Deck 27: Drugs Used to Treat Thromboembolic Disorders

Question 1

A patient receiving IV heparin therapy for a deep vein thrombosis in his right calf asks why his calf remains painful, edematous, and warm to touch after 2 days of anticoagulant therapy. Which response by the nurse is most accurate?

A) "It takes at least 3 days for the symptoms to resolve once the clot dissolves."
B) "Heparin does not dissolve blood clots, but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body."
C) "I will report this to your health care provider because there may be a need to look at alternative treatments."
D) "You appear anxious. The health care provider will eventually put you on ticlopidine, which allows for an earlier discharge."

Answer 1

"Heparin does not dissolve blood clots, but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body."

Question 2

A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin?

A) Warfarin sodium (Coumadin)
B) Enoxaparin (Lovenox)
C) Protamine sulfate
D) Vitamin K

Answer 2

Protamine sulfate

Question 3

Which are accurate nursing interventions when administering heparin subcutaneously? (Select all that apply.)

A) Assessment of recent aPTT levels
B) Massaging the site after injection of medication
C) Aspirating after needle insertion
D) Documentation of ecchymotic areas
E) Monitoring of vital signs

Answer 3

Documentation of ecchymotic areas
Monitoring of vital signs

Question 4

Anticoagulant therapy may be used for which situations? (Select all that apply.)

A) To prevent stroke in patients at high risk
B) Following a myocardial infarction
C) Following total hip or knee joint replacement surgery
D) With deep vein thrombosis

Question 5

The nurse is teaching a patient about dietary implications while on warfarin (Coumadin) therapy. Which salad is highest in vitamin K?

A) Fruit
B) Pasta
C) Potato
D) Spinach

Question 6

The nurse has provided instruction to a patient recently prescribed warfarin (Coumadin). Which statement by the patient indicates to the nurse the need for further teaching?

A) "I will always wear a medical alert bracelet."
B) "I will check with my health care provider before I take any OTC medications."
C) "I will be careful when I use a knife or other sharp objects."
D) "I will rinse my mouth with mouthwash instead of brushing my teeth."

Question 7

The pharmacologic agents used to treat deep vein thrombosis (DVT) may act in which of the following ways? (Select all that apply.)

A) Prevent platelet aggregation
B) Prevent the extension of existing clots
C) Inhibit steps in the fibrin clot formation cascade
D) Prolong bleeding time
E) Lower serum triglycerides

Question 8

A patient is receiving 1400 units of heparin/hour on an IV pump. The aPTT time is 54. The laboratory control is 25. Which action by the nurse is accurate?

A) Bolus the patient with an additional 5000 units of heparin.
B) Stop the heparin immediately and notify the health care provider that the patient's blood level is toxic.
C) Administer protamine sulfate stat.
D) Continue with the prescribed rate.

Question 9

Dipyridamole (Persantine) has been used extensively in combination with warfarin to prevent the formation of thromboembolism after which type of event?

A) Myocardial infarction
B) Transient ischemic attack
C) Cardiac valve replacement
D) Heart transplant

Question 10

What is the rationale for administering fibrinolytic agents, such as streptokinase, within hours of the onset of myocardial infarction?

A) Enhances myocardial oxygenation
B) Lyses the blood clot
C) Promotes platelet aggregation
D) Inhibits clotting mechanisms

Question 11

Which symptom is indicative of bleeding in a patient taking warfarin (Coumadin)?

A) Bradycardia
B) Petechiae
C) Increased urinary output
D) Dry skin

Question 12

The nurse is preparing discharge education for a patient who will be receiving warfarin (Coumadin) at home. Which important points will the nurse include? (Select all that apply.)

A) "Do not make any major changes to your diet without discussing it with your health care provider."
B) "Keep outpatient laboratory appointments for monitoring of therapy."
C) "Take the medication after meals."
D) "Report signs of bleeding to your health care provider, including observing skin for bruising, petechiae, blood in emesis, urine, or stools, bleeding gums, cold, clammy skin, faintness, or altered sensorium."
E) "Avoid aspirin products."

Question 13

A patient is receiving IV heparin therapy. The aPTT is 90; the laboratory control is 30 seconds. Which nursing intervention is most accurate?

A) Document in the nursing notes that these results are within therapeutic range.
B) Note the RBC count and wait for the health care provider to make the next round to discuss all laboratory values.
C) Stop the heparin drip.
D) Assess the patient for signs and symptoms of decreased sensorium.

Question 14

Which is an accurate nursing action when administering subcutaneous enoxaparin, a low molecular weight heparin product?

A) Expel the air bubble from the prefilled syringe.
B) Leave the needle in place for 10 seconds after injection.
C) Administer the medication into the deltoid muscle.
D) Massage the site after injection to increase absorption.

Question 15

What is the mechanism of action of drugs used to treat thromboembolic disease?

A) Dissolving clots and preventing formation of new clots
B) Making platelets more flexible and preventing formation of new clots
C) Causing vasodilation and increased blood flow
D) Preventing platelet aggregation and inhibiting clot formation

Question 16

Which medications may safely be administered to a patient on ticlopidine? (Select all that apply.)

A) Acetaminophen (Tylenol)
B) Acetylsalicylic acid
C) Propranolol (Inderal)
D) Cimetidine (Tagamet)
E) Furosemide (Lasix)

Question 17

Which action will the nurse implement to decrease the risk of clot formation in an older patient on bed rest?

A) Assess peripheral pulses.
B) Encourage passive leg exercises.
C) Limit fluid intake.
D) Position pillows behind the knees.