Deck 38: Pharmacotherapy of Coagulation Disorders

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?

A)"I can't believe this is happening.My baby is only a year old."
B)"I thought this was just my asthma acting up."
C)"I wonder if this was happening when I fell and hit my head last week."
D)"I had a blood clot in my leg last year after my baby was born."

Answer 1

"I wonder if this was happening when I fell and hit my head last week."

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?

A)A genetic deficiency of protein C can produce hypercoagulability.
B)Familial eating habits can result in deficiency of vitamin C that would increase clotting.
C)Genetic deficiency of C peptide is implicated in clotting disorders.
D)If there is a genetic tendency to decreased C reactive protein (CRP)the clotting cascade is enhanced.

Answer 2

A genetic deficiency of protein C can produce hypercoagulability.

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?

A)"If you develop a DVT,you will know it."
B)"Watch for paleness or coolness in your toes."
C)"Report any swelling in your knee."
D)"Look for increased tenderness in your lower legs."

Answer 3

"Look for increased tenderness in your lower legs."

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?

A)Enoxaparin (Lovenox)
B)Dalteparin (Fragmin)
C)Heparin
D)Warfarin (Coumadin)

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?

A)Evaluate further because this could indicate a complication of drug therapy.
B)Reposition the client to promote comfort.
C)Administer pain medication.
D)Document the finding and report it to the next shift.

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?

A)Immediately after increasing the rate
B)At 2000
C)At 1530
D)At 0800 the next morning

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?

A)Moderate-carbohydrate foods
B)Foods high in vitamin C
C)Fiber-rich foods
D)Foods rich in folic acid

Question 8

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

A)"Heparin dissolves the clot."
B)"Heparin makes the blood less viscous."
C)"Heparin decreases the number of platelets so that blood clots more slowly."
D)"Heparin prevents clots from forming."

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?

A)Administer the antidote and observe for bleeding.
B)Notify the health care provider so that the dose can be increased.
C)Administer the medication as ordered.
D)Hold medication and contact the health care provider.

Question 10

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

A)A client with a gastric ulcer
B)A client with hypertension
C)A client recovering from a knee replacement
D)A client with pneumonia

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?

A)"A pulmonary embolus is a stationary blood clot that formed in your lung."
B)"An embolus is a piece of the injured blood vessel that is moving in your lung."
C)"A pulmonary embolus is a portion of a blood clot that has moved from its original location to your lung."
D)"A pulmonary embolus is an area of tissue in your lung that has lost its blood supply and has become necrotic."

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.

A)"Tell your dentist you are taking warfarin prior to any procedures."
B)"Report to the lab for testing of activated partial thromboplastin time (APTT)."
C)"Avoid strenuous activities."
D)"Place ice at the injection site if stinging or burning occurs."
E)"Take nonsteroidal anti-inflammatories (NSAIDs)for minor pain relief."

Question 13

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

A)An extra protein is present that breaks down clots too quickly.
B)A substance that is part of the clotting process is missing.
C)The blood is missing a substance that inhibits clotting.
D)There are not enough platelets present.

Question 14

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

A)Pentoxifylline is given to dissolve clots.
B)Pentoxifylline acts by increasing platelet production.
C)Pentoxifylline increases fibrin production.
D)Pentoxifylline reduces the viscosity of red blood cells.

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?

A)Notify the health care provider and prepare to administer protamine sulfate.
B)Stop the infusion,increase the IV rate,and prepare to administer aminocaproic acid (Amicar).
C)Notify the supervisor and obtain a unit of clotting factors.
D)Call the health care provider and prepare to administer vitamin K.

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.

A)Teach the client or family to give subcutaneous injections at home.
B)Monitor for development of deep vein thrombosis.
C)Monitor multiple lab tests.
D)Teach the client signs of excessive bleeding.
E)Schedule administration times right before breakfast and the evening meal.

Question 17

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

A)Monitor APTT.
B)Monitor PT/INR.
C)Monitor injection sites.
D)Monitor level of consciousness (LOC).

Question 18

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

A)Thrombolytics
B)Antifibrinolytics
C)Anticoagulants
D)Prothrombin activators

Question 19

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

A)Whole-wheat bread with margarine
B)Roast beef
C)Salt substitute
D)Broccoli salad

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?

A)Prothrombin time (PT)
B)Fibrinogen level
C)Activated partial thromboplastin time (APTT)
D)Factor VIII level

Question 21

A client has been taking oral anticoagulant therapy for a number of years secondary to atrial fibrillation.Which client statement alerts the nurse to assess more closely for the development of drug-induced hepatitis? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"I seem to be making more urine that normal."
B)"My stools are a funny light yellow color."
C)"I need an ointment to keep my skin from itching so much."
D)"My legs hurt when I walk very far."
E)"I seem to be very thirsty most of the time."

Question 22

A client who has hemophilia A is scheduled for a minor surgical procedure.The client 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?" Which responses by the nurse is the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"You must have misunderstood the directions.Let me check with the health care provider."
B)"Blood will be taken and banked in case you need to have it retransfused on the day of surgery."
C)"You will be given a test dose of a medication used to increase your clotting factors."
D)"This visit is related to your hemophilia and keeping you safe during the surgery."
E)"Don't be worried about the testing.Nothing will hurt."

Question 23

A client is being treated for a thromboembolic disorder.If the goal is to prevent clot formation,the nurse anticipates the client will be treated with which classifications of drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Hemostatics
B)Thrombolytics
C)Anticoagulants
D)Antiplatelet agents
E)Clotting factor concentrates

Question 24

A client is maintained on warfarin (Coumadin)therapy secondary to refractory atrial fibrillation.Which statement by the client would alert the nurse to a possible problem with this therapy?

A)"I have started taking a vitamin C supplement to prevent colds this winter."
B)"I am learning to use olive oil in my cooking."
C)"I've stopped drinking coffee and now drink decaffeinated green tea."
D)"I have a big glass of grapefruit juice with my breakfast every day."

Question 25

The nurse is providing discharge teaching regarding anticoagulant therapy.Which statements by the client would the nurse evaluate as indicating the need for further instruction? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"I'll ask for an electric razor for my birthday next week."
B)"I guess my trip to the amusement park is off for now."
C)"I won't be able to cook anymore."
D)"I'll get one of those new electric toothbrushes with the firm bristles."
E)"I should make an appointment for a B₁₂ injection monthly."

Question 26

During health history assessment,an adult client says,"I've been told I have some sort of bleeding disorder,but I'm not certain." Which responses by the nurse are the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"Did the health care provider mention von Willebrand disease?"
B)"None of the inherited bleeding disorders affect women."
C)"Is there a history of bleeding disorders in your family?"
D)"Have you ever experienced excessive bleeding or easy bruising?"
E)"If you had a true bleeding disorder you would have had symptoms earlier in your life."

Question 27

The nurse is providing care for a client who developed heparin-induced thrombocytopenia (HIT)during heparin therapy.The nurse is aware that lepirudin (Refludan)is often given to clients with this condition.Which assessment findings should the nurse report to the medical team? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)The most recent aPTT is 2.8.
B)The client's last stool tested positive for blood.
C)The client is allergic to eggs.
D)The client's spleen was removed after a motor vehicle accident 3 years ago.
E)The client drinks 5-6 cups of coffee daily.

Question 28

A client is prescribed ticlopidine (Ticlid)after a myocardial infarction and stent placement.How should the nurse explain the action of this medication to the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"Ticlid will dissolve any clots that might form in your stent."
B)"Ticlid will make the platelets in your blood less sticky."
C)"Ticlid will change the way your platelets work their entire lives."
D)"Ticlid decreases your blood's ability to clot."
E)"Ticlid works just like the heparin you have been on in the hospital."