Review Thrombolytic agents

Anticoagulants and Thrombolytic Agents > Pharmacology

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Thrombolytic agents

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Total Questions : 5

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Question 1:

A nurse is preparing to administer alteplase, a second-generation thrombolytic agent, to a client with an acute ischemic stroke. Which of the following actions should the nurse take before administering the medication?

A. Check the client’s blood pressure and pulse B. Obtain a baseline complete blood count (CBC) and coagulation studies C. Assess the client’s neurological status using a standardized scale D. All of the above.

Answer and Explanation

Choice A:

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.

Choice B:

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

Choice C:

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.

Choice D:

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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Question 2:

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.)

A. History of peptic ulcer disease B. Recent dental extraction C. Chronic atrial fibrillation D. Pregnancy E. Diabetes mellitus.

Answer and Explanation

Choice A:

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

Choice B:

Dental extraction involves removing a tooth from its socket in the bone.

This can cause bleeding and infection in the oral cavity.

Choice C:

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.

Choice D:

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:

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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Question 3:

A. History of peptic ulcer disease B. Recent dental extraction C. Chronic atrial fibrillation D. Pregnancy E. Diabetes mellitus.

Answer and Explanation

Choice A:

Choice A is correct because tenecteplase is administered as a single intravenous bolus injection over 5 seconds.This is an advantage over other thrombolytic agents, such as alteplase, that require infusion over 90 minutes.

Choice B:

Choice B is correct because tenecteplase helps dissolve the clot that is blocking the coronary artery and causing the acute myocardial infarction.By restoring blood flow to the ischemic myocardium, tenecteplase can reduce infarct size, preserve left ventricular function, and improve survival.

Choice C:

Choice C is correct because tenecteplase can cause bleeding as a major adverse effect.This is due to its nonspecific action on fibrinogen and plasminogen, which leads to systemic fibrinolysis and depletion of clotting factors.Patients on tenecteplase should be monitored for signs of bleeding, such as hematuria, hematemesis, melena, petechiae, ecchymoses, and prolonged bleeding from puncture sites.

Choice D:

This statement indicates a need for further teaching because tenecteplase is a thrombolytic agent, not an anticoagulant. Thrombolytic agents work by dissolving existing clots, but they do not prevent new clots from forming. Anticoagulants, such as heparin or warfarin, are used to prevent clot formation by inhibiting the coagulation cascade.

Choice E:

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Question 4:

A nurse is monitoring a client who is receiving streptokinase, a first-generation thrombolytic agent, for a pulmonary embolism. The nurse observes that the client has developed a rash, fever, and hypotension after receiving the medication.

Which of the following actions should the nurse take first?

A. Stop the infusion of streptokinase B. Administer epinephrine as ordered C. Notify the health care provider D. Draw blood samples for antibody testing.

Answer and Explanation

Choice A:

The client has developed signs of an allergic reaction to streptokinase, which can be life-threatening.Streptokinase is a drug that can cause bleeding, allergic reactions, and general discomfort.Allergic reactions can include nausea, vomiting, and low blood pressure.The first step in managing anaphylaxis is to remove the trigger if possible.

Therefore, stopping the infusion of streptokinase is the most appropriate action.

Choice B:

Administering epinephrine is not the first action to take.Epinephrine is a medication that can help reduce an allergic response by constricting blood vessels and relaxing airways.

However, it should be used after stopping the infusion of streptokinase and only if the client has an auto-injector or a doctor’s order.

Choice C:

Notifying the health care provider is not the first action to take.

The client needs immediate treatment to prevent shock and respiratory failure.

Calling 999 for an ambulance is more urgent than notifying the health care provider.

Choice D:

Drawing blood samples for antibody testing is not the first action to take.

Antibody testing can help diagnose a previous exposure to streptokinase, but it does not help in

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Question 5:

A nurse is caring for a client who has received a thrombolytic agent for an acute ischemic stroke. The nurse notes that the client’s activated partial thromboplastin time (aPTT) is 120 seconds. What is the most appropriate action by the nurse?

A. Document the finding as normal B. Administer vitamin K as ordered C. Prepare to give protamine sulfate D. Notify the health care provider.

Answer and Explanation

Choice A:

Choice A is wrong because the finding is not normal and requires immediate intervention.

Choice B:

Choice B is wrong because vitamin K is an antidote for warfarin, an oral anticoagulant, not for a thrombolytic agent. Vitamin K would not reverse the effects of a thrombolytic agent.

Choice C:

Choice C is wrong because protamine sulfate is an antidote for heparin, an injectable anticoagulant, not for a thrombolytic agent. Protamine sulfate would not reverse the effects of a thrombolytic agent.

Choice D:

The nurse should notify the health care provider because an activated partial thromboplastin time (aPTT) of 120 seconds is significantly elevated and indicates a high risk of bleeding. The normal range for aPTT is 25 to 35 seconds. A thrombolytic agent is a medication that dissolves blood clots and restores blood flow to the brain after an acute ischemic stroke. However, it can also cause excessive bleeding and hemorrhage, which can be life-threatening.

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Thrombolytic agents

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