Pharmacology Ch27,28,29,30, Review questions

The client is prescribed digoxin (Lanoxin) for treatment of HR. Which of the following statements by the client indicates the need for further teaching by the nurse?

a) "I may feel tired during early treatment."
b) "I should not get short of breath anymore."
c) "This drug will help my heart muscle pump less."
d) "I may notice my heart rate decrease."

c

Rationale: The ability to increase the strength of contractions is a characteristic of cardiac glycosides. It may result in a decrease in pulse. Initially the client may experience some fatigue. Symptoms of CHF, such as dyspnea, should improve.

The nurse reviews lab studies of a client receiving digoxin (Lanoxin). Intervention by the nurse is required if the results include a

a) Serum sodium level of 140 mEq/L.
b) Hemoglobin 14.4 g/dL.
c) Serum potassium level of 3.0 mEq/L.
d) Serum digoxin level of 1.2 ng/dL.

c

Rationale: For each of the drug classes listed in Drugs at a Glance, know representative drug examples and explain their mechanisms of action, primary actions, and important adverse effects.

A client with heart failure has an order for lisinopril (Prinivil, Zestril). Which of the following conditions in the client's history would lead the nurse to confirm the order with the provider?

1. A history of hypertension previously treated with diuretic therapy.
2. A history of seasonal allergies currently treated with antihistamines.
3. A history of angioedema after taking enalapril (Vasotec)
4. A history of alcoholism, currently abstaining

3

Rationale: Angioedema is a rare but potentially serious adverse effect from ACE inhibitors; because this client has had a previous reaction to another drug within the same group (enalapril/Vasotec), the nurse should confirm the order with the provider.

The teaching plan for a client receiving hydralazine (Apresoline) should include which of the following points?

1. Returning for monthly urinalysis testing
2. Including citrus fruits, melons, and vegetables in the diet
3. Decreasing potassium rich food in the diet
4. Rising slowly to standing from a lying or sitting position

4

Rationale: Hydralazine (Apresoline) commonly causes orthostatic hypotension and the client should be taught to rise slowly from a lying or sitting position to standing.

Lisinopril (Prinivil) is part of the treatment regimen for a client with HF. The nurse monitors the client for the development of which of the following adverse effects of this drug? (Select all that apply.)

1. Hyperkalemia
2. Hypocalcemia
3. Cough
4. Dizziness
5. Heartburn

1,3, and 4
(check the answer for hypocalcemia)

Rationale: Common adverse effects of lisinopril (Prinvil) and other ACE inhibitors include cough, headache, dizziness, change in sensation of taste, comiting and diarrhea, and hypotension. Hyperkalemia may occur, especially when the drug is taken concurrently with potassium-sparing diuretics.

The client who has not responded well to other therapies has been prescribed milrinone (Primacor) for treatment of his heart failure. What essential assessment must the nurse make before starting this drug?

1. Weight and presence of edema
2. Dietary intake of sodium
3. Electrolytes, especially potassium
4. History of sleep patterns and presence of sleep apnea

3

Rationale: Electrolytes, especially potassium for the presence of hypokalemia, should be assessed before beginning milrinone (Primacor) or any phosphodiesterase inhibitory. Hypokalemia should be corrected before administering phosphodiesterase inhibitors because this can increase the likelihood of dysrhythmias.

A client with congestive heart failure, CHF, is prescribed digoxin (Lanoxin) and furosemide (Lasix). Nursing interventions will include: (Select all that apply.)

a) Monitor serum electrolytes.
b) Restrict intake of green, leafy vegetables.
c) Encourage intake of water and fruit juices.
d) Monitor hemoglobin and hematocrit levels.
e) Checking apical pulse before administering medication.

a and e

Rationale: Digoxin is a cardiac glycoside. which can slow heart rate, and an apical heart rate is checked prior to administration. Lasix is a loop diuretic used in treatment of CHF, which promotes not only water loss, but also loss of electrolytes. A low potassium level increases risk of digoxin toxicity. Fluids are often restricted with CHF. H and H level do not need to be checked, and green, leafy vegetables would not need to be restricted.

The client is prescribed captopril (Capoten) for treatment of HF. The nurse teaches that the primary action of the drug is to

a) Lower peripheral resistance and reduce blood volume.
b) Increase heart rate.
c) Increase strength of ventricular contractions.
d) Prevent influx of calcium.

a

Rationale: ACE inhibitors decrease peripheral resistance and reduce blood volume by enhancing the excretion of sodium and water. This results in decreased afterload and increased cardiac output.

A client is being started on lisinopril (Zestril). Nursing interventions during initial therapy with this medication must include

a) Monitoring intake and output.
b) Monitoring blood pressure.
c) Monitoring EKG.
d) Monitoring serum levels.

b

Rationale: Lisinopril is an ACE inhibitor, which can cause severe hypotension with initial doses. The nurse should monitor the client closely for several hours.

The nurse developing a teaching plan for a client receiving thiazide diuretics should include the following.

a) Teaching the client to check blood pressure t.i.d.
b) Including citrus fruits, melons, and vegetables in the diet.
c) Teaching the client to take apical pulse.
d) Decreasing potassium-rich foods in the diet.

b

Rationale: Thiazide diuretics are potassium wasting, and levels should be closely monitored. Encouraging foods rich in potassium could help maintain potassium levels. Taking an apical pulse is indicated before administering cardiac glycosides and beta blockers. It would not be necessary to check blood pressure TID unless the client was experiencing hypotension.

The client is prescribed a beta-blocker as adjunct therapy to treatment of heart failure. The nurse recognizes that beta blockers act by

a) Slowing the heart and decreasing afterload.
b) Decreasing preload.
c) Increasing contractility and cardiac output.
d) Decreasing peripheral resistance.

a

Rationale: Beta-blockers improve symptoms of HF by slowing heart rate and decreasing blood pressure. The decreased afterload causes decreased workload on the heart.

Lisinopril (Prinivil) is part of the treatment regimen for a client with HF. The nurse monitors the client for which electrolyte imbalance of this drug?

a) Hyperkalemia
b) Hypernatremia
c) Hypokalemia
d) Hyponatremia

a

Rationale: ACE inhibitors block aldosterone secretion, which results in sodium loss and potassium retention. Hyperkalemia may occur, especially when the drug is taken concurrently with potassium-sparing diuretics.

When caring for a client receiving triamterene (Dyrenium), the nurse places priority on which nursing intervention?

a) Monitor heart rate closely.
b) Monitor electrolytes for hypernatremia.
c) Monitor blood pressure closely.
d) Monitor electrolytes for hyperkalemia.

d

Rationale: Dyrenium is a potassium-sparing diuretic. The client should be monitored for signs of hyperkalemia. Hyponatremia, not hypernatremia may occur. BP and heart rate should be monitored, but are not priority with this drug.

The client is prescribed digoxin (Lanoxin) for treatment of HF. Which of the following statements by the client indicates the need for further teaching?

1. "I may notice my heart rate decrease."
2. "I may feel tired during early treatment."
3. "This drug should cure my heart failure."
4. "My energy level should gradually improve."

3

Rationale: Digoxin helps increase the contractility of the heart, this increasing cardiac output. But it is not a cure for heart failure, only a treatment option.

The nurse reviews laboratory studies of a client receiving digoxin (Lanoxin). Intervention by the nurse is required if the results include which of the following laboratory values?

1. Serum digoxin level of 1.2 ng/dL.
2. Serum potassium level of 3 mEq/L
3. Hemoglobin of 14.4 g/dL
4. Serum sodium level of 140 mEq/L.

2

Rationale: Normal serum potassium level is 3.5 to 5 mEq/L. Hypokalemia may predispose the client to digitalis toxicity.

The client's serum digoxin level is 2.2 ng/dL and the heart rate is 120 and irregular. The nurse expects to administer which of the following drugs?

Digoxin immune Fab (Digibind)
Furosemide (Lasix) 60 mg I.V.
Digoxin 0.5 mg bolus I.V.
Potassium 40 mEq added to I.V. fluids

Digoxin immune Fab (Digibind)

Rationale: Digibind binds and removes digoxin from the body and prevents toxic effects of digoxin overdose. A serum level of 2.2 is elevated, and the client is exhibiting signs of digoxin toxicity. The question does not indicate that the potassium level is low. Giving additional digoxin would exacerbate the toxicity. Giving Lasix may reduce potassium levels and contribute to increased toxicity.

The nurse includes the definition of HF in the teaching plan for the client. An accurate description of the mechanism of HF is that [Hint]

there is too much fluid in the heart.
the heart cannot get oxygen.
the heart is unable to pump effectively.
there is too much fluid in the lungs.

the heart is unable to pump effectively.

A client with HF has an order for lisnopril (Prinivil, Zestril) Which of the following conditions in the client's history would lead a nurse to confirm the order with the provider?
1. A history of HT previously treated with diuretics.
2. A history of seasonal allergies currently treated with antihistamines.
3. A history of angioedema after taking enalapril (Vasotec)
4. A history of alcoholism, currently abstaining.

A history of angioedema after taking enalapril (Vasotec)

A nurse in a provider's office is monitoring serum electrolytes for 4 older adult clients who take digoxin(Lanoxin) & furosemide(Lasix). Which of the following electrolyte values puts a client at risk for dig toxicity?
1. Calcium 9.2 mg/dL
2. Calcium 10.3 mg/dL
3. Potassium 3.4 mEq/L
4. Potassium 4.8 mEq/L

3. Potassium 3.4 mEq/L

A nurse is caring for an older adult client who has a new prescription for digoxin and takes multiple other medications. concurrent use of which of the following medications places the client at risk for dig toxicity?
1. Phenytoin (Dilantin)
2. Verapamil (Calan)
3. Warfarin (Coumadin)
4. Aluminum hydroxide (Amphojel)

2. Verapamil (Calan) -- CCB, can increase digoxin levels. if used together dig dosage may need to be lowered.

A nurse is administering a dopamine infusion at a moderate dose to a client who has severe HF. Which of the following is an expected effect?
1. Lowered heart rate
2. Increased myocardial contractility
3. Decreased conduction through the AV node
D. Vasoconstriction of the renal blood vessels

2. Increased myocardial contractility -- thus increasing CO

A nurse is providing teaching to a client who has a new prescription for digoxin (Lanoxin) Which of the following may indicate dig toxicity & should be reported to the provider?
1. Fatigue
2. constipation
3. Anorexia
4. Rash
5. Diplopia

1. Fatigue
Not constipation but -- nausea, vomiting & diarrhea
3. Anorexia b/c GI disturbances
5. Diplopia -- visual changes , halo, yellow-tinged vision.

A nurse is monitoring the digoxin level for a client who has been taking a daily dose of digoxin for 1 month. the digoxin level is 0.25 ng/mL. The nurse should notify the provider and anticipate which of the following:
1. An increase in the client's digoxin dose.
2. A decrease in the client's digoxin dose.
3. No change in the client's digoxin dose.
4. Dicontinuation of the client's digoxin dose.

1. An increase in the client's digoxin dose.

The client is admitted with a diagnosis of angina caused by coronary arteriospasms. The nurse recognizes that this type of angina is classified as:

a) Vasospastic angina.
b) Unstable angina.
c) Stable angina.
d) Classic angina.

a

Rationale: Angina that is fairly predictable is classic or stable angina. Intense, frequent episodes mark unstable angina. Vasospastic angina occurs when ischemia is present due to coronary arteriospasms.

The nurse teaches the client that the major difference between angina and pain associated with myocardial infarction (MI) is that:

a) Angina can be fatal.
b) Myocardial infarction pain always radiates to the left arm or jaw.
c) Angina is relieved with nitroglycerin and rest.
d) Both types of pain are treated the same.

c

Rationale: Angina pain is uncomfortable, but it rarely is fatal. It usually is relieved immediately by nitroglycerin. Pain from a myocardial infarction does not always radiate to the jaw or arm. Angina pain is treated differently than MI pain.

The teaching plan for a client being started on long-acting nitroglycerin includes the action of this drug. The nurse teaches that this drug relieves chest pain by which action?

a) Dilating just the coronary arteries
b) Decreasing the blood pressure
c) Dilating arteries and veins
d) Increasing contractility of the heart

c

Rationale: Organic nitrates relax both arterial and venous smooth muscle. This in turn decreases myocardial oxygen demand by decreasing heart rate, decreasing preload, decreasing contractility, and decreasing afterload. The blood pressure might decrease secondary to venous vasodilation, but this is not the primary way in which angina is relieved.

The nurse recognizes that the ability of organic nitrates to dilate coronary arteries is most effective for treating ____________________.

vasospastic.

Rationale: Dilation of coronary arteries is no longer considered the primary mechanism of nitrate action in stable angina. It is important in variant angina, in which chest pain is caused by coronary artery spasm. The drug can relax the spasms and terminate the pain.

The nurse cautions the client receiving isosorbide dinitrate for treatment of angina that long-term use can lead to the development of:

a) Tolerance.
b) Tachycardia.
c) Hypotension.
d) Urinary retention.

a

Rationale: Tolerance is a common problem with the use of longer-acting organic nitrates. Clients often are instructed to remove the transdermal patch for 6-12 hours each day in order to delay development of tolerance to the drug.

The nurse prepares discharge teaching for a client receiving isosorbide dinitrate for treatment of angina. What information must the nurse include?

a) Monitor intake and output.
b) Report skin flushing to the physician.
c) Limit exercise to 30 minutes twice per week.
d) Avoid alcohol consumption.

d

Rationale: Alcohol intake has additive vasodilation effect. Concurrent use could cause severe hypotension and cardiovascular collapse. Exercise does not need to be limited to twice a week. It is not necessary to monitor I & O. Flushing occurs with nitroglycerin.

The nurse recognizes that the mechanism for action of beta-adrenergic blockers in the treatment of angina is:

a) Positive inotropic effect.
b) Antidysrhythmia.
c) Positive chronotropic effect.
d) Negative inotropic effect.

d

Rationale: Beta blockers decrease the workload of the heart by slowing heart rate (negative chronotropic effect) and reducing contractility (negative inotropic effect).

What does the nurse include in the teaching plan for a client receiving a beta blocker for treatment of angina?

a) Discontinue drug if heart rate < 60.
b) Do not discontinue drug abruptly.
c) Monitor for hyperglycemia.
d) Exercise heart rate should be 110-120.

b

Rationale: Beta blocker treatment should never be abruptly discontinued. With abrupt cessation, a rebound excitation occurs, and adrenergic receptors are stimulated. This can exacerbate angina, increase heart rate, and cause myocardial infarction. Clients often tolerate heart rates as low as 50. The beta blocker might blunt the compensatory increase in heart rate with exercise. Hypoglycemia can occur.

The nurse recognizes that calcium channel blockers prescribed for treatment of angina exert their effect by:

a) Positive chronotropic effect.
b) Decreasing afterload.
c) Increasing preload.
d) Positive inotropic effect.

b

Rationale: Calcium channel blockers cause arteriolar smooth muscle relaxation, leading to lowered peripheral resistance and decreased blood pressure (decreased afterload). This decreases myocardial oxygen demand and reduces frequency of anginal pain.
Cognitive Level: Comprehension

The nurse determines that treatment of a client with a beta-adrenergic blocker for myocardial infarction has been effective when:

a) Tachycardia occurs.
b) Decreased urinary output occurs.
c) Blood pressure is 90/50.
d) Decreased dysrhythmias occur.

d

Rationale: Beta blockers have the ability to decrease heart rate, decrease contractility, and decrease blood pressure, leading to decreased oxygen demand. They also slow conduction, which suppresses dysrhythmias. Tachycardia would not be desired with an MI. A low BP alone would not indicate effective treatment of the MI.

The client is being discharged with nitroglycerin (Nitrostat) for sublingual use. While planning client education, what instruction will the nurse include?

1. "Swallow three tablets immediately for pain and call 911."
2. "Put one tablet under your tongue for chest pain. If pain does not subside, you may repeat in 5 minutes, taking no more than 3 tablets."
3. "Call your health care provider when you have chest pain. He will tell you how many tablets to take."
4. "Place three tablets under your tongue and call 911."

2

Rationale: At the initial onset of chest pain, sublingual nitroglycerin is administered and three doses may be taken 5 minutes apart. Pain that persists 5 to 10 minutes after the initial dose may indicate an MI, and the client should seek emergency medical assistance for more definitive diagnosis and care.

Nitroglycerin patches have been ordered for a client with a history of angina. What teaching will the nurse give to this client?

1. Keep the patches in the refrigerator.
2. Use the patches only if the chest pain is severe.
3. Remove the old patch before applying a new one.
4. Apply the patch only to the upper arm or thigh areas.

3

Rationale: To prevent the development of nitrate tolerance, nitroglycerin patches are often removed at night for 6 to 12 hours.

Which of the following assessment findings in a client who is receiving atenolol (Tenormin) for angina would be cause for the nurse to hold the drug and contact the provider? (Select all that apply.)

1. Heart rate of 50 beats/minute.
2. Heart rate of 124 beats/minute.
3. Blood pressure 86/56.
4. Blood pressure 156/88.
5. Tinnitus and vertigo

1 and 3

Rationale: Atenolol (Tenormin) decreases blood pressure and heart rate. The administration of this drug may cause significant hypotension and bradycardia in some clients,

The nurse is caring for a client with chronic stable angina who is receiving isosorbide dinitrate (Isordil). Which of the following are common adverse effects of isosorbide?

1. Flushing and headache
2. Tremors and anxiety
3. Sleepiness and lethargy
4. Light-headedness and dizziness

4

Rationale: Lightheadedness and dizziness may occur secondary to the hypotensive effects of the isosorbile (Isordil).

Place the following nursing interventions in order for a client who is experiencing chest pain.

1. Administer nitroglycerin sublingually.
2. Assess heart rate and blood pressure.
3. Assess the location, quality, and intensity of pain.
4. Document interventions and outcomes.
5. Evaluate the location, quality, and intensity of pain.

3, 2, 1, 5, (2), 4

Rationale: Prior to administering nitrates for chest pain, the nurse must first assess the location, quality, and intensity of pain. Blood pressure and heart rate should be assessed and the health care provider contacted if the blood pressure is below 90/60 (or below previously established parameters) or if tachycardia is present before administering the dose. Once nitrates are administered, the location, quality, and intensity of the pain are evaluated after 5 minutes. If the pain is still present, the blood pressure and pulse should be reassessed before giving another dose (the second (2) above). Documentation of drug administration and client outcomes is completed after administration and re-evaluation.

Erectile dysfunction drugs such as sildenafil (Viagra) are contraindicated in clients taking nitrates for angina. What is the primary concern with concurrent administration of these drugs?

1. They contain nitrates, resulting in an overdose.
2. They decrease blood pressure and may result in prolonged and sever hypotension when combined with nitrates.
3. They will adequately treat the patient's angina as well as erectile dysfunction.
4. They will increase the possibility of nitrate tolerance developing and should be avoided unless other drugs can be used.

2

Rationale: Erectile dysfunction drugs such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) decrease BP. When combined with nitrates, severe and prolonged hypotension may result.

29. 1 A client with type 1 diabetes on insulin therapy reports that he takes propranolol (Inderal) for his hypertension. The nurse will teach the client to check glucose levels more frequently because of what concern?

1. The propranolol can produce insulin resistance.
2. The two drugs used together will increase the risk of ketoacidosis.
3. Propranolol will increase insulin requirements by antagonizing the effects at the receptors.
4. The propranolol may mask symptoms of hypoglycemia.

The propranolol may mask symptoms of hypoglycemia

When monitoring for therapeutic effect of any antidysrhythmic drug, the nurse would be sure to assess which essential parameter?

1. Pulse
2. Blood pressure
3. Drug level
4. Hourly urine output

1. Pulse

Verapamil (Calan, Covera-HS, Verelan) should be used with extra caution or is contraindicated in clients with which cardiovascular condition?

1. Hypertension
2. Tachycardia
3. Heart failure
4. Angina

3. Heart failure

Common adverse effects of antidysrhythmic medications include which of the following? (Select all that apply.)

1. Hypotension
2. Hypertension
3. Dizziness
4. Weakness
5. Panic attacks

1. Hypotension
3. Dizziness
5. Panic attacks

A client was admitted from the emergency department after receiving treatment for dysrhythmias and will be started on amiodarone (Cordarone, Pacerone) because of lack of therapeutic effects from his other antidysrhythmic therapy. When the nurse checks with him in the afternoon, he complains of feeling light-headed and dizzy. What will the nurse assess first?

1. Whether there is the possibility of sleep deprivation from the stress of admission to the hospital
2. Whether an allergic reaction is occurring with anticholinergic-like symptoms
3. Whether the amiodarone level is not yet therapeutic enough to treat the dysrhythmias
4. Whether the client's pulse and blood pressure are within normal limits.

4. Whether the client's pulse and blood pressure are within normal limits.

A client is given a prescription for propranolol (Inderal) 40 mg bid. What is the most important instruction the nurse should give to this client?

1. Take this medication on an empty stomach, as food interferes with its absorption.
2. Do not stop taking this medication abruptly; the dosage must be decreased gradually if it is discontinued.
3. If the client experiences any disturbances in hearing, the client should notify the health care provider immediately.
4. The client may become very sleepy while taking this medication; do not drive.

2. Do not stop taking this medication abruptly; the dosage must be decreased gradually if it is discontinued.

A client with deep venous thrombosis (DVT) is receiving an infusion of heparin and will be started on warfarin (Coumadin) soon. While the client is receiving heparin, what laboratory test will provide the nurse with information about its therapeutic effects?

1. Prothrombin time (PT)
2. International Normalized Ratio (INR)
3. Activated partial thromboplastin time (aPTT)
4. Platelet count

3. Activated partial thromboplastin time (aPTT)

The client receiving heparin therapy asks how the "blood thinner" works. What is the best response by the nurse?

1. "Heparin makes the blood less thick."
2. "Heparin does not thin the blood but prevents clots from forming as easily in the blood vessels."
3. "Heparin decreases the number of platelets so that blood clots more slowly."
4. "Heparin dissolves the clot."

2. "Heparin does not thin the blood but prevents clots from forming as easily in the blood vessels.

What client education should be included for a client receiving enoxaparin (Lovenox)? (Select all that apply.)

1. Teach the client or family to give subcutaneous injections at home.
2. Teach the client or family not to take any OTC drugs without first consulting with the health care provider.
3. Teach the client to observe for unexplained bleeding such as pink, red, or dark brown urine or bloody gums.
4. Teach the client to monitor for the development of DVT.
5. Teach the client about the importance of drinking grapefruit juice daily.
1234

1. Teach the client or family to give subcutaneous injections at home.
2. Teach the client or family not to take any OTC drugs without first consulting with the health care provider.
3. Teach the client to observe for unexplained bleeding such as pink, red, or dark brown urine or bloody gums.
4. Teach the client to monitor for the development of DVT.

A client with a congenital coagulation disorder is given aminocaproic acid (Amicar) to stop bleeding following surgery. The nurse will carefully monitor this client for development of which of the following adverse effects? (Select all that apply.)

1. Anaphylaxis
2. Hypertension
3. Hemorrhage
4. Headache
5. Hypotension

1. Anaphylaxis
4. Headache
5. Hypotension

A client is receiving a thrombolytic drug, alteplase (Activase), following an acute myocardial infarction. Which of the following effects is most likely attributed to this drug?

1. Skin rash with urticaria
2. Wheezing with labored respirations
3. Bruising and epistaxis
4. Temperature elevation of 100.8 °F

3. Bruising and epistaxis

A client has started clopidogrel (Plavix) after experiencing a transient ischemic attack (TIA). What is the desired therapeutic effect of this drug?

1. Anti-inflammatory and antipyretic effects
2. To reduce the risk of a stroke from a blood clot
3. Analgesic as well as clot-dissolving effects
4. To stop clots from becoming emboli

2. To reduce the risk of a stroke from a blood clot

The client develops blood loss due to a ruptured blood vessel in the leg. The coagulation process is initiated through:

a) The platelet meshwork.
b) The clotting cascade.
c) The intrinsic pathway.
d) The extrinsic pathway.

c

Rationale: The intrinsic pathway is activated in response to injury. The extrinsic pathway is activated when blood leaks out of a vessel and enters tissue spaces.

The nurse's understanding of the clotting mechanism is important in administering anticoagulant drugs. The nurse understands that which of the following clotting factors are formed after injury to the vessels?

a) Fibrin and vitamin K
b) Prothrombin and thrombin
c) Thrombin and fibrin
d) Thromboplastin and fibrinogen

c

Rationale: Prothrombinase converts prothrombin to thrombin. Thrombin then converts fibrinogen to long strands of fibrin, which provides a framework for structure of the clot. Thrombin and fibrin are formed only after the injury occurs. Fibrin strands form an insoluble web over the injured area to stop blood loss.

The client receiving heparin therapy asks how the "blood thinner" works. The best response by the nurse would be:

a) "Heparin dissolves the clot."
b) "Heparin does not thin the blood, but prevents platelets from clumping."
c) "Heparin decreases the number of platelets so that blood clots slower."
d) "Heparin makes the blood less viscous."

b

Rationale: Anticoagulants do not change the viscosity of the blood. Instead, anticoagulants exert a negative charge on the surface of the platelets so that clumping or aggregation of cells is inhibited.

Nursing interventions for a client receiving enoxaparin (Lovenox) may include:

a) Teaching to observe for excessive bleeding.
b) Monitoring for development of deep vein thrombosis.
c) Teaching the client or family to give subcutaneous injections at home.
d) Monitoring multiple lab tests.

c

Rationale: Lovenox is a low-molecular-weight heparin. This class of drug has fewer side effects and is less likely to cause thrombocytopenia. Family and/or clients can be taught to give subcutaneous injections at home.

The nurse explains the action of pentoxifylline (Trental) to the client. The drug acts by:

a) Increasing platelet production.
b) Decreasing platelet aggregation.
c) Dissolving clots.
d) Reducing the viscosity of red blood cells.

d

Rationale: Trental acts on red blood cells to decrease their viscosity and increase their flexibility, allowing them to enter vessels that are partially occluded and prevent thrombi formation.

The nurse completes a physical assessment on the client receiving heparin therapy for DVT. The client complains of severe lumbar pain. The appropriate action by the nurse is to:

a) Reposition the client to promote comfort.
b) Document the finding, and report it to the next shift.
c) Administer pain medication.
d) Evaluate further; this could indicate a complication of drug therapy.

d

Rationale: A major side effect of heparin is bleeding. Lumbar pain and unilateral abdominal wall bulges or swelling could indicate retroperitoneal hemorrhage.

The nurse receives the client's lab values throughout Coumadin drug therapy. The expected therapeutic level is:

a) APTT 1-2 times the client's baseline.
b) APTT 25-40 seconds.
c) INR 0.5-1.5.
d) PT 1-2 times the client's baseline.

d

Rationale: Prothrombin time (PT) is the lab test to monitor effectiveness of warfarin (Coumadin) therapy. During therapeutic anticoagulation, PT should increase to 1-2 times the client's baseline. PT also is reported as an international normalized ratio (INR). INR values of 2-3.5 are considered therapeutic.

The client is prescribed enoxaparin (Lovenox). The initial dosage of the drug is determined by:

a) The client's weight.
b) The INR.
c) The APTT.
d) The PT.

a

Rationale: Lovenox is a low-molecular-weight heparin. Dosage calculations are based on the client's weight rather than on lab values. The dose is recalculated each morning based on the daily weight.

Alteplase (Activase) is prescribed for a client with an acute myocardial infarction. Priority nursing action includes:

a) Monitoring PT, INR.
b) Monitoring APTT.
c) Monitoring level of consciousness (LOC).
d) Monitoring injection sites.

c

Rationale: Thrombolytics will dissolve any clots they encounter. Cerebral hemorrhage is a major concern, so the nurse must assess the level of consciousness and neurological status.

Warfarin (Coumadin) is prescribed to treat clotting following a surgery. Which of the following findings requires immediate nursing intervention?

a) INR of 3.0
b) Urinary output 1,000 ml/L/day
c) Positive Homans' sign
d) Tylenol (acetaminophen) prescribed for headache

c

Rationale: Changes in peripheral pulses, paresthesias, positive Homans' sign, and prominence of superficial veins indicate clotting occurring in peripheral arterial or venous vasculature. International Normalized Ratio is used to indicate therapeutic range, and 2.0 is indicative that therapy is adequate.