A nurse is preparing to administer alteplase, a thrombolytic drug, to a client who has an acute myocardial infarction. The nurse knows that this drug works by which mechanism?

“It inhibits platelet aggregation and adhesion.”

“It interferes with one or more steps of the coagulation cascade.”

“It activates plasminogen, which converts to plasmin, an enzyme that degrades fibrin.”

“It blocks the action of platelet activators or receptors.”.

Answer and Explanation

The Correct Answer is C

Alteplase works by activating plasminogen, which converts to plasmin, an enzyme that degrades fibrin. Fibrin is a protein that forms the meshwork of a blood clot, so by breaking it down, alteplase helps dissolve the clot and restore blood flow.

Choice A is wrong because alteplase does not inhibit platelet aggregation and adhesion.

Platelets are blood cells that stick together and form the initial plug in a blood clot. Alteplase does not affect platelets directly, but rather targets fibrin.

Choice B is wrong because alteplase does not interfere with the coagulation cascade.

The coagulation cascade is a series of reactions that lead to the formation of fibrin from fibrinogen. Alteplase does not inhibit any of the steps in this process, but rather activates plasminogen, which is already present in the blood.

Choice D is wrong because alteplase does not block the action of platelet activators or receptors.

Platelet activators are substances that stimulate platelets to aggregate and adhere, such as thrombin, ADP, and collagen.

Platelet receptors are molecules on the surface of platelets that bind to these activators or to other platelets, such as GPIIb/IIIa and GPVI. Alteplase does not affect these molecules, but rather targets fibrin.

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Correct Answer is A

Explanation

Omeprazole, a proton pump inhibitor, is contraindicated with cilostazol, an antiplatelet drug, for intermittent claudication.

This is because omeprazole can inhibit the metabolism of cilostazol by affecting the hepatic/intestinal enzyme CYP2C19, which is responsible for converting cilostazol to its active metabolites.This can result in increased plasma levels of cilostazol and increased risk of bleeding and adverse effects.

Choice B is wrong because metoprolol, a beta blocker, is not contraindicated with cilostazol.

Metoprolol can be used to treat hypertension, angina, and heart failure, which are common comorbidities in patients with intermittent claudication.Metoprolol does not interact significantly with cilostazol or affect its metabolism.

Choice C is wrong because simvastatin, a statin, is not contraindicated with cilostazol.

Simvastatin can be used to lower cholesterol and prevent cardiovascular events in patients with intermittent claudication.Simvastatin does not interact significantly with cilostazol or affect its metabolism.

Choice D is wrong because glyburide, a sulfonylurea, is not contraindicated with cilostazol.

Glyburide can be used to treat type 2 diabetes mellitus, which is a common risk factor for intermittent claudication.Glyburide does not interact significantly with cilostazol or affect its metabolism.

A. Activated partial thromboplastin time (aPTT) B. International normalized ratio (INR) C. Platelet count D. Fibrinogen level.

Correct Answer is B

Explanation

The INR is a standardized measure of the prothrombin time (PT), which reflects the activity of the extrinsic and common pathways of coagulation.

Warfarin is an anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors (II, VII, IX, and X), which are involved in these pathways.

Therefore, the INR is used to monitor the effectiveness of warfarin therapy and adjust the dose accordingly.The target INR range depends on the indication for warfarin, but it is usually between 2 and 3.

Choice A is wrong because activated partial thromboplastin time (aPTT) reflects the activity of the intrinsic and common pathways of coagulation.

Heparin is an anticoagulant that enhances the activity of antithrombin, which inhibits factors II, IX, X, XI, and XII, which are involved in these pathways.Therefore, the aPTT is used to monitor the effectiveness of heparin therapy.

Choice C is wrong because platelet count measures the number of platelets in the blood, which are involved in primary hemostasis.Platelet count is not affected by warfarin therapy, but it can be decreased by heparin-induced thrombocytopenia (HIT), a rare but serious complication of heparin therapy.

Choice D is wrong because fibrinogen level measures the amount of fibrinogen in the blood, which is a precursor of fibrin, the main component of blood clots.Fibrinogen level is not affected by warfarin therapy, but it can be decreased by disseminated intravascular coagulation (DIC), a condition where widespread clotting and bleeding occur simultaneously.

The normal ranges for these tests are as follows:

• INR: 0.8 to 1.2

• aPTT: 25 to 35 seconds

• Platelet count: 150 to 450 x 10^9/L

• Fibrinogen level: 2 to 4 g/L

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A nurse is preparing to administer alteplase, a thrombolytic drug, to a client who has an acute myocardial infarction. The nurse knows that this drug works by which mechanism?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the medication history of a client who is prescribed cilostazol, an antiplatelet drug, for intermittent claudication. The nurse should recognize that which of the following medications is contraindicated with cilostazol?

Correct Answer is A

Explanation

A nurse is caring for a client who has a history of coronary thrombosis and is taking warfarin as a long-term anticoagulant therapy. What laboratory test should the nurse monitor to evaluate the effectiveness of warfarin?

Correct Answer is B

Explanation

A nurse is preparing to administer alteplase, a thrombolytic drug, to a client who has an acute myocardial infarction. The nurse knows that this drug works by which mechanism?

A nurse is teaching a client who is prescribed clopidogrel, an antiplatelet drug, to prevent recurrent stroke. Which of the following statements should the nurse include in the teaching? (Select all that apply.)

A nurse is administering enoxaparin, a low-molecular-weight heparin, to a client who has undergone orthopedic surgery. The nurse should administer this medication by which route and at which site?