Pharm: A Patient-Centered Nursing Process Approach
CH: 40
The nurse is caring for a postoperative patient. The nurse will anticipate administering which medication
to this patient to help prevent thrombus formation caused by slow venous blood flow?
a. Alteplase (Activase)
b. Aspirin
c. Clopidogrel (Plavix)
d. Low-molecular-weight heparin - ANS: D
Low-molecular-weight heparin is an anticoagulant, which is used to inhibit clot formation and is used
prophylactically to prevent postoperative deep vein thrombosis. Alteplase is a thrombolytic, which is
used to break down clots after they form; alteplase is contraindicated in any patient with recent surgery.
Aspirin and clopidogrel are antiplatelet drugs and are used to prevent arterial thrombosis.
A nursing student asks why the anticoagulant heparin is given to patients who have disseminated
intravascular coagulation (DIC) and are at risk for excessive bleeding. The nurse will explain that heparin
is used in this case for which reason?
a. To decrease the risk of venous thrombosis
b. To dissolve blood clots as they form
c. To enhance the formation of fibrous clots
d. To preserve platelet function - ANS: A
The primary use of heparin for patients with DIC is to prevent venous thrombosis, which can lead to
pulmonary embolism or stroke. Heparin does not break down blood clots, enhance the formation of
fibrous clots, or preserve platelet function.
A patient has been receiving intravenous heparin. When laboratory tests are drawn, the nurse has
difficulty stopping bleeding at the puncture site. The patient has bloody stools and is reporting
abdominal pain. The nurse notes elevated partial thromboplastin time (PTT) and activated PPT (aPTT).
Which action will the nurse perform?
a. Ask for an order for oral warfarin (Coumadin).
b. Obtain an order for protamine sulfate.
, c. Request an order for vitamin K.
d. Suggest that the patient receive subcutaneous heparin. - ANS: B
Protamine sulfate is given as an antidote to heparin when patient's clotting times are elevated. Oral
warfarin will not stop the anticoagulant effects of heparin. Vitamin K is used as an antidote for warfarin.
Administering heparin by another route is not indicated when there is a need to reverse the effects of
heparin.
A patient who has received heparin after previous surgeries will be given enoxaparin sodium (Lovenox)
after knee-replacement surgery. The patient asks how this drug is different from heparin. The nurse will
explain that enoxaparin
a. decreases the need for laboratory tests.
b. has a shorter half-life than heparin.
c. increases the risk of hemorrhage.
d. may be taken orally instead of subcutaneously. - ANS: A
Enoxaparin is a low-molecular-weight heparin, which produces more stable responses at lower doses,
thus reducing the need for frequent lab monitoring. It has a longer half-life than heparin. It decreases
the risk of hemorrhage because it is more stable at lower doses. It is given subcutaneously.
The nurse is caring for a patient who is receiving warfarin (Coumadin) and notes bruising and petechiae
on the patient's extremities. The nurse will request an order for which laboratory test?
a. International normalized ratio (INR)
b. Platelet level
c. PTT and aPTT
d. Vitamin K level - ANS: A
The INR is the test used most frequently to report prothrombin time results in patients taking warfarin.
Warfarin is not an antiplatelet drug, so platelet levels are not indicated. PTT and aPTT are used to
monitor heparin therapy. Vitamin K is an antidote for warfarin; levels are not routinely checked.
A patient who is taking warfarin has an international normalized ratio (INR) of 5.5. The nurse will
anticipate giving
a. fresh frozen plasma.
b. intravenous iron.
c. oral vitamin K.
CH: 40
The nurse is caring for a postoperative patient. The nurse will anticipate administering which medication
to this patient to help prevent thrombus formation caused by slow venous blood flow?
a. Alteplase (Activase)
b. Aspirin
c. Clopidogrel (Plavix)
d. Low-molecular-weight heparin - ANS: D
Low-molecular-weight heparin is an anticoagulant, which is used to inhibit clot formation and is used
prophylactically to prevent postoperative deep vein thrombosis. Alteplase is a thrombolytic, which is
used to break down clots after they form; alteplase is contraindicated in any patient with recent surgery.
Aspirin and clopidogrel are antiplatelet drugs and are used to prevent arterial thrombosis.
A nursing student asks why the anticoagulant heparin is given to patients who have disseminated
intravascular coagulation (DIC) and are at risk for excessive bleeding. The nurse will explain that heparin
is used in this case for which reason?
a. To decrease the risk of venous thrombosis
b. To dissolve blood clots as they form
c. To enhance the formation of fibrous clots
d. To preserve platelet function - ANS: A
The primary use of heparin for patients with DIC is to prevent venous thrombosis, which can lead to
pulmonary embolism or stroke. Heparin does not break down blood clots, enhance the formation of
fibrous clots, or preserve platelet function.
A patient has been receiving intravenous heparin. When laboratory tests are drawn, the nurse has
difficulty stopping bleeding at the puncture site. The patient has bloody stools and is reporting
abdominal pain. The nurse notes elevated partial thromboplastin time (PTT) and activated PPT (aPTT).
Which action will the nurse perform?
a. Ask for an order for oral warfarin (Coumadin).
b. Obtain an order for protamine sulfate.
, c. Request an order for vitamin K.
d. Suggest that the patient receive subcutaneous heparin. - ANS: B
Protamine sulfate is given as an antidote to heparin when patient's clotting times are elevated. Oral
warfarin will not stop the anticoagulant effects of heparin. Vitamin K is used as an antidote for warfarin.
Administering heparin by another route is not indicated when there is a need to reverse the effects of
heparin.
A patient who has received heparin after previous surgeries will be given enoxaparin sodium (Lovenox)
after knee-replacement surgery. The patient asks how this drug is different from heparin. The nurse will
explain that enoxaparin
a. decreases the need for laboratory tests.
b. has a shorter half-life than heparin.
c. increases the risk of hemorrhage.
d. may be taken orally instead of subcutaneously. - ANS: A
Enoxaparin is a low-molecular-weight heparin, which produces more stable responses at lower doses,
thus reducing the need for frequent lab monitoring. It has a longer half-life than heparin. It decreases
the risk of hemorrhage because it is more stable at lower doses. It is given subcutaneously.
The nurse is caring for a patient who is receiving warfarin (Coumadin) and notes bruising and petechiae
on the patient's extremities. The nurse will request an order for which laboratory test?
a. International normalized ratio (INR)
b. Platelet level
c. PTT and aPTT
d. Vitamin K level - ANS: A
The INR is the test used most frequently to report prothrombin time results in patients taking warfarin.
Warfarin is not an antiplatelet drug, so platelet levels are not indicated. PTT and aPTT are used to
monitor heparin therapy. Vitamin K is an antidote for warfarin; levels are not routinely checked.
A patient who is taking warfarin has an international normalized ratio (INR) of 5.5. The nurse will
anticipate giving
a. fresh frozen plasma.
b. intravenous iron.
c. oral vitamin K.
