Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is reviewing the medication list of a client who is prescribed dabigatran and has a history of peptic ulcer disease. The nurse should recognize that which of the following medications can increase the risk of bleeding in this client?
A. Omeprazole
Omeprazole is a proton pump inhibitor (PPI) that reduces the production of stomach acid. Dabigatran is an anticoagulant that prevents blood clots from forming. Both drugs can increase the risk of bleeding in the gastrointestinal tract, especially in clients with peptic ulcer disease.Therefore, they should not be used together unless absolutely necessary.
B. Ranitidine
Ranitidine is wrong because ranitidine is a histamine-2 receptor antagonist (H2RA) that also reduces the production of stomach acid, but to a lesser extent than PPIs.Ranitidine does not interact significantly with dabigatran and does not increase the risk of bleeding.
C. Sucralfate
Sucralfate is wrong because sucralfate is a mucosal protectant that forms a barrier over ulcers and protects them from acid and enzymes.Sucralfate does not affect the coagulation system and does not increase the risk of bleeding.
D. Misoprostol.
Misoprostol is wrong because misoprostol is a synthetic prostaglandin that inhibits gastric acid secretion and increases bicarbonate and mucus production. Misoprostol is used to prevent ulcers in clients who take NSAIDs, which can cause ulcers and bleeding. Misoprostol does not interact with dabigatran and does not increase the risk of bleeding.
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Full Explanation
Omeprazole is a proton pump inhibitor (PPI) that reduces the production of stomach acid.
Dabigatran is an anticoagulant that prevents blood clots from forming.
Both drugs can increase the risk of bleeding in the gastrointestinal tract, especially in clients with peptic ulcer disease. Therefore, they should not be used together unless absolutely necessary.
Choice B. Ranitidine is wrong because ranitidine is a histamine-2 receptor antagonist (H2RA) that also reduces the production of stomach acid, but to a lesser extent than PPIs. Ranitidine does not interact significantly with dabigatran and does not increase the risk of bleeding.
Choice C. Sucralfate is wrong because sucralfate is a mucosal protectant that forms a barrier over ulcers and protects them from acid and enzymes. Sucralfate does not affect the coagulation system and does not increase the risk of bleeding.
Choice D. Misoprostol is wrong because misoprostol is a synthetic prostaglandin that inhibits gastric acid secretion and increases bicarbonate and mucus production.
Misoprostol is used to prevent ulcers in clients who take NSAIDs, which can cause ulcers and bleeding.
Misoprostol does not interact with dabigatran and does not increase the risk of bleeding.
Similar Questions
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.
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.
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).