Pharmacology Made Easy 4.0: The Hematologic System + NCLEX questions

While a client is receiving continuous IV heparin, the provider prescribes oral warfarin. This is because A. warfarin takes 3-5 days to achieve therapeutic effects B. IV heparin alone becomes ineffective after the first 1-2 days C. abrupt cessation of heparin therapy increases the risk of thrombocytopenia D. warfarin increase the risk of hemorrhage

A. warfarin takes 3-5 days to achieve therapeutic effects Warfarin takes 3-5 days to achieve its therapeutic effects. Once the patient has an INR of 2 to 3, the provider should discontinue IV heparin therapy

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? a. Flumazenil b. Acetylcysteine c. Naloxone d. Deferoxamine

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.

What is the pharmacologic action of Epoetin alfa? A. Stimulates RBC production B. Stimulates leukocyte production C. Inhibits platelet aggregation D. Dissolves blood clots

Stimulates RBC production Epoetin alfa stimulates RBC production in the bone marrow. It treats anemia from renal failure, malignancies, or AIDS.

NCLEX: A client has a prescription to receive enoxaparin. The nurse would plan to administer this medication by which route? 1. Oral 2. Intravenous 3. Intramuscular 4. Subcutaneous

Subcutaneous

NCLEX: The nurse has provided instruction to a client with chronic kidney disease who has a prescription for epoetin alfa. Which statement by the client indicates that teaching was effective? 1. "I have to receive this medication subcutaneously." 2. "I will receive this medication through intramuscular injection." 3. "This medication has to be administered using the Z-track method." 4. "I will take this medication orally with the rest of my morning pills."

"I have to receive this medication subcutaneously" Epoetin alfa is administered parenterally by the intravenous or subcutaneous route. It cannot be given orally because it is a glycoprotein and would be degraded in the gastrointestinal tract.

NCLEX: A client with chronic kidney disease has been receiving epoetin alfa for the past 2 months. What would the nurse determine is an indicator that this therapy has been effective? 1. A decrease in blood pressure 2. An increase in white blood cells 3. An increase in serum hematocrit 4. A decrease in serum creatinine level

An increase in serum hematocrit Epoetin alfa stimulates red blood cell production. Initial effects would be seen within 1 to 2 weeks, and the hematocrit reaches normal levels in 2 to 3 months.

NCLEX: A client with chronic kidney disease is receiving ferrous sulfate. The nurse instructs the client that which finding is a common side/adverse effect associated with this medication? 1. Fatigue 2. Headache 3. Weakness 4. Constipation

Constipation

A nurse is monitoring a client following ferrous sulfate administration. The nurse should monitor the client for which of the following adverse effects? a. Phlebitis b. Dark, green-colored stools c. Constipation d. Injection site pain

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.

Which of the following drugs should you have ready in case of heparin overdose? A. Aminocaproic acid B. Deferoxamine C. Vitamin K D. Protamine

D. Protamine Protamine reverses the effects of heparin. For overdose, stop heparin and give no faster than 20mg/min.

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? a. Sleep modifications b. Fluid modifications c. Driving modifications d. Dietary modifications

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.

NCLEX: The nurse has provided medication instructions to a client with an iron deficiency anemia who will be taking iron supplements. Which statement made by the client indicates an understanding of this medication? 1. "I need to increase my fluid intake" 2. "I need to eliminate fiber foods from my diet" 3. "I need to take the medication with water before a meal 4. "I need to be sure to chew the tablet thoroughly before swallowing it"

"I need to increase my fluid intake" Rationale: Iron preparations can be very irritating to the stomach and are best taken between meals. Because iron supplements may be associated with constipation, the client would increase fluids and fiber in the diet to counteract this side effect of therapy. Iron preparations need to be taken with a substance that is high in vitamin C to increase its absorption. The tablet is swallowed whole and not chewed.

NCLEX: A client is being discharged on warfarin sodium, and the nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates to the nurse that the client understands the teaching provided? 1. "I'll stop my medication if I see bruising." 2. "Stiff joints are common while taking warfarin." 3. "This medication will prevent me from having a stroke." 4. "If I notice blood-tinged urine, I will call my doctor."

"If I notice blood-tinged urine, I will call my doctor" Clients must receive detailed instructions on the signs of bleeding. Hematuria is a sign of bleeding, which the client would report.

NCLEX: The nurse is reviewing heparin infusion therapy and pertinent laboratory values to monitor with the nursing student. Which statement by the student indicates that teaching has been effective? 1. "Bleeding time assesses for therapeutic effect of heparin." 2. "Thrombin time assesses for therapeutic effect of heparin." 3. "Prothrombin time assesses for therapeutic effect of heparin." 4. "Partial thromboplastin time assesses for therapeutic effect of heparin."

"Partial thromboplastin time (aPTT) assesses for therapeutic effect of heparin." The partial thromboplastin time will assess the therapeutic effect of heparin. The prothrombin time is one test that will assess for the therapeutic effect of warfarin. Bleeding time and thrombin time are hematological studies that may be prescribed for clients with coagulopathy or other disorders.

NCLEX: The nurse is providing dietary instructions to the client with anemia. The client tells the nurse that the iron pills are very expensive and that it will be difficult to pay for the pills and buy the proper food. What is the most appropriate nursing response? 1. "You will have to find a way to afford both." 2. "You will be fine as long as you take the iron pills." 3. "Why don't you ask your family to help you out financially?" 4. "Would you like for me to check into some other options for you?"

"Would you like for me to check into some other options for you?" Option 4 is correct because it validates the client's issue with cost.

A nurse is teaching a client about taking ferrous sulfate to treat iron-deficiency anemia. Which of the following instructions should the nurse include? (Select all that apply.) a. Eat iron-enriched foods. b. Spread the dosage across each day. c. Take the drug on an empty stomach. d. Report dark green or black stools. e. Increase dietary fiber intake.

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

NCLEX: The nurse is reviewing the laboratory results for a client who arrives at the health care clinic for follow-up assessment after being diagnosed with atrial fibrillation. The international normalized ratio (INR) is analyzed because the client has been taking warfarin sodium since discharge from the hospital. The nurse determines that the INR range is at an appropriate level if what value is noted on the laboratory report? 1. 0.6 2. 0.75 3. 1.0 4. 2.3

2.3 The recommended INR range for warfarin sodium therapy for atrial fibrillation is 2.0 to 3.0

A patient discharges home with a prescription for warfarin. The patient should be advises of which of the following? SATA A. Avoid taking NSAIDs B. Use a disposable razor C. Brush teeth with a soft toothbrush D. Increase intake of dark-green, leafy vegetables E. Ask the provider before taking over-the-counter drugs

A. Avoid taking NSAIDs C. Brush teeth with a soft toothbrush E. Ask the provider before taking over-the-counter drugs

You should monitor a client throughout continuous heparin therapy for which of the following adverse reactions? SATA A. Thrombocytopenia B. Hypotension C. Hyperkalemia D. Deep vein thrombosis E. Fever

A. Thrombocytopenia B. Hypotension D. Deep vein thrombosis E. Fever Monitor platelet count for thrombocytopenia and stop if a sudden drop in platelets occurs. Clients are at risk for bleeding, which causes hypotension and tachycardia. Heparin-induced thrombocytopenia can cause thrombus formation. A hypersensitivity reaction could occur causing fever, chills and hives.

A nurse is administering epoetin intravenously to a client who has renal failure. Which of the following actions should the nurse take? a. Shake the vial before using. b. Administer via IV bolus over 1 to 3 min. c. Dilute the drug first with D5W. d. Save the used vial for the next dose.

Administer via IV bolus over 1 to 3 min Instructions for administering the drug include administering it via IV bolus over 1 to 3 min.

NCLEX: The nurse is evaluating the results of laboratory studies for a client receiving epoetin alfa. When would the nurse expect to note a therapeutic effect of this medication? 1. Immediately 2. After 3 days of therapy 3. After 1 week of therapy 4. After 2 weeks of therapy

After 2 weeks of therapy Rationale:Epoetin alfa stimulates erythropoiesis. It takes 2 to 6 weeks after initiation of therapy before a clinically significant increase in hematocrit is observed. Therefore, this medication is not intended for clients who require immediate correction of severe anemia, and it is not a substitute for emergency blood transfusions.

NCLEX: A client who had surgery 3 days earlier is receiving heparin sulfate by subcutaneous injection every 12 hours. In planning for the client's morning care, the priority nursing intervention is which action? 1. Allow the client to sit only at the bedside. 2. Assist the client to shave using an electric razor. 3. Monitor the prothrombin time (PT) every 4 hours. 4. Tell the client that brushing the teeth is not allowed.

Assist the client to shave using an electric razor

A client is about to start taking liquid ferrous sulfate to treat iron deficiency anemia. Which of the following instructions should be included? SATA A. Swish it in your mouth before swallowing it B. Drink it through a straw C. Do not rinse your mouth after taking it D. Dilute it first with water E. Take it with food if needed

B. Drink it through a straw D. Dilute it first with water E. Take it with food if needed

A Provider prescrbes IV heparin for a client. Which of the following parameters should be followed to determine correct dose? A. INR, 2 to 3 times the client's baseline B. aPTT, 1.5 to 2 times the client's baseline C. Platelet count of 125,000/mm D. PT 11 to 12.5 sec

B. aPTT, 1.5 to 2 times the client's baseline Check aPTT every 4-6 hours for continuous IV therapy. The goal is an aPTT of 1.5 to 2 times the client's baseline.

NCLEX: The nurse is caring for a client who was just admitted to the hospital for the treatment of iron overload. The nurse anticipates that the primary health care provider will prescribe which medication to treat the iron overload? 1. Terbinafine 2. Granisetron 3. Ketoconazole 4. Deferoxamine

Deferoxamine Deferoxamine is a medication used to treat iron overload. Granisetron is an antiemetic. Ketoconazole and terbinafine are antifungal medications.

NCLEX: A client is prescribed a liquid iron preparation that has the potential to stain the teeth. The nurse would instruct the client to take which action to prevent staining of the teeth? 1. Brush the teeth before drinking the iron. 2. Drink the iron undiluted for maximal effect. 3. Dilute more than the amount prescribed to obtain the correct dosage. 4. Dilute the iron in juice, drink it through a straw, and rinse the mouth afterward.

Dilute the iron in juice, drink it through a straw, and rinse the mouth afterward Liquid iron preparations will stain the teeth. The best advice for the client who needs liquid iron is to dilute the iron in juice or water, drink it through a straw, and rinse the mouth well afterward. Brushing before taking the liquid iron would not be of any benefit. The nurse would not instruct a client to take more than the prescribed amount.

A nurse is caring for a client who is about to begin taking epoetin. An increase in which of the following laboratory values should indicate to the nurse that the therapy is effective? a. PT b. WBC c. Hgb d. Platelets

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.

NCLEX: The nurse is monitoring a client who is receiving epoetin alfa for adverse effects of the medication. Which finding indicates a side/adverse effect? 1. Diarrhea 2. Depression 3. Bradycardia 4. Hypertension

Hypertension Epoetin alfa generally is well tolerated. The most significant adverse effect is hypertension, and its use is contraindicated in uncontrolled hypertension. Occasionally a tachycardia may occur as a side effect. This medication also may cause an improved sense of well-being.

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? a. Hypertension b. Muscle pain c. Edema d. Dry mouth

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.

A client i about to start taking warfarin to prevent venous thrombosis. Which daily lab will the patient require to determine effectiveness? A. Fibrinogen B. PT/INR C. Platelets D. aPTT

PT/INR At the start of therapy, monitor prothrombin time (PT) and INR daily and adjust the dosage to maintain an INR of 2 to 3.

NCLEX: The nurse is caring for a client who is taking warfarin. The nurse notes the presence of gross hematuria and large areas of bruising on the client's body. The nurse notifies the primary health care provider (PHCP) and ensures that which prescribed medication is available? 1. Heparin sulfate 2. Protamine sulfate 3. Phytonadione (vitamin K) 4. Oral potassium supplements

Phytonadione (vitamin K)

NCLEX: Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit? 1. Vitamin K 2. Protamine sulfate 3. Aminocaproic acid 4. Potassium chloride

Protamine sulfate

NCLEX: Epoetin alfa by the subcutaneous route is prescribed for a client. What is the most appropriate nursing action? 1. Shake the vial before use. 2. Freeze the medication before use. 3. Refrigerate the medication until used. 4. Obtain syringes with 1½-inch (3.8 cm) needles for administration.

Refrigerate the medication until used Epoetin alfa would be refrigerated at all times. The bottle would not be shaken, and the medication would not be frozen because this will affect the chemical composition.

NCLEX: A client is diagnosed with iron-deficiency anemia, and ferrous sulfate is prescribed. The nurse would tell the client that it would be best to take the medication with which food? 1. Milk 2. Boiled egg 3. Tomato juice 4. Pineapple juice

Tomato juice Rationale: Ferrous sulfate is an iron preparation, and the client is instructed to take the medication with orange juice or another vitamin C-containing product or a product high in ascorbic acid to increase the absorption of the iron. Among the options presented, tomato juice is highest in vitamin C and ascorbic acid. Milk and eggs inhibit absorption of iron.

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? a. Uncontrolled bleeding b. Myocardial infarction c. Respiratory depression d. Decreased renal perfusion

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? a. Filgrastim b. Deferoxamine c. Protamine d. Vitamin K

Vitamin K Vitamin K reverses the effects of warfarin by promoting the synthesis of coagulation factors VI, IX, X, and prothrombin.

A nurse is monitoring a client who is undergoing anticoagulant therapy with heparin. Which of the following findings should nurse identify as a possible indication of hemorrhage? a. Rapid Pulse b. Yellowing of the sclera c. Elevated blood pressure d. Pale-colored stools

a. 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.