Chapter 7 Drug Therapy for Coagulation Disorders

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Chapter 7  Drug Therapy for Coagulation Disorders

 

 

Complete chapter Questions And Answers
 

Sample Questions

 

 

1. A patient is taking warfarin (Coumadin) after open heart surgery. The patient tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the complaint of pain, what does the nurse suspect is the cause of the pain?

  1. A)  Joint thrombosis
  2. B)  Torn medial meniscus
  3. C)  Degenerative joint disease caused by her medication
  4. D)  Bleeding

Ans: D
Feedback:
The main adverse effect of warfarin (Coumadin) is bleeding. The sudden onset of pain in the knees alerts the nurse to assess the patient for bleeding. Arthritis, torn medical meniscus, and degenerative joint disease could all be symptoms of knee pain, but the onset and combination of anticoagulant therapy is not an etiology of these types of injuries and disease.

2. A patient who has been treated with warfarin (Coumadin) after cardiac surgery is found to have an INR of 9.0. Which medication will be administered to assist in the development of clotting factors?

  1. A)  Vitamin K
  2. B)  Vitamin E
  3. C)  Protamine sulfate
  4. D)  Acetylsalicylic acid (Aspirin)

Ans: A
Feedback:
Vitamin K is the antidote for warfarin overdosage. In this case, the patient may be at the therapeutic level to control thrombus formation, but, due to the injury, it is important to control bleeding. Vitamin E is not used as an antidote for warfarin overdosage. Protamine sulfate is used as an antidote to heparin or low molecular-weight heparin. Acetylsalicylic acid (Aspirin) is used to decrease coagulation as a preventive measure for myocardial infarction.

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3. A patient has a history of clot formation. She is scheduled for bowel resection due to colorectal cancer. What anticoagulant agent will be administered prophylactically?

  1. A)  Acetylsalicylic acid (Aspirin)
  2. B)  Heparin
  3. C)  Warfarin (Coumadin)
  4. D)  Streptokinase (Streptase)

Ans: B
Feedback:
Prophylactically, low doses of heparin are given to prevent thrombus formation in patients having major abdominal surgery. Acetylsalicylic acid is not used to prevent thrombus in patients having major abdominal surgery. Warfarin takes several days for therapeutic effects to occur; thus it is not used prophylactically to prevent thrombus in a patient with abdominal surgery. Streptokinase promotes thrombolysis and is not used to prevent thrombus.

4. A patient has been administered heparin to prevent thromboembolism development status postmyocardial infarction. The patient develops heparin-induced thrombocytopenia. Which of the following medications will be administered?

  1. A)  Argatroban (Acova)
  2. B)  Vitamin K
  3. C)  Calcium gluconate
  4. D)  Aminocaproic acid (Amicar)

Ans: A
Feedback:
Heparin-induced thrombocytopenia may occur in 1% to 3% of those receiving heparin and is a very serious side effect of heparin. In this patient, all heparin administration must be discontinued and anticoagulation managed with a direct thrombin inhibitor, such as argatroban. The patient is not administered vitamin K, calcium gluconate, or aminocaproic acid.

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5. A patient is receiving low molecular weight heparin to prevent thromboembolic complications. The nursing student asks the nursing instructor the reason why this treatment is given instead of heparin. What is the instructor’s best explanation of the rationale for LMWH over heparin?

  1. A)  “LMWH is associated with less thrombocytopenia than standard heparin.”
  2. B)  “LMWH is associated with stronger anticoagulant effects than standard heparin.”
  3. C)  “LMWH is given to patients who have a history of blood dyscrasia.”
  4. D)  “LMWH is more effective than standard heparin for patients with hypertension.”

Ans: A
Feedback:
Low molecular weight heparins are associated with less thrombocytopenia than standard heparin. Low molecular weight heparin is not stronger than standard heparin. Low molecular weight heparin is administered cautiously in patients with blood dyscrasia and hypertension.

6. A patient who is receiving warfarin (Coumadin) has blood in his urinary catheter drainage bag. What medication will likely be ordered by the physician?

  1. A)  Aminocaproic acid (Amicar)
  2. B)  Platelets
  3. C)  Protamine sulfate
  4. D)  Vitamin K

Ans: D Feedback:

Vitamin K is the antidote for warfarin overdose. Aminocaproic acid is used to control excessive bleeding from systemic hyperfibrinolysis. Platelets are a blood product, not a medication. Protamine sulfate is the antidote for heparin therapy.

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