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Nurse Practitioner:
doi: 10.1097/01.NPR.0000437541.69380.ae
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Preventing stroke in patients with atrial fibrillation

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INSTRUCTIONS Preventing stroke in patients with atrial fibrillation

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Preventing stroke in patients with atrial fibrillation

General Purpose: To provide information on determining anticoagulant treatment options for adults with nonvalvular AF. Learning Objectives: After reading the article and taking this test, you should be able to: 1. Identify the types of AF and its associated risk assessments. 2. Examine the use of warfarin in the treatment of AF. 3. Compare and contrast the use of newer antithrombotic agents.

  1. Which statement about AF isnotcorrect?
    1. AF that lasts less than 7 days and returns spontaneously to normal sinus rhythm is called paroxysmal AF.
    2. Patients can have more than 1 type of chronic AF.
    3. Persistent AF often resolves without treatment.
    4. Paroxysmal, persistent, and permanent AF are associated with a similar increased risk of stroke.
  2. In the CHADS2 scoring schema, a 78-year-old patient with a history of heart failure would receive a score of
    1. 1.
    2. 2.
    3. 3.
    4. 4.
  3. According to the CHADS2 scoring schema, the highest relative risk factor for stroke in a person with AF is
    1. hypertension.
    2. diabetes.
    3. a history of a transient ischemic attack.
    4. age 75 years.
  4. A patient with a CHADS2 score of 6 has a risk of stroke of about
    1. 5%.
    2. 12%.
    3. 18%.
    4. 24%.
  5. The CHA2DS2 VASC scoring schema includes which additional risk factor?
    1. age 65-74 years
    2. male gender
    3. valvular heart disease
    4. mechanical heart valves
  6. According to stroke prevention recommendations, patients with a CHADS2 score of 2 should receive
    1. no therapy.
    2. aspirin alone.
    3. oral antithrombotic therapy.
    4. aspirin and clopidogrel.
  7. A challenge with the use of warfarin is
    1. providers' overutilization.
    2. maintaining the desired therapeutic range.
    3. the expense of the medication.
    4. its wide therapeutic window.
  8. Which drug is a factor IIa inhibitor?
    1. Apixaban
    2. Rivaroxaban
    3. Warfarin
    4. Dabigatran
  9. Patients with AF caused by valvular heart disease should be treated with
    1. dabigatran.
    2. rivaroxaban.
    3. warfarin.
    4. apixaban.
  10. Compared to warfarin, use of the three alternative oral agents is associated with
    1. more episodes of major bleeding.
    2. a 25% reduction in mortality.
    3. an increased risk of systemic emboli.
    4. fewer hemorrhagic strokes.
  11. The half-life of dabigatran in adults with normal kidney function is approximately
    1. 1 to 3 hours.
    2. 5 to 9 hours.
    3. 12 to 17 hours.
    4. 20 to 24 hours.
  12. Rivaroxaban is prescribed
    1. once every other day.
    2. once daily.
    3. twice daily.
    4. three times daily.
  13. The greatest risk factor for bleeding is
    1. a history of bleeding.
    2. abnormal liver or kidney disease.
    3. uncontrolled hypertension.
    4. reduced platelet count.
  14. The specific antidote for warfarin is
    1. prothrombin complex concentrate.
    2. Vitamin K.
    3. 2 to 4 units of fresh frozen plasma.
    4. hemodialysis.
  15. The patient who cannot swallow a dabigatran capsule should
    1. open the capsule and sprinkle the contents on applesauce.
    2. cut the capsule and swallow each half.
    3. remove it from the packaging and allow it to soften for one hour.
    4. ask the provider to prescribe an alternative agent.
  16. All three newer agents should be discontinued at least how many hours prior to any elective surgery that has a moderate-to-high risk of significant bleeding?
    1. 24 hours
    2. 48 hours
    3. 72 hours
    4. 96 hours
  17. Which statement is true about the newer antithrombotic agents?
    1. They require no lab monitoring.
    2. Most dental procedures require stopping the agents for at least 24 hours.
    3. They have a slower onset of action than warfarin.
    4. Dabigatran has less renal excretion compared to apixaban.
  18. Compared to the other two newer agents,
    1. apixaban causes less bleeding.
    2. dabigatran provides the most convenient dosing.
    3. rivaroxaban has the best efficacy.
    4. apixaban results in the most effective stroke prevention.
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