Chapter 26: Coagulation Modifier Drugs

Chapter 26: Coagulation Modifier Drugs

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient asks the nurse why he has to be on two medications. The nurse’s response is based on which rationale?

a.	The oral and injection forms work synergistically.
b.	The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used alone.
c.	Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone is unable to do so.
d.	Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.

 

 

ANS:  D

This overlap therapy is required in patients who have been receiving heparin for anticoagulation and are to be switched to warfarin so that prevention of clotting is continuous. This overlapping is done purposefully to allow time for the blood levels of warfarin to rise, so that when the heparin is eventually discontinued, therapeutic anticoagulation levels of warfarin will have been achieved. Recommendations are to continue overlap therapy of the heparin and warfarin for at least 5 days; the heparin is stopped after day 5 when the international normalized ratio (INR) is above 2.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                  REF:   p. 417

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

2. A patient is receiving thrombolytic therapy, and the nurse monitors the patient for adverse effects. What is the most common undesirable effect of thrombolytic therapy?

a.	Dysrhythmias
b.	Nausea and vomiting
c.	Anaphylactic reactions
d.	Internal and superficial bleeding

 

 

ANS:  D

Bleeding, both internal and superficial, as well as intracranial, is the most common undesirable effect of thrombolytic therapy. The other options list possible adverse effects of thrombolytic drugs, but they are not the most common effects.

 

DIF:    COGNITIVE LEVEL: Remembering (Knowledge)           REF:   p. 424

TOP:   NURSING PROCESS: Evaluation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

3. A patient who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the patient may have taken too much warfarin. The nurse anticipates that the patient will receive which antidote?

a.	Vitamin E
b.	Vitamin K
c.	Protamine sulfate
d.	Potassium chloride

 

 

ANS:  B

Vitamin K is given to reverse the anticoagulation effects of warfarin toxicity. Protamine sulfate is the antidote for heparin overdose. The other options are incorrect.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension)    REF:   p. 416

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

4. When administering heparin subcutaneously, the nurse will follow which procedure?

a.	Aspirating the syringe before injecting the medication
b.	Massaging the site after injection
c.	Applying heat to the injection site
d.	Using a – to -inch 25- to 28-gauge needle

 

 

ANS:  D

A – to -inch 25- to 28-gauge needle is the correct needle to use for a subcutaneous heparin injection. The other options would encourage hematoma formation at the injection site.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                  REF:   p. 429

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies