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CE Test

Pharmacologic Anticoagulation Reversal in the Emergency Department

Advanced Emergency Nursing Journal: July/September 2011 - Volume 33 - Issue 3 - p 224-225
doi: 10.1097/TME.0b013e31822cc011
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  • Registration deadline is September 30, 2013.

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Provider Accreditation

Lippincott Williams & Wilkins, the publisher of Advanced Emergency Nursing Journal, will award 2.8 contact hours and 2.0 pharmacology credit hours for this continuing nursing education activity.

Lippincott Williams & Wilkins is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 2.8 contact hours. LWW is also an approved provider of continuing nursing education by the District of Columbia #50-1223 and Florida #50-1223. Your certificate is valid in all states.

The ANCC's accreditation status of Lippincott Williams & Wilkins Department of Continuing Education refers only to its continuing nursing educational activities and does not imply Commission on Accreditation approval or endorsement of any commercial product.

Disclosure Statement

The authors have disclosed that they have no significant relationship with or financial interest in any commercial companies that pertain to this educational activity.


General Purpose Statement: To provide the registered professional nurse with an overview of the management issues associated with anticoagulant reversal in the emergency department.

Learning Objectives: After reading the article and taking this test, you should be able to:

  1. Describe the indications and recommendations for use of some of the common anticoagulant reversal agents in the emergency department.
  2. Discuss the dosages, concerns, and adverse effects of these anticoagulant reversal agents.
  1. Key determinants of oral vitamin K antagonist (VKA) bleeding are patient characteristics, concomitant medications, intensity of anticoagulation, and
    1. other concomitant diseases.
    2. duration of treatment.
    3. duration of disease.
    4. age of patient.
  2. The CHEST guideline for using vitamin K to manage a patient with no significant bleed and an INR of 5 to 8.9 is to
    1. lower the anticoagulant dose.
    2. omit 1 or 2 anticoagulant doses.
    3. omit anticoagulant dose and give 10 mg PO of vitamin K.
    4. omit anticoagulant dose and give 10 mg vitamin K by slow IV infusion.
  3. The CHEST guideline for the administration of vitamin K in a patient with life threatening bleeding is to
    1. administer 10 mg orally.
    2. repeat 10 mg orally every 2 to 3 hours until INR is normal.
    3. give 10 mg slowly by IV infusion.
    4. administer 100 mg by IV infusion over 12 hours.
  4. Following IV administration of vitamin K, bleeding is usually controlled in
    1. 30 to 60 minutes.
    2. 1 to 2 hours.
    3. 3 to 6 hours.
    4. 12 to 24 hours.
  5. The onset of action following IV administration of protamine sulfate is approximately
    1. 5 minutes.
    2. 15 minutes.
    3. 30 minutes.
    4. 60 minutes.
  6. Which statement about intravenous protamine sulfate is accurate?
    1. It has similar effects on both UFH and LMWH.
    2. It is dosed the same way for either UFH or LMWH.
    3. It has an incomplete reversal effect when associated with LMWH.
    4. It should be given at higher doses when LMWH was given more than 8 hours ago.
  7. Serious adverse effects of protamine sulfate include
    1. severe hypotension.
    2. severe hypertension.
    3. thrombotic events.
    4. tachycardia.
  8. Which reversal agent is effective for patients with qualitative platelet defects?
    1. Protamine sulfate
    2. Von Willebrand factor
    3. Vitamin K
    4. Desmopressin
  9. Which is a particularly important parameter to monitor in patients receiving desmopressin?
    1. fluid status
    2. heart rate and rhythm
    3. respiratory rate
    4. body temperature
  10. Recombinant factor VIIa(rVIIa) has been evaluated for reversal of all of the following except
    1. warfarin.
    2. bleeding associated with VKA therapy.
    3. fondaparinux.
    4. direct thrombin inhibitors.
  11. Which statement is accurate about rVIIa?
    1. It is provided in powder form and is reconstituted to a concentration of 1 mg/ml.
    2. It is reconstituted with sterile normal saline solution.
    3. It should be administered intravenously over 20 to 30 minutes.
    4. It corrects the INR to normal within 1 to 2 minutes.
  12. One serious adverse effect associated with rVIIa is
    1. a thromboembolic event.
    2. seizure activity.
    3. paradoxical bleeding.
    4. sudden cardiac asystole.
  13. Prothrombin complex concentrate (PCC) products
    1. are primarily used for bleeding in hemophilia A or B.
    2. are the reversal drugs of choice for heparin induced thrombocytopenia.
    3. contain higher concentrations of factor VII than other products.
    4. replace clotting factors that have been depleted by anticoagulation therapy.
  14. After reconstitution, Profilnine should be administered at a rate of
    1. 2 ml/min.
    2. 4 ml/min.
    3. 5 ml/min.
    4. 10 ml/min.
  15. When administering a PCC, monitor
    1. fluid and sodium status before and after administration.
    2. for flushing, headache, and changes in blood pressure and heart rate.
    3. for incomplete reversal of LMWH.
    4. for anaphylaxis.
  16. Which statement about PCCs in relation to FFP is accurate?
    1. Of the reversal agents, PCCs are the most similar to FFP in blood clotting factor composition.
    2. Both PCCs and FFP must be thawed before administration.
    3. Patient's blood must be typed and matched prior to administration of PCCs or FFP.
    4. To achieve hemostasis, 5 to 20 ml of PCCs are infused compared to l00 ml of FFP.
  17. The two major concerns with administration of PCCs are the potential for a subsequent thrombotic event and
    1. the cost of therapy.
    2. product sterility.
    3. pulmonary edema.
    4. allergic reactions in men who have had a vasectomy.
  18. Which statement about effective anticoagulation reversal is accurate?
    1. One obstacle is the lack of an antidote for direct thrombin inhibitors.
    2. All anticoagulants have an effective reversal agent available.
    3. Human studies have shown protamine sulfate effective against LMWH.
    4. Protamine sulfate is effective in reversing the anticoagulation effect of fondaparinux.
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