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 should the nurse recommended?
What is regular calf/leg exercises, frequent breaks 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 is the most serious complication associated with thrombolytic therapy, and what should the nurse monitor for as the highest priority?
What is major bleeding; continuously monitor for bleeding signs and neurologic status (if stroke) and vital signs
How does polycythemia increase clotting risk?
What is increased blood viscosity slows flow and promotes thrombus formation
An older adult with limited mobility is post-op. What prevention is the highest priority?
What is mechanical prophylaxis (SCDs) and early ambulation to reduce stasis
A patient receiving a continuous heparin infusion has a PTT of 28 seconds (therapeutic goal: 60–80 seconds). How should the nurse interpret this result, and what is the priority nursing action?
What is sub-therapeutic PTT — 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 patient with active internal bleeding or a history of hemorrhagic stroke
A recent major surgery or major trauma patient
Severe uncontrolled hypertension (e.g., >180/110) → high risk of intracranial bleeding
Known intracranial tumor or aneurysm
Recent GI bleed
Suspected aortic dissection
Pregnancy (relative contraindication)
Current anticoagulant therapy with very high INR
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 patient arrives to the emergency department with sudden onset dyspnea and pleuritic chest pain. Laboratory results show an elevated D-dimer. How should the nurse interpret this finding, and what is the priority next step?
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 D-dimer measures fibrin degradation products, which are released when a blood clot forms and is being broken down in the body.
A markedly elevated D-dimer suggests active clot formation, raising suspicion for pulmonary embolism (PE) in a patient with acute dyspnea.
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
Following an alteplase treatment for a massive PE, what clinical improvement would confirm that the therapy was successful?
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
Which modifiable lifestyle factor should a nurse prioritize when teaching older adults how to reduce their risk of developing blood clots?
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 receiving heparin therapy develops a rapidly decreasing platelet count along with signs of a new thrombosis. Which condition should the nurse suspect, and what is the priority nursing action?
What is heparin-induced thrombocytopenia (HIT); stop all heparin products, notify the provider, anticipate order alternative anticoagulation (non-heparin), and monitor platelets.
In rare cases, heparin triggers a reaction that causes your blood to clot excessively instead of preventing clots. It causes your immune system to make antibodies that activate your platelets.
A patient arrives 90 minutes after ischemic stroke symptoms began. What critical criterion must the nurse confirm to determine whether tPA can be safely given?
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.
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)
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 low-dose thrombolytic is being used to clear a central line occlusion. What is one key nursing precaution that differs from systemic tPA administration?
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.