Anti Coagulants

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Sample questions from Anti Coagulants

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In a community anticoagulation clinic, a 17-year-old client taking warfarin for a mechanical heart valve reports a nosebleed that stopped after 10 minutes of pressure. The INR is 4.8 (therapeutic range 2.0 to 3.0), and vital signs are stable. Which instruction should the nurse give?

   • A.Continue the prescribed dose and recheck the INR in 1 month.
   • B.Use an over-the-counter aspirin product for any recurring nosebleed.
   • C.Hold the next warfarin dose and contact the anticoagulation prescriber today.
   • D.Take an extra dose of warfarin tomorrow to prevent valve clotting.

   Rationale: An INR of 4.8 is above this client's therapeutic range, and the nosebleed is a bleeding cue that warrants prompt prescriber guidance about holding or adjusting warfarin. An extra dose or waiting a month could increase bleeding risk, while aspirin can further impair hemostasis. The exam takeaway is to respond to bleeding and an elevated INR promptly rather than independently changing the long-term regimen.

2. 2.At change of shift on a medical unit, a 72-year-old client taking warfarin for atrial fibrillation has an INR of 5.6 (target 2.0 to 3.0), new bleeding while brushing the teeth, and stable vital signs. Which actions should the nurse take? Select all that apply.

   • A.Document the bleeding assessment and follow the clinician's plan for repeat INR testing.
   • B.Assess for additional bleeding, including urine, stool, skin, and neurologic changes.
   • C.Encourage the client to take ibuprofen for any headache.
   • D.Hold the scheduled warfarin dose and notify the prescribing clinician.
   • E.Review the medication list for recently started drugs or supplements that can increase bleeding or INR.
   • F.Administer the next warfarin dose with food to reduce the INR.

   Rationale: Holding the dose and notifying the prescriber are appropriate because the INR is above target and gum bleeding is present; the nurse should also assess for occult or serious bleeding. Reviewing new medications or supplements can identify contributors, and documenting findings and following the plan supports safe monitoring. Giving warfarin would worsen anticoagulation, and ibuprofen can increase bleeding risk.

3. 3.A provider prescribes enoxaparin for a 28-year-old client at 30 weeks of pregnancy who has a new deep vein thrombosis. The client asks why warfarin was not prescribed. Which response by the nurse is best?

   • A.Warfarin is avoided only because it must be injected rather than taken by mouth.
   • B.Enoxaparin is generally used during pregnancy because it does not cross the placenta in the same way warfarin does.
   • C.Warfarin is avoided because it causes maternal hypoglycemia during pregnancy.
   • D.Enoxaparin is chosen because it dissolves the existing clot immediately.

   Rationale: Low-molecular-weight heparin is commonly used for treatment of venous thromboembolism during pregnancy because it does not cross the placenta. Warfarin crosses the placenta and can cause fetal harm. Enoxaparin does not immediately dissolve a clot, and route of administration is not the reason warfarin is avoided.

4. 4.In a rehabilitation facility, an 81-year-old client with atrial fibrillation takes apixaban. The client reports falling and striking the head 2 hours ago but denies pain; vital signs are BP 138/76 mm Hg, HR 88/min, and SpO2 97% on room air. Which action should the nurse take first?

   • A.Arrange immediate emergency evaluation for possible intracranial bleeding.
   • B.Apply a warm compress to the scalp and document the fall.
   • C.Observe the client for 24 hours and transfer only if a headache develops.
   • D.Administer the next apixaban dose to prevent an embolic stroke.

   Answer and rationale are in the full material.

5. 5.In the emergency department, a 63-year-old client receiving an unfractionated heparin infusion for pulmonary embolism has an aPTT of 112 seconds (therapeutic range 60 to 80 seconds) and new oozing at the IV site. Which action should the nurse take?

   • A.Increase the infusion rate because the aPTT is prolonged.
   • B.Flush the IV site vigorously and continue the infusion unchanged.
   • C.Give the next scheduled dose of aspirin to prevent clot extension.
   • D.Stop the infusion and follow the heparin protocol, notifying the prescribing clinician.

   Answer and rationale are in the full material.