NSG 210 CLOTTING EXAM TEST
BANK QUESTIONS WITH
CORRECT DETAILED ANSWERS
A 73-year-old patient with chronic atrial fibrillation develops sudden severe pain,
pulselessness, pallor, and coolness in the right leg. The nurse should notify the health
care provider and immediately
a. apply a compression stocking to the leg.
b. elevate the leg above the level of the heart.
c. assist the patient in gently exercising the leg.
d. keep the patient in bed in the supine position. - Answer-ANS: D
The patient's history and clinical manifestations are consistent with acute arterial
occlusion, and resting the leg will decrease the oxygen demand of the tissues and
minimize ischemic damage until circulation can be restored. Elevating the leg or
applying an elastic wrap will further compromise blood flow to the leg. Exercise will
increase oxygen demand for the tissues of the leg.
A patient at the clinic says, "I have always taken a walk after dinner, but lately my leg
cramps and hurts after just a few minutes of starting. The pain goes away after I stop
walking, though." The nurse should
a. check for the presence of tortuous veins bilaterally on the legs.
b. ask about any skin color changes that occur in response to cold.
c. assess for unilateral swelling, redness, and tenderness of either leg.
d. assess for the presence of the dorsalis pedis and posterior tibial pulses. - Answer-
ANS: D
The nurse should assess for other clinical manifestations of peripheral arterial disease
in a patient who describes intermittent claudication. Changes in skin color that occur in
response to cold are consistent with Raynaud's phenomenon. Tortuous veins on the
legs suggest venous insufficiency. Unilateral leg swelling, redness, and tenderness
indicate venous thromboembolism (VTE).
The health care provider has prescribed bed rest with the feet elevated for a patient
admitted to the hospital with venous thromboembolism. Which action by the nurse to
elevate the patient's feet is best?
a. The patient is placed in the Trendelenburg position.
b. Two pillows are positioned under the affected leg.
c. The bed is elevated at the knee and pillows are placed under the feet.
d. One pillow is placed under the thighs and two pillows are placed under the lower
legs. - Answer-ANS: D
The purpose of elevating the feet is to enhance venous flow from the feet to the right
atrium, which is best accomplished by placing two pillows under the feet and one under
,the thighs. Placing the patient in the Trendelenburg position will lower the head below
heart level, which is not indicated for this patient. Placing pillows under the calf or
elevating the bed at the knee may cause blood stasis at the calf level.
The health care provider prescribes an infusion of heparin (Hep-Lock) and daily partial
thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE).
The nurse will plan to
a. decrease the infusion when the PTT value is 65 seconds.
b. avoid giving any IM medications to prevent localized bleeding.
c. monitor posterior tibial and dorsalis pedis pulses with the Doppler.
d. have vitamin K available in case reversal of the heparin is needed. - Answer-ANS: B
IM injections are avoided in patients receiving anticoagulation. A PTT of 65 seconds is
within the therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality is not
affected by VTE.
A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox)
and warfarin (Coumadin). The patient asks the nurse why two medications are
necessary. Which response by the nurse is most appropriate?
a. "Taking two blood thinners reduces the risk for another clot to form."
b. "Lovenox will start to dissolve the clot, and Coumadin will prevent any more clots
from forming."
c. "Lovenox will work right away, but Coumadin takes several days to have an effect on
preventing clots."
d. "Because of the risk for a blood clot in the lungs, it is important for you to take more
than one blood thinner." - Answer-ANS: C
Low molecular weight heparin (LMWH) is used because of the immediate effect on
coagulation and discontinued once the international normalized ratio (INR) value
indicates that the warfarin has reached a therapeutic level. LMWH has no thrombolytic
properties. The use of two anticoagulants is not related to the risk for pulmonary
embolism, and two are not necessary to reduce the risk for another VTE. Furthermore,
anticoagulants should not be described as blood thinners.
The nurse has started discharge teaching for a patient who is to continue warfarin
(Coumadin) following hospitalization for venous thromboembolism (VTE). The nurse
determines that additional teaching is needed when the patient says which of the
following?
a. "I should get a Medic Alert device stating that I take Coumadin."
b. "I should reduce the amount of green, leafy vegetables that I eat."
c. "I will need routine blood tests to monitor the effects of the Coumadin."
d. "I will check with my health care provider before I begin any new medications." -
Answer-ANS: B
Patients taking warfarin are taught to follow a consistent diet with regard to foods that
are high in vitamin K, such as green, leafy vegetables. The other patient statements are
accurate.
, A 46-year-old service-counter worker undergoes sclerotherapy for treatment of
superficial varicose veins at an outpatient center. Which instructions should the nurse
provide to the patient before discharge?
a. Sitting at the work counter, rather than standing, is recommended.
b. Exercise, such as walking or jogging, can cause recurrence of varicosities.
c. Elastic compression stockings should be applied before getting out of bed.
d. Taking an aspirin daily will help prevent clots from forming around venous valves. -
Answer-ANS: C
Elastic compression stockings are applied with the legs elevated to reduce pressure in
the lower legs. Walking is recommended to prevent recurrent varicosities. Sitting and
standing are both risk factors for varicose veins and venous insufficiency. An aspirin a
day is not adequate to prevent venous thrombosis and would not be recommended for
the patient who had just had sclerotherapy.
The nurse is caring for a patient with critical limb ischemia who has just arrived on the
nursing unit after having percutaneous transluminal balloon angioplasty. Which action
should the nurse perform first?
a. Begin oral intake.
b. Obtain vital signs.
c. Assess pedal pulses.
d. Start discharge teaching. - Answer-ANS: B
Bleeding is a possible complication after catheterization of the femoral artery, so the
nurse's first action should be to assess for changes in vital signs that might indicate
hemorrhage. The other actions are also appropriate but can be done after determining
that bleeding is not occurring.
A 67-year-old patient is admitted to the hospital with a diagnosis of venous insufficiency.
Which patient statement is most supportive of the diagnosis?
a. "I can't get my shoes on at the end of the day."
b. "I can't seem to ever get my feet warm enough."
c. "I have burning leg pains after I walk two blocks."
d. "I wake up during the night because my legs hurt." - Answer-ANS: A
Because the edema associated with venous insufficiency increases when the patient
has been standing, shoes will feel tighter at the end of the day. The other patient
statements are characteristic of peripheral artery disease (PAD).
Which action by a nurse who is giving fondaparinux (Arixtra) to a patient with a lower leg
venous thromboembolism (VTE) indicates that more education about the drug is
needed?
a. The nurse avoids rubbing the injection site after giving the drug.
b. The nurse injects the drug into the abdominal subcutaneous tissue.
c. The nurse ejects the air bubble in the syringe before giving the drug.
d. The nurse fails to assess the partial thromboplastin time (PTT) before giving the drug.
- Answer-ANS: C
The air bubble is not ejected before giving fondaparinux to avoid loss of medication. The
other actions by the nurse are appropriate.
BANK QUESTIONS WITH
CORRECT DETAILED ANSWERS
A 73-year-old patient with chronic atrial fibrillation develops sudden severe pain,
pulselessness, pallor, and coolness in the right leg. The nurse should notify the health
care provider and immediately
a. apply a compression stocking to the leg.
b. elevate the leg above the level of the heart.
c. assist the patient in gently exercising the leg.
d. keep the patient in bed in the supine position. - Answer-ANS: D
The patient's history and clinical manifestations are consistent with acute arterial
occlusion, and resting the leg will decrease the oxygen demand of the tissues and
minimize ischemic damage until circulation can be restored. Elevating the leg or
applying an elastic wrap will further compromise blood flow to the leg. Exercise will
increase oxygen demand for the tissues of the leg.
A patient at the clinic says, "I have always taken a walk after dinner, but lately my leg
cramps and hurts after just a few minutes of starting. The pain goes away after I stop
walking, though." The nurse should
a. check for the presence of tortuous veins bilaterally on the legs.
b. ask about any skin color changes that occur in response to cold.
c. assess for unilateral swelling, redness, and tenderness of either leg.
d. assess for the presence of the dorsalis pedis and posterior tibial pulses. - Answer-
ANS: D
The nurse should assess for other clinical manifestations of peripheral arterial disease
in a patient who describes intermittent claudication. Changes in skin color that occur in
response to cold are consistent with Raynaud's phenomenon. Tortuous veins on the
legs suggest venous insufficiency. Unilateral leg swelling, redness, and tenderness
indicate venous thromboembolism (VTE).
The health care provider has prescribed bed rest with the feet elevated for a patient
admitted to the hospital with venous thromboembolism. Which action by the nurse to
elevate the patient's feet is best?
a. The patient is placed in the Trendelenburg position.
b. Two pillows are positioned under the affected leg.
c. The bed is elevated at the knee and pillows are placed under the feet.
d. One pillow is placed under the thighs and two pillows are placed under the lower
legs. - Answer-ANS: D
The purpose of elevating the feet is to enhance venous flow from the feet to the right
atrium, which is best accomplished by placing two pillows under the feet and one under
,the thighs. Placing the patient in the Trendelenburg position will lower the head below
heart level, which is not indicated for this patient. Placing pillows under the calf or
elevating the bed at the knee may cause blood stasis at the calf level.
The health care provider prescribes an infusion of heparin (Hep-Lock) and daily partial
thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE).
The nurse will plan to
a. decrease the infusion when the PTT value is 65 seconds.
b. avoid giving any IM medications to prevent localized bleeding.
c. monitor posterior tibial and dorsalis pedis pulses with the Doppler.
d. have vitamin K available in case reversal of the heparin is needed. - Answer-ANS: B
IM injections are avoided in patients receiving anticoagulation. A PTT of 65 seconds is
within the therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality is not
affected by VTE.
A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox)
and warfarin (Coumadin). The patient asks the nurse why two medications are
necessary. Which response by the nurse is most appropriate?
a. "Taking two blood thinners reduces the risk for another clot to form."
b. "Lovenox will start to dissolve the clot, and Coumadin will prevent any more clots
from forming."
c. "Lovenox will work right away, but Coumadin takes several days to have an effect on
preventing clots."
d. "Because of the risk for a blood clot in the lungs, it is important for you to take more
than one blood thinner." - Answer-ANS: C
Low molecular weight heparin (LMWH) is used because of the immediate effect on
coagulation and discontinued once the international normalized ratio (INR) value
indicates that the warfarin has reached a therapeutic level. LMWH has no thrombolytic
properties. The use of two anticoagulants is not related to the risk for pulmonary
embolism, and two are not necessary to reduce the risk for another VTE. Furthermore,
anticoagulants should not be described as blood thinners.
The nurse has started discharge teaching for a patient who is to continue warfarin
(Coumadin) following hospitalization for venous thromboembolism (VTE). The nurse
determines that additional teaching is needed when the patient says which of the
following?
a. "I should get a Medic Alert device stating that I take Coumadin."
b. "I should reduce the amount of green, leafy vegetables that I eat."
c. "I will need routine blood tests to monitor the effects of the Coumadin."
d. "I will check with my health care provider before I begin any new medications." -
Answer-ANS: B
Patients taking warfarin are taught to follow a consistent diet with regard to foods that
are high in vitamin K, such as green, leafy vegetables. The other patient statements are
accurate.
, A 46-year-old service-counter worker undergoes sclerotherapy for treatment of
superficial varicose veins at an outpatient center. Which instructions should the nurse
provide to the patient before discharge?
a. Sitting at the work counter, rather than standing, is recommended.
b. Exercise, such as walking or jogging, can cause recurrence of varicosities.
c. Elastic compression stockings should be applied before getting out of bed.
d. Taking an aspirin daily will help prevent clots from forming around venous valves. -
Answer-ANS: C
Elastic compression stockings are applied with the legs elevated to reduce pressure in
the lower legs. Walking is recommended to prevent recurrent varicosities. Sitting and
standing are both risk factors for varicose veins and venous insufficiency. An aspirin a
day is not adequate to prevent venous thrombosis and would not be recommended for
the patient who had just had sclerotherapy.
The nurse is caring for a patient with critical limb ischemia who has just arrived on the
nursing unit after having percutaneous transluminal balloon angioplasty. Which action
should the nurse perform first?
a. Begin oral intake.
b. Obtain vital signs.
c. Assess pedal pulses.
d. Start discharge teaching. - Answer-ANS: B
Bleeding is a possible complication after catheterization of the femoral artery, so the
nurse's first action should be to assess for changes in vital signs that might indicate
hemorrhage. The other actions are also appropriate but can be done after determining
that bleeding is not occurring.
A 67-year-old patient is admitted to the hospital with a diagnosis of venous insufficiency.
Which patient statement is most supportive of the diagnosis?
a. "I can't get my shoes on at the end of the day."
b. "I can't seem to ever get my feet warm enough."
c. "I have burning leg pains after I walk two blocks."
d. "I wake up during the night because my legs hurt." - Answer-ANS: A
Because the edema associated with venous insufficiency increases when the patient
has been standing, shoes will feel tighter at the end of the day. The other patient
statements are characteristic of peripheral artery disease (PAD).
Which action by a nurse who is giving fondaparinux (Arixtra) to a patient with a lower leg
venous thromboembolism (VTE) indicates that more education about the drug is
needed?
a. The nurse avoids rubbing the injection site after giving the drug.
b. The nurse injects the drug into the abdominal subcutaneous tissue.
c. The nurse ejects the air bubble in the syringe before giving the drug.
d. The nurse fails to assess the partial thromboplastin time (PTT) before giving the drug.
- Answer-ANS: C
The air bubble is not ejected before giving fondaparinux to avoid loss of medication. The
other actions by the nurse are appropriate.
