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Applying Evidence-Based Guidelines for Therapy in the Prevention and Treatment of Venous Thromboembolism This program is located at http://onlinece.ashpadvantage.com/vte

There are 17 questions associated with this self-assessment test.

1. Chest pain and dyspnea in a patient with a history of (DVT) are most likely signs of a. DVT recurrence. b. -induced (HIT). c. Post-thrombotic syndrome. d. (PE).

2. Which of the following tests is indicated for a patient with suspected DVT in a leg and a high clinical pretest probability? a. Computed tomography arteriography. b. D-dimer test. c. Duplex ultrasound with compression. d. Lung ventilation/perfusion (VQ) scan.

3. Which of the following is the most common preventable cause of hospital death? a. . b. HIT. c. Post-thrombotic syndrome. d. DVT leading to PE.

4. Which of the following comprise Virchow’s triad? a. Endothelial injury, circulatory stasis, and hypercoagulable state. b. Pain, swelling, and warmth. c. Post-thrombotic syndrome, pulmonary hypertension, and death. d. Tissue factor, , and fibrin.

5. A large study of first-time venous thromboembolism (VTE) cases found a 30% higher risk of idiopathic in which of the following racial/ethnic groups? a. African Americans. b. Asians. c. Caucasians. d. Pacific Islanders.

6. Which of the following selectively inhibits factor Xa activity? a. Unfractionated heparin (UFH). b. Low-molecular weight heparin (LMWH). c. . d. .

7. Which of the following is an appropriate strategy for preventing VTE in a 30-year-old patient planning to undergo minor surgery who has no other risk factors for VTE? a. Early ambulation. b. LMWH. c. Low-dose unfractionated heparin (LDUH) twice daily. d. LDUH three times daily.

8. Which of the following is an appropriate strategy for preventing VTE in a 30-year-old patient planning to undergo orthopedic surgery? a. Early ambulation. b. LMWH. c. LDUH twice daily. d. LDUH three times daily.

9. VTE prophylaxis typically is provided for 10 days in patients undergoing major orthopedic surgery because DVT symptoms usually occur within 10 days after this surgery. a. True. b. False.

10. The risk for VTE in medical patients is a. Considerably higher than that in surgical patients. b. Comparable to that in surgical patients. c. Considerably lower than that in surgical patients but a concern. d. Considerably lower than that in surgical patients and inconsequential.

11. Which of the following statements about the comparative efficacy of LMWH and LDUH 5000 units subcutaneously two or three times daily for preventing VTE in medical patients is correct? a. LMWH is more effective than LDUH, and LDUH three times daily is more effective than LDUH two times daily. b. LMWH is more effective than LDUH, and LDUH two times daily is more effective than LDUH three times daily. c. LDUH is more effective than LMWH, and LDUH three times daily is more effective than LDUH two times daily. d. LDUH is more effective than LMWH, and LDUH two times daily is more effective than LDUH three times daily.

12. Which of the following statements about the advantages and disadvantages of using LMWH and UFH for VTE prophylaxis in medical patients is correct? a. The -acquisition cost is higher for UFH than LMWH. b. Patient acceptance is higher for UFH than LMWH. c. The risk of HIT from LMWH is lower than the risk for HIT from UFH. d. The amount of nursing time required is higher for LMWH than UFH.

13. Heparin and warfarin therapy should overlap by 4-5 days in patients treated for VTE because a. Initial warfarin therapy can cause depletion of and bleeding, and 4-5 days are required for warfarin levels to reach steady state. b. Initial warfarin therapy can cause depletion of protein C and bleeding, and 4-5 days are required for heparin concentrations to decrease below therapeutic levels. c. Discontinuation of heparin therapy can cause depletion of protein C and a hypercoagulable state, and 4-5 days are required for warfarin levels to reach steady state. d. Initial warfarin therapy can cause depletion of protein C and a hypercoagulable state, and 4-5 days are required for warfarin levels to reach steady state.

14. According to the American College of Chest Physicians, which of the following is the recommended duration of warfarin therapy for a patient who experiences VTE as a first event with a reversible cause? a. 1 month. b. 3 months. c. 6 months. d. 12 months to lifetime.

15. According to the American College of Chest Physicians, which of the following is the recommended duration of warfarin therapy for a patient who experiences idiopathic DVT as a first event? a. 1-3 months. b. 3-6 months. c. 6-12 months. d. 12 months to lifetime.

16. Which of the following agents is an investigational oral, reversible, direct thrombin inhibitor that may prove useful for VTE prophylaxis? a. . b. etexilate. c. . d. .

17. A documented risk assessment or prophylaxis within 24 hours of admission or surgery for all hospitalized patients is one of the performance measures included in the National Quality Forum’s national voluntary consensus standards for prevention and care of VTE. a. True. b. False.