Pharmacology Exam 9

The nurse is teaching a nursing student about anemia and knows that it is important to start by explaining the causes of anemia. Which statement is true about the cause of anemia?

"Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues."

While preparing a client for discharge, the nurse teaches about the proper use of warfarin, which has been prescribed by the physician. Which statement by the client indicates that additional teaching is required?

"I should use aspirin to control my arthritis pain."

A patient has been receiving intramuscular injections of hydroxocobalamin as treatment for pernicious anemia. Which statement by the patient indicates that he understands the therapy?

"I will need these injections monthly for the rest of my life."

A client who is receiving cholestyramine also takes digoxin. The nurse teaches the client about the drug and administration. The client demonstrates understanding of the teaching when stating:

"I will take the digoxin about an hour before the cholestyramine."

A 39-year-old nulliparous woman has been taking atorvastatin for 2 years and has now decided that she would like to become pregnant. What health education should the nurse provide to this client?

"It's important that you stop taking atorvastatin before you stop using contraception."

The client receives a prescription for niacin. The nurse is providing education about the medication and possible adverse effects. Which adverse affect would the nurse include?

"Some people get very flushed skin when they take this medication."

A client recovering from joint replacement surgery is prescribed subcutaneous heparin injections. Which response will the nurse make when the client asks if the medication can be taken orally?

"The gastrointestinal tract does not absorb the drug, so it cannot be given by mouth."

The nurse is providing education to an older adult client who has been prescribed atorvastatin. How should the nurse describe the common adverse effects of the drug?

"The most common side effects of atorvastatin include some mild gastrointestinal upset."

An older client has been prescribed an anticoagulant. What statement made by the client assures the nurse that the discharge information was understood correctly? (Select all that apply.)

"They may need to increase the dosage of this medication." "It's really important that I have my blood tested on a regular basis." "Starting or stopping any of my other medications could cause me to bleed."

The client wants information about triglycerides and cholesterol. Which response by the nurse would be correct?

"Triglycerides and cholesterol are fatlike substances found in your blood."

Vitamin B12 function and deficiency

*Vegan disease* Cobalamin Function: Cofactor for methionine synthase (transfers CH3 groups as methylcobalamin) and methylmalonyl-CoA mutase. Important for DNA synthesis. Deficiency: Macrocytic, megaloblastic anemia; hypersegmented PMNs; paresthesias and subacute combined degeneration (degeneration of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts) due to *abnormal myelin* Associated with *↑ serum homocysteine and ↑ methylmalonic acid* and *2° ↓ folate*. Prolonged deficiency = irreversible nerve damage. Found in *animal products*. Stored primarily in liver. Deficiency caused by malabsorption (sprue, enteritis, Diphyllobothrium latum), lack of intrinsic factor (pernicious anemia, gastric bypass surgery), absence of terminal ileum (surgical resection), or insufficient intake (vegans). Anti-intrinsic factor antibodies diagnostic for pernicious anemia.

Types of Anemia

- Aplastic - Iron Deficiency - Folic Acid Deficiency - Vitamin B12 Deficiency (prenicious) - Sickle Cell

thrombolytic contraindications

- Recent surgery - Active internal bleeding - CVA within the last 2 months - Aneurysm - Obstetrical delivery - Organ biopsy - Recent major trauma - Recent CPR - Uncontrolled hypertension - Liver disease

Heparin lab values

-PTT: *1.5-2* times the control value (control 60-70 seconds) -aPTT: 30-85 seconds (control 20 to 35 seconds)

types of lipid lowering drugs

-Statins -Bile Acid Sequestrants -Cholesterol Absorption Inhibitors -Fibrates -Nicotinic Acid Agents

INR

0.8-1.1

The average lifespan of a red blood cell (RBC) is approximately:

120 days

warfarin INR range

2/3

How long does it take for warfarin to take effect?

3-5 days

aPTT

30-40 seconds

A client asks the nurse what dose of acetylsalicylic acid (aspirin) is needed for antiplatelet effects to prevent heart attacks. What dose is most appropriate to reduce platelet aggregation?

300 mg

HDL range

40-60

A client receiving heparin has a baseline aPTT of 28 seconds. Which result would the nurse interpret as suggesting too much heparin?

98 seconds

Triglyceride range

<150 mg/dL

Cholesterol levels

<200 Normal 200-239 Borderline High >240 High risk

A nurse will use extreme caution when administering heparin to which patient?

A 38-year-old male with peptic ulcer disease

Heparin therapy is prescribed to a client with deep vein thrombosis. Which client would be at greatest risk of bleeding from this therapy?

A 45-year-old corporate executive with peptic ulcer disease

Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy?

A 62-year-old male with cancer

The client has been prescribed lovastatin to treat mixed lipidemia. In addition to monitoring cholesterol levels, what other laboratory test value needs to be monitored on a routine basis during therapy?

AST and ALT

An adult client's total cholesterol level is 220 mg/dl (5.7 mmol/L). What information will the nurse provide concerning appropriate treatment?

Adopt a low-fat diet and have levels reevaluated in 6 months

Dissolve clots

Alteplase

A patient with chronic renal failure receiving epoetin alfa will be having a total left hip arthroplasty. What supplementation should the patient receive prior to surgery?

An iron supplement

A nurse is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics. Treatment of high cholesterol using statins would be contraindicated in which client?

An obese male client who is a heavy alcohol user and who has cirrhosis of the liver

An instructor is teaching a group of students about possible drug interactions with iron preparations. The instructor states that which drug should be separated from the administration of iron at least 2 hours? (Select all that apply.)

Antacids Tetracycline Norfloxacin

What type of medication is heparin?

Anticoagulant

Enoxaprin

Anticoagulant, Low Molecular Weight Heparin

ezetimibe class

Antihyperlipidemic, Cholesterol Absorption Inhibitor

Antiplatelets

Aspirin Clopidogrel

A nurse is preparing to administer the first dose of warfarin to a client. Which assessment should the nurse prioritize for this client?

Assess PT and INR.

Anticoagulants precautions

Avoid physical activity Use electric razor Soft tooth brush

When describing the action of atorvastatin, which would the nurse include?

Blocking the enzyme that is involved in cholesterol synthesis

A patient with atrial fibrillation is receiving warfarin therapy. The patient is also prescribed ezetimibe. The nurse would instruct the patient to watch for:

Blood in urine or stool

Hemophilia

Blood loving Increase bleeding Lack of clotting

Which medication is an example of an antiplatelet?

Clopidogrel

Which diagnosis is often an indication for a prescription for a statin?

Coronary artery disease

Lipid lowering agent function

Decrease cholesterol

A male client takes cholesterol absorption inhibitors as a monotherapy without statins. He develops mild hepatic insufficiency. What would the nurse expect the health care provider to do?

Decrease the dosage of his medication

A client is prescribed warfarin. The client also takes a diuretic for the treatment of cardiac problems. The nurse will monitor the client for which potential interaction?

Decreased effectiveness of the anticoagulant

A client is taking cholestyramine to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which medication?

Digoxin

A client has been prescribed cholestyramine powder to decrease cholesterol levels. What information should the nurse include when educating the client how to administer the medication to increase effectiveness?

Do not take within 1 hour before or 4-6 hours after taking other drugs.

The client is prescribed warfarin. His INR is 5.2. At what level is this dose?

Elevated Warfarin dosage is regulated according to the INR (derived from the prothrombin [PT] time), for which a therapeutic value is between 2.0 to 3.0 in most conditions. A therapeutic PT value is approximately 1.5 times the control, or 18 seconds. (less)

As part of a routine physical examination, a 60-year-old client's primary care provider has ordered blood work that includes cholesterol levels. What result would strongly suggest the need for an antihyperlipidemic drug?

Elevated LDL levels

The nurse instructs a patient to take his prescribed simvastatin at bedtime to promote:

Enhanced drug effectiveness

A client is admitted with thrombophlebitis and sent home on enoxaparin therapy. Which statement indicates a good understanding of why enoxaparin is being administered?

Enoxaparin inhibits the formation of additional clots.

Creatinine Kinase (CK)

Enzyme present in large amounts in brain tissue and heart and skeletal muscle that is measured to aid in diagnosing heart attack

There are two pathways that can be activated by the coagulation process. One pathway begins when factor XII is activated. The other pathway begins when there is trauma to a blood vessel. What are these pathways?

Extrinsic and intrinsic pathways

Why is cholesterol important?

Fat digestion and cell structure

Fenofibric Acid

Fibrate

A nurse is caring for a client prescribed nicotinic acid for hyperlipidemia. The nurse would assess the client for which findings as a possibility? Weakness Flushing of the skin Tachycardia Dyspnea

Flushing of the skin

A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment?

Frequently monitor blood cholesterol.

Statin side effects

GI upset

Fibric Acid Derivatives

Gemfibrozil Fenofibrate

Which juice should be avoided when taking a statin?

Grapefruit

Statin

HMG-CoA reductase inhibitor

-statin

HMG-CoA reductase inhibitor Lower LDL

Which drug is most effective in reducing most major types of dyslipidemia in patients at risk or who have already developed CAD?

HMG-CoA reductase inhibitors

Types of lipid lowering agents

HMG-CoA reductase inhibitors (statins) Bile acid resins Ezetimibe Fibrates Niacin PCSK9 inhibitors

A nurse is providing care to a client who has elevated levels of low-density lipoprotein (LDL). A review of the client's history reveals a sedentary lifestyle and a history of being overweight. The nurse understands that this combination of factors places the client at risk for which condition?

Heart disease

Natural anticoagulants include

Heparin

The nurse is preparing to administer protamine emergently to a client per instructions from the health care provider. The nurse concludes this is necessary due to an adverse reaction to which drug?

Heparin Explanation: An overdosage of any anticoagulant may result in uncontrolled bleeding in the client. In most cases, discontinuation of the drug is usually sufficient to correct overdosage; however, if the bleeding is severe there are antidotes. Protamine is used to treat overdose of heparin and low-molecular-weight heparins (LMWHs). Vitamin K is used to treat the overdosage of warfarin. Alteplase and clopidogrel do not require antidotes

What is the most common reason for an elevated cholesterol level in a client who does not have a genetic disorder of lipid metabolism?

His dietary intake of saturated fat

Warfarin lab

INR 2-3

Eptifibatide route

IV

When should a statin be administered?

In the evening

The nurse administers epoetin alfa (Epogen). What is the therapeutic response the nurse expects to assess?

Increased red blood cell count

Gemfibrozil lowers cholesterol via which following mechanisms? (Select all that apply.)

Increases excretion of cholesterol Reduces very-low-density lipoproteins (VLDL) Reduces production of triglycerides

What lab value should be monitored for a patient on warfarin?

International normalized ratio (INR)

A patient is ordered subcutaneous heparin every 8 hours. When the patient asks what this medication is for, what is the nurse's best answer?

It is to prevent you from developing blood clot

How does warfarin work?

It suppresses vitamin K and "thins" the blood.

PCSK9 inhibitors MOA

LDL receptors (LDL-R) clear LDL PCSK9 causes LDL-R to be degraded PCSK9 inhibitors cause LDL-R to not be degraded More LDL-R, the more clearance of LDL

Disseminated Intravascular Coagulation (DIC)

Medical emergency— excessive blood clot

Which adverse effect would a nurse expect to assess in a client taking ezetimibe?

Mild abdominal pain

Which intervention should be implemented for patients on any medications that increase the risk of bleeding?

Monitor for dark stools.

Evolocumab

PCSK9 inhibitor

Warfarin Lab

PT/INR

Warfarin labs

PT/INR

A nurse is conducting a community presentation on heart disease, cholesterol, and risk factors. The nurse determines that the class has been successful when the class correctly chooses which point as true?

Physical activity raises HDL cholesterol levels.

HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category?

Pregnancy category X

Lack of rbc production due to inability absorb vit b12

Prenicious Anemia

A male client is receiving heparin by continuous intravenous infusion. The nurse will instruct the client and family members to report what should it occur?

Presence of blood in urine or stools

A nurse is conducting an assessment on a client who has recently undergone exploratory laparotomy. The nurse notes the continued order for enoxaparin. The nurse predicts this is to accomplish which goal?

Prevent formation of a blood clot

The pharmacology instructor is discussing heparin with the students. How would the instructor explain the action of heparin?

Promotes the inactivation of clotting factors

For what purpose would the nurse administer postoperative epoetin alfa to the client who is a Jehovah's Witness?

Reduce the need for allogenic blood transfusion

Hemophilia treatment

Replacing the missing clotting factors. Replacement therapy. blood transfusion.

Enoxaparin route

SQ

nicotinic acid adverse effects

Skin (flushing, itching) Intense flushing initially; can pretreat with aspirin Decreased with sustained-release (SR) version of niacin Gastrointestinal Hepatotoxicity Hyperglycemia Gouty arthritis Can raise blood levels of uric acid

HMG— CoA

Statin

antihemophilic factor

Stop bleeding

Heparin route

SubQ or IV

A patient is on a heparin infusion. How does the nurse know if the medication is infusing at a therapeutic rate?

The activated partial thromboplastin clotting time (aPTT) is 1.5 to 2.5 times the normal time.

A client is on warfarin therapy for atrial fibrillation and the INR is 4.2 with no protocols for adjustment. What is the priority action by the nurse?

The nurse should hold the medication and notify the health care provider.

A client prescribed epoetin alfa requests changing the medication from the subcutaneous to the oral route. Which statement should the nurse use to formulate a response to this request?

This drug is destroyed by acids found in the stomach.

After teaching a group of students about metabolic syndrome, the instructor determines that the teaching was successful when the students identify which characteristic?

Triglyceride level above 150 mg/dL

The component of the red blood cell that is not recycled is bilirubin.

True Explanation: The only part of the RBC that cannot be recycled is the toxic pigment bilirubin, which is conjugated in the liver, passed into the bile, and excreted from the body in the feces or the urine.

Cyanocobalamin is a vitamin B12 in a nasal formulation.

True EXP: Vitamin B12 includes hydroxocobalamin (generic), an injectable drug, and cyanocobalamin (Nascobal), a nasal spray.

Hydroxocobalamin

Vitamin B12

pernicious anemia

Vitamin B12 deficiency

Pernicious anemia treatment

Vitamin B12 injections

Warfarin antidote

Vitamin K

When administering iron injections, which method would the nurse use?

Z-track intramuscular

ischemic stroke

a type of stroke that occurs when the flow of blood to the brain is blocked

A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the client's:

aPTT

A patient is on a heparin infusion. Which lab value is used to titrate this medication?

aPTT

Lack of RBC production due to poisoning of bone marrow

aplastic anemia

A client with acute coronary syndrome is prescribed clopidogrel. Which additional medication will the nurse expect to be prescribed for this client?

aspirin

A patient who recently started taking a statin reports new muscle cramps and weakness. What is the nurse's priority intervention?

assess for rhabdomyolysis

A 62-year-old man has been prescribed extended-release lovastatin. The nurse will instruct the patient to take the medication:

at bedtime

Cholestyramine

bile acid sequestrant

The home care nurse is caring for a client who is self-administering epoetin. What assessment is most important for the nurse to complete during the visit?

blood pressure

Which category of blood lipids is involved in the formation of atherosclerotic plaques?

cholesterol

Bile Acid Sequestrants

cholestyramine

Which would be classified as a bile acid sequestrant?

cholestyramine

While reviewing a client's the record, the nurse sees that the client received a dose of interferon alpha-2b? For what disorder does the nurse suspect the client was being treated?

chronic hepatitis C

A nurse is caring for a client receiving cholestyramine to improve his blood lipid profile at a home care setting. What adverse reactions to cholestyramine should the nurse monitor in the client?

constipation

iron can cause

constipation and dark stools, statin of teeth Bleeding

plasminogen activators

convert plasminogen to plasmin

CAD

coronary artery disease

A client with a history of clot formation is scheduled for bowel resection due to colorectal cancer. What anticoagulant agent will be administered prophylactically?

dalteparin

A client has had cholestyramine added to his or her treatment plan for dyslipidemia. What effect will cholestyramine have on the pharmacokinetics of the thiazide diuretic that the client is currently prescribed?

decreased absorption

DIC

disseminated intravascular coagulation

Alteplase

dissolves blood clots

thrombolytic

dissolves or causes a thrombus to break up

Statins

drugs used to lower cholesterol in the bloodstream

low molecular weight heparin

enoxaparin

A client has chronic renal failure. As the disease progresses, the client is experiencing increasing shortness of breath, due to anemia. The nurse would anticipate which medication order?

epoetin alfa

epoetin alfa class

erythropoiesis stimulating agent

aplastic anemia

failure of blood cell production in the bone marrow

Gemfibrozil MOA

fibric acid derivatives activate PPARalpha, which increase lipolysis and elimination of triglyceride rich particles from plasma.

Cholesterol function

helps maintain flexibility of membrane

A postsurgical client possesses numerous risk factors for venous thromboembolism, including a previous deep vein thrombosis. What drug would the nurse anticipate administering while this client recovers in the hospital?

heparin Explanation: Heparin is frequently used to prevent postsurgical venous thromboembolism. Antiplatelet drugs do not have this indication, and vitamin K would increase the client's risks.

Mr. Hon has been admitted to the hospital and placed on anticoagulant therapy. For what blood-related disorder is this therapy used?

hypercoagulation

Statin drugs

hyperlipidemia drugs that reduce cholesterol by blocking the enzyme necessary for cholesterol production in the liver; HMG-CoA reductase inhibitor drugs

Statin should be taken

in the evening or before bedtime

A nurse is caring for a client receiving warfarin drug therapy. The client informs the nurse that they are also taking chamomile, which is an herbal remedy. The nurse would alert the client to which adverse effects?

increased risk for bleeding

Ezetimibe MOA

inhibits absorption of cholesterol in small intestine

Aminocaproic acid moa

inhibits plasminogen activation

Heparin route

intravenous (IV) or subcutaneous

A male client is self-administering epoetin in the home. The nurse encourages him to include what supplements as part of his daily medication regimen?

iron

A patient comes to the clinic reporting fatigue and pica. Laboratory findings reveal a low serum iron level and a low ferritin level. Upon evaluation of this assessment and laboratory data, the nurse suspects that the patient will be diagnosed with:

iron deficiency anemia

Ferrous Sulfate

iron supplement

LDL range

less than 130

An elderly client with dyslipidemia has had fenofibrate added to the existing medication regimen. In addition to having the lipid profile drawn on a regular basis, the nurse should educate the client about the need for what ongoing laboratory testing during therapy?

liver panel

A client will begin taking atorvastatin, and the nurse is conducting relevant health education. The nurse should emphasize the need to report any new onset of:

muscle pain

A nurse at a long-term care facility is conducting a medication reconciliation for a client who has just moved into the facility. The client is currently taking clopidogrel. The nurse is most justified suspecting that this client has a history of what condition?

myocardial infarction

hemorrhagic stroke

occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed

How should intravenous (IV) heparin be administered?

on a pump with guardrails

clopidogrel route

oral

herparin lab

partial thromboplastin time (PTT)

Mr. Bradford is a 66-year-old smoker with a diagnosis of peripheral vascular disease who experiences lower leg pain when walking. In the last several months, his leg pain has progressed to the point where he now needs to take a rest when walking from the elevator to his apartment. Mr. Bradford has now sought care from his primary care provider, who would likely be justified in prescribing

pentoxifylline (Trental). The hemorheologic drugs, such as pentoxifylline is used to manage the symptoms of intermittent claudication from peripheral vascular disease. Using this drug improves the patient's ability to walk for longer distances without pain. Warfarin, alteplase, and ASA are not used to decrease blood viscosity and resolve the impaired perfusion associated with peripheral vascular disease. (less)

Heparin antidote

protamine sulfate

herparin antidote

protamine sulfate

A client accidentally ingested extra doses of warfarin at home and now presents with an elevated INR and bleeding. Which medication will the nurse prepare as prescribed to administer along with vitamin K?

prothrombin complex concentrate

A client has been largely unsuccessful in achieving adequate control of dyslipidemia through lifestyle changes and the use of a statin. As a result, the client has been prescribed cholestyramine. What change in this client's lipid profile will the nurse identify as the most likely goal of therapy?

reduction in LDL cholesterol levels

Which single class drug is known to be most effective in reducing the major types of dyslipidemia?

statins

All hematopoietic and immune blood cells are derived from which cells in the bone marrow?

stem cells

A student nurse is caring for a client who is receiving a hematopoietic agent. To test the student's understanding, the nursing instructor states that the drug could be administered by what route?

subcutaneous or intravenous

A client, currently prescribed epoetin alfa, has recent blood work that reveals a hemoglobin level of 12.8 g/dL. What action does this assessment finding necessitate regarding the epoetin alfa?

temporarily withholding administration

Alteplase

thrombolytic

tarry stool

upper GI bleed

After teaching a group of students about drugs used to treat hyperlipidemia, the instructor determines that the teaching was successful when the students identify which of the following? Select all that apply.

• HMG-CoA reductase inhibitors • Fibric acid derivatives • Bile acid resins

To effectively prevent or manage metabolic syndrome, what should the desired blood lipid profile include? (Select all that apply.)

• Low triglycerides • High HDL cholesterol • Low LDL cholesterol