Chapter 51: Anticoagulant, Antiplatelet, and Thrombolytic Drugs

Chapter 51: Anticoagulant, Antiplatelet, and Thrombolytic Drugs

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

1. A patient is being discharged to his home on enoxaparin (Lovenox) injections for treatment of deep vein thrombosis (DVT). Which of the following statements made by the patient indicates a need for further discharge teaching by the nurse?

ANS:   C

The half-life of a low-molecular-weight (LMW) heparin, such as enoxaparin, is up to six times longer than that of unfractionated heparin. Less binding to macrophages and slower clearance by the liver are also factors. Because of enoxaparin’s increased bioavailability, the plasma levels of the drug are highly predictable. As a result, it can be given on a fixed schedule with no need for routine monitoring of coagulation.

Enoxaparin is administered subcutaneously (into fatty tissue), and the abdomen is a correct injection site.

LMW heparins, such as enoxaparin, are available only for subcutaneous injection.

Bleeding is the major adverse effect and should be reported if it does not cease.

DIF:    Cognitive Level: Application             REF:    pp. 601-602

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

2. Which of the following INR results warrants a call to the prescriber by the nurse for adjustment of the daily warfarin (Coumadin) dosage?

ANS:   A

An INR of 2 to 3 is appropriate for patients with DVT. Because the INR is below the recommended range, the warfarin dosage should be increased, and the nurse must obtain an order from the prescriber.

The recommended range for the INR of a patient with atrial fibrillation is 2 to 3; no action is needed.

The recommended range for the INR of a patient with a pulmonary embolism is 2 to 3; no action is needed.

The recommended range for the INR of a patient with a mechanical heart valve is 3 to 4.5; no action is needed.

DIF:    Cognitive Level: Application             REF:    p. 605

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A patient is 2 days postoperative for a hip replacement, and her mobility is limited. The patient complains of pleuritic chest pain, shortness of breath, and hemoptysis, and her oxygen saturation level is 82% to 84%. The nurse should anticipate administration of ___________, for the signs and symptoms of ____________.

ANS:   A

The scenario describes the signs and symptoms of pulmonary emboli, as well as the patient’s risk factors for pulmonary embolism. Heparin is the preferred anticoagulant because of its rapid onset of action.

Furosemide would not be indicated in this situation, because the patient is not experiencing signs or symptoms of right-sided heart failure.

Hydrochlorothiazide would not be indicated in this situation. Although shortness of breath and decreased oxygen saturations are consistent with pulmonary edema, the patient typically produces excessive amounts of frothy sputum.

Although the patient is experiencing chest pain, the presentation of the pain is inconsistent with that of myocardial infarction, therefore tPA is not indicated. Although tPA can also be administered in pulmonary embolism, the patient’s recent surgery prevents this.

DIF:    Cognitive Level: Analysis                  REF:    p. 598

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies and Physiological Adaptation