NCLEX REVIEW Pharmacology: Hematological Medications

The nurse is evaluating the results of laboratory studies for a client receiving epoetin alfa (Epogen, Procrit). When should the nurse expect to note a therapeutic effect of this medication? 1. Immediately 2. 3 days after therapy 3. 2 weeks after therapy 4. After 1 week of therapy

3. 2 weeks after therapy 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.

The nurse is reviewing the laboratory results for a client who arrives at the health care clinic for follow-up assessment after insertion of a mechanical prosthetic heart valve. The international normalized ratio (INR) is analyzed because the client has been taking warfarin sodium (Coumadin) 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. 2.0 2. 2.3 3. 3.0 4. 5.0

3. 3.0 The recommended INR range for oral anticoagulant therapy is 2.0 to 3.0, but this value may vary with the goals of therapy. A recommended INR range with mechanical prosthetic heart valve is 2.5 to 3.5, and for those who experienced acute myocardial infarction, 2.5 to 3.5.

Epoetin alfa (Epogen, Procrit) by the subcutaneous route is prescribed for a client. Which is the correct action for the nurse to implement? 1. Shake the vial before use. 2. Freeze the medication before use. 3. Refrigerate the medication until used. 4. Obtain syringes with 1½-inch needles from the pharmacy.

3. Refrigerate the medication until used. Epoetin alfa (Epogen, Procrit) should be refrigerated at all times. The bottle should not be shaken and the medication should not be frozen because this will affect the chemical composition. Syringes with a 5/6-inch needle are used for subcutaneous injection. A 1½-inch needle may be used for intramuscular injection.

A client is being discharged to home with enoxaparin (Lovenox) for short-term therapy. What should the nurse explain to the family about the medication action? 1. Relieves joint pain 2. Dissolves urinary calculi 3. Stops progression of multiple sclerosis 4. Reduces the risk of deep vein thrombosis

4. Reduces the risk of deep vein thrombosis Enoxaparin is an anticoagulant that is administered to prevent deep vein thrombosis and thromboembolism in clients at risk. It is not used to treat the conditions listed in options 1, 2, or 3.

A client having a myocardial infarction is receiving alteplase (Activase) therapy. Which action should be carried out by the nurse to monitor for the most frequent adverse effect? 1. Check for signs of bleeding. 2. Assess for allergic reaction. 3. Evaluate the client for muscle weakness. 4. Monitor for signs and symptoms of infection.

1. Check for signs of bleeding. Alteplase is a thrombolytic medication, which means that it breaks down or dissolves clots; therefore bleeding is a concern. Allergic reaction is not a frequent response. Muscle weakness is not an adverse effect of this medication. Local or systemic infection could occur with poor aseptic technique during medication administration, but it is rare.

A client is receiving heparin sodium by continuous intravenous (IV) infusion. The nurse should notify the health care provider if ongoing nursing assessment reveals which finding? 1. Tinnitus 2. Ecchymoses 3. Increased pulse rate 4. Increased blood pressure

2. Ecchymoses The client who receives a continuous IV infusion of heparin is at risk for bleeding. The nurse assesses for signs of bleeding, which include bleeding from the gums, ecchymoses on the skin, cloudy or pink-tinged urine, tarry stools, and body fluids that test positive for occult blood. The other options are not side or adverse effects related to this medication.

A client receiving heparin sodium by continuous intravenous (IV) infusion removes the tubing from the pump to change his hospital gown. The nurse is concerned that the client received a bolus of medication. After requesting a prescription for a stat partial thromboplastin time (PTT), the nurse should check for availability of which medication in the medication cart? 1. Vitamin K 2. Protamine sulfate 3. Enoxaparin (Lovenox) 4. Aminocaproic acid (Amicar)

2. Protamine sulfate If the tubing is removed from an IV pump and the tubing is not clamped, the client will receive a bolus of the solution and the medication contained in the solution. The client who receives a bolus dose of heparin is at risk for bleeding. If the results of the next PTT are extremely high, a dose of protamine sulfate, the antidote for heparin, may be prescribed. Enoxaparin is an anticoagulant. Vitamin K is the antidote for warfarin sodium (Coumadin). Aminocaproic acid is an antithrombolytic (inhibits clot breakdown).

A nurse provides dietary instructions to a client who will be taking warfarin sodium (Coumadin). The nurse should tell the client to avoid which food item? 1. Grapes 2. Spinach 3. Watermelon 4. Cottage cheese

2. Spinach Warfarin sodium is an anticoagulant. Anticoagulant medications act by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K often are omitted from the diet. Vitamin K-rich foods include green leafy vegetables, fish, liver, coffee, and tea.

A home care nurse is preparing to administer filgrastim (Neupogen) to a client. The nurse plans to administer the medication by which route? 1. Oral 2. Subcutaneous 3. Intramuscular 4. Intravenous bolus

2. Subcutaneous Filgrastim (Neupogen) is a granulocyte colony-stimulating factor produced by human recombinant DNA technology. It is given by subcutaneous injection or continuous intravenous infusion.

The nurse provides instructions to a client who has a prescription for ticlopidine (Ticlid). Which statement, if made by the client, indicates a need for further teaching? 1. "I'll take my medicine with meals." 2. "Blood work will be done every 2 weeks for the first 3 months." 3. "I should not stop the medication without talking to my health care provider (HCP) first." 4. "Food will affect the medication, so I need to take the medication on an empty stomach."

4. "Food will affect the medication, so I need to take the medication on an empty stomach." Ticlopidine is an antiplatelet agent that is used for the prevention of thrombotic stroke. Ticlopidine is best tolerated when taken with meals. Blood work is monitored closely, particularly in early therapy, because the medication can cause neutropenia. A client should not stop medication without the HCP's permission.

The home care nurse is making a monthly visit to a client with a diagnosis of pernicious anemia who has been receiving a monthly injection of cyanocobalamin (vitamin B12). Before administering the injection, the nurse evaluates the effects of the medication and determines that a therapeutic effect is occurring if the client makes which statement? 1. "I feel really lightheaded." 2. "I no longer have any nausea." 3. "I have not had any pain in a month." 4. "I feel stronger and have a much better appetite."

4. "I feel stronger and have a much better appetite." Cyanocobalamin is essential for DNA synthesis. It can take up to 3 years for the vitamin B12 stores to be depleted and for symptoms of pernicious anemia to appear. Symptoms can include weakness, fatigue, anorexia, loss of taste, and diarrhea. To correct deficiencies, a crystalline form of vitamin B12, cyanocobalamin, can be given intramuscularly. The client statements in options 1, 2, and 3 do not identify a therapeutic effect of the medication.

The nurse is providing instructions to the parent of a child with iron deficiency anemia about the administration of a liquid oral iron supplement. Which statement, if made by the parent, indicates an understanding of the administration of this medication? 1. "I should give the iron with food." 2. "I can mix the iron with cereal to give it." 3. "I should add the iron to the formula in the baby's bottle." 4. "I should use a medicine dropper and place the iron near the back of the throat."

4. "I should use a medicine dropper and place the iron near the back of the throat." An oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth because it will stain the teeth. The parents should be instructed to brush or wipe the teeth after administration. Iron is administered between meals because absorption is decreased if there is food in the stomach. Iron requires an acidic environment to facilitate its absorption in the duodenum.

The nurse has given the client with atrial fibrillation instructions to take one aspirin daily. The client says to the nurse, "Why do I need to take this? I don't get any pain with my heart rhythm." The nurse should make which response? 1. "This will keep you from experiencing chest pain." 2. "This will most likely keep you from ever having a heart attack." 3. "This will prevent any inflammation from occurring on the walls of your heart." 4. "This will help prevent clot formation in your heart as a result of your heart's rhythm."

4. "This will help prevent clot formation in your heart as a result of your heart's rhythm." Atrial fibrillation puts the client at risk for mural thrombi because of the sluggish blood flow through the atria that occurs as a result of loss of the atrial kick. In atrial fibrillation, the health care provider may prescribe a daily aspirin. This will prevent clot formation along the walls of the atria and resultant embolus. Aspirin will not prevent chest pain or keep a client from ever having a heart attack. Although aspirin does have anti-inflammatory properties, it cannot prevent any inflammation from occurring, as stated in option 3.

A client who is due for a dose of warfarin (Coumadin) has a prothrombin time (PT) of 28 seconds. After analyzing this test result, what should the nurse do? 1. Give double the dose. 2. Administer the next dose. 3. Give half of the next dose. 4. Call the health care provider (HCP).

4. Call the health care provider (HCP). The PT is one test that may be used to monitor warfarin therapy. The international normalized ratio is another laboratory test used to monitor warfarin therapy. A PT of 28 seconds represents an elevated value. The therapeutic PT for a client receiving warfarin is 1.5 times the normal PT (9.5 to 11.5 seconds). The nurse should withhold the next dose and notify the HCP. A medication dose should not be changed without a specific prescription (options 1 and 3).

The nurse has a prescription to give heparin sodium 5000 units subcutaneously. The nurse should plan to take which action to administer this medication? 1. Inject via an infusion device. 2. Inject ½ inch from the umbilicus. 3. Massage the injection site after administration. 4. Change the needle after withdrawing the medication from the vial.

4. Change the needle after withdrawing the medication from the vial. After heparin sodium is drawn up from the vial, the needle is changed before injection to prevent contact of the medication with tissue along the needle track. Heparin sodium administered subcutaneously does not require an infusion device and is injected at least 2 inches from the umbilicus or any scar tissue. The needle is withdrawn rapidly, and the site is not massaged (although pressure is applied).

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

4. Constipation Feosol is an iron supplement used to treat anemia. Constipation is a frequent and uncomfortable side effect associated with the administration of oral iron supplements. Stool softeners often are prescribed to prevent constipation. Options 1, 2, and 3 are not side effects associated with this medication.

A client is prescribed a liquid iron preparation that has the potential to stain the teeth. The nurse should 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.

4. 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.

The nurse is preparing to administer filgrastim (Neupogen) by intravenous (IV) infusion. Which nursing action is appropriate for administering this medication? 1. Shake the solution before drawing it up. 2. Dilute the medication in normal (0.9%) saline. 3. Discard the medication if it has been refrigerated. 4. Dilute the medication in 5% dextrose in water (D5W).

4. Dilute the medication in 5% dextrose in water (D5W). Filgrastim (Neupogen) may be administered by continuous IV infusion. It is diluted only with D5W when administered by the IV route. The solution should not be shaken. It should be stored in a refrigerator and should be discarded if it has been exposed to room temperature for more than 6 hours.

The nurse is monitoring a client who is receiving epoetin alfa (Epogen, Procrit) for adverse effects of the medication. Which finding indicates an adverse effect? 1. Diarrhea 2. Depression 3. Bradycardia 4. Hypertension

4. Hypertension Epoetin alfa generally is well tolerated. The most significant adverse effect is hypertension. Occasionally a tachycardia may occur as a side effect. This medication also may cause an improved sense of well-being.

The client in chronic kidney disease is receiving epoetin alfa (Epogen). The nurse should monitor this client for which adverse effect of this medication? 1. Fever 2. Depression 3. Bradycardia 4. Hypertension

4. Hypertension Epoetin alfa (Epogen) is generally well tolerated, although hypertension can occur and is the most significant adverse effect. Occasionally, tachycardia may also occur. It may also cause an improved sense of well-being. Fever, depression, and bradycardia are not adverse effects.

The nurse is reviewing the laboratory test results for a client who is receiving filgrastim (Neupogen). Which reported value would indicate an effective response to this medication? 1. Hematocrit of 42% 2. Blood glucose level of 120 mg/dL 3. Platelet count of 150,000 cells/mm3 4. Neutrophil count of 10,000 cells/mm3

4. Neutrophil count of 10,000 cells/mm3 Filgrastim (Neupogen) is used to promote the growth of neutrophils and enhance the function of mature neutrophils. Treatment is continued until the absolute neutrophil count reaches 10,000 cells/mm3. Options 1, 2, and 3 are unrelated to the action of this medication.

A decision has just been made to give tissue plasminogen activator (t-PA) (Activase) to a client. The nurse should obtain which supply for standard use as part of safe nursing care related to this medication? 1. Flashlight 2. Pulse oximeter 3. Suction equipment 4. Occult blood test strips

4. Occult blood test strips Activase is a thrombolytic medication that dissolves thrombi or emboli. Bleeding is a frequent and potentially severe adverse effect of therapy. The nurse assesses for signs of bleeding in clients receiving this therapy using occult blood test strips to test urine, stool, or nasogastric drainage. A flashlight is used for pupil assessment as part of the neurological examination in the client who is neurologically impaired. Pulse oximeter and suction equipment would be needed if the client had evidence of oxygenation or respiratory problems.

The nurse is preparing to administer filgrastim (Neupogen) to a client with a diagnosis of agranulocytosis. The client asks the nurse about the purpose of the medication. The nurse explains that this medication will have which action? 1. Prevent bleeding. 2. Prolong the clotting time. 3. Increase the red blood cell count. 4. Promote the growth of neutrophils.

4. Promote the growth of neutrophils. Filgrastim is a granulocyte colony-stimulating factor produced by human recombinant DNA. It is administered to clients with agranulocytosis to promote the growth of neutrophils and enhance the function of mature neutrophils. Options 1, 2, and 3 are not actions of this medication.

Enoxaparin sodium (Lovenox) is prescribed for a client after hip replacement surgery. What should the nurse prepare to have available in the event that an overdose of the medication occurs? 1. Adrenalin 2. Vitamin K 3. Epinephrine 4. Protamine sulfate

4. Protamine sulfate Enoxaparin sodium is an anticoagulant. Accidental overdose of this medication may lead to bleeding complications. The antidote is protamine sulfate. Adrenalin is a trademarked preparation of epinephrine, which normally is used to treat hypersensitivity reactions or acute bronchial asthma attacks and bronchospasms. Vitamin K is the antidote for warfarin sodium (Coumadin).

Ticlopidine (Ticlid) is prescribed for a client. The nurse plans to take which action before implementing this medication therapy? 1. Taking the client's blood pressure 2. Obtaining a prothrombin time (PT) 3. Taking the client's apical heart rate 4. Reviewing the results of the complete blood cell (CBC) count

4. Reviewing the results of the complete blood cell (CBC) count Ticlopidine is an antiplatelet agent that is used for the prevention of thrombotic stroke. Ticlopidine is best tolerated when taken with meals. Blood work is monitored closely, particularly in early therapy, because the medication can cause neutropenia. A client should not stop medication without the HCP's permission.

A client has a prescription to receive enoxaparin (Lovenox). The nurse should plan to administer this medication by which route? 1. Oral 2. Intravenous 3. Intramuscular 4. Subcutaneous

4. Subcutaneous Enoxaparin is an anticoagulant that is administered by the subcutaneous route. It is used in preventing thromboembolism in selected clients at risk. It also may be administered by the client at home after hospital discharge with follow-up assessments by a home health nurse. It is not administered orally nor by the intravenous or intramuscular routes.

Epoetin alfa (Epogen, Procrit) has been prescribed for a client with chronic kidney disease who is being cared for by a nursing student. The nursing instructor determines that the student understands the procedure for administering the medication when the student states that which route of administration is acceptable? 1. Oral 2. Z-track 3. Intramuscular 4. Subcutaneous

4. Subcutaneous 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.

A nurse has a prescription to administer a dose of iron by a parenteral route to an assigned client. Which would the nurse implement to administer this medication correctly via the intramuscular route? Select all that apply. 1. Use a Z-track method. 2. Administer the medication only in the deltoid. 3. Aspirate for blood after the needle is inserted. 4. Use an air lock when drawing up the medication. 5. Change the needle after drawing up the dose and before injection. 6. Massage the injection site well after injection to hasten absorption.

1, 3, 4 ,5 An air lock and a Z-track technique should both be used when administering iron by the intramuscular route. Proper technique includes changing the needle after drawing up the medication but before giving it to prevent staining of skin. The dorsogluteal site should be used only after proper identification of appropriate landmarks. After the needle is inserted, the nurse should aspirate for the presence of blood and should proceed with the administration if no blood is aspirated. The site should not be massaged after injection because massaging could cause staining of the skin.

A nurse has provided discharge instructions to a client being placed on long-term anticoagulant therapy with warfarin (Coumadin). Adequate learning would be evident if the client makes which statements? Select all that apply. 1. "I will inform my dentist that I am taking Coumadin." 2. "I may take over-the-counter medications as needed." 3. "I should alternate the timing of my daily dose of Coumadin." 4. "I should use a firm-bristled toothbrush to prevent the side effects of Coumadin." 5. "I will have my blood levels checked as prescribed by my health care provider (HCP)." 6. "I will report any signs of blood in my urine or stool to my health care provider (HCP)."

1, 5, 6 Clients need to notify all health care providers that they are on warfarin (Coumadin) therapy. Dental procedures may put the client at risk for increased bleeding, so this should direct you to option 1. Knowing that the effectiveness of warfarin is based on maintaining a therapeutic blood level will direct you to select option 5. Awareness of bleeding as a primary complication will direct you to option 6.

Ticlopidine (Ticlid) has been prescribed for a client with a diagnosis of thrombotic stroke. The nurse provides instructions to the client and spouse regarding the medication. Which statement, if made by the client, indicates that the client understands the use of this medication? 1. "I'll take the medicine with meals." 2. "If I do not feel well, I should skip the medication." 3. "I won't have another stroke if I take this medicine faithfully." 4. "If I have any gastrointestinal side effects, I should call the health care provider (HCP)."

1. "I'll take the medicine with meals." Ticlopidine is an antiplatelet agent that is used to assist in preventing a thrombotic stroke. Ticlopidine is best tolerated when taken with meals. The most common adverse effects are gastrointestinal (GI) disturbances. Taking ticlopidine with meals tends to lessen those effects. It is not necessary to contact the HCP if GI upset occurs. The client should not skip medications. The medication is used to prevent strokes but does not guarantee that a stroke will not occur.

The nurse is providing discharge instructions to a client taking warfarin sodium (Coumadin). Which statement, based on health care provider (HCP) permission, is appropriate to include in client teaching for this medication? 1. "Tylenol, rather than aspirin, needs to be taken for headache." 2. "Alcohol can be consumed so long as it is in small amounts." 3. "It doesn't matter what time the daily dose is taken so long as it is taken each day." 4. "It is all right to take over-the-counter medications so long as they do not contain vitamin K."

1. "Tylenol, rather than aspirin, needs to be taken for headache." Warfarin sodium is an anticoagulant that prevents further extension of formed existing clots and also prevents new clot formation and secondary thromboembolic complications. Because the medication places the client at risk for bleeding, the client is instructed to avoid salicylates (acetylsalicylic acid, or aspirin) and alcohol. The medication should be taken exactly as prescribed and at the same time daily. The client needs to avoid all over-the-counter medications and needs to consult with the HCP before taking any other medications because of the risk for medication interactions.

A health care provider in the emergency department prescribes a thrombolytic medication for a client with an acute ischemic stroke. His wife asks the nurse how the medication works. How should the nurse respond about how the medication will work? 1. Dissolve clots. 2. Prevent ischemia. 3. Prevent bleeding. 4. Decrease the client's anxiety.

1. Dissolve clots. Thrombolytic medications are used to treat acute thrombolytic disorders. These medications dissolve clots. Because these medications alter the hemostatic capability of the client, any bleeding that does occur can be difficult to control. Options 2, 3, and 4 are not actions of this medication.

The nurse is reviewing the health care provider's (HCP) prescriptions for a client recently admitted to the hospital and notes that the HCP has prescribed ticlopidine (Ticlid) therapy. Which finding, if noted on the client's record, would indicate a need to contact the HCP before initiating the medication prescription? 1. Neutropenia 2. Client history of stroke 3. Client history of hypertension 4. Complaints of gastrointestinal disturbances

1. Neutropenia Neutropenia, or agranulocytosis, is the most serious adverse effect associated with the use of ticlopidine. A baseline complete blood cell (CBC) count with differential will be performed for the client. Neutropenia occurs most often within the first 3 months of therapy; therefore a CBC with differential is recommended every 2 weeks during the first 3 months. If a diagnosis of neutropenia is determined, the client will be withdrawn from therapy. This medication is used to prevent a stroke and is not contraindicated in hypertension. Gastrointestinal disturbances can occur as a result of taking the medication, and the client is instructed to take the medication with food to minimize these side effects.

In a client receiving heparin, which laboratory finding should be the cause for greatest concern? 1. Platelet count of 100,000 cells/mm3 2. International normalized ratio of 1.2 3. Red blood cell count of 4.2 million cells/mm3 4. Activated partial thromboplastin time (aPTT) of 60 seconds

1. Platelet count of 100,000 cells/mm3 he platelet count indicates that the client receiving heparin is at risk for heparin-induced thrombocytopenia (HIT). HIT should be suspected whenever platelet counts fall below normal. If severe thrombocytopenia develops (platelet count less than 100,000 cells/mm3), heparin should be discontinued. The aPTT in option 4 represents an expected finding for heparin therapy. Option 2 is not a value measured for heparin therapy but is used to measure a response to warfarin (Coumadin) therapy, and the red blood cell count in option 3 is normal.

The nurse medicates a client with phytonadione (vitamin K). The nurse should assess which laboratory value 24 hours after administering vitamin K? 1. Prothrombin time 2. Blood ammonia level 3. Direct serum bilirubin 4. Serum potassium level

1. Prothrombin time Vitamin K is needed for adequate blood clotting. Therefore checking the prothrombin time is necessary 24 hours after injection of vitamin K. Blood ammonia levels are assessed to determine the conversion of ammonia to urea that normally occurs in the liver. Bilirubin is a measurement of the ability of the liver to conjugate and excrete bilirubin. Serum potassium is an electrolyte and is not affected by the injection of vitamin K.

A client is admitted to the hospital emergency department with an acute anterior wall myocardial infarction. The nurse discusses streptokinase (Streptase) therapy with the client and spouse. The spouse is concerned about the dangers of this treatment. Which statement by the nurse is appropriate? 1. "There is no reason to worry. We use this medication all the time." 2. "I'm certain you made the correct decision to use this medication." 3. "You have concerns about whether this treatment is the best option." 4. "Your loved one is very ill. The health care provider has made the best decision for you."

3. "You have concerns about whether this treatment is the best option." Paraphrasing is restating the client's or family members' own words. This allows the client and family members to express their concerns and talk through the decisions that have been made. Option 1 is offering false reassurance. In option 2, the nurse is expressing approval, which can be harmful to the client-nurse or family-nurse relationship. Option 4 represents a communication block that denies the client's right to an opinion.

A client with chronic kidney disease was started on epoetin alfa (Epogen, Procrit) 2 months earlier. In evaluating the therapeutic effectiveness of the medication, the nurse should expect the client to exhibit which finding? 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 levels

3. An increase in serum hematocrit Epoetin alfa stimulates red blood cell production. Initial effects should be seen within 1 to 2 weeks, and the hematocrit reaches normal levels (30% to 33%) in 2 to 3 months.

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

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

A client is admitted to the hospital with a diagnosis of myocardial infarction (MI). The client is started on streptokinase (Streptase) therapy. The nurse determines that teaching has been effective when the client's wife states that the purpose of the medication is to perform which action? 1. Thin the blood. 2. Slow the clotting of the blood. 3. Dissolve any clots in the coronary arteries. 4. Prevent further clots from forming in the coronary arteries.

3. Dissolve any clots in the coronary arteries. Streptokinase converts plasminogen in the blood to plasmin. Plasmin is an enzyme that digests or dissolves fibrin clots wherever they exist. Heparin sodium and warfarin sodium (Coumadin) thin the blood, slow clotting, and prevent further clots from forming.

A client admitted to the hospital with a diagnosis of myocardial infarction is about to be started on alteplase (Activase), also known as tissue plasminogen activator (TPA). In reinforcing health care provider explanations of the medication, what should the nurse tell the client and his wife that this medication will do? 1. Slow the clotting of the blood. 2. Keep the blood thin to prevent clotting. 3. Dissolve any clots that are obstructing the coronary arteries. 4. Prevent any further clots from forming anywhere in the body.

3. Dissolve any clots that are obstructing the coronary arteries. Alteplase is a thrombolytic medication that is used to manage acute myocardial infarction. It lyses thrombi that are obstructing the coronary arteries, decreases infarct size, improves ventricular function, decreases the risk of heart failure, and limits the risk of death associated with myocardial infarction. Options 1, 2, and 4 are not actions of this medication.

A client is diagnosed with iron deficiency anemia, and ferrous sulfate (Feosol) is prescribed. The nurse should 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

3. Tomato juice 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 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.

When administering a subcutaneous injection of heparin sodium, the nurse should perform which action? 1. Apply heat after the injection. 2. Use a 21- to 23-gauge, 1-inch needle. 3. Use a 25- to 26-gauge, ⅝-inch needle. 4. Aspirate before injection of the medication.

3. Use a 25- to 26-gauge, ⅝-inch needle. For subcutaneous heparin sodium injection, a 25- to 26-gauge, ⅜- to ⅝-inch needle is used to prevent tissue trauma and inadvertent intramuscular injection. The application of heat may affect the absorption of the heparin and cause bleeding. A 1-inch needle would inject the heparin sodium into the muscle. Aspiration before injection is incorrect technique with heparin administration because it could cause bleeding in the tissues.

The nurse is providing dietary instructions to the client with anemia. The client tells the nurse that the iron pills are very expensive and 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?"

4. "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. The nurse offers help in a nonthreatening manner that will allow the client to accept or decline. Option 2 is incorrect because the client needs to consume a proper diet. Options 1 and 3 block the communication process and are nontherapeutic and nonhelpful statements.

The nurse is monitoring the laboratory test results for a client who is taking warfarin sodium (Coumadin). The nurse should expect the prothrombin time (PT) for this client to be at what value? 1. 8 seconds 2. 12 seconds 3. 15 seconds 4. 20 seconds

4. 20 seconds The normal PT is 9.5 to 11.8 seconds. A prolonged PT may be considered therapeutic for the client on anticoagulant therapy such as warfarin sodium. For the client on anticoagulant therapy, a PT of 1.5 to 2.5 times the normal value may be considered appropriate, putting the correct option within the therapeutic range. Another test that is used to monitor warfarin sodium therapy is the international normalized ratio.

A client is taking ticlopidine hydrochloride (Ticlid). The nurse should tell the client to avoid which substance while taking this medication? 1. Vitamin C 2. Vitamin D 3. Acetaminophen (Tylenol) 4. Acetylsalicylic acid (aspirin)

4. Acetylsalicylic acid (aspirin) Ticlopidine hydrochloride is a platelet aggregation inhibitor. It is used to decrease the risk of thrombotic stroke in clients with precursor symptoms. Because it is an antiplatelet agent, other medications that precipitate or aggravate bleeding should be avoided during its use. Therefore, aspirin or any aspirin-containing product should be avoided. The substances in options 1, 2, and 3 are safe to consume.

The nurse is caring for a postpartum client with a diagnosis of deep vein thrombosis who is receiving a continuous intravenous infusion of heparin sodium. Which laboratory result will the nurse specifically review to determine whether an appropriate dose of heparin is being delivered? 1. Platelet count 2. Prothrombin time (PT) 3. International normalized ratio (INR) 4. Activated partial thromboplastin time (aPPT)

4. Activated partial thromboplastin time (aPPT) Anticoagulation therapy may be used to prevent the extension of thrombus by delaying the clotting time of the blood. The aPTT time should be monitored, and the heparin dose should be adjusted to maintain a therapeutic level of 1.5 to 2.5 times the control. The platelet count cannot be used to determine an adequate dosage for the heparin infusion. The PT and the INR are used to monitor coagulation time when warfarin (Coumadin) is used.

A client with a subarachnoid hemorrhage needs to have surgery delayed until a stable clinical condition is achieved. The nurse prepares to administer which medication as prescribed to prevent clot breakdown and dissolution? 1. Alteplase (Activase) 2. Warfarin (Coumadin) 3. Heparin sodium (Heparin) 4. Aminocaproic acid (Amicar)

4. Aminocaproic acid (Amicar) Aminocaproic acid (Amicar) is an antifibrinolytic agent that prevents clot breakdown or dissolution. It is commonly prescribed after subarachnoid hemorrhage if surgery is delayed or contraindicated, to prevent further hemorrhage. Alteplase is a fibrinolytic that actively breaks down clots. Warfarin and heparin sodium are anticoagulants that interfere with propagation or growth of a clot.

A home care nurse is visiting a client who was discharged to home with a prescription for continued administration of enoxaparin (Lovenox) subcutaneously. What is the nurse's priority assessment for this client? 1. Constipation 2. Fear of needles 3. Nausea or vomiting 4. Bleeding gums or bruising

4. Bleeding gums or bruising Enoxaparin is an anticoagulant. An adverse effect of anticoagulant therapy is bleeding. Accordingly, the nurse questions the client about signs and symptoms that could indicate bleeding, such as bleeding gums, bruising, hematuria, or dark tarry stools.