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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 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.

A. History of hypertension B. History of stroke C. History of peptic ulcer disease D. History of diabetes mellitus. E. Shortness of breath.

Correct Answer is B

Explanation

A history of stroke is an absolute contraindication to the administration of a thrombolytic to a patient having an acute myocardial infarction (AMI).This is because thrombolytics can increase the risk of intracranial hemorrhage and worsen the neurological outcome.

Choice A is wrong because history of hypertension is not an absolute contraindication, but a relative one.This means that the benefits of thrombolytic therapy may outweigh the risks in some cases, depending on the severity and duration of hypertension.

Choice C is wrong because history of peptic ulcer disease is also a relative contraindication, not an absolute one.Thrombolytics can increase the risk of gastrointestinal bleeding, but this can be managed with proton pump inhibitors or histamine-2 blockers.

Choice D is wrong because history of diabetes mellitus is not a contraindication at all to thrombolytic therapy.In fact, some studies have shown that diabetic patients with AMI may benefit more from thrombolytic therapy than non-diabetic patients.

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Naxlex Comprehensive Predictor Exams

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

The nurse recognizes what absolute contraindication to the administration of a thrombolytic to a patient having an acute myocardial infarction?

Correct Answer is B

Explanation

The nurse is caring for a patient who has received alteplase [Activase]. It is most important for the nurse to take which action?

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 nurse is teaching a client who has a new prescription for bivalirudin about potential adverse effects of the drug. Which of the following effects should the nurse include? (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 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?

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 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 is receiving heparin therapy via continuous IV infusion for treatment of deep vein thrombosis (DVT). The nurse should monitor which of the following laboratory values to evaluate therapeutic effectiveness of heparin therapy?