Chapter 27 Drugs Used to Treat Thromboembolic Disorders

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Chapter 27  Drugs Used to Treat Thromboembolic Disorders

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

MULTIPLE CHOICE

1. A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin?
a.
Warfarin sodium (Coumadin)
b.
Enoxaparin (Lovenox)
c.
Protamine sulfate
d.
Vitamin K

ANS: C
Protamine sulfate is the antidote to heparin. With the patient’s risk of fluid volume deficit as a result of trauma, the primary intervention would be to counteract the effects of heparin to prevent hemorrhage. Warfarin is an anticoagulant and would not counteract hemorrhage. Lovenox is chemically related to heparin and would not counteract hemorrhage. Vitamin K is used to control the bleeding that results from use of warfarin (Coumadin), not heparin.

DIF: Cognitive Level: Comprehension REF: p. 437 OBJ: 8
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

2. A patient receiving IV heparin therapy for a deep vein thrombosis (DVT) in his right calf asks why his calf remains painful, edematous, and warm to touch after 2 days of anticoagulant therapy. Which response by the nurse is most accurate?
a.
“It takes at least 3 days for the symptoms to resolve once the clot dissolves.”
b.
“Heparin does not dissolve blood clots, but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body.”
c.
“I will report this to your health care provider because there may be a need to look at alternative treatments.”
d.
“You appear anxious. The health care provider will eventually put you on ticlopidine, which allows for an earlier discharge.”

ANS: B
Heparin is used to treat a thromboembolism and promote neutralization of activated clotting factors, preventing the extension of thrombi and the formation of emboli. Heparin will minimize tissue damage by preventing it from developing into an insoluble, stable thrombus. It is inappropriate to tell a patient how long it will take to dissolve a clot.The patient’s question does not warrant notification of the health care provider. Telling the patient that the health care provider will be starting the patient on ticlopidine is inappropriate and inaccurate.

DIF: Cognitive Level: Analysis REF: p. 436 OBJ: 2
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

3. A patient is receiving IV heparin therapy. The aPTT is 90; the laboratory control is 30 seconds. Which nursing intervention is most accurate?
a.
Document in the nursing notes that these results are within therapeutic range.
b.
Note the RBC count and wait for the health care provider to make the next round to discuss all laboratory values.
c.
Stop the heparin drip.
d.
Assess the patient for signs and symptoms of decreased sensorium.

ANS: C
Heparin dosage is considered to be in the normal therapeutic range if the aPTT is 1.5 to 2.5 times the control value. The patient’s aPTT value is above the therapeutic range, which puts her at risk for hemorrhage. The most appropriate nursing action would be to stop the heparin drip. These results cannot be documented as being within the normal therapeutic range. RBC count and mental status are not relevant in assessing therapeutic response to anticoagulation.

DIF: Cognitive Level: Application REF: p. 438 OBJ: 5 | 9
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity

4. Which is an accurate nursing action when administering subcutaneous enoxaparin, a low-molecular-weight heparin product?
a.
Expel the air bubble from the prefilled syringe.
b.
Leave the needle in place for 10 seconds after injection.
c.
Administer the medication into the deltoid muscle.
d.
Massage the site after injection to increase absorption.

ANS: B
The needle is left in place for 10 seconds after injection. Air is not expelled from the prefilled syringe. This medication is not administered intramuscularly. The site should not be massaged to increase absorption.

DIF: Cognitive Level: Application REF: p. 433 OBJ: 7
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

5. A patient is receiving 1400 units of heparin/hour on an IV pump. The aPTT time is 54. The laboratory control is 25. Which action by the nurse is accurate?
a.
Bolus the patient with an additional 5000 units of heparin.
b.
Stop the heparin immediately and notify the health care provider that the patient’s blood level is toxic.
c.
Administer protamine sulfate stat.
d.
Continue with the prescribed rate.

ANS: D
Therapeutic heparin values are 1.5 to 2.5 times the control value. The therapeutic range of heparin with a control of 25 is 37.5 to 62.5 units/hour. A time of 54 is within the therapeutic range. An increase of heparin is not indicated because the patient is in the therapeutic range. The range is not toxic. An antidote to the anticoagulant is not indicated because the patient is within the therapeutic range.

DIF: Cognitive Level: Analysis REF: p. 436 OBJ: 5 | 7 | 9
TOP: Nursing Process Step: Planning
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

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