Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
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?
A. 2 hours
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.
B. 4 hours
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.
C. 6 hours
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.
D. 8 hours.
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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Full 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.
Similar Questions
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. Headache
The nurse should include headache and dyspnea as potential adverse effects of bivalirudin.According to the drug information from various sources, bivalirudin can cause common side effects such as headache, nausea, low or high blood pressure, chest pain, abdominal pain, and shortness of breath (dyspnea).
B. Fever
Fever is not a common side effect of bivalirudin. However, fever can be a sign of infection or an allergic reaction to the drug, which should be reported to the provider immediately.
C. Chest pain
Chest pain is not an adverse effect of bivalirudin, but rather a symptom of angina, which is one of the conditions that bivalirudin is used to treat. Chest pain can also indicate a heart attack or other serious cardiac problems, which require immediate medical attention.
D. Backache E.
Backache is not a common side effect of bivalirudin. However, backache can be a sign of bleeding in the kidneys or other organs, which can be a serious complication of bivalirudin therapy. Therefore, any unusual pain or swelling in the back or abdomen should be reported to the provider as soon as possible.
Full Explanation
The nurse should include headache and dyspnea as potential adverse effects of bivalirudin. According to the drug information from various sources, bivalirudin can cause common side effects such as headache, nausea, low or high blood pressure, chest pain, abdominal pain, and shortness of breath (dyspnea).
These side effects should be reported to the provider if they are severe or persistent.
Choice B is wrong because fever is not a common side effect of bivalirudin.
However, fever can be a sign of infection or an allergic reaction to the drug, which should be reported to the provider immediately.
Choice C is wrong because chest pain is not an adverse effect of bivalirudin, but rather a symptom of angina, which is one of the conditions that bivalirudin is used to treat.
Chest pain can also indicate a heart attack or other serious cardiac problems, which require immediate medical attention.
Choice D is wrong because backache is not a common side effect of bivalirudin.
However, backache can be a sign of bleeding in the kidneys or other organs, which can be a serious complication of bivalirudin therapy.
Therefore, any unusual pain or swelling in the back or abdomen should be reported to the provider as soon as possible.
The nurse is caring for a patient who has received alteplase [Activase]. It is most important for the nurse to take which action?
A. Avoid applying pressure to needleless access sites after giving medications.
Choice A is wrong because applying pressure to needleless access sites after giving medications is a standard precaution to prevent bleeding and infection. It is not specific to alteplase [Activase] therapy.
B. Monitor neurologic status every 15 minutes during and after infusion.
This is because alteplase [Activase] is a thrombolytic drug that dissolves blood clots and can cause bleeding complications, especially intracranial hemorrhage. Neurologic assessment is essential to detect any signs of bleeding in the brain, such as altered level of consciousness, headache, or focal deficits.
C. Administer heparin when partial thromboplastin time (PTT) is less than 70 seconds.
Choice C is wrong because administering heparin when partial thromboplastin time (PTT) is less than 70 seconds is not recommended for patients who have received alteplase [Activase]. Heparin is an anticoagulant that can increase the risk of bleeding and should be used with caution in patients who have received thrombolytic therapy. The PTT should be monitored closely and heparin should be withheld if the PTT is above the therapeutic range.
D. Give aspirin when platelet count is greater than 150,000/mm3.
Choice D is wrong because giving aspirin when platelet count is greater than 150,000/mm3 is not indicated for patients who have received alteplase [Activase]. Aspirin is an antiplatelet drug that can also increase the risk of bleeding and should be avoided in patients who have received thrombolytic therapy. The platelet count should be monitored closely and aspirin should be withheld if the platelet count is below the normal range (150,000 to 450,000/mm3).
Full Explanation
This is because alteplase [Activase] is a thrombolytic drug that dissolves blood clots and can cause bleeding complications, especially intracranial hemorrhage. Neurologic assessment is essential to detect any signs of bleeding in the brain, such as altered level of consciousness, headache, or focal deficits.
Choice A is wrong because applying pressure to needleless access sites after giving medications is a standard precaution to prevent bleeding and infection. It is not specific to alteplase [Activase] therapy.
Choice C is wrong because administering heparin when partial thromboplastin time (PTT) is less than 70 seconds is not recommended for patients who have received alteplase [Activase].
Heparin is an anticoagulant that can increase the risk of bleeding and should be used with caution in patients who have received thrombolytic therapy. The PTT should be monitored closely and heparin should be withheld if the PTT is above the therapeutic range.
Choice D is wrong because giving aspirin when platelet count is greater than 150,000/mm3 is not indicated for patients who have received alteplase [Activase].
Aspirin is an antiplatelet drug that can also increase the risk of bleeding and should be avoided in patients who have received thrombolytic therapy.
The platelet count should be monitored closely and aspirin should be withheld if the platelet count is below the normal range (150,000 to 450,000/mm3).
The patient has been receiving heparin therapy for deep vein thrombosis (DVT). The patient’s activated partial thromboplastin time (aPTT) result is 90 seconds (therapeutic range: 60-80 seconds). What will be included in patient care? (Select all that apply.).
A. Assessing for signs and symptoms of bleeding
A patient with a high aPTT result is at risk for bleeding, so assessing for signs and symptoms of bleeding is important.
B. Continuing heparin therapy at current rate
Choice B is wrong because continuing heparin therapy at the current rate will increase the risk of bleeding and further prolong the aPTT.
C. Decreasing heparin therapy per protocol
Choice C is wrong because decreasing heparin therapy per protocol is not enough to reverse the effects of heparin. Heparin should be stopped until the aPTT returns to the therapeutic range.
D. Holding heparin therapy per protocol
Holding heparin therapy per protocol is also appropriate, as heparin is the cause of the prolonged aPTT.
E. Increasing heparin therapy per protocol.
Choice E is wrong because increasing heparin therapy per protocol will worsen the situation and cause more bleeding and coagulation problems. The normal range for aPTT is 25 to 35 seconds, and the therapeutic range for heparin therapy is 60 to 80 seconds.A result of 90 seconds indicates excessive anticoagulation and increased bleeding risk.
Full Explanation
A patient with a high aPTT result is at risk for bleeding, so assessing for signs and symptoms of bleeding is important.
Holding heparin therapy per protocol is also appropriate, as heparin is the cause of the prolonged aPTT.
The other choices are wrong because:
• Choice B is wrong because continuing heparin therapy at the current rate will increase the risk of bleeding and further prolong the aPTT.
• Choice C is wrong because decreasing heparin therapy per protocol is not enough to reverse the effects of heparin.
Heparin should be stopped until the aPTT returns to the therapeutic range.
• Choice E is wrong because increasing heparin therapy per protocol will worsen the situation and cause more bleeding and coagulation problems.
The normal range for aPTT is 25 to 35 seconds, and the therapeutic range for heparin therapy is 60 to 80 seconds. A result of 90 seconds indicates excessive anticoagulation and increased bleeding risk.