1.
Which of the following correctly describes how heparin works? Heparin works by:
Correct Answer
D. Preventing clot formation
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.
2.
True or False: SQ Heparin works in 2 hours, and IV Heparin works within one hour.
Correct Answer
B. False
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.
3.
When heparin is discontinued, how long does it take for clotting times to return to normal?
Correct Answer
B. 2-6 hours
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.
4.
True or False: Since heparin is an anticoagulant, there is no need to rotate sites with SQ injections.
Correct Answer
B. False
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.
5.
What is the preferred site for heparin SQ injections?
Correct Answer
C. Abdomen
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.
When injecting SQ heparin, which of the following steps is incorrect? Select all that apply.
Correct Answer(s)
C. Aspirate prior to injecting
F. Massage injection site
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.
7.
Which of the following medications is the "heparin antidote", or heparin antagonist?
Correct Answer
C. Protamine sulfate
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.
8.
Which of the following medications is the "coumadin antidote", or coumadin antagonist?
Correct Answer
D. Vitamin K
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.
9.
Which laboratory value is monitored with heparin therapy?
Correct Answer
B. PTT
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.
10.
Which of the following foods should be avoided by patients on anticoagulant therapy?
Correct Answer
C. Spinach
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.
11.
True or False: IV Heparin must always be given via an IV pump.
Correct Answer
A. True
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.
12.
Which of the following symptoms needs to be reported immediately, when on anticoagulant therapy? Select all that apply.
Correct Answer(s)
A. Unusual bleeding
B. Hematemesis
C. Hematuria
D. Bleeding gums
E. Excessive menstrual flow
F. Unusual abdominal or back pain
G. New right-sided facial droop
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.
13.
Which of the following is NOT one of the "Low Molecular-Weight Heparins"?
Correct Answer
E. Warfarin (Coumadin)
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.
14.
Which two lab values are monitored with coumadin therapy?
Correct Answer
C. PT and INR
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.