A patient is brought to the emergency department with complaints ...

[londonang]

A patient is brought to the emergency department with complaints of chest pressure for 1 hour and ECG changes significant for an evolving myocardial infarction.
 
  The nurse understands that the best response from thrombolytic therapy with tissue plasminogen activator (tPA) occurs when it is
  a. given concurrently with warfarin (Coumadin).
  b. started within 4 to 6 hours of the onset of symptoms.
  c. started immediately upon arrival in the emergency department.
  d. administered only after confirmation of the diagnosis by coronary angiogram.

Question 2

The nurse in the cardiac catheterization laboratory administers an intravenous bolus of bivalirudin (Angiomax) just prior to the start of coronary angioplasty. For which of the following adverse effects should the nurse monitor the patient?
 
  a. Back and pelvic pain
  b. Fever and sore throat
  c. Headache and lethargy
  d. Diarrhea and tachycardia

[matt95]

Answer to Question 1

ANS: B
Thrombolytic therapy is most effective when started within 4 to 6 hours of symptom onset and preferably sooner.
Warfarin prevents the formation of new clots but has no effect on existing clots. There is no basis for administration at the same time as thrombolytic agents. An evolving myocardial infarction must be confirmed, as well as the absence of contraindications to thrombolytic therapy.
A patient should not receive tPA immediately upon arrival in the emergency department; a thorough evaluation must be done first.
A coronary angiogram is an invasive diagnostic procedure and is not required to confirm the diagnosis prior to tPA therapy.

Answer to Question 2

ANS: A
Back pain is one of the most common side effects of bivalirudin (incidence of 42). Pelvic pain also is a common side effect.
Fever is a relatively common side effect (incidence >5), but sore throat is not a side effect. The incidence of headache as a side effect is about 12.
Lethargy is not a side effect.
Diarrhea is not a side effect; however, the patient may experience the gastrointestinal side effects of nausea, vomiting, and abdominal pain. Bradycardia rather than tachycardia is a side effect, although tachycardia may be seen in response to the side effect of hypotension.

[londonang]

Excellent

[meow1234]

TYSM