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?

Warfarin

Clopidogrel

Argatroban

Alteplase.

Answer and Explanation

The Correct Answer is C

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.

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Correct Answer is C

Explanation

This is because swelling in one leg could indicate a new or worsening deep vein thrombosis (DVT), which is a serious condition that can lead to pulmonary embolism or other complications. The client should report this finding to the provider immediately and seek medical attention.

Choice A) Bruising at injection site is wrong because bruising is a common and expected side effect of enoxaparin therapy, especially if the client is using the same injection site repeatedly.

The client should be instructed to rotate the injection sites and apply gentle pressure after each injection to minimize bruising.

Choice B) Redness at injection site is wrong because redness is also a common and expected side effect of enoxaparin therapy, as it indicates a local inflammatory response to the medication.

The client should be advised to avoid rubbing or scratching the injection site and to apply a cold compress if needed.

Choice D) Mild pain at injection site is wrong because mild pain is also a common and expected side effect of enoxaparin therapy, as it reflects the needle insertion and the medication delivery.

The client should be reassured that the pain will subside shortly and to use a different injection site for the next dose.

Normal ranges for enoxaparin therapy are based on the client’s weight, indication, and renal function.

The usual dose for DVT prophylaxis is 40 mg subcutaneously once daily, and the usual dose for DVT treatment is 1 mg/kg subcutaneously every 12 hours.

The client should have regular blood tests to monitor the anti-factor Xa level, which should be between 0.5 and 1.0 IU/mL for DVT prophylaxis and between 0.6 and 1.0 IU/mL for DVT treatment.

The client should also have regular platelet counts to check for heparin-induced thrombocytopenia (HIT), which is a rare but serious complication of enoxaparin therapy that causes a drop in platelets and an increased risk of thrombosis.

The normal platelet count range is 150,000 to 450,000/mm3.

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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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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?

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 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 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 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 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 rivaroxaban (Xarelto) for deep vein thrombosis (DVT). Which statement by the patient indicates understanding of medication teaching?

A nurse is caring for a patient who has been prescribed apixaban (Eliquis) for deep vein thrombosis (DVT). Which instructions should be included in patient teaching? Select all that apply.