Questions and Answers
Which sign or symptom during the assessment indicates a complication from clopidogrel bisulfate?
Which anticoagulant is considered a low-molecular-weight heparin (LMWH)?
Which laboratory test is used to monitor warfarin therapy?
By which route would the nurse expect to administer clopidogrel?
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Which action would the nurse take if a patient on atorvastatin reports muscle pain and tenderness?
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Which nonpharmacologic method of cholesterol reduction would the nurse include in a teaching session?
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Which action would the nurse take if a patient on cilostazol reports eating licorice several times a day?
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Which laboratory value would be monitored in a patient taking statin therapy? Select all that apply.
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Which underlying condition is a primary cause of peripheral arterial disease (PAD)?
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Which consequence may result from abrupt cessation of a statin?
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Which instruction would the nurse give to a patient to reduce the patient’s risk for adverse effects associated with atorvastatin? Select all that apply.
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Which statement made by a patient about antihyperlipidemic drugs indicates an understanding of discharge instructions?
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Which antidote is used for warfarin overdose?
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Which oral anticoagulant requires routine coagulation monitoring?
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The nurse is preparing to administer alteplase to a patient who presented with an ischemic stroke. Which question would the nurse ask prior to administering this medication?
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Which medication would the nurse anticipate prescribing for a patient with a new diagnosis of peripheral vascular disease?
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Which patient parameter is important to consider after learning that the patient has been prescribed atorvastatin?
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Which intervention would be needed for a patient who is receiving treatment with antihyperlipidemic drugs?
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Which statement by the nurse explains the reason for discontinuing aspirin 7 days before surgery?
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Which patient(s) cannot safely receive clopidogrel? Select all that apply.
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Which item(s) will a nurse include in medication teaching for a patient prescribed an anticoagulant? Select all that apply.
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Which statement(s) by a nurse about interventions for a patient undergoing thrombolytic therapy indicates a need for further teaching? Select all that apply.
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What is the preferred drug for a headache in a patient receiving warfarin?
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Which explanation describes how anticoagulants work?
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Which instruction would the nurse include in the plan of care for a patient receiving warfarin?
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Which type of drug is cilostazol?
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Which antiplatelet drug is also used as a vasodilator?
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Which laboratory value in a patient receiving intravenous heparin requires immediate action by the nurse?
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Which statement made by a patient receiving warfarin requires immediate correction by the nurse?
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Which nursing intervention is essential for the patient receiving alteplase?
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Which statement made by a patient indicates an understanding of the nurse’s teaching on warfarin?
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Which action would a nurse take to address an international normalized ratio (INR) of 6 in a patient receiving warfarin who is experiencing a bleed?
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Which patient does the nurse anticipate will receive alteplase therapy?
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Which drugs are known as 'clot busters'?
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Which step is an essential nursing intervention when preparing to administer enoxaparin sodium to a patient?
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Study Notes
Antiplatelet Drugs and Surgery
- Aspirin should be discontinued 7 days prior to surgery to prevent prolonged platelet activity, reducing bleeding risk.
- Aspirin does not directly interact with anesthesia, nor does it exhibit prolonged anticoagulant effects.
Clopidogrel Contraindications
- Clopidogrel is contraindicated in patients with active gastrointestinal (GI) bleeds and intracranial hemorrhages, posing bleeding risks.
- Safe for patients with thyroid cancer, type 2 diabetes mellitus, and gout.
Anticoagulant Patient Education
- Patients on anticoagulants should carry medical identification cards detailing medications and dosages.
- Signs of bleeding such as bruising and tarry stools must be reported to health care providers immediately.
- Avoid over-the-counter medications and herbs unless approved, as they may interfere with anticoagulation therapy.
- Acetaminophen is preferred for pain relief; aspirin and ibuprofen should be avoided due to bleeding risks.
Thrombolytic Therapy Monitoring
- Nurses must monitor for signs of hemorrhage and vital signs during thrombolytic therapy.
- Venipuncture should be avoided during thrombolytics to minimize bleeding risks.
- Administering nonsteroidal anti-inflammatory drugs (NSAIDs) is contraindicated as they increase bleeding risks.
Warfarin Patient Guidance
- Patients on warfarin should avoid taking aspirin; acetaminophen is safe for pain.
- Increasing leafy greens in diet is inadvisable as they contain vitamin K, which can reduce warfarin's effectiveness.
- Consistent intake of vitamin K is necessary rather than increasing it.
Drug Classifications and Functions
- Cilostazol is classified as an antiplatelet drug and is also used as a vasodilator for leg conditions.
- Thrombolytics are termed “clot busters” as they dissolve existing blood clots, while anticoagulants prevent clot formation.
Monitoring Drugs
- Activated partial thromboplastin time (aPTT) is monitored for heparin therapy; international normalized ratio (INR) is used for warfarin therapy.
- A prolonged aPTT (e.g. 120 seconds) while on heparin requires immediate nurse intervention.
Adverse Effects of Clopidogrel
- Monitoring for melena (bloody stools) is crucial as it indicates potential bleeding complications from clopidogrel therapy.
Administration Routes
- Clopidogrel is administered orally, while enoxaparin (a low-molecular-weight heparin) is given subcutaneously, particularly in the abdomen.
Essential Nursing Practices
- For patients on alteplase, monitor for dysrhythmias and bleeding; avoid actions like administering vitamin K or using the Z-track method with enoxaparin.
- Patients on anticoagulants should use electric razors to minimize bleeding risk from cuts.### Atorvastatin and Muscle Pain
- Report muscle pain or tenderness in patients on atorvastatin to the healthcare provider (HCP) to prevent complications like myopathy and rhabdomyolysis.
- Resting, muscle relaxants, and ibuprofen are not appropriate treatments for rhabdomyolysis.
Nonpharmacologic Methods of Cholesterol Reduction
- Regular exercise effectively reduces cholesterol levels; it should be emphasized in teaching sessions.
- Hypnotherapy and low-sodium diets are not effective for cholesterol reduction.
- Saturated fat intake should be decreased, not increased.
Cilostazol and Licorice Consumption
- Licorice can cause hypokalemia, which may enhance the toxicity of cilostazol.
- Draw blood for potassium testing when licorice is reported in a patient taking cilostazol.
Monitoring Laboratory Values in Statin Therapy
- Monitor cholesterol, triglycerides, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels every three months in patients on statins.
- Alanine aminotransferase (ALT), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) should also be routinely monitored to assess for hepatotoxicity.
- Amylase and lipase levels are not necessary unless pancreatitis is suspected; PT/INR is irrelevant for patients on statins.
Primary Causes of Peripheral Arterial Disease (PAD)
- The primary causes of PAD are arteriosclerosis and hyperlipidemia leading to atherosclerosis.
- Renal disease, protein S deficiency, and hypertension are not primary causes of PAD.
Consequences of Abrupt Statin Discontinuation
- Stopping a statin suddenly may lead to a rebound effect, increasing the risk of acute myocardial infarction.
- Statin therapy should be viewed as a lifelong commitment for maintaining lowered lipid levels.
Reducing Adverse Effects of Atorvastatin
- Recommend annual eye exams to monitor for cataract formation associated with statins.
- Regular monitoring of serum liver enzymes is essential due to potential elevations caused by statins.
- Advise patients to report any muscle weakness immediately, as it could signal rhabdomyolysis.
Patient Understanding of Antihyperlipidemic Drugs
- Patients should understand that antihyperlipidemic drugs complement other interventions aimed at lowering cholesterol.
- Patients should not double doses if missed and must not stop medications without consulting their provider.
Antidote for Warfarin Overdose
- Vitamin K is the antidote for warfarin overdose and takes 24 to 48 hours for effectiveness.
Coagulation Monitoring in Oral Anticoagulants
- Warfarin requires routine monitoring of prothrombin time and international normalized ratio (PT/INR).
- Newer anticoagulants like apixaban, dabigatran etexilate, and rivaroxaban do not require such monitoring.
Administration of Alteplase for Stroke
- Prior to administering alteplase for ischemic stroke, confirm the onset time of symptoms, as it must be given within 3 to 4 hours.
Medication Anticipation for Peripheral Vascular Disease
- Cilostazol is commonly prescribed for claudication and peripheral vascular disease due to its antiplatelet effects.
Grapefruit Juice Interaction with Atorvastatin
- Grapefruit juice can increase atorvastatin concentrations and the risk of side effects; it should be avoided.
Interventions for Antihyperlipidemic Drug Treatment
- Monitor liver function tests, including ALT and ALP, due to the risk of liver disorders.
- Patients should be counseled to follow a low-fat diet instead of a high-fat diet while being treated for high lipid levels.
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Description
This quiz covers various aspects of drugs that affect the hematologic system, exploring their mechanisms, effects, and nursing considerations. It's designed to test your knowledge in pharmacology related to hematology and prepare you for exams or practical application in the healthcare field.
