The nurse admits a client with an acute pulmonary embolism and is instructed to start heparin. Which of the following tests can the nurse best use to adjust the dose of heparin?
Partial thromboplastin time (PTT)
✓
Prothrombin time (PT)
International normalized ratio (INR)
Complete blood count (CBC)
Correct Answer
Partial thromboplastin time (PTT)
Heparin can be monitored by using the partial thromboplastin time or anti-factor Xa level, depending on the institutional protocol.
Question 2
A client who received heparin developed uncontrollable bleeding. What medication is the provider most likely to use as an antidote to the heparin?
Phytonadione
Protamine
✓
Idarucizumab
Andexanet alfa
Correct Answer
Protamine
Protamine is a protein that works to neutralize heparin.
Question 3
The nurse is answering the client's question about the risk for heparin-induced thrombocytopenia (HIT). Which of the following information should be included in the discussion?
The platelet count rises above normal initially.
The condition is immune mediated.
✓
The condition increases the risk for bleeding.
The skin rash is the most reliable diagnostic indicator.
Correct Answer
The condition is immune mediated.
The antibodies decrease the platelet count, leaving the client at risk for the development of thrombosis.
Question 4
A client is admitted to the emergency department with an acute myocardial infarction. Which medication does the nurse anticipate being ordered to dissolve the clot in the coronary artery?
Enoxaparin
Vitamin K
Warfarin
Alteplase
✓
Correct Answer
Alteplase
Alteplase is a thrombolytic drug used to dissolve clots.
Question 5
The nurse is teaching a client with a pulmonary embolism about their new medication, heparin. What will the nurse tell the client about the purpose of heparin?
It will prevent platelet-to-platelet adhesion.
It will dissolve the blood clot quickly.
It will prevent further clot formation.
✓
It will enhance clotting.
Correct Answer
It will prevent further clot formation.
Heparin is an anticoagulant. It will prevent further clot formation while the body naturally breaks down the clot, but it will not directly dissolve the clot.
Question 6
A nurse is teaching a client about warfarin dietary considerations. Which of the following statements by the client indicates understanding of the restrictions?
"I can eat a lot of extra broccoli with a meal as long as it is only occasionally due to decreased vitamin K needs."
"I should eat a consistent amount of vitamin K–containing foods in my diet."
✓
"I should avoid eating fruit like bananas due to excess vitamin K content."
"I should eat a lot of spinach every day due to increased vitamin K needs."
Correct Answer
"I should eat a consistent amount of vitamin K–containing foods in my diet."
Clients taking warfarin must maintain a consistent amount of vitamin K in their diet.
Question 7
A nurse admits a client who has been started on warfarin for a pulmonary embolism. Which test will the nurse monitor to assess warfarin's effect?
Anti-factor Xa level
Complete blood count (CBC)
Partial thromboplastin time (PTT)
International normalized ratio (INR)
✓
Correct Answer
International normalized ratio (INR)
Warfarin is monitored using the INR, or international normalized ratio.
Question 8
The nurse is monitoring for medication-related adverse effects in a client receiving heparin. Which of the following would indicate that the client should be assessed for heparin-induced thrombocytopenia (HIT)?
A decrease in platelet count and concomitant gastrointestinal bleed
An increase in platelet count and concomitant pulmonary embolism
A decrease in platelet count and concomitant deep vein thrombosis
✓
An increase in platelet count and concomitant intracranial hemorrhage
Correct Answer
A decrease in platelet count and concomitant deep vein thrombosis
Heparin-induced thrombocytopenia is characterized by a decreased platelet count. Contrary to typical thrombocytopenia, the client is extremely hypercoagulable and often has a thrombosis such as a deep vein thrombosis.
Question 9
Which of the following direct-acting oral anticoagulant drugs must be taken with food for effective absorption?
Rivaroxaban
✓
Endoxaban
Apixaban
Dabigatran
Correct Answer
Rivaroxaban
This drug is more effectively absorbed when taken with food.
Question 10
An emergency department nurse is assessing a client with an acute ischemic stroke prior to administering alteplase. Which finding will the nurse need to discuss with the provider prior to administering alteplase therapy?
Blood pressure of 197/110 mm Hg
✓
Past medical history of gastroesophageal reflux disease (GERD)
Total knee replacement surgery 6 months ago
Glucose level of 168 mg/dL
Correct Answer
Blood pressure of 197/110 mm Hg
Severe uncontrolled hypertension is a contraindication to alteplase administration.