betes type 1, and portal hypertension. He develops a DVT, and the physician prescribes warfarin. The nurse is concerned, for what reason? You selected: The client is more likely to experience bleeding. Correct Explanation: Warfarin is more likely to cause bleeding in clients with liver disease because of decreased synthesis of vitamin K. In addition, warfarin is eliminated only by hepatic metabo ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 111. Question 2: (see full question) Bleeding resulting from the administration of heparin is treated with which of the following substances? You selected: Protamine sulfate Correct Explanation: Protamine sulfate is the antidote for standard heparin. Options A, B, and D are incorrect. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 109. Question 3: (see full question) A hospital patient in a critical care setting is currently receiving an intravenous infusion of aminocaproic acid. What desired outcome is paramount in the care of this patient? You selected: Adequate tissue perfusion will be maintained Correct Explanation: Aminocaproic acid treats severe, life-threatening hemorrhage. As such, the goal of treatment is to preserve tissue perfusion and oxygenation. The goal of treatment is to prevent fi ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 123. Question 4: (see full question) After teaching a group of students about antiplatelet agents, the instructor determines that the teaching was successful when the students identify which drug as blocking the production of platelets in the bone marrow? You selected: Cilostazol Incorrect Correct response: Anagrelide Explanation: Anagrelide blocks the production of platelets in the bone marrow. Cilostazol inhibits platelet aggregation and adhesion by blocking receptor sites on the platelet membrane preventi ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 116. Question 5: (see full question) A patient receiving heparin has a baseline aPTT of 28 seconds. Which result would the nurse interpret as suggesting too much heparin? You selected: 98 seconds Correct Explanation: Therapeutic range for heparin would be 1.5 to 2.5 times the patient's baseline. For a baseline value of 28 seconds, this would range from 42 to 70 seconds. A value of 98 seconds, w ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 109. Question 6: (see full question) When should the nurse administer a 300 mg dose of clopidogrel (Plavix) to a patient, instead of the 75 mg dose? (Choose one) You selected: Loading dose Correct Explanation: Clopidogrel (Plavix) 300 mg should only be administered as a single loading dose. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 115. Question 7: (see full question) A nurse is caring for a patient prescribed warfarin. Which of the following foods should the nurse inform the patient as having high vitamin K content? You selected: Green leafy vegetables Correct Explanation: The nurse should inform the patient that green leafy vegetables are high in vitamin K. Increased amounts of vitamin K could decrease the PT/INR and increase the risk of clot formati ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 112. Question 8: (see full question) The client is prescribed warfarin. His INR is 5.2. At what level is this dose? You selected: Elevated Correct Explanation: Warfarin dosage is regulated according to the INR (derived from the prothrombin [PT] time), for which a therapeutic value is between 2.0 to 3.0 in most conditions. A therapeut ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 112. Question 9: (see full question) Your newest admit to your cardiac-monitored floor is being readied for cardiac catheterization. After you obtain a complete history and complete your nursing assessment, you notify the cardiac surgeon of your patient's contraindication to abciximab administration. What are the contraindications to percutaneous transluminal coronary angioplasty? Select all that apply. You selected: ¥ Major trauma within last 6 weeks Incorrect Correct response: ¥ Uncontrolled hypertension ¥ Major trauma within last 6 weeks Explanation: Contraindications for abciximab administration include major trauma within the previous 6 weeks and uncontrolled hypertension. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 119. Question 10: (see full question) A patient with thrombotic stroke is administered ticlopidine. What adverse reaction should the nurse monitor for in the patient? You selected: Hematoma Incorrect Correct response: Dyspepsia Explanation: The nurse should monitor for dyspepsia in the patient who has been administered ticlopidine. Hematoma is the adverse reaction to heparin. Dyspnea is an adverse reaction to protamin ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 118. Question 11: (see full question) Ms. Adams is started on warfarin therapy. The patient asks you why she is not on heparin therapy any longer. What differentiates heparin from warfarin? You selected: Heparin is administered parenterally, while warfarin is administered orally. Correct Explanation: Heparin is administered parenterally, while warfarin is administered orally. Warfarin is administered after heparin therapy to complete treating a thrombus or embolism. Patients re ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 111. Question 12: (see full question) When administering tirofiban, the nurse would administer the drug intravenously over which time frame? You selected: 30 minutes Correct Explanation: Tirofiban is administered intravenously over 30 minutes. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 116. Question 13: (see full question) The nurse would monitor the platelet levels closely for a client receiving which of the following? You selected: Anagrelide Correct Explanation: Anagrelide decreases the production of platelets in the bone marrow, necessitating close monitoring of platelet levels for thrombocytopenia. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 119. Question 14: (see full question) A nurse is caring for a patient undergoing warfarin therapy for the treatment of venous thrombosis. What symptom of warfarin overdose should the nurse be aware of? You selected: Melena Correct Explanation: Symptoms of warfarin overdosage include melena (blood in the stool); petechiae (pinpoint-sized red hemorrhagic spots on the skin); oozing from superficial injuries, such as cuts fr ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 111. Question 15: (see full question) Which of the following herbal products should not be used during warfarin therapy? (Select all that apply) You selected: ¥ Gingko biloba ¥ Garlic ¥ Ginseng ¥ Green tea Incorrect Correct response: ¥ Garlic ¥ Ginger ¥ Gingko biloba ¥ Ginseng ¥ Green tea Explanation: All of the herbal products listed should not be used during warfarin therapy because they can increase the risk of bleeding. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 112. Question 16: (see full question) A nurse would anticipate the need for an increased dosage of warfarin if the patient was also receiving which of the following? You selected: Clofibrate Incorrect Correct response: Carbamazepine Explanation: Carbamazepine decreases the anticoagulant effects of warfarin necessitating an increased dose of warfarin. Clofibrate increases the bleeding effects of warfarin necessitating a dec ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 111. Question 17: (see full question) Regular use of antiplatelet medications can contribute to increased risk of bleeding. Your patient, a 79-year-old woman, is admitted to the hospital with black, tarry stools and several large, scattered ecchymosis. She has a history of TIAs and has taken clopidogrel for several years. What would you expect the physician to prescribe to control her bleeding? You selected: Protamine sulfate Incorrect Correct response: None of these Explanation: Clopidogrel irreversibly blocks the (ADP) receptor on platelet cell membranes. This effectively prevents platelet aggregation for the lifespan of the platelet. Platelet transfusion ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 114. Question 18: (see full question) Which of the following should the nurse educate the client and family about prior to discharge on warfarin (Coumadin)? Select all that apply: You selected: ¥ Take the drug at the same time every evening. ¥ Do not change brands of warfarin without consulting the physician. ¥ Do not take or stop taking other medication except on the advice of the physician. ¥ Inform the dentist of therapy with warfarin prior to any treatment or procedure. Incorrect Correct response: ¥ Consistent vitamin K intake is important. ¥ Do not change brands of warfarin without consulting the physician. ¥ Take the drug at the same time every evening. ¥ Do not take or stop taking other medication except on the advice of the physician. ¥ Inform the dentist of therapy with warfarin prior to any treatment or procedure. Explanation: All of the above are things a nurse should educate the client and family about warfarin before discharge. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, pp. 110-112. Question 19: (see full question) Warfarin typically takes 3 days to achieve its onset of action. You selected: True Correct Explanation: Warfarin's onset of action is about 3 days; its effects last for 4 to 5 days. Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 110. Question 20: (see full question) Heparin is the anticoagulant of choice during lactation. You selected: True Correct Explanation: Although some adverse fetal affects have been reported with its use during pregnancy, heparin does not enter breast milk, and so it is the anticoagulant of choice if one is needed ... (more) Reference: Frandsen, G., & Pennington, S.S. Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 7: Drug Therapy for Coagulation Disorders, p. 106.