Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A patient has been prescribed dabigatran (Pradaxa) for atrial fibrillation (AF). Which laboratory test should be monitored while on this medication?
A. Prothrombin time (PT)
Prothrombin time (PT) is wrong because PT measures the extrinsic and common pathways of coagulation, which are not affected by dabigatran. PT is used to monitor warfarin therapy, not dabigatran.
B. International normalized ratio (INR)
International normalized ratio (INR) is wrong because INR is a standardized version of PT that is used to monitor warfarin therapy, not dabigatran. INR is not affected by dabigatran.
C. Activated partial thromboplastin time (aPTT)
Activated partial thromboplastin time (aPTT). Dabigatran (Pradaxa) is a direct oral anticoagulant (DOAC) that inhibits thrombin, a key enzyme in the coagulation cascade. Dabigatran prolongs the aPTT, which is a measure of the intrinsic and common pathways of coagulation.The aPTT can be used to monitor the anticoagulant effect of dabigatran, although routine monitoring is not required.
D. Platelet count.
Platelet count is wrong because platelet count is a measure of the number of platelets in the blood, which are involved in primary hemostasis. Platelet count is not affected by dabigatran, which acts on secondary hemostasis.
E. Platelet count.
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Full Explanation
Activated partial thromboplastin time (aPTT).
Dabigatran (Pradaxa) is a direct oral anticoagulant (DOAC) that inhibits thrombin, a key enzyme in the coagulation cascade.
Dabigatran prolongs the aPTT, which is a measure of the intrinsic and common pathways of coagulation. The aPTT can be used to monitor the anticoagulant effect of dabigatran, although routine monitoring is not required.
Choice A) Prothrombin time (PT) is wrong because PT measures the extrinsic and common pathways of coagulation, which are not affected by dabigatran.
PT is used to monitor warfarin therapy, not dabigatran.
Choice B) International normalized ratio (INR) is wrong because INR is a standardized version of PT that is used to monitor warfarin therapy, not dabigatran.
INR is not affected by dabigatran.
Choice D) Platelet count is wrong because platelet count is a measure of the number of platelets in the blood, which are involved in primary hemostasis.
Platelet count is not affected by dabigatran, which acts on secondary hemostasis.
Normal ranges for these tests are:
• aPTT: 25 to 35 seconds
• PT: 11 to 13.5 seconds
• INR: 0.8 to 1.2
• Platelet count: 150,000 to 450,000 per microliter of blood
Similar Questions
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.
A. “Avoid activities that may cause injury.”
Apixaban can increase the risk of bleeding, so patients should be careful not to cut or bruise themselves. They should use a soft toothbrush, an electric razor, and avoid contact sports or other activities that may cause bleeding.They should also wear a medical alert bracelet or carry an identification card that states they are taking apixaban.
B. “Take medication with food.”
Apixaban can be taken with or without food.Taking it with food does not affect its absorption or efficacy.
C. “Report signs and symptoms of bleeding immediately.”
Patients should notify their doctor or seek emergency care if they have any signs of bleeding, such as unusual bruising, red or black stools, blood in the urine, coughing up blood, vomiting blood, nosebleeds, heavy menstrual bleeding, headaches, dizziness, weakness, or swelling.
D. “Monitor vital signs regularly.”
Apixaban does not affect blood pressure, heart rate, or oxygen saturation. Therefore, monitoring vital signs regularly is not required for patients taking apixaban.However, patients should still follow their doctor’s advice on how often to check their blood tests, such as hemoglobin, hematocrit, and platelets.
E. “Do not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs).”.
These drugs can also increase the risk of bleeding and interfere with the effects of apixaban. Patients should avoid taking aspirin, ibuprofen, naproxen, or other NSAIDs unless prescribed by their doctor.They should also check the labels of any over-the-counter medications or supplements they use and avoid those that contain aspirin or NSAIDs.
Full Explanation
Apixaban (Eliquis) is a blood thinner that prevents blood clots from forming or growing larger.
It is used to treat or prevent deep vein thrombosis (DVT), a condition in which a blood clot forms in a vein deep in the body, usually in the legs.
It can also prevent pulmonary embolism (PE), a condition in which a blood clot breaks off and travels to the lungs, blocking blood flow and causing breathing problems.
Patients taking apixaban should follow these instructions:
• Avoid activities that may cause injury.
Apixaban can increase the risk of bleeding, so patients should be careful not to cut or bruise themselves.
They should use a soft toothbrush, an electric razor, and avoid contact sports or other activities that may cause bleeding. They should also wear a medical alert bracelet or carry an identification card that states they are taking apixaban.
• Report signs and symptoms of bleeding immediately. Patients should notify their doctor or seek emergency care if they have any signs of bleeding, such as unusual bruising, red or black stools, blood in the urine, coughing up blood, vomiting blood, nosebleeds, heavy menstrual bleeding, headaches, dizziness, weakness, or swelling.
• Do not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs).
These drugs can also increase the risk of bleeding and interfere with the effects of apixaban.
Patients should avoid taking aspirin, ibuprofen, naproxen, or other NSAIDs unless prescribed by their doctor. They should also check the labels of any over-the-counter medications or supplements they use and avoid those that contain aspirin or NSAIDs.
Choice B and D are wrong because:
• Take medication with food. Apixaban can be taken with or without food. Taking it with food does not affect its absorption or efficacy.
Therefore, this instruction is not necessary for patients taking apixaban.
• Monitor vital signs regularly. Apixaban does not affect blood pressure, heart rate, or oxygen saturation.
Therefore, monitoring vital signs regularly is not required for patients taking apixaban. However, patients should still follow their doctor’s advice on how often to check their blood tests, such as hemoglobin, hematocrit, and platelets.
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.
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.
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.