A nurse is caring for a client who is receiving argatroban IV for HIT and requires urgent surgery. The nurse should stop the infusion at least how many hours before the surgery?

2 hours

4 hours

6 hours

8 hours.

Answer and Explanation

The Correct Answer is B

Argatroban is a direct thrombin inhibitor (DTI) that is used as an alternative anticoagulant for patients with heparin-induced thrombocytopenia (HIT) who require urgent surgery. Argatroban has a half-life of about 40 to 50 minutes and is cleared by the liver. The infusion should be stopped at least 4 hours before the surgery to allow adequate time for the anticoagulant effect to wear off. The activated partial thromboplastin time (aPTT) should be monitored before and after the infusion to assess the degree of anticoagulation.

Choice A is wrong because 2 hours is not enough time to stop the argatroban infusion before surgery.

The patient may still have a high risk of bleeding if the aPTT is prolonged.

Choice C is wrong because 6 hours is longer than necessary to stop the argatroban infusion before surgery.

The patient may have a higher risk of thrombosis if the anticoagulation effect is too low.

Choice D is wrong because 8 hours is much longer than necessary to stop the argatroban infusion before surgery.

The patient may have a very low level of anticoagulation and a high risk of thrombosis if the infusion is stopped for too long.

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Correct Answer is ["A","C","D"]

Explanation

Warfarin (Coumadin) is a blood thinner that prevents blood clots from forming or growing larger.

It is used to treat or prevent deep vein thrombosis (DVT), a condition in which a blood clot forms in a vein deep in the body, usually in the legs.

It can also prevent pulmonary embolism (PE), a condition in which a blood clot breaks off and travels to the lungs, blocking blood flow and causing breathing problems.

Patients taking warfarin should follow these instructions:

• Avoid foods that are high in vitamin K.

Vitamin K is needed for the production of some clotting factors in the liver.

Warfarin blocks the action of vitamin K, and thus reduces the clotting ability of the blood.

However, if the intake of vitamin K varies significantly from day to day, it can affect the stability of the warfarin effect.Foods that are high in vitamin K include green leafy vegetables, such as spinach, kale, broccoli, cabbage, and lettuce, as well as some vegetable oils, such as soybean and canola.Patients should not avoid these foods completely, but they should keep their intake consistent and inform their doctor or pharmacist if they make any changes to their diet.

• Report any unusual bleeding to healthcare provider.

Warfarin can increase the risk of bleeding, especially if the dose is too high or if it interacts with other medications or supplements.Patients should notify their doctor or seek emergency care if they have any signs of bleeding, such as bruising, red or black stools, blood in the urine, coughing up blood, vomiting blood, nosebleeds, heavy menstrual bleeding, headaches, dizziness, weakness, or swelling.They should also inform their doctor of any other medications or supplements they are taking, including over-the-counter products and herbal remedies.

• Use an electric razor when shaving.

Warfarin can make the skin more prone to bleeding from minor cuts or injuries.

Patients should use an electric razor when shaving to reduce the risk of nicking themselves and causing bleeding.They should also use a soft toothbrush and avoid flossing if it causes bleeding.They should wear gloves when handling sharp objects or working in the garden.

Choice B and E are wrong because:

• Take aspirin for pain relief.

Aspirin is a medication that also prevents blood clots by inhibiting platelets, which are cells that stick together to form clots.Taking aspirin with warfarin can increase the risk of bleeding significantly and is not recommended unless prescribed by a doctor for a specific reason.Patients should avoid taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, for pain relief unless advised by their doctor.They should also check the labels of any over-the-counter medications or supplements they use and avoid those that contain aspirin or NSAIDs.

• Wear shoes that fit well and avoid tight clothing.

This instruction is not related to warfarin therapy and does not affect its efficacy or safety.

However, it may be a general advice for patients with DVT to prevent further complications or discomfort.Wearing shoes that fit well and avoiding tight clothing can help improve blood circulation in the legs and prevent swelling or pain.Patients with DVT should also elevate their legs when possible and wear compression stockings if prescribed by their doctor.

A. Activated partial thromboplastin time (aPTT) B. Prothrombin time (PT) C. International normalized ratio (INR) D. Platelet count.

Correct Answer is C

Explanation

Warfarin is an anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors. The INR is a standardized measure of the prothrombin time (PT), which reflects the degree of anticoagulation.The therapeutic range for INR is 2 to 3 for most conditions, and higher for some mechanical heart valves.

Choice A) Activated partial thromboplastin time (aPTT) is wrong because it is used to monitor heparin therapy, not warfarin therapy.

Heparin is another anticoagulant that works by activating antithrombin III, which inhibits thrombin and factor Xa.The therapeutic range for aPTT is 1.5 to 2.5 times the normal value, which is 30 to 40 seconds.

Choice B) Prothrombin time (PT) is wrong because it is not a standardized measure of the warfarin effect.

The PT can vary depending on the reagents and methods used by different laboratories.The INR was developed to eliminate this variability and provide a consistent measure of the warfarin effect.

Choice D) Platelet count is wrong because it is not affected by warfarin therapy.

Warfarin does not affect the number or function of platelets, only the clotting factors.Platelet count can be used to monitor other conditions that affect hemostasis, such as thrombocytopenia or thrombocytosis.

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A nurse is caring for a client who is receiving argatroban IV for HIT and requires urgent surgery. The nurse should stop the infusion at least how many hours before the surgery?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client has been prescribed warfarin (Coumadin) for treatment of deep vein thrombosis (DVT). Which of the following instructions should the nurse include in patient teaching? Select all that apply.

Correct Answer is ["A","C","D"]

Explanation

A nurse is caring for a client who has atrial fibrillation and is receiving warfarin therapy to prevent thromboembolism formation. The nurse should monitor which of the following laboratory values to determine the effectiveness of the medication?

Correct Answer is C

Explanation

A nurse is caring for a client who has deep vein thrombosis and is receiving enoxaparin therapy subcutaneously once daily at home. The nurse should instruct the client to report which of the following findings immediately?

Which patients below would be at a HIGH risk for developing adverse effects of Heparin drug therapy? Select all that apply:

The patient has been receiving heparin therapy for deep vein thrombosis (DVT). The patient’s activated partial thromboplastin time (aPTT) result is 90 seconds (therapeutic range: 60-80 seconds). What will be included in patient care? (Select all that apply.).

A patient is ordered to start an IV continuous Heparin drip. Prior to starting the medication, the nurse would ensure what information is gathered correctly before initiating the drip? Select all that apply: *.

A client who has atrial fibrillation is prescribed dabigatran etexilate mesylate (Pradaxa). The nurse should instruct the client to report which of the following findings immediately? (Select all that apply.)

A patient has been prescribed dabigatran (Pradaxa) for atrial fibrillation (AF). Which laboratory test should be monitored while on this medication?

A nurse is reviewing the medication list of a client who is prescribed dabigatran and has a history of peptic ulcer disease. The nurse should recognize that which of the following medications can increase the risk of bleeding in this client?

A nurse is caring for a client who has pulmonary embolism and is receiving alteplase via continuous IV infusion.The nurse should monitor for which adverse effects of this medication? (Select all that apply.)