A nurse is reviewing the contraindications for thrombolytic therapy for a client with a peripheral arterial occlusion. Which of the following conditions would make the client ineligible for this therapy? (Select all that apply.)
History of peptic ulcer disease
Recent dental extraction
Chronic atrial fibrillation
Pregnancy
Diabetes mellitus.
Correct Answer : A,B,C,D
These are all contraindications for thrombolytic therapy, which is the administration of agents directly into an artery to break down thrombus. Thrombolytic therapy presents a serious risk for bleeding and requires careful monitoring.
Therefore, any condition that increases the risk of bleeding or hemorrhage would make the client ineligible for this therapy.
These conditions include:
• History of peptic ulcer disease: Peptic ulcers are erosions in the lining of the stomach or duodenum that can bleed and perforate.
Thrombolytic therapy could worsen the bleeding and cause life-threatening complications.
• Recent dental extraction: Dental extraction involves removing a tooth from its socket in the bone.
This can cause bleeding and infection in the oral cavity.
Thrombolytic therapy could increase the bleeding and delay the healing process.
• Chronic atrial fibrillation: Atrial fibrillation is an irregular and often rapid heart rate that can cause blood clots to form in the heart chambers.
Thrombolytic therapy could dislodge these clots and cause embolism in the brain, lungs, or other organs.
• Pregnancy: Pregnancy is a state of hypercoagulability that increases the risk of thrombosis. However, thrombolytic therapy is contraindicated in pregnancy because it can cause bleeding complications for both the mother and the fetus.
Choice E, diabetes mellitus, is not a contraindication for thrombolytic therapy. Diabetes mellitus is a chronic condition that affects the metabolism of glucose and insulin. It can increase the risk of cardiovascular diseases and stroke, but it does not directly affect the clotting cascade or the risk of bleeding.
Therefore, diabetes mellitus alone would not make the client ineligible for thrombolytic therapy. However, other factors such as blood pressure, blood glucose level, and renal function should be monitored closely during thrombolytic therapy.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D"]
Explanation
A. History of peptic ulcer disease: Peptic ulcers increase the risk of gastrointestinal bleeding, making thrombolytics dangerous for these clients.
B. Recent dental extraction: Any recent surgery, including dental procedures, can lead to excessive bleeding due to clot dissolution from thrombolytics.
C. Chronic atrial fibrillation: Atrial fibrillation increases the risk of thromboembolism, but it is not a contraindication for thrombolytics. Clients with AFib may already be on anticoagulation therapy, which requires monitoring, but thrombolytics are still used in certain cases (e.g., ischemic stroke).
D. Pregnancy:Pregnancy is a relative contraindication due to the risk of placental abruption, fetal loss, and severe maternal bleeding.
E. Diabetes mellitus:Diabetes itself does not increase the risk of bleeding, so it is not a contraindication. However, diabetic clients with complications (e.g., retinopathy) require careful assessment.
Correct Answer is D
Explanation
The nurse should take all of the following actions before administering alteplase, a second-generation thrombolytic agent, to a client with an acute ischemic stroke:
• Check the client’s blood pressure and pulse.Alteplase can cause bleeding and hypotension, so the nurse should monitor the client’s vital signs closely and report any abnormal findings to the provider.
• Obtain a baseline complete blood count (CBC) and coagulation studies.Alteplase can increase the risk of hemorrhage, so the nurse should check the client’s platelet count, hemoglobin, hematocrit, prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) before and during therapy.The normal ranges for these tests are as follows:
➤ Platelet count: 150,000–400,000/mm3
➤ Hemoglobin: 13.5–17.5 g/dL for males; 12.0–15.5 g/dL for females
➤ Hematocrit: 38.8–50.0% for males; 34.9–44.5% for females
➤ PT: 11–13.5 seconds
➤ INR: 0.8–1.1
➤ aPTT: 25–35 seconds
• Assess the client’s neurological status using a standardized scale.Alteplase can improve the neurological outcome of ischemic stroke by dissolving the clot and restoring blood flow to the brain.However, it can also cause intracranial hemorrhage, which can worsen the neurological deficit.Therefore, the nurse should use a scale such as the National Institutes of Health Stroke Scale (NIHSS) or the Glasgow Coma Scale (GCS) to evaluate the client’s level of consciousness, motor function, sensory function, speech, vision, and other neurological functions before and after administering alteplase.
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