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A nurse is caring for a patient who has been prescribed warfarin [Coumadin] in addition to IV heparin therapy after experiencing an acute myocardial infarction (MI). The patient asks why both medications are necessary if they do similar things in preventing clots from forming in his body.

Which response by the nurse best explains why both medications are necessary? (Select all that apply.).

“Heparin works faster than warfarin, so it is given until warfarin reaches an effective level in your blood.”

“Heparin and warfarin work on different clotting factors in your blood, so they have a synergistic effect.”

“Heparin is given by injection, while warfarin is given by mouth, so they have different routes of administration.”

“Heparin prevents new clots from forming, while warfarin helps dissolve existing clots in your blood vessels.”

“Heparin has a shorter duration of action than warfarin, so it is easier to reverse if bleeding occurs.”.

Answer and Explanation

Correct Answer : A,E

Heparin works faster than warfarin, so it is given until warfarin reaches an effective level in your blood.

Heparin has a shorter duration of action than warfarin, so it is easier to reverse if bleeding occurs.

Choice B is wrong because heparin and warfarin do not have a synergistic effect.

They work on different clotting factors, but they do not enhance each other’s effects.

Choice C is wrong because the route of administration is not relevant to the rationale for using both medications.

Heparin and warfarin can be given by different routes, but that does not explain why they are both necessary.

Choice D is wrong because warfarin does not help dissolve existing clots.

Warfarin prevents the synthesis of vitamin K-dependent clotting factors, but it does not break down clots that have already formed.

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Correct Answer is C

Explanation

This is because argatroban is a direct thrombin inhibitor that can be used as an alternative anticoagulant for patients with heparin-induced thrombocytopenia (HIT).HIT is an immune-mediated disorder that occurs when antibodies form against heparin and platelet factor 4, leading to platelet activation and thrombosis.The diagnosis of HIT is based on clinical criteria and laboratory tests.

Choice A is wrong because warfarin is a vitamin K antagonist that interferes with the synthesis of clotting factors II, VII, IX, and X.Warfarin is contraindicated in patients with HIT because it can worsen the thrombotic complications and cause skin necrosis.Warfarin should only be started after the platelet count has recovered and the patient is adequately anticoagulated with a non-heparin agent.

Choice B is wrong because clopidogrel is an antiplatelet agent that inhibits the ADP receptor on platelets, preventing their aggregation.Clopidogrel is not effective for the treatment of HIT, as it does not target the underlying mechanism of thrombin generation.Clopidogrel may also increase the risk of bleeding in patients with HIT.

Choice D is wrong because alteplase is a fibrinolytic agent that converts plasminogen to plasmin, which breaks down fibrin clots.Alteplase is not indicated for the treatment of HIT, as it does not prevent further thrombosis and may cause severe bleeding complications.Alteplase may be used as a last resort for life-threatening thrombosis in patients with HIT who do not respond to other therapies.

A. 2 hours B. 4 hours C. 6 hours D. 8 hours.

Correct Answer is B

Explanation

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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Naxlex Comprehensive Predictor Exams

A patient is receiving heparin therapy during hemodialysis for chronic renal failure and develops heparin-induced thrombocytopenia (HIT). The nurse anticipates that which medication will be ordered for this patient?

Correct Answer is C

Explanation

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?

Correct Answer is B

Explanation

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.

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.)

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

A patient who has atrial fibrillation is taking warfarin and has an INR of 2.5.The patient reports having frequent headaches and asks for an over-the-counter pain reliever.The nurse will recommend which 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 variant angina and is prescribed verapamil. Which of the following are expected outcomes of this medication? (Select all that apply.)

A nurse is caring for a patient who has been prescribed enoxaparin (Lovenox) subcutaneously for prophylaxis against deep vein thrombosis (DVT). The nurse should instruct the patient to:

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: *.