The Hematologic System Test ATI

A nurse is administering epoetin intravenously to a client who has renal failure. What action should the nurse take?

Administer via IV bolus over 1 to 3 min - Instructions for administering the drug include administering it via IV bolus over 1 to 3 min.

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

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> What drug 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. What action 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 what drug inhibits the action of adenosine diphosphate receptors [ADP] on platelets and can be prescribed to reduce the client's risk for myocardial infarction?

Clopidogrel - A 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 what adverse effect?

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 iron toxicity. What drug 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 what topics to promote the effectiveness of the drug?

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 teaching a client about ferrous sulfate to treat iron-deficiency anemia. What instructions should the nurse include?

Eat iron-enriched foods: 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: 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: 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. Increase dietary fiber intake: 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 what 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 drug.

A nurse is caring for a client who is taking filgrastim to treat neutropenia. The nurse should assess the client for what adverse effect?

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 who recently started alteplase therapy. The nurse should monitor the client for what adverse effects?

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.

A nurse is reviewing the medication record of a client who is receiving alteplase following an acute myocardial infarction [MI]. What medication should the nurse expect the client to be taking in addition to the alteplase?

Heparin - Heparin therapy should be initiated before alteplase therapy and continued for at least 48 to 72 hr after the fibrinolytic therapy to reduce the risk of additional clot formation.

A nurse is caring for a client who has renal failure and is receiving epoetin. The nurse should monitor the client for what adverse effect?

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 what mechanism?

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 what 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. What finding should the 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 what 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 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 what complication?

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 what 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. What drug should the nurse expect to administer to the client?

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

A nurse is caring for a client who is about to begin factor VIII therapy to treat hemophilia A. When administering factor VIII, what action 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 drugs readily available.

A nurse is caring for a client who is taking clopidogrel to prevent stent restenosis. The nurse should monitor the client for what adverse reaction?

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 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 what?

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.

A nurse is caring for a client who is about to begin taking epoetin. An increase in what laboratory values should indicate to the nurse that the therapy is effective?

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.