PME Hematologic system

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

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?

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.

Before adminidtering IV folic acid, you should explain to the client that this drug can cause which adverse effect?

Rash

A client is about to start taking cyanocobalamin, a vitamin B12 preparation.You understand that this drug treats which of the following types of anemia?

Pernicious

Which of the following drugs should you have ready in case of heparin overdose?

Protamine

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

Administer via IV bolus over 1 to 3 min

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. Brush his teeth with a soft toothbrush. Ask the provider before taking over-the-counter drugs.

A nurse is caring for a client who is experiencing an acute ischemic cerebrovascular event due to thrombus in 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 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 preparing to administer a prescribed dose of desmopressin to a client who has hemophilia A. The client's laboratory results indicate that the client has a sodium level of 130 mEq/L. Which of the following actions should the nurse take?

Clarify the prescription with the provider

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

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).

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 therapy practically eliminates the risk for which of the following?

Creutzfeldt-Jakob disease

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

Deferoxamine

You should monitor a client throughout continuous heparin therapy for which of the following adverse reactions? (Select all that apply)

Fever Thrombocytopenia deep-vein thrombosis hypotension

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)

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

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 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?

Hgb

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

A client is about to start warfarin to prevent venous thrombosis. You should explain to the client that taking this drug initially requires daily blood samples to monitor the results of which of the following laboratory test?

PT/INT

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

Vitamin B12

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

You are caring for a client who is receiving alteplase to dissolve thrombus. Which of the following should you include in your care plan for this client? Select all that applies

a. Monitor temperature c.Limit venipunctures d. Assess neurologic status e. Applt pressure to oozing sites

Drag the drug in the left column to match it with it's therapeutic use in the right column

a. filgrastim chronic neutropenia b. folic acid megaloblastic anemia c.factor viii hemophilia A d. heparin DVT

A provider prescribes IV heparin for this client. Which of the following parameters should you monitor for in regard to determining if therapeutic dose is being administered?

aPTT, 1.5 to 2 times the client's baseline

A client is about to start taking liquid ferrous sulfate to treat iron deficiency anemia. Which of the following instructions you should include when talking to the client about this drug?

b. drink it with straw d. dilute it first with water e.take it with food if needed

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

constipation

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

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

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

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

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

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

peptic ulcer disease

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

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

While the patient is still receiving continuous IV heparin, the provider prescribes oral warfarin (Coumadin). This is because

warfarin takes 3 to 5 days to achieve therapeutic effects.

You are reviewing the history of a client who is about to start a therapy with factor viii to treat hemophilia A. Which of the following drugs the client takes should alert you in taking further action?

Aspirin

A nurse is caring for a client who is about to begin taking folic acid to treat megaloblastic anemia. The nurse should monitor which of the following laboratory 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.