Ch. 23, 31, 32 Study

A client on anticoagulant therapy is concerned about an upcoming trip. Which information should the nurse provide to this​ client?

"Short walks can be​ beneficial." When flying or taking long car​ rides, stopping for short walks can decrease venous stasis and prevent thrombus formation.

A client is diagnosed with a deep vein thrombosis​ (DVT). Which coagulation modifier should the nurse expect to be​ prescribed?

Antiplatelets and anticoagulants have the ability to prevent clot formation or clot enlargement. Antithrombin is a coagulation modifier used in clients with a high incidence of blood clots and DVTs.

A client has been taking atorvastatin​ (Lipitor) for 4 weeks. Which effect should the nurse​ expect?

Atorvastatin lowers triglycerides and decreases LDL and VLDL levels. It can also raise the level of​ "good" HDL cholesterol.

A client is receiving darbepoetin alfa​ (Aranesp) for anemia related to chemotherapy administration. Which finding should indicate to the nurse that the medication should be​ discontinued?

Darbepoetin alfa is a​ hematopoiesis-stimulating factor that is designed to increase RBC production in clients receiving chemotherapy. A hemoglobin level of 13.0​ g/dL is within normal limits and the medication should be discontinued.

A client receives filgrastim​ (Neupogen) for neutropenia for several days. Which manifestation should the nurse report as a possible splenic​ rupture?

Filgrastim​ (Neupogen) is a​ colony-stimulating factor that is used to increase WBC count in clients with neutropenia. Filgrastim has been associated with splenomegaly and splenic​ rupture, which is manifested as upper abdominal or left shoulder pain.​

A client is prescribed niacin as treatment for dyslipidemia. Which should the nurse include when teaching the client about this​ medication?

Niacin should be taken with cold water to decrease flushing. One aspirin should be taken 30 minutes before the niacin dose.

The nurse is teaching about different medications that stimulate platelet production. Which medication should be​ included?

Romiplostim​ (Nplate), oprelvekin​ (Neumega), and eltrombopag​ (Promacta) trigger platelet production.

A client on anticoagulant therapy is being evaluated. For which adverse effect should the nurse continue to assess throughout the​ client's anticoagulant​ therapy?

Tarry stools may signify bleeding from the gastrointestinal tract. Nosebleeds and abnormal bruising may indicate adverse effects from anticoagulants. Hematuria is another sign of abnormal bleeding.

A client comments that several friends are all taking statins. Which response should the nurse​ make?

​"Statins are the​ first-line drug of choice for lipid​ disorders, which is why they are so commonly​ used."

A client asks which medication blocks the absorption of cholesterol from the small intestine. Which response should the nurse​ provide?

​"The drug is called​ ezetimibe, or​ Zetia."

A client has no reduction in lipid levels after taking cholestyramine​ (Questran) for 4 weeks. Which response should the nurse​ make?

​"The medication can sometimes take 30 days or more to be​ effective."

The nurse is discussing with a client the role of cholesterol in the body. Which statement should the nurse make that describes why dietary cholesterol contributes to development of​ atherosclerosis?

​"While cholesterol is vital for several body​ processes, the body synthesizes most of what it​ needs, requiring little from the​ diet."

A client is taking oral anticoagulants. Which food rich in vitamin K should the nurse teach the client to​ avoid?

​Kale, broccoli, and asparagus are all rich in vitamin K. Increase or decrease in intake of these foods can increase or decrease the effectiveness of oral anticoagulants.

The nurse is teaching a client with hyperlipidemia about dietary changes. Which food rich in​ omega-3 and coenzyme Q10​ (CoQ10) should the nurse encourage the client to include in the​ diet?

​Nuts, beef,​ sardines, and​ extra-virgin olive oil are rich sources of​ omega-3 or CoQ10 and should be included in the diet in clients with hyperlipidemia.

A client with a history of cardiovascular disease has a platelet count of​ 20,000 ​cells/mm3. Before administering oprelvekin​ (Neumega), which baseline assessment data should the nurse​ obtain?

A baseline weight should be obtained because the client has preexisting cardiovascular​ disease, and one adverse effect of this medication is fluid retention.

The nurse is reviewing the history of a​ 3-year-old client. Which data should the nurse understand indicates the need for targeted screening of lipid​ levels?

A positive family history of​ dyslipidemia-related cardiovascular disease would indicate the need for targeted screening prior to age 9 to 11 years for dyslipidemias.

The nurse is caring for a client recovering from a percutaneous coronary intervention​ (PCI). Which medication should the nurse anticipate being prescribed immediately after the​ procedure?

Abciximab (ReoPro) is a glycoprotein​ IIb/IIIa inhibitor used to decrease the likelihood of thrombolytic events in clients with acute coronary syndrome.

The nurse is teaching a client about the use of​ colony-stimulating factors in the treatment of neutropenia. Which information should the nurse​ include?

Activates existing white blood cells​ (WBCs), Increases the phagocytic effect of leukocytes, Increases production of leukocytes, They increase migration and bacterial response.

A client receiving chemotherapy has a WBC count of 2.0 ​cells/mm3. Which hematopoietic growth factor should the nurse expect to be prescribed since the client has limited transportation to receive medical​ care?

Because the client has a decreased WBC count and has limited opportunities for transportation for medical​ care, the nurse should expect pegfilgrastim​ (Neulasta) to be prescribed. This medication is administered as a​ one-time injection per chemotherapy cycle.

A client receiving heparin therapy for a pulmonary embolism asks how the medication works. Which information should the nurse include about the action of​ heparin?

Binds to antithrombin III to prevent fibrin clots from forming. Its immediate impact on coagulation is one reason that it is used in emergency situations such as​ stroke, myocardial​ infarction, and pulmonary embolism.

A client is suspected of having thrombocytopenia. For which health problem should the nurse assess this​ client?

Bone marrow suppression, Vitamin B12 deficiency, Liver failure, Folic acid deficiency. Thrombocytopenia can occur from any condition that affects liver function or bone marrow suppression. It is also caused by a folic acid and vitamin B12 deficiency.

A client is taking cholestyramine​ (Questran). Which laboratory value should the nurse expect to be decreased in this​ client?

Calcium, Potassium, Sodium

The nurse is planning a presentation about risk factors for decreased erythropoietin production. Which information should the nurse​ include?

Clients who are unable to produce enough erythropoietin are those with kidney disease and those receiving chemotherapy. It is occasionally prescribed for clients prior to blood transfusions or​ surgery, and to treat anemia in clients treated with zidovudine for human immunodeficiency virus​ (HIV) infection.

A client with acute coronary syndrome develops​ ST-elevation. Which medication should the nurse expect to reduce this​ client's risk of​ death?

Clopidogrel​ (Plavix) is used to reduce the risk of​ stroke, myocardial​ infarction, and death in clients with acute coronary syndrome. In clients with ST segment​ elevation, clopidogrel has been shown to reduce the risk of​ death, reinfarction, or stroke.

A client is receiving a statin and gemfibrozil​ (Lopid). For which increased risk should the nurse monitor the​ client?

Combining gemfibrozil​ (Lopid) with a statin increases the risk of rhabdomyolysis. It results from the death of muscle fibers and the release of their contents into the bloodstream.

The nurse prepares to administer a monthly injection of cyanocobalamin​ (vitamin B12​) to an older client. Which assessment finding should be reported before administering the dose of​ medication?

Cyanocobalamin​ (vitamin B12​) can cause sodium retention. Edema should be reported since this could indicate the development of heart failure.

A client demonstrates signs of a deep vein thrombosis​ (DVT). Which should the nurse suspect as a cause for this health​ problem?

DVT is often the result of estrogen​ replacement, either as hormone replacement therapy or due to contraceptives.​ Surgery, particularly replacement of the knee and​ hip, are associated with DVT development. Extended immobility encourages pooling of blood in the deep veins.

A​ 4-year-old child accidentally ingested several ferrous sulfate tablets. Which antidote should the nurse expect to be​ prescribed?

Deferoxamine is the antidote for iron intoxication.

The nurse is discussing the mechanism of action for a direct thrombin inhibitor. Which statement should the nurse include in the​ discussion?

Direct thrombin inhibitors bind reversibly to thrombin and prevent the formation of fibrin.

A client is prescribed a thrombolytic medication for a postoperative deep vein thrombosis. Which mechanism of action should the nurse recognize for this​ medication?

Dissolves clots that have formed. Thrombolytics promote​ fibrinolysis, the process in the body that limits clot formation and removes clots that are present. During this​ process, clots begin to dissolve and are removed.

The nurse is preparing to administer erythropoietin​ (Epogen) to a client with​ end-stage renal disease. Which laboratory value should the nurse​ assess?

Erythropoietin​ (Epogen) is a hematopoietic growth factor used in the treatment of anemia. Because it is used to stimulate RBC​ production, the RBC count and hemoglobin should be assessed before administering the dose.

A client receiving filgrastim​ (Neupogen) asks how many days the medication will be administered. Which information about the duration of therapy should the nurse provide in​ response?

Filgrastim​ (Neupogen) is a​ colony-stimulating factor used to increase WBC count in clients with neutropenia. The client should be instructed that the WBC count will be monitored and when it reaches a certain​ level, the injections will be discontinued. The medication is given to boost the immune system to prevent the development of an infection.

A client with a folic acid deficiency is instructed on ways to increase folic acid in the diet. Which food choice made by the client should indicate that teaching has been​ effective?

Fresh green​ vegetables, beans, and wheat products are high in folic acid. The choices of​ spinach, pinto​ beans, and​ whole-wheat toast indicate that teaching is effective.

Gemfibrozil​ (Lopid) is being considered for a client. For which preexisting condition should the nurse recognize the medication is​ contraindicated?

Gemfibrozil is contraindicated in clients with hepatic​ impairment, severe chronic kidney disease​ (CKD), pre-existing gallbladder​ disease, or those with prior hypersensitivity to the drug.

The nurse is teaching a​ community-based group about factors that contribute to the development of hyperlipidemia. Which information should the nurse​ include?

Genetics and lifestyle factors contribute to the development of hyperlipidemia.

The nurse is caring for a client with a postoperative hemorrhage. Which mechanism of action should the nurse consider when administering a​ hemostatic?

Hemostatics are also known as antifibrinolytics. They work to decrease bleeding time. All hemostatics prevent fibrin from​ dissolving, which strengthens the stability of the clot and prevents excessive bleeding.

The nurse is concerned that a client receiving heparin is at risk for​ heparin-induced thrombocytopenia. For which adverse reaction should the nurse​ observe?

Increase in thrombotic events caused by platelet aggregation.

The nurse is reviewing laboratory findings for a client. Which results should the nurse identify as characteristic of familial​ hypercholesterolemia?

Increased​ low-density lipoprotein​ (LDL) and cholesterol

A client with hyperlipidemia is being instructed on lifestyle changes to supplement medications. Which change should the nurse suggest to help reduce​ cholesterol?

Lifestyle changes to supplement drug therapy for hyperlipidemia include eliminating tobacco​ use, maintaining weight at an optimal​ level, reducing dietary saturated fats and​ cholesterol, and implementing a medically supervised exercise plan.

A client will be starting pharmacotherapy for hyperlipidemia. Which laboratory finding should the nurse​ evaluate?

Lipid​ profiles, creatine​ kinase, and liver function studies should be evaluated before a client starts pharmacotherapy for hyperlipidemia

A client with iron deficiency anemia is prescribed intravenous iron dextran. Which intervention should the nurse include in the plan of​ care?

Monitor for anaphylactic reaction.

The nurse is teaching a client with thrombocytopenia about normal platelet production. In which area should the nurse instruct the client that this process​ occurs?

Normal platelet production begins with the hormone thrombopoietin that is produced in the liver.

The nurse is providing a presentation about the use of platelet enhancers. Which disorder should the nurse discuss as benefiting from this​ treatment?

Platelet enhancers promote the production of platelets in clients with​ chemotherapy-induced thrombocytopenia and chronic immune idiopathic thrombocytopenia purpura.​

A client experiences difficulty​ breathing, cough, and chest pain approximately 1 week after a total knee replacement. Which complication should the nurse​ consider?

Pulmonary embolism is a​ serious, life-threatening condition that can occur when a venous thrombus dislodges and travels to the pulmonary vessels.

A client receives oprelvekin​ (Neumega) for thrombocytopenia. Which finding should indicate to the nurse that the client is developing heart​ failure?

Since oprelvekin can worsen fluid overload in clients with a preexisting heart​ condition, signs of fluid overload such as​ edema, dyspnea, and weight gain must be reported to the healthcare provider.

A client is prescribed a statin. At which time should the nurse instruct the client to take the medication to have the optimal​ effects?

Statins should generally be taken in the evening to optimize impact during the night when most cholesterol biosynthesis takes place

A client is prescribed ferrous sulfate to treat​ iron-deficiency anemia. Which side effect of the medication should the nurse include when instructing the​ client?

The adverse effects of oral ferrous sulfate include​ nausea, vomiting,​ constipation, and black tarry stools.

A client taking a statin has an elevated creatine kinase level. Which medication change should the nurse​ expect?

The drug should immediately be discontinued.

A client receiving an intravenous infusion of a thrombolytic is prescribed an arterial blood gas. For which reason should the nurse use acute observation skills when obtaining this blood​ sample?

The major adverse effect associated with thrombolytic therapy is excessive bleeding. Invasive procedures into an artery are very likely to cause bleeding. After arterial blood​ gases, pressure should be maintained on the site for at least 30 minutes to prevent hemorrhage.

A client is receiving thrombolytic therapy. For which adverse reaction should the nurse assess this​ client?

The primary adverse reaction from thrombolytic therapy is bleeding. Signs and symptoms of bleeding include​ epistaxis, hemoptysis,​ hypotension, and vomiting​ coffee-ground emesis.

A client receiving pegfilgrastim​ (Neulasta) reports increased pain and redness of the foot joints. Which laboratory value should the nurse​ assess?

The redness and pain in the foot joints may indicate gout. The uric acid level should be assessed. This level can increase with the use of WBC​ colony-stimulating factors.

The nurse is teaching a female client about interactions that can occur while taking warfarin​ (Coumadin). Which content should the nurse include in the teaching​ session?

There are multiple drug-drug interactions associated with warfarin. The therapeutic index of warfarin is​ low, and drugs that interact with warfarin can impact coagulation times and result in client harm.​ Therefore, clients should check with the healthcare provider before taking​ over-the-counter drugs. Warfarin is a Pregnancy category X medication which is known to cause fetal abnormalities if taken during pregnancy. Any drug with anticoagulant properties should not be taken with warfarin. This includes​ aspirin, nonsteroidal​ anti-inflammatory drugs, or certain vitamins. Should the client experience any signs or symptoms of​ bleeding, the healthcare provider should be notified immediately.

A client receives filgrastim​ (Neupogen) for​ chemotherapy-induced neutropenia. Which location should the nurse instruct the client that bone pain may​ occur?

The​ colony-stimulating factors, such as filgrastim​ (Neupogen), stimulate bone marrow in the​ sternum, lower​ back, and posterior iliac crests to produce WBCs. These are the locations where the client should expect to experience bone pain.

A client with no previous history of a clotting disorder develops bruising on all extremities and nosebleeds. Which health problem should the nurse suspect is causing the​ client's symptoms?

Thrombocytopenia occurs when the platelet count decreases below the normal level. This is caused by a decrease in platelet production or an increase in platelet destruction.

A client is demonstrating signs of a bleeding disorder. Which laboratory test should the nurse expect to be prescribed to determine the reason for the​ client's symptoms?

To diagnose a bleeding​ disorder, laboratory tests measuring coagulation must be obtained. These may include platelet​ count, prothrombin time​ (PT), and activated partial thromboplastin time​ (aPTT).

The nurse is counseling a client with hemophilia about medical procedures to ensure good health. Which procedure should the nurse discuss that can include the administration of aminocaproic acid​ (Amicar)?

Tooth extractions. Aminocaproic acid fills the binding sites on plasminogen and plasmin and prevents clots from dissolving. It is used for​ short-term management of bleeding after dental procedures in clients with hemophilia.

The nurse is reviewing a​ client's laboratory results. Which value should the nurse note as​ undesirable?

Total cholesterol of 220​ mg/dL would be considered borderline high risk and undesirable.

A client receiving filgrastim​ (Neupogen) for​ chemotherapy-induced neutropenia has a WBC count of​ 120,000 ​cells/mm3. Which clinical manifestation should indicate to the nurse that the client is experiencing a serious adverse effect of this​ medication?

WBC counts higher than​ 100,000 cells/mm3 increase the risk of serious adverse​ effects, such as retinal or intracranial​ hemorrhage, respiratory​ failure, and myocardial infarction. Lethargy or decreased vision could indicate retinal or intracranial hemorrhage. Shortness of breath is a sign of respiratory failure.

The nurse is teaching a client starting medication for hyperlipidemia. Which​ follow-up action should the nurse instruct the client to​ do?

While receiving drug therapy for​ hyperlipidemia, the client should be instructed to return periodically for liver function studies and creatine kinase levels.

The nurse is asked about the process for selecting a statin. Which statement should the nurse make to describe this​ process?

​"Generally, the experience of the healthcare provider and the individual client response guide​ selection."