Chapter 36: Anticoagulant and Thrombolytic Drugs Introductory Clinical Pharmacology 12th Edition by Susan M Ford

Introductory Clinical Pharmacology 12th Edition by Susan M Ford 1. The nurse is preparing to administer protamine emergently to a client per instructions from the health care provider. The nurse concludes this is necessary due to an adverse reaction to which drug? a. Clopidogrel b. Heparin c. Alteplase d. Warfarin Answer: B Rationale: An overdosage of any anticoagulant may result in uncontrolled bleeding in the client. In most cases, discontinuation of the drug is usually sufficient to correct overdosage; however, if the bleeding is severe there are antidotes. Protamine is used to treat overdose of heparin and low– molecular-weight heparins (LMWHs). Vitamin K is used to treat the overdosage of warfarin. Alteplase and clopidogrel do not require antidotes. Question format: Multiple Choice Chapter: 36 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 468, Parenteral Anticoagulants 2. A nurse is conducting a seminar on thrombosis. The nurse should point out that arterial thrombus can occur related to which situation? a. Decreased blood flow b. Injury to the vessel wall c. Arrhythmias d. Altered blood coagulation Answer: C Rationale: The nurse should mention that arterial thrombosis is caused by atherosclerosis and arrhythmias. Decreased blood flow, injury to the vessel wall, and altered blood flow are causes of venous thrombosis. Question format: Multiple Choice Chapter: 36 Learning Objective: 1 Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Reference: p. 3, Introduction 3. A client with intermittent claudication is prescribed cilostazol by the primary health care provider. The nurse will administer this drug cautiously if the client's history reveals which disorder? a. Intermittent claudication b. Pulmonary emboli c. Myocardial infarction d. Pancytopenia Answer: D Rationale: The nurse should administer cilostazol with caution to clients with pancytopenia. Anticoagulants are used for the prevention and treatment of pulmonary emboli, the adjuvant treatment of myocardial infarction, and the treatment of intermittent claudication. Question format: Multiple Choice Chapter: 36 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 462, Actions and Uses 4. A client is prescribed warfarin. The client also takes a diuretic for the treatment of cardiac problems. The nurse will monitor the client for which potential interaction? a. Decreased effectiveness of the anticoagulant b. Increased effectiveness of the diuretic c. Increased absorption of the anticoagulant d. Increased absorption of the diuretic Answer: A Rationale: The nurse should monitor for decreased effectiveness of warfarin as an effect of the interaction between the anticoagulant and the diuretic. The nurse need not monitor for the increased effectiveness of the diuretic, the increased absorption of the anticoagulant, or the increased absorption of the diuretic in the client. Question format: Multiple Choice Chapter: 36 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 461, Precautions 5. The nurse is monitoring a client who is receiving heparin by continuous IV infusion. Which action should the nurse prioritize? a. Perform a complete blood count. b. Perform baseline PT/INR. c. Perform aPTT test 4–6 hours after injection. d. Perform blood coagulation tests every 4 hours. Answer: D Rationale: The nurse should perform blood coagulation tests every 4 hours for the client receiving heparin by continuous IV infusion. A blood count test or the baseline PT/INR test is not the right intervention for this client. When administering heparin by the subcutaneous route, an aPTT test is performed 4–6 hours after the injection. Question format: Multiple Choice Chapter: 36 Learning Objective: 3 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 464, Ongoing Assessment 6. A nurse is preparing to administer the first dose of warfarin to a client. Which assessment should the nurse prioritize for this client?