FA Davis Hematologic Drugs

16. In which patient with anemia might the APN suspect folic acid deficiency? 1. A patient taking phenytoin for a seizure disorder 2. A patient eating excessive amounts of raw green, leafy vegetables. 3. A patient taking nitrofurantoin for a urinary tract infection 4. A patient with hypothyroidism

1. A patient taking phenytoin for a seizure disorder

23. A patient taking clopidogrel is experiencing symptoms of gastroesophageal reflux disease (GERD) and requests medication. Which drug should be avoided in this situation? 1. Omeprazole 2. Calcium carbonate 3. Ranitidine 4. Famotidine

1. Omeprazole

46. Which patient is at greatest risk for hypersensitivity to aspirin or NSAIDs? 1. A patient with moderately decreased platelet count 2. A patient with nasal polyps 3. A patient with hypersensitivity to penicillin 4. A patient with history of sensitivity to heparin

2. A patient with nasal polyps

10. Which of these is a potential side effect of ticlopidine? 1. Neutropenia 2. Tinnitus 3. Deep vein thrombosis 4. Constipation

1. Neutropenia

48. A patient with atrial fibrillation, as well as a prosthetic heart valve, is to be anticoagulated. Which is the optimal international normalized ratio (INR) range for this patient? 1. 2.5 to 3.5 2. 1.5 to 3.0 3. 2.0 to 3.0 4. 3.0 to 4.0

1. 2.5 to 3.5

17. The APRN is planning to start anticoagulation with warfarin. The Institute for Clinical Systems Improvement (ICSI) recommends a lower initiation dose for some patients. Which patient should be considered for starting at a dose lower than 5 mg daily? 1. A 78-year-old man with atrial fibrillation 2. A 45-year-old woman with deep vein thrombosis (DVT) 3. A 46-year-old man with recurrent thromboembolism 4. A 50-year-old man with pulmonary emboli (PE)

1. A 78-year-old man with atrial fibrillation

2. A patient taking warfarin for treatment of deep vein thrombosis (DVT) presents to the clinic with a fungal infection requiring treatment with antifungal agent. The APN recognizes that there is an interaction between many antifungal agents and warfarin. Which action by the APN is most appropriate? 1. Adjust the dose of warfarin and monitor the patient's international normalized ratio (INR) more frequently while the patient is taking the new medication. 2. Increase the dose of warfarin to counteract the effects of the new medication. 3. Hold the warfarin until the patient completes the new medication. 4. Discontinue the warfarin and start a different anticoagulant for the time the patient is taking the antifungal medication.

1. Adjust the dose of warfarin and monitor the patient's international normalized ratio (INR) more frequently while the patient is taking the new medication.

9. When adjusting the dose of warfarin for a patient with a mechanical heart valve how should the APN proceed? 1. Adjust the weekly dose up or down by 10% in most cases. 2. Adjust the weekly dose up or down by 15% in most cases. 3. Adjust the weekly dose up or down by 20% in most cases. 4. Adjust the weekly dose up or down by 5% in most cases.,

1. Adjust the weekly dose up or down by 10% in most cases.

34. An elderly patient with a history of atrial fibrillation on dabigatran presents with gastrointestinal bleeding. The APN reviews the patient's current medications. Which medication is most likely to cause a significantly increased risk for bleeding when combined with dabigatran? 1. Aspirin taken for arthritis pain 2. Metoprolol taken for heart rate control 3. Hydrochlorothiazide taken to reduce blood pressure 4. Diltiazem used for heart rate control

1. Aspirin taken for arthritis pain

12. There are several side effects associated with hematopoietic growth factors. Which side effect is common to all? 1. Bone pain 2. Tachycardia 3. Fluid retention 4. Diarrhea

1. Bone pain

38. Which effect is reported with all types of hematopoietic growth factors? 1. Bone pain 2. Pruritus 3. Bronchospasm 4. Seizures

1. Bone pain

21. The APN is caring for a patient receiving intravenous heparin for treatment of pulmonary embolus. Which drug, when given concurrently, is associated with increased risk for bleeding? 1. Cefepime 2. Levofloxacin 3. Digitalis 4. Nitroglycerin

1. Cefepime

4. A patient presents with a transient ischemic attack (TIA) and needs long-term anticoagulation. He reports an allergy to aspirin. Which other medication is recommended by the American College of Chest Physicians (ACCP)? 1. Clopidogrel 75 mg daily 2. Warfarin daily 3. Dipyridamole 200 mg daily 4. Low molecular weight heparin

1. Clopidogrel 75 mg daily

29. Which agent is categorized as a direct thrombin inhibitor? 1. Dabigatran (Pradaxa) 2. Fondaparinux (Arixtra) 3. Rivaroxaban (Xarelto) 4. Low molecular weight heparin (LMWH)

1. Dabigatran (Pradaxa)

36. A patient is scheduled for elective surgery and wishes to donate her own blood prior to the procedure. Which medication is indicated to increase baseline hemoglobin prior to blood donation? 1. Epoetin alfa 2. Filgrastim (G-CSF) 3. Ferrous sulfate 4. Ferrous gluconate

1. Epoetin alfa

8. Which iron preparation is most effective for an otherwise healthy 24-year-old woman on a limited income with iron deficiency associated with menorrhagia? 1. Ferrous sulfate tablets 2. Sustained release ferrous gluconate tablets 3. Fer-In-Sol 4. Ferrous gluconate chewable tablets

1. Ferrous sulfate tablets

47. A patient taking warfarin for a history of deep vein thrombosis presents with an international normalized ratio (INR) of 4.2. His examination shows no evidence of bleeding. Which action taken by the APN is most appropriate? 1. Hold one or more doses, recheck the INR and adjust the dose accordingly. 2. Treat with 2 mg of vitamin K and adjust the dose accordingly. 3. Treat with protamine sulfate and adjust the dose accordingly. 4. Stop the warfarin and begin treatment with a direct factor Xa inhibitor.

1. Hold one or more doses, recheck the INR and adjust the dose accordingly.

35. There is little risk associated with administration of epoetin alpha however, monitoring is necessary to prevent complications. Which of these is a major adverse effect of epoetin alpha? 1. Hypertension 2. Fatigue 3. Dyspnea 4. Rash

1. Hypertension

14. A 5-year-old is brought to the emergency department after ingesting some supplements in her mother's medicine cabinet a few hours ago. The child is exhibiting nausea vomiting, abdominal pain, and lethargy. The parent tells the APN that prior to coming to the hospital, the child had a black, tarry-looking stool. Which is the most likely cause of the child's symptoms? 1. Iron toxicity 2. Acute gastrointestinal bleeding caused by ingestion of the supplements 3. Folate toxicity 4. Vitamin B12 toxicity

1. Iron toxicity

44. Which condition is likely to increase a patient's response to warfarin? 1. Liver disease 2. Hypoglycemia 3. Hypothyroidism 4. Hypersensitivity to NSAIDs

1. Liver disease

3. A patient with breast cancer presents to the emergency department with deep vein thrombosis (DVT) in her right leg. She will require anticoagulation. Which regimen is most appropriate for this patient? 1. Low molecular weight heparin (LMWH) for 3 months 2. Warfarin for 3 months 3. Dabigatran for 3 months 4. Dabigatran for 6 months

1. Low molecular weight heparin (LMWH) for 3 months

41. Which of these best explains the need for iron supplementation in individuals with iron deficiency anemia? 1. Only about 1 to 2 mg/day of iron is absorbed from the average diet. 2. Iron rich foods are difficult to obtain. 3. Large amounts of iron are lost via the urinary tract in many adults, causing anemia. 4. Drug-drug interactions deceasing absorption of iron from food are very common.

1. Only about 1 to 2 mg/day of iron is absorbed from the average diet.

31. Interference of the effectiveness of factor Xa inhibitors such as rivaroxaban (Xarelto) can occur when given with some drugs. Which drug should be avoided when rivaroxaban is in use? 1. Phenytoin 2. Penicillin 3. Acetaminophen 4. Digitalis

1. Phenytoin

42. Which laboratory indicator gives the earliest evidence of response to iron therapy in treatment of anemia? 1. Reticulocyte count 2. Hemoglobin 3. Hematocrit 4. White blood cell count

1. Reticulocyte count

33. A cancer patient with a long-term implanted venous access device is being considered for anticoagulation. Which condition would exclude the patient from having any anticoagulant prescribed? 1. Stage 4 hypertension 2. Hyperkalemia 3. Renal insufficiency 4. Hypersensitivity to NSAIDs

1. Stage 4 hypertension

45. When a patient prematurely discontinues taking factor Xa inhibitor, they increase their risk for which problem? 1. Stroke 2. Hematoma 3. Hematuria 4. Hematemesis

1. Stroke

43. When a patient with iron deficiency is receiving oral iron therapy with an oral agent, which advice from the APN is most appropriate? 1. Take the medication on an empty stomach or with orange juice to get the greatest benefit. 2. Take the medication with a full meal to improve absorption. 3. Sustained release forms are best to improve absorption and reduce side effects. 4. Ferric forms of iron are better absorbed than ferrous forms.

1. Take the medication on an empty stomach or with orange juice to get the greatest benefit.

1. A patient receiving heparin for treatment of deep vein thrombosis (DVT) has an elevated activated partial thromboplastin time (aPTT) slightly over the therapeutic range. He has no evidence of bleeding. Which action is recommended to reduce risk for bleeding and achieve a therapeutic level? 1. Temporarily holding the drug and reducing the dose 2. Administering protamine sulfate 1 mg for every 100 units 3. Administering vitamin K 4. Administering platelets

1. Temporarily holding the drug and reducing the dose

30. The anticoagulation effects of warfarin (Coumadin) often do not occur for 3 to 4 days after initiating treatment. Which of these is the reason for this phenomenon? 1. The effects of warfarin are dependent on depletion of clotting factors. 2. Warfarin is not well absorbed from the gastrointestinal (GI) tract. 3. Metabolism of warfarin may be delayed in the presence of kidney disease. 4. Foods containing vitamin K interfere with absorption of warfarin from the gastrointestinal (GI) tract.

1. The effects of warfarin are dependent on depletion of clotting factors.

39. The APN is caring for a patient with anemia related to cancer chemotherapy who will be receiving darbepoetin alfa. How would the APN explain the medication administration schedule to the patient and family? 1. The injection will be given subcutaneously every 3 weeks. 2. The injection will be given three times each week. 3. The injection will be given every 2 weeks. 4. The injection will be given every 4 weeks.

1. The injection will be given subcutaneously every 3 weeks.

49. Which statement provides the best explanation for why NSAIDs are contraindicated when anticoagulants are prescribed? 1. There is interference with platelet aggregation. 2. There is direct inhibition of thrombin. 3. There is acceleration of antithrombin III. 4. There is inhibition of hepatic synthesis of clotting factors.

1. There is interference with platelet aggregation.

6. Which regimen is American College of Chest Physicians (ACCP)-recommended for prevention of myocardial infarction (MI) for a patient who has had acute coronary syndrome (ACS) and placement of a stent? 1. Ticagrelor (Brilinta) 90 mg twice daily and aspirin 75 to 100 mg daily 2. Clopidogrel (Plavix) 75 mg daily 3. Aspirin 100 mg daily 4. Warfarin with target international normalized ratio (INR) of 2.0 to 3.0

1. Ticagrelor (Brilinta) 90 mg twice daily and aspirin 75 to 100 mg daily

37. Which of these is a contraindication to the use of darbepoetin alfa and epoetin alfa in treatment of anemia associated with renal disease? 1. Uncontrolled hypertension 2. History of allergy to E. coli derived proteins 3. History of atopic dermatitis 4. Uncontrolled diabetes

1. Uncontrolled hypertension

32. Which drug is recommended for anticoagulation in a patient with a prosthetic heart valve? 1. Warfarin (Coumadin) 2. Low molecular weight heparin (LMWH) 3. Clopidogrel (Plavix) 4. Aspirin

1. Warfarin (Coumadin)

7. Which patient taking warfarin should be considered for "bridging" with heparin in the perioperative period? 1. A patient having a skin biopsy 2. A patient with history of stroke with atrial fibrillation 3. A patient with remote history of deep vein thrombosis 4. A patient having cataract surgery

2. A patient with history of stroke with atrial fibrillation

5. Which anticoagulation regimen is contraindicated in a pregnant woman with a mechanical heart valve? 1. Warfarin at a dose that maintains the international normalized ratio (INR) at a level between 2.5 and 3.5 2. Low-molecular-weight heparin (LMWH) every 12 hours 3. Subcutaneous heparin every 12 hours 4. Subcutaneous heparin or low-molecular-weight heparin (LMWH) for the first 13 weeks of the pregnancy, then warfarin daily

1. Warfarin at a dose that maintains the international normalized ratio (INR) at a level between 2.5 and 3.5

27. A 17-year-old female with acne is being treated with minocycline. She was recently diagnosed with iron deficiency anemia and will need to begin treatment with ferrous sulfate tablets. Which advice from the APRN is most appropriate to give the patient about taking these two medications? 1. "Do your best to separate taking the two medications by at least an hour. The iron interferes with the action of the antibiotic." 2. "Take the two medications at least 2 hours apart. When taken together, the effectiveness of both is less." 3. "These two drugs can be taken together, and it is best to take them with a meal." 4. "Take the two medications at least 2 hours apart. When taken together, the serum tetracycline levels will be increased."

2. "Take the two medications at least 2 hours apart. When taken together, the effectiveness of both is less."

26. A 68-year-old man with Parkinson's disease is being treated for iron deficiency anemia following an upper gastrointestinal bleeding episode. His Parkinson's symptoms have been stable for the last few months, but he is now exhibiting increased rigidity and freezing. Which of these is the most likely explanation for the increase in symptoms? 1. Iron is required for effective functioning of the dopaminergic system. 2. Iron salts interfere with absorption levodopa. 3. Methyldopa levels are decreased when given concomitantly with iron. 4. The presence of anemia accounts for the symptoms, and they should improve with increases in the patient's hemoglobin and hematocrit levels within the next few weeks.

2. Iron salts interfere with absorption levodopa

13. Which of these might explain a failure to maintain a response to regular doses of epoetin alfa in a patient with chronic renal disease? 1. Iron supplementation 2. Occult blood loss 3. Folate supplementation 4. Discontinuation of an antacid containing aluminum

2. Occult blood loss

22. A patient taking warfarin is having pain associated with an acute musculoskeletal injury. He asks the APN if he can take acetaminophen because he knows he should not take an NSAID for pain while on warfarin. Which response by the APN is most appropriate? 1. "Unfortunately, you can't take any analgesic drugs while taking warfarin." 2. "There is no problem when taking acetaminophen and warfarin." 3. "You can take the acetaminophen as needed, and then I will check your [international normalized ratio] INR in a few days to see if there is a change." 4. "The best medication to use is an opioid such as oxycodone."

3. "You can take the acetaminophen as needed, and then I will check your [international normalized ratio] INR in a few days to see if there is a change."

11. When would the APN expect to see an increase in reticulocytes after a patient with chronic renal failure begins treatment with epoetin alfa to treat anemia? 1. 2 to 3 days 2. 5 to 7 days 3. 7 to 10 days 4. 14 to 21 days

3. 7 to 10 days

25. A patient receiving chemotherapy for non-Hodgkin lymphoma is scheduled to receive pegfilgrastim to reduce the risk of neutropenia after his treatment. When is the best time for the patient to receive the pegfilgrastim? 1. Immediately after completing his chemotherapy session 2. Immediately before his chemotherapy session 3. At least 24 hours after his chemotherapy session 4. 5 days after his chemotherapy session

3. At least 24 hours after his chemotherapy session

24. Which statement about clopidogrel is most accurate? 1. Dose adjustment is always necessary in patients with renal insufficiency. 2. Dose adjustment is necessary in adults over 65 years of age. 3. Clopidogrel is contraindicated in patients with severe liver disease. 4. Clopidogrel is classified as Pregnancy Category D.

3. Clopidogrel is contraindicated in patients with severe liver disease.

28. A 76-year-old patient with pernicious anemia is scheduled to begin treatment for his anemia and vitamin B12 deficiency. In addition to anemia, he has been experiencing paresthesia in his lower extremities and an unsteady gait. Which treatment regimen will the APRN anticipate providing for this patient? 1. Hydroxocobalamin 1000 mcg injection daily for 7 days, followed by 1000 mcg weekly for 1 month, followed by 1000 mcg monthly for 6 months 2. Hydroxocobalamin 1000 mcg injection, followed by 1000 mcg weekly for 1 month, followed by 1000 mcg monthly for 6 months 3. Hydroxocobalamin 1000 mcg injection daily for 7 days, followed by 1000 mcg weekly for 1 month, followed by 1000 mcg twice monthly for 6 months, then monthly for the rest of his life 4. Hydroxocobalamin 1000 mcg injection monthly for life

3. Hydroxocobalamin 1000 mcg injection daily for 7 days, followed by 1000 mcg weekly for 1 month, followed by 1000 mcg twice monthly for 6 months, then monthly for the rest of his life

19. A 60-year-old male with a history of ongoing alcohol abuse disorder and an acute flare of gout needs treatment for megaloblastic anemia associated with vitamin B12 deficiency. Which is the most efficacious and cost-effective way to administer vitamin B12 to this patient? 1. Orally 2. Intravenously 3. Intramuscularly 4. Intranasally

3. Intramuscularly

15. When educating a patient who is taking oral iron supplements for anemia which advice is most appropriate for the APN to offer? 1. Always take this supplement with food. 2. Taking this medication with milk or other dairy products will improve absorption. 3. It is best to take this medication on an empty stomach. 4. There is no need to keep the medication away from children, because it is harmless.

3. It is best to take this medication on an empty stomach.

40. The APN is caring for a patient who will be receiving epoetin alfa preoperatively to reduce the need for blood transfusion during the surgery. Which prescriptions will the patient need in addition to the one for the epoetin alfa? 1. An anticoagulant 2. Oral iron supplement 3. Oral iron supplement and anticoagulant 4. Folic acid

3. Oral iron supplement and anticoagulant

20. A 60-year-old female patient is being treated for pernicious anemia. In addition to anemia she has neurologic symptoms associated with vitamin B12 deficiency. Which regimen is recommended for treatment in this situation? 1. Vitamin B12 injection 1,000 mcg weekly for 6 months 2. Vitamin B12 orally 1,000 mcg monthly indefinitely 3. Vitamin B12 1,000 mcg weekly for 1 month, then twice monthly for 6 months, and then monthly for life 4. Vitamin B12 injections twice monthly indefinitely

3. Vitamin B12 1,000 mcg weekly for 1 month, then twice monthly for 6 months, and then monthly for life

18. Which client is at lowest risk for folic acid deficiency? 1. A 45-year-old male with alcohol abuse disorder 2. A 23-year-old female who recently delivered a baby and is breastfeeding 3. A 15-year-old female who has celiac disease 4. A 50-year-old man who is a vegetarian

4. A 50-year-old man who is a vegetarian

50. A patient is taking clopidogrel for its antiplatelet effect. Which medication is known to increase clopidogrel's effectiveness? 1. Cimetidine 2. Omeprazole 3. Vitamin K supplements 4. Aspirin

4. Aspirin