Quiz
Chapter 16.4: Deep Venous Thrombosis
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Perguntas do quiz (13)
1Select the patient that would NOT be at risk of getting DVT.
- AA 65-year-old female that just got out of a hip arthroplasty.
- BA 70-year-old female that has experienced a hip fracture.
- CA 49-year-old male with atrial fibrillation.
- DA 50 year-old male that has just had an MI after having a history of angina.
- EAn 81-year-old female that has had an ischemic stroke and is paralyzed on her right side.
- FA 25-year-old back on oral contraceptives after giving birth 3 months prior.
- GA 50 year old with restrictive cardiomyopathy, but no noticeable activity intolerance.
2You have a male post-knee arthroplasty patient that you are about to release back home. His wife is going to be the primary caregiver, so you are performing education on what the signs of DVT are. Which of the following statements made by the wife shows that she understands the teaching you have given?
- A"I should call my husband's doctor if he starts to have a dull, aching pain in either of his calves when he walks."
- B"I should not worry about tenderness, swelling, warmth, and redness in his leg. That is a normal part of healing after a knee replacement."
- C"I should wait until I see that the affected leg is blue-tinted and swelling before I call his doctor."
- D"DVT does not have many serious complications; it is simply uncomfortable."
3Match the diagnostic test with its correct description:
[blank_start]Duplex venous ultrasonography[blank_end]: Used to visualize vein and measure velocity of blood flow in the veins. Although the clot cannot be visualized, its presence can be inferred by an inability to compress the vein during examination.
[blank_start]Ascending contrast venography[blank_end]: Most accurate diagnostic tool for venous thrombosis. A contrast medium is injected to assess the location and extent of venous thrombosis.
[blank_start]Plethysmography:[blank_end] A noninvesive test that measures changes in blood flow through the veins. It is often used with Doppler ultrasonography. It is particularly useful in diagnosing thromboses of larger or superficial veins.
[blank_start]Magnetic resonance imaging[blank_end]: A noninvesive test that is particularly useful in a thrombosis of the venae cavae or pelvic veins is suspected.- ADuplex venous ultrasonography
- BDoppler ultrasound
- CAscending contrast venography
- DPlethysmography:
- EMagnetic resonance imaging
- FPositron emission tomography
- GX-ray
4Heparin is an anticoagulant that interferes with the clotting cascade by inhibiting thrombin and preventing the conversion of fibrinogen to fibrin. If used at therapeutic levels, it prolongs thrombin time, clotting time, and aPTT. If given IV, it works immediately; if given SQ, it takes under an hour to work. It should be given frequently or continually because it has a short biological half-life.
Select the nursing considerations for this drug (7 of these are right).- AAssess patient history for unexplained or active bleeding.
- BGive a test dose to all patients.
- CIf giving SQ, administer in abdominal sites, but not within 2 inches of the umbilicus.
- DDo not aspirate prior to injecting or massage the site after the injection.
- EIV solutions can only be diluted with normal saline. Be sure to give with an infusion pump.
- FKeep protamine sulfate nearby to reverse effects of drug.
- GMonitor and report lab values outside of therapuetic range.
- HPromptly report bloody vomit, bloody urine, bleeding gums, or unexplained abdomen or back pain.
- IDo not give the drug during pregnancy.
- JBe vigilant for signs of heparin-induced thrombocytopenia.
5Which of the following is NOT proper patient and family teaching for this female patient on heparin?
- AReport unusual bleeding, including heavy menstrual bleeding.
- BUse an electric razor and soft bristled toothbrush.
- CPrevent injuries the best you can by utilizing nightlights and keeping clear pathways in your house.
- DAvoid contact sports, such as football and soccer.
- EEat plenty of yellow and dark green vegetables.
- FIf you are in pain and considering taking an over the counter pain medication, take Tylenol, NOT Motrin, Advil, Aleve, Naprosyn, or Aspirin.
- GWear a medical alert tag and alert all healthcare personnel of heparin therapy,
6Low molecular weight heparins provide a more precise and predictable anticoagulant effect than unfractionated heparins. They prevent the conversion of prothrombin to thrombin, liberation of thromboplastin from platelets, and formation of a stable clot.
Which of the following is INCORRECT about low molecular weight heparins?- ALow molecular weight heparins are interchangeable with each other, but not with unfractionated heparin.
- BThe risk of heparin-induced thrombocytopenia is significantly lower, but if a client was previously treated with an unfractionated heparin, HIT may still develop.
- CThe nurse should assess for evidence of active bleeding, a history of bleeding disorders and/or thrombocytopenia, or sensativity to heparin or sulfites.
- DThe nurse should be aware that PT and aPTT levels may still be within normal levels even if hemorrhage is occurring.
- EThe nurse should be be vigilant for unusual or masked bleeding.
- FAdminister SQ injections into abdominal wall, thigh, or butt, and make sure you rotate sites,
- GDo not aspirate or massage when you inject drug.
7Select the PROPER patient teaching to give to a patient on a low-molecular weight heparin.
- ATeach patient to self-inject into different sites each injection, then rub injection site.
- BExcessive bruising and bleeding is normal for this type of drug.
- CUnlike with unfractionated heparins, it is safe to take NSAIDs with this drug.
- DReport chest pain, difficulty breathing, itching, rash, or swelling to your healthcare provider.
8Warfarin interferes with the synthesis of vitamin-K dependent clotting factors by the liver. It has no effect on already circulating clotting factors or on existing clots. It does, however, inhibit the extension of existing thrombi and the formation of new clots. Its action is cumulative & more prolonged than heparin.
Select the nursing considerations for this drug.- AAssess lab results and history for evidence of bleeding.
- BCheck all drugs the patient is on for interactions with warfarin.
- CInform women of childbearing age that that they should tell their doctor if they are pregnant or trying to become pregnant.
- DDo not crush oral tablets.
- EDrug should be given with a meal.
- FDilute IV solutions with dextrose, normal saline, or Ringer's solution and administer within 4 hours by direct IV at rate of 25 mg/min.
- GKeep vitamin K available to reverse effects in the event of excessive bleeding or hemorrhage.
- HMonitor PT and INR and report results outside of therapeutic range.
9Which of the following is inappropriate teaching to give to a patient on warfarin?
- AIf you experience bloody vomit, urine, or feces; excessive bleeding gums; excessive bruising; or anything else that could indicate excessive bleeding, skip dose and contact provider.
- BReport rash, dark urine, and yellowing of your skin or eyes, as these can be signs of hepatitis.
- CIt is okay to substitute a name brand for a genetic, or one brand for another brand.
- DTake drug at the same time every day,
- EContact your doctor if you think you are pregnant.
- FUse a soft-bristle toothbrush and electric razors, make sure your wear shoes, and keep a night light and clear walking path, as these things can prevent injury and bleeding.
- GDo not smoke or drink, and call your doctor before taking any OTC drugs.
- HNotify all healthcare personnel of warfarin therapy.
- IWear a medical alert tag.
10Frequent monitoring of the infusion pump during anticoagulation therapy is an important nursing responsibility.
- AVerdadeiro
- BFalso
11Anticoagulation is initiated with unfractionated or LMW heparin. The initial IV bolus should consist of [blank_start]7,500-10,000 units[blank_end] of unfractionated heparin, then the continuous heparin infusion should be at [blank_start]1,000-1,500 IU[blank_end] per hour (IU standing for "international units"). The dosage is calculated to maintain the [blank_start]aPTT[blank_end] at approximately [blank_start]twice[blank_end] the normal value. An infusion pump is used to deliver the prescribed dosage.
LMW heparins are increasingly used to prevent and treat venous thrombosis. They do not require the close lab monitoring of unfractionated heparins. These heparins are administered [blank_start]subcutaneously[blank_end] in fixed doses, QD or BID, which allows outpatient treatment. These types of heparins are also more effective and carry lower risks for [blank_start]bleeding and thrombocytopenia[blank_end].
Warfarin may be initiated with heparin therapy. Overlapping therapy for [blank_start]4-5 days[blank_end] is important because the full anticoagulant effect of warfarin is delayed, and warfarin may actually promote clotting during the first few days of therapy. Warfarin doses are adjusted to maintain the INR at [blank_start]2.0-3.0[blank_end]. Once the INR has been achieved, [blank_start]heparin[blank_end] is discontinued and a maintenance dose of [blank_start]warfarin[blank_end] is prescribed.
Anticoagulation will generally be continued for at least [blank_start]3 months[blank_end]. When DVT recurs or risk factors are present, anticoagulant therapy may be prolonged. Regular follow ups are necessary to be sure INR remains within the desirable range.- A7,500-10,000 units
- B1,000-1,500 IU
- C5,000-10,000 units
- D10,000-20,000 units
- E1,000-1,500 IU
- F7,500-10,000 units
- G500-1,000 IU
- H2,000-3,000 IU
- IaPTT
- JPT
- KINR
- Ltwice
- Mthree times
- Nsubcutaneously
- Oinstramuscularly
- Psubdermally
- Qbleeding and thrombocytopenia
- Rexcessive bleeding
- Sexcessive menstrual bleeding
- Tthrombocytopenia
- U4-5 days
- V4-5 weeks
- W4 weeks
- X5 weeks
- Y2.0-3.0
- Z1.0-2.0
- AA3.0-4.0
- AB4.0-5.0
- ACheparin
- ADwarfarin
- AEwarfarin
- AFheparin
- AG3 months
- AH3 weeks
- AI6 months
- AJ1 year
12You have a 61-year-old patient that is presenting with a thrombosis in her deep femoral vein. She has already been placed on a LMW heparin. She is concerned that the DVT will not go away, and she is incredibly uncomfortable. What else can be done to help this patient? (3 of these are right).
- A"If the heparin does not work, doctors can perform surgery to remove the blood clot."
- B"Since your DVT is in your femoral vein, we can insert a Greenfield filter to trap it so it doesn't reach your lungs and become a pulmonary embolism."
- C"I can apply a warm, moist compress over your femoral vein."
- D"We can elevate you legs 15-20 degrees, with your knees slightly flexed above the level of your heart."
- E"We can give you elastic antiembolism socks."
- F"You should probably avoid walking, but it's a good idea for you to perform leg exercises."
13You have a 71-year-old male post-knee replacement surgery. He has a history of hemphilia type B, so doctors deemed it unsafe to give him anticoagulants. Despite the usage of elastic antiembolism stockings and the history of hemophilia, the patient still develops a thrombus in his left popliteal vein. The patient can ambulate, but only very briefly and not for very long distances. He last reported his pain to be a 6/10.
What are appropriate interventions for this patient?- AObtain a baseline calf measurement, mark where you measured his calf, and then measure his calf every day.
- BAssess pain location, characteristics, and level when you take the rest of vitals,
- CApply warm, moist heat to his left popliteal vein once a day.
- DAssess the skin of his left leg and foot every time you assess vitals.
- EKeep the legs elevated at 15-20 degrees at all times.
- FWash the patient's thrombosis with a soap that the patient brought from home.
- GEncourage position changes once every 4 hours.
- HEncourage active ROM exercises at least every 8 hours and try to ambulate the patient at least once a day, as long as is tolerated.
- IEncourage deep breathing and coughing.
- JEncourage a fluid intake of at least 2,500 mL/day and increased fiber intake.
Informações
- Descrição
- NCLEX Nursing (Medical-Surgical) Quiz sobre Chapter 16.4: Deep Venous Thrombosis, criado por Olivia McRitchie em 02-10-2018.
- Autor
- Olivia McRitchie
- Idioma
- English
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