The Hematologic System

A nurse should identify that clopidogrel is contraindicated for clients who have which of the following conditions? A) Myocardial infarction B) Peptic ulcer disease C) Pancreatitis D) Myasthenia gravis

ANS: B) Peptic ulcer disease RATIONALE: Clients who have peptic ulcer disease should not take clopidogrel, because it can cause gastric bleeding.

A nurse is caring for a client who is taking filgrastim to treat neutropenia. The should assess the client for which of the following adverse effects? A) Dusky nail beds B) Petechiae C) Enlarged spleen D) Swollen calf

ANS: C) Enlarged spleen RATIONALE: With long-term use, filgrastim, a leukopoietic growth factor, can cause an enlarged spleen. The nurse should tell the client to monitor and report abdominal pain or fullness.

A nurse is reviewing the medication record of a client who is receiving alteplase following an acute myocardial infarction (MI). Which of the following medications should the nurse expect the client to be taking in addition to the alteplase? A) Protamine B) Desmopressin C) Ferrous sulfate D) Heparin

ANS: D) Heparin RATIONALE: Heparin therapy should be initiated before alteplase therapy and continued for at least 48 to 72 hr after the fibrinolytic therapy to reduce the risk of additional clot formation.

A nurse is caring for a client who is about to begin taking aspirin to reduce the risk of a cardiovascular event. The nurse should identify that the drug inhibits platelet aggression by which of the following mechanisms? A) Activating thromboxane A2 B) Blocking adenosine diphosphate receptor agonists C) Suppressing specific clotting factors D) Inhibiting cyclooxygenase action in platelets

ANS: D) Inhibiting cyclooxygenase action in platelets RATIONALE: Salicylates, such as aspirin, work by inhibiting platelet aggregation. They do this by blocking the action of cyclooxygenase on platelets. As a result, activation of thromboxane A2 does not occur.

A nurse is caring for a client who recently started alteplase therapy. The nurse should monitor the client for which of the following adverse effects? A) Bronchodilation B) Headache C) Edema D) Hypertension

ANS: B) Headache RATIONALE: Alteplase, a thrombolytic drug, can cause intracranial bleeding. The nurse should monitor the client for changes in level of consciousness, headache, one-sided weakness, and other indications of intracranial bleeding.

A nurse is administering epoetin intravenously to a client who has renal failure. Which of the following actions should the nurse take? A) Shake the vial before using. B) Administer via IV bolus over 1 to 3 min. C) Dilute the drug first with D5W. D) Save the used vial for the next dose.

ANS: B) Administer via IV bolus over 1 to 3 min. RATIONALE: Instructions for administering the drug include administering it via IV bolus over 1 to 3 min.