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Article: AENJ-D-15-00044 Date: October 17, 2015 Time: 14:51 EARN CE CREDIT ONLINE Go to http://www.nursingcenter.com/CE/AENJ and receive a certificate within minutes. CE Test Alteplase for the Treatment of Pulmonary Embolism: A Review Test Instructions For questions, contact Lippincott Williams & Wilkins: ber CEP 11749 for 3.0 contact hours. LWW is also an Read the article. The test for this CE activity can only be 1-800-787-8985. approved provider of continuing nursing education by taken online at http://www.nursingcenter.com/CE/AENJ. Registration deadline is December 31, 2017. the District of Columbia, Georgia, and Florida CE Broker Tests can no longer be mailed or faxed. #50-1223. Your certificate is valid in all states. You will need to create (its free!) and login to your The ANCC’s accreditation status of Lippincott Provider Accreditation personal CE Planner account before taking online tests. Williams & Wilkins Department of Continuing Educa- Lippincott Williams & Wilkins, the publisher of Advanced Your planner will keep track of all your Lippincott Williams tion refers only to its continuing nursing educational Emergency Nursing Journal, will award 3.0 contact hours & Wilkins online CE activities for you. activities and does not imply Commission on Accred- including 3.0 Pharmacology credits for this continuing There is only one correct answer for each question. itation approval or endorsement of any commercial nursing education activity. A passing score for this test is 13 correct answers. If product. Lippincott Williams & Wilkins is accredited as you pass, you can print your certificate of earned contact a provider of continuing nursing education by the hours and access the answer key. If you fail, you have Disclosure Statement American Nurses Credentialing Center’s Commission on the option of taking the test again at no additional cost. The authors and planners have disclosed that they have Accreditation. no financial relationships related to this article. This activity is also provider approved by the California Board of Registered Nursing, Provider Num- CE TEST QUESTIONS General Purpose: To provide information on the 7. The American Heart Association 14. The current Food and Drug use of alteplase (rt-PA) for treating pulmonary embolism (2011) gives a Class IIa recommenda- Administration-approved dose of (PE). tion for the use of thrombolysis for rt-PA for the treatment of acute PE is Learning Objectives: After completing this a. low-risk PE. a. 10 mg intravenous bolus and then 40 mg infu- continuing education activity, you should be able to: b. submassive PE with clinical evidence of adverse sion over 2 hr. 1. Identify the method of diagnosis, cause of mortal- prognosis. b. 50 mg infusion over 2 hr. c. massive acute PE with acceptable risk of c. 100 mg infusion over 2 hr. ity, and risk factors, as well as general treatment guidelines for acute PE. bleeding complications. 15. The 2012 American College of Chest 2. Examine practice guidelines for using rt-PA for 8. Which oral anticoagulant does not re- Physicians guidelines recommend treating PE. quire concomitant parenteral antico- what dose of rt-PA for patients in car- agulant therapy after initiation? diac arrest? 1. Risk parameters for intermediate-risk a. apixaban a. 0.6 mg/kg (maximum 50 mg) bolus over 15 min PE include b. dabigatran etexilate b. 0.6 mg/kg (maximum 100 mg) infusion over a. sustained hypotension for at least 15 min. c. edoxaban 2hr b. elevated cardiac biomarkers. 9. Which statement is true regarding rt- c. 1.5 mg/kg (maximum 100 mg) infusion over c. persistent profound bradycardia. PA? 2hr 2. Death from PE results from a. It has limited systemic effects. 16. After administering rt-PA for car- a. respiratory failure. b. It is metabolized through the kidneys. diac arrest, cardiopulmonary resusci- b. intracranial hemorrhage. c. Hemodynamics are improved within 30 minutes tation must be continued for at least c. right ventricular failure. of starting the infusion. a. 10 min. 3. The most common signs and symp- 10. When used for PE, rt-PA should be b. 15 min. toms of PE include given c. 30 min. a. elevated pulmonary arterial pressure. a. within 3 hr. 17. Which statement is true regarding the b. hemoptysis. b. within 4.5 hr. administration of rt-PA? c. hypotension. c. as soon as possible; there is no specified time a. Reconstituted rt-PA is stable at room tempera- 4. The gold standard for the diagnosis frame. ture for 12 hr. of acute PE is 11. Major contraindications to rt-PA ad- b. It can be administered safely via a peripheral a. a ventilation–perfusion scan. ministration include intravenous line. b. cardiac biomarker analysis. a. pregnancy. c. Once reconstituted, rt-PA should be shaken c. computed tomography–pulmonary angiogra- b. ischemic stroke within 3 months. until all of the drug is dissolved. phy. c. current anticoagulation therapy. 18. Care of the patient for the first 24 hr 5. Which drug is preferred for the first- 12. The risk of bleeding from rt-PA and after rt-PA administration includes line treatment of PE? concomitant administration of an an- a. holding pressure on venous blood draw sites for a. low-molecular-weight heparin (LMWH) ticoagulant can last as long as 15–30 min. b. unfractionated heparin (UHF) a. 2–3 days. b. inserting a urinary catheter to monitor output. c. warfarin b. 5–7 days. c. placing an additional intravenous line for the 6. Which anticoagulant is preferred c. 8–10 days. anticoagulant infusion. when a fibrinolytic is administered for 13. An UFH infusion should be restarted PE? after rt-PA administration if the acti- a. fondaparinux vated partial thromboplastin time is b. UFH a. less than or equal to 80 seconds. c. LMWH b. between 90 and 100 seconds. c. more than 100 seconds. E4
Advanced Emergency Nursing Journal – Wolters Kluwer Health
Published: Dec 1, 2015
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