Question 1

A patient states that his legs have pain with walking that decreases with rest. The nurse observes absence of hair on the patient's lower leg and the patient has a thready, posterior tibial pulse. How would the nurse position the patient's legs?

A) Elevated
B) Crossed at the knee
C) Slightly bent with a pillow under the knees
D) Dependent position

Dependent position

Accepted Answer

A patient with arterial insufficiency is taught to position their legs in a dependent position to use gravity to help perfuse the tissues. Crossing legs at the knee may interfere with blood flow. Slightly bent legs do not enhance blood flow.

Question 2

The nurse would anticipate that which of the following patient conditions will be treated with the collaborative treatment of regular phlebotomies?&#10;A) Hemophilia&#10;B) Thrombocytopenia&#10;C) Eosinophilia&#10;D) Polycythemia

Accepted Answer

The removal of blood by using phlebotomy is used for thrombocytopenia to decrease the blood volume and decrease blood viscosity to prevent the formation of blood clots. Hemophilia and thrombocytopenia would not benefit from phlebotomy; eosinophilia is an overproduction of eosinophils from an abnormal allergic reaction and is treated with removal of the agent the person is allergic to and possibly administration of steroids.

Question 3

Which statement by a patient indicates additional teaching is required about the medication warfarin?&#10;A) &#34;I will continue my diabetic diet and restrict sugar.&#34;&#10;B) &#34;I will increase the intake of green, leafy vegetables for a more healthful diet.&#34;&#10;C) &#34;I will restrict the intake of foods high in vitamin C.&#34;&#10;D) &#34;I will increase the amount of protein in my diet to protect my kidneys.&#34;

Accepted Answer

Foods such as green, leafy vegetables have high levels of vitamin K. Warfarin is an anticoagulant that acts by interfering with vitamin K-dependent clotting factors. If the amount of vitamin K is increased in the diet, the medication dose may need to be adjusted. A diabetic diet would be continued as indicated for a patient receiving warfarin. Vitamin C is not related to warfarin.

Question 4

The nurse would expect to administer an anticoagulant to a patient following which surgery?&#10;A) Hip replacement&#10;B) Hysterectomy&#10;C) Abdominal aorta aneurism (AAA) repair&#10;D) Appendectomy

Accepted Answer

Prophylactic anticoagulation is used for hip replacement because of the high risk of developing a deep vein thrombosis after hip replacement. Anticoagulants are not routinely administered to patients with hysterectomies, AAA repairs, and appendectomies.

Question 5

Which nursing observation would indicate that the nurse hold the medication warfarin (Coumadin)?&#10;A) An INR (international normalize ratio) of 1.8&#10;B) An INR of 4.8&#10;C) A partial thromboplastin time (APTT) level of 25 seconds&#10;D) An APTT level of 35 seconds

Accepted Answer

The INR of 4.8 is too high. The dosage of warfarin is adjusted to maintain an INR between 2 and 3. A level of 4.8 indicates that the patient is at risk for excessive bleeding. An INR of 1.8 is below the therapeutic range and would indicate the need for warfarin. APPT is not used to monitor effectiveness of the dose for warfarin.

Question 6

The nurse is making a home visit to a patient who was discharged from the hospital on Lovenox and warfarin following replacement of the patient's pacemaker. Which observation indicates excessive bleeding? (Select all that apply.)

A) New ecchymosis on the abdomen
B) A nosebleed that does not stop with pressure
C) Pain of the lower extremity with flexion
D) Extreme fatigue
E) Pallor
F) Sudden onset of severe headache

Accepted Answer

Excessive bleeding includes large bruises that may be increasing in size, nosebleeds, extreme fatigue from decreased tissue oxygenation due to decreased hemoglobin, and sudden onset of a severe headache, which may indicate a cerebral hemorrhage. Pain in the lower extremity may be a result of a deep vein thrombosis. Pain of the legs with flexion may be associated with venous thrombosis.

Question 7

A patient on a medical surgical unit has a platelet count of 90,000 per mm&#179;. The nurse knows to include which of the following precautions in discharge instructions?&#10;A) Use a standard safety razor for shaving.&#10;B) Use a soft bristle toothbrush.&#10;C) Have aggressive dental care immediately to prevent dental caries.&#10;D) Do not eat fresh fruit.

Accepted Answer

The use of a soft bristle toothbrush will help prevent bleeding of the gums in a patient with thrombocytopenia. The blade of a safety razor can nick or cut the skin and cause bleeding. Dental care can cause gum bleeding. The consumption of fresh fruit is not part of bleeding precautions.

Deck 20: Clotting