Nokea
A patient is being discharged on anticoagulant therapy. The nurse will include in the patient-education conversation that it is important to avoid herbal products that contain which substance?
- A. Soy
- B. Valerian
- C. Saw palmetto
- D. St. John's wort
Correct Answer: D
Rationale: Capsicum pepper, dong quai, feverfew, garlic, ginger, ginkgo, and St. John's wort are some herbal products that have potential interactions with anticoagulants, especially with warfarin.
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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
Correct Answer: D
Rationale: 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.
A patient will be receiving a thrombolytic drug as part of the treatment for acute myocardial infarction. The nurse explains to the patient that this drug is used for which purpose?
- A. To relieve chest pain
- B. To prevent further clot formation
- C. To dissolve the clot in the coronary artery
- D. To control bleeding in the coronary vessels
Correct Answer: C
Rationale: Thrombolytic drugs lyse, or dissolve, thrombi. They are not used to prevent further clot formation or to control bleeding. As a result of dissolving of the thrombi, chest pain may be relieved, but that is not the primary purpose of thrombolytic therapy.
A patient will be taking dabigatran as part of treatment for chronic atrial fibrillation. Which statements about dabigatran are true?
- A. The dose of dabigatran is reduced in patients with decreased renal function.
- B. Bleeding is the most common adverse effect.
- C. Idarucizumab is given as an antidote in cases of uncontrolled bleeding.
- D. Dabigatran levels are monitored by measuring prothrombin time/international normalized ratio (PT/INR) results.
- E. This drug is a prodrug and becomes activated in the liver.
Correct Answer: A,B,C,E
Rationale: Dabigatran is excreted extensively in the kidneys, and the dose is dependent upon renal function. The normal dose is 150 mg twice daily, but it will be given at reduced dosage if renal impairment is present. The most common and serious side effect is bleeding. Dabigatran is a prodrug that becomes activated in the liver. Idarucizumab (Praxbind) is a specific dabigatran antidote that reverses the anticoagulant effects of dabigatran for emergency surgery or in life-threatening or uncontrolled bleeding. Dabigatran levels are not monitored by PT/INR.
A patient has been prescribed warfarin 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. The warfarin is 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.
Correct Answer: D
Rationale: 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.
A patient has had recent mechanical heart valve surgery and is receiving anticoagulant therapy. While monitoring the patient's laboratory work, the nurse interprets that the patient's international normalized ratio (INR) level of 1.8 indicates: which of these?
- A. The patient is not receiving enough warfarin to have a therapeutic effect.
- B. The patient's warfarin dose is at therapeutic levels.
- C. The patient's intravenous heparin dose is dangerously high.
- D. The patient's intravenous heparin dose is at therapeutic levels.
Correct Answer: A
Rationale: A normal INR (without warfarin) is 1.0. A therapeutic INR for patients who have had mechanical heart valve surgery ranges from 2 to 3.5. For this patient, an INR of 1.8 is not a therapeutic level. Heparin is monitored by aPTT levels, not INR.