Thank you so much for visiting the EmpoweRN Blog. This topic is going over the medication ticlopidine, which is also known as Ticlid .
In this post you will find”
1. A video playlist, which you can watch
by clicking the image here –>
2. NCLEX style questions
3. Link to an audio of the video, which you can find here: https://s3.amazonaws.com/websiteaudiosempowern/Ticlid+Audio.m4a
Nursing Exam or NCLEX style Questions:
1. The nurse reviews the medication list of a client post cerebrovascular attack, she sees Ticlodipine (Ticlid) in the list of medications. The nurse knows that this drug is under which of the following classifications?
B. Platelet Aggregation Inhibitors
C. Cardiac Glycosides
D. None of the above
Ans.: B. Ticlodipine is an antiplatelet medication which inhibits the aggregation of platelets in the clotting process.
2. In explaining the indication for the use of the medication Ticlodipine (Ticlid), the nurse enumerates which of the following conditions? Select all that apply:
A. Post Cerebrovascular Accident
B. Post Liver Transplant
C. Post abdominal trauma
D. Post Myocardial Infarction
E. Post Coronary Revascularization
F. Post Coronary Stent Implantation
Ans.:A, D, E, F are all possible indications for the use of Ticlid. It is also used as prophylaxis of complications following myocardial infarction, coronary revascularization, stents and brain attacks. It is not used in clients who are at risk for bleeding due to trauma, surgery or pathological conditions.
3. In instructing the client on how to take Ticlid, the nurse notes how food affects the absorption of this medication in the body. Which of the following is a correct statement of the nurse for this medication?
A. “To decrease stomach upset, this medication should be taken with food or just after eating.”
B. “To lessen gastric irritation, this medication should not be taken with food.”
C. “To avoid stomach cramps, take this medication 2 hours before of after eating.”
D. B and C.
Ans.: A. Food can enhance the levels of ticlodipine in the body and taking it with food or just after eating will help lessen stomach upset.
4. The nurse is reviewing the medication list of the client who has orders from the attending physician to start with Ticlodipine 250 mg BID. She alerts the physician with which of the following medications that would cause drug interactions when taken with Ticlid? Select all that apply:
A. Fondaparinux (Arixtra)
B. Clopidogrel (Plavix)
C. Clozapine (Clopine)
E. Esomeprazole (Nexium)
F. Amlodipine (Norvasc)
Ans.: A, B, C, D are contraindicated to use with Ticlodipine. Arixtra and Plavix could both increase the risk of bleeding and hemorrhage, while Clopine and Citalopram increases the risk for arrhythmias.
5. As the nurse teaches the discharge instructions for a client post Coronary Stent Implantation, she includes the following side effects of this medication. Select all that apply:
B. Abdominal Pain
Ans.:A, B, C, D, E, F are all side effects of this medication that the client should monitor for and alert the physician if such side effects would persist.
6. Prior to initiating Ticlodipine in a client post cardiac revascularization, the nurse reviews the client’s medical history. Which of the following conditions should the nurse report to the prescribing physician? Select all that apply:
A. Thrombotic Thrombocytopenic Purpura
B. Aplastic Anemia
D. Diabetes Mellitus
E. Peptic Ulcer Disease
F. Liver Disease
Ans.:A, B, D, E. Immune disorders, bleeding and clotting disorders, liver and kidney diseases should warrant the attention on the physician prior to initiating Ticlodipine therapy.
7. The client asks the nurse why his doctor had told him that taking Ticlodipine would increase his risk of acquiring infections. The nurse correctly responds to the client with which of the following statements?
A. “This medication boosts your immune system but it would take about 2 weeks to have that effect, so you are advised to avoid crowded places in the meantime.”
B. “This medication causes you for increased risk of bleeding which puts you at risk for acquiring communicable diseases.”
C. “This medication increases your platelet count which makes you immunocompromised.”
D. “This medication causes you to have a low count of the white blood cells that helps fight off infections, so you are advised to avoid situations that would likely expose you to acquiring infections or communicable diseases.”
8. The nurse asks the client who is taking Ticlodipine his knowledge about bleeding precautions. Which of the following statements indicate the need for further teaching by the nurse?
A. “I should use electric razor for shaving.”
B. “I should stop taking my medications when I go to the dentist.”
C. “I should limit or avoid drinking alcoholic beverages to decrease the risk for stomach bleeding.”
D. “I should not engage in sports or activities that could cause me to get hurt.”
Ans.: B. Ticlodpine should not be discontinued without the knowledge of the prescribing physician. If a client has invasive procedures or surgery, he should consult first with the prescribing physician on how he should be taking this medication.
9. The nurse teaches the client on the neutropenic effects of Ticlodipine and the precautions when on this medication. Which of the following statements made by the client indicates further teaching by the nurse?
A. “I should get my flu and pneumonia vaccine at the local clinic to help fight off these communicable diseases”
B. “I should avoid crowded areas and people who have infections and communicable diseases.”
C. “I should observe proper hand washing at all times.”
D. “When going to crowded places such as the doctor’s office, I should wear a face mask.”
Ans.: A. The client should not have immunizations / vaccinations without the knowledge of the prescribing physician.
10. The nurse reads on the client’s chart that he is allergic to Clopidogrel when she is about to start the ordered dose of Ticlodipine 250 mg for the same client. Which of the following is an appropriate action by the nurse?
A. Inform the nurse supervisor.
B. Do a scratch test to the client
C. Give the ordered dose and observe for allergic reactions.
D. Inform the prescribing physician that the client is allergic to clopidogrel.
Ans.: D. Before initiating this medication, the nurse should inform the prescribing doctor that the client is allergic to a similar antiplatelet medication. All other options are incorrect.
11. A nurse is about to give the initial dose of Ticlodipine 500 mg to a client post percuteneous coronary intervention. She reads in the client’s chart that he is allergic to Prasugrel, what should be the nurse’s next action?
A. Hold the medication and inform the ordering physician.
B. Disregard the allergy alert and proceed with giving the initial dose.
C. Call the nurse supervisor to give the initial dose.
D. Do a patch testing prior to administration.
Ans.: A. Allergy to Thienopyridine derivatives include Clopidogrel, Prasugrel and Ticlodipine. The nurse should first report to the ordering physician that the client is allergic to a similar drug so that he can order an different adjunctive therapy.
12. The client post implantation of a coronary artery stent is to be discharged. He tells the nurse that he is scared to be taking blood thinners at home because he had a previous experience with aspirin allergy before. Which of the following are significant signs and symptoms of an allergic reaction that he should report immediately to his physician? Select all that apply:
B. Chest tightness
E. Swelling of lips
Ans.: A, B, C, E, F are signs and symptoms of an allergic reaction that should be consulted with the prescribing physician immediately.
13. The client post stroke has been taking Ticlid 250 mg twice a day for two weeks already. He tells the nurse case manager that he is having trouble with reading and has a severe headache. Which of the following should the nurse do?
A. Instruct the client to drive to the nearest urgent care facility
B. Have the client call 911 immediately
C. Facilitate a teleconference to the physician to report the symptoms
D. Instruct the client non pharmacologic measures to relieve headaches
Ans.: C. Adverse effects such as vision changes and severe headaches in clients taking Ticlodipine should be reported to the prescribing physician. The nurse should not advise the client to drive himself due to safety reasons.
14. The client on Ticlodipine 250 mg BID tells the nurse that he does not like this medication because it is causing him to have stomach cramps. Which of the following is an appropriate response of the nurse?
A.”Do you take Ticlid with meals?”
B. “You may not take them in the meantime and tell it to your physician on your next visit.”
C. “You may take Tums OTC prior to taking Ticlid.”
D. “Ask your doctor if you can be prescribed with a different medication.”
Ans.: A. The nurse should first assess how the client is taking the medication as Ticlodipine should be taken with food to avoid gastrointestinal upset.
15. The nurse received the laboratory results for the post stroke client who is taking Ticlodipine. Which of the following results needs to be reported to the attending physician?
A. Hemoglobin: 12 g/dL
B. Neutrophils: 800 cells/mm3
C. INR: 2
D. WBC: 4,000 cells/mcL
Ans.:B is indicative of a low neutrophil count and the physician should be informed if the client is experiencing the adverse effect of neutropenia. All other results are within normal limits.
16. The nurse anticipates that the client post stroke who is unable to take Aspirin may benefit from another antiplatelet aggregating agent such as which of the following?
A. Ticlodipine (Ticlid)
B. Pentoxifylline (Trental)
C. Clozapine (Clopine)
D. Citalopram (Celexa)
Ans.: A. To prevent future strokes, the platelet aggregation inhibitor Ticlodipine (Ticlid) can be used in patients who cannot take aspirin.
17. The client tells the nurse that he is to be scheduled for a laparoscopic cholecystectomy the next day. Upon reviewing the client’s current medications, she finds that the client is taking a daily dose of Ticlid 250 mg. What should be the next action of the nurse?
A. Advise the client to stop taking the medications for ten days.
B. Reschedule the client’s laparoscopic cholecystectomy for today.
C. Inform the performing surgeon of the client’s current medications and inform the prescribing physician of the upcoming procedure.
D. Have the client take aspirin instead and schedule the procedure for tomorrow.
Ans.: C. Ticlid is an anitplatelet aggregating agent and clients taking such medications should be reported to their physicians prior to undergoing invasive tests or procedures. It should not be continued without the knowledge of the prescribing physician.
18. The client has a coronary artery stent that was implanted a week ago. He tells the nurse that his current medication, Ticlodipine (Ticlid) 250 mg BID, is causing him to feel dizzy. The nurse does an assessment on when this often happens and finds out that it happens when the client is picking up pots while he is gardening. Which of the following is an appropriate advise for this client?
A. “Stop taking the medication and visit your doctor immediately.”
B. “Change the schedule of your medications so that you can take it prior to meals.”
C. “Bend your knees and keep your head up when picking something off the floor.”
D. “Do not do gardening until you feel better.”
Ans.: C. Bending over with the head lower than the shoulders often causes clients taking taking antiplatet aggregating agents t become dizzy and lightheaded. The nurse should advise proper body mechanics to prevent this occurrence.
19. The nurse reads in the chart that the client admitted in the ICU has a history of maintenance with Ticloodipine and was admitted due to low platelet count, fever and neurological changes. The nurse suspects which of the following adverse effects?
A. Pulmonary congestion
B. Von Willebrand disease
D. Thrombotic thrombocytopenic purpura
Ans.: D. Thrombotic thrombocytopenic purpura (TTP) is a blood disorder that causes blood clots to form in small blood vessels around the body. It is an adverse effect that can happen in clients taking Ticlid which present as thrombocytopenia, microangiopathic haemolytic anemia, renal dysfunction, fever and neurological changes.
20. The receiving nurse has received a call from the urgent care facility that they will be transferring a client who has developed Thrombotic Thrombocytopenic Purpura (TTP) due to Ticlodipine regimen. The nurse knows that TTP shows which of the following symptoms? Select all that apply:
A. bleeding into the mucus membranes
B. changes in level of consciousness
C. flushed skin complexion
E. shortness of breath
Ans.: A, B, E, F are signs of TTP. Clients with TTP would also present with a pale or yellowish colored skin, tachycardia and weakness.
21. The attending physician tells the nurse that the client with Thrombotic Thrombocytopenic Purpura (TTP) would need to have the antibodies affecting the clotting from his blood removed through a machine. The nurse anticipates this as which of the following procedures?
B. Blood transfusion
D. Hyperbaric Oxygen Therapy
Ans.: A. Plasmapheresis is a blood purification procedure in which whole blood is taken from a person with the plasma component separated the remaining components reinfused. Plasma will then be replaced through transfusion.
22. The client with Thrombotic Thrombocytopenic Purpura (TTP) due to Ticlid maintenance asks the nurse he is scared with the risks during plasmapheresis. The nurse correctly responds with which of the following?
A. “Would you like to cancel the procedure?”
B. “You will be just fine.”
C. “I will call your physician to have him explain to you the procedure one more time.”
D. “Tell me more about it.”
Ans.: D. The nurse should first explore the client’s feelings so that she can address the client’s feeling of anxiety properly.
23. The client with Neutropenia due to Ticlid maintenancetherapy has an ongoing plasma transfusion, during the first 12 minutes of transfusion, the nurse notes that the patient is having chills, fever, backache and hypotension. What should the nurse initially do?
A. Start a normal saline infusion at 10 cc/hr
B. Notify the blood bank
C. Stop the transfusion
D. Change the tubing
Ans.: C. When a transfusion reaction is suspected, the nurse should immediately stop the transfusion. Other options are correct and should follow once the transfusion is interrupted.
24. The nurse caring for a client with Neutropenia due to Ticlid maintenance therapy has orders for plasma transfusion. As the nurse gathers the details needed from the client she notes that the client previously had an experience of transfusion reaction. Which of the following should be her priority action?
A. Ask if the client has relatives who can donate blood for her
B. Note it in the client’s record
C. Inform the attending physician and ask for prophylactic treatment
D. Obtain an order for BUN, Creatinine and Bilirubin levels
Ans.: C. The attending physician should be initially informed if a client has a history of transfusion reaction so that the physician can order prophylactic treatment and will order additional laboratory tests if needed.
25. The student nurse asks the charge nurse why the client post coronary artery stent implantation is given an order of Ticlodipine 500 mg OD initially then 250 mg po BID. The nurse correctly responds with which of the following statements?
A. “It is used to prevent bleeding post stent implantation.”
B. “It is used to prevent thrombosis post stent implantation.”
C. “It is used to promote revascularization and adequate stent placement.”
D. None of the above
Ans.: B. Antiplatelet aggregation agents are used in clients post coronary stent implantation to reduce or prevent the incidence of subacute stent thrombosis.
26. The nurse is about to administer the initial dose of Ticlodipine to a client who is suspecting that she may be pregnant. The nurse knows that this drug belongs to which pregnancy risk factor classification?
A. Category A
B. Category B
C. Category C
D. Category D
Ans.: B. Teratogenic effects have not been observed in animal reproduction studies and this medication should only be given during pregnancy when the benefits outweighs the risks.
27. The post percutaneous coronary intervention client is discharged with Ticlodipine (Ticlid) 250 mg po BID. During follow up, which of the following statements needs further attention by the nurse practitioner?
A. “I have been very careful at home so that I don’t hurt or cut myself, I actually replaced my razor with an electrical one.”
B. “I marked my calendar already for the next blood tests for liver function and CBCs.”
C. “I have been compliant in taking OTC antacids with Ticlid to prevent stomach aches.”
D. “I watch out for dark colored stools every time I go number two.”
Ans.: C. Antacids are contraindicated with Ticlodipine for they decrease its absorption. It should rather be taken with food to prevent stomach upset.
28. The telephonic nurse case manager is doing following up call on a client post stroke with a prescription of Ticlodipine 250 mg po BID. The client reports to the nurse that he is currently has a temperature of 103 degrees F, sore throat and body malaise. Which of the following interventions should the nurse do next?
A. Report the signs and symptoms to the attending physician
B. Instruct the client to go back to the hospital
C. Instruct the client to withhold taking the medication until the fever has subsided
D. Instruct the client to do a tepid sponge bath
Ans.: A. Ticlodipine may cause a decrease in white blood cells, which fight infection in the body and the signs and symptoms noted by the nurse should be reported to the attending physician for further management.