Preventing stroke in patients with atrial fibrillation

INSTRUCTIONS Preventing stroke in patients with atrial fibrillation TEST INSTRUCTIONS To take the test online, go to our secure website at http://www.nursingcenter.com/ce/NP. On the print form, record your answers in the test answer section of the CE enrollment form on page 32. Each question has only one correct answer. You may make copies of these forms. Complete the registration information and course evaluation. Mail the completed form and registration fee of $24.95 to: Lippincott Williams & Wilkins, CE Group, 74 Brick Blvd., Bldg. 4, Suite 206, Brick, NJ 08723. We will mail your certificate in 4 to 6 weeks. For faster service, include a fax number and we will fax your certificate within 2 business days of receiving your enrollment form. You will receive your CE certificate of earned contact hours and an answer key to review your results.There is no minimum passing grade. Registration deadline is November 30, 2015. 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This activity has been assigned 2.8 pharmacology credits. 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. 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. Which statement about AF isnotcorrect? AF that lasts less than 7 days and returns spontaneously to normal sinus rhythm is called paroxysmal AF. Patients can have more than 1 type of chronic AF. Persistent AF often resolves without treatment. Paroxysmal, persistent, and permanent AF are associated with a similar increased risk of stroke. In the CHADS2 scoring schema, a 78-year-old patient with a history of heart failure would receive a score of 1. 2. 3. 4. According to the CHADS2 scoring schema, the highest relative risk factor for stroke in a person with AF is hypertension. diabetes. a history of a transient ischemic attack. age 75 years. A patient with a CHADS2 score of 6 has a risk of stroke of about 5%. 12%. 18%. 24%. The CHA2DS2 VASC scoring schema includes which additional risk factor? age 65-74 years male gender valvular heart disease mechanical heart valves According to stroke prevention recommendations, patients with a CHADS2 score of 2 should receive no therapy. aspirin alone. oral antithrombotic therapy. aspirin and clopidogrel. A challenge with the use of warfarin is providers' overutilization. maintaining the desired therapeutic range. the expense of the medication. its wide therapeutic window. Which drug is a factor IIa inhibitor? Apixaban Rivaroxaban Warfarin Dabigatran Patients with AF caused by valvular heart disease should be treated with dabigatran. rivaroxaban. warfarin. apixaban. Compared to warfarin, use of the three alternative oral agents is associated with more episodes of major bleeding. a 25% reduction in mortality. an increased risk of systemic emboli. fewer hemorrhagic strokes. The half-life of dabigatran in adults with normal kidney function is approximately 1 to 3 hours. 5 to 9 hours. 12 to 17 hours. 20 to 24 hours. Rivaroxaban is prescribed once every other day. once daily. twice daily. three times daily. The greatest risk factor for bleeding is a history of bleeding. abnormal liver or kidney disease. uncontrolled hypertension. reduced platelet count. The specific antidote for warfarin is prothrombin complex concentrate. Vitamin K. 2 to 4 units of fresh frozen plasma. hemodialysis. The patient who cannot swallow a dabigatran capsule should open the capsule and sprinkle the contents on applesauce. cut the capsule and swallow each half. remove it from the packaging and allow it to soften for one hour. ask the provider to prescribe an alternative agent. 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? 24 hours 48 hours 72 hours 96 hours Which statement is true about the newer antithrombotic agents? They require no lab monitoring. Most dental procedures require stopping the agents for at least 24 hours. They have a slower onset of action than warfarin. Dabigatran has less renal excretion compared to apixaban. Compared to the other two newer agents, apixaban causes less bleeding. dabigatran provides the most convenient dosing. rivaroxaban has the best efficacy. apixaban results in the most effective stroke prevention. Figure