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 medication will be stopped.

C The dose will be decreased.

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

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

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

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

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 Within normal limits

D Inadequate to evaluate treatment

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 Within normal limits

B Inadequate to evaluate treatment

C Significantly decreased

D Significantly elevated

Question #5

Which nursing intervention is essential for a patient receiving alteplase?

A Administer prescribed vitamin K if bruising is observed.

B Assess for dysrhythmias.

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

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 Administering the medication intramuscularly in the vastus lateralis

B Administering the medication when convenient

C Checking if the patient’s prescription contains enoxaparin

D Massaging the site after the injection

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 do not take aspirin for pain relief.”

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

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

D “I take ginkgo supplements for memory enhancement.”

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’ve been on prolonged bed rest.”

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

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

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

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 Tranexamic acid

B Aminocaproic acid

C Alteplase

D Phytonadione

Question #10

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

A Cimetidine

B Carbamazepine

C Barbiturate

D Cholestyramine

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

C Platelet count, Heart rate, Blood pressure

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

Question #12

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

A “I will take the medication with food.”

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

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

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

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 Creatinine clearance of 25 mL/min

C Loss of 10 pounds

D Diagnosis of diabetes mellitus

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 decreased by half.

D The dosage of the amiodarone will be increased 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 Instruct the patient to notify the nurse if he or she begins to experience discomfort.

B Monitor the patient for decreased action of the anticoagulant.

C Monitor the patient for increased action of the anticoagulant.

D Continue to administer cimetidine with each dose of warfarin.

Question #16

Alteplase therapy is indicated for a patient with which condition?

A Gastrointestinal bleed

B Peptic ulcer disease

C Local thrombosis from a peripheral intravenous line

D Severe chest pain for the past 2 hours

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 Increase the dose of heparin.

B Notify the health care provider immediately.

C Monitor the patient and check the therapeutic range.

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

B Within the expected target therapeutic level of anticoagulation

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 #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 Hemoglobin level: 11 g/dL

B Prothrombin time: 13 sec

C Platelet count: 100,000/mm3

D Leukocyte count: 3000 cells/mm3

Question #20

Which condition is a contraindication for dabigatran?

A Atrial fibrillation, History of myocardial infarction

B Chronic obstructive pulmonary disease, Atrial fibrillation

C History of myocardial infarction, Chronic obstructive pulmonary disease

D Peptic ulcer disease, Chronic kidney disease

Question #21

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

A Platelet count of 95,000/mm3

B Activated partial thromboplastin time (aPTT) of 37 seconds

C International normalized ratio (INR) of 1

D Potassium level of 3.5 mEq/L

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

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

C Within the expected target therapeutic level of anticoagulation

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

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

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

D “Refrigerate and keep away from direct sunlight.”

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 Ketoconazole

B Amiodarone

C Enoxaparin

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 Have protamine sulfate readily available at all times.

B Monitor the patient’s laboratory values correctly.

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

D Ensure that a loading dose was initially administered when beginning

Question #26

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

A Administer vitamin K1 (phytonadione) IV.

B Stop the intravenous (IV) drip.

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 Reversal of damage from the infarction

B Dissolution of the clot that caused the heart attack

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 take oral contraceptives during the therapy.”

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

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

D “I should refrain from eating broccoli 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 should keep taking ibuprofen for my arthritis.”

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

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

Question #30

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

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

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

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

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

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

B Rub the administration site after injecting.

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

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 increase dark green leafy vegetables in my diet.”

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

C “I will avoid contact sports.”

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 E

C Vitamin K

D Calcium gluconate

Question #34

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

A Vitamin K daily

B Warfarin 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 Vitamin K deficiency

D Peripheral vascular disease

Question #36

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

A Warfarin orally

B Dabigatran orally

C Enoxaparin intramuscularly

D Heparin subcutaneously

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 September 15

B October 1

C July 31

D August 29

Question #39

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

A Chest pain

B Itching

C Nausea

D Edema

Question #40

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

A International normalized ratio (INR) of 1.0

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

C Activated partial thromboplastin time (aPTT) of 120 seconds

D Platelet count of 150,000 mm3

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 Creatinine clearance value of 40 mL/min

C Platelet count of 75,000 cell/μL

D Hemoglobin level of 16.5 g/dL

Question #42

A nurse understands that warfarin works by affecting which substance?

A Factor Xa

B Antithrombin III

C Vitamin K

D Thrombin

Question #43

Which antifibrinolytic agent is used for surgical and postoperative hemostasis?

A Tranexamic acid

B Alteplase

C Desmopressin

D Aminocaproic acid

Question #44

Which class of drugs is also known as hemostatic drugs?

A Thrombolytic

B Antiplatelet

C Antifibrinolytic

D Anticoagulant

Question #45

Which condition is an indication for thrombolytic therapy?

A Cardiomyopathy

B Coronary artery disease

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 Aspirin

B Cilostazol

C Pentoxifylline

D Dipyridamole

Question #47

Which anticoagulant can be given orally?

A Dabigatran

B Fondaparinux

C Enoxaparin

D Argatroban

Question #48

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

A Direct thrombin inhibitors

B Heparins

C Selective factor Xa inhibitors

D Warfarin

Question #49

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

A Anticoagulants prevent clots from forming.

B Anticoagulants dissolve clots.

C Anticoagulants alter platelet function.

D Anticoagulants interfere with drug metabolism.

Question #50

Cilostazol belongs to which drug class?

A Thrombolytic

B Anticoagulant

C Antifibrinolytic

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 Medication reaction

B Embolus to the lungs

C Fatigue from walking with pain

D Anxiety

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 Infusing 50 mL of warfarin sodium

B Administering vitamin K1

C Increasing the dose of enoxaparin

D Administering protamine sulfate

Question #53

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

A Calcium

B Potassium

C Vitamin K

D Aspirin

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