NURS 5463 LATEST COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS SURE A+
✔✔Paclitaxel (Taxol) Adverse Effects - ✔✔Diarrhea, myelosuppression, peripheral
neuropathy, alopecia, edema, mucositis
✔✔Danuorubicin (Cerubidine) Adverse Effects - ✔✔Nausea/vomiting, diarrhea,
red/orange urine, myelosuppression, dose related cardiotoxicity
✔✔Doxorubicin (Adriamycin) Adverse Effects - ✔✔Nausea/vomiting, diarrhea,
red/orange urine, myelosuppression, dose related cardiotoxicity
✔✔Etoposide (Vepesid) Adverse Effects - ✔✔Nausea/vomiting, diarrhea, fever,
hypotension, myelosuppression, alopecia, fatigue
✔✔Prolonged aPTT, Normal PT/INR - ✔✔- von Willebrand Diesase
- Factor deficiencies: VIII, IX, XI, XII, prekallikrein, HMW kininogen
- Heparin
- Lupus anticoagulant
✔✔Normal aPTT, Prolonged PT/INR - ✔✔- Liver disease
- Vitamin K deficiency
- Warfarin
,✔✔Prolonged aPTT, Prolonged PT/INR - ✔✔- Issue in the Common Pathway
- Deficiency of prothrombin, fibrinogen, factor V, or factor X
- Combined factor deficiencies
- Diseases such as liver disease, DIC, over coagulation with warfarin
- Draw a thrombin time. If normal the issue lies with abnormalities in factors II, V, or X
✔✔Normal aPTT, Normal PT/INR, but Bleeding - ✔✔- von Willebrand Disease
- Platelet dysfunction
- Thrombocytopenia
✔✔Proximal DVT - ✔✔Above the knee
- Popliteal, femoral, iliac
- Superficial femoral vein is considered deep vein
- 80% of symptomatic DVTs
**Higher mortality and complication rate than distal DVTs**
✔✔Distal DVT - ✔✔Below the knee
- Typically confined to calf veins
- 80% will resolve without anticoagulation
✔✔DVT Risk Factors - ✔✔Previous VTE, inheritable coagulopathy, hospitalization
within the last 3 months, COPD & CHF exacerbations,
prolonged immobility >48 hours, paralysis, obesity, pregnancy, ICU admission, stroke,
nursing home, estrogen & testosterone therapy, tamoxifen, glucocorticoids, cancer,
cirrhosis, IBD, major trauma, renal disease, infection
✔✔Virchow's Triad - ✔✔- Venous stasis
- Vessel damage
- Hypercoagulable states
✔✔Wells Criteria for DVT - ✔✔Clinical prediction rule designed to help stratify
individuals into a low, moderate or high risk category for having a DVT
*Score:
</= 0: Low probability (5%)
1-2: moderate probability (17%)
>2: high probability (53%)*
✔✔Venography - ✔✔*Gold Standard* for diagnosing VTE
- Uses contrast and is invasive
- Painful and rarely used
, ✔✔Compression Venous Ultrasound (CUS) - ✔✔Most commonly used test for
diagnosing VTE
- 97% sensitivity, 94% specificity in symptomatic DVT
- Only 60% sensitivity in asymptomatic proximal DVT
✔✔CT Scan Venography - ✔✔- Radiation and contrast can be limiting
- 89-100% sensitivity, 94-100% specificity
✔✔Magnetic Resonance Venography - ✔✔- Expensive and not widely available
- Uses gadolinium, contraindicated in GFR < 30
✔✔PE Clinical Manifestations - ✔✔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 - ✔✔Pulmonary angiogram, CTA PE, V/Q scan
✔✔Absolute Contraindications to Anticoagulation - ✔✔- 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 - ✔✔- 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 - ✔✔PT: 8.3 - 10.8 seconds
INR: 0.9 - 1.2
aPTT: 21 - 33 seconds
✔✔Thrombin Time - ✔✔- 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 - ✔✔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 - ✔✔Used in the hospital as parenteral infusion
QUESTIONS AND ANSWERS SURE A+
✔✔Paclitaxel (Taxol) Adverse Effects - ✔✔Diarrhea, myelosuppression, peripheral
neuropathy, alopecia, edema, mucositis
✔✔Danuorubicin (Cerubidine) Adverse Effects - ✔✔Nausea/vomiting, diarrhea,
red/orange urine, myelosuppression, dose related cardiotoxicity
✔✔Doxorubicin (Adriamycin) Adverse Effects - ✔✔Nausea/vomiting, diarrhea,
red/orange urine, myelosuppression, dose related cardiotoxicity
✔✔Etoposide (Vepesid) Adverse Effects - ✔✔Nausea/vomiting, diarrhea, fever,
hypotension, myelosuppression, alopecia, fatigue
✔✔Prolonged aPTT, Normal PT/INR - ✔✔- von Willebrand Diesase
- Factor deficiencies: VIII, IX, XI, XII, prekallikrein, HMW kininogen
- Heparin
- Lupus anticoagulant
✔✔Normal aPTT, Prolonged PT/INR - ✔✔- Liver disease
- Vitamin K deficiency
- Warfarin
,✔✔Prolonged aPTT, Prolonged PT/INR - ✔✔- Issue in the Common Pathway
- Deficiency of prothrombin, fibrinogen, factor V, or factor X
- Combined factor deficiencies
- Diseases such as liver disease, DIC, over coagulation with warfarin
- Draw a thrombin time. If normal the issue lies with abnormalities in factors II, V, or X
✔✔Normal aPTT, Normal PT/INR, but Bleeding - ✔✔- von Willebrand Disease
- Platelet dysfunction
- Thrombocytopenia
✔✔Proximal DVT - ✔✔Above the knee
- Popliteal, femoral, iliac
- Superficial femoral vein is considered deep vein
- 80% of symptomatic DVTs
**Higher mortality and complication rate than distal DVTs**
✔✔Distal DVT - ✔✔Below the knee
- Typically confined to calf veins
- 80% will resolve without anticoagulation
✔✔DVT Risk Factors - ✔✔Previous VTE, inheritable coagulopathy, hospitalization
within the last 3 months, COPD & CHF exacerbations,
prolonged immobility >48 hours, paralysis, obesity, pregnancy, ICU admission, stroke,
nursing home, estrogen & testosterone therapy, tamoxifen, glucocorticoids, cancer,
cirrhosis, IBD, major trauma, renal disease, infection
✔✔Virchow's Triad - ✔✔- Venous stasis
- Vessel damage
- Hypercoagulable states
✔✔Wells Criteria for DVT - ✔✔Clinical prediction rule designed to help stratify
individuals into a low, moderate or high risk category for having a DVT
*Score:
</= 0: Low probability (5%)
1-2: moderate probability (17%)
>2: high probability (53%)*
✔✔Venography - ✔✔*Gold Standard* for diagnosing VTE
- Uses contrast and is invasive
- Painful and rarely used
, ✔✔Compression Venous Ultrasound (CUS) - ✔✔Most commonly used test for
diagnosing VTE
- 97% sensitivity, 94% specificity in symptomatic DVT
- Only 60% sensitivity in asymptomatic proximal DVT
✔✔CT Scan Venography - ✔✔- Radiation and contrast can be limiting
- 89-100% sensitivity, 94-100% specificity
✔✔Magnetic Resonance Venography - ✔✔- Expensive and not widely available
- Uses gadolinium, contraindicated in GFR < 30
✔✔PE Clinical Manifestations - ✔✔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 - ✔✔Pulmonary angiogram, CTA PE, V/Q scan
✔✔Absolute Contraindications to Anticoagulation - ✔✔- 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 - ✔✔- 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 - ✔✔PT: 8.3 - 10.8 seconds
INR: 0.9 - 1.2
aPTT: 21 - 33 seconds
✔✔Thrombin Time - ✔✔- 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 - ✔✔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 - ✔✔Used in the hospital as parenteral infusion
