Deck 30: Antiplatelets,anticoagulants,fibrinolytics,and Blood Components

Question 1

Before discharge,a client begins oral anticoagulant therapy with sodium warfarin (Coumadin)while he is still taking heparin.He questions the nurse about being on both of the medications.The nurse's best response would be

A) "Before you go home,let me check with the doctor about this."
B) "It takes a few days for the warfarin to work,so we need to keep you on the heparin."
C) "Because of your valve replacement,you need to take additional medication."
D) "You have increased your activity and mobility,so you should be on both of these medications."

Answer 1

"It takes a few days for the warfarin to work,so we need to keep you on the heparin."

Question 2

A client who has also started nursing school asks the nurse how sodium warfarin (Coumadin)exerts its anticoagulant effect.The nurse explains that the drug does which of the following?

A) Interferes with production of vitamin K-dependent clotting factors
B) Dilates the arterial blood vessel so blood can flow around the injured site
C) Prevents thrombi from forming by making the platelets sticky
D) Inactivates clotting factors circulating in the bloodstream

Answer 2

Interferes with production of vitamin K-dependent clotting factors

Question 3

A client who will be taking sodium warfarin (Coumadin)at home indicates an understanding of drug-food interactions by limiting intake of which of the following foods?

A) Milk products
B) Citrus fruits
C) Green,leafy vegetables
D) Chicken and pork

Answer 3

Green,leafy vegetables

Question 4

The nurse would question the use of anticoagulants for which client condition considered to be a contraindication for its use?

A) Hypotension
B) Recent childbirth
C) Diabetes insipidus
D) Leg ulcer

Question 5

A client who is receiving a continuous heparin infusion is reporting a chill and low back pain.The most appropriate nursing action would be to

A) increase the heparin infusion.
B) stop the heparin infusion.
C) administer sodium warfarin (Coumadin).
D) place a heating pad on the client's lower back.

Question 6

A client who had a thromboembolic event is taking sodium warfarin (Coumadin).The nurse evaluates that the client is having the expected effect of drug therapy if the international normalized ratio laboratory result is within which of the following ranges?

A) 4 to 5
B) 3 to 4
C) 2 to 3
D) 1 to 2

Question 7

The nurse reviews the results of which of the following tests used for monitoring therapy with oral anticoagulants?

A) Activated partial thromboplastin time and activated clotting time
B) Prothrombin time and partial thromboplastin time
C) Prothrombin time and international normalized ratio
D) Activated clotting time and partial thromboplastin time

Question 8

During streptokinase administration,which of the following nursing interventions is important?

A) Monitor hourly urinary outputs
B) Monitor for any signs of blood loss
C) Evaluate for renal damage
D) Have heparin on hand

Question 9

The nurse plans to monitor the results of which of the following laboratory studies to monitor the therapeutic effects of heparin?

A) Prothrombin time
B) Hematocrit
C) Hemoglobin
D) Activated partial thromboplastin time

Question 10

Discharge teaching by the nurse about sodium warfarin (Coumadin)should include instructions to

A) double up on any doses that are missed.
B) keep taking aspirin with the warfarin.
C) alter the dose if bleeding occurs.
D) use a soft toothbrush.

Question 11

The nurse hears in intershift report that a client receiving heparin therapy has an activated partial thromboplastin time in the therapeutic range.The nurse anticipates that a review of the laboratory results will reveal an activated partial thromboplastin time result that is how many times the control (normal)value?

A) 0.5 to 1 times
B) 1.5 to 2.5 times
C) 3 to 4 times
D) 4 to 5 times

Question 12

While explaining the purpose of intravenous heparin therapy,the nurse would include in language appropriate to the client's level of understanding that the drug has which of the following actions?

A) Interferes with production of vitamin K-dependent clotting factors
B) Dilates the arterial blood vessel so blood can flow around the injured site
C) Prevents thrombi from forming by making the platelets sticky
D) Inactivates clotting factors circulating in the bloodstream

Question 13

The nurse chooses which drug from the emergency cart as the antidote for heparin (Liquaemin)overdose that results in hemorrhaging?

A) Protamine sulfate
B) Phytonadione (Vitamin K)
C) Calcium gluconate
D) Potassium phosphate

Question 14

The nurse determines that a client may be having an allergic reaction to streptokinase after noting which of the following?

A) Hypertension
B) Flushed,red skin
C) Vomiting
D) Dyspnea

Question 15

The nurse concludes that the occurrence of hematuria and petechiae in a client receiving heparin (Liquaemin)is most likely attributed to the concurrent use of which drug?

A) Ampicillin (Amoxicillin)
B) Digoxin (Lanoxin)
C) Ibuprofen (Motrin)
D) Acetaminophen (Tylenol)

Question 16

Which of the following is an appropriate nursing diagnosis for the client who is taking heparin?

A) Ineffective tissue perfusion
B) Deficient fluid volume
C) Imbalanced nutrition
D) Ineffective airway clearance

Question 17

After receiving a first dose of sodium warfarin (Coumadin),the client receiving intravenous heparin therapy asks when the intravenous infusion can be discontinued.Which correct timeframe should the nurse share with the client?

A) 48 to 72 hours
B) 24 to 48 hours
C) 12 to 24 hours
D) 4 to 6 hours

Question 18

A client who is taking anticoagulants requests an aspirin for his headache.The nurse should take which appropriate action?

A) Give him 650 mg after receiving the order from the physician
B) Suggest that he take ibuprofen (Motrin)with food instead of taking another aspirin
C) Contact the physician for an analgesic that does not contain aspirin
D) Explain that the headache is an expected adverse effect caused by vasodilation from the heparin

Question 19

The nurse would withhold a newly ordered dose of sodium warfarin (Coumadin)for a client who has which of the following contraindications for its use?

A) Pregnancy
B) Hypercoagulability state
C) Deep vein thrombosis
D) Pulmonary embolism

Question 20

The nurse would explain to a client beginning anticoagulant therapy that the primary goal of therapy will be to do which of the following?

A) Stabilize the existing thrombus
B) Prevent the thrombus from becoming an embolus
C) Dissolve the existing thrombus
D) Prevent the formation of new thrombi

Question 21

A nurse has just obtained a unit of packed red blood cells from the blood bank.The nurse carefully plans care of the client so that the blood transfusion is hung within how many minutes of being signed out of the blood bank?

A) 15 minutes
B) 30 minutes
C) 45 minutes
D) 60 minutes

Question 22

The nurse is initiating an intravenous infusion of anistreplase (Eminase).The nurse would assess the client for which of the following signs of allergic reaction during the early minutes of the infusion?

A) Dyspnea and wheezing
B) Muscle aches
C) Sudden rise in blood pressure
D) Dizziness and confusion

Question 23

A client is due to receive a scheduled dose of enoxaparin (Lovenox).The nurse should do which of the following to administer this drug correctly?

A) Use a 20- to 22-gauge,1- to 1.5-inch needle
B) Rotate sites systematically on the abdomen
C) Aspirate before injecting to ensure no blood return
D) Massage the site after injection to aid in drug absorption

Question 24

A client has just completed intravenous thrombolytic therapy.The nurse places a sign above the client's head of bed reminding caregivers not to give drugs by which route for at least 24 hours?

A) Oral
B) Enteral tube
C) Intravenous
D) Intramuscular

Question 25

The client with a history of heart failure has an order to receive one unit of packed red blood cells.If the nurse hangs the unit at 10:00 AM,the infusion must be completed absolutely no later than

A) 12 noon.
B) 1:00 PM.
C) 2:00 PM.
D) 3:00 PM.

Question 26

The nurse would pretreat the client with acetaminophen (Tylenol)according to protocol orders if the client has a history of which of the following transfusion reactions?

A) Allergic transfusion reaction (cutaneous)
B) Anaphylactic transfusion reaction
C) Immune-mediated hemolytic transfusion reaction
D) Febrile nonhemolytic reaction

Question 27

The nurse is preparing to administer a blood product to an assigned client.The nurse checks the client's intravenous catheter to make sure that it is no smaller than which of the following sizes?

A) 16 gauge
B) 19 gauge
C) 25 gauge
D) 27 gauge

Question 28

The nurse preparing to hang a unit of blood for an assigned client would select which of the following intravenous solutions to prime the blood tubing before administration?

A) 5% Dextrose in lactated Ringer's solution
B) 5% Dextrose in water
C) 0.45% Sodium chloride
D) 0.9% Sodium chloride

Question 29

The nurse overhears the prescriber tell a client that drug therapy with dalteparin (Fragmin)will be started.The nurse plans to teach the client that this drug will be administered by which of the following routes?

A) Oral
B) Sublingual
C) Intramuscular
D) Subcutaneous

Question 30

A client receiving anticoagulant therapy with heparin has an activated partial thromboplastin time in the critically high range.The nurse should ensure that which of the following drugs is on hand to use as an antidote?

A) Phytonadione (Vitamin K)
B) Aminocaproic acid (Amicar)
C) Protamine sulfate (Protamine)
D) Anistreplase (Eminase)

Question 31

A client is starting drug therapy with clopidogrel (Plavix).The nurse evaluates that the client understands drug interactions when the client states to take which of the following drugs as an over-the-counter analgesic when needed?

A) Aspirin (Ecotrin)
B) Ibuprofen (Motrin)
C) Naproxen (Aleve)
D) Acetaminophen (Tylenol)

Question 32

The nurse has an order to give a newly ordered dose of ticlopidine (Ticlid)to a client.The nurse checks the client's medical record to be sure the client does not have a history of which of the following?

A) Pulmonary embolism
B) Deep vein thrombosis
C) Liver disease
D) Diabetes mellitus

Question 33

A client meets the criteria to be a candidate for drug therapy with alteplase (Activase).The nurse explains the use of this drug to the client by telling the client that the drug will

A) stabilize the blood clot so that no further growth can occur.
B) prevent the breakdown of the existing blood clot.
C) dissolve the blood clot that has already formed.
D) prevent formation of additional blood clots.

Question 34

A client is nearing the completion of an intravenous infusion of alteplase (Activase).The nurse prepares to hang which of the following drugs next as part of standard drug protocol?

A) Morphine sulfate
B) Streptokinase (Streptase)
C) Nitroglycerin (Nitrostat)
D) Heparin (Liquaemin)

Question 35

The nurse is providing discharge instructions to a client who will be discharged to home while on anticoagulant therapy.The nurse would encourage the client to use which of the following as an acceptable item for self-care?

A) Soft toothbrush
B) Straight razor
C) Alcohol-based mouthwash
D) Unwaxed dental floss