Nokea
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.
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The nurse is reviewing new medication orders for a patient who has an epidural catheter for administration of pain medications. One of the orders is for enoxaparin, a low-molecular-weight heparin (LMWH). What is the nurse's priority action?
- A. Give the LMWH as ordered.
- B. Double-check the LMWH order with another nurse, and then administer as ordered.
- C. Stop the epidural pain medication, and then administer the LMWH.
- D. Contact the prescriber because the LMWH cannot be given if the patient has an epidural catheter.
Correct Answer: D
Rationale: LMWHs are contraindicated in patients with an indwelling epidural catheter; they can be given 2 hours after the epidural is removed. This is very important to remember, because giving an LMWH with an epidural has been associated with epidural hematoma.
An elderly patient has had hip surgery and will be receiving heparin, 4000 units subcutaneously every 12 hours. The heparin is available in vials of 5000 units/mL. Calculate how much heparin the nurse will administer for this dose.
Correct Answer: 0.8 mL
Rationale: 5000 units : 1 mL :: 4000 units : x mL; (5000 * x) = (1 * 4000); 5000x = 4000; x = 4000/5000 = 0.8 mL.
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.
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 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.