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An inside view of Venous Thromboembolism

doi: 10.1097/01.NPR.0000388182.24347.bc
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INSTRUCTIONS An inside view of venous thromboembolism


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Lippincott Williams & Wilkins, publisher of The Nurse Practitioner journal, will award 1.9 contact hours for this continuing nursing education activity.

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An inside view of venous thromboembolism

General Purpose: To provide the NP with an overview of the pathophysiology, diagnosis, and treatment of VTE. Learning Objectives: After reading this article and taking this test, you will be able to: 1. Explain the pathophysiology of VTE. 2. Distinguish between the modalities available for diagnosing VTE. 3. Discuss the prevention and treatment of VTE.

1. Virchow triad for progression of venous thrombosis includes all except

a. venous stasis.

b. endothelial injury.

c. arterial pressure.

d. hypercoagulation.

2. One change in the fibrinolytic system associated with thrombosis includes

a. increased endothelial release of tissue plasminogen activator.

b. abnormalities of plasminogen.

c. inhibition of fibronectin.

d. decreased levels of plasminogen activator inhibitor.

3. Small emboli typically lodge in

a. proximate regions of the lungs.

b. the upper lobes of the lungs.

c. distal regions of the lungs.

d. the coronary arteries.

4. The clinical diagnosis of DVT is

a. often unreliable.

b. confirmed in only 50% of suspected cases.

c. confirmed by a positive Homans sign.

d. confirmed by unilateral edema and warmth in the lower extremity.

5. The most common symptom of PE identified by the PIOPED study was

a. tachycardia.

b. tachypnea.

c. temperature higher than 103.1oF.

d. crackles.

6. The most widely used modality for evaluating suspected DVT is

a. contrast venography.

b. magnetic resonance imaging.

c. D-dimer assay.

d. Doppler ultrasonography.

7. The gold standard for DVT diagnosis is

a. D-dimer assay.

b. Doppler ultrasonography.

c. contrast venography.

d. magnetic resonance imaging.

8. Which Wells Clinical Prediction Rule score indicates high probability of PE?

a. 2.0

b. 4.0

c. 6.0

d. 9.0

9. A first-line imaging modality for suspected PE is

a. a ventilation-perfusion (V/Q) scan.

b. Doppler ultrasonography.

c. contrast venography.

d. a magnetic resonance imaging.

10. Currently, helical CT scanning is best used to

a. detect small PEs.

b. detect large thrombi in deep veins.

c. confirm PE when a V/Q scan is nondiagnostic.

d. replace pulmonary angiography.

11. Contrast-enhanced CT arteriography

a. should not be used with patients with a high probability of PE.

b. warrants caution in patients with renal insufficiency.

c. has no advantages over V/Q scanning.

d. lacks characterization of nonvascular structures.

12. The purpose of heparin therapy is to

a. eliminate incidences of fatal pulmonary emboli.

b. eliminate incidences of nonfatal pulmonary emboli.

c. eliminate recurrent thrombi.

d. prevent extension of thrombi.

13. For the patient on warfarin, an INR of 2.2 is

a. lower than goal range.

b. within goal range.

c. higher than goal range.

d. an irrelevant test result.

14. Which medication would the NP prescribe for heparin-induced thrombocytopenia?

a. lepirudin

b. warfarin

c. enoxaparin

d. fondaparinux

15. The patient who is not

a candidate for an inferior vena cava filter has

a. recurrent emboli.

b. a proven PE and cardiogenic shock.

c. bleeding complications during anticoagulation.

d. contraindications to anticoagulation.

16. For DVT prevention, advise high-risk patients to do all except

a. control hypertension.

b. stop smoking.

c. avoid compression stockings.

d. avoid prolonged standing.



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