A patient with chronic atrial fibrillation managed with warfarin is suspected to have developed HIT 8 days after a cardiac catheterization. What
... [Show More] interventions should the nurse initiate or anticipate before administering a direct thrombin inhibitor? - correct answer Discontinue warfarin to prevent microthrombosis
When HIT is suspected, discontinue all heparin products. The highest risk for thrombosis onset is within a few days of stopping heparin. If the patient is also receiving warfarin, discontinue the warfarin because of the rare risk of microthrombosis associated with warfarin in HIT.
A patient with a history of warfarin (Coumadin) therapy for VTE is admitted with multitrauma and receives five units of packed RBCs. Which factors might indicate the patient should receive fresh frozen plasma (FFP) also? - correct answer Greater than 4 units of packed RBCs transfused
Need to reverse warfarin
Active bleeding
The decision to transfuse FFP should be based on patient symptoms and not on an isolated value, such as an INR >4. Indications for the transfusion of FFP may include: active bleeding, high risk of bleeding with a planned procedure (e.g., prior to surgery), need to reverse anticoagulants such as warfarin (Coumadin), and/or massive transfusion (>4 units packed RBC).
A patient is receiving UFH at 15 units/kg/hr for treatment of a PE. Which set of lab arameters six hours after dose change should the nurse anticipate indicate UFH's intended therapeutic effect? - correct answer aPTT is used to monitor IV UFH infusions. Draw aPTT 6 hours after any dose adjustment. The therapeutic range is usually 1.5 to 2 times the control; an aPTT of 45 seconds is within that range. Anti-Xa is occasionally used to evaluate UFH. The anti-Xa level of 0.5 IU/mL is within the goal range of 0.3-0.7 IU/mL
A patient with sepsis develops hematuria and hemoptysis. Bleeding precautions and orders for blood product transfusion are initiated. Which intervention is essential to manage the suspected secondary condition? - correct answer Treat underlying cause
Two hours post-transfusion of one unit of packed RBCs, a nurse assesses the patient and observes dyspnea and crackles throughout lung fields. Which should the nurse anticipate initially? - correct answer IV diuretics
A nurse monitoring a patient who was bleeding and underwent platelet transfusion 18 hours earlier observes that the initially increased platelet count is now decreased. What are the nurse's initial priorities? - correct answer Monitor for bleeding and/or changes in vital signs
Which signs and symptoms should the nurse observe for during transfusion and in the first 24 hours after transfusion of packed RBCs, FFP, platelets, and/or cryoprecipitate? - correct answer Chest or back pain
Dyspnea
Tachycardia
Within 1 week of admission, which cause of iatrogenic anemia result in 97% of critical-care patients? - correct answer Phlebotomy practices
Which two are accurate statements about H&H, WBC, and platelet diagnostic test results? - correct answer The HCT may drop in a patient receiving aggressive fluid resuscitation.
Critical values for WBC are less than 2,500/mm^3 or greater than 30,000/mm^3.
A patient being managed for atrial fibrillation develops sudden onset of chest pain with dyspnea. CT angiogram confirms a PE. Which intervention should the nurse next anticipate? - correct answer Administration of subQ enoxaparin (Lovenox)
Initial treatment with therapeutic doses of IV or subcutaneous unfractionated heparated (UFH), subcutaneous low molecular weight heparin (LMWH), or subcutaneous fondaparinux (Arixtra) is recommended for acute lower- and upper-extremity DVT and acute PE.
A patient receiving warfarin with an elevated INR is to undergo emergency surgery. Vitamin K has been administered. The nurse should anticipate administration of which additional reversal agent to achieve a rapid decrease in the PT-INR? - correct answer Prothrombin Complex Concentrate
Reversal agents for warfarin include vitamin K, PCC, and FFP. PCC is recommended and preferred over FFP for the emergent reversal of warfarin.
A patient with a history of atrial fibrillation is receiving warfarin (Coumadin) and has limited mobility. For which set of lab results should the nurse be concerned for risk of developing VTE? - correct answer A: 1.5/25
In a patient with sepsis or trauma, and who has low platelets and an elevated PT-INR and aPTT, which lab results should prompt the nurse to notify the provider? - correct [Show Less]