of action of anticoagulant drugs is to
1)alter plasma membrane and platelets.
2)convert plasminogen to plasmin.
3)prevent fibrin from dissolving.
4)inhibit clotting factors to prevent clot formation.

Question 23

A patient who has hemophilia A is scheduled for a minor surgical procedure.The patient states,"I'm worried about this surgery.My doctor told me I had to come to the hospital for some kind of treatment a week before it.What is that all about?" How should the nurse respond? Credit will be given only if all correct choices and no incorrect choices are selected.
1)"You must have misunderstood the directions.Let me check with the health care provider."
2)"Blood will be taken and banked in case you need to have it retransfused on the day of surgery."
3)"You will be given a test dose of a medication used to increase your clotting factors."
4)"This visit is related to your hemophilia and keeping you safe during the surgery."
5)"Don't be worried about the testing.Nothing will hurt."

Question 24

A clinic nurse is developing a teaching handout for patients who are prescribed warfarin (Coumadin)therapy.Which statement should be included in this information? Credit will be given only if all correct choices and no incorrect choices are selected.
1)"Tell your dentist you are taking warfarin prior to any procedures."
2)"Report to the lab for testing of activated partial thromboplastin time (APTT)."
3)"Avoid strenuous activities."
4)"Place ice at the injection site if stinging or burning occurs."
5)"Take nonsteroidal anti-inflammatories (NSAIDs)for minor pain relief."

Question 25

The nurse is aware that the drug that will most likely be used in the treatment of warfarin sodium overdose is
1)aspirin.
2)heparin.
3)vitamin K.
4)protamine sulfate.

Question 26

A patient has been started on ticlopidine (Ticlid)after a myocardial infarction and stent placement.How should the nurse explain the action of this medication to the patient? Credit will be given only if all correct choices and no incorrect choices are selected.
1)"Ticlid will dissolve any clots that might form in your stent."
2)"Ticlid will make the platelets in your blood less sticky."
3)"Ticlid will change the way your platelets work their entire lives."
4)"Ticlid decreases your blood's ability to clot."
5)"Ticlid works just like the heparin you have been on in the hospital."

Question 27

The nurse is planning care for a patient receiving enoxaparin (Lovenox).Which interventions should be included? Credit will be given only if all correct choices and no incorrect choices are selected.
1)Teach the patient or family to give subcutaneous injections at home.
2)Monitor for development of deep vein thrombosis.
3)Monitor multiple lab tests.
4)Teach the patient signs of excessive bleeding.
5)Schedule administration times right before breakfast and the evening meal.

Question 28

A patient is taking warfarin sodium.The nurse will reinforce teaching by telling the patient that he should watch for
1)bleeding.
2)pain.
3)headache.
4)rash.

Question 29

A patient is being treated for a thromboembolic disorder.If the goal is to prevent clot formation,the nurse anticipates the patient will be treated with which classification of drug? Credit will be given only if all correct choices and no incorrect choices are selected.
1)Hemostatics
2)Thrombolytics
3)Anticoagulants
4)Antiplatelet agents
5)Clotting factor concentrates

Question 30

Thrombolytic drugs are used to
1)convert plasmin to plasminogen.
2)prevent the liver from making fibrin.
3)prevent a thrombus from forming.
4)lyse a thrombus.