Ch. 23, 31, 32 Study
A client on anticoagulant therapy is concerned about an upcoming trip. Which information should the nurse provide to this client?
"Short walks can be beneficial." When flying or taking long car rides, stopping for short walks can decrease venous stasis and prevent thrombus formation.
A client is diagnosed with a deep vein thrombosis (DVT). Which coagulation modifier should the nurse expect to be prescribed?
Antiplatelets and anticoagulants have the ability to prevent clot formation or clot enlargement. Antithrombin is a coagulation modifier used in clients with a high incidence of blood clots and DVTs.
A client has been taking atorvastatin (Lipitor) for 4 weeks. Which effect should the nurse expect?
Atorvastatin lowers triglycerides and decreases LDL and VLDL levels. It can also raise the level of "good" HDL cholesterol.
A client is receiving darbepoetin alfa (Aranesp) for anemia related to chemotherapy administration. Which finding should indicate to the nurse that the medication should be discontinued?
Darbepoetin alfa is a hematopoiesis-stimulating factor that is designed to increase RBC production in clients receiving chemotherapy. A hemoglobin level of 13.0 g/dL is within normal limits and the medication should be discontinued.
A client receives filgrastim (Neupogen) for neutropenia for several days. Which manifestation should the nurse report as a possible splenic rupture?
Filgrastim (Neupogen) is a colony-stimulating factor that is used to increase WBC count in clients with neutropenia. Filgrastim has been associated with splenomegaly and splenic rupture, which is manifested as upper abdominal or left shoulder pain.
A client is prescribed niacin as treatment for dyslipidemia. Which should the nurse include when teaching the client about this medication?
Niacin should be taken with cold water to decrease flushing. One aspirin should be taken 30 minutes before the niacin dose.
The nurse is teaching about different medications that stimulate platelet production. Which medication should be included?
Romiplostim (Nplate), oprelvekin (Neumega), and eltrombopag (Promacta) trigger platelet production.
A client on anticoagulant therapy is being evaluated. For which adverse effect should the nurse continue to assess throughout the client's anticoagulant therapy?
Tarry stools may signify bleeding from the gastrointestinal tract. Nosebleeds and abnormal bruising may indicate adverse effects from anticoagulants. Hematuria is another sign of abnormal bleeding.
A client comments that several friends are all taking statins. Which response should the nurse make?
"Statins are the first-line drug of choice for lipid disorders, which is why they are so commonly used."
A client asks which medication blocks the absorption of cholesterol from the small intestine. Which response should the nurse provide?
"The drug is called ezetimibe, or Zetia."
A client has no reduction in lipid levels after taking cholestyramine (Questran) for 4 weeks. Which response should the nurse make?
"The medication can sometimes take 30 days or more to be effective."
The nurse is discussing with a client the role of cholesterol in the body. Which statement should the nurse make that describes why dietary cholesterol contributes to development of atherosclerosis?
"While cholesterol is vital for several body processes, the body synthesizes most of what it needs, requiring little from the diet."
A client is taking oral anticoagulants. Which food rich in vitamin K should the nurse teach the client to avoid?
Kale, broccoli, and asparagus are all rich in vitamin K. Increase or decrease in intake of these foods can increase or decrease the effectiveness of oral anticoagulants.
The nurse is teaching a client with hyperlipidemia about dietary changes. Which food rich in omega-3 and coenzyme Q10 (CoQ10) should the nurse encourage the client to include in the diet?
Nuts, beef, sardines, and extra-virgin olive oil are rich sources of omega-3 or CoQ10 and should be included in the diet in clients with hyperlipidemia.
A client with a history of cardiovascular disease has a platelet count of 20,000 cells/mm3. Before administering oprelvekin (Neumega), which baseline assessment data should the nurse obtain?
A baseline weight should be obtained because the client has preexisting cardiovascular disease, and one adverse effect of this medication is fluid retention.
The nurse is reviewing the history of a 3-year-old client. Which data should the nurse understand indicates the need for targeted screening of lipid levels?
A positive family history of dyslipidemia-related cardiovascular disease would indicate the need for targeted screening prior to age 9 to 11 years for dyslipidemias.
The nurse is caring for a client recovering from a percutaneous coronary intervention (PCI). Which medication should the nurse anticipate being prescribed immediately after the procedure?
Abciximab (ReoPro) is a glycoprotein IIb/IIIa inhibitor used to decrease the likelihood of thrombolytic events in clients with acute coronary syndrome.
The nurse is teaching a client about the use of colony-stimulating factors in the treatment of neutropenia. Which information should the nurse include?
Activates existing white blood cells (WBCs), Increases the phagocytic effect of leukocytes, Increases production of leukocytes, They increase migration and bacterial response.
A client receiving chemotherapy has a WBC count of 2.0 cells/mm3. Which hematopoietic growth factor should the nurse expect to be prescribed since the client has limited transportation to receive medical care?
Because the client has a decreased WBC count and has limited opportunities for transportation for medical care, the nurse should expect pegfilgrastim (Neulasta) to be prescribed. This medication is administered as a one-time injection per chemotherapy cycle.
A client receiving heparin therapy for a pulmonary embolism asks how the medication works. Which information should the nurse include about the action of heparin?
Binds to antithrombin III to prevent fibrin clots from forming. Its immediate impact on coagulation is one reason that it is used in emergency situations such as stroke, myocardial infarction, and pulmonary embolism.
A client is suspected of having thrombocytopenia. For which health problem should the nurse assess this client?
Bone marrow suppression, Vitamin B12 deficiency, Liver failure, Folic acid deficiency. Thrombocytopenia can occur from any condition that affects liver function or bone marrow suppression. It is also caused by a folic acid and vitamin B12 deficiency.
A client is taking cholestyramine (Questran). Which laboratory value should the nurse expect to be decreased in this client?
Calcium, Potassium, Sodium
The nurse is planning a presentation about risk factors for decreased erythropoietin production. Which information should the nurse include?
Clients who are unable to produce enough erythropoietin are those with kidney disease and those receiving chemotherapy. It is occasionally prescribed for clients prior to blood transfusions or surgery, and to treat anemia in clients treated with zidovudine for human immunodeficiency virus (HIV) infection.
A client with acute coronary syndrome develops ST-elevation. Which medication should the nurse expect to reduce this client's risk of death?
Clopidogrel (Plavix) is used to reduce the risk of stroke, myocardial infarction, and death in clients with acute coronary syndrome. In clients with ST segment elevation, clopidogrel has been shown to reduce the risk of death, reinfarction, or stroke.
A client is receiving a statin and gemfibrozil (Lopid). For which increased risk should the nurse monitor the client?
Combining gemfibrozil (Lopid) with a statin increases the risk of rhabdomyolysis. It results from the death of muscle fibers and the release of their contents into the bloodstream.
The nurse prepares to administer a monthly injection of cyanocobalamin (vitamin B12) to an older client. Which assessment finding should be reported before administering the dose of medication?
Cyanocobalamin (vitamin B12) can cause sodium retention. Edema should be reported since this could indicate the development of heart failure.
A client demonstrates signs of a deep vein thrombosis (DVT). Which should the nurse suspect as a cause for this health problem?
DVT is often the result of estrogen replacement, either as hormone replacement therapy or due to contraceptives. Surgery, particularly replacement of the knee and hip, are associated with DVT development. Extended immobility encourages pooling of blood in the deep veins.
A 4-year-old child accidentally ingested several ferrous sulfate tablets. Which antidote should the nurse expect to be prescribed?
Deferoxamine is the antidote for iron intoxication.
The nurse is discussing the mechanism of action for a direct thrombin inhibitor. Which statement should the nurse include in the discussion?
Direct thrombin inhibitors bind reversibly to thrombin and prevent the formation of fibrin.
A client is prescribed a thrombolytic medication for a postoperative deep vein thrombosis. Which mechanism of action should the nurse recognize for this medication?
Dissolves clots that have formed. Thrombolytics promote fibrinolysis, the process in the body that limits clot formation and removes clots that are present. During this process, clots begin to dissolve and are removed.
The nurse is preparing to administer erythropoietin (Epogen) to a client with end-stage renal disease. Which laboratory value should the nurse assess?
Erythropoietin (Epogen) is a hematopoietic growth factor used in the treatment of anemia. Because it is used to stimulate RBC production, the RBC count and hemoglobin should be assessed before administering the dose.
A client receiving filgrastim (Neupogen) asks how many days the medication will be administered. Which information about the duration of therapy should the nurse provide in response?
Filgrastim (Neupogen) is a colony-stimulating factor used to increase WBC count in clients with neutropenia. The client should be instructed that the WBC count will be monitored and when it reaches a certain level, the injections will be discontinued. The medication is given to boost the immune system to prevent the development of an infection.
A client with a folic acid deficiency is instructed on ways to increase folic acid in the diet. Which food choice made by the client should indicate that teaching has been effective?
Fresh green vegetables, beans, and wheat products are high in folic acid. The choices of spinach, pinto beans, and whole-wheat toast indicate that teaching is effective.
Gemfibrozil (Lopid) is being considered for a client. For which preexisting condition should the nurse recognize the medication is contraindicated?
Gemfibrozil is contraindicated in clients with hepatic impairment, severe chronic kidney disease (CKD), pre-existing gallbladder disease, or those with prior hypersensitivity to the drug.
The nurse is teaching a community-based group about factors that contribute to the development of hyperlipidemia. Which information should the nurse include?
Genetics and lifestyle factors contribute to the development of hyperlipidemia.
The nurse is caring for a client with a postoperative hemorrhage. Which mechanism of action should the nurse consider when administering a hemostatic?
Hemostatics are also known as antifibrinolytics. They work to decrease bleeding time. All hemostatics prevent fibrin from dissolving, which strengthens the stability of the clot and prevents excessive bleeding.
The nurse is concerned that a client receiving heparin is at risk for heparin-induced thrombocytopenia. For which adverse reaction should the nurse observe?
Increase in thrombotic events caused by platelet aggregation.
The nurse is reviewing laboratory findings for a client. Which results should the nurse identify as characteristic of familial hypercholesterolemia?
Increased low-density lipoprotein (LDL) and cholesterol
A client with hyperlipidemia is being instructed on lifestyle changes to supplement medications. Which change should the nurse suggest to help reduce cholesterol?
Lifestyle changes to supplement drug therapy for hyperlipidemia include eliminating tobacco use, maintaining weight at an optimal level, reducing dietary saturated fats and cholesterol, and implementing a medically supervised exercise plan.
A client will be starting pharmacotherapy for hyperlipidemia. Which laboratory finding should the nurse evaluate?
Lipid profiles, creatine kinase, and liver function studies should be evaluated before a client starts pharmacotherapy for hyperlipidemia
A client with iron deficiency anemia is prescribed intravenous iron dextran. Which intervention should the nurse include in the plan of care?
Monitor for anaphylactic reaction.
The nurse is teaching a client with thrombocytopenia about normal platelet production. In which area should the nurse instruct the client that this process occurs?
Normal platelet production begins with the hormone thrombopoietin that is produced in the liver.
The nurse is providing a presentation about the use of platelet enhancers. Which disorder should the nurse discuss as benefiting from this treatment?
Platelet enhancers promote the production of platelets in clients with chemotherapy-induced thrombocytopenia and chronic immune idiopathic thrombocytopenia purpura.
A client experiences difficulty breathing, cough, and chest pain approximately 1 week after a total knee replacement. Which complication should the nurse consider?
Pulmonary embolism is a serious, life-threatening condition that can occur when a venous thrombus dislodges and travels to the pulmonary vessels.
A client receives oprelvekin (Neumega) for thrombocytopenia. Which finding should indicate to the nurse that the client is developing heart failure?
Since oprelvekin can worsen fluid overload in clients with a preexisting heart condition, signs of fluid overload such as edema, dyspnea, and weight gain must be reported to the healthcare provider.
A client is prescribed a statin. At which time should the nurse instruct the client to take the medication to have the optimal effects?
Statins should generally be taken in the evening to optimize impact during the night when most cholesterol biosynthesis takes place
A client is prescribed ferrous sulfate to treat iron-deficiency anemia. Which side effect of the medication should the nurse include when instructing the client?
The adverse effects of oral ferrous sulfate include nausea, vomiting, constipation, and black tarry stools.
A client taking a statin has an elevated creatine kinase level. Which medication change should the nurse expect?
The drug should immediately be discontinued.
A client receiving an intravenous infusion of a thrombolytic is prescribed an arterial blood gas. For which reason should the nurse use acute observation skills when obtaining this blood sample?
The major adverse effect associated with thrombolytic therapy is excessive bleeding. Invasive procedures into an artery are very likely to cause bleeding. After arterial blood gases, pressure should be maintained on the site for at least 30 minutes to prevent hemorrhage.
A client is receiving thrombolytic therapy. For which adverse reaction should the nurse assess this client?
The primary adverse reaction from thrombolytic therapy is bleeding. Signs and symptoms of bleeding include epistaxis, hemoptysis, hypotension, and vomiting coffee-ground emesis.
A client receiving pegfilgrastim (Neulasta) reports increased pain and redness of the foot joints. Which laboratory value should the nurse assess?
The redness and pain in the foot joints may indicate gout. The uric acid level should be assessed. This level can increase with the use of WBC colony-stimulating factors.
The nurse is teaching a female client about interactions that can occur while taking warfarin (Coumadin). Which content should the nurse include in the teaching session?
There are multiple drug-drug interactions associated with warfarin. The therapeutic index of warfarin is low, and drugs that interact with warfarin can impact coagulation times and result in client harm. Therefore, clients should check with the healthcare provider before taking over-the-counter drugs. Warfarin is a Pregnancy category X medication which is known to cause fetal abnormalities if taken during pregnancy. Any drug with anticoagulant properties should not be taken with warfarin. This includes aspirin, nonsteroidal anti-inflammatory drugs, or certain vitamins. Should the client experience any signs or symptoms of bleeding, the healthcare provider should be notified immediately.
A client receives filgrastim (Neupogen) for chemotherapy-induced neutropenia. Which location should the nurse instruct the client that bone pain may occur?
The colony-stimulating factors, such as filgrastim (Neupogen), stimulate bone marrow in the sternum, lower back, and posterior iliac crests to produce WBCs. These are the locations where the client should expect to experience bone pain.
A client with no previous history of a clotting disorder develops bruising on all extremities and nosebleeds. Which health problem should the nurse suspect is causing the client's symptoms?
Thrombocytopenia occurs when the platelet count decreases below the normal level. This is caused by a decrease in platelet production or an increase in platelet destruction.
A client is demonstrating signs of a bleeding disorder. Which laboratory test should the nurse expect to be prescribed to determine the reason for the client's symptoms?
To diagnose a bleeding disorder, laboratory tests measuring coagulation must be obtained. These may include platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT).
The nurse is counseling a client with hemophilia about medical procedures to ensure good health. Which procedure should the nurse discuss that can include the administration of aminocaproic acid (Amicar)?
Tooth extractions. Aminocaproic acid fills the binding sites on plasminogen and plasmin and prevents clots from dissolving. It is used for short-term management of bleeding after dental procedures in clients with hemophilia.
The nurse is reviewing a client's laboratory results. Which value should the nurse note as undesirable?
Total cholesterol of 220 mg/dL would be considered borderline high risk and undesirable.
A client receiving filgrastim (Neupogen) for chemotherapy-induced neutropenia has a WBC count of 120,000 cells/mm3. Which clinical manifestation should indicate to the nurse that the client is experiencing a serious adverse effect of this medication?
WBC counts higher than 100,000 cells/mm3 increase the risk of serious adverse effects, such as retinal or intracranial hemorrhage, respiratory failure, and myocardial infarction. Lethargy or decreased vision could indicate retinal or intracranial hemorrhage. Shortness of breath is a sign of respiratory failure.
The nurse is teaching a client starting medication for hyperlipidemia. Which follow-up action should the nurse instruct the client to do?
While receiving drug therapy for hyperlipidemia, the client should be instructed to return periodically for liver function studies and creatine kinase levels.
The nurse is asked about the process for selecting a statin. Which statement should the nurse make to describe this process?
"Generally, the experience of the healthcare provider and the individual client response guide selection."
