Lilley Chapter 26
A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient
asks the nurse why he has to be on two medications. The nurse's response is based on which
rationale?
a.
The oral and injection forms work synergistically.
b.
The combination of heparin and an oral anticoagulant results in fewer adverse effects than
heparin used alone.
c.
Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone
is unable to do so.
d.
Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to
reach adequate levels. - ANSANS: D
This overlap therapy is required in patients who have been receiving heparin for anticoagulation
and are to be switched to warfarin so that prevention of clotting is continuous. This overlapping
is done purposefully to allow time for the blood levels of warfarin to rise, so that when the
heparin is eventually discontinued, therapeutic anticoagulation levels of warfarin will have been
achieved. Recommendations are to continue overlap therapy of the heparin and warfarin for at
least 5 days; the heparin is stopped after day 5 when the international normalized ratio (INR) is
above 2.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 417
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient is receiving thrombolytic therapy, and the nurse monitors the patient for adverse
effects. What is the most common undesirable effect of thrombolytic therapy?
a.
Dysrhythmias
b.
Nausea and vomiting
c.
Anaphylactic reactions
d.
Internal and superficial bleeding - ANSANS: D
Bleeding, both internal and superficial, as well as intracranial, is the most common undesirable
effect of thrombolytic therapy. The other options list possible adverse effects of thrombolytic
drugs, but they are not the most common effects.
, DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 424
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient who has been anticoagulated with warfarin (Coumadin) has been admitted for
gastrointestinal bleeding. The history and physical examination indicates that the patient may
have taken too much warfarin. The nurse anticipates that the patient will receive which antidote?
a.
Vitamin E
b.
Vitamin K
c.
Protamine sulfate
d.
Potassium chloride - ANSANS: B
Vitamin K is given to reverse the anticoagulation effects of warfarin toxicity. Protamine sulfate is
the antidote for heparin overdose. The other options are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 416
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
When administering heparin subcutaneously, the nurse will follow which procedure?
a.
Aspirating the syringe before injecting the medication
b.
Massaging the site after injection
c.
Applying heat to the injection site
d.
Using a - to -inch 25- to 28-gauge needle - ANSANS: D
A - to -inch 25- to 28-gauge needle is the correct needle to use for a subcutaneous heparin
injection. The other options would encourage hematoma formation at the injection site.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 429
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient has been instructed to take one enteric-coated low-dose aspirin a day as part of
therapy to prevent strokes. The nurse will provide which instruction when providing patient
teaching about this medication?
a.
Aspirin needs to be taken on an empty stomach to ensure maximal absorption.
b.
A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient
asks the nurse why he has to be on two medications. The nurse's response is based on which
rationale?
a.
The oral and injection forms work synergistically.
b.
The combination of heparin and an oral anticoagulant results in fewer adverse effects than
heparin used alone.
c.
Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone
is unable to do so.
d.
Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to
reach adequate levels. - ANSANS: D
This overlap therapy is required in patients who have been receiving heparin for anticoagulation
and are to be switched to warfarin so that prevention of clotting is continuous. This overlapping
is done purposefully to allow time for the blood levels of warfarin to rise, so that when the
heparin is eventually discontinued, therapeutic anticoagulation levels of warfarin will have been
achieved. Recommendations are to continue overlap therapy of the heparin and warfarin for at
least 5 days; the heparin is stopped after day 5 when the international normalized ratio (INR) is
above 2.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 417
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient is receiving thrombolytic therapy, and the nurse monitors the patient for adverse
effects. What is the most common undesirable effect of thrombolytic therapy?
a.
Dysrhythmias
b.
Nausea and vomiting
c.
Anaphylactic reactions
d.
Internal and superficial bleeding - ANSANS: D
Bleeding, both internal and superficial, as well as intracranial, is the most common undesirable
effect of thrombolytic therapy. The other options list possible adverse effects of thrombolytic
drugs, but they are not the most common effects.
, DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 424
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient who has been anticoagulated with warfarin (Coumadin) has been admitted for
gastrointestinal bleeding. The history and physical examination indicates that the patient may
have taken too much warfarin. The nurse anticipates that the patient will receive which antidote?
a.
Vitamin E
b.
Vitamin K
c.
Protamine sulfate
d.
Potassium chloride - ANSANS: B
Vitamin K is given to reverse the anticoagulation effects of warfarin toxicity. Protamine sulfate is
the antidote for heparin overdose. The other options are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 416
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
When administering heparin subcutaneously, the nurse will follow which procedure?
a.
Aspirating the syringe before injecting the medication
b.
Massaging the site after injection
c.
Applying heat to the injection site
d.
Using a - to -inch 25- to 28-gauge needle - ANSANS: D
A - to -inch 25- to 28-gauge needle is the correct needle to use for a subcutaneous heparin
injection. The other options would encourage hematoma formation at the injection site.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 429
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient has been instructed to take one enteric-coated low-dose aspirin a day as part of
therapy to prevent strokes. The nurse will provide which instruction when providing patient
teaching about this medication?
a.
Aspirin needs to be taken on an empty stomach to ensure maximal absorption.
b.
