Question 1

Why is warfarin (Coumadin)avoided during pregnancy?&#10;A) Warfarin can induce premature closure of the foramen ovale in the fetus.&#10;B) The fetal and newborn liver cannot metabolize warfarin and anemia results.&#10;C) The fetus and newborn are more likely to have allergic reactions to warfarin.&#10;D) Warfarin crosses the placenta and causes birth defects or hemorrhage in the fetus.

Accepted Answer

Warfarin is a pregnancy category D drug with a chemical composition the same as rat poison.It can cause birth defects and can reduce clotting in the fetus to such an extent that severe and fatal hemorrhage in the fetus is possible (especially brain hemorrhage).

Question 2

A patient prescribed an anticoagulant long-term engages in all of the following activities.Which activity does the nurse teach the patient to avoid?&#10;A) Golfing&#10;B) Bowling&#10;C) Jumping rope&#10;D) Walking 2 miles daily

Accepted Answer

Any person taking anticoagulants long-term must avoid activities that can traumatize tissue and lead to bleeding,such as contact sports (e.g.,football,hockey),and activities that put extra weight and stress on the leg joints and spine (e.g.,jumping rope,jogging,high impact exercise).Jumping rope can cause bleeding into the joints,especially the knee,which can lead to permanent damage.

Question 3

Which condition occurs as a result of a thrombus developing in a coronary artery?&#10;A) Cerebrovascular accident&#10;B) Deep vein thrombosis&#10;C) Pulmonary embolus&#10;D) Myocardial infarction

Accepted Answer

When a thrombus develops in a coronary artery and blocks the blood supply to a part of the heart muscle,a heart attack (myocardial infarction)occurs.Cerebrovascular accident (stroke)occurs when a thrombus blocks an artery in the brain.Deep vein thrombosis occurs when a clot blocks a deep vein,such as a leg vein.Pulmonary embolus occurs when an embolus blocks blood flow in an artery in the lungs.

Question 4

A patient who has been receiving heparin subcutaneously for 3 weeks has all of the following laboratory blood test values.Which value does the nurse report immediately to the prescriber? A) Activated partial thromboplastin time 1.5 B) International normalized ratio (INR) 1.7 C) Red blood cells 4.2 million/mm³ D) Platelets 20,000/mm³

Accepted Answer

The normal range for platelets is 200,000 to 400,000/mm³.Platelets are needed for blood clotting.This patient's platelet count is extremely low and he or she is at grave risk for severe bleeding.The low platelet count is an indication of an adverse reaction to heparin known as heparin-induced thrombocytopenia (HIT).The heparin needs to be discontinued and the patient needs to receive platelet therapy before life-threatening hemorrhage occurs.

Question 5

A patient prescribed subcutaneous heparin tells the nurse that her menstrual bleeding is heavier than usual.What is the nurse's best response?&#10;A) &#34;I will hold the drug and notify your prescriber.&#34;&#10;B) &#34;This is a fairly common and expected side effect of the drug.&#34;&#10;C) &#34;Heavy bleeding is a concern because you might become anemic.&#34;&#10;D) &#34;I will have to give you a shot of protamine sulfate to reverse the drug's action.&#34;

Accepted Answer

Common side effects of anticoagulant therapy include increased risk for bleeding.Bleeding from the gums,oozing from cuts or wounds,nosebleeds,and heavier than usual menstrual bleeding can occur.

Question 6

A patient in the emergency department developed stroke symptoms one hour ago.Which type of drug will the nurse expect to administer to resolve this problem?&#10;A) Thrombolytic&#10;B) Thrombin inhibitor&#10;C) Antiplatelet drug&#10;D) Clotting factor synthesis inhibitor

Accepted Answer

When an ischemic stroke occurs there is an existing clot in an artery in the brain.To resolve this problem early after symptoms develop,a thrombolytic drug (clot buster)is prescribed.These drugs must be administered within 3 hours of the onset of symptoms for stroke.Thrombin inhibitors and clotting factor synthesis inhibitors prevent new clots from forming and existing clots from getting larger.Antiplatelet drugs prevent platelets from clumping together (aggregating).

Question 7

A patient is being discharged on enoxaparin (Lovenox).Which statement does the nurse include in the discharge teaching plan?&#10;A) &#34;An advantage of this drug is that labs do not need to be drawn to guide therapy.&#34;&#10;B) &#34;Follow-up lab work must be drawn every 2 to 6 months.&#34;&#10;C) &#34;Enoxaparin is given intramuscularly twice a day.&#34;&#10;D) &#34;The purpose of this drug is to dissolve clots.&#34;

Accepted Answer

A major advantage of using low-molecular-weight heparins such as enoxaparin is that patients are not required to have laboratory work done to guide their therapy.The drug is given two times daily subcutaneously.Its purpose is to prevent venous thromboembolic events and pulmonary embolism.

Question 8

A patient has been discontinued from warfarin (Coumadin)therapy for 3 weeks.Which laboratory test indicates to the nurse that all effects of the warfarin have been eliminated? A) International normalized ratio (INR) of 0.9 B) Red blood cell count of 5 million/mm³ C) Hemoglobin of 16 g/dL D) Hematocrit of 42%

Accepted Answer

Warfarin therapy increases the INR,which normally ranges between 0.7 and 1.8.Therapeutic warfarin levels should maintain the INR between 2.0 and 3.0.When the effects of warfarin are no longer present,the INR returns to normal levels.Warfarin therapy does not affect white blood cell count,serum ferritin levels,or the reticulocyte count.

Question 9

A patient is taking warfarin (Coumadin)daily to prevent blood clots from forming in deep veins.Which statement made by the patient indicates that more teaching is needed about this therapy?&#10;A) &#34;I have been eating more salads and other green, leafy vegetables to prevent constipation.&#34;&#10;B) &#34;I have been using acetaminophen (Tylenol) instead of aspirin for pain.&#34;&#10;C) &#34;Instead of a safety razor, I have been using an electric shaver.&#34;&#10;D) &#34;On hot days, I make sure to drink at least two quarts of water.&#34;

Accepted Answer

Vitamin K is present in green,leafy vegetables and increases blood clotting by increasing the synthesis of specific clotting factors in the liver.Warfarin is a vitamin K antagonist.Ingestion of large amounts of vitamin K can counteract the therapeutic effects of warfarin.

Question 10

Which action does the nurse avoid after administering a thrombolytic drug?&#10;A) Administering IV drugs&#10;B) Using electric razors&#10;C) Providing a soft toothbrush&#10;D) Giving an intramuscular injection

Accepted Answer

Thrombolytic drugs dissolve existing clots,so there is a high risk for bleeding with any invasive procedures such as intramuscular injections.Administration of IV drugs through an already existing line is acceptable,but the nurse would not want to place a new line or discontinue an existing line.Use of electric razors and soft toothbrushes are safe with patients who have received a thrombolytic drug.

Question 11

Which drug must always be available on a unit where heparin therapy is occurring?&#10;A) aspirin&#10;B) vitamin K&#10;C) protamine sulfate&#10;D) warfarin (Coumadin)

Accepted Answer

The answer of Which drug must always be available on...

Question 12

A patient who has been prescribed continuous intravenous (IV)heparin asks the nurse why being weighed is necessary.What is the nurse's best response?&#10;A) &#34;All patients are weighed upon admission to the hospital.&#34;&#10;B) &#34;IV heparin has been known to cause weight gain.&#34;&#10;C) &#34;The initial IV bolus of heparin is prescribed based on your weight.&#34;&#10;D) &#34;The rate of the heparin infusion is based on your weight.&#34;

Accepted Answer

The answer of A patient who has been prescribed continuous...

Question 13

How are anticoagulant drugs and thrombolytic drugs different?&#10;A) There is no difference; they both have the same actions.&#10;B) Anticoagulants prevent clots from forming whereas thrombolytics can dissolve clots that have already formed.&#10;C) Thrombolytics must be administered intravenously while all anticoagulants are administered as oral agents.&#10;D) Anticoagulants prevent clots by actually thinning the blood whereas thrombolytics reduce platelet aggregation and do not affect blood thickness.

Accepted Answer

The answer of How are anticoagulant drugs and thrombolytic drugs...

Question 14

Which blood component forms the initial plug that helps stop bleeding?&#10;A) Fibrin&#10;B) Platelets&#10;C) Neutrophils&#10;D) Eosinophils

Accepted Answer

The answer of Which blood component forms the initial plug...

Question 15

A patient with a vein thromboembolism is to be started on oral warfarin (Coumadin)while still receiving intravenous heparin.What is the nurse's best action?&#10;A) Administer the drugs as prescribed.&#10;B) Remind the prescriber that two anticoagulants should not be administered concurrently.&#10;C) Hold the dose of warfarin until the patient's activated partial thromboplastin time is the same as the control value.&#10;D) Monitor the patient for clinical manifestations of internal or external bleeding at least every 2 hours.

Accepted Answer

The answer of A patient with a vein thromboembolism is...

Question 16

A patient asks the nurse why an anticoagulant has been prescribed.What is the nurse's best response?&#10;A) &#34;It will dissolve any clots in your blood vessels.&#34;&#10;B) &#34;It will prevent any new clots from forming.&#34;&#10;C) &#34;It will prevent a clot from migrating.&#34;&#10;D) &#34;It will thin your blood.&#34;

Accepted Answer

The answer of A patient asks the nurse why an...

Question 17

Why should children not be prescribed aspirin or aspirin-containing products?&#10;A) There is more risk for bleeding in children than in adults.&#10;B) Aspirin products are more likely to cause GI upset in children.&#10;C) Children are more likely to experience allergic reactions to aspirin-containing products.&#10;D) Risk for Reye's syndrome, which effects brain and liver function, is increased in children.

Accepted Answer

The answer of Why should children not be prescribed aspirin...

Question 18

Which statement by a patient who is prescribed heparin indicates to the nurse the need for additional teaching?&#10;A) &#34;I'll be sure to have my follow-up aPTT drawn when the prescriber tells me to.&#34;&#10;B) &#34;I will not take over-the-counter drugs that contain aspirin.&#34;&#10;C) &#34;I will get plenty of exercise playing soccer.&#34;&#10;D) &#34;I'll tell my prescriber if I have headaches.&#34;

Accepted Answer

The answer of Which statement by a patient who is...

Question 19

Which dietary teaching does the nurse include for a patient who is prescribed warfarin (Coumadin)on discharge?&#10;A) &#34;Weight loss diets such as the Atkins diet are OK while taking this drug.&#34;&#10;B) &#34;Be sure to eat lots of green leafy vegetables for extra vitamin K.&#34;&#10;C) &#34;Dietary changes do not affect the action of this drug.&#34;&#10;D) &#34;Drinking alcoholic beverages can change the action of warfarin.&#34;

Accepted Answer

The answer of Which dietary teaching does the nurse include...

Question 20

The aPTT of a patient who is prescribed continuous intravenous (IV)heparin is two times the control value.What is the nurse's best action?&#10;A) Increase the IV rate as ordered.&#10;B) Decrease the IV rate as ordered.&#10;C) Leave the rate unchanged.&#10;D) Stop the infusion and notify the prescriber.

Accepted Answer

The answer of The aPTT of a patient who is...

Question 21

A patient coming to the clinic for a weekly infusion of darbepoetin alpha (Aranesp)has all of the following changes.For which change does the nurse hold the dose of the drug?&#10;A) Weight loss of five pounds&#10;B) Hemoglobin increase from 8 g/dL to 10 g/dL&#10;C) Blood potassium increase from 3.8 mEq/L to 4.8 mEq/L&#10;D) Blood pressure increase from 126/80 mm Hg to 148/92 mm Hg

Accepted Answer

The answer of A patient coming to the clinic for...

Question 22

Which factors are absolute contraindications for thrombolytic therapy?&#10;A) Active peptic ulcer disease&#10;B) Active internal bleeding&#10;C) Recent head trauma&#10;D) Endocarditis&#10;E) Suspected aortic aneurysm&#10;F) Surgery within the last 10 days

Accepted Answer

The answer of Which factors are absolute contraindications for thrombolytic...

Question 23

The nurse prepares to administer an intramuscular injection to a patient who is on anticoagulation therapy.Which techniques does the nurse perform to prevent excessive bleeding?&#10;A) Using the smallest possible injection needle&#10;B) Injecting the drug slowly, over at least a 60-second period&#10;C) Applying pressure to the site for at least 5 minutes after the injection&#10;D) Ensuring that the needle is placed within a previous injection puncture site&#10;E) Cleansing the skin at the injection site for at least 30 seconds before the injection&#10;F) Applying warm compresses to the site for at least 15 minutes after the injection

Accepted Answer

The answer of The nurse prepares to administer an intramuscular...

Question 24

Which actions are performed by the nurse when giving a subcutaneous injection of low-molecular weight heparin?&#10;A) Position the patient lying down.&#10;B) Expel the air bubble before injection.&#10;C) Insert the needle into a skin fold held between the thumb and forefinger.&#10;D) Release the skin fold then inject the drug.&#10;E) Rub the injection site to avoid bruising.

Accepted Answer

The answer of Which actions are performed by the nurse...

Question 25

A patient is prescribed 3000 units/mL of heparin subcutaneously.The drug on hand is heparin 5000 units/mL.How many milliliters does the nurse administer?&#10;_____ mL

Accepted Answer

The answer of A patient is prescribed 3000 units/mL of...

Question 26

Why are erythropoiesis-stimulating agents (ESAs)prescribed for patients with chronic kidney disease?&#10;A) To protect the kidney from further hypoxic damage during anemia episodes&#10;B) To improve blood cell counts and reduce the need for blood transfusions&#10;C) To prevent vein thromboembolism during periods of dehydration&#10;D) To reduce the risk of uric acid precipitation and renal failure

Accepted Answer

The answer of Why are erythropoiesis-stimulating agents (ESAs)prescribed for patients...

Question 27

A patient who received the thrombolytic drug alteplace (Activase)asks the nurse why continuous heparin is now infusing intravenously.What is the nurse's best response?&#10;A) &#34;There may be additional clots in your body and we want to be sure they are all dissolved.&#34;&#10;B) &#34;Once the clot is dissolved, heparin is given continuously to prevent any new clots from forming.&#34;&#10;C) &#34;The heparin finishes the job of dissolving the clot that the alteplace started.&#34;&#10;D) &#34;Heparin is infused continuously in case we need to give additional dosages of alteplase.&#34;

Accepted Answer

The answer of A patient who received the thrombolytic drug...

Question 28

Which types of clots are thrombolytic events?&#10;A) Scab&#10;B) Thrombus&#10;C) Embolus&#10;D) Clotted intravenous catheter&#10;E) Fat embolus

Accepted Answer

The answer of Which types of clots are thrombolytic events?&#10;A)...

Question 29

A patient is receiving oprelvekin (Neumega)subcutaneously daily.Which laboratory value indicates to the nurse that the therapy is effective? A) Hemoglobin 12 g/dL B) Platelet level 55,000/mm³ C) Red blood cells 4.5 million/mm³ D) International normalized ratio (INR) 1.0

Accepted Answer

The answer of A patient is receiving oprelvekin (Neumega)subcutaneously daily.Which...

Deck 17: Drugs That Affect Blood Clotting