Pharmacology ATI Ch 25-27

A nurse is assessing a client who has chronic neutropenia and who has been receiving filgrastim. Which of the following actions should the nurse take to assess for an adverse effect of filgrastim? A. Assess for bone pain. B. Assess for right lower quadrant pain. C. Auscultate for crackles in the bases of the lungs. D. Auscultate the chest to listen for a heart murmur.

A. Bone pain is a dose-related adverse effect of filgrastim. It can be treated with acetaminophen and, if necessary, an opioid analgesic.

A nurse is preparing to administer a transfusion of 300 mL of pooled platelets for a client who has severe thrombocytopenia. The nurse should plan to administer the transfusion over which of the following time frames? A. Within 30 min/unit B. Within 60 min/unit C. Within 2 hr/unit D. Within 4 hr/unit

A. Platelets are fragile and should be administered quickly to reduce the risk of clumping. The nurse should administer the platelets within 15 to 30 min/unit.

A nurse is transfusing a unit of packed red blood cells (PRBCs) for a client who has anemia due to chemotherapy. The client reports a sudden headache and chills. The client's temperature is 2° F higher than her baseline. In addition to notifying the provider, which of the following actions should the nurse take? (Select all that apply.) A. Stop the transfusion. B. Place the client in an upright position with feet down. C. Remove the blood bag and tubing from the IV catheter. D. Obtain a urine specimen. E. Infuse dextrose 5% in water through the IV.

A --- The nurse should stop the transfusion for a rise in temperature of 2° F and reports of chills and fever. The client can be having a hemolytic reaction to the blood or a febrile reaction. C---The nurse should avoid infusing more PRBCs into the client's vein, and should remove the blood bag and tubing from the client's IV catheter. D---Obtaining a urine specimen to check for hemolysis is standard procedure when the client has a reaction to a blood transfusion.

A nurse is monitoring a client who is receiving epoetin alfa for adverse effects. The nurse should identify which of the following findings as an adverse effect of this medication? (Select all that apply) A. Leukocytosis B. Hypertension C. Edema D. Blurred vision E. Headache

B. Hypertension is an adverse effect of epoetin alfa that the nurse should monitor for throughout treatment. E. Headache is an adverse effect of epoetin alfa.

A nurse is preparing to transfuse a unit of packed red blood cells (PRBCs) for a client who has severe anemia. Which of the following interventions will prevent an acute hemolytic reaction? A. Ensure that the client has a patent IV line before obtaining blood product from the refrigerator. B. Obtain help from another nurse to confirm the correct client and blood product. C. Take a complete set of vital signs before beginning transfusion and periodically during the transfusion. D. Stay with the client for the first 15 to 30 min of the transfusion.

B. Identifying and matching the correct blood product with the correct client will prevent an acute hemolytic reaction from occurring because this reaction is caused by ABO or Rh incompatibility.

A nurse is planning to administer subcutaneous enoxaparin 40 mg using a prefilled syringe of enoxaparin 40 mg/0.4 mL to an adult client following hip arthroplasty. Which of the following actions should the nurse plan to take? A. Expel the air bubble from the prefilled syringe before injecting. B. Insert the needle completely into the client's tissue. C. Administer the injection in the client's thigh. D. Aspirate carefully after inserting the needle into the client's skin.

B. The nurse should inject the needle on the prefilled syringe completely when administering enoxaparin in order to administer the medication by deep subcutaneous injection.

3. A nurse is planning to administer IV alteplase to a client who is demonstrating manifestations of a massive pulmonary embolism. Which of the following interventions should the nurse plan to take? A. Administer IM enoxaparin along with the alteplase dose. B. Hold direct pressure on puncture sites for up to 30 min. C. Administer aminocaproic acid IV prior to alteplase infusion. D. Prepare to administer alteplase within 8 hr of manifestation onset.

B. The nurse should plan to hold direct pressure on puncture sites for 10 to 30 min or until oozing of blood stops.

A nurse is monitoring a client who takes aspirin 81 mg PO daily. The nurse should identify which of the following manifestations as adverse effects of daily aspirin therapy? (Select all that apply.) A. Hypertension B. Coffee-ground emesis C. Tinnitus D. Paresthesias of the extremities E. Nausea

B. CORRECT: GI bleeding with dark stools or coffee-ground emesis can be an adverse effect of aspirin therapy. C. CORRECT: Tinnitus and hearing loss can occur as an adverse effect of aspirin therapy D. Paresthesias of the extremities are not adverse effects of aspirin therapy. E. CORRECT: Nausea, vomiting, and abdominal pain can occur as a result of aspirin therapy.

4. A nurse is caring for a hospitalized client who has an activated partial thromboplastin time (aPTT) greater than 1.5 times the expected reference range. Which of the following blood products should the nurse prepare to transfuse? A. Whole blood B. Platelets C. Fresh frozen plasma D. Packed red blood cells

C Fresh frozen plasma is indicated for a client who has an elevated aPTT because it replaces coagulation factors and can help prevent bleeding.

A nurse is assessing a client during transfusion of a unit of whole blood. The client develops a cough, shortness of breath, elevated blood pressure, and distended neck veins. The nurse should anticipate a prescription for which of the following medications? A. Epinephrine B. Lorazepam C. Furosemide D. Diphenhydramine

C. Furosemide, a loop diuretic, may be prescribed to relieve manifestations of circulatory overload.

5. A nurse is caring for a client who has atrial fibrillation and a new prescription for dabigatran to prevent development of thrombosis. Which of the following medications is prescribed concurrently to treat an adverse effect of dabigatran? A. Vitamin K1 B. Protamine C. Omeprazole D. Probenecid

C. Omeprazole or another proton pump inhibitor is prescribed for a client who is taking dabigatran and has abdominal pain and other GI findings that can occur as adverse effects of dabigatran. The nurse should advise the client who has GI effects to take dabigatran with food.

A nurse is caring for a hospitalized client who is receiving IV heparin for a deep-vein thrombosis. The client begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer? A. Vitamin K1 B. Atropine C. Protamine D. Calcium gluconate

C. Protamine reverses the anticoagulant effect of heparin.

A nurse is caring for a client who is receiving daily doses of oprelvekin. Which of the following laboratory values should the nurse monitor to determine effectiveness of this medication? A. Hemoglobin B. Absolute neutrophil count C. Platelet count D. Total white blood count

C. The expected outcome for oprelvekin is a platelet count greater than 50,000/mm3.

A nurse is preparing to administer filgrastim for the first time to a client who has just undergone a bone marrow transplant. Which of the following interventions is appropriate? A. Administer IM in a large muscle mass to prevent injury. B. Ensure that the medication is refrigerated until just prior to administration. C. Shake vial gently to mix well before withdrawing dose. D. Discard vial after removing one dose of the medication.

D. Only one dose of filgrastim should be withdrawn from the vial and the vial should then be discarded.