Chapter 45: Anticoagulants, Antiplatelets, and Thrombolytics Nursing School Test Banks

Kee: Pharmacology, 7th Edition

Chapter 45: Anticoagulants, Antiplatelets, and Thrombolytics

Test Bank

MULTIPLE CHOICE

1. The client who is most likely to be ordered lowmolecular-weight heparin would be the client who is considered to be at high risk to develop:

a.

venous thrombosis.

b.

arterial embolism.

c.

thrombocytopenia.

d.

leukopenia.

ANS: A

These heparin-like medications prevent clot formation.

DIF: Cognitive Level: Application REF: pp. 671-672

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A client is to receive a heparin injection. The highest priority nursing intervention before administration of the medication is to check the:

a.

PT and INR.

b.

PTT and APTT.

c.

CBC.

d.

platelet count.

ANS: B

PTT and APTT are the blood tests that assess bleeding times.

DIF: Cognitive Level: Application REF: pp. 671-672

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

3. In planning care for a client receiving heparin, the nurse is aware that the dose is administered subcutaneously. What is the reason for using this route?

a.

Heparin is absorbed readily by the gastrointestinal mucosa and protected by the liver.

b.

Heparin is poorly absorbed by the gastrointestinal mucosa and destroyed by liver enzymes.

c.

The effective absorption of heparin can be hampered by food.

d.

The effective absorption of heparin is hampered by the stomachs inadequate blood flow.

ANS: B

Subcutaneous administration of heparin prevents poor absorption and eliminates destruction of heparin by the liver.

DIF: Cognitive Level: Application REF: pp. 671-672

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A client is being treated with warfarin (Coumadin). The highest priority nursing intervention before administration of the medication is to check the:

a.

PTT and APTT.

b.

PT and INR.

c.

most current CBC.

d.

most current platelet count.

ANS: B

PT and INR are the tests monitored with warfarin.

DIF: Cognitive Level: Application REF: pp. 672, 674

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A client receiving warfarin (Coumadin) is noted to have significant bleeding from the gums while on therapy. The physician orders an antidote. If excess bleeding occurs because of warfarin accumulation in the body, what is the antidote?

a.

Vitamin K

b.

Vitamin E

c.

Naloxone (Narcan)

d.

Protamine sulfate

ANS: A

Vitamin K is the antidote for warfarin.

DIF: Cognitive Level: Application REF: pp. 672, 674

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

6. Which statement made by a client receiving (warfarin) Coumadin therapy indicates a need for further teaching?

a.

I shouldnt take aspirin while Im on Coumadin.

b.

I will use a toothbrush with soft bristles.

c.

I will eat large quantities of green leafy vegetables.

d.

I will use an electric razor to avoid shaving cuts.

ANS: C

Vitamin K is an antagonist against warfarin, and green leafy vegetables are known sources of vitamin K.

DIF: Cognitive Level: Application REF: p. 677

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

7. The client has been ordered treatment with warfarin. She tells the nurse that she self-medicates with herbal remedies as much as possible. The highest priority teaching point that the nurse should give the client is the avoid the use of _____ while taking warfarin.

a.

ephedra and dill

b.

black cohosh and licorice

c.

garlic and ginkgo

d.

ginseng and green tea

ANS: C

Garlic and ginkgo interfere with the formation of platelet aggregations.

DIF: Cognitive Level: Application REF: p. 677

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Safety and Infection Control: Complementary and Alternative

8. The client has received an overdose of a thrombolytic drug. The nurse anticipates that he will be treated with:

a.

naloxone (Narcan).

b.

protamine sulfate.

c.

vitamin E.

d.

aminocaproic acid (Amicar).

ANS: D

Aminocaproic acid (Amicar) is the drug to have on hand in the event of hemorrhage as a result of thrombolytic drugs.

DIF: Cognitive Level: Comprehension REF: p. 681

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A new nurse is listing the interventions he should employ when caring for a client on thrombolytic therapy. Which nursing intervention is inappropriate for the client during thrombolytic therapy?

a.

Monitor vital signs and reporting changes.

b.

Check for active bleeding for 24 hours after therapy.

c.

Inform the client that aspirin and NSAIDs may be taken for discomfort.

d.

Monitor electrocardiogram strips for cardiac dysrhythmias.

ANS: C

Aspirin or NSAIDs would increase the bleeding time further. ECGs may be done to assess for changes to the myocardial muscle.

DIF: Cognitive Level: Application REF: p. 681

TOP: Nursing Process: Intervention

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A client receiving clopidogrel (Plavix) has the following conditions as part of the health history. Which causes the greatest concern to the nurse?

a.

Asthma

b.

Glaucoma

c.

Allergy to shellfish

d.

Active peptic ulcer

ANS: D

An active peptic ulcer may bleed subsequent to use of this medication.

DIF: Cognitive Level: Analysis REF: p. 679

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The client is being treated with Plavix. He complains to the nurse of experiencing chest pain. The highest priority nursing intervention is to call the physician because the client is experiencing a(n):

a.

adverse reaction to the medication.

b.

myocardial infarction.

c.

expected side effect of the medication.

d.

anaphylactic reaction to the medication.

ANS: C

Chest pain is an expected side effect of treatment with Plavix.

DIF: Cognitive Level: Application REF: p. 679

TOP: Nursing Process: Intervention

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

12. The client is being treated with heparin and also with nitroglycerin. The nurse anticipates that the interaction of the two drugs will produce which effect?

a.

Inadequate effect from the nitroglycerin

b.

Decreased effect from the heparin

c.

Toxic dose of the nitroglycerin

d.

Increased effect from the heparin

ANS: B

The interaction of heparin with nitroglycerin will most likely produce a decreased effect from the heparin.

DIF: Cognitive Level: Application REF: p. 675

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

13. The client is being treated with warfarin sodium as well as a diuretic. The nurse anticipates that the interaction of the two drugs will produce a(n) _____ effect from the _____.

a.

increased; warfarin sodium

b.

decreased; warfarin sodium

c.

increased; diuretic

d.

decreased; diuretic

ANS: A

The interaction of warfarin sodium and a diuretic will produce an increased effect from the warfarin sodium.

DIF: Cognitive Level: Application REF: p. 675

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

14. The client is being treated with warfarin sodium. She complains to the nurse of soreness in her mouth. The highest priority nursing intervention is to call the physician because the client is _____ the medication.

a.

beginning to hemorrhage from

b.

developing a clot from

c.

experiencing an expected side effect of

d.

experiencing an adverse reaction to

ANS: D

Mouth soreness would be indicative of stomatitis, an adverse reaction to the medication.

DIF: Cognitive Level: Application REF: p. 675

TOP: Nursing Process: Intervention

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

 

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