ATI Pharmacology 4.0 Hematologic System

A nurse is monitoring a client following ferrous sulfate administration. The nurse should monitor the client for which of the following adverse effects?

Constipation. Oral iron supplementation is associated with constipation. The nurse should encourage the client to consume adequate amounts of fiber and fluids in their diet to minimize this effect. - Ferrous sulfate is administered orally. Phlebitis could occur in clients receiving iron supplementation IV, not by mouth. Iron dextran, iron sucrose, and sodium ferric gluconate are iron formulations that can be administered IV. - Oral iron supplementation is associated with dark green or black-colored stools. - Ferrous sulfate is administered orally, not via intramuscular injection. Iron dextran is available for IM injection.

A nurse is caring for a client who is about to begin therapy with recombinant factor IX to treat hemophilia B. The client asks the nurse about the risk of disease transmission with recombinant factor IX as compared with plasma-derived factor IX. The nurse should explain that recombinant factor IX practically eliminates the risk for which of the following?

Creutzfeldt-Jakob disease - Recombinant factor IX is safer than the plasma-derived formulation because it practically eliminates the risk for Creutzfeldt-Jakob disease, a prion-transmitted infection, from human sources. - None of the factor IX products currently in use, plasma-derived or recombinant, carry a risk of acquiring HIV. However, plasma-derived products carry a minimal risk of acquiring hepatitis A and parvovirus B19. - None of the factor IX products currently in use, plasma-derived or recombinant, carry a risk of acquiring cytomegalovirus. However, plasma-derived products carry a minimal risk of acquiring hepatitis A and parvovirus B19. -Both recombinant and plasma-derived factor IX carry a risk for anaphylaxis. The nurse should have epinephrine and diphenhydramine available and monitor clients who are receiving these products for an allergic reaction that could lead to anaphylaxis. Plasma-derived products carry a minimal risk of acquiring hepatitis A and parvovirus B19.

A nurse is caring for a client who has renal failure and is receiving epoetin. The nurse should monitor the client for which of the following adverse effects?

Hypertension - Epoetin, an erythropoietic growth factor, can cause hypertension. The nurse should monitor the client's BP before and during therapy and inform the provider if it increases. - Epoetin, an erythropoietic growth factor, tends to result in adverse effects involving the cardiovascular and central nervous system and does not cause muscle pain. - Epoetin alfa, an erythropoietic growth factor, is unlikely to cause edema. Oprelvekin, a thrombopoietic growth factor, is a drug that can cause edema and fluid retention. - Epoetin, an erythropoietic growth factor, tends to result in adverse effects involving the cardiovascular and central nervous system and does not cause dry mouth.

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

Inhibiting cyclooxygenase action in platelets. Salicylates, such as aspirin, work by inhibiting platelet aggregation. They do this by blocking the action of cyclooxygenase on platelets. As a result, activation of thromboxane A2 does not occur. - Part of the process by which salicylates, such as aspirin, inhibit platelet aggregation involves preventing the activation of thromboxane A2, which would otherwise stimulate platelet aggregation and vasoconstriction. - Part of the process by which drugs such as clopidogrel, not aspirin, inhibit platelet aggregation involves the irreversible blockade of adenosine diphosphate receptor agonists on the surface of platelets, preventing clotting. - Warfarin, not aspirin, inhibits clotting by limiting the production of clotting factors VII, IX, X, and prothrombin.

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

Peptic ulcer disease. Clients who have peptic ulcer disease should not take clopidogrel, because it can cause gastric bleeding. - Myocardial infarction Clients who have had a myocardial infarction can take clopidogrel; in fact, the drug prevents clot formation in clients who have recently had a myocardial infarction or a cerebrovascular accident. - Clients who have pancreatitis can take clopidogrel. However, the drug is contraindicated for clients who have hemophilia or other bleeding disorders. - Clients who have myasthenia gravis can take clopidogrel. The drug is contraindicated for clients who have thrombocytopenia or intracranial bleeding.

A nurse in the ED 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 - reverses the effects of warfarin by promoting the synthesis of coagulation factors VI, IX, X, and prothrombin. - Filgrastim, a leukopoietic growth factor, stimulates neutrophil production in the bone marrow. It is ineffective for bleeding caused by an anticoagulant, such as warfarin. - A chelating agent, such as deferoxamine, treats iron toxicity. It is ineffective for bleeding caused by an anticoagulant, such as warfarin. - Protamine reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties. It is ineffective for bleeding caused by an anticoagulant, such as warfarin.

A nurse should assess a client who has megaloblastic anemia for indications of which of the following vitamin deficiencies?

Vitamin B12: Clients who have megaloblastic anemia have a deficiency of vitamin B12, folic acid, or both. Cyanocobalamin (vitamin B12) treats moderate vitamin B12 deficiencies. Clients who have a severe vitamin B12 deficiency should take cyanocobalamin and folic acid. - Vitamin C treats scurvy and is unlikely to cause megaloblastic anemia. - Vitamin K helps reverse warfarin OD, causes spontaneous bleeding and is unlikely to cause megaloblastic anemia. - Vitamin D treats and prevents rickets. Unlikely to cause megaloblastic anemia.

A nurse is administering epoetin IV to a client who has renal failure. Which of the following actions should the nurse take?

Administer via IV bolus over 1-3 min. - Shaking the vial can damage the glycoprotein that comprises the drug, making it ineffective. - Instructions for administering the drug include mixing it with 0.9% NaCl. The nurse should also examine the solution and discard it if it is cloudy or discolored. - Instructions for administering the drug include using the vial only once and then discarding it.

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 - Alteplase is a thrombolytic drug, meaning it can dissolve existing thrombi, whereas anticoagulant/antiplatelet drugs do not. An acute ischemic cerebrovascular event is often caused by the occlusion of a cerebral vessel by a thrombus. Administration of alteplase should be within 3 hr of the original onset of symptoms for the drug to be effective. - Aspirin While antiplatelet therapy with aspirin may be used prophylactically to reduce the risk of having an acute ischemic cerebrovascular event, it will not treat one that has already happened. Only thrombolytic drugs can dissolve existing thrombi and treat an acute ischemic cerebrovascular event. - Clopidogrel is an antiplatelet drug and may be used prophylactically to reduce the risk of having an acute ischemic cerebrovascular event, but it will not treat one that has already happened. Only thrombolytic drugs can dissolve existing thrombi and treat an acute ischemic cerebrovascular event. - Heparin is an anticoagulant drug that can prevent the formation of deep vein thrombosis or pulmonary embolism, but it is not prescribed to treat a thrombotic cardiovascular event.

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. Aminocaproic acid, a coagulator, inhibits fibrinolysis and stops excessive fibrinolytic bleeding, a severe adverse effect of alteplase. - Vitamin K reverses the effects of warfarin. It is unlikely to reverse the thrombolytic effects of alteplase. - Protamine reverses the effects of heparin. It is unlikely to reverse the thrombolytic effects of alteplase. - Deferoxamine is a chelating agent that binds with iron to reverse iron toxicity. It is unlikely to reverse the thrombolytic effects of alteplase.

A nurse is preparing to administer a prescribed dose of desmopressin to a client who has hemophilia A. The client has a sodium level of 130 mEg/L. Which of the following actions should the nurse take?

Clarify the prescription with the provider. Hyponatremia and fluid retention can occur with the administration of desmopressin, an antidiuretic hormone used in the treatment of hemophilia A. The client's sodium level is below the expected range of 136 to 145 mEq/L. The nurse should notify the provider of the client's current sodium level and clarify the prescription prior to administration. - Filgrastim, a leukopoietic growth factor, stimulates neutrophil production in the bone marrow. It is possible that it could cause bone pain, requiring the concomitant administration of a mild analgesic. Desmopressin does not require the administration of an analgesic. - Desmopressin is available for use in treating hemophilia A intravenously or via nasal spray. It is not administered orally for treatment of hemophilia. - Desmopressin is used in the treatment of hemophilia A and stimulates the release of factor VIII. It does not have therapeutic effects on hemophilia B, which is a factor IX deficiency.

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 MI?

Clopidogrel - Clopidogrel is an antiplatelet medication that blocks the ADP receptors on platelets, preventing platelet aggregation. This effect is irreversible and lasts the lifespan of the platelets (7 to 10 days). - Heparin binds with antithrombin, increasing its ability to inactivate factor Xa and thrombin. This prevents the formation of fibrin. - Warfarin inhibits vitamin K by preventing its activation. As a result, there is a decreased production of vitamin K dependent clotting factors VII, IX, X, and prothrombin. - Alteplase is a thrombolytic drug. Thrombolytic drugs selectively convert plasminogen into the enzyme plasmin, which can actively breakdown the fibrin meshwork of a clot.

A nurse is caring for a client who is taking ferrous sulfate to treat iron-deficiency anemia and develops iron toxicity. Which of the following drugs should the nurse expect to use to treat this complication?

Deferoxamine. Indications of iron toxicity include nausea, vomiting, and diarrhea. Iron toxicity can lead to acidosis and shock. A chelating agent, such as deferoxamine, binds to the iron to reduce toxicity. - Flumazenil, a benzodiazepine antagonist, reverses the effects of benzodiazepines. - Acetylcysteine, a mucolytic, reduces the risk of hepatotoxicity after acetaminophen overdose. Acetylcysteine binds to the toxic byproducts of acetaminophen metabolism to prevent liver toxicity. - Naloxone, an opioid antagonist, reverses the effects of opioid narcotics.

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. - There are no specific recommendations about sleep modifications that would affect a client taking warfarin. - There are no specific recommendations about fluid intake that would affect a client taking warfarin. Clients taking drugs for heart failure might need to monitor fluid intake. - There are no specific recommendations about operating a motor vehicle that would affect a client taking warfarin. Warfarin does not cause sedation or altered judgment or coordination.

A nurse is teaching a client about taking ferrous sulfate to treat iron-deficiency anemia. Which of the following instructions should the nurse take?

Eat iron-enriched foods (egg yolks, wheat germ, meat, fish). Spread the dosage across each day (throughout waking hours to allow bone marrow to maximize production of RBCs). Take the drug on an empty stomach (food reduces absorption of ferrous sulfate unless GI effects are troublesome). - Increase dietary fiber intake as ferrous sulfate can cause constipation. - Dark green/black stools are expected and not necessary to report.

A nurse is caring for a client who has hemophilia A and is about to begin taking desmopressin to prevent bleeding. The nurse should monitor the client for which of the following adverse reactions?

Edema - Desmopressin, an antidiuretic hormone, can cause fluid retention and edema. The nurse should monitor fluid intake and output for clients receiving this drug. - Desmopressin, an antidiuretic hormone, can cause hyponatremia and weight gain. The nurse should monitor serum sodium levels and daily weight for clients receiving the drug therapy. - Desmopressin, an antidiuretic hormone, can reduce urine output. It is unlikely to cause polyuria. - Bradycardia Desmopressin, an antidiuretic hormone, can cause a slight increase in blood pressure and tachycardia when administered in large IV doses, but it does not cause bradycardia.

A nurse is caring for a client who is taking filgrastim to treat neutropenia. The nurse should assess the client for which of the following adverse effects?

Enlarged spleen - With long-term use, filgrastim, a leukopoietic growth factor, can cause an enlarged spleen. The nurse should tell the client to monitor and report abdominal pain or fullness. - Filgrastim, a leukopoietic growth factor, is unlikely to cause hypoxemia and dusky nail beds. However, it can cause fever, bone pain, and ECG changes. - Unlikely to cause petechiae and to cause a clot. It can cause leukocytosis.

A nurse is caring for a client who is about to begin factor VIII therapy to treat hemophilia A. When administering factor VIII, which of the following actions should the nurse take?

Have emergency equipment ready, as factor VIII can cause a hypersensitive reaction and anaphylaxis. Monitor for hives, fever, wheezzing, and difficulty breathing. - The powdered form of factor VIII is concentrated factor VIII. The nurse should dissolve it in a sterile solution and administer it via IV. - Aspirin and first-generation NSAIDs are contraindicated for clients who have hemophilia A because they increase the risk for bleeding. - The nurse should administer factor VIII slowly over 5 to 10 min.

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?

Headache - the thrombolytic drug can cause intracranial bleeding. The nurse should monitor the client for changes in level of consciousness, headache, one-sided weakness, and other indications of intracranial bleeding. - Alteplase, a thrombolytic drug, can cause bronchospasm, not bronchodilation. - Alteplase, a thrombolytic drug, is unlikely to cause edema. Desmopressin is a drug that can cause this adverse effect because it causes fluid retention. - Alteplase, a thrombolytic drug, can cause bleeding and hemorrhage, usually at sites of previous tissue damage. Severe and excessive bleeding can cause hypotension, not hypertension.

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

Heparin - Heparin therapy should be initiated before alteplase therapy and continued for at least 48 to 72 hr after the fibrinolytic therapy to reduce the risk of additional clot formation. - Protamine is responsible for reversing heparin's effects and would only be administered as an antidote to heparin in the case of an uncontrolled bleeding event. The nurse should not expect the client to take these simultaneously. - Desmopressin is a form of antidiuretic hormone, which is prescribed for clients who have mild hemophilia A to treat bleeding from an injury or in preparation for surgery. - Iron supplements, such as ferrous sulfate, are commonly prescribed for the treatment of iron-deficiency anemia. Iron plays a key role in hemoglobin's ability to bind and carry oxygen, but it is not directly involved in the formation of thrombi.

A nurse is caring for a client who is about to begin taking epoetin. An increase in which of the following lab values should indicate to the nurse that the therapy is effective?

Hgb. Epoetin, an erythropoietic growth factor, increases the production of RBCs for clients who have anemia due to chronic renal failure or chemotherapy. Hgb and Hct should increase with effective therapy. - Warfarin, not epoetin, increases PT and causes anticoagulation. - Epoetin stimulates the production of RBCs, not WBCs. Therefore, the nurse should monitor Hgb and Hct levels to determine efficacy. - Epoetin can cause thrombocytosis, which is an excessive increase in platelet counts. This is an adverse effect of the drug and is not an indication of effective therapy.

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. In the event of a moderate to severe hemorrhage, the volume of blood in the circulatory system decreases significantly, resulting in hypotension. Tachycardia is a compensatory mechanism of the heart that serves to combat the hypotension that results from the decreased volume of blood. Tachycardia can be detected by checking the client's pulse. - Due to decreased blood volume, the nurse should expect to see pallor of the sclera, skin, and mucous membranes if hemorrhage occurs. The client might also have visible bruising or petechiae. - Due to decreased blood volume, a reduction in blood pressure (hypotension) is an expected finding if hemorrhage occurs. The client might experience dizziness upon standing because the body cannot adjust blood pressure rapidly to compensate for the position change. - The nurse should recognize that black, tarry stools, or stools with frank blood visible are indications of hemorrhage.

A nurse is monitoring for a client who is about to begin taking folic acid to treat megaloblastic anemia. The nurse should monitor which of the following lab values to determine therapeutic effectiveness?

Reticulocyte count - a reticulocyte count measures the amount of immature RBCs. Folic acid, also called folate, is essential for erythropoiesis. Clients who have a folic acid deficiency require a baseline reticulocyte count, as well as a serum folate, Hgb, Hct, and RBC count and periodic monitoring during folic acid therapy to determine effectiveness. - Folic acid, also called folate, is unlikely to alter amylase levels. Amylase is an enzyme that helps digest carbohydrates. Levels rise with pancreatic inflammation or injury or when taking drugs used to treat viral invasion. - Folic acid, also called folate, is unlikely to alter C-reactive protein. Levels of this substance rise with inflammation and cardiovascular disease. - Folic acid, also called folate, is unlikely to alter creatinine clearance, which is a test that helps determine kidney function. Creatinine clearance is altered in drugs that affect the renal output, such as diuretics and antidiuretic hormone.

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?

Thrombocytopenia. Clopidogrel, an antiplatelet drug, can cause thrombotic thrombocytopenic purpura. The nurse should monitor the client's platelet count and also monitor for bruising, bleeding gums, and petechiae. - Clopidogrel, an antiplatelet drug, is unlikely to cause hyperuricemia, which is elevated uric acid levels. Filgrastim, a leukopoietic growth factor, is a drug that can cause hyperuricemia. - Clopidogrel, an antiplatelet drug, is unlikely to cause hyponatremia. Desmopressin is a drug that can cause this adverse effect. Clopidogrel, however, can cause hypercholesterolemia. - Clopidogrel, an antiplatelet drug, is unlikely to cause lymphocytopenia, neutropenia, or granulocytopenia.

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. Aspirin is a salicylate (antiplatelet) that irreversibly binds to and inhibits platelet activation. Because the lifespan of a platelet is 7 to 10 days, this is the average span of time needed after discontinuing antiplatelet therapy with aspirin before its effects are no longer present and the chance of an uncontrolled bleeding event is decreased. - Although many clients are prescribed aspirin to reduce their chances of having a myocardial infarction (MI), the client's risk for an MI would not increase due to missing the single dose. - Taking aspirin does not increase the risk of respiratory depression. Taking opioid analgesics can increase the risk of respiratory depression. - Taking aspirin does not increase the risk of renal perfusion. Aspirin can cause gastrointestinal distress.