PHARM - Hematological Medications

Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit?

Protamine sulfate Rationale: The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage occurs. Potassium chloride is administered for a potassium deficit. Vitamin K is an antidote for warfarin sodium. Aminocaproic acid is the antidote for thrombolytic therapy.

A client in renal failure is receiving epoetin alfa. The nurse should monitor the client for which adverse effect of this medication?

Hypertension Rationale: Epoetin alfa is an erythropoietic growth factor and generally is well tolerated, although hypertension can occur and is the most significant adverse effect. Occasionally, tachycardia also may occur as a side effect and may cause an improved sense of well-being. Fever, depression, and bradycardia are not adverse effects of epoetin alfa.

Warfarin sodium has been prescribed for a client, and the nurse teaches the client and family about the medication. Which statement by the client indicates a need for further teaching?

"I will not take any over-the-counter medications except aspirin." Rationale: No over-the-counter medications of any kind should be ingested by a client who is taking anticoagulants unless approved by the primary health care provider (PHCP). This is especially true of aspirin and/or aspirin-containing products (because of the potential to cause bleeding). Electric shavers are less irritating to the skin than razors and less likely to cause a skin breakdown. Medic-Alert tags or bracelets should be worn. In addition, all clients should be taught to carry identification cards that list all of the medications currently being taken. Strenuous games such as contact sports that can cause bruising and skin breakdown are to be avoided.

The nurse is caring for a hospitalized client with a mechanical heart valve who is receiving maintenance therapy of warfarin sodium. The client's international normalized ratio (INR) is 3. The nurse anticipates which prescription?

Administering the next dose of warfarin sodium Rationale: A client's INR of 2 to 3 is appropriate for most clients. An INR of 3 to 4.5 is recommended for clients with mechanical heart valves. If the client's INR is below the recommended range, the warfarin sodium dose is increased. If the client's INR is above the recommended range, the warfarin sodium dose is decreased. Because the value identified in this question is within the therapeutic range, the nurse would administer the next dose of warfarin.

The nurse is assisting in preparing a diet plan for a client who is taking the anticoagulant, warfarin. The nurse instructs the client to limit which food from the diet?

Broccoli Rationale: Anticoagulant medications act to prevent coagulation by antagonizing the action of vitamin K. When a client is taking an anticoagulant, foods high in vitamin K are often omitted from the diet. Vitamin K is found in large amounts in green, leafy vegetables. Pasta, oranges, and potatoes are very low in vitamin K.

A client is receiving supplemental therapy with folic acid. The nurse evaluates the effectiveness of this therapy by monitoring the results of which laboratory study?

Complete blood count Rationale: Folic acid is necessary for red blood cell production and is classified as a vitamin and an antianemic agent. The effectiveness of therapy can be measured by monitoring the results of periodic complete blood count levels, noting particularly the hematocrit level. Blood glucose, Blood urea nitrogen, and alkaline phosphatase are not associated with the use of this medication.

A client with chronic kidney disease is receiving ferrous sulfate. The nurse should monitor the client for which common side effect associated with this medication?

Constipation Rationale: Ferrous sulfate is an iron supplement used to treat anemia. Constipation is a frequent and uncomfortable side effect associated with the administration of oral iron supplements. Stool softeners are often prescribed to prevent constipation.

Enoxaparin sodium is prescribed for the client following hip replacement surgery. The nurse prepares to have which available in the event that an overdose of the medication occurs?

Protamine sulfate Rationale: Enoxaparin sodium is a low molecular weight heparin anticoagulant. Accidental overdose of this medication may lead to bleeding complications. The antidote is protamine sulfate. Naloxone is the antidote for opioids. Phytonadione is the antidote for warfarin sodium. Epinephrine is used to treat hypersensitivity reactions or acute bronchial asthma attacks and bronchospasms.

The nurse is reinforcing instructions to a client regarding epoetin alfa that will be administered subcutaneously by the client at home. The nurse tells the client to do which action?

Refrigerate the medication Rationale: The medication should be refrigerated but not frozen. The client should be instructed not to shake the medicine bottle. Syringes with a ½-inch needle are used to administer subcutaneous injections.

A client who was recently prescribed warfarin is being instructed on diet changes necessary with this medication. The client reports enjoying all of these food items. Which items should the nurse instruct the client to limit consuming? Select all that apply.

Spinach salad Mustard Greens Rationale: Dark green, leafy vegetables such as spinach and mustard greens contain vitamin K, which can interfere with the function of warfarin. The client needs instruction to eat these foods in limited amounts to prevent interference. The other options do not contain large amounts of vitamin K. Bananas and orange juice contain potassium (K+), but this is not the same as vitamin K.

A client with no history of heart disease has experienced an acute myocardial infarction and been given thrombolytic therapy with tissue plasminogen activator (tPA). The nurse interprets that the client is likely experiencing a complication of this therapy if which occurs?

Tarry Stools Rationale: Thrombolytic agents are used to dissolve existing thrombi, and the nurse must monitor the client for obvious or occult signs of bleeding. This includes assessment for obvious bleeding within the gastrointestinal (GI) tract, urinary system, and skin. It also includes testing secretions for occult blood. Option 1 is the only option that indicates the presence of blood Orange-colored urine is associated with administration of the antibiotic rifampin. Orange-colored urine, nausea and vomiting, and decreased urine output are not complications associated with administration of tPA.

The nurse is reviewing the postoperative prescriptions for a client who has just returned from surgery and notes that the surgeon has prescribed lepirudin. Which is this medication prescribed to prevent?

Thromboembolic complications Rationale: Lepirudin is an anticoagulant used in clients with heparin-induced thrombocytopenia and associated thromboembolic disease to prevent further thromboembolic complications. In the postoperative client, the initial dose is administered as soon as possible after surgery but not more than 24 hours after surgery.

Iron dextran is prescribed to be administered intramuscularly to a client. The nurse prepares the medication and determines that the appropriate method of administration is which?

Using the Z-track technique Rationale: A disadvantage of administering iron dextran intramuscularly is that it causes pain and discoloration at the injection site. When intramuscular administration is prescribed, the medication should be injected deep into the buttock with the Z-track technique. Z-track injection keeps the iron dextran deep in the muscle, thereby minimizing leakage and surface discoloration. The Z-track technique is used for injection of medications that can stain or irritate the skin. A ⅝-inch needle is used for subcutaneous injections. Applying heat to an injection site before administration is an incorrect action.

The nurse is reinforcing instructions to the parents of a child with iron deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction should the nurse provide the mother?

Administer the iron through a straw. Rationale: Oral iron supplements should be administered through a straw or medicine dropper placed at the back of the mouth; otherwise, it will stain the teeth. The parents should be instructed to brush or wipe the teeth after administration. Iron is administered between meals because absorption is decreased if there is food in the stomach. Iron requires an acidic environment to facilitate its absorption in the duodenum.

The nurse is reviewing the primary health care provider's (PHCP) prescriptions for a client scheduled for a cardiac catheterization and notes that the PHCP has prescribed tirofiban. The nurse understands that this medication has been prescribed for which purpose?

To inhibit thrombus formation Rationale: Tirofiban is an antiplatelet and antithrombotic medication. It produces rapid inhibition of platelet aggregation by preventing binding of fibrinogen to receptor sites on platelets. This action inhibits thrombus formation. It is used as an adjunct to aspirin and heparin for hospitalized clients at high risk for myocardial infarction or for clients undergoing a cardiac catheterization procedure. The action of tirofiban is not the prevention of infection or dysrhythmias. Bleeding is a side effect of the medication.

The nurse reinforces instructions to a pregnant client regarding the administration of iron. The nurse determines that the teaching is effective if the client states that she will take the iron with which food items?

Tomato juice Rationale: Foods containing ascorbic acid (vitamin C), such as tomato juice, may increase absorption of iron. Additionally, absorption of iron is affected by many substances. Calcium and phosphorus in milk and tannin in tea decrease iron absorption. Water will not act to increase the absorption of the iron.

The nurse is caring for a client with a diagnosis of chronic kidney disease who is receiving dialysis. Epoetin alfa has been prescribed for the client. How should the nurse prepare to administer the medication?

The subcutaneous route Rationale: Epoetin alfa is dispensed for subcutaneous or intravenous injections. Vials should not be shaken because epoetin alfa is a protein that can be denatured by agitation. Epoetin alfa is not to be mixed with other medications. The medication should be refrigerated but should not be frozen.