Deck 40: Pharmacotherapy of Coagulation Disorders

Question 1

Included in the teaching plan for clients receiving warfarin (Coumadin)therapy will be: (Select all that apply.)
1)Place ice at the injection site if stinging or burning occurs.
2)Report to the lab for testing of activated partial thromboplastin time (APTT).
3)Use effective birth control to prevent pregnancy while taking warfarin (Coumadin).
4)Avoid strenuous activities.

Answer 1

3, 4

Question 2

The nurse explains the action of pentoxifylline (Trental)to the client.The drug acts by:
1)Dissolving clots.
2)Decreasing platelet aggregation.
3)Reducing the viscosity of red blood cells.
4)Increasing platelet production.

Answer 2

3

Question 3

The client receives warfarin (Coumadin).The nurse plans to teach the client to avoid which foods that are served for lunch?
1)Fettuccine Alfredo
2)Salt substitute
3)Tomato salad with basil
4)Whole-wheat bread with margarine

Answer 3

3

Question 4

The client develops blood loss due to a ruptured blood vessel in the leg.The coagulation process is initiated through:
1)The intrinsic pathway.
2)The extrinsic pathway.
3)The clotting cascade.
4)The platelet plug.

Question 5

A nurse assessing a client on a heparin drip notes bloody drainage in the nasogastric tube and Foley catheter.A stat partial thromboplastin time (PTT)is drawn; the result is 224 seconds.The next action of the nurse should be:
1)Call the physician and prepare to administer protamine sulfate.
2)Call the physician and prepare to administer vitamin K.
3)Stop the infusion, increase the IV rate, and prepare to administer aminocaproic acid (Amicar).
4)Notify the supervisor and obtain a unit of clotting factors.

Question 6

Nursing interventions for a client receiving enoxaparin (Lovenox)can include: (Select all that apply.)
1)Teaching the client or family to give subcutaneous injections at home.
2)Monitoring multiple lab tests.
3)Teaching to observe for excessive bleeding.
4)Monitoring for development of deep vein thrombosis.

Question 7

Which drug class is appropriate to promote clot formation at a surgical site?
1)Anticoagulation
2)Antifibrinolytic
3)Thrombolytic
4)Prothrombin activators

Question 8

Several clotting factors are produced by the:
1)Pancreas.
2)Liver.
3)Bone marrow.
4)Lymph nodes.

Question 9

Prior to administration of heparin therapy to a client with deep vein thrombosis (DVT), which is the most important lab value to check?
1)Activated partial thromboplastin time (APTT)
2)Prothrombin time (PT)
3)Factor VIII
4)Fibrinogen level

Question 10

The most appropriate choice for long-term anticoagulation for a client with a prosthetic heart valve is:
1)Heparin.
2)Enoxaparin (Lovenox).
3)Dalteparin (Fragmin).
4)Warfarin (Coumadin).

Question 11

The client asks what an embolus is.The nurse replies:
1)"An embolus is a stationary blood clot."
2)"An embolus is a portion of a blood clot that has moved from its original location."
3)"An embolus is an area of necrotic lung tissue."
4)"An embolus is a piece of the injured blood vessel that is moving in your blood."

Question 12

The client receiving heparin therapy asks how the "blood thinner" works.The best response by the nurse would be:
1)"Heparin makes the blood less viscous."
2)"Heparin dissolves the clot."
3)"Heparin does not thin the blood, but prevents clots from forming."
4)"Heparin decreases the number of platelets so that blood clots more slowly."

Question 13

The nurse is teaching a client with hemophilia about the disease.Which statement is most appropriate?
1)The blood is missing an enzyme that inhibits clotting.
2)An extra enzyme is present that breaks down clots too quickly.
3)There are not enough platelets present.
4)An enzyme that is part of the clotting process is missing.

Question 14

The baseline INR of a client receiving warfarin (Coumadin)was 1.2 seconds.The nurse notes that the INR value is 2.3 prior to administration of the next dose of medication.The appropriate nursing action is to:
1)Hold medication, and contact the physician.
2)Notify the physician so that the dose can be increased.
3)Administer the antidote, and observe for bleeding.
4)Administer the medication as ordered.

Question 15

Contraindications to the use of alteplase (Activase)include:
1)History of asthma.
2)History of deep vein thrombosis (DVT).
3)Childbirth one year before.
4)Head injury five days before.

Question 16

A genetic cause of thromboembolic disorders is:
1)Deficient C-reactive protein (CRP).
2)Deficient protein C.
3)Deficient C peptide.
4)Deficient vitamin C.

Question 17

The nurse completes a physical assessment on the client receiving heparin therapy for deep vein thrombosis (DVT).The client complains of severe lumbar pain.The priority action by the nurse is to:
1)Reposition the client to promote comfort.
2)Document the finding and report it to the next shift.
3)Administer pain medication.
4)Evaluate further, because this could indicate a complication of drug therapy.

Question 18

Which of the following patients is priority for DVT assessment?
1)A client recovering from a knee replacement
2)A patient with pneumonia
3)A patient with an ulcer
4)A patient with hypertension

Question 19

The nurse's understanding of the clotting mechanism is important in administering anticoagulant drugs.The nurse understands that which of the following clotting factors are formed after injury to the vessels?
1)Thrombin; fibrin
2)Prothrombin; thrombin
3)Thromboplastin; fibrinogen
4)Fibrin; vitamin K

Question 20

A past history of which of the following diseases would not put the client at risk for DVT?
1)Systemic lupus erythematosus
2)Guillain-Barré syndrome
3)Myeloma
4)Stroke with quadriplegia

Question 21

Alteplase (Activase)is prescribed for a client with an acute myocardial infarction.Priority nursing action includes:
1)Monitoring APTT.
2)Monitoring PT/INR.
3)Monitoring level of consciousness (LOC).
4)Monitoring injection sites.