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When teaching a client how to inject heparin subcutaneously, which of the following would the nurse include? Select all that apply.
- A. Holding the needle at a 45-degree angle
- B. Pinching a fold of skin
- C. Aspirating before injecting the drug
- D. Applying firm pressure after injection
- E. Changing sites for each dose
Correct Answer: B,D,E
Rationale: When administering a subcutaneous dose of heparin, the nurse picks a site that has not been used previously, pinches a fold of skin, holds the needle at a 90-degree angle, does not aspirate before injecting, and then applies firm pressure to the area after injection.
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When teaching a class about parenterally administered heparin, which of the following would the nurse include? Select all that apply.
- A. Onset of action is almost immediate.
- B. Maximum effect occurs within 10 minutes.
- C. It is preferably given intramuscularly.
- D. Clotting time returns to normal within 4 hours.
- E. It causes fewer adverse reactions than the oral form.
Correct Answer: A,B,D
Rationale: Parenteral heparin results in an almost immediate onset of action with a maximum effect within 10 minutes, but clotting returns to normal within 4 hours unless subsequent doses are given. It is preferably given subcutaneously or intravenously.
Which of the following may be ordered periodically during therapy with anticoagulants? Select all that apply.
- A. Urinalysis
- B. Platelet count
- C. Blood count
- D. Stool analysis
- E. Ultrasound
Correct Answer: B,C,D
Rationale: A complete blood count, platelet count, and stool analysis for occult blood may be ordered periodically throughout anticoagulant therapy.
When reviewing the medical records of several clients, the nurse understands that the use of anticoagulants is contraindicated in clients with which of the following medical conditions? Select all that apply.
- A. Leukemia
- B. Hypotension
- C. Atrial fibrillation
- D. GI ulcers
- E. Tuberculosis
Correct Answer: A,D,E
Rationale: Anticoagulants are contraindicated in clients with known sensitivity to the drug, active bleeding, hemorrhagic disease, tuberculosis, leukemia, uncontrolled hypertension, GI ulcers, recent eye or CNS surgery, aneurysms, and severe renal and hepatic disease and during pregnancy and lactation.
A female client is prescribed warfarin. The client also uses oral contraceptives. The nurse would assess the client closely for which of the following? Select all that apply.
- A. Bruising
- B. Blood in the stool
- C. Subtherapeutic INR
- D. Supratherapeutic INR
- E. Calf pain and warmth
Correct Answer: C,E
Rationale: Coadministration of warfarin and oral contraceptives can result in a decreased anticoagulant effect, leading to subtherapeutic INR and increased chance of clotting (signs and symptoms of DVT or PE).
A nurse is reviewing a journal article about antiplatelet agents. Which of the following would the nurse expect to be discussed? Select all that apply.
- A. Heparin
- B. Warfarin
- C. Abciximab
- D. Anagrelide
- E. Dipyridamole
Correct Answer: C,D,E
Rationale: Abciximab, anagrelide, and dipyridamole are antiplatelet agents. Heparin and warfarin are anticoagulants.