The nurse is caring for a client who currently has a deep vein thrombosis. Which of the following medications would be administered to lyse existing clots? (Select All that Apply.)
Aspirin
Heparin
warfarin (Coumadin)
alteplase (Activase)
anistreplase (Eminase)
Correct Answer : D,E
A) Aspirin: While aspirin is an antiplatelet medication that can help prevent further clot formation, it does not have thrombolytic properties and does not directly lyse existing clots. Therefore, it is not appropriate for this purpose.
B) Heparin: Heparin is an anticoagulant used to prevent the extension of existing clots and reduce the risk of new clots forming, but it does not dissolve existing clots. It helps manage deep vein thrombosis but does not have thrombolytic activity.
C) Warfarin (Coumadin): Warfarin is an oral anticoagulant that is used to prevent new clot formation and the growth of existing clots. However, like heparin, it does not actively lyse or dissolve existing clots.
D) Alteplase (Activase): This medication is a thrombolytic agent that actively dissolves blood clots by activating plasminogen to plasmin, leading to clot breakdown. It is appropriate for use in cases of deep vein thrombosis when clot lysis is indicated.
E) Anistreplase (Eminase): Similar to alteplase, anistreplase is another thrombolytic agent used to lyse existing clots. It acts by converting plasminogen to plasmin, effectively breaking down fibrin in clots, making it suitable for the treatment of deep vein thrombosis.
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Correct Answer is A
Explanation
A) Hypokalemia: Hypokalemia, or low potassium levels, significantly increases the risk of digoxin toxicity. Since digoxin competes with potassium for binding at the sodium-potassium ATPase site in the heart, low potassium levels can lead to increased digoxin effects and toxicity. Therefore, it is crucial to monitor potassium levels and correct any deficiencies before administering digoxin.
B) Hyperkalemia: While hyperkalemia is a serious concern and can also affect digoxin therapy, it usually results in decreased effectiveness of digoxin rather than increasing toxicity. Elevated potassium levels can diminish the drug's positive inotropic effect.
C) Hypocalcemia: Although calcium levels can influence cardiac function, hypocalcemia is not directly related to digoxin toxicity. Monitoring calcium is important for overall cardiac health, but it is not the primary focus when assessing the risk for digoxin toxicity.
D) Hypernatremia: Elevated sodium levels do not have a direct impact on the efficacy or toxicity of digoxin. While sodium levels are essential to monitor for overall health, they are not critical in the context of digoxin administration and toxicity risk.
Correct Answer is D
Explanation
A) Pancytopenia: While some medications can cause pancytopenia, it is not a common or direct side effect of alteplase. This condition involves a reduction in red blood cells, white blood cells, and platelets, and is not typically associated with thrombolytics.
B) Hypertension: Alteplase is not known to cause hypertension. In fact, the goal of administering alteplase in the context of a pulmonary embolism is to dissolve the clot and restore normal blood flow, which may help stabilize blood pressure.
C) Hypokalemia: This condition, characterized by low potassium levels, is not a common side effect of alteplase. There are other medications that may cause electrolyte imbalances, but alteplase itself is not typically linked to hypokalemia.
D) Internal bleeding: This is a significant risk associated with alteplase, as it is a thrombolytic agent that dissolves clots. The nurse should closely monitor for signs of internal bleeding, such as changes in vital signs, unexplained bruising, or blood in urine or stool. This is the most critical side effect to assess for in a client receiving alteplase