NUR 3420 Exam 2 – Study Guide, Revision Notes, and Practice Questions for
Nursing Exam Preparation
Essential thrombocythemia - ANS ✔✔chronic blood disorder characterized by the
overproduction of platelets by megakaryocytes in the absence of another cause
Fibrinolysin (plasmin) - ANS ✔✔breaks down clots by dissolving the fibrin plug after the clot is
no longer needed
Hemostasis - ANS ✔✔prevention or stoppage of blood loss from an injured blood vessels & is
the process that maintains the integrity of the vascular compartment
steps of hemostasis - ANS ✔✔1. Vasoconstriction: formation of platelet plug
2. Primary Hemostasis: platelet aggregation (plugs injury)
3. Secondary Hemostasis: formation of fibrin (thrombin) coagulation
4. Thrombus & Antithrombotic events
Heparin induced thrombocytopenia - ANS ✔✔immune mediated adverse effect that leads to
thrombogenisis resulting in a decrease in platelet count associated with heparin administration
in pts with detectable HIT antibodies
Thrombogenesis - ANS ✔✔formation of a blood clot
thrombolysis - ANS ✔✔destruction of a blood clot
thrombus - ANS ✔✔blood clot
stationary clot - ANS ✔✔thrombus
,traveling clot - ANS ✔✔embolus
Arterial clot - ANS ✔✔causes ischemia (restriction in blood supply to tissues, causing a shortage
of O2 that is needed to keep cells alive) & infarction of distal tissues/cells
- associated with artherosclerotic plaque, hypertension
Mechanism of arterial thrombosis - ANS ✔✔a-fib -> clot in left atrium -> sent into arterial
circulation -> travels to brain causing a stroke
venous clot - ANS ✔✔usually found in the deep veins of the legs
- associated with venous stasis
Clot lysis (fibrinolysis) - ANS ✔✔Removal of clots.
plasminogen is bound to fibrin & becomes component of clot -> outward blood flow is stopped
& tear in blood vessel is repaired -> plasminogen is activated by plasminogen activator to
produce plasmin -> fibrinolysin (plasmin) breaks down the fibrin meshwork that stabilizes the
clot -> clot dissolved
anticoagulant - ANS ✔✔prevent formation of new clots & existing clots but to not dissolve
already formed clots.
-more effective against venous thrombosis
4 types of anticoagulants - ANS ✔✔1. Heparins
,2. Vit K antagonists
3. direct thrombin inhibitors (DIT's)
4. Direct Xa inhibitors
Heparin - ANS ✔✔enhances action of anti-thrombin III, which inactivates thrombin & activation
of factor Xa -> results in a loss of activated clotting factors necessary to form fibrin -> prevents
fibrin clots.
Indications of Heparin - ANS ✔✔prevents further clotting in thromboembolic disorders, DVT's,
PE's, A-fib, & MI
Side effects of heparin - ANS ✔✔-Hemorrhage: from inadvertent overdose or from undiagnosed
disease site
-Hematoma at site of injection
-Less common side effects: platelet aggregation, thrombocytopenia (heparin-induced
thrombocytopenia or HIT), acute hypersensitivity, alopecia, osteoporosis, priapism
Heparin antidote - ANS ✔✔protamine sulfate
Heparin Contraindications - ANS ✔✔- in pts with GI ulcers, intracranial bleeding, dissecting
aortic aneurysm, blood dyscrais, severe liver/kidney disease, severe hypertension, & recent
surgery to eye, spinal cord or brain.
-given IV or SQ: narrow therapeutic window
-monitor activated partial thromboplastin time (aPTT) normal is: 25-35 sec (can be given drip or
bolus)
, -therapeutic levels: 1.5-2 times (45-70 sec)
- platelet count is important
- HIT can happen at anytime (antidote: dabigatran or argotroban)
-heparin is often given before surgery
Low-Weight-Molecular Heparin (LWMH) - ANS ✔✔-Enoxaparin (lovanox)
-Fondaparinux
LWMH Action - ANS ✔✔inactivates factor Xa (enzyme of the liver that aids in coagulation, needs
vit K for synthesis) via antithrombin binding
LWMH indications - ANS ✔✔1. prevents further clotting in thromboembolic disorders, DVT's,
PE's, and a-fib
2. prophylaxis to prevent DTV's in pts at high risk for clots, prevention of ischemia in unstable
angina
-administer SQ - no labs needed
LWMH side effects - ANS ✔✔bleeding, thrombocytopenia
- Fondaparinux has high-alert b/c it has a high risk of drug error
LMWH antidote - ANS ✔✔Protamine
Nursing Exam Preparation
Essential thrombocythemia - ANS ✔✔chronic blood disorder characterized by the
overproduction of platelets by megakaryocytes in the absence of another cause
Fibrinolysin (plasmin) - ANS ✔✔breaks down clots by dissolving the fibrin plug after the clot is
no longer needed
Hemostasis - ANS ✔✔prevention or stoppage of blood loss from an injured blood vessels & is
the process that maintains the integrity of the vascular compartment
steps of hemostasis - ANS ✔✔1. Vasoconstriction: formation of platelet plug
2. Primary Hemostasis: platelet aggregation (plugs injury)
3. Secondary Hemostasis: formation of fibrin (thrombin) coagulation
4. Thrombus & Antithrombotic events
Heparin induced thrombocytopenia - ANS ✔✔immune mediated adverse effect that leads to
thrombogenisis resulting in a decrease in platelet count associated with heparin administration
in pts with detectable HIT antibodies
Thrombogenesis - ANS ✔✔formation of a blood clot
thrombolysis - ANS ✔✔destruction of a blood clot
thrombus - ANS ✔✔blood clot
stationary clot - ANS ✔✔thrombus
,traveling clot - ANS ✔✔embolus
Arterial clot - ANS ✔✔causes ischemia (restriction in blood supply to tissues, causing a shortage
of O2 that is needed to keep cells alive) & infarction of distal tissues/cells
- associated with artherosclerotic plaque, hypertension
Mechanism of arterial thrombosis - ANS ✔✔a-fib -> clot in left atrium -> sent into arterial
circulation -> travels to brain causing a stroke
venous clot - ANS ✔✔usually found in the deep veins of the legs
- associated with venous stasis
Clot lysis (fibrinolysis) - ANS ✔✔Removal of clots.
plasminogen is bound to fibrin & becomes component of clot -> outward blood flow is stopped
& tear in blood vessel is repaired -> plasminogen is activated by plasminogen activator to
produce plasmin -> fibrinolysin (plasmin) breaks down the fibrin meshwork that stabilizes the
clot -> clot dissolved
anticoagulant - ANS ✔✔prevent formation of new clots & existing clots but to not dissolve
already formed clots.
-more effective against venous thrombosis
4 types of anticoagulants - ANS ✔✔1. Heparins
,2. Vit K antagonists
3. direct thrombin inhibitors (DIT's)
4. Direct Xa inhibitors
Heparin - ANS ✔✔enhances action of anti-thrombin III, which inactivates thrombin & activation
of factor Xa -> results in a loss of activated clotting factors necessary to form fibrin -> prevents
fibrin clots.
Indications of Heparin - ANS ✔✔prevents further clotting in thromboembolic disorders, DVT's,
PE's, A-fib, & MI
Side effects of heparin - ANS ✔✔-Hemorrhage: from inadvertent overdose or from undiagnosed
disease site
-Hematoma at site of injection
-Less common side effects: platelet aggregation, thrombocytopenia (heparin-induced
thrombocytopenia or HIT), acute hypersensitivity, alopecia, osteoporosis, priapism
Heparin antidote - ANS ✔✔protamine sulfate
Heparin Contraindications - ANS ✔✔- in pts with GI ulcers, intracranial bleeding, dissecting
aortic aneurysm, blood dyscrais, severe liver/kidney disease, severe hypertension, & recent
surgery to eye, spinal cord or brain.
-given IV or SQ: narrow therapeutic window
-monitor activated partial thromboplastin time (aPTT) normal is: 25-35 sec (can be given drip or
bolus)
, -therapeutic levels: 1.5-2 times (45-70 sec)
- platelet count is important
- HIT can happen at anytime (antidote: dabigatran or argotroban)
-heparin is often given before surgery
Low-Weight-Molecular Heparin (LWMH) - ANS ✔✔-Enoxaparin (lovanox)
-Fondaparinux
LWMH Action - ANS ✔✔inactivates factor Xa (enzyme of the liver that aids in coagulation, needs
vit K for synthesis) via antithrombin binding
LWMH indications - ANS ✔✔1. prevents further clotting in thromboembolic disorders, DVT's,
PE's, and a-fib
2. prophylaxis to prevent DTV's in pts at high risk for clots, prevention of ischemia in unstable
angina
-administer SQ - no labs needed
LWMH side effects - ANS ✔✔bleeding, thrombocytopenia
- Fondaparinux has high-alert b/c it has a high risk of drug error
LMWH antidote - ANS ✔✔Protamine
