Question 1

Which of the following patients would the nurse anticipate the collaborative treatment of regular phlebotomies?

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 2

Which statement by a patient indicates additional teaching is required about the medication warfarin?

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 3

A patient on a medical surgical unit has a platelet count of 90,000 per mm³.The nurse knows to include which of the following precautions in discharge instructions?

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.

Question 4

Which nursing observation would indicate that the nurse hold the medication warfarin (Coumadin)?

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 5

The nurse would expect to administer an anticoagulant to a patient following which surgery?

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 6

A patient states that his/her 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?

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 7

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.)

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.

Quiz 17: Clotting