The nurse prepares discharge instructions for a patient recovering from percutaneous transluminal coronary intervention (PTCI). What medication information should the nurse include with this teaching?
Ibuprofen.
Warfarin.
Plavix.
Heparin.
The Correct Answer is C
Choice A rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug that is generally discouraged immediately following a myocardial infarction or coronary intervention. It can increase the risk of cardiovascular events, such as reinfarction or stroke, by interfering with the antiplatelet effects of aspirin. Additionally, it may cause sodium retention and increase blood pressure, which adds unnecessary strain on the healing cardiac muscle. Patients are instead educated to use acetaminophen for minor pain management to avoid these risks.
Choice B rationale
Warfarin is an anticoagulant that inhibits vitamin K-dependent clotting factors, typically used for atrial fibrillation or prosthetic heart valves. While it prevents systemic emboli, it is not the standard medication for maintaining stent patency after a percutaneous transluminal coronary intervention. The primary concern after stent placement is platelet aggregation on the foreign metal surface. Warfarin alone does not adequately inhibit the specific pathways of platelet activation required to prevent acute or subacute stent thrombosis.
Choice C rationale
Plavix, or clopidogrel, is a P2Y12 receptor antagonist that inhibits platelet aggregation. Following percutaneous transluminal coronary intervention, especially with stent placement, dual antiplatelet therapy is essential. It prevents the formation of thrombi on the stent surface while the vessel wall undergoes endothelialization. Patients must be educated on the importance of strict adherence to this regimen to prevent catastrophic stent thrombosis. Common side effects include an increased risk of bruising and minor bleeding episodes.
Choice D rationale
Heparin is an intravenous or subcutaneous anticoagulant used in the acute hospital setting to provide immediate anticoagulation by potentiating antithrombin III. It is frequently used during the actual percutaneous procedure to prevent clotting on catheters and wires. However, it is not a discharge medication because it requires frequent monitoring of the partial thromboplastin time and is not available in a practical oral form. Long-term outpatient management relies on oral antiplatelet agents rather than heparin therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
While aspirin does possess analgesic properties by inhibiting the synthesis of prostaglandins in the central and peripheral nervous systems, this is not the primary reason for its prescription following a myocardial infarction. In the context of post-MI care, the dose of 325 mg is intended for its systemic vascular benefits rather than simple pain relief. Other medications or lower doses of aspirin might be used for pain, but the clinical priority here is cardiovascular protection.
Choice B rationale
Aspirin exhibits anti-inflammatory effects by blocking cyclooxygenase enzymes, which reduces the production of mediators that cause tissue swelling and pain. Although inflammation plays a significant role in the progression of atherosclerosis, the specific indication for a client with a history of myocardial infarction focuses more on the immediate prevention of acute thrombotic events. While the anti-inflammatory benefit is present, it is secondary to the critical need for maintaining patency in the coronary arteries.
Choice C rationale
The antipyretic action of aspirin involves acting on the hypothalamus to override an interleukin-induced increase in body temperature. While effective for reducing fever, this pharmacological action is irrelevant to the long-term management of a client with a history of myocardial infarction. Clients in this category are not typically suffering from chronic febrile conditions; therefore, using aspirin for its heat-reducing properties would not provide the specific secondary prevention required for their underlying cardiac pathology.
Choice D rationale
In post-myocardial infarction management, aspirin is primarily used for its antiplatelet aggregate effect. It irreversibly inhibits the cyclooxygenase-1 enzyme within platelets, preventing the formation of thromboxane A2, which is a potent inducer of platelet aggregation. By reducing the ability of platelets to clump together, aspirin decreases the risk of re-occlusion of coronary arteries and prevents subsequent ischemic events. This is the therapeutic cornerstone for long-term survival and reduction of recurrent cardiac mortality.
Correct Answer is ["0.15"]
Explanation
Step 1 is 0.15 mg ÷ 1 mg/ml = 0.15 ml. The nurse will administer 0.15 ml.
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