Final Exam Flashcards
By which method do antiplatelet medications, such as clopidogrel (Plavix), work to prevent thrombus?
They inhibit platelet aggregation.
Antiplatelets are used to prevent thrombosis in the arteries by suppressing platelet aggregation. Antiplatelets prolong bleeding time.
The nurse understands that which of the following are the main uses of antiplatelet drug therapy?
Prevention of repeat myocardial infarction or stroke
Prevention of myocardial infarction for patients with familial history
Prevention of stroke in patients having TIAs (transient ischemic attacks)
In developing a discharge teaching plan, the nurse will teach that the initial intervention for a patient taking an anticoagulant who cuts himself or herself is to
Apply direct pressure with a clean cloth to the cut for 5–10 minutes.
The nurse assesses the patient who is taking enoxaparin. Which signs and symptoms should prompt the nurse to take further action?
Petechiae
Bruising
Hematuria
The nurse prepares to administer enoxaparin to a patient who is post-operative total knee replacement. How should the nurse administer the medication?
Deep subQ injection
Which statement BEST describes how Heparin works as an anticoagulant?
It enhances the activation of antihrombin III, which prevents the activation of thrombin and the conversion of fibrinogen to fibrin.
A patient is receiving Heparin IV for treatment of pulmonary emboli. The nurse would monitor all of the following labs:
Platelets
aPPT
Hemoglobin & Hematocrit
Which medication is associated with a risk of heparin induced thrombocytopenia (HIT)?
Enoxaparin (Lovenox)
The nurse knows that clopidogrel should be discontinued in the preoperative patient at what point in time?
5 days (up to a week before)
A patient is to be discharged with a transdermal nitroglycerin patch. Which instruction should the nurse include in the patient’s teaching plan?
“Apply the patch to a non-hairy area of the upper torso or arm.”
A nurse is monitoring a patient with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective?
Patient stating that pain is 0 out of 10
The patient taking nitroglycerin should expect the therapeutic effect of absence of chest pain.
The nurse is monitoring a patient during IV nitroglycerin infusion. Which assessment finding warrants nursing action?
Chest pain
Which statement made by the patient demonstrates a need for additional instruction from the nurse regarding the use of nitroglycerin?
“I can take up to five tablets at 3-minute intervals for chest pain if necessary.”
Patients are taught to take up to three tablets every 5 min. If no relief from chest pain is obtained after one tablet, they should seek medical assistance and take up to two more tablets.
“If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief.”
“I should change positions slowly to avoid getting dizzy.”
“I should keep my nitroglycerin in a cool, dry place.”
Which patient assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker?
Absence of chest pain.
The workload in the heart should be decreased with the vasodilation from the calcium channel blocker. With less strain, the patient should have fewer incidences of angina as afterload is decreased.
Before the nurse administers isosorbide dinitrate, what is a priority nursing assessment?
Assess blood pressure
Isosorbide dinitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.
The patient asks the nurse how nitroglycerin should be stored while traveling. What is the nurse’s best response?
“It’s best to keep it in its original container away from heat and light.”
Which statement indicates to the nurse that the patient understands sublingual nitroglycerin medication instructions?
“I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness.”
What instruction should the nurse provide to the patient who needs to apply nitroglycerin ointment?
Apply the ointment to a non-hairy part of the upper torso.
A patient receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse’s priority action?
Decrease the intravenous nitroglycerin by 10 mcg/min.
Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 min while changing the rate of the intravenous nitroglycerin infusion
A patient’s serum digoxin level is noted to be 0.4 ng/mL. What is the nurse’s priority action?
Administer ordered dose of digoxin.
Therapeutic serum digoxin levels are 0.8–2 ng/mL. The patient should receive the next dose to bring the level into therapeutic range.
A patient is taking digoxin 0.25 mg and furosemide 40 mg. The patient tells the nurse, there are yellow halos around the lights. Which priority action will the nurse take?
Evaluate digoxin levels.
Seeing yellow or green halos around lights is a symptom of digoxin toxicity. The nurse should evaluate the patient’s digoxin levels.
Which assessment finding will alert the nurse to suspect early digitalis toxicity?
Loss of appetite with slight bradycardia
Early symptoms of digitalis toxicity include anorexia, nausea and vomiting, and bradycardia.
A patient is being treated for short-term management of heart failure with milrinone. What is the primary nursing action?
Monitor cardiac rhythm and blood pressure continuously.
Milrinone lactate is a phosphodiesterase inhibitor administered intravenously for short-term treatment in patients with heart failure not responding adequately to digoxin, diuretics, or other vasodilators. Blood pressure and heart rate should be closely monitored.
A nurse is caring for a patient who has been started on ibutilide. Which assessment is a priority for this patient?
ECG and palpitations
Ibutilide is specifically indicated for treatment of recent-onset atrial fibrillation and flutter. It is important for the nurse to obtain an ECG to see if the patient has converted to sinus rhythm and to watch for palpitations.
