The Hematologic System ATI Pharmacology 4.0

A health care professional is caring for a patient who is about to begin taking clopidogrel (Plavix) to prevent thrombus formation. The health care professional should question the use of clopidogrel by a patient who has which of the following?

Peptic ulcer disease Patients who have peptic ulcer disease should not take clopidogrel because it can cause gastric bleeding.

A health care professional is caring for a patient who is about to begin alteplase (Activase) therapy to treat pulmonary embolism. Which of the following drugs should the health care professional have available in the event of a severe adverse reaction?

Aminocaproic acid (Amicar) Aminocaproic acid, a coagulator, inhibits fibrinolysis and stops fibrinolytic bleeding. For severe bleeding, patients often require blood replacement.

A health care professional is preparing to administer the prescribed dose of filgrastim (Neupogen) to a patient. The client's laboratory results indicate that the client has a WBC count of 12,000/mm3. Which of the following actions should the health care professional take?

Clarify the prescription with the provider. Leukocytosis can occur with filgrastim therapy. It is essential to monitor WBC twice per week and reduce the dosage or stop therapy for WBC count above 10,000/mm3. The health care professional should notify the provider of the patient's current WBC count and clarify the prescription prior to administration.

A nurse is caring for a client who is about to begin therapy with recombinant factor IX to treat hemophilia B. The client asks the nurse about the risk of disease transmission with recombinant factor IX as compared with plasma-derived factor IX. The nurse should explain that recombinant factor IX therapy practically eliminates the risk for which of the following?

Creutzfeldt-Jakob disease Recombinant factor IX is safer than the plasma-derived formulation because of the risk of Creutzfeldt-Jakob disease, a prion-transmitted infection, from human sources. Plasma-derived products also carry a minimal risk of acquiring hepatitis A and parvovirus B19.

A nurse is caring for a client who is taking ferrous sulfate to treat iron deficiency anemia and develops toxicity. Which of the following drugs should the nurse expect to use to treat this complication?

Deferoxamine (Desferal) Indications of iron toxicity include nausea, vomiting, and diarrhea. Iron toxicity can lead to acidosis and shock. A chelating agent, such as deferoxamine, binds to the iron to reduce toxicity.

A health care professional is caring for a patient who is about to begin taking ferrous sulfate (Feosol) to treat iron-deficiency anemia. When talking with the patient about the drug, the health care professional should include which of the following instructions? (Select all that apply)

Eat iron-enriched foods is correct. Patients who have iron-deficiency anemia should increase iron intake with foods such as egg yolks, wheat germ, meat, and fish to supplement ferrous sulfate. Spread the dosage across each day is correct. Spreading out the iron intake throughout patients' waking hours allows the bone marrow to maximize the production of RBCs. Take the drug on an empty stomach is correct. Food reduces the absorption of ferrous sulfate. Patients should take the drug on an empty stomach to increase drug absorption. If GI effects are troublesome, patients can take the drug with food. Report dark green or black stools is incorrect. Health care professionals should tell patients to expect dark green or black stools. It is not necessary to report this effect. Increase dietary fiber intake is correct. Ferrous sulfate can cause constipation. Patients should increase fiber and fluid intake and exercise more often or more intensely.

A health care professional is caring for patient who has mild hemophilia A and is about to begin taking desmopressin (DDAVP) to prevent bleeding. The health care professional should monitor for which of the following adverse reactions?

Edema Desmopressin, an antidiuretic hormone, can cause fluid retention and edema. Health care professionals should monitor fluid intake and output for patients receiving the drug therapy.

A health care professional is caring for a patient who is undergoing bone marrow transplantation following high-dose chemotherapy. Which of the following drugs should the health care professional expect the primary care provider to prescribe the reduce the patient's risk of infection?

Filgrastim (Neupogen) Filgrastim, a leukopoietic growth factor, stimulates production of neutrophils in the bone marrow. It helps reduce the risk for infection due to bone marrow transplantation, severe chronic neutropenia, and myelosuppressive chemotherapy.

A health care professional is caring for a patient who has a known sensitivity to Escherichia coli-derived proteins. This sensitivity is a contraindication for which of the following drugs?

Filgrastim (Neupogen) Patients who have active internal bleeding or pericarditis should not receive alteplase, a thrombolytic.

A health care professional is caring for a patient who is about to begin factor VIII (Advate) therapy to treat hemophilia A. When administering factor VIII, which of the following actions should the health care professional take?

Have emergency equipment ready Factor VIII can cause a hypersensitive reaction and anaphylaxis. The health care professional should monitor for hives, fever, wheezing, and difficulty breathing, and have emergency equipment and drugs readily available.

A health care professional is caring for a patient who is about to begin alteplase (Activase) therapy. The health care professional should monitor the patient for which of the following indications of a possible adverse effect?

Headache Alteplase, a thrombolytic drug, can cause intracranial bleeding. Monitor patients receiving the drug for changes in level of consciousness, headache, one-sided weakness, and other indications of intracranial bleeding.

A health care professional is caring for a patient who is about to begin taking epoetin alfa (Epogen). Which of the following laboratory values should increase with effective therapy?

Hgb Epoetin alfa, an erythropoietic growth factor, increases the production of RBCs for patients who have anemia due to chronic renal failure or chemotherapy. Hgb and Hct should increase with effective therapy.

A health care professional administers epoetin alfa (Epogen) subcutaneously to a patient who has renal failure. The health care professional should monitor the patient for which of the following adverse effects?

Hypertension Epoetin alfa, an erythropoietic growth factor, can cause hypertension. The health care professional should monitor blood pressure and regulate it prior to initiating epoetin alfa therapy, then monitor it during therapy. For elevations, recommend a reduced dosage or antihypertensive drug therapy.

A health care professional is caring for a patient who is about to begin taking warfarin (Coumadin). The health care professional should caution the patient about taking which of the following over-the-counter drugs?

Ibuprofen (Motrin) NSAIDs, such as ibuprofen and especially aspirin, can increase the risk of bleeding for patients taking warfarin, an anticoagulant.

A health care professional is caring for a patient who is about to begin taking clopidogrel (Plavix) to prevent stent stenosis. The health care professional should monitor the patient for which of the following adverse reactions?

Thrombocytopenia Clopidogrel, an antiplatelet drug, can cause thrombotic thrombocytopenic purpura. The health care professional should monitor platelet count, bruising, bleeding gums, and petechiae.

A nurse should assess a client who has megaloblastic anemia for indications of which of the following vitamin deficiencies?

Vitamin B12 Patients who have megaloblastic anemia have a deficiency of vitamin B12, folic acid, or both. Cyanocobalamin (Nascobal) treats moderate vitamin B12 deficiencies. Patients who have a severe vitamin B12 deficiency should take cyanocobalamin and folic acid.

A patient who is taking warfarin (Coumadin) arrives at the emergency department and reports rectal bleeding. Which of the following drugs should the health care professional have available?

Vitamin K Vitamin K reverses the effects of warfarin by promoting the synthesis of coagulation factors VI, IX, X, and prothrombin.

A health care professional is caring for a patient who is about to begin taking alteplase (Activase) to treat acute myocardial infarction. The health care professional should understand the drug is most effective when the patient receives it

Within 3 hr of symptom onset. Alteplase, a thrombolytic drug, is most effective in treating acute myocardial infarction if the patient receives it as soon as possible after the onset of symptoms.

A health care professional is caring for a patient who is about to begin taking oprelvekin (Neumega) to treat thrombocytopenia. The healthc are professional should tell the patient to report which of the following idications of an adverse reaction? (select all that apply).

Conjunctivitis is correct. Oprelvekin, a thrombopoietic growth factor, can cause conjunctivitis, blurred vision, and papilledema. Patients should report eye redness or blurred vision. Tinnitus is incorrect. Oprelvekin, a thrombopoietic growth factor, is unlikely to cause tinnitus. Aspirin (Ecotrin) is a drug that can cause tinnitus. Swollen ankles is correct. Oprelvekin, a thrombopoietic growth factor, can cause fluid retention. The health care professional should monitor I&O and patients should report edema or difficulty breathing. Jaundice is incorrect. Oprelvekin, a thrombopoietic growth factor, is unlikely to cause jaundice. However, it can cause fever, rash, and hypotension. Palpitations is correct. Oprelvekin, a thrombopoietic growth factor, can cause cardiac dysrhythmias. Patients should report palpitations or dizziness.

A nurse is caring for a client who is taking filgrastim (Neupogen) to treat neutropenia. The nurse should assess the client for which of the following adverse effects?

Enlarged Spleen With long-term use, filgrastim, a leukopoietic growth factor, can cause an enlarged spleen. Health care professionals should tell patients taking the drug to monitor and report abdominal pain or fullness.

A health care professional is caring for a patient who is about to begin taking asprin (Ecotrin) to reduce the risk of a cardiovascular event. The health care professional should understand that the drug inhibits platelet aggregation by which of the following mechanisms?

Inhibiting cyclooxygenase action in platelets 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 health care professional is administering epoetin alfa (Epogen) subcutaneously to a patient who has renal failure. The health care professional should take which of the following actions?

Insert the needle into the vial once. Instructions for administering the drug include inserting the needle into the vial only once. Health care professionals should also examine the solution and discard it if it is cloudy or discolored.

A nurse is caring for a client who is about to begin taking folic acid to treat megaloblastic anemia. The nurse should monitor which of the following laboratory values to determine therapeutic effectiveness>

Reticulocyte count A reticulocyte count measures the amount of immature RBCs. Folic acid, also called folate, is essential for erythropoiesis. Patients who have a folic acid deficiency require a baseline reticulocyte count, as well as a serum folate, Hgb, Hct, and RBC count and periodic monitoring during folic acid therapy to determine effectiveness.

A health care professional is caring for a patient who is about to begin iron dextran (INFeD) therapy. When administering the drug IM, the health care professional should take which of the following actions?

Administer a test dose is correct. Iron dextran can cause a hypersensitivity reaction. It is essential to administer a test dose to determine hypersensitivity prior to giving the full dosage initially and to allow 1 hr for identifying any adverse reactions. Monitor blood pressure is correct. Iron dextran can cause hypotension and hypersensitivity reactions, so it is important to monitor blood pressure. Have epinephrine available is correct. Iron dextran can cause a hypersensitivity reaction. It is essential to have epinephrine and resuscitation equipment available and to monitor for skin rash, fever, and chills. Premedicate with atropine is incorrect. Iron dextran is more likely to cause tachycardia than bradycardia. Therefore, it is unnecessary to premedicate with atropine. Use the Z-track technique is correct. Health care professionals giving the drug IM should use the Z-track technique to make sure to deposit it deep into the buttocks. Superficial injection can cause abscesses and brown discoloration of the skin.

A health care professional is caring for a patient who is about to begin taking oprelvekin (Neumega). The health care professional should explain to the patient that the drug has which of the following effects?

Increases platelet production Oprelvekin, a thrombopoietic growth factor, increases platelet production. It treats thrombocytopenia that is associated with myelosuppression.