Thomboembolism

Question 1

Where does Heparin work?

Answer 1

anticoagulant

Question 2

where does Alteplase work?

Answer 2

at the clot

Question 3

where does aspirin work?

Answer 3

antiplatelets

Question 4

where does clopidogrel work?

Answer 4

thrombolytic

Question 5

a patient started heparin therapy. “can this be administered in a pill?

Answer 5

no, heparin can only be admin by injection

Question 6

a pt with a history of CVD will receive therapy to prevent arterial thrombosis. what class of drug will they most likely be prescribed?

what about if it were venous thrombosis?

Answer 6

anti platelet for arterial thrombosis like aspirin

anti-coagulant for venous thrombosis like Heparin

Question 7

what labwork will the nurse monitor for pt on heparin? What will the nurse do if she suspects HIT?

Answer 7

Anti-Xa, aPtt,
we are trying to prevent over-medication
-send an HIT immunoassay which will detect the presence of antibodies

Question 8

what labwork will the nurse monitor for pt on warfarin?

Answer 8

PT & INR

Question 9

What is PTT?

Answer 9

partial thromboblastin time
how long does the clot take to form

Question 10

What is anti-Xa?

Answer 10

(anti factor ten a)
indirectly measure activity of heparins
an acceptable level would be 0.3-0.7 U/ml

Question 11

heparin routes

Answer 11

subQ or IV infusion

Question 12

a pt is on warfarin for a-fib. What is the recommended INR range for a therapeutic effectiveness?

Answer 12

2-3
(Normal INR is .8-1.2)

Question 13

Pt has been on long term heparin therapy and will continue to use at home? what nurse education to prevent common ADRs of this drug?

Answer 13

void contact sports or vigorous exercise

Question 14

Which of the following will the nurse include in teaching for the pt on anti-thrombotics?

Answer 14

avoid alcohol, use a soft toothbrush, avoid tattooing, use an electric razor for shaving
overall goal: avoid risk of excessive bleeding

Question 15

what is the reversal agent for heparin? nclex

Answer 15

protamine sulphate

Question 16

which of the following is a low molecular weight heparin?
clopidogrel
dalteparin
warfarin
bivalrudin

Answer 16

dalteparin

Question 17

what are the advantages of enoxaparin over heparin?

Answer 17

enoxaparin is a low molecular weight heparin (LMWH)
-has greater bioavalibility, a fixed dose, does not require frequent monitoring

Question 18

what is the priority to clairfy if the pt has been on LMWH for a pt scheduled for orthopedic surgery
a) warfarin is also ordered to start 3 days after surgery
b) K+ of 3.3 with PO supplements
c) Spinal anesthesia is considered for surgery tomorrow
d) INR of 1.2

Answer 18

spinal anesthesia needs to be clarified

Question 19

pt on heparin for DVT prophylaxis after open reduction and internal fixation of a tibial fracture. what would be the greatest concern to the nurse after beginning this therapy?
a) bruising at injection site
B. headache and confusion
c. pain and body temp of 37.8
pink saliva after brushing teeth

Answer 19

headache and confusion –> we are worried that they have a bleed in their head

Question 20

a nurse is caring for a pt receiving heparin therapy
HR of 98, blood pressure of 110/72. fingertips are purple, and platelets are low. what is happening?

Answer 20

heparin induced thrombocytopenia
the body makes antibodies against it so the blood starts clotting
-will clot int he periphery first

Question 21

what is the antidote to excess warfarin dose?

Answer 21

vitamin K! (phytonadione)

Question 22

match the following to dabigatran or warfarin:
Delayed onset
Rapid onset
direct thrombin inhibitor
vitamin K antagonist

Answer 22

delayed - warfarin
vitamin K antagonist is warfarin
rapid is Dabigatran
direct thrombin inhibitor is Dabigatran

Question 23

PO clopidogrel (Plavix) to a pt iwth Coronary Artery Disease. pt asks “why am I getting this”

Answer 23

a) it is anti-platelet, so it will prevent your blood from clotting in the arteries

Question 24

match the following to warfain or dabigatran
a) fixed dose with no coagulation testing
b) fixed dose with few drug-food interation
c) lower risk of hemorrhagic stroke or other bleeds
d) vitamin K as reversal
e) take with empty stomach for increased absorption

Answer 24

Dabigatran
a) fixed dose with no coagulation testing
b) fixed dose with few drug-food interation
c) lower risk of hemorrhagic stroke or other bleeds
e)take on empty stomach for increased absorption

warfarin:
vitamin K as reversal

Question 25

what is the antidote to Dabigatran

Answer 25

idarucizumab (praxbind)

Question 26

can warfarin be used in pregnancy?

Answer 26

no
the anticoagulant you can use during pregnancy is (low dose aspirin )

Question 27

if a pt is taking warfarin they should not use mayo, canola oil, or spinach T/F

Answer 27

false –
they can still have vitamin k rich foods, just keep it constant

Question 28

T/F: one 325mg tab of aspirin can double bleeding time for up to 10 days

Answer 28

true

Question 29

pt will go to surgery this week and is on a direct thrombin inhibitor. what will the nurse recommend to the provider

Answer 29

stop the direct thrombin inhibitor for 1-3 days prior to surgery

Question 30

T/F Alteplase (tPA) and other thrombolytic drugs are use used to prevent thrombi from forming

Answer 30

false, they just dissolve existing thrombi

Question 31

what is the greatest concern for bleeding?

Answer 31

intracranial hemorrhage

Question 32

matching:
Clopidogrel, Tirofiban (GP 11b receptor blocker), Rivaroxaban, Aspirin
with
A) The most effective anti-platelet drug available
B) oral anticoagulants that work by direct inhibition of factor Xa
C) suppresses platelet aggregation by irreversible inhibition of cyclooxyrgenase
D) suppresses platelet aggregation by irreversible blockade of P2Y12ADP receptor of the platelet surface

Answer 32

*aspirin inhibits cyclooxyrgenase
*GP 2b/3a receptor blocker is the most effective anti-platelet drug
*Rivaroxaban is an anticoagulant and works by direct inhibition of factor Xa
*Clopidogrel suppresses platelet aggregation by blockade of P2Y12ADP receptors of platelet surface

Question 33

a pt will need injectable vitamin K:
what might the nurse do first:
A) dilute the solution
B) give IV slowly
C) provide RBC infusions first
D) push quickly with a fast IV flush
E) A and B
F) C and D

Answer 33

A and B

Question 34

what is the reversal for Rivaroxaban (Xarelto)?

Answer 34

Andexnet (andexxa)

Question 35

the nurse is caring for a pt with a hemorrhagic stroke. which medication order should the nurse question:
A) Mannitol
B) Clopidogrel
C) nifedipine
D) Dexamethasone
E) Furosemide

Answer 35

clopidogrel, and mannitol

Question 36

the pt is in traction on bedrest and has a red edematous calf. which medication should the nurse prepare to administer
A. IV Heparin
B. Oral Warfarin
C. SQ clopidogrel
D. Oral Aspirin