Hematology (ATI Test/Drills/Case Study/Book)

The provider discharges the patient to home with a prescription for warfarin (Coumadin). You should advise the patient to do which of the following? (Select all that apply) -Avoid taking NSAIDs -Use a disposable razor -Brush his teeth with a soft toothbrush -Increase intake of dark green, leafy vegetables -Ask the provider before taking over-the-counter drugs -Check bowel movements for signs of bleeding

-Avoid taking NSAIDs -Brush his teeth with a soft toothbrush -Ask the provider before taking over-the-counter drugs -Check bowel movements for signs of bleeding

Ch 27 A nurse is caring for a hospitalized client who has an activated partial thromboplastin time (aPTT) greater than 1.5 times the expected referent range. Which of the following blood products should the nurse prepare to transfuse? -Whole blood -Platelets -Fresh frozen plasma -Packed RBCs

-Fresh frozen plasma

Ch 27 A nurse is preparing to transfuse a unit of packed RBC's for a client who has severe anemia. Which of the following interventions will prevent an acute hemolytic reaction? -Ensure that the client has a patent IV line before obtaining blood product from the refrigerator -Obtain help from another nurse to confirm the correct client and blood product -Take a complete set of vital signs before beginning transfusion and periodically during the transfusion -Stay with the client for the first 15-30 min of the transfusion

-Obtain help from another nurse to confirm the correct client and blood product

Ch 27 A nurse is transfusing a unit of packed RBC's for a client who has anemia due to chemotherapy. The client reports a sudden headache and chills. The client's temperature is 2 degrees F higher than her baseline. In addition to notifying the provider, which of the following actions should the nurse take? (Select all that apply.) -Stop the transfusion -Place the client in an upright position with feet down -Remove the blood bag and tubing from the IV catheter -Obtain a urine specimen -Infuse dextrose 5% in water through the iV

-Stop the transfusion -Remove the blood bag and tubing from the IV catheter -Obtain a urine specimen

You should monitor a patient throughout continuous heparin therapy for which of the following adverse reactions? (Select all that apply) -Thrombocytopenia -Hypotension -Hypokalemia -Deep-vein thrombosis -Fever

-Thrombocytopenia -Hypotension -Hypokalemia -Deep-vein thrombosis -Fever

A provider prescribes IV heparin for this patient. Which of the following parameters should you monitor for in regard to determining if a therapeutic dose is being administered? -INR, two to three times the patient's baseline -aPTT, one and a half to two times the patient's baseline -Platelet count of 100,000 mm3 -PT 11-12.5 seconds

-aPTT, one and a half to two times the patient's baseline

Ch 26 A nurse is assessing a client who has chronic neutropenia and who has been receiving filgrastim. Which of the following actions should the nurse take to assess for an adverse effect of filgrastim? A. Assess for bone pain B. Assess for right lower quadrant pain C. Auscultate for crackles in the bases of the lungs. D. Auscultate the chest to listen for a heart murmur.

A. Assess for bone pain (can be treated with acetaminophen)

HCP caring for pt about to begin iron dextran (INFeD). Which admin. drug IM, HCP should take which of the following actions? SATA Administer a test dose. Premedicate with atropine. Use the Z-track technique. Have epinephrine available. Monitor blood pressure.

Administer a test dose. Use the Z-track technique. Have epinephrine available. Monitor blood pressure.

HCP caring for pt about to begin alteplase (Activase) for PE. Which of the following drugs should the HCP have available in case of severe adverse rxn? Protamine Vitamin K Aminocaproic acid (Amicar) Deferoxamine (Desferal)

Aminocaproic acid (Amicar)

You are reviewing the history of a patient who is about to begin therapy with factor VIII (Advate) to treat hemophilia A. Which of the following drugs that the patient takes should alert you to take further action? Albuterol (Proventil) Phenytoin (Dilantin) Phenelzine (Nardil) Aspirin (Ecotrin)

Aspirin

Ch 25 A nurse is monitoring a client who takes aspirin 81 mg PO daily. The nurse should identify which of the following manifestations as adverse effects of the daily aspirin therapy? Select all that apply. A. Hypertension B. Coffee-ground emesis C. Tinnitus D. Parasthesias of the extremities E. Nausea

B. Coffee-ground emesis C. Tinnitus E. Nausea

Ch 25 A nurse is planning to administer IV alteplase to a client who is demonstrating manifestations of a massive PE. Which of the following interventions should the nurse plan to take? A. Administer IM enoxaparin along with the alteplase dose B. Hold direct pressure on puncture sites for up to 30 mins C. Administer aminocaproic acid IV prior to alteplase infusion D. Prepare to administer alteplase within 8 hours of manifestation onset

B. Hold direct pressure on puncture sites for up to 30 mins

Ch 26 A nurse is monitoring a client who is receiving epoetin alfa for adverse effects. The nurse should identify which of the following as an adverse effect? Select all that apply. A. Leukocytosis B. Hypertension C. Edema D. Blurred vision E. Headache

B. Hypertension E. Headache

Ch 25 A nurse is planning to administer subcutaneous enoxaparin 40 mg using a prefilled syringe if enoxaparin 40 mg/0.4 mL to an adult client following hip arthoplasty. Which of the following actions should the nurse plan to take? A. Expel the air bubble from the prefilled syringe before injection. B. Insert the needle completely into the client's tissue. C. Administer the injection into the client's thigh D. Aspirate carefully after inserting the needle into the client's skin.

B. Insert the needle completely into the client's tissue.

HCP should assess pt w/ megaloblastic anemia for indications of which of the following vitamin deficiencies? Vitamin B12 Vitamin D Vitamin C Vitamin K

B12

Ch 25 A nurse is caring for a client who has atrial fibrillation and a new prescription for dabigatran to prevent development of thrombosis. Which of the following medications is prescribed concurrently to treat an adverse effect of dabigatran? A. Vitamin K B. Protamine C. Omeprazole D. Probenecid

C. Omeprazole

HCP preparing to admin. Rx dose of filgrastim (Neupogen). Pt's lab values indicate WBC 12000. Which of the following actions should the HCP take? Limit venipunctures. Administer the drug with an analgesic. Assess breath sounds. Clarify the prescription with the provider.

Clarify

Pt about to begin recombinant factor IX (BeneFix) for hemophilia B. Pt asks HCP about r/o disease transmission w/ recombinant factor IX compared to plasma-derived factor IX. HCP should explain that recomb. factor IX eliminates r/o which of the following? HIV Cytomegalovirus Creutzfeldt-Jakob disease Anaphylaxis

Creutzfeldt-Jakob disease

You are caring for a patient who is about to begin taking oprelvekin (Neumega) for thrombocytopenia. To evaluate the potential for adverse effects, you should monitor which of the following during drug therapy? Liver function Hearing ECG Level of consciousness

ECG

Ch 26 A nurse is preparing to administer filgrastrim for the first time to a client who has just undergone a bone marrow transplant. Which of the following interventions is appropriate? A. Administer IM in a large muscle mass to prevent injury B. Ensure that the medication is refrigerated until just prior to administration C. Shake vial gently to mix well before withdrawing dose D. Discard vial after removing one dose of the medication

D. Discard vial after removing one dose of the medication

Therapeutic use: heparin (Lovenox)

DVT

Pt taking ferrous sulfate (Feosol) for iron deficiency anemia develops severe N/V d/t iron toxicity. Which of the following drugs should HCP use to treat this complication? Flumazenil (Mazicon) Naloxone Deferoxamine (Desferal) Acetylcysteine (Acetadote)

Deferoxamine (Desferal)

You are talking to a patient who is about to begin taking liquid ferrous sulfate (Feosol) to treat iron-deficiency anemia. Which of the following instructions should you include about the drug? (Select all that apply.) Swish it in your mouth before swallowing it. Drink it through a straw. Do not rinse your mouth after taking it. Dilute it first with water. Take it with food.

Drink it through a straw. Dilute it first with water.

HCP caring for pt w/ mild hemophilia A & about to begin desmopressin (DDAVP) to prevent bleeding. HCP should monitor for which of the following adverse reactions? Weight loss Tachycardia Polyuria Edema

Edema

HCP caring for pt about to begin filgrastim (Neupogen) for neutropenia. HCP should assess the pt for which of the following adverse effects? Swollen calf Petechiae Enlarged spleen Dusky nail beds

Enlarged spleen

HCP caring for pt undergoing BM transplant following high dose chemo. Which of the following drugs should the HCP expect the PCP to Rx to reduce pt r/o infxn? Oprelvekin (Neumega) Epoetin alfa (Erythropoietin) Alteplase (Activase) Filgrastim (Neupogen)

Filgrastim

HCP caring for pt w/ known sensitivity to E coli derived proteins, this is a contraindication for which of the following drugs? Epoetin alfa (Erythropoietin) Alteplase (Activase) Filgrastim (Neupogen) Oprelvekin (Neumega)

Filgrastim

Before administering IV folic acid, you should explain to the patient that the drug can cause which of the following adverse effects? Headache Nausea Dizziness Flushing

Flushing

Ch 27 A nurse is assessing a client during transfusion of a unit of whole blood. The client develops a cough, shortness of breath, elevated blood pressure, and distended neck veins. The nurse should anticipate a prescription for which of the following medications? -Epinephrine -Lorazepam -Furosemide -Diphenhydramine

Furosemide

HCP caring for pt about to begin alteplase (Activase). HCP should monitor pt for which of the following indications of possible adverse effect? Edema HTN HA Hives

HA

HCP administers eopoetin alfa (Epogen) SC to a pt who has renal failure. HCP should monitor the pt for which of the following adverse effects? Dry mouth Edema HTN Muscle pain

HTN

HCP caring for pt about to begin factor VIII (Advate) for hemophilia A. When admin. factor VIII, which of the following actions should the HCP take? Premedicate with aspirin (Ecotrin). Administer the powdered form orally. Administer via rapid IV bolus. Have emergency equipment ready.

Have emergency equipment ready

HCP caring for pt about to begin epoetin alfa (Epogen). Which of the following lab values should increase with effective therapy? Hgb WBC PT Platelets

Hgb

HCP caring for pt about to begin taking warfarin (Coumadin). HCP should caution the pt about taking which of the following OTC drugs? Calcium carbonate (Tums) Dimenhydrinate (Dramamine) Ibuprofen (Motrin) Diphenhydramine

Ibuprofen (Motrin)

HCP caring for pt about to begin ferrous sulfate (Feosol) for iron def. anemia. When talking w/ pt, HCP should include which of the following instructions? SATA Increase dietary fiber intake. Take the drug on an empty stomach. Eat iron-enriched foods. Report dark green or black stools. Spread the dosage across each day.

Increase dietary fiber intake. Take the drug on an empty stomach. Eat iron-enriched foods. Spread the dosage across each day.

HCP caring for pt about to begin oprelvekin (Neumega). HCP should explain that the drug has which of the following effects? Causes myelosuppression Stimulates leukocyte maturation Destroys blood clots Increases platelet production

Increases platelet production

HCP caring for pt about to begin asa (Ecotrin) to reduce r/o CV event. HCP should understand that the drug inhibits plt aggregation by which of the following mechanisms? Inhibiting cyclooxygenase action in platelets Suppressing specific clotting factors Blocking adenosine diphosphate receptor agonists Activating thromboxane A2

Inhibiting cyclooxygenase action in platelets

HCP admin epoetin alfa (Epogen) SC to a pt w/ renal failure. HCP should take which of the following actions? Insert needle into vial once Save used vial for next dose Shake vial before using Dilute drug first with NS

Insert needle into vial once

You are caring for a patient who is receiving alteplase (Activase) to dissolve a thrombus. Which of the following should you include in the care plan for the patient? (Select all that apply.) Monitor BP Reposition frequently Limit punctures Check LOC Apply pressure to oozing sites

Monitor BP Limit punctures Check LOC Apply pressure to oozing sites

You are caring for a patient who is taking warfarin (Coumadin) to prevent venous thrombosis. You should explain that taking the drug requires daily blood samples to monitor of which of the following laboratory tests? Fibrinogen PT/INR Platelets aPTT

PT/INR

HCP caring for a pt about to begin clopidogrel (Plavix) to prevent thrombus formation. HCP should question the use of clopidogrel by a pt who has which of the following? Pancreatitis Myasthenia gravis Peptic ulcer disease Myocardial infarction

Peptic Ulcer disease

You are caring for a patient who is about to begin taking cyanocobalamin (Nascobal), a vitamin B12 preparation. You should understand that the drug treats which of the following types of anemia? Pernicious ​Sickle cell Aplastic Iron-deficiency

Pernicious

You are caring for a patient who is about to begin taking clopidogrel (Plavix) to prevent transient ischemic attacks. You should tell the patient to report which of the following adverse effects? (Select all that apply.) Petechiae Tinnitus Diaphoresis Weakness Vision changes

Petechiae Weakness Vision changes

Ch 26 A nurse is caring for a client who is receiving daily doses of oprelvekin. Which of the following lab values should the nurse monitor to determine effectiveness of the medication? A. Hemoglobin B. Absolute neutrophil count C. Platelet count D. Total WBC

Platelet count

Ch 25 A nurse is caring for a hospitalized client who is receiving IV heparin for a DVT. The client begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer? A. Vitamin K B. Atropine C. Protamine D. Calcium gluconate

Protamine

Which of the following drugs should you have ready in case of heparin overdose? -Aminocaproic acid (Amicar) -Deferoxamine (Desferal) -Vitamin K -Protamine

Protamine

HCP caring for pt about to begin taking folic acid for megaloblastic anemia. HCP should monitor which of the following lab values? Amylase level C-reactive protein Reticulocyte count Creatinine clearance

Reticulocyte count

HCP caring for pt about to begin oprelvekin (Neumega) for thrombocytopenia. HCP should tell pt to report which of the following indications of an adverse rxn? SATA Jaundice Swollen ankles Palpitations Conjunctivitis Tinnitus

Swollen ankles Palpitations Conjunctivitis

HCP caring for pt about to begin taking clopidogrel (Plavix) to prevent stenosis. HCP should monitor pt for which of the following adverse reactions? Lymphocytopenia Hyponatremia Thrombocytopenia Uricemia

Thrombocytopenia

Pt on warfarin (Coumadin) arrives at ED reporting rectal bleeding. Which of the following drugs should the HCP have available? Vitamin K Protamine Deferoxamine (Desferal) Filgrastim (Neupogen)

Vit K

While the patient is still receiving continuous IV heparin, the provider prescribes oral warfarin (Coumadin). This is because -warfarin takes 3-5 days to achieve therapeutic effects -IV heparin alone becomes ineffective after the first 1 to 2 days -Abrupt cessation of heparin therapy increases the risk for thrombocytopenia -Warfarin reduces the risk for hemorrhage

Warfarin takes 3-5 days to achieve therapeutic effects

Ch 27 A nurse is preparing to administer a transfusion of 300 mL of pooled platelets for a client who has severe thrombocytopenia. The nurse should plant to administer the transfusion over which of the following time frames? -Within 30 min/unit -within 60 min/unit -within 2 hr/unit -within 4 hr/unit

Within 30 min/unit

Therapeutic use: alteplase (Activase)

dissolves blood clots

Therapeutic use: factor VIII

hemophilia A

Therapeutic use: clopidogrel (Plavix)

inhibits plt aggregation

Therapeutic use: folic acid

megaloblastic anemia

HCP caring for pt about to begin alteplase (Activase) for acute MI. HCP should understand drug is most effective when patient receives it _____________ 24 hr after clot formation. within 3 hr of symptom onset. after initiation of anticoagulation. prior to clot formation.

with 3 hour of symptom onset

Therapeutic use: filgrastim (Neupogen)

severe chronic neutropenia

Therapeutic use: epoetin alfa (Procrit)

stimulates RBC production

Therapeutic use: filgrastim (Neupogen)

stimulates leukocyte production