Drugs That Affect Blood Clotting

Understanding Pharmacology Essentials for Medication Safety

Nursing
30
Questions
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True/False
24
Choices
6
Essay
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Questions

Q1
Free

How are anticoagulant drugs and thrombolytic drugs different?

Multiple Choice
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A) There is no difference; they both have the same actions.
B) Anticoagulants prevent clots from forming whereas thrombolytics can dissolve clots that have already formed.
C) Thrombolytics must be administered intravenously while all anticoagulants are administered as oral agents.
D) Anticoagulants prevent clots by actually thinning the blood whereas thrombolytics reduce platelet aggregation and do not affect blood thickness.
Answer:
B) Anticoagulants prevent clots from forming whereas thrombolytics can dissolve clots that have already formed.

Explanation:
Both thrombolytics and anticoagulants disrupt steps in clot formation. However, anticoagulants have no effect on clots that have already formed. Only thrombolytics can dissolve an existing clot. Neither drug causes a thinning of the blood. Blood viscosity (thickness or specific gravity) remain the same when a person receives either class of drug.
Q2
Free

Which blood component forms the initial plug that helps stop bleeding?

Multiple Choice
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A) Fibrin
B) Platelets
C) Neutrophils
D) Eosinophils
Answer:
B) Platelets

Explanation:
While fibrin creates threads that make the plasma sticky and able to clot, it is platelets that clump together to create the initial plug that helps to stop bleeding. Neutrophils and eosinophils are types of white blood cells that help the body fight off infection.
Q3
Free

Which condition occurs as a result of a thrombus developing in a coronary artery?

Multiple Choice
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A) Cerebrovascular accident
B) Deep vein thrombosis
C) Pulmonary embolus
D) Myocardial infarction
Answer:
D) Myocardial infarction

Explanation:
When a thrombus develops in a coronary artery and blocks the blood supply to a part of the heart muscle, a heart attack (myocardial infarction) occurs. Cerebrovascular accident (stroke) occurs when a thrombus blocks an artery in the brain. Deep vein thrombosis occurs when a clot blocks a deep vein, such as a leg vein. Pulmonary embolus occurs when an embolus blocks blood flow in an artery in the lungs.
Q4

A patient asks the nurse why an anticoagulant has been prescribed. What is the nurses best response?

Multiple Choice
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A) It will dissolve any clots in your blood vessels.
B) It will prevent any new clots from forming.
C) It will prevent a clot from migrating.
D) It will thin your blood.
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Q5

A patient prescribed an anticoagulant long-term engages in all of the following activities. Which activity does the nurse teach the patient to avoid?

Multiple Choice
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A) Golfing
B) Bowling
C) Jumping rope
D) Walking 2 miles daily
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Q6

A patient in the emergency department developed stroke symptoms one hour ago. Which type of drug will the nurse expect to administer to resolve this problem?

Multiple Choice
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A) Thrombolytic
B) Thrombin inhibitor
C) Antiplatelet drug
D) Clotting factor synthesis inhibitor
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Q7

Which action does the nurse avoid after administering a thrombolytic drug?

Multiple Choice
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A) Administering IV drugs
B) Using electric razors
C) Providing a soft toothbrush
D) Giving an intramuscular injection
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Q8

A patient who has been prescribed continuous intravenous (IV) heparin asks the nurse why being weighed is necessary. What is the nurses best response?

Multiple Choice
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A) All patients are weighed upon admission to the hospital.
B) IV heparin has been known to cause weight gain.
C) The initial IV bolus of heparin is prescribed based on your weight.
D) The rate of the heparin infusion is based on your weight.
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Q9

The aPTT of a patient who is prescribed continuous intravenous (IV) heparin is two times the control value. What is the nurses best action?

Multiple Choice
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A) Increase the IV rate as ordered.
B) Decrease the IV rate as ordered.
C) Leave the rate unchanged.
D) Stop the infusion and notify the prescriber.
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Q10

A patient is being discharged on enoxaparin (Lovenox). Which statement does the nurse include in the discharge teaching plan?

Multiple Choice
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A) An advantage of this drug is that labs do not need to be drawn to guide therapy.
B) Follow-up lab work must be drawn every 2 to 6 months.
C) Enoxaparin is given intramuscularly twice a day.
D) The purpose of this drug is to dissolve clots.
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Q11

A patient who has been receiving heparin subcutaneously for 3 weeks has all of the following laboratory blood test values. Which value does the nurse report immediately to the prescriber?

Multiple Choice
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A) Activated partial thromboplastin time 1.5
B) International normalized ratio (INR) 1.7
C) Red blood cells 4.2 million/mm3
D) Platelets 20,000/mm3
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Q12

Which drug must always be available on a unit where heparin therapy is occurring?

Multiple Choice
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A) aspirin
B) vitamin K
C) protamine sulfate
D) warfarin (Coumadin)
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Q13

A patient is taking warfarin (Coumadin) daily to prevent blood clots from forming in deep veins. Which statement made by the patient indicates that more teaching is needed about this therapy?

Multiple Choice
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A) I have been eating more salads and other green, leafy vegetables to prevent constipation.
B) I have been using acetaminophen (Tylenol) instead of aspirin for pain.
C) Instead of a safety razor, I have been using an electric shaver.
D) On hot days, I make sure to drink at least two quarts of water.
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Q14

A patient has been discontinued from warfarin (Coumadin) therapy for 3 weeks. Which laboratory test indicates to the nurse that all effects of the warfarin have been eliminated?

Multiple Choice
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A) International normalized ratio (INR) of 0.9
B) Red blood cell count of 5 million/mm3
C) Hemoglobin of 16 g/dL
D) Hematocrit of 42%
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Q15

A patient with a vein thromboembolism is to be started on oral warfarin (Coumadin) while still receiving intravenous heparin. What is the nurses best action?

Multiple Choice
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A) Administer the drugs as prescribed.
B) Remind the prescriber that two anticoagulants should not be administered concurrently.
C) Hold the dose of warfarin until the patients activated partial thromboplastin time is the same as the control value.
D) Monitor the patient for clinical manifestations of internal or external bleeding at least every 2 hours.
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Q16

Why is warfarin (Coumadin) avoided during pregnancy?

Multiple Choice
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A) Warfarin can induce premature closure of the foramen ovale in the fetus.
B) The fetal and newborn liver cannot metabolize warfarin and anemia results.
C) The fetus and newborn are more likely to have allergic reactions to warfarin.
D) Warfarin crosses the placenta and causes birth defects or hemorrhage in the fetus.
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Q17

A patient prescribed subcutaneous heparin tells the nurse that her menstrual bleeding is heavier than usual. What is the nurses best response?

Multiple Choice
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A) I will hold the drug and notify your prescriber.
B) This is a fairly common and expected side effect of the drug.
C) Heavy bleeding is a concern because you might become anemic.
D) I will have to give you a shot of protamine sulfate to reverse the drugs action.
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Q18

Which statement by a patient who is prescribed heparin indicates to the nurse the need for additional teaching?

Multiple Choice
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A) Ill be sure to have my follow-up aPTT drawn when the prescriber tells me to.
B) I will not take over-the-counter drugs that contain aspirin.
C) I will get plenty of exercise playing soccer.
D) Ill tell my prescriber if I have headaches.
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Q19

Which dietary teaching does the nurse include for a patient who is prescribed warfarin (Coumadin) on discharge?

Multiple Choice
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A) Weight loss diets such as the Atkins diet are OK while taking this drug.
B) Be sure to eat lots of green leafy vegetables for extra vitamin K.
C) Dietary changes do not affect the action of this drug.
D) Drinking alcoholic beverages can change the action of warfarin.
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Q20

Why should children not be prescribed aspirin or aspirin-containing products?

Multiple Choice
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A) There is more risk for bleeding in children than in adults.
B) Aspirin products are more likely to cause GI upset in children.
C) Children are more likely to experience allergic reactions to aspirin-containing products.
D) Risk for Reyes syndrome, which effects brain and liver function, is increased in children.
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Q21

A patient who received the thrombolytic drug alteplace (Activase) asks the nurse why continuous heparin is now infusing intravenously. What is the nurses best response?

Multiple Choice
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A) There may be additional clots in your body and we want to be sure they are all dissolved.
B) Once the clot is dissolved, heparin is given continuously to prevent any new clots from forming.
C) The heparin finishes the job of dissolving the clot that the alteplace started.
D) Heparin is infused continuously in case we need to give additional dosages of alteplase.
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Q22

Why are erythropoiesis-stimulating agents (ESAs) prescribed for patients with chronic kidney disease?

Multiple Choice
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A) To protect the kidney from further hypoxic damage during anemia episodes
B) To improve blood cell counts and reduce the need for blood transfusions
C) To prevent vein thromboembolism during periods of dehydration
D) To reduce the risk of uric acid precipitation and renal failure
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Q23

A patient coming to the clinic for a weekly infusion of darbepoetin alpha (Aranesp) has all of the following changes. For which change does the nurse hold the dose of the drug?

Multiple Choice
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A) Weight loss of five pounds
B) Hemoglobin increase from 8 g/dL to 10 g/dL
C) Blood potassium increase from 3.8 mEq/L to 4.8 mEq/L
D) Blood pressure increase from 126/80 mm Hg to 148/92 mm Hg
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Q24

A patient is receiving oprelvekin (Neumega) subcutaneously daily. Which laboratory value indicates to the nurse that the therapy is effective?

Multiple Choice
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A) Hemoglobin 12 g/dL
B) Platelet level 55,000/mm3
C) Red blood cells 4.5 million/mm3
D) International normalized ratio (INR) 1.0
Answer:

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Q25

[Multiple Response] Which types of clots are thrombolytic events? (Select all that apply.)
a. Scab
b. Thrombus
c. Embolus
d. Clotted intravenous catheter
e. Fat embolus

Essay
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Q26

[Multiple Response] The nurse prepares to administer an intramuscular injection to a patient who is on anticoagulation therapy. Which techniques does the nurse perform to prevent excessive bleeding? (Select all that apply.)
a. Using the smallest possible injection needle
b. Injecting the drug slowly, over at least a 60-second period
c. Applying pressure to the site for at least 5 minutes after the injection
d. Ensuring that the needle is placed within a previous injection puncture site
e. Cleansing the skin at the injection site for at least 30 seconds before the injection
f. Applying warm compresses to the site for at least 15 minutes after the injection

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Q27

[Multiple Response] Which actions are performed by the nurse when giving a subcutaneous injection of low-molecular weight heparin? (Select all that apply.)
a. Position the patient lying down.
b. Expel the air bubble before injection.
c. Insert the needle into a skin fold held between the thumb and forefinger.
d. Release the skin fold then inject the drug.
e. Rub the injection site to avoid bruising.

Essay
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Q28

[Multiple Response] Which factors are absolute contraindications for thrombolytic therapy? (Select all that apply.)
a. Active peptic ulcer disease
b. Active internal bleeding
c. Recent head trauma
d. Endocarditis
e. Suspected aortic aneurysm
f. Surgery within the last 10 days

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Q29

[Multiple Response] Which factors are absolute contraindications for thrombolytic therapy? (Select all that apply.)
a. Active peptic ulcer disease
b. Active internal bleeding
c. Recent head trauma
d. Endocarditis
e. Suspected aortic aneurysm
f. Surgery within the last 10 days

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Q30

A patient is prescribed 3000 units/mL of heparin subcutaneously. The drug on hand is heparin 5000 units/mL. How many milliliters does the nurse administer? _____ mL

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