Pharmacology Ch 18 Drugs Affecting the Hematopoietic System *updated with current book questions*

A patient with breast cancer presents to the emergency department with deep vein thrombosis (DVT) in her right leg. She will require anticoagulation. Which regimen is most appropriate for this patient? 1. Low molecular weight heparin (LMWH) for 3 months 2. Warfarin for 3 months 3. Dabigatran for 3 months 4. Dabigatran for 6 months

1. Low molecular weight heparin (LMWH) for 3 months

Which of these is a potential side effect of ticlopidine? 1. Neutropenia 2. Tinnitus 3. Deep vein thrombosis 4. Constipation

1. Neutropenia

A patient taking clopidogrel is experiencing symptoms of gastroesophageal reflux disease (GERD) and requests medication. Which drug should be avoided in this situation? 1. Omeprazole 2. Calcium carbonate 3. Ranitidine 4. Famotidine

1. Omeprazole

Which of these best explains the need for iron supplementation in individuals with iron deficiency anemia? 1. Only about 1 to 2 mg/day of iron is absorbed from the average diet. 2. Iron rich foods are difficult to obtain. 3. Large amounts of iron are lost via the urinary tract in many adults, causing anemia. 4. Drug-drug interactions deceasing absorption of iron from food are very common.

1. Only about 1 to 2 mg/day of iron is absorbed from the average diet.

Interference of the effectiveness of factor Xa inhibitors such as rivaroxaban (Xarelto) can occur when given with some drugs. Which drug should be avoided when rivaroxaban is in use? 1. Phenytoin 2. Penicillin 3. Acetaminophen 4. Digitalis

1. Phenytoin

A patient with atrial fibrillation, as well as a prosthetic heart valve, is to be anticoagulated. Which is the optimal international normalized ratio (INR) range for this patient? 1. 2.5 to 3.5 2. 1.5 to 3.0 3. 2.0 to 3.0 4. 3.0 to 4.0

1. 2.5 to 3.5

When patients are started on darbepoetin alfa (Aranesp) they need monitoring of their blood counts to determine a dosage adjustment in: 1. 6 weeks if they are a cancer patient 2. 1 week if they have chronic renal failure 3. 2 weeks if they are taking it for allogenic transfusion 4. Each week throughout therapy

1. 6 weeks if they are a cancer patient

The APRN is planning to start anticoagulation with warfarin. The Institute for Clinical Systems Improvement (ICSI) recommends a lower initiation dose for some patients. Which patient should be considered for starting at a dose lower than 5 mg daily? 1. A 78-year-old man with atrial fibrillation 2. A 45-year-old woman with deep vein thrombosis (DVT) 3. A 46-year-old man with recurrent thromboembolism 4. A 50-year-old man with pulmonary emboli (PE)

1. A 78-year-old man with atrial fibrillation

In which patient with anemia might the APN suspect folic acid deficiency? 1. A patient taking phenytoin for a seizure disorder 2. A patient eating excessive amounts of raw, green, leafy vegetables. 3. A patient taking nitrofurantoin for a urinary tract infection 4. A patient with hypothyroidism

1. A patient taking phenytoin for a seizure disorder

A patient taking warfarin for treatment of deep vein thrombosis (DVT) presents to the clinic with a fungal infection requiring treatment with antifungal agent. The APN recognizes that there is an interaction between many antifungal agents and warfarin. Which action by the APN is most appropriate? 1. Adjust the dose of warfarin and monitor the patient's international normalized ratio (INR) more frequently while the patient is taking the new medication. 2. Increase the dose of warfarin to counteract the effects of the new medication. 3. Hold the warfarin until the patient completes the new medication. 4. Discontinue the warfarin and start a different anticoagulant for the time the patient is taking the antifungal medication.

1. Adjust the dose of warfarin and monitor the patient's international normalized ratio (INR) more frequently while the patient is taking the new medication.

When adjusting the dose of warfarin for a patient with a mechanical heart valve, how should the APN proceed? 1. Adjust the weekly dose up or down by 10% in most cases. 2. Adjust the weekly dose up or down by 15% in most cases. 3. Adjust the weekly dose up or down by 20% in most cases. 4. Adjust the weekly dose up or down by 5% in most cases.

1. Adjust the weekly dose up or down by 10% in most cases.

An elderly patient with a history of atrial fibrillation on dabigatran presents with gastrointestinal bleeding. The APN reviews the patient's current medications. Which medication is most likely to cause a significantly increased risk for bleeding when combined with dabigatran? 1. Aspirin taken for arthritis pain 2. Metoprolol taken for heart rate control 3. Hydrochlorothiazide taken to reduce blood pressure 4. Diltiazem used for heart rate control

1. Aspirin taken for arthritis pain

Which effect is reported with all types of hematopoietic growth factors? 1. Bone pain 2. Pruritus 3. Bronchospasm 4. Seizures

1. Bone pain

The APN is caring for a patient receiving intravenous heparin for treatment of pulmonary embolus. Which drug, when given concurrently, is associated with increased risk for bleeding? 1. Cefepime 2. Levofloxacin 3. Digitalis 4. Nitroglycerin

1. Cefepime

A patient presents with a transient ischemic attack (TIA) and needs long-term anticoagulation. He reports an allergy to aspirin. Which other medication is recommended by the American College of Chest Physicians (ACCP)? 1. Clopidogrel 75 mg daily 2. Warfarin daily 3. Dipyridamole 200 mg daily 4. Low molecular weight heparin

1. Clopidogrel 75 mg daily

Which agent is categorized as a direct thrombin inhibitor? 1. Dabigatran (Pradaxa) 2. Fondaparinux (Arixtra) 3. Rivaroxaban (Xarelto) 4. Low molecular weight heparin (LMWH)

1. Dabigatran (Pradaxa)

Patient education when prescribing clopidogrel includes: 1. Do not take any herbal products without discussing it with the provider. 2. Monitor urine output closely and contact the provider if it decreases. 3. Clopidogrel can be constipating, use a stool softener if needed. 4. The patient will need regular anticoagulant studies while on clopidogrel.

1. Do not take any herbal products without discussing it with the provider.

A patient is scheduled for elective surgery and wishes to donate her own blood prior to the procedure. Which medication is indicated to increase baseline hemoglobin prior to blood donation? 1. Epoetin alfa 2. Filgrastim (G-CSF) 3. Ferrous sulfate 4. Ferrous gluconate

1. Epoetin alfa

Which iron preparation is most effective for an otherwise healthy 24-year-old woman on a limited income with iron deficiency associated with menorrhagia? 1. Ferrous sulfate tablets 2. Sustained release ferrous gluconate tablets 3. Fer-In-Sol 4. Ferrous gluconate chewable tablets

1. Ferrous sulfate tablets

There is little risk associated with administration of epoetin alpha; however, monitoring is necessary to prevent complications. Which of these is a major adverse effect of epoetin alpha? 1. Hypertension 2. Fatigue 3. Dyspnea 4. Rash

1. Hypertension

A 5-year-old is brought to the emergency department after ingesting some supplements in her mother's medicine cabinet a few hours ago. The child is exhibiting nausea, vomiting, abdominal pain, and lethargy. The parent tells the APN that prior to coming to the hospital, the child had a black, tarry-looking stool. Which is the most likely cause of the child's symptoms? 1. Iron toxicity 2. Acute gastrointestinal bleeding caused by ingestion of the supplements 3. Folate toxicity 4. Vitamin B12 toxicity

1. Iron toxicity

Which condition is likely to increase a patient's response to warfarin? 1. Liver disease 2. Hypoglycemia 3. Hypothyroidism 4. Hypersensitivity to NSAIDs

1. Liver disease

Patients receiving heparin therapy require monitoring of: 1. Platelets every 2 to 3 days for thrombocytopenia that may occur on day 4 of therapy 2. Electrolytes for elevated potassium levels in the first 24 hours of therapy 3. INR throughout therapy to stay within the range of 2.0 4. Blood pressure for hypertension that may occur in the first 2 days of treatment

1. Platelets every 2 to 3 days for thrombocytopenia that may occur on day 4 of therapy

Monitoring for a patient being prescribed iron for iron deficiency anemia includes: 1. Reticulocyte count 1 week after therapy is started 2. Complete blood count every 2 weeks throughout therapy 3. Hemoglobin level at 1 week of therapy 4. INR weekly throughout therapy

1. Reticulocyte count 1 week after therapy is started

A cancer patient with a long-term implanted venous access device is being considered for anticoagulation. Which condition would exclude the patient from having any anticoagulant prescribed? 1. Stage 4 hypertension 2. Hyperkalemia 3. Renal insufficiency 4. Hypersensitivity to NSAIDs

1. Stage 4 hypertension

A patient receiving heparin for treatment of deep vein thrombosis (DVT) has an elevated activated partial thromboplastin time (aPTT) slightly over the therapeutic range. He has no evidence of bleeding. Which action is recommended to reduce risk for bleeding and achieve a therapeutic level? 1. Temporarily holding the drug and reducing the dose 2. Administering protamine sulfate 1 mg for every 100 units 3. Administering vitamin K 4. Administering platelets

1. Temporarily holding the drug and reducing the dose

The anticoagulation effects of warfarin (Coumadin) often do not occur for 3 to 4 days after initiating treatment. Which of these is the reason for this phenomenon? 1. The effects of warfarin are dependent on depletion of clotting factors. 2. Warfarin is not well absorbed from the gastrointestinal (GI) tract. 3. Metabolism of warfarin may be delayed in the presence of kidney disease. 4. Foods containing vitamin K interfere with absorption of warfarin from the gastrointestinal (GI) tract.

1. The effects of warfarin are dependent on depletion of clotting factors.

The APN is caring for a patient with anemia related to cancer chemotherapy who will be receiving darbepoetin alfa. How would the APN explain the medication administration schedule to the patient and family? 1. The injection will be given subcutaneously every 3 weeks. 2. The injection will be given three times each week. 3. The injection will be given every 2 weeks. 4. The injection will be given every 4 weeks.

1. The injection will be given subcutaneously every 3 weeks.

Which statement provides the best explanation for why NSAIDs are contraindicated when anticoagulants are prescribed? 1. There is inference with platelet aggregation. 2. There is direct inhibition of thrombin. 3. There is acceleration of antithrombin III. 4. There is inhibition of hepatic synthesis of clotting factors.

1. There is inference with platelet aggregation.

Which regimen is American College of Chest Physicians (ACCP)-recommended for prevention of myocardial infarction (MI) for a patient who has had acute coronary syndrome (ACS) and placement of a stent? 1. Ticagrelor (Brilinta) 90 mg twice daily and aspirin 75 to 100 mg daily 2. Clopidogrel (Plavix) 75 mg daily 3. Aspirin 100 mg daily 4. Warfarin with target international normalized ratio (INR) of 2.0 to 3.0

1. Ticagrelor (Brilinta) 90 mg twice daily and aspirin 75 to 100 mg daily

Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She also takes aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity for which she would need to be evaluated? 1. Tinnitus 2. Diarrhea 3. Hearing loss 4. Photosensitivity

1. Tinnitus

Which of these is a contraindication to the use of darbepoetin alfa and epoetin alfa in treatment of anemia associated with renal disease? 1. Uncontrolled hypertension 2. History of allergy to E. coli derived proteins 3. History of atopic dermatitis 4. Uncontrolled diabetes

1. Uncontrolled hypertension

Which drug is recommended for anticoagulation in a patient with a prosthetic heart valve? 1. Warfarin (Coumadin) 2. Low molecular weight heparin (LMWH) 3. Clopidogrel (Plavix) 4. Aspirin

1. Warfarin (Coumadin)

A patient is taking clopidogrel for its antiplatelet effect. Which medication is known to increase clopidogrel's effectiveness? 1. Cimetidine 2. Omeprazole 3. Vitamin K supplements 4. Aspirin

4. Aspirin

Which patient is at greatest risk for hypersensitivity to aspirin or NSAIDs? 1. A patient with moderately decreased platelet count 2. A patient with nasal polyps 3. A patient with hypersensitivity to penicillin 4. A patient with history of sensitivity to heparin

2. A patient with nasal polyps

Kenneth is taking warfarin and is asking about what he can take for minor aches and pains. The best recommendation is: 1. Ibuprofen 400 mg three times a day 2. Acetaminophen, not to exceed 4 grams per day 3. Prescribe acetaminophen with codeine 4. Aspirin 640 mg three times a day

2. Acetaminophen, not to exceed 4 grams per day

Robert, age 51 years, has been told by his primary care provider (PCP) to take an aspirin a day. Why would this be recommended? 1. He has arthritis and this will help with the inflammation and pain. 2. Aspirin has anti-platelet activity and prevents clots that cause heart attacks. 3. Aspirin acidifies the urine and he needs this for prostrate health. 4. He has a history of GI bleed, and one aspirin a day is a safe dosage.

2. Aspirin has anti-platelet activity and prevents clots that cause heart attacks.

Education of patients who are taking warfarin includes discussing their diet. Instructions include: 1. Avoiding all vitamin K-containing foods 2. Avoiding High vitamin K-containing foods 3. Increasing intake of iron-containing foods 4. Making sure they eat 35 grams of fiber daily

2. Avoiding High vitamin K-containing foods

Education of patients who are taking warfarin includes discussing their diet. Instructions include: 1. Avoiding all vitamin K-containing foods 2. Avoiding high-vitamin K-containing foods 3. Increasing intake of iron-containing foods 4. Making sure they eat 35 grams of fiber daily

2. Avoiding high-vitamin K-containing foods

Juanita had a deep vein thrombosis (DVT) and was on heparin in the hospital and was discharged on warfarin. She asks her primary care provider NP why she was getting both medications while in the hospital. The best response is to: 1. Contact the hospitalist as this is not the normal guideline for prescribing these two medications and she may have had a more complicated case. 2. Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness. 3. Encourage the patient to contact the Customer Service department at the hospital as this was most likely a medication error during her admission. 4. Draw anticoagulation studies to make sure she does not have dangerously high bleeding times.

2. Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness.

The first laboratory value indication that vitamin B12 therapy is adequately treating pernicious anemia is: 1. Hematocrit levels start to rise 2. Hemoglobin levels return to normal 3. Reticulocyte count begins to rise 4. Vitamin B12 levels return to normal

2. Hemoglobin levels return to norma

A 68-year-old man with Parkinson's disease is being treated for iron deficiency anemia following an upper gastrointestinal bleeding episode. His Parkinson's symptoms have been stable for the last few months, but he is now exhibiting increased rigidity and freezing. Which of these is the most likely explanation for the increase in symptoms? 1. Iron is required for effective functioning of the dopaminergic system. 2. Iron salts interfere with absorption levodopa. 3. Methyldopa levels are decreased when given concomitantly with iron. 4. The presence of anemia accounts for the symptoms, and they should improve with increases in the patient's hemoglobin and hematocrit levels within the next few weeks.

2. Iron salts interfere with absorption levodopa.

Jim is having a hip replacement surgery and would like to self-donate blood for the surgery. In addition to being prescribed epogen alpha he should also be prescribed: 1. Folic acid to prevent megaloblastic anemia 2. Iron, to start when the epogen starts 3. An antihypertensive to counter the adverse effects of epogen 4. Vitamin B12 to prevent pernicious anemia

2. Iron, to start when the epogen starts

Which of these might explain a failure to maintain a response to regular doses of epoetin alfa in a patient with chronic renal disease? 1. Iron supplementation 2. Occult blood loss 3. Folate supplementation 4. Discontinuation of an antacid containing aluminum

2. Occult blood loss

When writing a prescription for warfarin it is common to write _________ on the prescription. 1. OK to substitute for generic 2. The brand name of warfarin and Do Not Substitute 3. PRN refills 4. Refills for 1 year

2. The brand name of warfarin and Do Not Substitute

The FDA issued a safety announcement regarding the use of erythropoiesis-stimulating agents (ESAs) in 2010 with the recommendation that: 1. ESAs no longer be prescribed to patients with chronic renal failure 2. The risk of tumor development be explained to cancer patients on ESA therapy 3. Patients should no longer receive ESA therapy to prepare for allogenic transfusions 4. ESAs be prescribed only to patients younger than age 60 years

2. The risk of tumor development be explained to cancer patients on ESA therapy

A patient taking warfarin is having pain associated with an acute musculoskeletal injury. He asks the APN if he can take acetaminophen because he knows he should not take an NSAID for pain while on warfarin. Which response by the APN is most appropriate? 1. "Unfortunately, you can't take any analgesic drugs while taking warfarin." 2. "There is no problem when taking acetaminophen and warfarin." 3. "You can take the acetaminophen as needed, and then I will check your [international normalized ratio] INR in a few days to see if there is a change." 4. "The best medication to use is an opioid such as oxycodone."

3. "You can take the acetaminophen as needed, and then I will check your [international normalized ratio] INR in a few days to see if there is a change."

When would the APN expect to see an increase in reticulocytes after a patient with chronic renal failure begins treatment with epoetin alfa to treat anemia? 1. 2 to 3 days 2. 5 to 7 days 3. 7 to 10 days 4. 14 to 21 days

3. 7 to 10 days

Which statement about clopidogrel is most accurate? 1. Dose adjustment is always necessary in patients with renal insufficiency. 2. Dose adjustment is necessary in adults over 65 years of age. 3. Clopidogrel is contraindicated in patients with severe liver disease. 4. Clopidogrel is classified as Pregnancy Category D.

3. Clopidogrel is contraindicated in patients with severe liver disease.

The routine monitoring recommended for low molecular weight heparin is: 1. INR every 2 days until stable, then weekly 2. aPTT every week while on therapy 3. Factor Xa levels if the patient is pregnant 4. White blood cell count every 2 weeks

3. Factor Xa levels if the patient is pregnant

A 76-year-old patient with pernicious anemia is scheduled to begin treatment for his anemia and vitamin B12 deficiency. In addition to anemia, he has been experiencing paresthesia in his lower extremities and an unsteady gait. Which treatment regimen will the APRN anticipate providing for this patient? 1. Hydroxocobalamin 1000 mcg injection daily for 7 days, followed by 1000 mcg weekly for 1 month, followed by 1000 mcg monthly for 6 months 2. Hydroxocobalamin 1000 mcg injection, followed by 1000 mcg weekly for 1 month, followed by 1000 mcg monthly for 6 months 3. Hydroxocobalamin 1000 mcg injection daily for 7 days, followed by 1000 mcg weekly for 1 month, followed by 1000 mcg twice monthly for 6 months, then monthly for the rest of his life 4. Hydroxocobalamin 1000 mcg injection monthly for life

3. Hydroxocobalamin 1000 mcg injection daily for 7 days, followed by 1000 mcg weekly for 1 month, followed by 1000 mcg twice monthly for 6 months, then monthly for the rest of his life

Patients who are being treated with epoetin alfa need to be monitored for the development of: 1. Thrombocytopenia 2. Neutropenia 3. Hypertension 4. Gout

3. Hypertension

A 60-year-old male with a history of ongoing alcohol abuse disorder and an acute flare of gout needs treatment for megaloblastic anemia associated with vitamin B12 deficiency. Which is the most efficacious and cost-effective way to administer vitamin B12 to this patient? 1. Orally 2. Intravenously 3. Intramuscularly 4. Intranasally

3. Intramuscularly

Patient education regarding taking iron replacements includes: 1. Doubling the dose if they miss a dose to maintain therapeutic levels 2. Taking the iron with milk or crackers if it upsets their stomach 3. Iron is best taken on an empty stomach with juice 4. Antacids such as Tums may help the upset stomach caused by iron therapy

3. Iron is best taken on an empty stomach with juice

Patients who are beginning therapy with vitamin B12 need to be monitored for: 1. Hypertensive crisis that may occur in the first 36 hours 2. Hypokalemia that occurs in the first 48 hours 3. Leukopenia that occurs at 1 to 3 weeks of therapy 4. Thrombocytopenia that may occur at any time in therapy

3. Leukopenia that occurs at 1 to 3 weeks of therapy

The APN is caring for a patient who will be receiving epoetin alfa preoperatively to reduce the need for blood transfusion during the surgery. Which prescriptions will the patient need in addition to the one for the epoetin alfa? 1. An anticoagulant 2. Oral iron supplement 3. Oral iron supplement and anticoagulant 4. Folic acid

3. Oral iron supplement and anticoagulant

The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should be considered in which patients? 1. Pregnant women 2. Elderly men 3. Overweight or obese patients 4. Patients with multiple comorbidities

3. Overweight or obese patients

A 60-year-old female patient is being treated for pernicious anemia. In addition to anemia, she has neurologic symptoms associated with vitamin B12 deficiency. Which regimen is recommended for treatment in this situation? 1. Vitamin B12 injection 1,000 mcg weekly for 6 months 2. Vitamin B12 orally 1,000 mcg monthly indefinitely 3. Vitamin B12 1,000 mcg weekly for 1 month, then twice monthly for 6 months, and then monthly for life 4. Vitamin B12 injections twice monthly indefinitely

3. Vitamin B12 1,000 mcg weekly for 1 month, then twice monthly for 6 months, and then monthly for life

Cecil and his wife are traveling to Southeast Asia on vacation and he has come into the clinic to review his medications. He is healthy with only mild hypertension that is well controlled. He asks about getting "a shot" to prevent blood clots like his friend Ralph did before international travel. The correct respond would be: 1. Administer one dose of low-molecular weight heparin 24 hours before travel. 2. Prescribe one dose of warfarin to be taken the day of travel. 3. Consult with a hematologist regarding a treatment plan for Cecil. 4. Explain that Cecil is not at high risk of a blood clot and provide education about how to prevent blood clots while traveling.

4. Explain that Cecil is not at high risk of a blood clot and provide education about how to prevent blood clots while traveling.

The safest drug to use to treat pregnant women who require anticoagulant therapy is: 1. Low-molecular-weight heparin 2. Warfarin 3. Aspirin 4. Heparin

4. Heparin

For patients taking warfarin, INRs are best drawn: 1. Monthly throughout therapy 2. Three times a week throughout therapy 3. Two hours after the last dose of warfarin to get an accurate peak level 4. In the morning if the patient takes their warfarin at night

4. In the morning if the patient takes their warfarin at night

Patients with pernicious anemia require treatment with: 1. Iron 2. Folic acid 3. Epogen alpha 4. Vitamin B12

4. Vitamin B12