Mastery EAQ Ch. 26

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Question #1

The nurse is caring for a patient who is being treated with fondaparinux and notes a platelet count of 80,000/mm3. Based on this information, the nurse anticipates which change to the medication regimen?

A The dose will be increased.

B The dose will be decreased.

C The medication will be stopped.

D The dose will be unchanged.

Question #2

The nurse is screening a patient for candidacy for treatment with fondaparinux. The nurse reviews the patient’s laboratory test results and finds a creatinine clearance of 20 mL/min and a body weight of 48 kg. Which interpretation of these findings is correct?

A Is a candidate for fondaparinux based on a sufficient creatinine clearance and adequate body weight

B Not a candidate for fondaparinux based on both an insufficient creatinine clearance and an inadequate body weight

C Is a candidate for fondaparinux based on sufficient creatinine clearance and after body weight attains an adequate level

D Not a candidate for fondaparinux based on an insufficient creatinine clearance

Question #3

The nurse assesses the patient’s activated partial thromboplastin time (aPTT) to determine the effectiveness of the heparin regimen and notes that it is 35 seconds. Which interpretation of this aPTT is correct?

A Too low

B Too high

C Inadequate to evaluate treatment

D Within normal limits

Question #4

The nurse assesses the patient’s prothrombin time (PT) to determine the effectiveness of anticoagulant therapy and notes that it is 32 seconds. Which interpretation of this PT value is correct?

A Inadequate to evaluate treatment

B Significantly elevated

C Within normal limits

D Significantly decreased

Question #5

Which nursing intervention is essential for a patient receiving alteplase?

A Administer prescribed vitamin K if bruising is observed.

B Stop the medication if the systolic blood pressure drops below 110 mm Hg.

C Assess for dysrhythmias.

D Monitor liver enzymes.

Question #6

A registered nurse is teaching a student nurse about safe and effective administration of heparin. Which action by the student nurse is appropriate?

A Massaging the site after the injection

B Administering the medication when convenient

C Checking if the patient’s prescription contains enoxaparin

D Administering the medication intramuscularly in the vastus lateralis

Question #7

After talking with a patient who is receiving warfarin sodium therapy, the nurse believes that the patient is at increased risk for bleeding. Which statement made by the patient supports the nurse’s conclusion?

A “I refrain from drinking coffee and citrus fruit juices daily.”

B “I take ginkgo supplements for memory enhancement.”

C “I do not take aspirin for pain relief.”

D “I eat 1 cup of green leafy vegetables daily.”

Question #8

A nurse is providing care to a patient who is at risk for deep vein thrombosis (DVT). The health care provider prescribes aspirin therapy. Which statement from the patient supports this prescription?

A “I never sit with my legs crossed at the knees.”

B “I avoid tight-fitting stockings or leggings.”

C “I’ve been on prolonged bed rest.”

D “I get up and walk around at least once an hour.”

Question #9

A patient is experiencing chest pain, dyspnea, hemoptysis, and hypotension. The patient’s arterial blood gas analysis indicates a decreased level of oxygen. Which medication prescription would the nurse expect for the patient based on the current assessment data?

A Phytonadione

B Alteplase

C Aminocaproic acid

D Tranexamic acid

Question #10

In a patient receiving warfarin therapy, the addition of which medication would require the dose of warfarin to be increased?

A Cholestyramine

B Barbiturate

C Cimetidine

D Carbamazepine

Question #11

The nurse is caring for a patient who is prescribed long-term aspirin therapy to prevent a stroke. Which parameters would the nurse assess as a result of this prescription?

A Heart rate, Hemoglobin, Blood pressure

B Hemoglobin, Platelet count, Activated partial thromboplastin time (aPTT)

C Platelet count, Heart rate, Blood pressure

D Activated partial thromboplastin time (aPTT), Blood pressure, Heart rate

Question #12

Which patient statement indicates a need for additional teaching about the safe use of dabigatran?

A “I will use the medication within 60 days after it is opened.”

B “I will place the pills in an organizer for easy use.”

C “I will take the medication with food.”

D “I will store the bottle in a dry place.”

Question #13

A patient is prescribed dabigatran to treat atrial fibrillation. On a follow-up visit, the medication dose is reduced by half. Which assessment finding supports the change in the prescribed dose?

A Platelet count of 80,000/mm3

B Diagnosis of diabetes mellitus

C Loss of 10 pounds

D Creatinine clearance of 25 mL/min

Question #14

The nurse is caring for a patient who is scheduled to begin warfarin treatment and is currently being treated with amiodarone. Considering this information, the nurse anticipates that which change will be made to the medication regimen?

A The dosage of the warfarin will be decreased by half.

B The dosage of the warfarin will be increased by half.

C The dosage of the amiodarone will be increased by half.

D The dosage of the amiodarone will be decreased by half.

Question #15

The nurse is caring for a patient who is being treated with warfarin. The patient has just been administered cimetidine. Which action would the nurse take?

A Continue to administer cimetidine with each dose of warfarin.

B Instruct the patient to notify the nurse if he or she begins to experience discomfort.

C Monitor the patient for increased action of the anticoagulant.

D Monitor the patient for decreased action of the anticoagulant.

Question #16

Alteplase therapy is indicated for a patient with which condition?

A Local thrombosis from a peripheral intravenous line

B Severe chest pain for the past 2 hours

C Peptic ulcer disease

D Gastrointestinal bleed

Question #17

A patient has been receiving intravenous heparin. The nurse notes that today’s activated partial thromboplastin time (aPTT) result is elevated. Which action would the nurse take?

A Monitor the patient and check the therapeutic range.

B Increase the dose of heparin.

C Notify the health care provider immediately.

D Stop the medication.

Question #18

A patient who is undergoing treatment with heparin therapy has an activated partial thromboplastin time (aPTT) level of 98 seconds. Which interpretation of this level is correct?

A Outside the expected target therapeutic level of anticoagulation; it is too low

B Within the expected target therapeutic level of anticoagulation

C Cannot be interpreted without knowing the prothrombin time and international normalized ratio

D Outside the expected target therapeutic level of anticoagulation; it is too high

Question #19

After reviewing the laboratory reports of a patient who was prescribed long-term heparin therapy, the nurse is asked to administer argatroban. Which laboratory result indicates the need for this medication?

A Platelet count: 100,000/mm3

B Hemoglobin level: 11 g/dL

C Prothrombin time: 13 sec

D Leukocyte count: 3000 cells/mm3

Question #20

Which condition is a contraindication for dabigatran?

A Peptic ulcer disease, Chronic kidney disease

B Atrial fibrillation, History of myocardial infarction

C Chronic obstructive pulmonary disease, Atrial fibrillation

D History of myocardial infarction, Chronic obstructive pulmonary disease

Question #21

The nurse is reviewing laboratory data before initiating a patient’s heparin infusion. Which finding requires immediate action?

A Potassium level of 3.5 mEq/L

B Platelet count of 95,000/mm3

C International normalized ratio (INR) of 1

D Activated partial thromboplastin time (aPTT) of 37 seconds

Question #22

The patient is receiving warfarin therapy, and the nurse finds the international normalized ratio (INR) to be 4.0. Which interpretation of the INR finding is correct?

A Within the expected target therapeutic level of anticoagulation

B The prothrombin time and activated partial thromboplastin time (aPTT) value are needed to interpret the finding.

C Outside the expected target therapeutic level of anticoagulation; it is too high

D Outside the expected target therapeutic level of anticoagulation; it is too low

Question #23

Which instruction will the nurse provide to the patient regarding storing dabigatran for home use?

A “Discard the drug within 21 days of opening the original container.”

B “Remove from the original package and place in aluminum foil.”

C “Refrigerate and keep away from direct sunlight.”

D “Store the drug with the desiccant-drying agent in the packing cap.”

Question #24

A patient with atrial fibrillation is admitted to the emergency unit for symptoms of warfarin toxicity. The primary health care provider instructs the nurse to administer 6 mg of vitamin K to the patient. Which medication would be included in the patient’s prescription to provide safe and effective treatment?

A Amiodarone

B Enoxaparin

C Ketoconazole

D Furosemide

Question #25

The patient is being treated with a continuous intravenous infusion of heparin. Which action is the nurse’s highest priority?

A Monitor the patient’s laboratory values correctly.

B Teach the patient about dietary restrictions while on the medication.

C Ensure that a loading dose was initially administered when beginning

D Have protamine sulfate readily available at all times.

Question #26

A patient receiving warfarin has an international normalized ratio (INR) of 6. Which action would the nurse take?

A Stop the intravenous (IV) drip.

B Administer vitamin K1 (phytonadione) IV.

C Wait for the INR to decrease.

D Administer protamine sulfate IV.

Question #27

The nurse is administering tenecteplase (TNKase) therapy to a patient experiencing an acute myocardial infarction. Which outcome is expected from this therapy?

A Dissolution of the clot that caused the heart attack

B Reversal of damage from the infarction

C Prevention of new clots from forming

D A quick decrease in pain

Question #28

The nurse is teaching a patient who is receiving aminocaproic acid the measures to prevent adverse effects. Which statement made by the patient indicates the need for further teaching?

A “I should refrain from eating broccoli during the therapy.”

B “I should not use any acetaminophen during the therapy.”

C “I should take oral contraceptives during the therapy.”

D “I should follow a low-cholesterol diet during the therapy.”

Question #29

The nurse confirms that a patient has understood discharge teaching regarding warfarin based on which statement by the patient?

A “I should use a soft toothbrush for dental hygiene.”

B “I will double my dose if I forget to take it the day before.”

C “I should keep taking ibuprofen for my arthritis.”

D “I should decrease the dose if I start bruising easily.”

Question #30

The patient asks the nurse to explain the difference between dalteparin and regular heparin. Which response by the nurse is accurate?

A “There is no real difference; dalteparin is interchangeable with regular heparin.”

B “The only difference is that regular heparin dosing is based on the patient’s weight.”

C “You should ask your doctor why dalteparin was ordered instead of regular heparin.”

D “Dalteparin is a low-molecular-weight heparin that is more predictable in its effect and has a lower risk of bleeding.”

Question #31

A nurse is preparing to administer enoxaparin sodium to a patient for prevention of deep vein thrombosis. Which nursing intervention is essential?

A Utilize the Z-track method to inject the medication.

B Rub the administration site after injecting.

C Draw up the medication in a syringe with a 22-gauge, 1.5-inch needle.

D Administer the medication into subcutaneous tissue of the abdomen.

Question #32

A patient is receiving warfarin for a chronic condition. Which patient statement requires immediate action by the nurse?

A “I will avoid contact sports.”

B “I will contact my health care provider if I develop excessive bruising.”

C “I will increase dark green leafy vegetables in my diet.”

D “I will take my medication at the same time each day.”

Question #33

A patient who has been taking warfarin is admitted with coffee-ground emesis. Which medication would the nurse anticipate being prescribed for this patient?

A Protamine sulfate

B Vitamin K

C Vitamin E

D Calcium gluconate

Question #34

A patient is diagnosed with hemophilia. Which medication therapy is essential?

A Warfarin daily

B Vitamin K daily

C Aspirin daily (i.e., 81 mg)

D Recombinant factors

Question #35

Which condition is a contraindication to therapy with an antiplatelet drug?

A Transient ischemic attack

B Acute unstable angina

C Peripheral vascular disease

D Vitamin K deficiency

Question #36

The nurse is preparing to administer an anticoagulant to a patient. Which medication and route of administration is in error?

A Heparin subcutaneously

B Warfarin orally

C Enoxaparin intramuscularly

D Dabigatran orally

Question #37

A patient who is receiving heparin therapy has bruises covering the abdomen as well as red-colored urine. Which assessment does the nurse need to address?

A Over-the-counter medications

B Urine culture

C Ingestion of acetaminophen

D Platelet level

Question #38

The patient is being treated with dabigatran and opens a new bottle of the medication on July 1. The nurse will instruct the patient to discard any unused medication by which date?

A October 1

B August 29

C July 31

D September 15

Question #39

The patient has been placed on aspirin as an antiplatelet drug. Which is a side effect of aspirin therapy?

A Edema

B Nausea

C Chest pain

D Itching

Question #40

A patient is receiving an intravenous heparin drip. Which laboratory value requires immediate action by the nurse?

A Blood urea nitrogen (BUN) level of 12 mg/dL

B Platelet count of 150,000 mm3

C Activated partial thromboplastin time (aPTT) of 120 seconds

D International normalized ratio (INR) of 1.0

Question #41

A patient with deep vein thrombosis is receiving fondaparinux therapy. After reviewing the patient’s laboratory reports, the nurse believes that discontinuing the therapy will be beneficial for the patient. Which finding supports the nurse’s suspicion?

A Fasting blood glucose level of 95 mg/dL

B Platelet count of 75,000 cell/μL

C Creatinine clearance value of 40 mL/min

D Hemoglobin level of 16.5 g/dL

Question #42

A nurse understands that warfarin works by affecting which substance?

A Thrombin

B Antithrombin III

C Vitamin K

D Factor Xa

Question #43

Which antifibrinolytic agent is used for surgical and postoperative hemostasis?

A Aminocaproic acid

B Tranexamic acid

C Alteplase

D Desmopressin

Question #44

Which class of drugs is also known as hemostatic drugs?

A Anticoagulant

B Antiplatelet

C Thrombolytic

D Antifibrinolytic

Question #45

Which condition is an indication for thrombolytic therapy?

A Coronary artery disease

B Cardiomyopathy

C Heart failure

D Acute myocardial infarction

Question #46

Which antiplatelet drug works by inhibiting the cyclooxygenase in the platelet irreversibly so that the platelet cannot regenerate this enzyme, thereby preventing clot formation?

A Dipyridamole

B Pentoxifylline

C Cilostazol

D Aspirin

Question #47

Which anticoagulant can be given orally?

A Enoxaparin

B Argatroban

C Fondaparinux

D Dabigatran

Question #48

Which subclass of anticoagulants may cause the adverse effect of purple toes?

A Warfarin

B Direct thrombin inhibitors

C Selective factor Xa inhibitors

D Heparins

Question #49

The nurse is teaching a patient about therapy with anticoagulants. Which is essential information to include in the teaching plan?

A Anticoagulants dissolve clots.

B Anticoagulants interfere with drug metabolism.

C Anticoagulants alter platelet function.

D Anticoagulants prevent clots from forming.

Question #50

Cilostazol belongs to which drug class?

A Anticoagulant

B Antifibrinolytic

C Thrombolytic

D Antiplatelet

Question #51

A patient who was admitted with deep vein thrombophlebitis is complaining of difficulty breathing and chest pain. Which is the most likely cause of these symptoms?

A Anxiety

B Embolus to the lungs

C Fatigue from walking with pain

D Medication reaction

Question #52

A patient who is on enoxaparin therapy has hematuria, melena, petechiae, and bleeding from the gums. Which treatment strategy will be beneficial for the patient?

A Administering protamine sulfate

B Infusing 50 mL of warfarin sodium

C Administering vitamin K1

D Increasing the dose of enoxaparin

Question #53

A patient has overdosed on warfarin. Which substance will the nurse administer to reverse the effect of warfarin?

A Aspirin

B Calcium

C Vitamin K

D Potassium

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