Practice questions for Pharm exam 2

A nurse is educating a group of clients about the contraindications of warfarin therapy. Which of the following statements should the nurse include in the teaching?

"Clients who are pregnant should not take warfarin." Rationale: Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk for bleeding.

A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide?

"Crushing the medication might cause you to have a stomachache or indigestion." Rationale: The pill is enteric-coated to prevent breakdown in the stomach and decrease the possibility of GI distress. Crushing the pill destroys that protection.

A nurse is teaching a client who has a new prescription for enteric-coated aspirin as stroke prophylaxis. The client asks the nurse why the provider prescribed an enteric-coated medication. Which of the following responses should the nurse give?

"Enteric-coated medications cause less gastric irritation." Enteric-coated medications do not dissolve until they reach the small intestine, which reduces the risk of gastric irritation.

A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching?

"I have started taking ginger root to treat my joint stiffness." Rationale: Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching.

A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make?

"Warfarin takes 5 days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." Rationale: Heparin and warfarin are both anticoagulants that decrease the clotting ability of the blood and help prevent thrombosis formation in the blood vessels. However, these medications work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which is usually within 1 to 5 days. When the client's PT and INR are within therapeutic range, the heparin can be discontinued.

A nurse is teaching a client who has a new prescription for clopidogrel. Which of the following instructions should the nurse include?

"You might have to stop taking this medication 5 days before any planned surgeries." Rationale: Clopidogrel inhibits platelet aggregation and can cause bleeding. The client should report taking this medication to providers to determine whether to discontinue the medication prior to elective procedures to reduce the risk for bleeding.

PT levels/INR levels therapeutic ranges

- 18-24 sec - 2.3

A nurse is caring for a client who is taking clopidogrel to prevent stent restenosis. The nurse should monitor the client for which of the following adverse reactions?

- Hemorrhage - Thrombocytopenia - GI upset - Rash

Adverse effects of Clopidogrel

- Hemorrhage (Petechiae, hematomas, tarry stools) - Weakness - Vision changes - Gi upset (Pantoprazole decreases GI effects) - Rash

A nurse is caring for a client who recently started alteplase therapy. The nurse should monitor the client for which of the following adverse effects?

- Hemorrhage, headache

PE for a pt taking Alteplase

- Monitor Temp - Limit Venipunctures - Assess Neuro Function - Apply pressure in oozing sites.

Labs to monitor while on warfarin

- PT (18-24 sec) - INR (2-3) for the tx of Acute MI, Afib, & Venous Thrombus - INR (2.5-3) for the tx of DVT

A nurse is administering subcutaneous heparin to a client who is at risk for deep vein thrombosis. Which of the following actions should the nurse take?

Administer the medication into the client's abdomen using a 25-gauge or smaller needle to decrease the risk of hemorrhage.

A nurse is caring for a client who is experiencing an acute ischemic cerebrovascular event due to a thrombus in a cerebral vessel. Which of the following drugs should the nurse expect to administer?

Alteplase

A nurse is caring for a client who is about to begin alteplase therapy to treat pulmonary embolism. Which of the following drugs should the nurse have available in the event of a severe adverse reaction?

Aminocaproic Acid

A nurse is assessing a client who is experiencing chest pain. Which of the following medications should the nurse expect to administer to suppress the aggregation of platelets?

Aspirin Aspirin suppresses platelet aggregation, producing an immediate antithrombotic effect. The client should chew the first dose of aspirin to allow rapid absorption.

A nurse is caring for a client who has a prescription for clopidogrel. The nurse should monitor the client for which of the following adverse effects?

Bleeding Clopidogrel is an antithrombotic medication that inhibits platelet aggregation. It is used to prevent stenosis of coronary stents, myocardial infarctions, and strokes. The nurse should monitor for coffee-ground emesis, black tarry stools, ecchymosis, or any indication of bleeding.

A nurse is teaching a client who has a new prescription for aspirin to treat rheumatoid arthritis. The nurse should include to monitor for which of the following adverse effects of this medication?

Bleeding Rationale: Aspirin can cause bleeding, tinnitus, gastric ulceration, nausea, and heartburn. The client should monitor and report manifestations of bleeding, such as black tarry stools.

A nurse is caring for a client who had a myocardial infarction 2 hours ago and is receiving alteplase. Which of the following findings should the nurse identify as an adverse effect of receiving this medication?

Bleeding The nurse should identify that an adverse effect of alteplase is bleeding. Severe bleeding can occur as a result of the alteplase-plasminogen complex, which catalyzes the conversion of other plasminogen molecules that digest fibrin clots. This action of the medication can contribute to hemorrhage.

A nurse is providing discharge teaching to a client who has venous thrombosis and a prescription for warfarin. Which of the following instructions should the nurse include in the teaching?

Carry a medical alert ID card A client who is taking warfarin is at increased risk for bleeding. In the case of an emergency, any medical personnel must be aware of the client's medication history.

A nurse is caring for a client who is receiving a continuous IV infusion of heparin. Which of the following actions should the nurse take?

Check the activated partial thromboplastin time (aPTT) every 4 hr. Rationale: Heparin is an anticoagulant. The activated partial thromboplastin time (aPTT) should be monitored every 4 hr and the infusion rate should be adjusted accordingly until the effective dose has been determined.

A nurse is reviewing the medical record of a client who might have hearing loss. Which of the following data from the client's medical record should the nurse identify as a risk factor for hearing loss?

Chronic use of salicylates Chronic use of salicylates such as aspirin can lead to ototoxicity, which can manifest as tinnitus or hearing loss.

A nurse is caring for a client who has chronic stable angina. The nurse should identify that which of the following drugs inhibits the action of adenosine diphosphate receptors (ADP) on platelets and can be prescribed to reduce the client's risk for myocardial infarction?

Clopidogrel

A nurse is caring for a client who takes Ginkgo biloba daily at home. Which of the following effects should the nurse expect from the use of this herbal supplement?

Decreased platelet aggregation Ginkgo biloba can decrease platelet aggregation by inhibiting the ability of platelets to clump together. The nurse and the client should discuss the potential increase in bleeding tendencies when taking Ginkgo biloba and other antiplatelet aggregates, such as NSAIDs and clopidogrel.

A nurse is teaching a client who is starting treatment with warfarin. The nurse should plan to include information on which of the following topics to promote the effectiveness of the drug?

Dietary modifications: Warfarin is an anticoagulant drug that functions by inhibiting the action of vitamin K. Many foods, such as green, leafy vegetables, are rich in vitamin K. The client should maintain a consistent intake of vitamin K to avoid excesses or deficits and ensure the therapeutic effects of warfarin are consistent.

A nurse is caring for a client who is postoperative following hip arthroplasty. The nurse should anticipate which of the following prescriptions for this client?

Enoxaparin Rationale: The nurse should anticipate a prescription for enoxaparin as prophylaxis therapy for venous thromboembolism. Clients following hip arthroplasty are usually on anticoagulants for 3 to 6 weeks after surgery.

A nurse is caring for a client who is 12 hours postoperative following a total hip arthroplasty. Which of following medications should the nurse anticipate administering to this client to prevent deep vein thrombosis (DVT)?

Enoxaparin The nurse should anticipate the administration of enoxaparin for a client who is 12 hours postoperative following surgery. Enoxaparin is low-molecular-weight (LMW) heparin that is used to prevent a DVT by inhibiting the effects of antithrombin and thrombin.

A nurse is receiving a client who is immediately postoperative following hip arthroplasty. Which of the following medications should the nurse plan to administer for DVT prophylaxis?

Enoxaparin subcutaneous Rationale: Enoxaparin is a low molecular heparin that inhibits thrombus and clot formation. Preventive doses of enoxaparin are low and the client does not require monitoring of prothrombin time or activated partial thromboplastin time, making it the preferred treatment for DVT prophylaxis following orthopedic surgery.

A nurse is reviewing the medication record of a client who is receiving alteplase following an acute myocardial infarction (MI). Which of the following medications should the nurse expect the client to be taking in addition to the alteplase?

Heparin

A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give?

Heparin does not dissolve clots. It stops new clots from forming." Rationale: This statement accurately answers the client's question.

A nurse is caring for a female client who has rheumatoid arthritis and asks the nurse if it is safe for her to take aspirin. The nurse should recognize which of the following findings in the client's history is a contraindication to this medication?

History of gastric ulcers Rationale: Aspirin is contraindicated for clients who have a history of gastrointestinal bleeding and peptic ulcer disease because it impedes platelet aggregation. An adverse effect of aspirin is gastric bleeding.

A nurse is caring for a client who is taking warfarin. Which of the following laboratory values should the nurse recognize as an effective response to the medication?

INR 3.0 Warfarin is an anticoagulant that prevents thrombus formation in susceptible clients. The INR measures its effectiveness. For most clients taking warfarin, an INR of 3.0 indicates effective therapy.

A nurse is caring for a client who is about to begin taking aspirin to reduce the risk of a cardiovascular event. The nurse should identify that the drug inhibits platelet aggregation by which of the following mechanisms?

Inhibiting Cyclooxygenase action in platelets

Clopidogrel

Inhibits platelet aggregation

A nurse is preparing to administer heparin to a client. Which of the following actions should the nurse plan to take?

Inject the medication into the abdomen above the level of the iliac crest. Rationale: The nurse should inject the medication into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus.

A nurse is teaching a client who has a new prescription for aspirin to prevent cardiovascular disease. Which of the following instructions should the nurse include in the teaching?

Monitor for tinnitus. Rationale: Tinnitus is a manifestation of salicylism, or aspirin toxicity. Other manifestations include sweating, headache, and dizziness.

A nurse is reviewing laboratory results of a client who has atrial fibrillation and is taking warfarin. For which of the following results should the nurse notify the provider?

PT 45 seconds Rationale: The expected reference range for PT is 11 to 12.5 seconds. During therapy, the nurse should expect to see the values increase 1.5 to 2.5 times the baseline. Therefore, the nurse should withhold the warfarin and notify the provider.

A nurse should identify that clopidogrel is contraindicated for clients who have which of the following conditions?

Peptic Ulcer disease

A nurse is reviewing the laboratory data on a client who has a new prescription for heparin for treatment of a pulmonary embolism. Which of the following data should the nurse report to the provider?

Platelets 74,000/mm3 Rationale: Heparin-induced thrombocytopenia is a disorder characterized by low platelet counts. It is an adverse effect of heparin that causes the activation of platelets, resulting in widespread clot formation and depletion of platelets. The expected reference range for platelets is 150,000-400,000/mm3.

A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects?

Protamine sulfate Rationale: Protamine sulfate reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties.

A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin?

Prothrombin time (PT) Rationale: This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation.

A nurse is monitoring a client who is undergoing anticoagulant therapy with heparin. Which of the following findings should the nurse identify as a possible indication of hemorrhage?

Rapid pulse

A nurse is reviewing the medical record of a client. The medication administration record shows the client is taking clopidogrel. Which of the following events should the nurse expect in the client's medical history?

Recent myocardial infarction The nurse should expect the client's medical record to indicate a history of an atherosclerotic event such as myocardial infarction, ischemic stroke, or peripheral vascular disease. Clopidogrel is an antiplatelet medication that inhibits the aggregation of platelets to prevent such thrombotic events.

A nurse is reviewing the laboratory values of a client who is receiving a continuous IV heparin infusion and has an aPTT of 90 sec. Which of the following actions should the nurse prepare to take?

Reduce the infusion rate An aPTT of 90 seconds is outside the expected reference range of 60 to 80 seconds, which can cause anticoagulation. The nurse should contact the provider, reduce the infusion rate, and assess the client for bleeding.

A nurse is providing teaching to a group of new parents about medications. The nurse should include that aspirin is contraindicated for children who have a viral infection due to the risk of developing which of the following adverse effects?

Reye's syndrome Aspirin should not be given to children or adolescents who have a viral infection like chickenpox or influenza due to the risk of developing Reye's syndrome.

A nurse is providing teaching to a client who is taking warfarin about monitoring its therapeutic effects. Which of the following explanations should the nurse provide about the international normalized ratio (INR) test?

The INR is a standardized test that eliminates the variations between laboratories reports in prothrombin times." Rationale: The INR is a standardized test, which means that the result will be the same, no matter which laboratory performs it.

A nurse is completing a medical interview with a client who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin?

The client uses garlic to lower cholesterol levels. Rationale: The nurse should recognize that garlic can potentiate the action of the warfarin.

A nurse is providing discharge teaching for a client who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching?

Use an electric razor while on this medication. Rationale: Warfarin, an anticoagulant, increases the client's risk for bleeding. The nurse should teach the client safety measures, such as using an electric razor, to decrease the risk for injury and bleeding.

A nurse is caring for a client who has cirrhosis and a prothrombin time of 30 seconds. Which of the following medications should the nurse plan to administer?

Vitamin K Rationale: A prothrombin time of 30 seconds indicates the clotting time is prolonged and bleeding could occur. Vitamin K injection increases the synthesis of prothrombin by the liver; therefore, the nurse should plan to administer vitamin k.

A nurse is reviewing the medication list for a client who has a new prescription for warfarin. The nurse should recognize that which of the following medications is incompatible with warfarin?

Vitamin K Rationale: These two medications are not compatible. Vitamin K antagonizes the action of warfarin and is the antidote for warfarin toxicity.

A nurse is caring for a client who is on warfarin therapy for atrial fibrillation. The client's INR is 5.2. Which of the following medications should the nurse prepare to administer?

Vitamin K Rationale: Vitamin K reverses the effects of warfarin.

A nurse is caring for a client who takes warfarin 2.5 mg PO daily and has an INR of 6.2. The nurse should anticipate a prescription from the provider for which of the following medications?

Vitamin K The nurse should anticipate the provider to prescribe vitamin K for a client who has an INR of 6.2. Vitamin K antagonizes warfarin's actions, which can reverse warfarin-induced inhibition of clotting factor synthesis.

Alteplase

dissolves blood clots

A nurse is caring for a client who is scheduled for an outpatient surgical procedure and reports taking aspirin 81 mg daily, including this morning. The nurse should identify that this places the client at risk for which of the following complications?

uncontrolled bleeding

A nurse in an emergency department is assessing a client who has been taking warfarin and is experiencing rectal bleeding. Which of the following drugs should the nurse expect to administer to the client?

vitamin k