Deck 45: Anticoagulants, Antiplatelets, and Thrombolytics

Question 1

A patient who has recently had a myocardial infarction (MI)will begin taking clopidogrel (Plavix)to prevent a second MI.Which medication will the nurse expect the provider to order as adjunctive therapy for this patient?

A)Aspirin
B)Enoxaparin sodium (Lovenox)
C)Ticagrelor (Brilinta)
D)Warfarin (Coumadin)

Answer 1

Aspirin

Question 2

A patient is taking clopidogrel bisulfate (Plavix).When teaching this patient about dietary restrictions while taking this medication,the nurse will instruct the patient to avoid excessive consumption of which food?

A)Garlic
B)Grapefruit
C)Green,leafy vegetables
D)Red meats

Answer 2

Garlic

Question 3

A patient has been receiving intravenous heparin.When laboratory tests are drawn,the nurse has difficulty stopping bleeding at the puncture site.The patient has bloody stools and is reporting abdominal pain.The nurse notes elevated partial thromboplastin time (PTT)and activated partial thromboplastin time (aPTT).Which action will the nurse perform?

A)Ask for an order for oral warfarin (Coumadin).
B)Obtain an order for protamine sulfate.
C)Request an order for vitamin K.
D)Suggest that the patient receive subcutaneous heparin.

Answer 3

Obtain an order for protamine sulfate.

Question 4

A patient is receiving a thrombolytic medication.The patient calls the nurse to report having bloody diarrhea.The nurse will anticipate administering which medication?

A)Aminocaproic acid (Amicar)
B)Enoxaparin sodium (Lovenox)
C)Protamine sulfate
D)Vitamin K

Question 5

The nurse is caring for a patient who is receiving clopidogrel (Plavix).The patient calls the nurse to report flulike symptoms.The nurse notes a heart rate of 76 beats per minute,a blood pressure of 110/76 mm Hg,and a respiratory rate of 20 breaths per minute.The nurse suspects that the patient is experiencing which condition?

A)Anaphylaxis
B)An expected drug side effect
C)Hemorrhage
D)Possible myocardial infarction

Question 6

The nurse is caring for a postoperative patient who is receiving alteplase tPA (Activase)after developing a blood clot.The nurse notes a heart rate of 110 beats per minute and a blood pressure of 90/60 mm Hg.The nurse will perform which action?

A)Ask the patient about itching or shortness of breath.
B)Assess the surgical dressing for bleeding.
C)Evaluate the patient's urine output and fluid intake.
D)Recheck the patient's vital signs in 15 minutes.

Question 7

A patient who is taking warfarin has an international normalized ratio (INR)of 5.5.The nurse will anticipate giving

A)fresh frozen plasma.
B)intravenous iron.
C)oral vitamin K.
D)protamine sulfate.

Question 8

A patient who has received heparin after previous surgeries will be given enoxaparin sodium (Lovenox)after knee-replacement surgery.The patient asks how this drug is different from heparin.The nurse will explain that enoxaparin

A)decreases the need for laboratory tests.
B)has a shorter half-life than heparin.
C)increases the risk of hemorrhage.
D)may be taken orally instead of subcutaneously.

Question 9

A nursing student asks why the anticoagulant heparin is given to patients who have disseminated intravascular coagulation (DIC)and are at risk for excessive bleeding.The nurse will explain that heparin is used in this case for which reason?

A)To decrease the risk of venous thrombosis
B)To dissolve blood clots as they form
C)To enhance the formation of fibrous clots
D)To preserve platelet function

Question 10

The nurse has just begun administering intravenous streptokinase (Streptase).The nurse assesses vital signs and notes a temperature of 37° C,a heart rate of 70 beats per minute,and a blood pressure of 88/58 mm Hg.The nurse will contact the provider to

A)request an adjustment of the streptokinase dose.
B)request an order for aminocaproic acid (Amicar).
C)request epinephrine to prevent anaphylaxis.
D)report potential hemorrhage in this patient.

Question 11

The nurse is assessing a patient prior to administering thrombolytic therapy.Which is an important assessment for this patient?

A)Determining whether the patient has a history of diabetes
B)Finding out about a history of renal disease
C)Assessing which medications are taken for discomfort
D)Assessing whether the patient eats green,leafy vegetables

Question 12

A patient who is taking clopidogrel (Plavix)and aspirin is preparing for orthopedic surgery.The nurse will consult with the surgeon and provide which instruction to the patient?

A)Continue taking aspirin and stop taking clopidogrel 2 weeks prior to surgery.
B)Continue taking clopidogrel and stop taking aspirin 5 days prior to surgery.
C)Continue both medications to prevent thromboembolic events during surgery.
D)Stop taking both medications 7 days prior to surgery.

Question 13

The nurse is caring for a patient who is receiving warfarin (Coumadin)and notes bruising and petechiae on the patient's extremities.The nurse will request an order for which laboratory test?

A)International normalized ratio (INR)
B)Platelet level
C)Partial thromboplastin time (PTT) and activated partial thromboplastin time (aPTT)
D)Vitamin K level

Question 14

The nurse is caring for a postoperative patient.The nurse will anticipate administering which medication to this patient to help prevent thrombus formation caused by slow venous blood flow?

A)Alteplase (Activase)
B)Aspirin
C)Clopidogrel (Plavix)
D)Low-molecular-weight heparin

Question 15

The nurse is assessing a patient who takes warfarin (Coumadin).The nurse notes a heart rate of 92 beats per minute and a blood pressure of 88/78 mm Hg.To evaluate the reason for these vital signs,the nurse will assess the patient's

A)gums,nose,and skin.
B)lung sounds and respiratory effort.
C)skin turgor and oral mucous membranes.
D)urine output and level of consciousness.

Question 16

A patient experiences a blood clot in one leg,and the provider has ordered a thrombolytic medication.The patient learns that the medication is expensive and asks the nurse if it is necessary.Which response by the nurse is correct?

A)"The drug will decrease the likelihood of permanent tissue damage."
B)"This medication also acts to prevent future blood clots from forming."
C)"You could take aspirin instead of this drug to achieve the same effect."
D)"Your body will break down the clot,so the drug is not necessary."

Question 17

The nurse is teaching a patient who will begin taking warfarin (Coumadin)for atrial fibrillation.Which statement by the patient indicates understanding of the teaching?

A)"I should eat plenty of green,leafy vegetables while taking this drug."
B)"I should take a nonsteroidal anti-inflammatory drug (NSAID) instead of acetaminophen for pain or fever."
C)"I will take cimetidine (Tagamet) to prevent gastric irritation and bleeding."
D)"I will tell my dentist that I am taking this medication."

Question 18

The nurse is preparing to administer a first dose of clopidogrel (Plavix)to a patient.As part of the history,the nurse learns that the patient has a previous history of peptic ulcers,diabetes,and hypertension.The nurse understands it will be necessary to notify the provider and obtain an order for

A)a proton pump inhibitor (PPI) medication.
B)frequent serum glucose monitoring.
C)increased antihypertensive medications.
D)nonsteroidal antiinflammatory medications.