Nokea
A patient who has been anticoagulated with warfarin 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
Correct Answer: B
Rationale: 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.
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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 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 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.
The nurse notes in the patient's medication orders that the patient will be starting anticoagulant therapy. What is the primary goal of anticoagulant therapy?
- A. Stabilizing an existing thrombus
- B. Dissolving an existing thrombus
- C. Preventing thrombus formation
- D. Dilating the vessel around a clot
Correct Answer: C
Rationale: Anticoagulants prevent thrombus formation but do not dissolve or stabilize an existing thrombus, nor do they dilate vessels around a clot.