Question 1

An adult client is brought to the emergency department (ED)and diagnosed with a thrombotic stroke.The team plans to administer alteplase (Activase).The client makes the following comments to a nurse.Which information is critical for the nurse to relay to the health care provider?

Accepted Answer

C) The information about the client falling and hitting their head last week is critical for the nurse to relay to the healthcare provider because alteplase (Activase) is a thrombolytic agent that dissolves blood clots and increases the risk of bleeding. A recent head injury could significantly increase the risk of intracranial hemorrhage if thrombolytic therapy is administered.

Question 2

The nurse is addressing a group of clients who have experienced thromboembolic disorders.One of the clients states,"My dad had a problem with clotting too much and so does my brother." Before responding to this comment,the nurse considers which information?

Accepted Answer

A genetic deficiency of protein C can produce hypercoagulability, which can run in families and increase the likelihood of thromboembolic disorders. The other options are not relevant to clotting disorders.

Question 3

The nurse is providing discharge instruction to a client who is going home after a knee replacement.Which information regarding symptoms of deep vein thrombosis (DVT)should the nurse include?

Accepted Answer

Increased tenderness in the lower legs is a common sign of DVT, and it should be reported immediately to the healthcare provider. The other options are not specific enough or incorrect. Clients may not always know they have a DVT, and paleness or coolness in the toes may indicate poor circulation rather than DVT. Swelling in the knee is common after knee replacement surgery, but it is not necessarily indicative of DVT.

Question 4

A client with a newly placed prosthetic heart valve will be maintained on long-term anticoagulant therapy.Which medication does the nurse anticipate being used for this purpose?

Accepted Answer

Warfarin (Coumadin) is a common anticoagulant medication used for long-term management of patients with prosthetic heart valves. Enoxaparin (Lovenox) and Dalteparin (Fragmin) are low molecular weight heparins that may be used in the acute postoperative period, but not for long-term maintenance. Heparin may also be used acutely, but not for long-term management.

Question 5

As the nurse is completing the physical assessment of a client receiving heparin therapy for deep vein thrombosis (DVT),the client complains of severe lumbar pain.Which is the nurse's priority action?

Accepted Answer

The client's severe lumbar pain could indicate a complication of the heparin therapy, such as a spinal hematoma, which is a rare but serious side effect. The nurse's priority action should be to evaluate the pain further and notify the healthcare provider immediately. Options B, C, and D may be appropriate interventions depending on the cause and severity of the pain, but assessing for potential complications is the priority.

Question 6

A client's intravenous heparin drip rate will be increased at 1400.The nurse plans to draw an activated partial thromboplastin time (aPTT)at which time?

Accepted Answer

The nurse should wait at least 6 hours after adjusting the heparin drip rate to draw an aPTT. Therefore, the best choice is option B, which is 6 hours after the rate increase at 1400.

Question 7

A client has lost 50 pounds by following a diet that allows 1200 calories each day.Today's laboratory results reveal a significant decrease in platelets.Which foods should the nurse recommend the client add to the daily diet?

Accepted Answer

A decrease in platelets can indicate a deficiency in folic acid. Therefore, the nurse should recommend foods that are rich in folic acid such as leafy greens, beans, and fortified grains.

Question 8

The client prescribed heparin therapy asks how the "blood thinner" works.Which response by the nurse is the most appropriate?

Accepted Answer

Heparin prevents clots from forming by inhibiting the clotting factors in the blood. It does not dissolve clots or decrease platelets. While heparin can make the blood less viscous, this is not the primary mode of action for the medication.

Question 9

The baseline international normalized ratio (INR)of a client started on warfarin (Coumadin)for atrial fibrillation was 1.2 The nurse notes that the INR value is 2.5 prior to administration of the next dose of medication.Which action by the nurse is the most appropriate?

Accepted Answer

The therapeutic INR range for a patient on warfarin for atrial fibrillation is typically between 2.0 and 3.0. An INR of 2.5 is within this therapeutic range, so the nurse should administer the medication as ordered.

Question 10

Assessment for deep vein thrombosis (DVT)is a priority for which client?

Accepted Answer

Clients recovering from knee replacement surgery are at high risk for DVT due to immobilization during the recovery period. It is important to assess for signs and symptoms of DVT and implement preventative measures. Clients with a gastric ulcer, hypertension, or pneumonia may have other priority assessments or interventions.

Question 11

The client states,"I've never had such trouble breathing.What is a pulmonary embolus anyway?" Which response by the nurse is the most appropriate?

Accepted Answer

A pulmonary embolus is a portion of a blood clot that has moved from its original location, typically from a deep vein in the legs, to the lung where it can block blood flow and cause difficulty breathing. Choice A is incorrect because a pulmonary embolus is not stationary. Choice B is incorrect because an embolus is not a piece of injured blood vessel, but rather a traveling clot. Choice D is incorrect because it describes tissue necrosis, which is not the result of a pulmonary embolus.

Question 12

A clinic nurse is developing a teaching handout for clients who are prescribed warfarin (Coumadin)therapy.Which statements should be included in this information? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

Accepted Answer

A) Clients taking warfarin need to inform their dentists before any procedure to manage the risk of bleeding.
C) Clients on warfarin should avoid strenuous activities or sports that may cause injury or bleeding. APTT testing is not necessary for warfarin therapy, and clients should not take NSAIDs as they can increase the risk of bleeding. Ice may not be effective for managing stinging or burning at the injection site.

Question 13

The nurse is planning a teaching session for a client newly diagnosed with hemophilia A.Which information should be included?

Accepted Answer

Hemophilia A is caused by a missing or decreased level of clotting factor VIII, a substance needed for the normal clotting process. The other options do not accurately describe the pathophysiology of hemophilia A.

Question 14

How would a nurse explain the action of pentoxifylline (Trental)to a client?

Accepted Answer

Pentoxifylline reduces the viscosity of red blood cells by decreasing their ability to stick together, therefore improving blood flow and oxygen delivery to tissues.

Question 15

A nurse assessing a client on a heparin drip notes bloody drainage in the nasogastric tube and indwelling urinary catheter.A stat partial thromboplastin time (PTT)is drawn according to heparin protocol.The result is 224 seconds.Which action by the nurse is the most appropriate?

Accepted Answer

A PTT of 224 seconds is significantly higher than the therapeutic range for heparin, indicating a high risk for bleeding. The presence of bloody drainage in two separate drainage systems further supports this assessment. The nurse should immediately notify the healthcare provider and prepare to administer protamine sulfate, which is the antidote for heparin. Option B is incorrect because increasing the IV rate and administering aminocaproic acid (Amicar) may further increase the risk of bleeding. Option C is incorrect because obtaining clotting factors is not appropriate in this situation as the high PTT is likely due to heparin therapy and not a deficiency in clotting factors. Option D is incorrect because vitamin K is used to reverse the effects of warfarin, not heparin.

Question 16

The nurse is planning care for a client prescribed enoxaparin (Lovenox).Which interventions should be included? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

Accepted Answer

The answer of The nurse is planning care for a...

Question 17

Alteplase (Activase)is prescribed for a client with an acute myocardial infarction.Which is the priority nursing intervention for this client?

Accepted Answer

Monitoring the client's level of consciousness (LOC) is the priority nursing intervention for a client receiving alteplase (Activase) for acute myocardial infarction. Alteplase is a thrombolytic agent that can dissolve blood clots and increase the risk of bleeding, including intracranial bleeding. Therefore, it is critical to monitor the client's LOC for any signs of neurological changes or bleeding in the brain. APTT and PT/INR are laboratory tests used to monitor blood clotting time and are not the priority interventions in this scenario. Injection site monitoring is important, but it is not the priority compared to monitoring the client's neurological status.

Question 18

Which class of drugs would the nurse expect to be prescribed to a client who is bleeding excessively at a surgical site?

Accepted Answer

Antifibrinolytics are drugs that prevent the breakdown of clots by inhibiting the activation of plasminogen to plasmin. This would be the appropriate class of drugs to treat a client who is bleeding excessively at a surgical site because it would help to stabilize the clot and prevent further bleeding. Thrombolytics would break down clots and increase bleeding, anticoagulants would prevent the formation of clots in the first place, and prothrombin activators would increase clotting activity, further exacerbating excessive bleeding.

Question 19

A hospitalized client is prescribed warfarin (Coumadin).The nurse teaches the client to avoid which food on the lunch selection menu?

Accepted Answer

Broccoli is high in vitamin K, which can counteract the effects of warfarin (Coumadin), a medication used to prevent blood clots. Warfarin works by inhibiting vitamin K-dependent clotting factors, so consuming foods high in vitamin K can decrease its effectiveness.

Question 20

A client is prescribed intermittent intravenous heparin therapy to treat deep vein thrombosis (DVT).Which laboratory value should the nurse review prior to administering this medication?

Accepted Answer

The laboratory value that should be reviewed prior to administering heparin is the activated partial thromboplastin time (APTT). This measures the time it takes for clot formation to occur and is used to monitor the effectiveness and safety of heparin therapy. The other options are not typically used to monitor heparin therapy.

Quiz 38: Pharmacotherapy of Coagulation Disorders

An adult client is brought to the emergency department (ED) and diagnosed with a thrombotic stroke.The team plans to administer alteplase (Activase) .The client makes the following comments to a nurse.Which information is critical for the nurse to relay to the health care provider?

The nurse is addressing a group of clients who have experienced thromboembolic disorders.One of the clients states,"My dad had a problem with clotting too much and so does my brother." Before responding to this comment,the nurse considers which information?

The nurse is providing discharge instruction to a client who is going home after a knee replacement.Which information regarding symptoms of deep vein thrombosis (DVT) should the nurse include?

A client with a newly placed prosthetic heart valve will be maintained on long-term anticoagulant therapy.Which medication does the nurse anticipate being used for this purpose?

As the nurse is completing the physical assessment of a client receiving heparin therapy for deep vein thrombosis (DVT) ,the client complains of severe lumbar pain.Which is the nurse's priority action?

A client's intravenous heparin drip rate will be increased at 1400.The nurse plans to draw an activated partial thromboplastin time (aPTT) at which time?

A client has lost 50 pounds by following a diet that allows 1200 calories each day.Today's laboratory results reveal a significant decrease in platelets.Which foods should the nurse recommend the client add to the daily diet?

The client prescribed heparin therapy asks how the "blood thinner" works.Which response by the nurse is the most appropriate?

The baseline international normalized ratio (INR) of a client started on warfarin (Coumadin) for atrial fibrillation was 1.2 The nurse notes that the INR value is 2.5 prior to administration of the next dose of medication.Which action by the nurse is the most appropriate?

Assessment for deep vein thrombosis (DVT) is a priority for which client?

The client states,"I've never had such trouble breathing.What is a pulmonary embolus anyway?" Which response by the nurse is the most appropriate?

A clinic nurse is developing a teaching handout for clients who are prescribed warfarin (Coumadin) therapy.Which statements should be included in this information? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

The nurse is planning a teaching session for a client newly diagnosed with hemophilia A.Which information should be included?

How would a nurse explain the action of pentoxifylline (Trental) to a client?

A nurse assessing a client on a heparin drip notes bloody drainage in the nasogastric tube and indwelling urinary catheter.A stat partial thromboplastin time (PTT) is drawn according to heparin protocol.The result is 224 seconds.Which action by the nurse is the most appropriate?

The nurse is planning care for a client prescribed enoxaparin (Lovenox) .Which interventions should be included? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

Alteplase (Activase) is prescribed for a client with an acute myocardial infarction.Which is the priority nursing intervention for this client?

Which class of drugs would the nurse expect to be prescribed to a client who is bleeding excessively at a surgical site?

A hospitalized client is prescribed warfarin (Coumadin) .The nurse teaches the client to avoid which food on the lunch selection menu?

A client is prescribed intermittent intravenous heparin therapy to treat deep vein thrombosis (DVT) .Which laboratory value should the nurse review prior to administering this medication?