Question

In: Nursing

10. A patient calls the clinic’s answering service stating she missed her morning dose of dabigatran,...

10. A patient calls the clinic’s answering service stating she missed her morning dose of dabigatran, which she usually takes twice daily at 8 a.m. and 8 p.m. It is 5 p.m. when she calls for advice. What advice should the nurse practitioner give the patient?

a. Take the missed dose now and then resume the usual schedule with the 8 p.m. dose.

b. Take the missed dose now and then reset the usual regimen to 5 a.m. and 5 p.m., maintaining a 12-hour interval.

c. Take two capsules at 8 p.m. and then resume the normal dosing schedule.

d. Forgo the morning dose because it is less than 6 hours from the next scheduled dose and then resume the normal dosing schedule with the 8 p.m. dose.

11. The duration of venous thromboembolism (VTE) treatment should be extended if the patient

a. has a positive d-dimer.

b. is female.

c. is of advanced age.

d. has renal failure.

12. Which of the following therapies is matched to its approved indication?

a. Argatroban: venous thromboembolism (VTE) prophylaxis

b. Unfractionated heparin (UFH): heparin-induced thrombocytopenia (HIT)

c. Bivalirudin: percutaneous coronary intervention (PCI)

d. Enoxaparin: ST-segment elevation myocardial infarction (STEMI)

13. There is an increased risk of limb gangrene and skin necrosis in patients with heparin-induced thrombocytopenia (HIT) who are initially anticoagulated with

a. a novel oral anticoagulant (NOAC).

b. dalteparin.

c. warfarin.

d. argatroban.

14. A supplemental anticoagulant is needed to prevent catheter-related thrombosis in a patient being treated for acute coronary syndrome (ACS) with

a. unfractionated heparin (UFH).

b. dalteparin.

c. fondaparinux
d. bivalirudin.

Expert Solution

10. Answer d is correct : Forgot the morning dose because it is less than 6 hours from the next scheduled dose and then resume the normal dosing schedule with the 8 p.m. dose.

Answer a.Take the missed dose now and then resume the usual schedule with the 8 p.m. dose. is incorrect since there are only three hours gap between 5pm and the next scheduled dose at 8.p.m.

Answer b. Take the missed dose now and then reset the usual regimen to 5 a.m. and 5 p.m., maintaining a 12-hour interval. is incorrect since the anticoagulants should be taken as prescribed.

Answer c. Take two capsules at 8 p.m. and then resume the normal dosing schedule. is incorrect because never take double dose of dabigatran.

11. Answer a.has a positive d-dimer. is correct. since positive d-dimer status is associated with an increased risk of VTE recurrence.Hence the VTE therapy should be extended.

Answer b. is female. is incorrect since both males and females will be affected with VTE recurrence.

Answer c. is of advanced age is incorrect Although advanced age is a risk factor for VTE recurrence, it is not a prior one.

Answer d. has renal failure is incorrect. Since the anticoagulant doses need to be reduced for patients with renal failure.

12. Answer a. is unmatched. Since Argatroban is Heparin induced thrombocytopenia (HIT)

Answer b. is unmatched. sinceUnfractionated heparin (UFH) isa VTE prophylaxis.

Answer c. is matched. Bivalirudin: percutaneous coronary intervention (PCI)

Answer d. is Matched. Enoxaparin: ST-segment elevation myocardial infarction (STEMI)

13.Answer b. dalteparin. is correct. since it has sideeffect of numbness of legs, itching of skin etc.

Answer a,c,d, is incorrect

14 Answer d. bivalirudin .is correct since it is an alternative drug for ACS patients.

Answer a. unfractionated heparin is incorrect. since it exerts anticoagulant effect.

Answer b. dalteparin is incorrect. Since it is a low molecular weight heparin.

Answer c. fondaparinux is incorrect. Since it doesnot prevent catheter thrombosis.

Nightingale answered 2 years ago

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