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.”.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Activated partial thromboplastin time (aPTT).
Dabigatran (Pradaxa) is a direct oral anticoagulant (DOAC) that inhibits thrombin, a key enzyme in the coagulation cascade.
Dabigatran prolongs the aPTT, which is a measure of the intrinsic and common pathways of coagulation.The aPTT can be used to monitor the anticoagulant effect of dabigatran, although routine monitoring is not required.
Choice A) Prothrombin time (PT) is wrong because PT measures the extrinsic and common pathways of coagulation, which are not affected by dabigatran.
PT is used to monitor warfarin therapy, not dabigatran.
Choice B) International normalized ratio (INR) is wrong because INR is a standardized version of PT that is used to monitor warfarin therapy, not dabigatran.
INR is not affected by dabigatran.
Choice D) Platelet count is wrong because platelet count is a measure of the number of platelets in the blood, which are involved in primary hemostasis.
Platelet count is not affected by dabigatran, which acts on secondary hemostasis.
Normal ranges for these tests are:
• aPTT: 25 to 35 seconds
• PT: 11 to 13.5 seconds
• INR: 0.8 to 1.2
• Platelet count: 150,000 to 450,000 per microliter of blood
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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