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

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

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 high

B Too low

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 Significantly decreased

B Inadequate to evaluate treatment

C Within normal limits

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 Monitor liver enzymes.

C Assess for dysrhythmias.

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

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 when convenient

B Administering the medication intramuscularly in the vastus lateralis

C Massaging the site after the injection

D Checking if the patient’s prescription contains enoxaparin

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 take ginkgo supplements for memory enhancement.”

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

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

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

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

C “I’ve been on prolonged bed rest.”

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 Aminocaproic acid

B Alteplase

C Tranexamic acid

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 Carbamazepine

B Cholestyramine

C Barbiturate

D Cimetidine

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 take the medication with food.”

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

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

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 Creatinine clearance of 25 mL/min

B Diagnosis of diabetes mellitus

C Platelet count of 80,000/mm3

D Loss of 10 pounds

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 increased by half.

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

C The dosage of the warfarin will be decreased 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 Monitor the patient for decreased action of the anticoagulant.

C Monitor the patient for increased action of the anticoagulant.

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

Question #16

Alteplase therapy is indicated for a patient with which condition?

A Gastrointestinal bleed

B Peptic ulcer disease

C Severe chest pain for the past 2 hours

D Local thrombosis from a peripheral intravenous line

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 Stop the medication.

B Notify the health care provider immediately.

C Monitor the patient and check the therapeutic range.

D Increase the dose of heparin.

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 Within the expected target therapeutic level of anticoagulation

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

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 Peptic ulcer disease, Chronic kidney disease

B Atrial fibrillation, History of myocardial infarction

C History of myocardial infarction, Chronic obstructive pulmonary disease

D Chronic obstructive pulmonary disease, Atrial fibrillation

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 Activated partial thromboplastin time (aPTT) of 37 seconds

C International normalized ratio (INR) of 1

D Platelet count of 95,000/mm3

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 high

C Within the expected target therapeutic level of anticoagulation

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 “Refrigerate and keep away from direct sunlight.”

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

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

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 Furosemide

D Ketoconazole

Question #25

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

A Ensure that a loading dose was initially administered when beginning

B Have protamine sulfate readily available at all times.

C Monitor the patient’s laboratory values correctly.

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

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 Wait for the INR to decrease.

C Administer vitamin K1 (phytonadione) IV.

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 A quick decrease in pain

D Prevention of new clots from forming

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 follow a low-cholesterol diet during the therapy.”

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

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

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

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

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

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

D “There is no real difference; dalteparin is interchangeable with 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 Rub the administration site after injecting.

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

C Administer the medication into subcutaneous tissue of the abdomen.

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

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 take my medication at the same time each day.”

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

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 Vitamin E

B Protamine sulfate

C Calcium gluconate

D Vitamin K

Question #34

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

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

B Vitamin K daily

C Warfarin daily

D Recombinant factors

Question #35

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

A Acute unstable angina

B Transient ischemic attack

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 Enoxaparin intramuscularly

B Dabigatran orally

C Warfarin orally

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 Ingestion of acetaminophen

B Over-the-counter medications

C Urine culture

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 August 29

C July 31

D October 1

Question #39

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

A Edema

B Itching

C Nausea

D Chest pain

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 International normalized ratio (INR) of 1.0

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 Creatinine clearance value of 40 mL/min

B Platelet count of 75,000 cell/μL

C Hemoglobin level of 16.5 g/dL

D Fasting blood glucose level of 95 mg/dL

Question #42

A nurse understands that warfarin works by affecting which substance?

A Vitamin K

B Antithrombin III

C Thrombin

D Factor Xa

Question #43

Which antifibrinolytic agent is used for surgical and postoperative hemostasis?

A Alteplase

B Aminocaproic acid

C Desmopressin

D Tranexamic acid

Question #44

Which class of drugs is also known as hemostatic drugs?

A Antifibrinolytic

B Thrombolytic

C Anticoagulant

D Antiplatelet

Question #45

Which condition is an indication for thrombolytic therapy?

A Acute myocardial infarction

B Heart failure

C Coronary artery disease

D Cardiomyopathy

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 Pentoxifylline

C Cilostazol

D Dipyridamole

Question #47

Which anticoagulant can be given orally?

A Fondaparinux

B Dabigatran

C Enoxaparin

D Argatroban

Question #48

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

A Selective factor Xa inhibitors

B Warfarin

C Heparins

D Direct thrombin inhibitors

Question #49

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

A Anticoagulants alter platelet function.

B Anticoagulants dissolve clots.

C Anticoagulants prevent clots from forming.

D Anticoagulants interfere with drug metabolism.

Question #50

Cilostazol belongs to which drug class?

A Antiplatelet

B Antifibrinolytic

C Thrombolytic

D Anticoagulant

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 Anxiety

C Fatigue from walking with pain

D Embolus to the lungs

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 vitamin K1

B Administering protamine sulfate

C Infusing 50 mL of warfarin sodium

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 Potassium

B Calcium

C Vitamin K

D Aspirin

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