PHARM ATI Hematologic System

A nurse in the emergency department (ED) is caring for a client. A nurse is providing medication teaching to a client who has a new prescription for apixaban. Which of the following statements should the nurse make?Select all that apply.

"You can take this medication on an empty stomach or with food." "This medication will reduce your risk of stroke." "Avoid taking NSAIDs while taking this medication." When taking action, the nurse should instruct the client who has a new prescription for apixaban that the medication can be taken without regard to food, that the medication will reduce the risk of stroke related to atrial fibrillation, and that they should avoid taking NSAIDs while taking apixaban as the combination of medications can increase the risk for bleeding.

A nurse is caring for a client who is experiencing an acute ischemic cerebrovascular event due to thrombus in cerebral vessel. Which of the following drugs should the nurse expect to administer?

Alteplase Alteplase is a thrombolytic medication, meaning it can dissolve existing thrombi, whereas anticoagulant/antiplatelet medications 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 manifestations for the medication to be effective.

A nurse is caring for a client who is about alteplase therapy to treat pulmonary embolism. Which of the following drugs should the nurse have available in the event of a severe adverse reaction?

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 130 mEq/L. Which of the following actions should the nurse take?

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 actions of adenosine diphosphate receptors (ADP) on platelets and can be prescribed to reduce the client's risk for myocardial infarction?

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 the client for which of the following adverse effects?

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 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 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?

Dietary modifications Warfarin is an anticoagulant medication 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 teaching a client about taking ferrous sulfate to treat iron-deficiency anemia. Which of the following instructions should the nurse include?

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 medication on an empty stomach is correct. Food reduces the absorption of ferrous sulfate. The client should take the medication on an empty stomach to increase medication absorption. If GI effects are troublesome, they can take the medication 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 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?

Edema Desmopressin, an antidiuretic hormone, can cause fluid retention and edema. The nurse should monitor fluid intake and output for clients receiving this medication.

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?

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.

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?

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 medications readily available.

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?

Headache Alteplase, a thrombolytic medication, 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 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?

Hemoglobin (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 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?

Heparin Heparin therapy should be initiated 24 hr after alteplase therapy due to increased risk of bleeding if a thrombolytic and anticoagulant are administered concurrently.

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 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 should identify that clopidogrel is contraindicated for clients who have which of the following conditions?

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

A nurse is monitoring a client who is undergoing anticoagulant therapy with heparin. Which of the following findings should nurse identify as a possible indication of hemorrhage?

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?

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?

Thrombocytopenia Clopidogrel, an antiplatelet medication, can cause thrombotic thrombocytopenic purpura. The nurse should monitor the client's platelet count and 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 81 mg daily, including this morning. The nurse should identify that this places the client at risk for which of the following complications?

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 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.

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?

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

A nurse in a provider's clinic is reviewing the medical record of a client who has been taking ferrous sulfate for anemia. A nurse is providing teaching to a client who is being treated in the outpatient clinic. Which of the following five foods should the nurse recommend the client include in their diet? Select the 5 foods the nurse should recommend.

Whole grains, liver, egg yolks, leafy green vegetables, and boneless chicken. When taking action, the nurse should instruct the client who has iron-deficiency anemia to increase the consumption of whole grains, egg yolks, green leafy vegetables, muscle meats such as boneless chicken, and liver.

A nurse in an outpatient oncology clinic is reviewing a female client's medical record. The nurse should anticipate a prescription for _____ due to the clients ____

filgrastim; WBC count When analyzing cues, the nurse should anticipate a prescription for filgrastim due to the client's WBC count, which is below the expected reference range and places the client at risk for infection. Filgrastim is a leukopoietic growth factor that is used to raise neutrophil counts in clients who have neutropenia due to cancer and chemotherapy.