Chapter 15 Flashcards
(28 cards)
A patient with a clotting disorder is prescribed an anticoagulant and asks you to explain the
purpose of anticoagulant therapy. What is your best response?
a. Anticoagulants are used to lyse existing clots.
b. Anticoagulants are used to increase the flow of blood.
c. Anticoagulants are used to prevent new clot formation.
d. Anticoagulants are used to thin the viscosity of the blood.
ANS: C
Anticoagulants are drugs that interfere with the clotting process, so they are used to reduce
existing clots or to prevent new clots from forming.
An older patient who takes a daily NSAID for arthritis pain has been prescribed aspirin as
an antiplatelet agent. What information regarding risks associated with aspirin use should be
included in this teaching plan?
a. The risk for urinary retention
b. The risk for cognitive decline
c. The risk for gastrointestinal bleeding
d. The risk for peripheral arterial disease
ANS: C
Most drugs that affect the blood clotting system, such as antiplatelet drugs, have the
potential to cause bleeding, especially in older patients.
Which statement made by a patient with a recent coronary artery stent placement who is
taking clopidogrel informs you that the patient requires further teaching about this drug?
a. “I will avoid herbal supplements while taking this drug.”
b. “I will need to take this drug every day for 3 months.”
c. “I will report any abnormal bleeding.”
d. “I will take this drug with food.”
ANS: B
For patients who have had a stent placed into the coronary artery as a result of severe
narrowing or blockage of the artery, clopidogrel prevents platelets from sticking to the stent
mesh. For these patients, clopidogrel must be taken daily for a year or longer to prevent clots
from developing and plugging up the stent.
Which symptom when reported by a patient taking aspirin alerts you to a possible adverse
reaction to the drug?
a. Nausea
b. Itching and hives
c. Decreased vision
d. Increased urination
ANS: B
Allergic reactions to aspirin and NSAIDs generally occur within a few hours of taking the
drug. Symptoms of allergic reactions include itching, hives, and runny nose, with more
severe reactions causing swelling of the lips, tongue, or face.
You are taking the drug history of a patient who will be starting on an anticoagulant. Which
of the following drug categories from this patients’ drug list would potentially interfere with
an anticoagulant?
a. Beta blockers
b. Loop diuretics
c. Oral contraceptives
d. Inhaled corticosteroids
ANS: C
Oral contraceptives decrease the effects of anticoagulants.
A patient prescribed an anticoagulant asks you about potential drug interactions with this
new drug. Which of the following drugs would you advise this patient to avoid while taking
anticoagulants?
a. Vitamin C
b. Thiazide diuretics
c. Proton pump inhibitor
d. Nonsteroidal anti-inflammatory analgesics
ANS: D
Nonsteroidal anti-inflammatory drugs (NSAIDs) will increase the risk of bleeding and
hemorrhage in a patient receiving anticoagulants.
You are reviewing the laboratory values of an outpatient who is on anticoagulant therapy.
The laboratory tests show a less than desired level of anticoagulation. The patient states that
the drug has been taken as prescribed. Which food would you advise the patient to avoid
while on anticoagulant therapy?
a. Spinach
b. Bananas
c. Tomatoes
d. Sweet potatoes
ANS: A
The patient should avoid excessive amounts of foods high in vitamin K (spinach, broccoli,
cabbage, kale, dark leafy greens, and asparagus).
A patient who is taking an anticoagulant informs you that the herbal supplement St. John’s
wort is taken daily for depression. What should you teach the patient about the use of herbal
supplements with anticoagulant therapy?
a. Herbal drugs may decrease clotting times.
b. Herbal drugs may increase the risk of bleeding.
c. There are no risks associated with this drug combination.
d. They are safe to take together if you take them an hour apart.
ANS: B
St. John’s wort, as well as other herbal drugs, may increase the risk of bleeding in patients
on anticoagulants.
A patient with atrial fibrillation has been prescribed the drug dabigatran (Pradaxa). The
patient asks you what the advantage of this drug may be over warfarin (Coumadin). What is
your best response?
a. “This drug is taken only once daily.”
b. “This drug does not carry a risk for excessive bleeding.”
c. “This drug does not require frequent laboratory testing.”
d. “This drug does not interact with other drugs you may be taking.”
ANS: C
The advantage of direct thrombin inhibitors (DTIs) is that they do not require the frequent
laboratory blood testing as part of the monitoring process that is required by warfarin.
You are caring for a patient who is taking an indirect thrombin inhibitor following surgery.
What laboratory value should you monitor for possible adverse effects of this therapy?
a. Platelet count
b. Potassium level
c. Serum calcium level
d. White blood cell count
ANS: A
The most common adverse reactions from indirect thrombin inhibitors are excessive
bleeding and thrombocytopenia, so monitoring of the patient’s platelet count is needed.
A patient taking a direct thrombin inhibitor (DTI) tells you he is going on vacation and will
be taking his anticoagulant drug with him. What advice should you give to this patient
related to this specific class of drugs?
a. “Keep this drug in its original bottle while traveling.”
b. “Stop this drug while on vacation to avoid the risk of bleeding.”
c. “Take this drug with only a few sips of water to avoid GI upset.”
d. “Make sure you eat plenty of green vegetables while on vacation.”
ANS: A
Instruct patients to keep DTIs in the original bottle to protect the drug from moisture and
light. Teach them not to put DTIs in pill boxes or pill organizers.
You are teaching a patient who has been prescribed apixaban (Eliquis) about symptoms of
drug overdose. What symptom should you alert the patient to report?
a. Abnormal pulse rate
b. Gastric upset after eating
c. Excessive sleepiness during the day
d. Bleeding from the gums while brushing the teeth
ANS: D
Early signs of overdose or internal bleeding include bleeding from the gums while brushing
teeth, excessive bleeding or oozing from cuts, unexplained bruising or nosebleeds, and
unusually heavy or unexpected menses in women.
What category of anticoagulant drugs works by increasing the amount of the protein
antithrombin III?
a. Fibrinolytics
b. Vitamin K antagonists
c. Direct thrombin inhibitors
d. Indirect thrombin inhibitors
ANS: D
Indirect thrombin inhibitors (ITIs) are anticoagulant drugs that decrease clot formation by
increasing the amount and action of a protein called antithrombin III. This protein inhibits
thrombin from doing its job in the blood clotting cascade, and clot formation is reduced.
A patient with a history of deep vein thrombosis is prescribed subcutaneous heparin before
surgery. The patient asks you if the heparin can be taken orally instead of by injection. What
is your best response?
a. “Oral heparin is quite expensive, and not covered by insurance.”
b. “Heparin is given by injection because it cannot be absorbed orally.”
c. “Heparin is given by injection before surgery because it works faster.”
d. “Heparin cannot be given orally because you are fasting for your surgery.”
ANS: B
Heparin is given only by injection because it cannot be absorbed orally.
You are reviewing the laboratory values of a patient whose heparin dose has been changed
by the healthcare provider. Which laboratory value will inform you about effect of the dose
change on this anticoagulant therapy?
a. PT
b. INR
c. aPTT
d. DIC panel
ANS: C
Therapy with heparin sodium must be monitored for its anticoagulation effect by a blood
test known as the activated partial thromboplastin time (aPTT). The prescriber maintains or
adjusts dosages according to this test result.
A patient is suspected of having an overdose of heparin. What drug should you prepare for
the healthcare provider to give?
a. Naloxone
b. Warfarin
c. Acetylcysteine
d. Protamine sulfate
ANS: D
Protamine sulfate is a strongly basic (alkaline) protein that acts as an antagonist to neutralize
(reverse) the actions of heparin.
A patient prescribed subcutaneous heparin tells you that her menstrual bleeding is heavier
than usual. What is your best response?
a. “I will hold the drug and notify your healthcare provider.”
b. “This is a fairly common and expected side effect of the drug.”
c. “Heavy menstrual bleeding indicates the drug is working properly.”
d. “I will have to give you a shot of protamine sulfate to reverse the drug’s action.”
ANS: A
Watch for signs of abnormal bleeding and teach patients to report abnormal bleeding,
including heavy menses, to the healthcare provider because these may indicate overdosage.
You are preparing to draw up a dose of heparin to give subcutaneously to a patient. Which
of the following represents the best procedure in preparing this injection?
a. Roll the vial between your hands in order to distribute the solution.
b. Insert the needle, then turn the vial upside down to distribute the drug.
c. Shake the vial vigorously to adequately distribute the drug molecules.
d. Carefully draw the solution up from the vial without disturbing the contents.
ANS: A
Do not shake the bottle containing the heparin; only roll it carefully between your hands
before inserting the needle. If the heparin solution is discolored or contains a precipitate or
particles at the bottom of the bottle, do not use it.
The aPTT of a patient who is prescribed continuous intravenous (IV) heparin is two times
the control value. What is your best action?
a. Increase the IV rate as ordered.
b. Decrease the IV rate as ordered.
c. Leave the rate unchanged.
d. Stop the infusion and notify the prescriber.
ANS: C
The goal of continuous heparin therapy is to keep the aPTT within a therapeutic range of 1.5
to 2.5 times greater than the laboratory-established control value. Two times the control
value is within this range. The prescriber should be notified, but the infusion rate, which is
therapeutic, will not change at this time.
A patient taking an oral anticoagulant has had an international normalized ratio (INR) drawn
to check the therapeutic drug response. Which range represents the therapeutic INR range
for a patient taking an oral anticoagulant?
a. 1.0 to 2.0
b. 2.0 to 3.0
c. 3.0 to 4.0
d. 4.0 to 5.0
ANS: B
The normal range for the INR is 0.8 to 1.2, with a therapeutic target range of 2.0 to 3.0. For
patients with mechanical heart valves, this therapeutic range is slightly higher at 2.5 to 3.5,
because of the high risk for clots forming within the valve itself.
A young mother who is breast-feeding now requires treatment with heparin. The patient asks
you if she should continue breast-feeding during her treatment. What is your best response?
a. “You will need to stop breast-feeding during treatment with heparin.”
b. “Heparin is not found in breastmilk, so you may continue breast-feeding.”
c. “The half-life of heparin is short, so breastfeed before your daily heparin injection.”
d. “Pump your breasts to keep breastmilk flowing so you can resume breast-feeding
later.”
ANS: B
Breast-feeding is safe during heparin therapy because the drug is not found in breastmilk.
An obese, menopausal woman is beginning warfarin (Coumadin) therapy. Which adverse
effect should you monitor this patient for in the first 10 days of drug therapy?
a. Neutropenia
b. Skin necrosis
c. Severe diarrhea
d. Pulmonary edema
ANS: B
Warfarin can cause skin necrosis (death) that can occur within the first 10 days of therapy
and is associated with larger dosages. Obese, menopausal women are at greatest risk for this
rare adverse reaction.
You are assessing a patient who is on long-term warfarin (Coumadin) therapy who has been
diagnosed with a warfarin overdosage. What drug would you anticipate would be needed as
the antidote for warfarin overdose?
a. Paroxetine
b. Phytonadione
c. Protamine sulfate
d. Prothrombin factor
ANS: B
In response to some bleeding disorders or warfarin overdosage, vitamin K, phytonadione
(AquaMEPHYTON), may be given either orally or parenterally to help stimulate the liver to
resume manufacture of prothrombin and serve as an anticoagulant antagonist. However, this
clotting activity may not return for 48 to 72 hours.
- A patient has been prescribed a fibrinolytic drug. What response to the patient best describes
the action of this class of drug?
a. “This drug works to prevent blood clot formation.”
b. “This drug acts to reverse the effects of heparin.”
c. “This drug works to lyse existing blood clots.”
d. “This drug thins out the blood.”
ANS: C
Fibrinolytic drugs convert plasminogen to the enzyme plasmin, which breaks down fibrin
clots, fibrinogen, and other plasma proteins, and thus, they dissolve and break down existing
blood clots.
