Anticoagulant Monitoring and Management Quiz
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Questions and Answers

What is the normal range for aPTT (activated partial thromboplastin time)?

  • 45-55 seconds
  • 35-45 seconds
  • 25-35 seconds (correct)
  • 15-25 seconds

    • What is the therapeutic level of aPTT when a patient is on heparin?

  • 70-90 seconds
  • 50-70 seconds (correct)
  • 90-110 seconds
  • 40-50 seconds

    • What is the normal range for platelet count per microliter of blood?

  • 100,000 to 250,000
  • 450,000 to 600,000
  • 150,000 to 450,000 (correct)
  • 50,000 to 100,000

    • What is the priority intervention to reverse an asthma attack?

    <p>Administer a bronchodilator</p> Signup and view all the answers

    What are the signs and symptoms of pulmonary toxicity caused by amiodarone?

    <p>Dyspnea, coughing, pleuritic chest pain</p> Signup and view all the answers

    What is the priority intervention for a patient with uncontrolled atrial fibrillation (A-FIB) with a heart rate over 100 bpm?

    <p>Administer calcium channel blockers</p> Signup and view all the answers

    What is the purpose of transesophageal echocardiography (TEE) in a patient with new onset atrial fibrillation (A-FIB)?

    <p>To detect blood clots before cardioversion</p> Signup and view all the answers

    What is the primary goal of anticoagulation therapy for a patient with A-FIB?

    <p>To prevent blood clots</p> Signup and view all the answers

    What is the antidysrhythmic effect of amiodarone?

    <p>Slows the heart rate and can prolong QT intervals</p> Signup and view all the answers

    What is the primary purpose of TEE (transesophageal echocardiography) in a patient with new onset atrial fibrillation?

    <p>To look for blood clots before cardioversion</p> Signup and view all the answers

    What is the priority intervention for a patient with uncontrolled atrial fibrillation (A-FIB) and a heart rate over 100 bpm?

    <p>Administer calcium channel blockers or beta blockers</p> Signup and view all the answers

    What is the potential consequence of heparin-induced thrombocytopenia (HIT)?

    <p>Decreased platelet count due to the immune system causing clotting</p> Signup and view all the answers

    What is the desired effect of heparin therapy in terms of aPTT (activated partial thromboplastin time) values?

    <p>Higher aPTT values</p> Signup and view all the answers

    What is the primary medication for an asthma exacerbation?

    <p>Albuterol (short-acting beta agonist)</p> Signup and view all the answers

    What is the normal range for platelet count per microliter of blood?

    <p>150,000 to 450,000 platelets</p> Signup and view all the answers

    What should be monitored to detect potential pulmonary toxicity caused by amiodarone?

    <p>Dyspnea, coughing, SOB, pleuritic chest pain</p> Signup and view all the answers

    What is the normal range for aPTT (activated partial thromboplastin time)?

    <p>25-35 seconds</p> Signup and view all the answers

    What is the antidysrhythmic effect of amiodarone?

    <p>Slows heart rate</p> Signup and view all the answers

    What is the priority intervention for a patient with uncontrolled atrial fibrillation (A-FIB) and a heart rate over 100 bpm?

    <p>Administer beta blockers</p> Signup and view all the answers

    What is the potential consequence of heparin-induced thrombocytopenia (HIT)?

    <p>Decreased platelet count</p> Signup and view all the answers

    What is the primary goal of anticoagulation therapy for a patient with A-FIB?

    <p>Prevent blood clot formation</p> Signup and view all the answers

    What should be monitored to detect potential pulmonary toxicity caused by amiodarone?

    <p>Symptoms such as dyspnea and coughing</p> Signup and view all the answers

    What is the priority intervention to reverse an asthma attack?

    <p>Administer a bronchodilator</p> Signup and view all the answers

    What is the normal range for platelet count per microliter of blood?

    <p>150,000 to 450,000</p> Signup and view all the answers

    What is the desired effect of heparin therapy in terms of aPTT (activated partial thromboplastin time) values?

    <p>Higher aPTT values</p> Signup and view all the answers

    What is the primary medication for an asthma exacerbation?

    <p>Albuterol</p> Signup and view all the answers

    What is the therapeutic level of aPTT when a patient is on heparin?

    <p>50-70 seconds</p> Signup and view all the answers

    What is the purpose of TEE (transesophageal echocardiography) in a patient with new onset atrial fibrillation?

    <p>Detect blood clots before cardioversion</p> Signup and view all the answers

    Which electrolyte has an abnormal range of (8.5-10.0)?

    <p>Calcium</p> Signup and view all the answers

    Which symptom is associated with right-sided heart failure?

    <p>Jugular venous distension (JVD)</p> Signup and view all the answers

    Which symptom is associated with left-sided heart failure?

    <p>Fatigue</p> Signup and view all the answers

    Which electrolyte has an abnormal range of (3.5-5.0)?

    <p>Potassium</p> Signup and view all the answers

    Which symptom is associated with right-sided heart failure?

    <p>Jugular venous distension (JVD)</p> Signup and view all the answers

    What are the signs and symptoms of left-sided heart failure?

    <p>Fatigue and weakness</p> Signup and view all the answers

    Which of the following is a potential cause of hypovolemia (isotonic dehydration)?

    <p>Hemorrhage</p> Signup and view all the answers

    What is a potential complication of a rapid and severe dehydration?

    <p>Seizures</p> Signup and view all the answers

    What is a common sign of hypovolemia (isotonic dehydration)?

    <p>Thready pulse</p> Signup and view all the answers

    What is the recommended nursing care for a patient with hypovolemia?

    <p>Give fluids (oral or IV)</p> Signup and view all the answers

    Which symptom is associated with fluid volume excess?

    <p>Bounding pulse</p> Signup and view all the answers

    What is the potential consequence of severe hyponatremia in the context of fluid imbalance?

    <p>Seizures</p> Signup and view all the answers

    What is the recommended position for a patient with pulmonary edema?

    <p>High fowlers position</p> Signup and view all the answers

    Which action is essential for a patient taking warfarin?

    <p>Limiting intake of green leafy vegetables</p> Signup and view all the answers

    What should a patient do if they notice blood in their stool while taking warfarin?

    <p>Immediately report it</p> Signup and view all the answers

    What is an important precaution for a patient on warfarin therapy?

    <p>Using an electric razor when shaving</p> Signup and view all the answers

    Which of the following is a potential sign or symptom of anemia?

    <p>Confusion and disorientation</p> Signup and view all the answers

    Which of the following laboratory findings is indicative of anemia?

    <p>Low hemoglobin, hematocrit, and ferritin</p> Signup and view all the answers

    Which of the following physical signs is associated with anemia?

    <p>Spoon-shaped fingernails</p> Signup and view all the answers

    Which of the following is a potential sign of anemia?

    <p>Cool, pale skin</p> Signup and view all the answers

    Which laboratory finding is indicative of anemia?

    <p>Low ferritin</p> Signup and view all the answers

    Which symptom is commonly associated with anemia?

    <p>Fatigue</p> Signup and view all the answers

    Which group of individuals is at higher risk for osteoporosis?

    <p>Petite, older, white women</p> Signup and view all the answers

    What is a common risk factor for osteoporosis?

    <p>Chronic steroid use</p> Signup and view all the answers

    What is considered the gold standard test for osteoporosis?

    <p>DEXA scan</p> Signup and view all the answers

    What is a recommended precaution for a patient post hip replacement surgery?

    <p>Turn with a pillow in between legs to prevent hips from crossing</p> Signup and view all the answers

    What is a prophylactic medication recommended for a patient at home post hip replacement surgery?

    <p>Lovenox</p> Signup and view all the answers

    What is a recommended assistive device for a patient post hip replacement surgery?

    <p>A raised toilet seat</p> Signup and view all the answers

    Which of the following is not a common sign of osteomyelitis?

    <p>Hypertension</p> Signup and view all the answers

    Which symptom is not typically associated with osteomyelitis?

    <p>Hypothermia</p> Signup and view all the answers

    What is a potential indicator of poor perfusion in a patient with osteomyelitis?

    <p>Venostasis ulcers</p> Signup and view all the answers

    Which of the following is a recommended approach to decrease the incidence of falls and injuries in individuals at risk of vertigo or dizziness?

    <p>Take vitamin D and calcium supplements</p> Signup and view all the answers

    What is a recommended activity to help prevent osteoporosis and strengthen muscles?

    <p>Engaging in weight-bearing exercises</p> Signup and view all the answers

    What is a recommended limit for alcohol intake for individuals at risk of vertigo or dizziness?

    <p>No more than 3 drinks per day</p> Signup and view all the answers

    What is a potential risk of taking calcium and vitamin D supplements for osteoporosis?

    <p>Renal stones/calculi</p> Signup and view all the answers

    What might a patient complain of if they have too much calcium in their body due to supplementation?

    <p>Colicky flank pain</p> Signup and view all the answers

    Which nutrients are commonly recommended as supplements for osteoporosis?

    <p>Calcium, vitamin D</p> Signup and view all the answers

    What is the immediate issue in wet macular degeneration?

    <p>Abnormal blood vessel growth under the macula</p> Signup and view all the answers

    What is the early indication of dry macular degeneration?

    <p>Drusen bodies</p> Signup and view all the answers

    Which activity should a patient with glaucoma avoid to prevent an increase in intraocular pressure (IOP)?

    <p>Sneezing and coughing</p> Signup and view all the answers

    What should a patient with corneal abrasion report as a manifestation of infection?

    <p>Yellow or green drainage</p> Signup and view all the answers

    What should a patient with corneal abrasion avoid to prevent exacerbating the condition?

    <p>Tilting head back to wash hair</p> Signup and view all the answers

    What is a recommended measure to reduce the risk of DVT related to hip replacement surgery?

    <p>Administering prophylactic anticoagulants</p> Signup and view all the answers

    Why are older adults considered more at risk for DVT after hip replacement surgery?

    <p>Because of compromised circulation before surgery</p> Signup and view all the answers

    What is a risk factor that predisposes individuals to DVT after hip replacement surgery?

    <p>History of venous thromboembolism formation</p> Signup and view all the answers

    Which activity should a patient avoid to prevent an increase in intraocular pressure (IOP) after cataract surgery?

    <p>Tilting head back to wash hair</p> Signup and view all the answers

    What is a potential manifestation of infection that a patient should report after cataract surgery?

    <p>Yellow or green drainage</p> Signup and view all the answers

    Which symptom should a patient report immediately after cataract surgery?

    <p>Flashes of light</p> Signup and view all the answers

    What is the recommended treatment for severe pain in patients with Sickle Cell Disease?

    <p>Oxygen therapy</p> Signup and view all the answers

    What should be avoided to prevent vasoconstriction in patients with Sickle Cell Disease?

    <p>Cold compresses</p> Signup and view all the answers

    What is a common trigger to be avoided by patients with Sickle Cell Disease?

    <p>High atmospheric pressure</p> Signup and view all the answers

    What is the most appropriate intervention for a patient with a new onset of DVT?

    <p>Measure the difference in size of the calf and assess for warmth and redness</p> Signup and view all the answers

    What is the contraindication for a patient with new onset DVT?

    <p>Massaging the affected leg</p> Signup and view all the answers

    What lab test is likely to be elevated in a patient with a new onset of DVT?

    <p>D-dimer</p> Signup and view all the answers

    Which symptom is commonly associated with pericarditis?

    <p>Pleuritic chest pain</p> Signup and view all the answers

    Which finding on an ECG is indicative of pericarditis?

    <p>ST elevation</p> Signup and view all the answers

    What is a potential complication of pericarditis?

    <p>Cardiac tamponade</p> Signup and view all the answers

    Which class of medication is zoledronic acid?

    <p>Bisphosphonate</p> Signup and view all the answers

    What is the mechanism of action of zoledronic acid in Paget's disease?

    <p>Inhibition of bone resorption</p> Signup and view all the answers

    What is the preferred medication for Paget disease?

    <p>Alendronate</p> Signup and view all the answers

    Which medication is commonly used for the treatment of osteoporosis?

    <p>Teriparatide</p> Signup and view all the answers

    Which medication is a bisphosphonate commonly used for osteoporosis and Paget disease?

    <p>Ibandronate</p> Signup and view all the answers

    What is the primary purpose of bumetanide (bumex) client teaching?

    <p>To educate the client about the medication's use and potential side effects</p> Signup and view all the answers

    What is a potential risk factor for a patient taking bumetanide (bumex)?

    <p>Hypokalemia</p> Signup and view all the answers

    What is a common side effect associated with bumetanide (bumex) use?

    <p>Hypotension</p> Signup and view all the answers

    What is a potential side effect associated with bumetanide (Bumex) use?

    <p>Hypokalemia</p> Signup and view all the answers

    What is a recommended nursing consideration for a patient receiving bumetanide (Bumex)?

    <p>Monitor for signs of dehydration</p> Signup and view all the answers

    What is a potential consequence of severe dehydration?

    <p>Hypovolemic shock</p> Signup and view all the answers

    What is the antidote for enoxaparin (Lovenox) if needed?

    <p>Protamine sulfate</p> Signup and view all the answers

    What is a key advantage of enoxaparin (Lovenox) over heparin?

    <p>Lower risk of bleeding</p> Signup and view all the answers

    What should be monitored in patients taking enoxaparin (Lovenox)?

    <p>INR (International Normalized Ratio)</p> Signup and view all the answers

    Which of the following is a potential adverse effect of clopidogrel (Plavix) therapy?

    <p>Tinnitus</p> Signup and view all the answers

    What is the recommended action regarding the use of caffeine while on clopidogrel (Plavix) therapy?

    <p>Limit caffeine intake</p> Signup and view all the answers

    When should clopidogrel (Plavix) be discontinued prior to surgery?

    <p>5-7 days before surgery</p> Signup and view all the answers

    What effect does high dose dopamine produce?

    <p>Constriction of renal blood vessels</p> Signup and view all the answers

    What is the purpose of low dose dopamine therapy?

    <p>Causing renal blood vessels to dilate</p> Signup and view all the answers

    What is the purpose of high dose dopamine therapy?

    <p>Constricting renal blood vessels</p> Signup and view all the answers

    What is the evaluation of outcomes for dopamine therapy?

    <p>Improved perfusion as evidenced by urine output of greater than or equal to 30mL/hr</p> Signup and view all the answers

    Which is a potential side effect of statin use that requires monitoring of CK levels?

    <p>Myopathy</p> Signup and view all the answers

    What is a contraindication for the use of statins?

    <p>Liver disorders</p> Signup and view all the answers

    What is the purpose of using lidocaine in CPR for dysrhythmias?

    <p>Treatment of dysrhythmias</p> Signup and view all the answers

    What is the primary purpose of using lipid-lowering agents such as simvastatin and atorvastatin?

    <p>Decreased LDL</p> Signup and view all the answers

    What is the purpose of using lidocaine in CPR for dysrhythmias?

    <p>To stabilize cardiac rhythm</p> Signup and view all the answers

    What is the primary action of lidocaine in CPR for dysrhythmias?

    <p>Local anesthesia</p> Signup and view all the answers

    How is the effectiveness of lidocaine in CPR for dysrhythmias evaluated?

    <p>Continuous ECG monitoring</p> Signup and view all the answers

    What is a potential side effect of trimethoprim-sulfamethoxazole (TMP-SMZ) therapy?

    <p>Photosensitivity</p> Signup and view all the answers

    Which of the following is a contraindication for trimethoprim-sulfamethoxazole (TMP-SMZ) use?

    <p>Renal insufficiency</p> Signup and view all the answers

    What is a potential serious adverse effect of trimethoprim-sulfamethoxazole (TMP-SMZ) therapy?

    <p>Agranulocytosis</p> Signup and view all the answers

    Which condition is a contraindication for the use of trimethoprim-sulfamethoxazole (TMP-SMZ)?

    <p>Steven-Johnson's syndrome</p> Signup and view all the answers

    What should be monitored periodically for individuals on trimethoprim-sulfamethoxazole (TMP-SMZ) therapy?

    <p>Renal function tests</p> Signup and view all the answers

    What is a potential risk for newborns associated with trimethoprim-sulfamethoxazole (TMP-SMZ)?

    <p>Jaundice</p> Signup and view all the answers

    What is the most important teaching point for a client prescribed nitrofurantoin (Macrodantin)?

    <p>The medication can cause urine discoloration and tooth staining, so it should be taken with food or milk.</p> Signup and view all the answers

    What should a client report as a potential sign of an adverse reaction to nitrofurantoin (Macrodantin)?

    <p>Flushing, chills, fever, shortness of breath, and chest pain.</p> Signup and view all the answers

    What is a potential risk of chronic use of nitrofurantoin (Macrodantin)?

    <p>Peripheral neuropathy.</p> Signup and view all the answers

    What nursing action is appropriate for a patient experiencing N/V/D while taking fluoroquinolones?

    <p>Advise the patient to take the medication with food, except with dairy products</p> Signup and view all the answers

    What precaution should a patient taking fluoroquinolones observe to prevent phototoxicity?

    <p>Wearing protective clothing and avoiding sunlight exposure</p> Signup and view all the answers

    What complication should be monitored when a patient is concurrently using warfarin and fluoroquinolones?

    <p>Increased INR levels</p> Signup and view all the answers

    Which of the following is a potential adverse effect of tolterodine tartrate (Detrol) therapy?

    <p>Photosensitivity</p> Signup and view all the answers

    What is a contraindication for the use of tolterodine tartrate (Detrol)?

    <p>Narrow-angle glaucoma</p> Signup and view all the answers

    What is the primary purpose of tolterodine tartrate (Detrol) in the management of overactive bladder?

    <p>Reduce urge to void</p> Signup and view all the answers

    What is the recommended action for a patient taking NSAIDs before surgery?

    <p>Stop taking 1 week before surgery</p> Signup and view all the answers

    Which supplement can suppress coagulation effect and should be used with caution in those taking NSAIDs?

    <p>Ginkgo biloba</p> Signup and view all the answers

    What should be done to reduce gastrointestinal upset when taking NSAIDs?

    <p>Take NSAIDs with milk, water, or food</p> Signup and view all the answers

    What is the recommended initial treatment for aspirin toxicity?

    <p>Use of activated charcoal</p> Signup and view all the answers

    What are the potential systemic effects of mydriatic eye drops containing phenylephrine?

    <p>Tachycardia and respiratory depression</p> Signup and view all the answers

    What is the primary purpose of cooling a patient down with tepid water in aspirin toxicity?

    <p>To lower body temperature</p> Signup and view all the answers

    Study Notes

    Laboratory Values and Therapeutic Ranges

    • Normal range for aPTT (activated partial thromboplastin time) is approximately 25 to 35 seconds.
    • Therapeutic aPTT level when on heparin is typically 1.5 to 2.5 times the normal range, around 60 to 80 seconds.
    • Normal platelet count per microliter of blood ranges from 150,000 to 450,000.

    Asthma Management

    • Priority intervention to reverse an asthma attack is the administration of a bronchodilator, such as a short-acting beta-agonist.
    • Primary medication for an asthma exacerbation is typically albuterol or a similar bronchodilator.

    Cardiac Interventions and Atrial Fibrillation

    • Priority intervention for uncontrolled atrial fibrillation with a heart rate over 100 bpm is to control the heart rate, often with medications like beta-blockers or calcium channel blockers.
    • Primary goal of anticoagulation therapy for a patient with atrial fibrillation is to prevent stroke and systemic embolism.
    • Purpose of transesophageal echocardiography (TEE) in new-onset atrial fibrillation is to assess for thrombi in the left atrial appendage.

    Amiodarone and Pulmonary Toxicity

    • Antidysrhythmic effect of amiodarone includes rhythm control in various types of tachyarrhythmias.
    • Signs and symptoms of pulmonary toxicity caused by amiodarone can include cough, dyspnea, and chest pain.
    • Monitoring for pulmonary toxicity includes assessing lung function and signs of pulmonary compromise.

    Heparin and Thrombocytopenia

    • Desired effect of heparin therapy is an aPTT value within the therapeutic range to ensure effective anticoagulation without excessive bleeding.
    • Potential consequence of heparin-induced thrombocytopenia (HIT) is a paradoxical increase in thromboembolic events due to a decreased platelet count.

    Heart Failure Symptoms

    • Symptoms associated with right-sided heart failure may include peripheral edema and jugular venous distension.
    • Symptoms associated with left-sided heart failure typically include dyspnea and pulmonary congestion.

    Fluid Volume Disorders

    • Common signs of hypovolemia (isotonic dehydration) may include dry mucous membranes and decreased urinary output.
    • Recommended nursing care for a patient with hypovolemia includes monitoring vital signs and ensuring adequate fluid intake.
    • A common symptom of fluid volume excess is pulmonary edema, characterized by difficulty breathing and cough.

    Osteoporosis and Fracture Prevention

    • Individuals at higher risk for osteoporosis include postmenopausal women and older adults.
    • Gold standard test for osteoporosis is a dual-energy X-ray absorptiometry (DEXA) scan.
    • Recommended activity to help prevent osteoporosis includes weight-bearing exercises.

    Postoperative Care for Hip Replacement

    • Recommended nursing care post-hip replacement includes monitoring for signs of infection and ensuring mobility.
    • Prophylactic medication for a patient at home after hip replacement surgery may include anticoagulants to prevent DVT.
    • Recommended assistive devices post-surgery can include walkers or canes for safety and mobility support.

    DVT and Postoperative Risks

    • Risk factors for DVT after hip replacement surgery include immobility and previous history of venous thromboembolism.
    • A recommended measure to reduce the risk of DVT is early mobilization and the use of compression stockings.

    Calcium and Vitamin D Supplementation

    • Potential risk of calcium and vitamin D supplements includes hypercalcemia if taken excessively.
    • Symptoms of too much calcium can include nausea, vomiting, and abdominal pain.

    Macular Degeneration and Eye Care

    • Immediate issue in wet macular degeneration typically involves vision loss due to fluid accumulation.
    • Early indication of dry macular degeneration may include blurred or distorted vision.
    • Patients with glaucoma should avoid activities that may increase intraocular pressure, such as bending forward.

    Medication Safety and Side Effects

    • Essential action for a patient taking warfarin includes regular INR monitoring to manage anticoagulation levels.
    • Patients on warfarin should report any signs of bleeding, such as blood in stool, to their healthcare provider immediately.
    • Common side effects associated with bumetanide (Bumex) include electrolyte imbalances, especially hypokalemia.

    General Nursing Interventions

    • For a new onset of DVT, appropriate interventions include anticoagulation therapy to prevent clot extension and new thrombus formation.
    • Key nursing considerations for patients receiving bumetanide include monitoring for signs of dehydration and electrolyte abnormalities.
    • Common indicator of poor perfusion in osteomyelitis can include localized warmth and swelling in the affected area.

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    Description

    Test your knowledge on anticoagulant monitoring and management with this quiz. Explore topics such as INR, PT, aPTT, and their relation to medications like warfarin and heparin. Learn about the desired effect of heparin, the significance of aPTT values, and the importance of monitoring platelet levels.

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