Clotting Around
What local sign differentiates a localized DVT from a systemic hematologic bleed?
What is unilateral leg swelling and tenderness rather than generalized bruising or petechiae
A patient on a long car trip asks what to do to reduce DVT risk. What single action do you teach?
What is regular calf/leg exercises and frequent ambulation to prevent venous stasis. If accessible things like compression socks, hydration, and IPC/ SCDs devices
What does an INR of 1.1 mean for a patient on warfarin whose goal INR is 2–3, and what should the nurse do?
What is the INR is sub-therapeutic (risk of clotting); notify the provider anticipate dose increase or evaluate adherence/interaction and recheck per protocol.
A patient will self-inject LMWH at home. What teaching point prevents injection errors?
What is inject into the abdomen, do not expel the air bubble (airlock) in prefilled syringes, rotate sites, and do not massage the site
What’s the primary risk with thrombolytics and the immediate nursing monitoring priority?
What is major bleeding; continuously monitor for bleeding signs and neurologic status (if stroke) and vital signs
How does polycythemia increase clotting risk (physiologic mechanism)?
What is increased blood viscosity slows flow and promotes thrombus formation
An older adult with limited mobility is post-op. Which prevention is highest priority?
What is mechanical prophylaxis (SCDs) and early ambulation to reduce stasis
A patient on heparin infusion has an aPTT of 28 seconds (goal 60–80). Interpret and the immediate nursing action.
What is sub-therapeutic aPTT — the heparin effect is inadequate; notify provider and expect a bolus or rate increase per protocol and frequent rechecks
A patient on warfarin prefers herbal supplements. Which common supplement causes concern and why?
What is vitamin K-rich herbal products (e.g., some herbal teas) can lower warfarin effect; others like St. John’s wort alter metabolism always reconcile meds/supplements.
Which patients are contraindicated for thrombolytics? Provide two examples and rationale.
What is a recent intracranial hemorrhage or active internal bleeding, because thrombolytics dissolve clots and greatly increase bleeding risk
Petechiae in thrombocytopenia indicate what failure in hemostasis?
What is impaired primary hemostasis due to low platelet count
Why are smoking and hyperlipidemia a dangerous combination for clot risk?
What is smoking causes endothelial injury and hyperlipidemia accelerates atherosclerosis which together increasing sites for thrombus formation
A D-dimer returns markedly elevated in an ED patient with sudden dyspnea. How do you interpret this and what’s next?
What is elevated D-dimer suggests fibrin formation and breakdown (possible PE); obtain diagnostic imaging (CT pulmonary angiography or V/Q scan) as ordered.
A patient on a DOAC /Direct Oral Anticoagulant (rivaroxaban) asks why they don’t need routine INR checks. What is your clinical explanation?
What is DOACs have predictable pharmacokinetics, fewer food/drug interactions, and do not require routine INR monitoring , but assess renal function and adherence
After alteplase for massive PE, what clinical endpoint indicates the drug worked?
What is improved hemodynamics (BP, decreased tachycardia), improved oxygenation, and decreased RV (right ventricular) strain on echo.
Why does hydration reduce VTE (venous thromboembolism) risk physiologically?
What is maintaining intravascular volume prevents blood stasis and lowers viscosity, improving venous return
For community education to lower clot risk in older adults, which modifiable factor has greatest population impact?
What is physical activity (increase movement) because it reduces multiple risk pathways (stasis, obesity, metabolic disease).
A patient’s INR is 4.8 with minor nosebleed. What does ‘supra-therapeutic’ mean here and what nursing actions are indicated?
What is INR is supra-therapeutic (high bleeding risk); hold warfarin, assess/stop bleeding, notify provider, may administer vitamin K per orders and monitor closely
A patient on heparin develops falling platelet count and new thrombosis. What condition do you suspect and immediate steps?
What is “heparin-induced thrombocytopenia (HIT); stop all heparin products, notify the provider, anticipate order alternative anticoagulation (non-heparin), and monitor platelets
A patient arrives within 90 minutes of ischemic stroke symptoms. What principle guides tPA(tissue plasminogen activator) eligibility that nurses must verify?
What is time window (early administration improves outcomes) and rule out contraindications such as hemorrhage (get CT) and recent major surgery
Explain why hypertension predisposes to ischemic stroke from a clot.
What is chronic high pressure injures endothelium, promoting platelet adhesion and atherosclerotic plaque formation that can thrombus
A patient refuses smoking cessation. Give a concise pathophysiologic rationale to encourage quitting.
What is smoking increases platelet aggregation and endothelial dysfunction, directly raising thrombotic risk and morbidity from stroke/MI.
Explain why PT/INR and PTT are ordered together for a bleeding patient and name two medication classes you’d expect to review for interactions.
What is “they assess different coagulation pathways (extrinsic vs intrinsic) to identify where the clotting cascade is altered; review warfarin (PT/INR) and heparin/LMWH (PTT) plus other interacting drugs like antibiotics and antifungals which can alter warfarin metabolism.
Compare nursing implications for warfarin vs direct thrombin inhibitors (dabigatran) in a patient needing urgent surgery. Name a couple of differences!
What is warfarin has many drug/food interactions and needs reversal (vitamin K) with prolonged effect; dabigatran has more rapid offset but may require specific reversal agents and renal dosing considerations coordinated with surgery and the coagulation team.
A central line clot is being cleared with low-dose thrombolytic. What special nursing precautions apply compared to systemic tPA? Name one!
What is monitor site and systemic bleeding, use lowest effective dose and duration specific to central line protocols, and observe for systemic effects despite local use.