Questions and Answers
The nurse is caring for a postoperative patient. The nurse will anticipate administering which medication to this patient to help prevent thrombus formation caused by slow venous blood flow?
A nursing student asks why the anticoagulant heparin is given to patients who have disseminated intravascular coagulation (DIC) and are at risk for excessive bleeding. The nurse will explain that heparin is used in this case for which reason?
A patient has been receiving intravenous heparin. When laboratory tests are drawn, the nurse has difficulty stopping bleeding at the puncture site. The patient has bloody stools and is reporting abdominal pain. Which action will the nurse perform?
A patient who has received heparin after previous surgeries will be given enoxaparin sodium (Lovenox) after knee-replacement surgery. The patient asks how this drug is different from heparin. The nurse will explain that the benefit of enoxaparin over heparin is that it:
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The nurse is caring for a patient who is receiving warfarin (Coumadin) and notes bruising and petechiae on the patient’s extremities. The nurse will request an order for which laboratory test?
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A patient who is taking warfarin has an international normalized ratio (INR) of 5.5. The nurse will anticipate giving which of the following?
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The nurse is teaching a patient who will begin taking warfarin (Coumadin) for atrial fibrillation. Which statement by the patient indicates understanding of the teaching?
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The nurse is assessing a patient who takes warfarin (Coumadin). The nurse notes a heart rate of 92 beats per minute and a blood pressure of 88/78 mm Hg. To evaluate the reason for these vital signs, the nurse will assess which of the following?
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A patient who has recently had a myocardial infarction (MI) will begin taking clopidogrel (Plavix) to prevent a second MI. Which medication will the nurse expect the provider to order as adjunctive therapy for this patient?
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A patient is taking clopidogrel (Plavix). When teaching this patient about dietary restrictions while taking this medication, the nurse will instruct the patient to avoid excessive consumption of which food?
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A patient experiences a blood clot in one leg, and the provider has ordered a thrombolytic medication. The patient learns that the medication is expensive and asks the nurse if it is necessary. Which response by the nurse is correct?
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Which of the following thrombolytics carries a higher risk for anaphylaxis?
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The nurse is caring for a postoperative patient who is receiving alteplase tPA (Activase) after developing a blood clot. The nurse notes a heart rate of 110 beats per minute and a blood pressure of 90/60 mm Hg. The nurse will perform which action?
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A patient is receiving a thrombolytic medication. The patient calls the nurse to report having bloody diarrhea. The nurse will anticipate administering which medication?
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The nurse is assessing a patient prior to administering thrombolytic therapy. Which is an important assessment for this patient?
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The nurse is preparing to administer a first dose of clopidogrel (Plavix) to a patient. As part of the history, the nurse learns that the patient has a previous history of peptic ulcers, diabetes, hyperlipidemia, and hypertension. The nurse understands that which of these conditions warrants caution with clopidogrel treatment?
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A patient who is taking clopidogrel (Plavix) and aspirin is preparing for orthopedic surgery. The nurse will consult with the surgeon and provide which instruction to the patient?
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Which of the following is NOT considered a potential life-threatening adverse reaction to clopidogrel (Plavix) use?
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Study Notes
Anticoagulants
- Low–molecular-weight heparins prevent thrombus formation in postoperative patients by inhibiting clot formation.
- Heparin is used in disseminated intravascular coagulation (DIC) to prevent venous thrombosis and related complications.
- Protamine sulfate is the antidote for heparin overdose when elevated clotting times occur.
- Enoxaparin sodium (Lovenox) requires less laboratory monitoring than standard heparin due to its more stable response.
- Warfarin (Coumadin) requires monitoring via the International Normalized Ratio (INR), particularly when bruising is evident.
Antiplatelets
- Clopidogrel (Plavix) is often used with aspirin to enhance the prevention of arterial thrombus formation.
- Patients on clopidogrel should limit garlic intake to avoid increased bleeding risk.
Thrombolytics
- Alteplase (Activase) is used after blood clot formation to prevent permanent tissue damage.
- Streptokinase (Streptase) carries a higher risk for anaphylaxis compared to other thrombolytic agents.
- Nursing assessments for thrombolytics should include monitoring for signs of bleeding, particularly with vital symptoms like tachycardia and hypotension.
Patient Education and Safety
- Patients taking warfarin should avoid green leafy vegetables rich in vitamin K to maintain anticoagulant effectiveness.
- Prospective surgical patients on antiplatelets should discontinue these medications seven days prior to surgery to mitigate bleeding risks.
Adverse Reactions
- Clopidogrel can lead to severe adverse reactions including hepatic failure, thrombocytopenia, and Stevens-Johnson syndrome, but not ischemic stroke.
Key Nursing Interventions
- Monitor patients for bleeding, especially those taking anticoagulants and thrombolytics.
- Assess the surgical dressing for bleeding post-thrombolytic therapy.
- Provide dietary counseling to patients on anticoagulants about foods affecting medication effectiveness.
Medical Orders and Treatments
- Administer oral vitamin K for patients with elevated INR on warfarin.
- Aminocaproic acid (Amicar) is used to manage hemorrhage when patients on thrombolytics report serious bleeds.
These notes provide concise information about anticoagulants, antiplatelets, thrombolytics, their uses, risks, patient education, and nursing interventions critical for effective patient care.
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Description
Test your knowledge on anticoagulants, antiplatelets, and thrombolytics as discussed in Chapter 40 of McCuistion's Pharmacology, 10th Edition. This quiz covers medication administration and patient care related to thrombus prevention post-surgery. Challenge yourself with multiple-choice questions designed for nursing professionals.
