Which medication should not be given to a patient on anticoagulant therapy Quizlet

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Terms in this set (36)

Which oral anticoagulant drug requires routine coagulation monitoring?
1
Apixaban (Eliquis)
2
Warfarin (Coumadin)
3
Dabigatran (Pradaxa)
4
Rivaroxaban (Xarelto)

2
Warfarin (Coumadin) is an oral anticoagulant that requires regular monitoring of prothrombin time because oral anticoagulants prolong clotting time. Apixaban (Eliquis), dabigatran (Pradaxa), and rivaroxaban (Xarelto) are anticoagulants that do not alter clotting time; therefore, a patient on those medications would not require routine coagulation monitoring.

What does the nurse administer when a patient has a sudden attack of angina?
1
Atenolol (Tenormin)
2
Nimodipine (Nimotop)
3
Nitroglycerin (Nitro-Bid)
4
Transdermal patch (Nitro-Dur)

3

Intravenous infusion of nitroglycerin (Nitro-Bid) is administered to a patient with acute angina because it has an onset of action of 1 to 2 minutes, which can provide prompt relief to the patient. A nitroglycerin transdermal patch has an onset of action of 30 to 60 minutes and may be ineffective in relieving a sudden attack of angina. The dihydropyridine calcium channel blocker (CCB) nimodipine (Nimotop) is used for cerebral artery spasms associated with aneurysm rupture. Atenolol (Tenormin) is available only in the oral form and is more effective in patients after myocardial infarction.

Which would be an appropriate intervention in a patient on warfarin (Coumadin) who is exhibiting petechiae?
1
Administering fresh whole blood
2
Administering fresh frozen plasma
3
Administering vitamin K1 (Mephyton)
4
Administering protamine sulphate (Protamine)

3

Oral anticoagulants such as warfarin (Coumadin), because of overdose or as a side effect, may cause uncontrollable bleeding or hemorrhage, as indicated by signs such as petechiae and ecchymosis. Vitamin K1 (Mephyton) is an antagonist of warfarin that is used for warfarin overdose or uncontrollable bleeding. Fresh whole blood or fresh frozen plasma are administered when vitamin K1 fails to control bleeding. Protamine sulphate (Protamine) is an antidote for heparin overdose rather than warfarin.

Which are true of calcium channel blockers (CCBs)? Select all that apply.
1
Peripheral edema is a common side effect.
2
CCBs relax the coronary arteries.
3
Nisoldipine is effective for long-term treatment of angina.
4
Bioavailability is consistent among all drugs in the class.
5
Verapamil is indicated for paroxysmal supraventricular tachycardia (PSVT).

1,2,5

Peripheral edema is a common side effect with CCBs. They work by relaxing the coronary arteries, increasing blood flow to the heart. Verampamil is a specific CCB that treats PSVT. Verapamil, diltiazem, and nifedipine are effective in long-term treatment of angina; nisoldipine is not. Bioavailability varies considerably among CCBs, ranging from 20% for verapamil to 65% for diltiazem.

What is the primary effect of calcium channel blockers (CCBs)?
1
To treat acute myocardial infarction (MI)
2
To reduce exercise-induced elevations in heart rate
3
To prolong the QT interval on the electrocardiogram (ECG)
4
To decrease the afterload and reduce the workload of the heart

4
The calcium channel blockers decrease the afterload and reduce the workload of the heart by preventing muscle contraction and promoting muscle relaxation. The beta blockers are more effective in reducing exercise-induced heart rate elevations, as they decrease blood pressure and heart rate promptly. CCBs are contraindicated in patients with acute MI. Ranolazine (Ranexa) is used to prolong the QT interval on the ECG.

The registered nurse is teaching a nursing student about the drug interactions associated with heparin and warfarin (Coumadin). Which statement by the nursing student indicates effective learning?
1
"The effect of only warfarin decreases with nitroglycerin."
2
"The effect of only heparin increases with oral hypoglycemics."
3
"The effect of both heparin and warfarin increases with aspirin."
4
"The effect of both heparin and warfarin increases with vitamin K."

3

Patients taking heparin are instructed not to take antiplatelet drugs such as aspirin, because they increase the action of heparin. Because warfarin is highly protein-bound, aspirin can displace warfarin from the protein-bound site, causing more free-circulating anticoagulant. This will in turn increase the action of warfarin. The effect of heparin decreases with nitroglycerin; nitroglycerin has no specific effect on warfarin. Oral hypoglycemic drugs that are used for diabetes also displace warfarin from the protein-bound site and increase its effect; oral hypoglycemics have no specific effect on heparin. Vitamin K is used to decrease the action of warfarin in situations where frank bleeding results from excess free drug; vitamin K has no effect on heparin.

A patient is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg daily. When the nurse enters the room, the patient reports seeing yellow halos around the lights. What is the nurse's first action?
1
Administer the medication as prescribed
2
Withhold the next dose of furosemide (Lasix)
3
Document the findings and reassess in 1 hour
4
Assess the patient for symptoms of digoxin toxicity

4

Change in vision, such as green, yellow, or purple halo surrounding the peripheral field of vision, is a direct symptom of digoxin toxicity. So, the first action the nurse would take is to assess the patient for the symptoms of digoxin toxicity. Furosemide (Lasix) is a loop diuretic, so it does not relate directly to digoxin toxicity. Medication can be administered as prescribed to remedy of the situation. Documentation and reassessment acts are a part of the nurse's responsibility, which will follow the remedy for digoxin toxicity.

The nurse is monitoring a patient during intravenous (IV) nitroglycerin infusion. Which assessment finding will cause the nurse to take action?
1
Flushing
2
Headache
3
Chest pain
4
Blood pressure 110/90 mm Hg

3

The patient should not continue to have chest pain while on IV nitroglycerin. This would prompt the nurse to intervene. Blood pressure of 110/90 mm Hg is not cause for concern and is expected with nitroglycerin. Headache and flushing are common side effects of nitroglycerin.

What is the most common adverse reaction of digoxin?
1
Tachycardia
2
Bradycardia
3
Atrial fibrillation
4
Atrioventricular (AV) block

2
Bradycardia is the most likely adverse reaction with digoxin use. Since bradycardia can occur, tachycardia is not likely. Atrial fibrillation and AV block are contraindications for digoxin use.

A patient who is receiving heparin therapy has bruises covering the abdomen as well as red-colored urine. What does the nurse need to assess?
1
Urine culture
2
Platelet level
3
Over-the-counter medications
4
Ingestion of acetaminophen (Tylenol)

2
The patient's platelet level should be assessed when he or she receives heparin and then develops bruises and blood in the urine. The patient may have type II heparin-induced thrombocytopenia (HIT). The patient's medication would need to be changed. Although over-the-counter medications may potentiate bleeding, they are not likely to cause these symptoms. Acetaminophen and urinary tract infections should not cause these symptoms.

When titrating intravenous nitroglycerin for a patient, what is important for the nurse to monitor? Select all that apply.
1
Visual acuity
2
Presence of chest pain
3
Serum nitroglycerin levels
4
Hourly electrocardiograms
5
Continuous blood pressure
6
Continuous oxygen saturation

2,5

Intravenous nitroglycerin can cause hypotension and tachycardia. Relief of chest pain and systolic blood pressure <90 mm Hg are typical parameters used for titrating nitroglycerin. Pulse should also be monitored.

The nurse is preparing to administer an anticoagulant to a patient. Which action, if observed, is in error?
1
The nurse administers heparin subcutaneously to a patient.
2
The nurse adminsters warfarin (Coumadin) orally to a patient.
3
The nurse administers dabigatran (Pradaxa) orally to a patient.
4
The nurse adminsters enoxaparin (Lovenox) intramuscularly to a patient.

4

The nurse should not adminsiter an anticoagulant intramuscularly, because this would cause a high risk of bleeding into the muscle and a large hematoma to form at the injection site. The other medications can be administered via the routes listed.

Which category of medication is the first-line treatment for reducing fluid volume associated with heart failure?
1
Angiotensin-converting enzyme (ACE) inhibitors
2
Vasodilators
3
Beta blockers
4
Diuretics

4
Diuretics are the first-line therapy for reducing fluid associated with heart failure. ACE inhibitors, vasodilators, and beta blockers may also be used, but this will be done as secondary treatments or along with diuretics.

A patient eats large amounts of garlic for its cardiovascular benefits. Which drug in the patient's medication history would prompt the nurse to ask the patient to stop consuming garlic?
1
Digoxin (Lanoxin)
2
Fenofibrate (Tricor)
3
Colestipol (Colestid)
4
Warfarin (Coumadin)

4

Warfarin (Coumadin) shows potential drug interactions with garlic. There is a possible interaction between garlic and warfarin (Coumadin) that could increase the risk of bleeding in people taking blood thinning medication. Colestipol (Colestid) and fenofibrate (Tricor) are used to treat elevated blood lipid and cholesterol concentrations and do not have any potential interactions with garlic. Digoxin (Lanoxin) is a cardiac glycoside drug which has no potential interactions with garlic.

The nurse will include which instructions in the plan of care for a patient receiving warfarin therapy?
1
"Do not take aspirin for pain."
2
"Do not eat foods with potassium."
3
"Avoid the use of acetaminophen (Tylenol)."
4
"Increase your intake of dark, leafy green vegetables."

1
The patient who is taking warfarin should not take nonsteroidal antiinflammatory drugs (aspirin) for pain, because this may cause increased bleeding due to antiplatelet effects. The patient should take acetaminophen for pain since acetaminophen will not have an effect on the clotting process. Potassium is not a concern for patients taking warfarin. The patient should not increase intake of dark, leafy green vegetables because these are likely to have high levels of vitamin K and could counteract the therapeutic effect of the medication.

The patient is receiving warfarin therapy, and the nurse finds the international normalized ratio (INR) to be 4.0. How will the nurse interpret this finding?
1
The level is within the expected target therapeutic level of anticoagulation.
2
The level is outside the expected target therapeutic level of anticoagulation; it is too low.
3
The level is outside the expected target therapeutic level of anticoagulation; it is too high.
4
The level cannot be interpreted without knowing the prothrombin time and an activated partial thromboplastin time (aPTT) value.

3
Target levels of INR typically range from 2 to 3 with an average of 2.5; the average may increase to 3.0 for individuals taking warfarin for treatment of recurring systemic clots or emboli or those having mechanical heart valves.

he nurse is assessing a patient with hemorrhage from the rectum and mouth who is on thrombolytic therapy. The nurse finds that the patient is also on herbal therapy. What reason would the nurse anticipate for this condition?
1
Consumption of valerian
2
Consumption of feverfew
3
Consumption of black haw
4
Consumption of goldenseal

2
Herbs such as Ginkgo biloba, garlic, feverfew, ginger, and green tea may increase bleeding when taken with thrombolytic drugs. Valerian may decrease the effects of warfarin (Coumadin), which is an anticoagulant. Black haw increases the action of anticoagulants. Goldenseal may decrease the effects of heparin sodium (Heparin) and other oral anticoagulants.

The registered nurse is teaching a nursing student about care for a patient who is on oral warfarin therapy. Which statement made by the nursing student indicates the need for further teaching?
1
"I will suggest that the patient use aspirin for pain."
2
"I will warn the patient to shave only with an electric razor."
3
"I will teach the patient techniques to control external hemorrhage."
4
"I will teach the patient to inform his or her dentist about the medication therapy."

1
Aspirin is contraindicated in a patient who is on oral anticoagulant medication because aspirin intensifies the action of the anticoagulant, which results in bleeding. Bleeding from shaving cuts may be difficult to control, so the patient should be advised to use an electric razor only. Patients who are on oral anticoagulant medication have difficulty controlling bleeding from injuries or external hemorrhage. The nurse should teach the patient techniques such as the application of pressure to control bleeding. Dental extraction may cause bleeding, which may be uncontrollable for a patient who is on anticoagulation medication, so patients on anticoagulation medication should inform the dentist before starting the treatment.

The nurse evaluates that the patient has understood discharge teaching regarding warfarin (Coumadin) based on which statement by the patient?
1
"I should keep taking ibuprofen for my arthritis."
2
"I should use a soft toothbrush for dental hygiene."
3
"I should decrease the dose if I start bruising easily."
4
"I will double my dose if I forget to take it the day before."

2
Using a soft-bristled toothbrush for dental hygiene will reduce the risk of bleeding. The patient should not double the dose of warfarin. Ibuprofen will potentiate bleeding. The patient should call the health care provider if experiencing excessive bruising.

What does the nurse teach the patient about sublingual nitroglycerin (Nitrostat)?
1
"Chew the tablet for the fastest effect."
2
"Keep the tablets locked in a safe place until you need them."
3
"You can take up to five doses every 3 minutes for chest pain."
4
"Sit or lie down after you take a nitroglycerin tablet to prevent dizziness."

4
Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. Hence the patient is instructed to avoid movement or move slowly after taking the drug. The patient needs to take only one dose for chest pain and contact the primary health care provider if the pain persists. Sublingual tablets need to dissolve in the mouth and are not to be chewed or crushed. The tablets are not locked away but kept in a cool, dry place in their original container, because exposure to heat or moisture can decrease their potency.

The nurse is caring for a patient who has depression. While reviewing the nurse's medication administration record (MAR), the nurse manager finds that the nurse has administered clopidogrel (Plavix) instead of paroxetine (Paxil). What is the most likely consequence of this medication error?
1
The patient is at a high risk of bleeding.
2
The patient is at a high risk of developing a stroke.
3
The patient is at a high risk of myocardial infarction.
4
The patient is at a high risk of pulmonary embolism

1

Large numbers of drugs are similar in spelling or pronunciation, which can lead to medication errors. Plavix and Paxil are drug names that sound alike. The nurse administered Plavix, an antiplatelet drug, instead of Paxil, an antidepressant drug. This error may have occurred because the nurse did not hear or read the prescription properly. As the nurse administered an antiplatelet drug to the patient, the patient is at a high risk of bleeding. Antiplatelet drugs are usually prescribed for preventing stroke, myocardial infarction, and pulmonary embolism.

What is the mechanism of action of digoxin-immune Fab?
1
Binding to the digoxin
2
Decreasing elimination
3
Inducing a heart block
4
Speeding up metabolism

1
Digoxin-immune Fab works by binding to the digoxin molecules that are then excreted in the urine. Elimination is not decreased. Digoxin toxicity can cause a heart block. Metabolism is not affected.

A patient is receiving warfarin (Coumadin) as an outpatient to manage a lower extremity blood clot. The international normalized ratio (INR) value for the patient today is 1.5. In response to this, the nurse would anticipate the health care provider placing which order?
1
Administer protamine sulfate.
2
Administer a one-time dose of intravenous heparin.
3
Hold the next dose of warfarin (Coumadin).
4
Administer an additional dose of warfarin (Coumadin)

4
A therapeutic INR for a patient on warfarin (Coumadin) is 2 to 3.5. The patient needs an additional dose and/or an increased daily dose of warfarin to reach a therapeutic level. Protamine sulfate is used to reverse the action of heparin in the setting of heparin overdose. Intravenous heparin is contraindicated in a patient currently taking oral warfarin in an outpatient setting. Since the INR is sub-therapeutic, the warfarin dose would not be held.

The nurse is teaching a patient about therapy with anticoagulants. What is essential information to include in the teaching plan?
1
Anticoagulants dissolve clots.
2
Anticoagulants alter platelet function.
3
Anticoagulants prevent clots from forming.
4
Anticoagulants interfere with drug metabolism

3
The patient needs to understand that anticoagulants will prevent new clots from forming but will not dissolve clots that are already formed. Anticoagulants inhibit clotting by acting on clotting factors and do not alter platelets or drug metabolism.

The nurse who is caring for a patient with a myocardial infarction informs the patient that "This drug will increase the contractions of your heart." Which drug has been prescribed to the patient?
1
Carvedilol (Coreg)
2
Digoxin (Lanoxin)
3
Verapamil (Verelan)
4
Metoprolo (Lopressor)

2
Digoxin (Lanoxin) is a cardiac glycoside that acts as a positive inotropic drug by increasing myocardial contractility. Carvedilol (Coreg) is a beta blocker that acts as a negative inotropic drug that reduces the force of contractions. Verapamil (Verelan) is a calcium channel blocker that is a negative inotropic drug. Metoprolol (Lopressor) is a beta blocker that reduces myocardial contractility and thus is a negative inotropic drug.

The nurse is assessing a pregnant woman with swollen and bulging veins in the legs. The condition is confirmed as deep vein thrombosis. Which anticoagulant drug will alleviate this patient's condition?
1
Lepirudin (Refludan)
2
Warfarin (Coumadin)
3
Dabigatran (Pradaxa)
4
Enoxaparin sodium (Lovenox)

4
Heparin drugs do not cross the placental barrier and are therefore safe for pregnant women to use if the potential benefits are warranted. Enoxaparin sodium (Lovenox) is a low-molecular-weight heparin anticoagulant that is a pregnancy category B drug and can be safely used to treat deep vein thrombosis in a pregnant woman. Lepirudin (Refludan) is also a pregnancy category B drug that can be safely used to treat thrombosis due to heparin-induced thrombocytopenia in a pregnant woman. Warfarin (Coumadin) is a pregnancy category X drug and is not safe in pregnant women. Dabigatran (Pradaxa) is a pregnancy category C drug that can be safely used with caution to prevent stroke and atrial fibrillation in a pregnant woman.

The registered nurse is teaching a nursing student about the assessments to be made before a patient undergoes anticoagulant drug therapy. Which statement made by the student nurse indicates the need for further teaching?
1
"I will examine the patient for epistaxis and petechiae."
2
"I will gather the patient's history of herbal medication."
3
"I will develop a flow chart with prothrombin time and drug dose."
4
"I will check for a history of any genetic disorder such as hemophilia."

1
Epistaxis and petechiae are observed in a patient who is undergoing anticoagulant therapy. Examining the patient for epistaxis and petechiae is not the correct assessment before anticoagulant therapy. It is done to monitor the patient for any internal or external bleeding. The patient's history of herbal medication should be gathered before administering the drug because a few herbal medicines are contraindicated with warfarin (Coumadin) drug therapy. A flow chart with prothrombin time and drug doses should be developed as a baseline before administering the drug. Warfarin is contraindicated in a patient with a history of a genetic disorder such as hemophilia.

A patient is prescribed digoxin (Lanoxin) to treat heart failure. Which biochemical parameter is to be assessed to ensure safe drug administration?
1
Liver enzyme concentration
2
Blood glucose concentration
3
Serum calcium concentration
4
Serum potassium concentration

4
Digoxin (Lanoxin) is a cardiac glycoside. The serum potassium concentration is assessed before digoxin (Lanoxin) is administered because low concentrations of potassium (hypokalemia) may precipitate digoxin (Lanoxin) toxicity. Digoxin (Lanoxin) does not have any effect on liver enzymes, blood glucose, and serum calcium. Therefore assessment of these parameters is not necessary before administering digoxin (Lanoxin).

A patient's serum digoxin level is noted to be 0.4 ng/mL. What is the nurse's priority action?
1
Administer potassium
2
Hold future digoxin doses
3
Call the health care provider
4
Administer the ordered dose of digoxin

4
Therapeutic serum digoxin levels are 0.5 to 2 ng/mL. The patient should receive the next dose to bring the level into therapeutic range. Because the dose is in the therapeutic range, it is not necessary to hold future doses. Potassium should never be given without documented potassium deficiency. The level is therapeutic, so the health care provider does not need to be notified.

A patient taking warfarin (Coumadin) asks for an aspirin for a headache. What is the nurse's best action?
1
Teach the patient about the potential drug interactions with anticoagulants.
2
Explain that the headache is an expected side effect and will subside shortly.
3
Administer 650 mg of acetylsalicylic acid (ASA) and reassess pain in 30 minutes.
4
Explain to the patient that ASA is contraindicated and administer ibuprofen as ordered.

1
Patients taking an anticoagulant should not use medications that would further increase the risk of bleeding, which include aspirin as well as ibuprofen. Aspirin should not be administered to the patient taking other anticoagulants, unless it is ordered specifically as a low-dose daily therapy. Ibuprofen is not the best choice of medication for the patient receiving Coumadin. Tylenol (acetaminophen) would be preferred for pain relief. Headache is not an expected side effect of Coumadin therapy.

The patient is scheduled to receive argatroban (Argatroban). Which is the correct route by which to administer the drug?
1
Intradermal
2
Intravenous
3
Intramuscular
4
Subcutaneous

2
Argatroban, which has the same trade name, is given only by the intravenous route.

What are the therapeutic effects of digoxin (Lanoxin)?
1
Positive inotropic, positive chronotropic, and negative dromotropic
2
Positive inotropic, negative chronotropic, and positive dromotropic
3
Positive inotropic, negative chronotropic, and negative dromotropic
4
Negative inotropic, negative chronotropic, and negative dromotropic

3
Digoxin (Lanoxin) increases cardiac contractility (positive inotropic effect), decreases heart rate (negative chronotropic effect), and decreases conductivity (negative dromotropic effect). The other options are not applicable.

The nurse recognizes which drug as a Class III antidysrhythmic?
1
Atenolol
2
Lidocaine
3
Verapamil
4
Amiodarone

4
Class III drugs, such as amiodarone, prolong repolarization in phase 3. Verapamil is a class IV calcium channel blocker that depresses phase 4 depolarization. Lidocaine is a class I membrane-stabilizing antidysrhythmic. Atenolol is a class II beta blocker that depresses phase 4 of depolarization.

A patient is receiving warfarin (Coumadin) for a chronic condition. Which patient statement requires immediate action by the nurse?
1
"I will avoid contact sports."
2
"I will take my medication at the same time each day."
3
"I will increase dark-green, leafy vegetables in my diet."
4
"I will contact my health care provider if I develop excessive bruising."

3
Dark-green, leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Rather than increase the intake of these, it is important to maintain a consistent daily intake of vitamin K. The patient should monitor his or her incidence of bruising carefully. The medication will usually be ordered to be taken at the same time each day.

Cilostazol (Pletal) belongs to which drug class?
1
Antiplatelet
2
Thrombolytic
3
Anticoagulant
4
Antifibrinolytic

1
Cilostazol is an antiplatelet drug, which works through inhibition of type 3 phosphodiesterase in the platelets and primarily lower-extremity blood vessels.

Which side effect is associated with the use of nitroglycerin (Nitrostat)?
1
Diplopia
2
Anorexia
3
Diaphoresis
4
Abdominal pain

3
Nitroglycerin (Nitrostat) is an antianginal drug that causes diaphoresis as a side effect. Diplopia, anorexia, and abdominal pain are side effects associated with the use of digoxin (Lanoxin).

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Which medication should not be given to a patient on anticoagulant therapy?

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