Question 1

You are reviewing the laboratory values of a patient whose heparin dose has been changed by the healthcare provider. Which laboratory value will inform you about effect of the dose change on this anticoagulant therapy?

Accepted Answer

The laboratory value that will inform about the effect of the heparin dose change on anticoagulant therapy is aPTT (activated partial thromboplastin time). This test measures the amount of time it takes for blood to clot and is commonly used to monitor heparin therapy. A change in the heparin dose can alter the aPTT value, and adjustments to the dose are made based on the results. PT (prothrombin time) and INR (international normalized ratio) are laboratory values used to monitor warfarin therapy, another anticoagulant medication. DIC panel (disseminated intravascular coagulation panel) is a set of laboratory tests used to diagnose a condition where the body's clotting system is abnormally activated, leading to excessive clotting in some parts of the body and bleeding in others. It is not used to monitor anticoagulant therapy.

Question 2

A patient prescribed subcutaneous heparin tells you that her menstrual bleeding is heavier than usual. What is your best response?

Accepted Answer

Heavy menstrual bleeding while taking heparin could indicate a potential bleeding disorder or other medical issue. Holding the medication and notifying the healthcare provider is the appropriate action to take to ensure the patient's safety and wellbeing.

Question 3

You are teaching a patient who has been prescribed apixaban (Eliquis) about symptoms of drug overdose. What symptom should you alert the patient to report?

Accepted Answer

Apixaban is an anticoagulant medication used to prevent blood clots. The main adverse effect of apixaban is bleeding, which can range from mild bruising to severe bleeding. Bleeding from the gums while brushing teeth can be a symptom of drug overdose and should be immediately reported to the healthcare provider. Abnormal pulse rate, gastric upset after eating, and excessive sleepiness during the day are not commonly associated with apixaban overdose.

Question 4

A patient prescribed an anticoagulant asks you about potential drug interactions with this new drug. Which of the following drugs would you advise this patient to avoid while taking anticoagulants?

Accepted Answer

Nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the risk of bleeding when taken with anticoagulants, so patients taking anticoagulants should avoid NSAIDs unless directed by their healthcare provider. Vitamin C, thiazide diuretics, and proton pump inhibitors are not known to have significant interactions with anticoagulants.

Question 5

An older patient who takes a daily NSAID for arthritis pain has been prescribed aspirin as an antiplatelet agent. What information regarding risks associated with aspirin use should be included in this teaching plan?

Accepted Answer

The use of aspirin for its antiplatelet effects places the patient at an increased risk for gastrointestinal bleeding, particularly when taken with other NSAIDs like ibuprofen. The other options are not associated with aspirin use.

Question 6

A patient with atrial fibrillation has been prescribed the drug dabigatran (Pradaxa). The patient asks you what the advantage of this drug may be over warfarin (Coumadin). What is your best response?

Accepted Answer

Dabigatran does not require frequent laboratory testing, unlike warfarin, which requires frequent monitoring of the patient's international normalized ratio (INR) levels to ensure that the drug is effective and not causing excessive bleeding.

Question 7

You are caring for a patient who is taking an indirect thrombin inhibitor following surgery. What laboratory value should you monitor for possible adverse effects of this therapy?

Accepted Answer

The laboratory value that should be monitored for possible adverse effects of indirect thrombin inhibitors is the platelet count, as these drugs can cause thrombocytopenia (decrease in platelet count) which can increase the risk of bleeding. Potassium level, serum calcium level, and white blood cell count are not directly affected by thrombin inhibitors.

Question 8

A patient taking a direct thrombin inhibitor (DTI) tells you he is going on vacation and will be taking his anticoagulant drug with him. What advice should you give to this patient related to this specific class of drugs?

Accepted Answer

It is important for the patient to keep the DTI in the original bottle so that customs and security can easily identify the medication and avoid any issues during travel.

Question 9

A patient with a history of deep vein thrombosis is prescribed subcutaneous heparin before surgery. The patient asks you if the heparin can be taken orally instead of by injection. What is your best response?

Accepted Answer

Heparin is given by injection because it cannot be absorbed orally. Heparin is a large molecule that cannot pass through the gastrointestinal tract and be absorbed into the bloodstream intact. Therefore, it must be administered via injection, either subcutaneously or intravenously. In addition, heparin given by injection works faster than oral heparin because it is absorbed more quickly and directly into the bloodstream.

Question 10

A patient with a clotting disorder is prescribed an anticoagulant and asks you to explain the purpose of anticoagulant therapy. What is your best response?

Accepted Answer

Anticoagulants are used to prevent new blood clot formation. By inhibiting certain clotting factors or platelet aggregation, anticoagulants decrease the ability of blood to clot within the circulatory system, preventing clots from forming in the first place.

Question 11

You are reviewing the laboratory values of an outpatient who is on anticoagulant therapy. The laboratory tests show a less than desired level of anticoagulation. The patient states that the drug has been taken as prescribed. Which food would you advise the patient to avoid while on anticoagulant therapy?

Accepted Answer

Spinach is high in Vitamin K, which can counteract the effects of anticoagulant therapy. It is important for patients on anticoagulant therapy to maintain a consistent intake of Vitamin K, so they should be advised to limit or avoid foods high in Vitamin K, such as spinach. Bananas, tomatoes, and sweet potatoes are not high in Vitamin K and do not have a significant effect on anticoagulation levels.

Question 12

A patient is suspected of having an overdose of heparin. What drug should you prepare for the healthcare provider to give?

Accepted Answer

Protamine sulfate is the antidote for heparin overdose, as it binds to heparin and neutralizes its anticoagulant effects. Naloxone is used as an antidote for opioid overdose, warfarin is not effective in reversing the effects of heparin, and acetylcysteine is used as an antidote for acetaminophen overdose.

Question 13

A patient taking an oral anticoagulant has had an international normalized ratio (INR) drawn to check the therapeutic drug response. Which range represents the therapeutic INR range for a patient taking an oral anticoagulant?

Accepted Answer

The therapeutic INR range for a patient taking an oral anticoagulant is 2.0 to 3.0. This range indicates that the patient's blood is appropriately anticoagulated to prevent blood clots while minimizing the risk of bleeding events.

Question 14

The aPTT of a patient who is prescribed continuous intravenous (IV) heparin is two times the control value. What is your best action?

Accepted Answer

The aPTT (activated partial thromboplastin time) value being two times the control value is typically the therapeutic goal for patients on continuous intravenous heparin therapy, indicating that the heparin is effectively thinning the blood to prevent clot formation without causing excessive bleeding. Therefore, the IV rate should be left unchanged.

Question 15

What category of anticoagulant drugs works by increasing the amount of the protein antithrombin III?

Accepted Answer

Indirect thrombin inhibitors, also known as heparinoids or heparin derivatives, work by enhancing the effects of antithrombin III, a natural protein in the body that inhibits blood clot formation. This leads to a decrease in the activity of clotting factors and an overall reduction in clot formation. Examples of indirect thrombin inhibitors include heparin, enoxaparin, and dalteparin. Fibrinolytics work by breaking down existing blood clots, vitamin K antagonists inhibit the production of clotting factors, and direct thrombin inhibitors target the enzyme thrombin directly to prevent blood clot formation.

Question 16

You are taking the drug history of a patient who will be starting on an anticoagulant. Which of the following drug categories from this patients' drug list would potentially interfere with an anticoagulant?

Accepted Answer

Oral contraceptives can increase the risk of bleeding when taken with anticoagulants. It is important for the prescribing physician to monitor the patient closely and adjust the anticoagulant dose as necessary. Beta blockers, loop diuretics, and inhaled corticosteroids do not have a significant interaction with anticoagulants.

Question 17

You are preparing to draw up a dose of heparin to give subcutaneously to a patient. Which of the following represents the best procedure in preparing this injection?

Accepted Answer

Rolling the vial between your hands is the recommended method to gently mix the solution without creating bubbles or froth, which can occur with shaking. This ensures an even distribution of the drug in the solution.

Question 18

A patient who is taking an anticoagulant informs you that the herbal supplement St. John's wort is taken daily for depression. What should you teach the patient about the use of herbal supplements with anticoagulant therapy?

Accepted Answer

St. John's wort has been shown to have anticoagulant effects, and when combined with anticoagulant therapy, it may increase the risk of bleeding. It is important for patients to inform their healthcare provider of all herbal supplements they are taking to prevent potential interactions with other medications.

Question 19

Which statement made by a patient with a recent coronary artery stent placement who is taking clopidogrel informs you that the patient requires further teaching about this drug?

Accepted Answer

Clopidogrel is typically prescribed for at least 12 months following a coronary artery stent placement, not just 3 months. This duration can vary based on the type of stent and clinical circumstances, but 3 months is generally shorter than the recommended duration.

Question 20

Which symptom when reported by a patient taking aspirin alerts you to a possible adverse reaction to the drug?

Accepted Answer

Itching and hives are indicative of an allergic reaction to aspirin. Nausea and increased urination are common side effects, and decreased vision is not typically associated with aspirin use.

Quiz 14: Drugs Affecting the Hematologic System