NURS 5463 TEST 5 EXAM SCRIPT TESTED
QUESTIONS WITH CORRECT ANSWERS
PRACTICE SOLUTION GRADED A+
⩥ Magnetic Resonance Venography.
Answer: - Expensive and not widely available
- Uses gadolinium, contraindicated in GFR < 30
⩥ PE Clinical Manifestations.
Answer: Chest pain, shortness of breath, palpitations, hemoptysis,
syncope, tachycardia, tachypnea, large S wave in lead I, Q wave in lead
III, inverted T wave in lead III (EKG changes only occur in maybe 20%
of cases)
⩥ Diagnostic Tests for PE.
Answer: Pulmonary angiogram, CTA PE, V/Q scan
⩥ Absolute Contraindications to Anticoagulation.
Answer: - active bleeding, severe bleeding diathesis, platelets < 50,000,
recent high bleeding-risk surgery/procedure, major trauma, history of
intracranial hemorrhage,
⩥ Causes of Prolonged PT/INR.
,Answer: - Vitamin K deficiency: poor nutrition, prolonged antibiotic use
- Liver dysfunction: decrease synthesis of clotting factors
- Deficiency of factors II, V, VII, X, or fibrinogen
- Use of warfarin
⩥ PT/INR, aPTT Normal Values.
Answer: PT: 8.3 - 10.8 seconds
INR: 0.9 - 1.2
aPTT: 21 - 33 seconds
⩥ Thrombin Time.
Answer: - Measures the conversion of fibrinogen to fibrin
- Normal value: 14 - 16 seconds
- Prolonged by: Disorders of fibrinogen, presence of heparin, presence
of direct thrombin inhibitors, presence of fibrin degradation products
⩥ Wells Criteria for PE.
Answer: Not to be confused with Wells criteria for DVT
Clinical prediction rule to help determine the probability of a PE
*Score:
Low Probability: < 2 points (3.4%)
, Moderate Probability: 2-6 points (27.8%)
High probability: > 6 points (78.4%)*
⩥ Systemic Heparin Therapy.
Answer: Used in the hospital as parenteral infusion
- 80 units/kg initial IV bolus then 18units/kg/hr infusion
- Titrate for aPTT 1.5-2.5 times normal (aPTT 60-85 seconds)
- Check aPTT prior to infusion, 6 hours after starting infusion, & 6 hours
after any dose change
- Reversal: protamine sulfate
- Risk for HIT; Monitor platelets at baseline, daily to every other day
- Ok to use in renal failure
- Do not use if platelets < 50,000
⩥ Systemic Enoxaparin Therapy.
Answer: - 1mg/kg subcutaneous injection
- No reversal agent, protamine may help
- Moderate risk for HIT; Do not use if platelets < 50,000
- Contraindicated in creat clearance <30ml/minute
⩥ Systemic Fondaparinux Therapy.
Answer: - Weight based 5-10 mg subcutaneous injection
QUESTIONS WITH CORRECT ANSWERS
PRACTICE SOLUTION GRADED A+
⩥ Magnetic Resonance Venography.
Answer: - Expensive and not widely available
- Uses gadolinium, contraindicated in GFR < 30
⩥ PE Clinical Manifestations.
Answer: Chest pain, shortness of breath, palpitations, hemoptysis,
syncope, tachycardia, tachypnea, large S wave in lead I, Q wave in lead
III, inverted T wave in lead III (EKG changes only occur in maybe 20%
of cases)
⩥ Diagnostic Tests for PE.
Answer: Pulmonary angiogram, CTA PE, V/Q scan
⩥ Absolute Contraindications to Anticoagulation.
Answer: - active bleeding, severe bleeding diathesis, platelets < 50,000,
recent high bleeding-risk surgery/procedure, major trauma, history of
intracranial hemorrhage,
⩥ Causes of Prolonged PT/INR.
,Answer: - Vitamin K deficiency: poor nutrition, prolonged antibiotic use
- Liver dysfunction: decrease synthesis of clotting factors
- Deficiency of factors II, V, VII, X, or fibrinogen
- Use of warfarin
⩥ PT/INR, aPTT Normal Values.
Answer: PT: 8.3 - 10.8 seconds
INR: 0.9 - 1.2
aPTT: 21 - 33 seconds
⩥ Thrombin Time.
Answer: - Measures the conversion of fibrinogen to fibrin
- Normal value: 14 - 16 seconds
- Prolonged by: Disorders of fibrinogen, presence of heparin, presence
of direct thrombin inhibitors, presence of fibrin degradation products
⩥ Wells Criteria for PE.
Answer: Not to be confused with Wells criteria for DVT
Clinical prediction rule to help determine the probability of a PE
*Score:
Low Probability: < 2 points (3.4%)
, Moderate Probability: 2-6 points (27.8%)
High probability: > 6 points (78.4%)*
⩥ Systemic Heparin Therapy.
Answer: Used in the hospital as parenteral infusion
- 80 units/kg initial IV bolus then 18units/kg/hr infusion
- Titrate for aPTT 1.5-2.5 times normal (aPTT 60-85 seconds)
- Check aPTT prior to infusion, 6 hours after starting infusion, & 6 hours
after any dose change
- Reversal: protamine sulfate
- Risk for HIT; Monitor platelets at baseline, daily to every other day
- Ok to use in renal failure
- Do not use if platelets < 50,000
⩥ Systemic Enoxaparin Therapy.
Answer: - 1mg/kg subcutaneous injection
- No reversal agent, protamine may help
- Moderate risk for HIT; Do not use if platelets < 50,000
- Contraindicated in creat clearance <30ml/minute
⩥ Systemic Fondaparinux Therapy.
Answer: - Weight based 5-10 mg subcutaneous injection
