Class 9 Prep U
A 22-year-old female client is seen in the primary care provider's office for follow-up. The client was diagnosed six weeks ago with iron deficiency anemia and has been taking the prescribed iron supplement when she notices that her stool has turned black. She tells the nurse that she fears that she is bleeding to death inside her belly. The nurse teaches the client about which expected outcome? - "Don't worry, iron supplements can cause black or dark stools because of the iron composition." - "Don't worry, iron supplements cannot cause bleeding." - "Iron supplements may cause bleeding but this is nothing to worry about." - "Don't worry, black stool is not a sign of internal bleeding."
"Don't worry, iron supplements can cause black or dark stools because of the iron composition." Explanation: Iron supplements can cause black or dark stools because of the iron composition. Bleeding in the stool that causes dark stool from iron administration is not an expected outcome of the drug therapy.
A nurse is preparing to discharge a client who has been prescribed warfarin. While assessing the client's knowledge of the drug, what statement should the nurse address? - "I take vitamin C when I feel like I'm getting a cold." - "I take aspirin to help with the pain of my arthritis." - "I aim to walk 2 miles a day." - "I drink a glass of wine with dinner some evenings."
"I take aspirin to help with the pain of my arthritis." Explanation: Increased bleeding can occur if a salicylate is taken in combination with warfarin. The nurse will instruct the client to stop taking aspirin. Walking, taking vitamin C, and drinking an occasional glass of wine should not interfere with the therapeutic effects of warfarin.
A client is discharged from the hospital with a prescription of warfarin. Which statement indicates successful client teaching? - "If I miss a dose, I will take two doses." - "I will avoid herbal remedies." - "I will eat spinach or broccoli daily." - "I will discontinue my other medications.
"I will avoid herbal remedies." Explanation: Most commonly used herbs and supplements have a profound effect on drugs for anticoagulation. The client should never double up on dosing related to a missed dose. The client should avoid green leafy vegetables due to vitamin K. The client should not discontinue his or her medications without first consulting with the primary health care provider.
A client with a diagnosis of chronic renal failure will soon begin a regimen of epoetin that will be administered by the client at home. Which statement indicates that the nurse's initial health education has been successful? - "I'll make sure to take my epoetin pill on a strict schedule and make sure I never miss a dose." - "I'm glad that epoetin can help to protect me from getting an infection." - "I'm excited that there's a medication that can help my kidneys work better." - "I'm not all that comfortable with giving myself an injection, but I'm sure I'll be able to learn."
"I'm not all that comfortable with giving myself an injection, but I'm sure I'll be able to learn." Explanation: The client's statement indicates an understanding of the appropriate route of administration of this medication. Epoetin is administered parenterally, not orally. It acts by stimulating erythroid progenitor cells to produce RBCs but does not enhance overall renal function. Epoetin does not enhance immune function.
A client is being administered heparin IV and has been started on warfarin. The client asks the nurse why both medications have been prescribed. What is the nurse's most accurate response? - "After a certain period of time, you must start warfarin and heparin together." - "You will need both warfarin and heparin for several days." - "Warfarin takes 3-5 days to develop anticoagulant effects, and you still need heparin." - "Warfarin cannot be given without heparin due to the amount of clotting you need."
"Warfarin takes 3-5 days to develop anticoagulant effects, and you still need heparin." Explanation: Anticoagulant effects do not occur for 3 to 5 days after warfarin is started because clotting factors already in the blood follow their normal pathway of elimination. The statement, "After a certain period of time, you must start warfarin and heparin together" does not explain clearly the reason for the two medications concurrently. The statement, "You will need both warfarin and heparin for several days" does not explain clearly the reason for the two medications. The statement, "Warfarin cannot be given without heparin due to the amount of clotting you need" is not accurate.
A client who has anemia and a severe GI absorption disorder has been ordered iron dextran . What is the most appropriate nursing diagnosis for the client related to the administration of this drug? - Acute pain related to drug administration - Deficient knowledge regarding drug therapy - Risk for injury related to CNS effects - Disturbed body image related to drug staining of teeth
Acute pain related to drug administration Explanation: Iron dextran is a parenteral form of iron. It is given intramuscularly and must be given by the Z-track method. It can be very painful. Certainly, deficient knowledge and risk for injury are appropriate diagnoses for this client but would not be related to the administration of the drug. Because this medication is not given orally, tooth staining would not be a concern. Reference:
The nurse is teaching a nursing student about anemia and knows that it is important to include why anemia occurs. Which statement is true about why anemia occurs? - Anemia occurs due to chronic illnesses or specific deficiencies such as iron. - Anemia occurs due to chronic illnesses or specific deficiencies such as vitamin C. - Anemia occurs due to chronic illnesses or specific deficiencies such as vitamin A. - Anemia occurs due to acute illnesses or specific deficiencies such as vitamin D
Anemia occurs due to chronic illnesses or specific deficiencies such as iron. Explanation: Anemia occurs due to chronic illnesses or specific deficiencies such as iron. Deficiencies of vitamins C, A, and D do not cause anemia.
A female patient is taking warfarin (Coumadin) after open heart surgery. The patient tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the report of pain, what does the nurse suspect is the cause of the pain? - Arthritis - Torn medial meniscus - Degenerative joint disease - Bleeding
Bleeding Explanation: The main adverse effect of warfarin (Coumadin) is bleeding. The sudden onset of pain in the knees alerts the nurse to assess the patient for bleeding. Arthritis, torn medical meniscus, and degenerative joint disease could all be symptoms of knee pain, but the onset and combination of anticoagulant therapy is not an etiology of these types of injuries and disease.
The client is prescribed a thrombolytic agent. The nurse understands that the purpose of this order may be to achieve which effects? (Select all that apply.) - Dissolve thrombi - Limit tissue damage - Prevent platelet aggregation - Increase coagulation - Reestablish blood flow
Dissolve thrombi Limit tissue damage Reestablish blood flow Explanation: Thrombolytic agents are used to dissolve thrombi with the goal of reestablishing blood flow and limiting tissue damage in selected thromboembolic disorders.
The client is prescribed warfarin. His INR is 5.2. At what level is this dose? - Subtherapeutic - Therapeutic - Elevated - Within prescribed limits
Elevated Explanation: Warfarin dosage is regulated according to the INR (derived from the prothrombin [PT] time), for which a therapeutic value is between 2.0 to 3.0 in most conditions. A therapeutic PT value is approximately 1.5 times the control, or 18 seconds.
A client has been diagnosed with chronic renal failure. Which agent will assist in raising the client's hemoglobin levels? - Epoetin alfa - Pentoxifylline - Estazolam - Dextromethorphan hydrobromide
Epoetin alfa Explanation: Uses of epoetin include the prevention and treatment of anemia associated with chronic renal failure, hepatic impairment, or anticancer chemotherapy. Pentoxifylline is used for intermittent claudication to maintain the flexibility of red blood cells. Estazolam is a benzodiazepine agent used short term for insomnia. Dextromethorphan hydrobromide is used to relieve cough.
A client has suffered from a gastrointestinal hemorrhage. Which agent will assist in raising the hemoglobin? - Epoetin alfa - Pentoxifylline - Estazolam (Prosom) - Dextromethorphan hydrobromide
Epoetin alfa Explanation: Epoetin alfa is used to raise the hemoglobin and reduce the need for blood transfusions in clients with anemia. Pentoxifylline is used for intermittent claudication to maintain the flexibility of red blood cells. Estazolam is a benzodiazepine agent used short term for insomnia. Dextromethorphan hydrobromide is used to relieve cough.
The nurse notes a decreased red blood cell (RBC) count, decreased hemoglobin and hematocrit, as well as a decreased mean corpuscular volume. This could be attributable to a decrease in secretion of what hormone? - Interleukins - Interferon - Erythropoietin - Colony-stimulating factor
Erythropoietin Explanation: Erythropoietin is a hormone responsible for increasing hemoglobin, red blood cell counts, and mean corpuscular volume. Decreases in any of these could be attributed to a decrease in erythropoietin. The other hormones listed will not have the same effect on the blood studies.
Folic acid is necessary for cell growth and maintenance of the myelin sheath. - True - False
False Explanation: Folic acid is necessary for cell growth and development; vitamin B12 is necessary for maintenance of the myelin sheath.
A nurse is caring for a client receiving warfarin therapy. The nurse instructs the client and family that certain foods must be ingested in moderation because of the possible interference with the effect of the therapy. Which foods must be taken in limited quantity? - Foods rich in vitamin A - Foods rich in vitamin C - Foods rich in vitamin K - Foods rich in Vitamin D
Foods rich in vitamin K Explanation: The nurse should inform the client to limit the intake of foods rich in vitamin K as they interfere with warfarin therapy. Foods rich in vitamin A, C, or D need not be limited, as they do not affect the treatment.
The client is currently receiving a continuous IV infusion of heparin. Which procedure should the nurse avoid when possible? - Giving intramuscular injections - Measuring urine output - Measuring noninvasive blood pressure - Assessing respirations
Giving intramuscular injections Explanation: When caring for clients who are receiving anticoagulation therapy, nurses should, when possible, avoid procedures that present the risk of trauma or bleeding. Nursing procedures to avoid include intramuscular injections, venipuncture, and arterial puncture.
What would a nurse identify as a contraindication for iron therapy? (Select all that apply.) - Hemolytic anemia - Peptic ulcer disease - Colitis - Nasal ulcers - Leukopenia
Hemolytic anemia Peptic ulcer disease Colitis Explanation: Patients with hemolytic anemia may develop iron toxicity with iron therapy. Patients with peptic ulcer disease may experience irritation of the tissues and exacerbate the condition with iron therapy. Patients with colitis may experience increased tissue irritation, exacerbating the condition when iron is used. Nasal ulcers require cautious use of intranasal cyanocobalamin. Leukopenia is a contraindication for the use of hydroxyurea for sickle cell anemia.
Which genetic clinical condition will likely, over the course of the client's lifetime, require the pharmaceutical introduction of clotting factors to assure the client's safety? - Cystic fibrosis - Hemophilia - Leukemia - Diabetes
Hemophilia Explanation: Hemophilia is a genetic lack of clotting factors that leaves the patient vulnerable to excessive bleeding with any injury. Treatment of classic hemophilia with antihemophilic factor provides temporary replacement of clotting factors to correct or prevent bleeding episodes or to allow necessary surgery. Bone marrow disorders are disorders in which platelets are not formed in sufficient quantity to be effective. Neither diabetes nor cystic fibrosis is treated with antihemophilic agents.
A client is receiving subcutaneous heparin 5,000 units every 8 hours. An activated thromboplastin time (aPTT) is drawn 1 hour before the 8:00 AM dose; the aPTT is at 3.5 times the control value. What is the nurse's priority action? - Give a larger dose to increase the aPTT. - Give the dose as ordered and chart the results. - Check the client's vital signs prior to administering the dose. - Hold the dose and call the result to the prescriber.
Hold the dose and call the result to the prescriber. Explanation: The therapeutic level of heparin is demonstrated by an activated partial thromboplastin time (aPTT) that is 1.5 to 3 times the control value. The client's value is 3.5 times control, which indicates clotting time is a bit too delayed and the dosage will likely either be reduced or a dosage may be held according to the order received from the physician. It would be inappropriate to give two doses at once, give the dose and chart the results, or simply check the vital signs without holding the dose and calling the physician.
A female client has been prescribed epoetin alfa therapy for anemia associated with chemotherapy. What other nonpharmacologic remedies can the client use to improve her anemia? - Include milk and dairy products in her diet. - Include in her diet green, leafy vegetables, beans, and organ meats that are high in iron. - Include a lot of fatty products in her diet. - Include fatty and sugar-rich foods, such as sweets and desserts, in her diet.
Include in her diet green, leafy vegetables, beans, and organ meats that are high in iron. Explanation: The patient needs a good iron intake while on this drug to support the increase in RBC production. To fulfill all the iron level needs, the nurse must advise the patient to include in the diet green, leafy vegetables, beans, and organ meats that are high in iron. The patient should avoid fatty products, which may cause heart problems.
The nurse administers epoetin alfa (Epogen). What is the therapeutic response the nurse expects to assess? - Elevated white blood cell count - Increased red blood cell count - Increased resistance to infection - Elevated heart rate
Increased red blood cell count Explanation: Epoetin alfa is the recombinant form of human erythropoietin, which increases the body's ability to produce red blood cells (RBCs). The patient's RBCs should increase in response. This medication will not increase white blood cells or the patient's resistance to infection. The patient's heart rate would not increase in response to this medication.
A female client is seen in the clinic for iron deficiency anemia and the nurse provides comprehensive discharge instructions about allergic reactions. The client appears nervous, then demands to see another nurse. The nurse asks the client why she is distressed. The client replies, "because I have had a bad reaction to iron supplements before and almost died." The nurse asks for an order to change the prescription for which reason? - Iron is contraindicated in clients with known hypersensitivity to the drug, or any component of the drug. - The client is in need of bipolar disease medication instead. - The client is in need of antianxiety medication instead. - The client is in need of a placebo instead to prevent the same complication from occurring again.
Iron is contraindicated in clients with known hypersensitivity to the drug, or any component of the drug. Explanation: Iron is contraindicated in clients with known hypersensitivity to the drug, or any component of the drug. Treating anxiety, bipolar disease, and administration of placebo are not indicated to treat iron deficiency anemia.
The black box warning associated with warfarin concerns its risk of causing what condition? - DIC - Severe coagulopathy - Hypotension - Major or fatal bleeding
Major or fatal bleeding Explanation: The FDA has issued a black box warning for warfarin due to its risk of causing major or fatal bleeding.
The effects of warfarin (Coumadin) are monitored by what laboratory test(s)? - RBC - aPTT - PT and INR - Platelet count
PT and INR Explanation: The warfarin dose is regulated according to the INR. INR is based upon the PT.
A client is taking warfarin to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin monitored? - RBC - aPTT - PT and INR - Platelet count
PT and INR Explanation: The warfarin dose is regulated according to the INR. The INR is based on the prothrombin time. The red blood cell count is not indicative of warfarin dosage. The aPTT is utilized to determine heparin dose. The platelet count is required to determine warfarin dose.
A male client is receiving heparin by continuous intravenous infusion. The nurse will instruct the client and family members to report what should it occur? - A skin rash - Sudden occurrence of sleepiness and drowsiness - Dizziness - Presence of blood in urine or stools
Presence of blood in urine or stools Explanation: The nurse should instruct the client and family members to report the presence of blood in urine or stools and any bleeding from the gums, nose, vagina, or wounds. The anticoagulation properties of heparin can sometimes result in abnormal bleeding. Sleepiness, drowsiness, skin rash, and dizziness are not commonly identified adverse effects of the drug.
Indications for the nurse to administer heparin include what? Select all that apply. - Treatment of hemophilia - Prevention and treatment of pulmonary emboli - Treatment of atrial fibrillation with embolization - Prevention and treatment of venous thrombosis - Diagnosis and treatment of disseminated intravascular coagulation (DIC)
Prevention and treatment of pulmonary emboli Treatment of atrial fibrillation with embolization Prevention and treatment of venous thrombosis Diagnosis and treatment of disseminated intravascular coagulation (DIC) Explanation: Indications include prevention and treatment of venous thrombosis and pulmonary emboli, treatment of atrial fibrillation with embolization, and diagnosis and treatment of DIC. Heparin is not given to clients with hemophilia because the drug would worsen bleeding.
The nurse is caring for a client who is going home on warfarin. What lab test(s) will the client require to evaluate therapeutic effects of the drug? - Activated partial thromboplastin time (APTT) - Platelet levels - Prothrombin time (PT) and international normalized ratio (INR) - Prothrombin time (PT) and activated partial thromboplastin time (APTT)
Prothrombin time (PT) and international normalized ratio (INR) Explanation: PT and INR are ordered to evaluate for therapeutic effects of warfarin. Normal values of PT is 1.3 to 1.5 times the control value, and the ratio of PT to INR is 2 to 3.5.
What genetic carrier screening would be appropriate for an African American couple planning to begin a family? - Renal failure - Sickle cell anemia - Iron deficiency anemia - Vitamin B12 deficiency
Sickle cell anemia Explanation: Sickle cell anemia is a chronic hemolytic anemia that occurs most commonly in people of African descent, so it would be appropriate to have genetic screening to determine the risk associated with having children. The other answers are incorrect because they are not associated with people of African descent.
Which patient should not receive epoetin alfa (Epogen) as ordered at 9 am? - The patient who has a blood pressure of 240/120 mm Hg - The patient with a heart rate of 100 beats per minute - The patient who is "too tired to get out of bed" - The patient who has missed a round of chemotherapy
The patient who has a blood pressure of 240/120 mm Hg Explanation: Hypertension is the most common adverse effect of administration of epoetin alfa (Epogen). Patients with uncontrolled hypertension should not receive the medication. Administering to patients whose heart rate is elevated or who verbalize fatigue is acceptable, because the medication should decrease the symptoms. Patients receiving chemotherapy often need to halt chemotherapy while their red blood cells have a chance to rebound. Administration of Epogen is commonly done when patients are awaiting chemotherapy.
Which patient will the nurse assess first? - The patient with a decreased RBC count - The patient with a decreased WBC count - The patient with anemia - The patient with elevated erythropoietin
The patient with a decreased WBC count Explanation: The patient with a decreased WBC count may have difficulty fighting infection and may be at risk for a contagious disease. The patient with a decreased RBC and anemia would be the second priority and the patient with the elevated counts would be the lowest priority, as erythropoietin is a hormone secreted by the kidneys that should stimulate RBC production.
A nurse preparing to teach a client about their newly prescribed cancer treatment should consider addressing which primary reason for non-adherence to the medication regimen? Select all that apply. - The route of medication administration - Time constraints and family obligations - Adverse effects of medications - The cancer remission rate - Health care provider attitudes
The route of medication administration Adverse effects of medications Explanation: Treatment for cancer combines a variety of medications. All of these medications may produce adverse effects so that clients may not feel "better" when taking the drug. The combination of injections and adverse effects may lead to nonadherence to the drugs prescribed. Time constraints, family obligations, cancer remission rate, and health care provider attitude are not as likely to affect adherence to medications.
A patient has pernicious anemia. The nurse understands that this patient cannot absorb which vitamin? - Vitamin D - Vitamin B6 - Vitamin B12 - Vitamin C
Vitamin B12 Explanation: Pernicious anemia occurs when the gastric mucosa cannot produce intrinsic factor, leading to an inability for vitamin B12 to be absorbed. The person with pernicious anemia will experience fatigue and lethargy. The central nervous system also will be affected because of damage to the myelin sheath.
The nurse is teaching a client about iron deficiency anemia. The nurse would include in the teaching plan that iron deficiency anemia results from: - a lack of iron in the body. - a lack of white cells in the body. - too much iron in the body. - a lack of platelets in the body.
a lack of iron in the body. Explanation: Iron deficiency anemia results from a lack of iron in the body. Too much iron would cause an excess. Platelets and white cells do not cause iron deficiency anemia.
A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the client's: - heart rate and pulse. - sodium and potassium levels. - aPTT. - blood glucose level.
aPTT. Explanation: Before initiating therapy, it is important to review the client's aPTT, hematocrit, and platelet count. These tests provide baseline information on the client's blood clotting abilities and identify conditions that may cause heparin therapy to be contraindicated. The client's heart rate and pulse, electrolyte levels, and blood sugar levels would not be priority nursing assessments.
A 51-year-old man is being discharged from the hospital following treatment with anticoagulants for a deep vein thrombosis. The nurse will instruct the client to: - alternate between the types of anticoagulant drugs in the therapy. - consider safety measures to prevent bleeding and be alert for signs of bleeding. - change the route of administration to intravenous if oral proves ineffective. - eat small amounts of food during drug administration.
consider safety measures to prevent bleeding and be alert for signs of bleeding. Explanation: Client education on anticoagulant therapy should include safety measures to prevent bleeding, instructions to remain alert for signs of bleeding, and directions on what to do if bleeding occurs. Clients should be advised to eat small amounts of food when the drug is known to cause gastrointestinal distress. Clients should never alternate between similar types of drugs or change the route of drug administration at home without consulting the prescriber.
The provider orders heparin for a 35-year-old female client. The nurse administers the drug only after confirming that the client: - does not have asthma. - does not have peptic ulcer disease. - does not have a urinary tract infection. - is not hypertensive.
does not have peptic ulcer disease. Explanation: Contraindications of heparin include GI ulcerations (e.g., peptic ulcer disease, ulcerative colitis), active bleeding, severe kidney or liver disease, severe hypertension, and recent surgery of the eye, spinal cord, or brain. The drug should be used cautiously in clients with non-severe hypertension.
A 59-year-old client is on warfarin therapy. On follow-up visits to the clinic, the nurse will assess the client's: - blood glucose level. - intake of vitamin K. - presence of skin-related disorders. - presence of breathing disorders.
intake of vitamin K. Explanation: It is important to assess the client's usual vitamin K intake because warfarin interferes with the synthesis of vitamin K-derived clotting factors. Increases in vitamin K intake will interfere with the action of warfarin if the increase in intake occurs after the warfarin dosage has been titrated. In addition, a deficiency of vitamin K can increase the risk of bleeding. The client's sugar intake or the presence of a skin-related or breathing disorder does not affect the administration of warfarin.
A client comes to the clinic asking what erythropoiesis means. The nurse would state that erythropoiesis is the process of making: - red blood cells. - white blood cells. - stem cells. - platelets.
red blood cells. Explanation: Erythropoiesis means the process of making red blood cells. The production of white blood cells, stem cells, and platelets do not fit the definition of erythropoiesis.