Deck 26: Coagulation Modifier Drugs

Question 1

The nurse is reviewing new medication orders for a patient who has an epidural catheter for administration of pain medications. One of the orders is for enoxaparin (Lovenox), a low-molecular-weight heparin (LMWH). What is the nurse's priority action?

A) Give the LMWH as ordered.
B) Double-check the LMWH order with another nurse, and then administer as ordered.
C) Stop the epidural pain medication, and then administer the LMWH.
D) Contact the prescriber because the LMWH cannot be given if the patient has an epidural catheter.

Answer 1

Contact the prescriber because the LMWH cannot be given if the patient has an epidural catheter.

Question 2

An elderly patient has had hip surgery and will be receiving heparin, 4000 units subcutaneously every 12 hours. The heparin is available in vials of 5000 units/mL. Calculate how much heparin the nurse will administer for this dose. _______

Answer 2

0.8 mL
5000 units:1 mL :: 4000 units:x mL.
Solve for x: (5000 × x) = (1 × 4000); 5000x = 4000; x = 4000 × 5000 = 0.8; x = 0.8.

Question 3

A patient has had recent mechanical heart valve surgery and is receiving anticoagulant therapy. While monitoring the patient's laboratory work, the nurse interprets that the patient's international normalized ratio (INR) level of 3 indicates: which of these?

A) The patient is not receiving enough warfarin to have a therapeutic effect.
B) The patient's warfarin dose is at therapeutic levels.
C) The patient's intravenous heparin dose is dangerously high.
D) The patient's intravenous heparin dose is at therapeutic levels.

Answer 3

The patient's warfarin dose is at therapeutic levels.

Question 4

The nurse notes in the patient's medication orders that the patient will be starting anticoagulant therapy. What is the primary goal of anticoagulant therapy?

A) Stabilizing an existing thrombus
B) Dissolving an existing thrombus
C) Preventing thrombus formation
D) Dilating the vessel around a clot

Question 5

A patient will be taking dabigatran (Pradaxa) as part of treatment for chronic atrial fibrillation. Which statements about dabigatran are true?

A) The dose of dabigatran is reduced in patients with decreased renal function.
B) Bleeding is the most common adverse effect.
C) Idarucizumab (Praxbind) is given as an antidote in cases of uncontrolled bleeding.
D) Dabigatran levels are monitored by measuring prothrombin time/international normalized ratio (PT/INR) results.
E) This drug is a prodrug and becomes activated in the liver.

Question 6

When administering heparin subcutaneously, the nurse will follow which procedure?

A) Aspirating the syringe before injecting the medication
B) Massaging the site after injection
C) Use the same area for each injection.
D) Using a 1/2- to 5/8-inch 25- to 27-gauge needle

Question 7

A patient will be receiving a thrombolytic drug as part of the treatment for acute myocardial infarction. The nurse explains to the patient that this drug is used for which purpose?

A) To relieve chest pain
B) To prevent further clot formation
C) To dissolve the clot in the coronary artery
D) To control bleeding in the coronary vessels

Question 8

A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient asks the nurse why he has to be on two medications. The nurse's response is based on which rationale?

A) The oral and injection forms work synergistically.
B) The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used alone.
C) The warfarin is used to reach an adequate level of anticoagulation when heparin alone is unable to do so.
D) Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.

Question 9

A patient is being discharged on anticoagulant therapy. The nurse will include in the patient-education conversation that it is important to avoid herbal products that contain which substance?

A) Valerian
B) Ginkgo
C) Soy
D) Saw palmetto

Question 10

A patient has been instructed to take one enteric-coated low-dose aspirin a day as part of therapy to prevent strokes. The nurse will provide which instruction when providing patient teaching about this medication?

A) Aspirin needs to be taken on an empty stomach to ensure maximal absorption.
B) Low-dose aspirin therapy rarely causes problems with bleeding.
C) Take the medication with 6 to 8 ounces of water and with food.
D) Coated tablets may be crushed if necessary for easier swallowing.

Question 11

A patient who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the patient may have taken too much warfarin. The nurse anticipates that the patient will receive which antidote?

A) Vitamin E
B) Vitamin K
C) Protamine sulfate
D) Potassium chloride

Question 12

A patient is receiving thrombolytic therapy, and the nurse monitors the patient for adverse effects. What is the most common undesirable effect of thrombolytic therapy?

A) Dysrhythmias
B) Nausea and vomiting
C) Anaphylactic reactions
D) Internal and superficial bleeding

Question 13

A patient has received an overdose of enoxaparin (Lovenox). The order was for 30 mg, but the patient received 90 mg. The nurse notes that the patient is showing signs of bleeding (oozing blood from the intravenous sites, increased bruising) and notifies the physician, who prescribes protamine sulfate to cover the excess amount of enoxaparin that the patient received. Calculate how much protamine sulfate the patient will receive. _______

Question 14

A patient has received an overdose of intravenous heparin, and is showing signs of excessive bleeding. Which substance is the antidote for heparin overdose?

A) Vitamin E
B) Vitamin K
C) Protamine sulfate
D) Potassium chloride

Question 15

A patient is receiving heparin therapy as part of the treatment for a pulmonary embolism. The nurse monitors the results of which laboratory test to check the drug's effectiveness?

A) Bleeding times
B) Activated partial thromboplastin time (aPTT)
C) Prothrombin time/international normalized ratio (PT/INR)
D) Vitamin K levels