Chapter 52: Anticoagulant, Antiplatelet, and Thrombolytic Drugs

Chapter 52: Anticoagulant, Antiplatelet, and Thrombolytic Drugs

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A nursing student who is preparing to care for a postoperative patient with deep vein thrombosis asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct?

a.	“Heparin has a longer half-life.”
b.	“Heparin has fewer adverse effects.”
c.	“The onset of warfarin is delayed.”
d.	“Warfarin prevents platelet aggregation.”

 

 

ANS:  C

Warfarin is not useful for treating existing thromboses or for emergencies because the onset of action is delayed. Heparin has a shorter half-life and has more side effects. Warfarin does not prevent platelet aggregation.

 

PTS:   1                    DIF:    Cognitive Level: Analysis                REF:   p. 599 | p. 604

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

2. A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats per minute. The patient’s most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The nurse will request an order for:

a.	a repeat aPTT to be drawn immediately.
b.	analgesic medication.
c.	changing heparin to aspirin.
d.	protamine sulfate.

 

 

ANS:  D

Heparin overdose may cause hemorrhage, which can be characterized by low blood pressure, tachycardia, and lumbar pain. Protamine sulfate should be given, and the heparin should be discontinued. An aPTT may be drawn later to monitor the effectiveness of protamine sulfate. Analgesics are not indicated because the lumbar pain is likely caused by adrenal hemorrhage. Aspirin will only increase the risk of hemorrhage.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 601 | p. 621

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

3. A patient has been receiving heparin while in the hospital to treat deep vein thromboses and will be discharged home with a prescription for enoxaparin [Lovenox]. The nurse provides teaching for the nursing student who asks about the advantages of enoxaparin over heparin. Which statement by the student indicates a need for further teaching?

a.	“Enoxaparin does not require coagulation monitoring.”
b.	“Enoxaparin has greater bioavailability than heparin.”
c.	“Enoxaparin is more cost-effective than heparin.”
d.	“Enoxaparin may be given using a fixed dosage.”

 

 

ANS:  C

Low-molecular-weight (LMW) heparins have higher bioavailability and longer half-lives, so routine coagulation monitoring is not necessary and fixed dosing is possible. LMW heparins are more expensive, however, so this statement indicates a need for further teaching.

 

PTS:   1                    DIF:    Cognitive Level: Analysis                REF:   p. 602

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

4. A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the patient’s INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider and:

a.	administer the dose as ordered.
b.	request an order to decrease the dose.
c.	request an order to give vitamin K (phytonadione).
d.	request an order to increase the dose.

 

 

ANS:  A

This patient has an INR in the appropriate range, which is 2 to 3 for most patients and 2.5 to 3.5 for some, so no change in warfarin dosing is necessary. It is not correct to request an order to either decrease or increase the dose of warfarin. It is not necessary to give vitamin K, which is an antidote for warfarin toxicity.

 

PTS:   1                    DIF:    Cognitive Level: Analysis                REF:   pp. 604-605

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies