Saunders: Hematology Meds

A health care provider prescribed ticlopidine to the client with thrombotic stroke. The nurse provides instructions to the client and spouse regarding the medication. Which statement made by the client indicates that education was effective? 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." Rationale: 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 side effects are gastrointestinal (GI) disturbances. Taking ticlopidine with meals tends to lessen those effects. It is not necessary to contact the health care provider (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 reviewing the health care provider's (HCP's) prescriptions for a client recently admitted to the hospital and notes that the HCP has prescribed ticlopidine therapy. Which finding 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 Rationale: 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 If a diagnosis of neutropenia is determined, the client will be withdrawn from therapy.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

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. Ecchymosis 3. Increased pulse rate 4.Increased blood pressure

2. Ecchymosis Rationale: The client who receives a continuous IV infusion of heparin sodium is at risk for bleeding. The nurse assesses for signs/symptoms of bleeding, which include bleeding from the gums, ecchymosis 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.

The nurse is preparing to administer filgrastim to the client. Which route of administration should the nurse determine is the most appropriate for this medication? 1. Oral 2. Subcutaneous 3. Intramuscular 4.Intravenous bolus

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

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

3. After 2 weeks of therapy Rationale: 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 being diagnosed with atrial fibrillation. The international normalized ratio (INR) is analyzed because the client has been taking warfarin sodium 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. 0.6 2. 0.75 3. 1.0 4.2.3

4. 2.3 Rationale: The recommended INR range for warfarin sodium therapy for atrial fibrillation is 2.0 to 3.0 (2.0 to 3.0). Subtherapeutic INRs increase the client's risk for thrombus formation. The normal range for INR is 0.81 to 1.2 (0.81 to 1.2), so option 4 is therapeutic for this client.

The nurse provides instructions to a client who has a prescription for ticlopidine. Which statement 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 doctor 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." Rationale: 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 health care provider'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. 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." Rationale: 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 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?" Rationale: 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 after mechanical heart valve replacement. The nurse should expect the international normalized ratio (INR) for this client to be at what value in order to be therapeutic? 1. 0.2 2. 0.5 3. 1.0 4.3.0

4.3.0 Rationale: The normal value for INR is 0.81 to 1.2 (0.81 to 1.2). The target INR or therapeutic level for a client receiving warfarin sodium is 2.5 to 3.5 (2.5 to 3.5).

A client is scheduled to have heparin sodium 5000 units subcutaneously. What is the most appropriate nursing intervention? 1. Inject via an infusion device. 2. Inject ½ inch (1.25 cm) from the umbilicus. 3. Massage the injection site after administration. 4.Avoid aspirating prior to injecting the medication.

4.Avoid aspirating prior to injecting the medication. Rationale: Aspiration should be avoided before injecting the heparin because it can cause hematoma at the administration site. Heparin sodium administered subcutaneously does not require an infusion device and is injected at least 2 inches (5 cm) from the umbilicus or any scar tissue. The needle is withdrawn rapidly, and the site is not massaged (although pressure is applied).

A client who is scheduled to have warfarin sodium therapy has a prothrombin time (PT) of 28 seconds (28 seconds). What is the most appropriate nursing intervention at this time? 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). Rationale: The PT is one test that may be used to monitor warfarin sodium therapy. The international normalized ratio is another laboratory test used to monitor warfarin therapy. The normal PT is 11 to 12.5 seconds (11 to 12.5 seconds). A PT of 28 seconds represents an elevated value. 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).

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

4.Constipation Rationale: Ferrous sulfate 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 or adverse effects associated with this medication.

1. 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. Rationale: 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 to a client with a diagnosis of agranulocytosis. The client asks the nurse about the purpose of the medication. Which information should the nurse include in the response regarding action of this medication? 1. It prevents bleeding. 2. It prolongs the clotting time. 3. It increases the red blood cell count. 4.It promotes the growth of neutrophils.

4.It promotes the growth of neutrophils. Rationale: 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.

A client is scheduled to have alteplase. Which item should the nurse obtain to monitor side/adverse effects of the medication therapy? 1. Flashlight 2. Pulse oximeter 3. Suction equipment 4.Occult blood test strips

4.Occult blood test strips Rationale: Alteplase 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 {Guaiac 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.

A client is being discharged to home with enoxaparin 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 Rationale: 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 is scheduled to take ticlopidine. The nurse plans to take which action before implementing this medication therapy? 1. Take the client's blood pressure. 2. Obtain a prothrombin time (PT). 3. Take the client's apical heart rate. 4.Review the results of the complete blood cell (CBC) count.

4.Review the results of the complete blood cell (CBC) count. Rationale: Ticlopidine {Ticlid} is an antiplatelet agent that is used for the prevention of thrombotic stroke. Ticlopidine's effects last for the life of the platelet, 7 to 10 days. Ticlopidine also can cause neutropenia, which is an abnormally small number of mature white blood cells (WBCs). Baseline data from a CBC count are necessary before implementation of therapy, and the nurse should monitor for neutropenia during this medication therapy. If this adverse effect does occur, the health care provider is notified and therapy should be stopped. The effects of neutropenia are reversible within 1 to 3 weeks. Options 1, 2, and 3 are actions that are not specific to this medication therapy.