Do you know Anticoagulant therapy ? Play this Quiz

1. Which of the following medications is the "heparin antidote", or heparin antagonist?

Coumadin

Metoprolol

Protamine sulfate

Pantoprazole

Protamine sulfate is the heparin antidote or heparin antagonist.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

Explanation

Protamine sulfate is the heparin antidote or heparin antagonist.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

2. True or False: Since heparin is an anticoagulant, there is no need to rotate sites with SQ injections.

True

False

False - you definitely want to rotate sites with heparin SQ injections.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

Explanation

False - you definitely want to rotate sites with heparin SQ injections.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

3. Which of the following foods should be avoided by patients on anticoagulant therapy?

Bologna

Whole milk

Spinach

Watermelon

Anything with dark green leaves (spinach) should be avoided because these foods contain Vitamin K. Vitamin K is the "blood clotter" - it's the antidote for coumadin, and it works against anticoagulant medications.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

Explanation

Anything with dark green leaves (spinach) should be avoided because these foods contain Vitamin K. Vitamin K is the "blood clotter" - it's the antidote for coumadin, and it works against anticoagulant medications.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

4. Which of the following medications is the "coumadin antidote", or coumadin antagonist?

Potassium Chloride (K+)

Vitamin B12

Protamine sulfate

Vitamin K

Vitamin K! NEVER confuse potassium with Vitamin K.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

Explanation

Vitamin K! NEVER confuse potassium with Vitamin K.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

5. What is the preferred site for heparin SQ injections?

Buttocks

Upper outer arms

Abdomen

Forearm

The abdomen is the preferred site - but go at least 2 inches away from the umbilicus. This is often referred to as the "heparin belt".

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

Explanation

The abdomen is the preferred site - but go at least 2 inches away from the umbilicus. This is often referred to as the "heparin belt".

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

6. Which of the following correctly describes how heparin works? Heparin works by:

Decreasing platelet aggregation (clumping)

Dissolving existing clots

Surrounding existing clots

Preventing clot formation

Heparin interrupts one of the steps in the "clotting cascade", and prevents the formation of good, stable clots. Clots can still form when on heparin - but hopefully they don't stay together long, and soon fall apart. Antiplatelet medications decrease platelet aggregation, and thrombolytics dissolve existing clots.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

Explanation

Heparin interrupts one of the steps in the "clotting cascade", and prevents the formation of good, stable clots. Clots can still form when on heparin - but hopefully they don't stay together long, and soon fall apart. Antiplatelet medications decrease platelet aggregation, and thrombolytics dissolve existing clots.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

7. Which of the following is NOT one of the "Low Molecular-Weight Heparins"?

Ardeparin (Normiflo)

Dalteparin (Fragmin)

Enoxaparin (Lovenox)

Tinzaparin (Innohep)

Warfarin (Coumadin)

Coumadin is not a low molecular-weight heparin, but all the others are!

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

Explanation

Coumadin is not a low molecular-weight heparin, but all the others are!

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

8. Which laboratory value is monitored with heparin therapy?

PT

PTT

INR

BUN

PTT, or partial thromboplastin time, is monitored with heparin. You will often need to titrate the heparin dose according to the PTT levels.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

Explanation

PTT, or partial thromboplastin time, is monitored with heparin. You will often need to titrate the heparin dose according to the PTT levels.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

9. True or False: IV Heparin must always be given via an IV pump.

True

False

ALWAYS use an IV pump with heparin!!!

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

Explanation

ALWAYS use an IV pump with heparin!!!

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

10. Which two lab values are monitored with coumadin therapy?

PT and PTT

PTT and INR

PT and INR

Hgb and Hct

With coumadin, you monitor PT and INR.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

Explanation

With coumadin, you monitor PT and INR.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

11. True or False: SQ Heparin works in 2 hours, and IV Heparin works within one hour.

True

False

False - SQ Heparin works within one hour, and IV heparin works immediately.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

Explanation

False - SQ Heparin works within one hour, and IV heparin works immediately.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

12. When heparin is discontinued, how long does it take for clotting times to return to normal?

1-2 hours

2-6 hours

4-12 hours

24-72 hours

After heparin is stopped, it takes approximately 2-6 hours for clotting times to return to normal.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

Explanation

After heparin is stopped, it takes approximately 2-6 hours for clotting times to return to normal.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

13. Which of the following symptoms needs to be reported immediately, when on anticoagulant therapy? Select all that apply.

Unusual bleeding

Hematemesis

Hematuria

Bleeding gums

Excessive menstrual flow

Unusual abdominal or back pain

New right-sided facial droop

All of them! These could all be danger signs of excess bleeding - unusual abdominal or back pain could be signs of internal bleeding/GI bleed. New facial droop could be indicative of a hemorrhagic stroke.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

Explanation

All of them! These could all be danger signs of excess bleeding - unusual abdominal or back pain could be signs of internal bleeding/GI bleed. New facial droop could be indicative of a hemorrhagic stroke.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

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14. When injecting SQ heparin, which of the following steps is incorrect? Select all that apply.

Clean site with alcohol swab and allow to dry

Administer by deep subcutraneous injection

Aspirate prior to injecting

Inject the solution

Withdraw needle quickly

Massage injection site

You do NOT aspirate - and you do NOT massage the injection site.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

Explanation

You do NOT aspirate - and you do NOT massage the injection site.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.1053.

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Do You Know Anticoagulant Therapy ? Play This Quiz