Professor quiz exam 3

46. Whenever a nurse is caring for clients who are receiving warfarin (Coumadin), which of the following medications should the nurse have on hand in the event of an overdose? ​Epinephrine ​Atropine ​Protamine ​Vitamin K

Vitamin K MY ANSWER​Vitamin K reverses the effects of warfarin. EXTRA :​ Epinephrine ​Epinephrine treats anaphylaxis, not a warfarin overdose. ​Atropine ​Atropine treats bradycardia, not a warfarin overdose. ​Protamine ​Protamine reverses the effects of heparin, not warfarin.

*Practice b quiz* `***** #58. A nurse is caring for a client who is receiving haloperidol. The nurse should observe for which of the following findings as an adverse effect of the medication? Akathisia Paresthesia Excess tear production Anxiety

akathisia

A nurse is assessing a client who comes to the clinic for a seasonal influenza vaccine. The client says he read about an influenza vaccine that is given as a nasal spray and wants to receive it. Which of the following is a contraindication for theclient to receiving the live attenuated influenza vaccine (LAIV)? Just turned 62 Smokes one pack of cigarettes a day Has a history of myocardial infarction Recent traveled to Europe

1. Just turned 62 Clients must be between the ages of 2 and 49 to receive the LIAV; therefore, it is contraindicated for this client. Pregnancy and immunocompromised status are also contraindications.

A nurse is caring for an adolescent client who has a sarcoma of the femur and is admitted for chemotherapy. The client is to receive ifosfamide (Ifex) and mesna (Mesnex). The nurse should assess for which of the following manifestations of a serious adverse reaction? Painful urination and hematuria Dependent edema and dyspnea Fatigue and muscle weakness Paresthesia and paralysis

1. Ifosfamide, an antineoplastic, is an alkylating agent that slows or stops the growth of cancer cells. Ifosfamide can cause hemorrhagic cystitis, a serious urinary system side effect. The client will be given mesna, a hemorrhagic cystitis prophylactic medication, and will receive intravenous hydration to prevent damage to the kidneys and bladder. The nurse should monitor the client for the development of hemorrhagic cystitis by assessing for the presence of painful urination or hematuria.

​18. A nurse is teaching a client who has multiple sclerosis about starting therapy with baclofen (Lioresal). Which of the following instructions should the nurse include? ​Avoid driving until the drug's effects are evident. ​Take the medication on an empty stomach. ​Stop taking the drug immediately for headache. ​Expect to develop diarrhea initially.

1. Several CNS-related effects are common, including drowsiness, dizziness, headache, and confusion. Therefore, until the client knows show the medication will affect him, he should not drive a vehicle.

A nurse is caring for a 2-year-old child who is receiving phenytoin (Dilantin) in suspension form. Which of the following actions should the nurse take before administering each dose? Shake the container vigorously. Be sure the child has not eaten within the hour. Perform mouth care. Check the child's blood pressure

1. Shake the container vigorously. A suspension form of medication refers to one in which the particles of medication are mixed with, but not dissolved in, a fluid. It is important for the nurse to shake the container that contains the suspension, because the child can be under-medicated if the medication is not evenly distributed. EXTRA Be sure the child has not eaten within the hour. Phenytoin is a gastric irritant. It should be given with meals to decrease gastric upset. Perform mouth care. Mouth care is not necessary prior to every dose. Check the child's blood pressure. MY ANSWERWhen giving the oral form of phenytoin, this action is not necessary.

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1. Valium has sedative properties, so the client should not engage in potentially hazardous activities after receiving diazepam EXTRA:Clients who take monoamine oxidase inhibitors must avoid foods that contain tyramine.​Although grapefruit juice can affect the metabolism of many medications, generally raising their blood levels, diazepam is not among them.

A nurse is teaching a client who is about to start therapy with methotrexate (Rheumatrex) to treat rheumatoid arthritis. Which of the following instructions should the nurse include? (Select all that apply.) ​Expect to feel the medication's effects immediately. ​Do not drink alcoholic beverages. ​Report unexplained bruising to the provider. ​Avoid people who have infections. ​Take ascorbic acid to help minimize side effects.

2,3,4, ​Expect to feel the medication's effects immediately is incorrect. It may take 4 to 6 weeks to achieve the drug's therapeutic effects. Do not drink alcoholic beverages is correct. Alcohol ingestion can increase the risk of liver damage. Report unexplained bruising to the provider is correct. Methotrexate can cause thrombocytopenia. Clients should report bruising or petechiae as they may indicate a low platelet count. Avoid people who have infections is correct. Methotrexate causes bone marrow suppression and increases the risk for infection. Take ascorbic acid to help minimize side effects is incorrect. Providers sometimes prescribe folic acid to help minimize the side effects of methotrexate.

nurse is providing discharge teaching for a client who has a new prescription for warfarin sodium (Coumadin). Which of the following should the nurse include in the teaching? ​Mild nosebleeds are common during initial treatment. ​He should use an electric razor while on this medication. ​If he misses a dose, he should double the dose at the next scheduled time. ​Coumadin increases the risk for deep vein thrombosis.

2. He should use an electric razor while on this medication. MY ANSWER​Coumadin, an anticoagulant, increases the client's risk for bleeding. The nurse should teach the client safety measure, such as using an electric razor, to decrease the risk for injury and bleeding. EXTRA: ​If he misses a dose, he should double the dose at the next scheduled time. ​Coumadin, an anticoagulant, should be taken at the same time each day and the client should not adjust the dose. Doubling a dose increases the client's risk for bleeding. ​Coumadin increases the risk for deep vein thrombosis. ​Coumadin, an anticoagulant, is a medication for the prophylaxis and treatment of deep vein thrombosis.Coumadin, an anticoagulant, increases the client's risk for bleeding. The nurse should instruct the client to stop the medication and notify the provider if signs of bleeding are present.

A nurse is caring for a client who has been prescribed timolol (Timoptic). Which of the following is the appropriate procedure for administration of this medication? ​Place the eyedropper gently against the sclera. ​Instill the medication directly onto the client's cornea. ​Drop prescribed amount of medication into the conjunctival sac. ​Protect the distal portion of the eye dropper using clean technique.

3 ​With the dominant hand resting on client's forehead, hold filled medication eyedropper or ophthalmic solution approximately 1-2 cm above conjunctival sac. Instill prescribed number of medication drops into the conjunctival sac. After instilling drops, ask client to close eye gently. If the client is to receive more than one eye medication to the same eye, wait at least 5 min before administering the next medication. EXTRA:Sterile technique should be used when handling the distal portion of the eyedropper. This portion of the dropper should not be exposed to any contaminates. Avoid touching any part of the application apparatus, and keep the lid in place when not in use. The risk of transmitting infection from one eye to the other is high.

A nurse is caring for a client diagnosed with thrombophlebitis who has a swollen and inflamed right calf. The client is started on a continuous heparin infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give? "It usually takes at least two to three days to reach a therapeutic blood level." "A pharmacist is the person to answer this question." "Heparin does not dissolve clots, it stops new clots from forming." "The pill that you will take after this IV will dissolve the clot.

3 "Heparin does not dissolve clots, it stops new clots from forming." EXTRA: Intravenous heparin starts to work immediately.

nurse is caring for a client who is taking ferrous sulfate (Feosol) tablets twice daily for iron-deficiency anemia. The client asks the nurse why the provider suggested that she take the ferrous sulfate with orange juice. Which of the following is an appropriate response by the nurse? "The orange juice will help you avoid becoming constipated." "The medication has an unpleasant taste, and the orange juice will help to disguise it." "The orange juice will help you absorb the medication more efficiently." "The medication can cause nausea, and the orange juice will prevent this."

3. The orange juice will help you absorb the medication more efficiently." MY ANSWERFerrous sulfate provides the iron needed by the body to produce red blood cells. Taking iron supplements with a citrus fruit juice, such as orange juice, helps to increase the bioavailability of the iron.

145. A client provides a nurse with a list of home medications. Which of the following should the nurse recognize as incompatible? ​Furosemide (Lasix) and digoxin (Lanoxin) Alprazolam (Xanax) and zolpidem (Ambien) Warfarin sodium (Coumadin) and multivitamins​ Gentamicin sulfate (Garamycin) and fluconazole (Diflucan)

3. These two medications must be considered for incompatibility. Warfarin sodium is classified as an anticoagulant used for prophylaxis and treatment of deep-vein thrombosis, pulmonary embolism, and atrial fibrillation. Multivitamins contain fat-soluble vitamins A, D, E, and K. Vitamin K is the antidote for overdosage of warfarin sodium because it assists in hepatic synthesis of blood coagulation. The amount of vitamin K in the multivitamins must be considered for incompatibility.

A client is receiving lithium carbonate (Eskalith) to treat manic behavior. The nurse caring for this client should use which of the following strategies to guide the administration of this medication? ​-Maintaining a therapeutic dose of 900 mg TID ​-Encouraging regular (serum lithium level) determination until stabilization of the maintenance dose ​-Telling the client to expect control of manic symptoms 7 to 10 days after starting lithium therapy ​-Advising the client to report muscle weakness as it indicates severe toxicity

3. ​It will take 7 to 10 days before the client experiences a decrease in the manic symptoms. EXTRA: The therapeutic dose of lithium is 300 mg TID.The client must continue regular serum lithium level determinations for the duration of medication therapy.Muscle weakness is an expected side effect and does not indicate lithium toxicity.

A nurse is preparing to administer heparin subcutaneously to a client? Which of the following techniques should the nurse use? ​Cleanse the skin with an alcohol swab, insert the needle, and aspirate and inject the heparin. ​Cleanse the skin with an alcohol swab, insert the needle, aspirate and inject the heparin, and massage the site. ​Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, and observe for bleeding. ​Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, and aspirate and observe for bleeding.

3. Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, and observe for bleeding. MY ANSWER​This is the correct technique for the nurse to use prior to injecting heparin.

8. A nurse is caring for a client who is receiving a unit of packed RBC. The nurse notices the client's face is flushing and he begins to report low back pain. Which of the following actions is the nurse's priority? ​- Stop the transfusion. ​-Administer an antihistamine. -Monitor vital signs. -Begin an infusion of 0.9% sodium chloride through new tubing.

​1. - Stop the transfusion. MY ANSWER​When using the Saftey/Greatest Risk approach to client care, the nurse should place priority on stopping the blood transfusion as even a small additional amount of blood can worsen the client's adverse reaction and will post the greatest risk to the client's safety. trash: ​The client will require antihistamines for the transfusion reaction, but this is not the priority action.The nurse should remain with the client and monitor vital signs every few minutes, but this is not the priority action. The nurse should maintain venous access with 0.9% sodium chloride, either through a different IV access site or after replacement of all infusion tubing, but this is not the priority action.

nurse is reviewing the history and physical for a client who has schizophrenia. Reported findings include jerky choreiform movements, lip smacking, and neck and back tonic contractions. These findings are chronic despite the discontinuation of chlorpromazine (Thorazine). The nurse should suspect that the client has developed which of the following adverse effects? Tardive dyskinesia ​Pseudoparkinsonism Dystonia ​Akathisia

​1. Tardive dyskinesia MY ANSWER​These findings indicate tardive dyskinesia which is persistent even with the discontinuation of the conventional antipsychotic. ​Pseudoparkinsonism ​Pseudoparkinsonism is temporary and findings usually disappear with the discontinuation of the conventional antipsychotic. ​Dystonia ​Dystonia is an acute adverse effect that is responsive to treatment and the discontinuation of the conventional antipsychotic. ​Akathisia​Akathisia disappears with the discontinuation of the conventional antipsychotic.

A nurse is caring for a client who has just begun therapy with alprazolam (Xanax) to treat anxiety. The nurse should observe the client for which of the following adverse effects of this medication? ​Sedation ​Bradycardia ​Hearing loss ​Abdominal pain

1. ​Sedation and drowsiness are common side effects of this medication. EXTRA:​Bradycardia ​Alprazolam is more likely to cause tachycardia than bradycardia. ​Hearing loss ​Alprazolam is more likely to cause blurred vision than hearing loss. ​Abdominal pain ​Alprazolam is more likely to cause headache than abdominal pain.

*Practice b quiz* `***** #56. A nurse is assessing a client who is receiving epoetin alfa to treat anemia. Which of the following findings should the nurse monitor? Paresthesia Increased blood pressure Fever Respiratory depression

Increased blood pressure

45. A nurse is monitoring a client who is receiving a parental lipid infusion. Which of the following findings is the highest priority for the nurse to report to the provider? ​Elevated temperature ​Hyperlipidemia ​Periorbital edema ​Erythema at the insertion site

1. The nurse should immediately report an elevated temperature to the provider as this is a potential sign of an allergic reaction or fat overload syndrome. According to the safety and risk reduction priority setting framework, this finding is the highest priority.

​A charge nurse is assessing a newly licensed nurse's understanding of the need to administer 0.9% sodium chloride with packed RBC for a client who has anemia. Which of the following statements by the newly licensed nurse indicates an understanding of this intervention? ​"These products should be administered together to decrease the risk of hemolysis." ​"0.9% sodium chloride decreases the risk of an allergic reaction during the transfusion." ​"When these products are administered together the risk for circulatory overload is decreased." ​"0.9% sodium chloride decreases the risk of bacterial contamination during a transfusion."

1. These products should be administered together to decrease the risk of hemolysis." MY ANSWER​The nurse should administer 0.9% sodium chloride with blood products to decrease the risk for clotting and hemolysis.

A nurse is caring for a client who has prostate cancer. The nurse should expect the provider to prescribe which of the following medications for this client? ​Leuprolide (Lupron) ​Cyclophosphamide (Cytoxan) ​Finasteride (Proscar) ​Tamoxifen (Nolvadex)

1. ​Leuprolide (Lupron) MY ANSWER​Leuprolide treats cancer of the prostate hormonally. It antagonizes the androgens that androgen-dependent neoplasms require.

provider prescribes a transfusion of one unit of packed RBC for a client who has a low hemoglobin level. The provider also prescribes diphenhydramine (Benadryl) for administration before the transfusion to prevent ​urticaria. ​fever. ​fluid overload. ​hemolysis.

1. ​urticaria. aka hives​ For clients who have previously had allergic reactions to blood transfusions, administering an antihistamine such as diphenhydramine (Benadryl) before transfusion may prevent future reactions. Allergic reactions typically include urticaria (hives).

an older adult client's provider prescribes aspirin, 650 mg/q6h PO to treat rheumatoid arthritis. The nurse should teach the client that a possible adverse effect of aspirin therapy is ​constipation. ​bleeding. ​blurred vision. ​insomnia.

2. ​Aspirin can cause bleeding, tinnitus, gastric ulceration, nausea, and heartburn.

223. a nurse is talking with a client who is about to undergo hip arthroplasty. The nurse explains that the surgeon will prescribe anticoagulant therapy to prevent deep-vein thrombosis postoperatively. The nurse should explain that the client will not require frequent clotting time determinations because the surgeon plans to prescribe which of the following medications? ​Aspirin ​Enoxaparin (Lovenox) ​Heparin ​Warfarin (Coumadin)

2. Enoxaparin (Lovenox) ​Enoxaparin (Lovenox) is a low molecular heparin that inhibits thrombus and clot formation. Preventive doses are low and the client does not require monitoring of prothrombin time or activated partial thromboplastin time. EXTRA:Heparin and W therapy requires frequent monitoring of clotting times. Aspirin can cause bleeding. The surgeon would not prescribe this medication for a client who undergoing hip arthroplasty.

233. A nurse is teaching a patient who has rheumatoid arthritis about taking methotrexate (Rheumatrex). The nurse should tell the patient to ​take it with food to reduce gastric irritation. ​drink 2 to 3 L of water per day to promote its excretion. ​take an NSAID to help reduce toxicity. ​take it in the morning to prevent insomnia

2. ​drink 2 to 3 L of water per day to promote its excretion. ​Methotrexate can cause renal toxicity. Adequate hydration promotes its excretion and helps prevent this adverse effect. EXTRA:The client should take methotrexate on an empty stomach.Methotrexate is more likely to cause drowsiness than insomnia.

A nurse is monitoring a client's transfusion of packed red blood cells and suspects that a hemolytic reaction is occurring. Which of the following is the priority intervention? ​Assess the client's respiratory rate. ​Administer 0.9% sodium chloride through the IV line. ​Stop the transfusion. ​Notify the blood bank

3 When suspecting a hemolytic reaction the priority action by the nurse is to immediately stop the transfusion to prevent further hemolysis. eXTRA THEN Assess the client's respiratory rate. ​Administer 0.9% sodium chloride through the IV line. ​. ​Notify the blood bank

A nurse is caring for a client who has a prescription for clozapine (Clozaril). Which of the following is an expected response to this medication? ​Development of orthostatic hypotension. ​Control of seizure activity . ​Decreased auditory hallucinations. ​Increased energy level and involvement in activities.

3 ​Clozapine is prescribed for the treatment of psychotic findings which include auditory hallucinations. SCHIZOPHRENIA

A nurse is teaching about ferrous iron to a parent of a child with iron deficiency anemia. Which of the following should be included in the teaching? Administer ferrous iron with milk Administer ferrous iron with meals Administer ferrous iron with fruit juice Administer ferrous iron with yogurt

3. Administer ferrous iron with fruit juice Ferrous iron is best absorbed with an acidic environment. Therefore, administering with fruit juice is recommended. EXTRA:Ferrous iron is best absorbed with an acidic environment. Therefore, administering with meals is not recommended.

A nurse has just administered a dose of diazepam (Valium) to a client. Which of the following actions should the nurse take before she leaves the client's room? ​Turn off the overhead lights. ​Reduce the ringer volume on the client's telephone. ​Put up the side rails on the client's bed. ​Turn off the client's television.

3. Put up the side rails on the client's bed. MY ANSWER​Diazepam is a benzodiazepine that causes sedation and has antianxiety and muscle relaxation properties. For the client's safety, the nurse should raise the side rails, place the bed in the lowest position, and make sure the client's call light access device is within reach.

212. A nurse at an ophthalmology clinic is caring for a client who has open-angle glaucoma. The client is started on a treatment regimen of timolol (Timoptic) and pilocarpine (Pilocar) eye drops. The nurse should understand that these medications will be administered when the client is experiencing eye pain. until the client's intraocular pressure returns to normal. on a regular schedule for the rest of the client's life. for approximately 10 days, followed by a gradual tapering off.

3. on a regular schedule for the rest of the client's life. Medications prescribed for glaucoma are intended to enhance aqueous outflow, or decrease its production, or both. The client must continue the eye drops on an uninterrupted basis for life. EXTRA:

A nurse is preparing to initiate a transfusion of packed RBC for a client who has anemia. Which of the following rates is appropriate when the nurse starts the transfusion? ​10 mL/min for 10 minutes. ​20 mL/min for 10 minutes. ​5 mL/min for 15 minutes. ​15 mL/min for 15 minutes

3. ​5 mL/min for 15 minutes. ​The nurse should begin the transfusion no faster than 5 mL/min during the first 15 minutes in order to decrease the risk for adverse reactions.

**@@@@139. A nurse is caring for a client who has a hip fracture. The nurse should expect the provider to prescribe which of the following medications for prophylactic anticoagulant therapy? ​Aspirin ​Clopidogrel (Plavix) ​Heparin ​Warfarin (Coumadin)

3. ​Heparin ​A client who has a hip fracture requires the immediate anticoagulant prophylaxis heparin therapy provides. EXTRA:Aspirin ​Although aspirin has anticoagulant effects, clients generally take it for ongoing primary prevention of cardiovascular and cerebrovascular events, not for the immediate anticoagulant effects a client with a hip fracture requires. ​Clopidogrel (Plavix) ​Clopidogrel is an oral antiplatelet drug clients take to prevent stenosis of coronary stents and for some secondary prevention indications, not for the immediate anticoagulant effects a client with a hip fracture requires. ​Warfarin (Coumadin) MY ANSWER​Warfarin is an oral anticoagulant clients take for long-term anticoagulant prophylaxis, not for the immediate anticoagulant effects a client with a hip fracture requires.

A nurse is preparing to administer heparin to a client via the deep subcutaneous (intrafat) route. Which of the following is an appropriate action for administering this medication? ​Use a 22-gauge needle to inject the medication. ​Use a 1-inch needle to inject the medication. ​Inject the medication into the abdomen above the level of the iliac crest. ​Massage the injection site after administration of the medication.

3. ​Inject the medication into the abdomen above the level of the iliac crest. ​The nurse should inject the medication into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus. EXTRA:​The nurse should use a small needle, 25- or 26-gauge, when administering a deep subcutaneous injection.​ The nurse should use a short needle, 1/2- to 5/8-inch, when administering a deep subcutaneous injection.​ The nurse should apply firm pressure without massage to the site for 1 to 2 min after administration. Massaging the area after injecting heparin can cause bleeding.

A nurse is providing discharge teaching to a client who will be taking warfarin (Coumadin) at home. Which of the following statements indicates that the client understands the effects of this medication? ​"It's okay to have a couple of glasses of wine with dinner." ​"I'll be sure to eat foods with lots of vitamin K." ​"I'll take aspirin for my headaches." ​"I'll use my electric razor for shaving

4 . ​"I'll use my electric razor for shaving." ​Because this medication prolongs clotting times, the client should avoid situations that put him at risk for bleeding, such as shaving with a straight razor or a razor blade.

NOT ON EXAM 185. A nurse is preparing to administer digoxin (Lanoxin) to a client who has heart failure. Which of the following actions is appropriate? ​Withholding the medication if the heart rate is above 100/min ​Instructing the client to eat foods that are low in potassium ​Measuring apical pulse rate for 30 seconds before administration ​Evaluating the client for nausea, vomiting, and anorexia

4 ​Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity.

A charge nurse is evaluating the care of a newly licensed nurse as he cares for a client who is receiving a transfusion of packed RBC. The nurse suspects a possible hemolytic reaction. After stopping the blood transfusion, which of the following actions by the newly licensed nurse requires intervention by the charge nurse? ​The nurse initiates an infusion of 0.9% sodium chloride. ​The nurse collects a urine specimen. ​The nurse sends a blood specimen to the laboratory. ​The nurse starts the transfusion of another unit of blood product.

4. When suspecting a hemolytic reaction, the nurse should immediately stop the transfusion of all blood products. The transfusion of additional products can increase the client's risk for further complication. EXTRA:When suspecting a hemolytic reaction, the nurse should maintain IV access and blood volume with an infusion of 0.9% sodium chloride. When suspecting a hemolytic reaction, the nurse should obtain a urine specimen to assess for the presence of hemoglobin in the urine.When suspecting a hemolytic reaction, the nurse should obtain a blood specimen from the client for laboratory analysis.

trrsah. A client who has left ventricular failure and a high pulmonary capillary wedge pressure (PCWP) is receiving dopamine IV to improve ventricular function. Which of the following changes indicates to the nurse that the medication is having a therapeutic effect? systolic blood pressure increases. ​ ​QRS width increases. ​Apical heart rate increases. ​PCWP increases.

​1. Systolic blood pressure increases. ​When dopamine has a therapeutic effect, it causes vasoconstriction peripherally and increases systolic blood pressure.

2. A nurse is assessing a client who has numerous bruises on his upper extremities. The client reports that he has taken warfarin (Coumadin) daily for the past 3 months. Which of the following statements by the client indicates the client needs further teaching? "I have started taking ginger root to treat my joint stiffness." "I take Tylenol whenever I have a headache." "I eat a green salad every night with dinner." "I had my INR checked three weeks ago

1. Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching.

Whenever a nurse is caring for clients who are receiving heparin, which of the following medications should the nurse have on hand in the event of an overdose? ​Iron ​Glucagon ​Protamine ​Vitamin K

3

34. A nurse is assessing an older adult client who is receiving digoxin (Lanoxin). To evaluate the client for digoxin toxicity, the nurse should check for which of the following manifestations? ​Anorexia ​Ataxia ​Photosensitivity ​Jaundice

1. Anorexia, vomiting, confusion, headache, and vision changes are typical manifestations of digoxin toxicity in older adult clients.

6. A nurse is caring for a client who is hospitalized with deep vein thrombosis and has been on IV heparin for 5 days. The provider prescribes oral warfarin (Coumadin) without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following is an appropriate nursing response? "The Coumadin takes several days to work, so the IV heparin will be used until the Coumadin reaches a therapeutic level." "I will call the provider to get a prescription for discontinuing the IV heparin today." "Both heparin and Coumadin work together to dissolve the clots." "The IV heparin increases the effects of the Coumadin and decreases the length of your hospital stay."

1. Heparin and warfarin are both anticoagulants that decrease the clotting ability of the blood and help prevent thrombosis formation in the blood vessels. However, these medications work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which is usually within 1 to 5 days. When the client's PT and INR are within therapeutic range, the heparin can be discontinued.

A client is to receive a unit of packed red blood cells. The nurse should prime the blood administration tubing using which of the following IV solutions? ​Lactated Ringer's solution ​0.9% sodium chloride ​Dextrose 5% in water ​Dextrose 5% in 0.45% sodium chloride

2 0.9% sodium chloride MY ANSWER​The nurse should prime the tubing with 0.9% sodium chloride, as this is the only IV solution that does not hemolyze RBCs.

162. A nurse is caring for a client who is recovering from surgical placement of an artificial heart valve and is to be started on warfarin (Coumadin) prior to discharge. Which of the following diagnostic tests should the nurse use to monitor the effect of this therapy? Platelet count Prothrombin time (PT) Bleeding time aPTT

2 Prothrombin time (PT) MY ANSWERThis test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation. EXTRA:Bleeding time This test is not used to monitor therapeutic anticoagulation. Abnormal bleeding time results are usually associated with platelet dysfunction. aPTT This test is used to monitor heparin, not warfarin, therapy.

167. A nurse in a regional oncology center is recording the dose of doxorubicin (Adriamycin) that a client receives with each visit. The nurse should know that this medication has a maximum lifetime cumulative dose range due to the risk for irreversible myelosuppression. alopecia. cardiomyopathy. paresthesia.

3 cardiomyopathy. Doxorubicin is an antineoplastic antibiotic used in the treatment of various cancers. Irreversible cardiomyopathy with congestive heart failure can result from repeated doses of doxorubicin, and prolonged use can also cause severe heart damage, even years after the client has stopped taking it. The maximum cumulative dose a client should receive is 550 mg/m2 or 450 mg/m2 with a history of radiation to the mediastinum.

A nurse is caring for a client who is HIV positive and is started on zidovudine (AZT). The nurse should monitor the client for which of the following life-threatening side effects of this medication? Cardiac dysrhythmia Fever Renal failure Aplastic anemia

4. Aplastic anemia MY ANSWERSevere myelosuppression bone marrow depression) that results in anemia (decreased red blood cells), agranulocytosis (decreased white blood cells), and thrombocytopenia (decreased platelets) is a life-threatening adverse reaction to zidovudine therapy. Consequently, zidovudine must be used cautiously in clients already experiencing myelosuppression, and the client must be monitored with a CBC performed every few weeks for early detection of marrow failure.

51. nurse is caring for client who has a prescription for phenytoin (Dilantin). For which of the following findings should the nurse instruct the client to notify the provider? ​Headache ​Insomnia ​Skin rash ​Gastric discomfort

Skin rash ​Phenytoin is an antiepileptic medication used to treat partial seizures and generalized tonic-clonic seizures. It slows the entrance of sodium and calcium back into the neuron and extends the time it takes for the nerve to return to its active state. Phenytoin can cause a rash that may progress to more serious conditions, such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). If a rash develops, the client should notify the provider immediately and stop the use of phenytoin EXTRA:Headache is not an adverse reaction of phenytoin. Adverse effects include sedation, ataxia, diplopia, cognitive impairment, skin rash, dysrhythmias, hypotension, hirsutism, and gingival hyperplasia.

15. A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects? ​Vitamin K ​Protamine sulfate ​Acetylcysteine (Mucomyst) ​Deferoxamine (Desferal)

​Protamine sulfate MY ANSWER​ Protamine sulfate reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties. EXTRA: ​A chelating agent such as deferoxamine binds to iron to reduce iron toxicity from supplemental iron therapy. It does not reverse the effects of heparin toxicity.Vitamin K reverses the effects of warfarin (Coumadin), not heparin, by promoting the synthesis of coagulation factors VI, IX, X and prothrombin