Hematologic System
A nurse is teaching a client about taking ferrous sulfate to treat iron-deficiency anemia. Which of the following instructions should the nurse include? SATA Eat iron-enriched foods. Spread the dosage across each day. Take the drug on an empty stomach. Report dark green or black stools. Increase dietary fiber intake.
-Eat iron-enriched foods is correct. A client who has iron-deficiency anemia should increase iron intake by eating foods such as egg yolks, wheat germ, meat, and fish. -Spread the dosage across each day is correct. Spreading out the iron intake throughout the client's 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. The client should take the drug on an empty stomach to increase drug absorption. If GI effects are troublesome, they can take the drug with food. -Report dark green or black stools is incorrect. The nurse should tell the client to expect dark green or black stools. However, it is not necessary to report this adverse effect. -Increase dietary fiber intake is correct. Ferrous sulfate can cause constipation. The client should increase fiber and fluid intake and exercise more often or more intensely.
A nurse is administering epoetin intravenously to a client who has renal failure. Which of the following actions should the nurse take? Shake the vial before using. Administer via IV bolus over 1 to 3 min. Dilute the drug first with D5W. Save the used vial for the next dose.
Administer via IV bolus over 1 to 3 min. Instructions for administering theterm-20 drug include administering it via IV bolus over 1 to 3 min. Do not shake the vial, can damage the glycoprotein that comprises the drug, making it ineffective. Mix it with 0.9% NaCl. The vial is for one time use only and then discard it.
A nurse for a client who is experiencing an acute ischemic cerebrovascular event due to a thrombus in a cerebral vessel. Which of the following drugs should the nurse expect to administer? Alteplase Aspirin Clopidogrel Heparin
Alteplase Alteplase is a thrombolytic drug, meaning it can dissolve existing thrombi, whereas anticoagulant/antiplatelet drugs do not. An acute ischemic cerebrovascular event is often caused by the occlusion of a cerebral vessel by a thrombus. Administration of alteplase should be within 3 hr of the original onset of symptoms for the drug to be effective.
A nurse is caring for a client who is about to begin alteplase therapy to treat pulmonary embolism. Which of the following drugs should the nurse have available in the event of a severe adverse reaction? Vitamin K Aminocaproic acid Protamine Deferoxamine
Aminocaproic acid Aminocaproic acid, a coagulator, inhibits fibrinolysis and stops excessive fibrinolytic bleeding, a severe adverse effect of alteplase.
A nurse is preparing to administer a prescribed dose of desmopressin to a client who has hemophilia A. The client's laboratory results indicate that the client has a sodium level of 130mEq/L. Which of the following actions should the nurse take? Clarify the prescription with the provider. Administer the drug with an analgesic. Administer the required dose orally. Assess factor IX levels.
Clarify the prescription with the provider. Hyponatremia and fluid retention can occur with the administration of desmopressin, an antidiuretic hormone used in the treatment of hemophilia A. The client's sodium level is below the expected range of 136 to 145 mEq/L. The nurse should notify the provider of the client's current sodium level and clarify the prescription prior to administration.
A nurse is caring for a client who has chronic stable angina. The nurse should identify that which of the following drugs inhibits the action of adenosine diphosphate receptors (ADP) on platelets and can be prescribed to reduce the client's risk for myocardial infarction? Clopidogrel Heparin Warfarin Alteplase
Clopidogrel Clopidogrel is an antiplatelet medication that blocks the ADP receptors on platelets, preventing platelet aggregation. This effect is irreversible and lasts the lifespan of the platelets (7 to 10 days).
A nurse is monitoring a client following ferrous sulfate administration. The nurse should monitor the client for which of the following adverse effects? Phlebitis Dark, orange-colored stools Constipation Injection site pain
Constipation Oral iron supplementation is associated with constipation. The nurse should encourage the client to consume adequate amounts of fiber and fluids in their diet to minimize this effect.
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 practically eliminates the risk for which of the following? HIV Cytomegalovirus Creutzfeldt-Jakob disease Anaphylaxis
Creutzfeldt-Jakob disease Recombinant factor IX is safer than the plasma-derived formulation because it practically eliminates the risk for Creutzfeldt-Jakob disease, a prion-transmitted infection, from human sources. Both recombinant and plasma-derived factor IX carry a risk for anaphylaxis. The nurse should have epinephrine and diphenhydramine available and monitor clients who are receiving these products for an allergic reaction that could lead to anaphylaxis. Plasma-derived products carry a minimal risk of acquiring hepatitis A and parvovirus B19. plasma-derived products 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 iron toxicity. Which of the following drugs should the nurse expect to use to treat this complication? Flumazenil Acetylcysteine Naloxone Deferoxamine
Deferoxamine 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 nurse is teaching a client who is starting treatment with warfarin. The nurse should plan to include information on which of the following topics to promote the effectiveness of the drug? Sleep modifications Fluid modifications Driving modifications Dietary modifications
Dietary modifications Warfarin is an anticoagulant drug that functions by inhibiting the action of vitamin K. Many foods, such as green, leafy vegetables, are rich in vitamin K. The client should maintain a consistent intake of vitamin K to avoid excesses or deficits and ensure the therapeutic effects of warfarin are consistent.
A nurse is caring for a client who has hemophilia A and is about to begin taking desmopressin to prevent bleeding. The nurse should monitor the client for which of the following adverse reactions? Weight loss Edema Polyuria Bradycardia
Edema Desmopressin, an antidiuretic hormone, can cause fluid retention and edema. The nurse should monitor fluid intake and output for clients receiving this drug.
A nurse is caring for a client who is taking filgrastim to treat neutropenia. The nurse should assess the client for which of the following adverse effects? Dusky nail beds Petechiae Enlarged spleen Swollen calf
Enlarged spleen 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. -it can cause leukocytosis, fever, bone pain, and ECG changes.
A nurse is caring for a client who is about to begin factor VIII therapy to treat hemophilia A. When administering factor VIII, which of the following actions should the nurse take? Administer the powdered form orally. Premedicate with aspirin. Administer it via rapid IV bolus. Have emergency equipment ready.
Have emergency equipment ready. Factor VIII can cause a hypersensitive reaction and anaphylaxis. The nurse should monitor the client for hives, fever, wheezing, and difficulty breathing and have emergency equipment and drugs readily available. The powdered form of factor VIII is concentrated factor VIII. The nurse should dissolve it in a sterile solution and administer it via IV. Administer factor VIII slowly over 5 to 10 min. Do not administer aspirin and first-generation NSAIDs, contraindicated for clients who have hemophilia A because they increase the risk for bleeding.
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? Bronchodilation Headache Edema Hypertension
Headache 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. bronchospasm bleeding and hemorrhage, usually at sites of previous tissue damage. Severe and excessive bleeding can cause hypotension, not hypertension.
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? Protamine Desmopressin Ferrous sulfate Heparin
Heparin Heparin therapy should be initiated before alteplase therapy and continued for at least 48 to 72HR 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 epoetin. An increase in which of the following laboratory values should indicate to the nurse that the therapy is effective? PT WBC Hgb Platelets
Hgb Epoetin, an erythropoietic growth factor, increases the production of RBCs for clients who have anemia due to chronic renal failure or chemotherapy. Hgb and Hct should increase with effective therapy.
A nurse is caring for a client who has renal failure and is receiving epoetin. The nurse should monitor the client for which of the following adverse effects? Hypertension Muscle pain Edema Dry mouth
Hypertension Epoetin, an erythropoietic growth factor, can cause hypertension. The nurse should monitor the client's BP before and during therapy and inform the provider if it increases.
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 aggregation by which of the following mechanisms? Activating thromboxane A2 Blocking adenosine diphosphate receptor agonists Suppressing specific clotting factors Inhibiting cyclooxygenase action in platelets
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 nurse should identify that clopidogrel is contraindicated for clients who have which of the following conditions? Myocardial infarction Peptic ulcer disease Pancreatitis Myasthenia gravis
Peptic ulcer disease Clients who have peptic ulcer disease should not take clopidogrel, because it can cause gastric bleeding. The drug is contraindicated for clients who have hemophilia, other bleeding disorders, thrombocytopenia, or intracranial bleeding.
protamine sulfate
Protamine reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties. It is ineffective for bleeding caused by an anticoagulant, such as warfarin.
A nurse is monitoring a client who is undergoing anticoagulant therapy with heparin. Which of the following findings should the nurse identify as a possible indication of hemorrhage? Rapid pulse Yellowing of the sclera Elevated blood pressure Pale-colored stools
Rapid pulse In the event of a moderate to severe hemorrhage, the volume of blood in the circulatory system decreases significantly, resulting in hypotension. Tachycardia is a compensatory mechanism of the heart that serves to combat the hypotension that results from the decreased volume of blood. Tachycardia can be detected by checking the client's pulse.
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? Amylase level Reticulocyte count C-reactive protein Creatinine clearance
Reticulocyte count A reticulocyte count measures the amount of immature RBCs. Folic acid, also called folate, is essential for erythropoiesis. Clients 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 nurse is caring for a client who is taking clopidogrel to prevent stent restenosis. The nurse should monitor the client for which of the following adverse reactions? Hyperuricemia Hyponatremia Lymphocytopenia Thrombocytopenia
Thrombocytopenia Clopidogrel, an antiplatelet drug, can cause thrombotic thrombocytopenic purpura. The nurse should monitor the client's platelet count and also monitor for bruising, bleeding gums, and petechiae.
A nurse is caring for a client who is scheduled for an outpatient surgical procedure and reports taking aspirin 81mg daily, including this morning. The nurse should identify that this places the client at risk for which of the following complications? Uncontrolled bleeding Myocardial infarction Respiratory depression Decreased renal perfusion
Uncontrolled bleeding Aspirin is a salicylate (antiplatelet) that irreversibly binds to and inhibits platelet activation. Because the lifespan of a platelet is 7 to 10 days, this is the average span of time needed after discontinuing antiplatelet therapy with aspirin before its effects are no longer present and the chance of an uncontrolled bleeding event is decreased.
A nurse should assess a client who has megaloblastic anemia for indications of which of the following vitamin deficiencies? Vitamin C Vitamin K Vitamin B12 Vitamin D
Vitamin B12 Clients who have megaloblastic anemia have a deficiency of vitamin B12, folic acid, or both. Cyanocobalamin (vitamin B12) treats moderate vitamin B12 deficiencies. Clients who have a severe vitamin B12 deficiency should take cyanocobalamin and folic acid.
vitamin deficiencies
Vitamin C treats scurvy. Vitamin K helps reverse warfarin overdose. A vitamin K deficiency causes spontaneous bleeding. Vitamin B12 Clients who have megaloblastic anemia have a deficiency of vitamin B12, folic acid, or both. Cyanocobalamin (vitamin B12) treats moderate vitamin B12 deficiencies. Clients who have a severe vitamin B12 deficiency should take cyanocobalamin and folic acid. Vitamin D treats and prevents rickets.
a nurse in an emergency department is assessing a client who has been taking warfarin and is experiencing rectal bleeding. Which of the following drugs should the nurse expect to administer to the client? Filgrastim Deferoxamine Protamine Vitamin K
Vitamin K Vitamin K reverses the effects of warfarin by promoting the synthesis of coagulation factors VI, IX, X, and prothrombin.
Antidotes
Vitamin K reverses the effects of warfarin. It is unlikely to reverse the thrombolytic effects of alteplase. Aminocaproic acid, a coagulator, inhibits fibrinolysis and stops excessive fibrinolytic bleeding, a severe adverse effect of alteplase. Protamine reverses the effects of heparin. It is unlikely to reverse the thrombolytic effects of alteplase. Deferoxamine is a chelating agent that binds with iron to reverse iron toxicity. Flumazenil, a benzodiazepine antagonist, reverses the effects of benzodiazepines. Acetylcysteine, a mucolytic, reduces the risk of hepatotoxicity after acetaminophen overdose. Acetylcysteine binds to the toxic byproducts of acetaminophen metabolism to prevent liver toxicity. Naloxone, an opioid antagonist, reverses the effects of opioid narcotics.
Labs
Warfarin - PT increase & anticoagulation Epoetin - Hgb and Hct increase Epoetin = increase of platelets = thrombocytosis; adverse effect
