Nursing 3100 Exam #2: Hematology and Coagulation Medications, Exams of Nursing

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A health care professional is caring for a patient who is about to begin taking epoetin alfa (Epogen). Which of the following laboratory values should increase with effective therapy? a) PT b) WBC c) Hgb d) Platelets - correct answer ✔✔c) Hgb A patient who is taking ferrous sulfate (Feosol) to treat iron-deficiency anemia develops severe nausea and vomiting due to iron toxicity. Which of the following drugs should the health care professional use to treat this complication? a) Flumazenil (Mazicon) b) Acetylcysteine (Acetadote) c) Naloxone d) Deferoxamine (Desferal) - correct answer ✔✔d) Deferoxamine (Desferal) A patient who is taking warfarin (Coumadin) arrives at the emergency department and reports rectal bleeding. Which of the following drugs should the health care professional have available? a) Filgrastim (Neupogen) b) Deferoxamine (Desferal) c) Protamine d) Vitamin K - correct answer ✔✔d) Vitamin K A health care professional should assess a patient who has megaloblastic anemia for indications of which of the following vitamin deficiencies?

a) Vitamin B b) Vitamin K c) Vitamin C d) Vitamin D - correct answer ✔✔a) Vitamin B A health care professional is caring for a patient who is about to begin taking clopidogrel (Plavix) to prevent thrombus formation. The health care professional should question the use of clopidogrel by a patient who has which of the following? a) Myocardial infarction b) Peptic ulcer disease c) Pancreatitis d) Myasthenia gravis - correct answer ✔✔b) Peptic ulcer disease A health care professional administers epoetin alfa (Epogen) subcutaneously to a patient who has renal failure. The health care professional should monitor the patient for which of the following adverse effects? a) Hypertension b) Muscle pain c) Edema d) Dry mouth - correct answer ✔✔a) Hypertension A health care professional is caring for a patient who is about ot begin taking folic acid to treat megaloblastic anemia. The health care professional should monitor which of the following laboratory values? a) Amylase level b) Reticulocyte count c) C-reactive protein

d) Creatinine clearance - correct answer ✔✔b) Reticulocyte count A health care professional is caring for a patient who is about to begin factor III (Advate) therapy to treat hemophilia A. When administering factor VIII, which of the following actions should the health care professional take? a) Have emergency equipment ready b) Premedicate with aspirin (Ecotrin) c) Administer via rapid IV bolus d) Administer the powdered form orally - correct answer ✔✔a) Have emergency equipment ready A health care professional is caring for a patient who is about to begin taking filgrastim (Neupogen) to treat neutropenia. The health care professional should assess the patient for which of the following adverse effects? a) Dusky nails bed b) Petechiae c) Enlarged spleen d) Swollen calf - correct answer ✔✔c) Enlarged spleen A health care professional is caring for patient who has mild hemophilia A and is about to begin taking desmopressin (DDAVP) to prevent bleeding. The health care professional should monitor for which of the following adverse reactions? a) Weight loss b) Edema c) Polyuria d) Tachycardia - correct answer ✔✔b) Edema A health care professional is caring for a patient who is about ot begin alteplase (Activase) therapy to treat pulmonary embolism. Which of the following drugs should the health care professional have available in the event of a severe adverse reaction?

a) Vitamin K b) Aminocaproic acid (Amicar) c) Protamine d) Deferoxamine (Deseferal) - correct answer ✔✔b) Aminocaproic acid (Amicar) A health care professional is caring for a patient who is about to begin taking asprin (Ecotrin) to reduce the risk of a cardiovascular event. The health care professional should understand that the drug inhibits platelet aggregation by which of the following mechanisms? a) Activating thromboxane A b) Blocking adenosine diphosphate receptor agonists c) Supressing specific clotting factors d) Inhibiting cyclooxygenase action in platelets - correct answer ✔✔d) Inhibiting cyclooxygenase action in platelets A health care professional is caring for a patient who is about to begin taking ferrous sulfate (Feosol) to treat iron-deficiency anemia. When talking with the patient about the drug, the health care professional should include which of the following instructions? (Select all that apply) a) Eat iron-enriched foods b) Spread the dosage across each day c) Take the drug on an empty stomach d) Report dark green or black stools e) Increase dietary fiber intake - correct answer ✔✔a) Eat iron-enriched foods b) Spread the dosage across each day c) Take the drug on an empty stomach e) Increase dietary fiber intake A patient is about to begin therapy with recombinant factor IX (BeneFix) to treat hemophilia B. The patient asks the health care professional about the risk of disease transmission with recombinant factor

IX, as compared with plasma-derived factor IX. The health care professional should explain that recombinant factor IX eliminates the risk of which of the following? a) HIV b) Cytomegalovirus c) Creutzfeldt-jakob disease d) Anaphylaxis - correct answer ✔✔c) Creutzfeldt-jakob disease 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? a) Rapid Pulse b) Yellowing of the sclera c) Elevated Blood pressure d) Pale-colored stools - correct answer ✔✔a) Rapid Pulse 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? a) Hyperuricemia b) Hyponatrmia c) Lyphocytopenia d) Thrombocytopenia - correct answer ✔✔d) Thrombocytopenia 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? a) Uncontrolled bleeding b) Myocardial infarction c) Respiratory depression d) Decreased renal perfusion - correct answer ✔✔a) Uncontrolled 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? a) Bronchodilation b) Headache c) Edema d) Hypertension - correct answer ✔✔b) Headache 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 clients risk for myocardial infarction? a) Clopidogrel b) Heparin c) Warfarin d) Alteplase - correct answer ✔✔a) Clopidogrel A nurse is monitoring a client following ferrous sulfate administration. The nurse should monitor the client for which of the following adverse effects? a) Phlebitis b) Dark, orange-colored stools c) Constipation d) Injection site pain - correct answer ✔✔c) Constipation 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? a) Sleep modifications b) Fluid modifications c) Driving modifications d) Dietary modifications - correct answer ✔✔d) Dietary modifications

A nurse is reviewing the medication record of a client who is recieving atleplase following an acute myocardial infarction (MI). Which of the following medications should the nurse expect the client to be taking in addition to atleplase? a) Protamine b) Desmopressin c) Ferrous sulfate d) Heparin - correct answer ✔✔d) Heparin A nurse is caring 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? a) Alteplase b) Aspirin c) Clopidogrel d) Heparin - correct answer ✔✔a) 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? a) Clarify the prescription with the provider b) Administer the drug with an analgesic c) Administer the required dose orally d) Assess factor IX levels - correct answer ✔✔a) Clarify the prescription with the provider A nurse is administering epoetin intravenously to a client who has renal failure. Which of the following actions should the nurse take? a) Shake the vial before using b) Administer via IV bolus over 1 to 3 min. c) Dilute the drug with D5W d) Save the used vial for the next dose - correct answer ✔✔b) Administer via IV bolus over 1 to 3 min.

A nurse is providing teaching to a client who is taking simvastatin. Which of the following is a serious adverse reaction that could require discontinuing drug therapy? Bronchoconstriction Muscle pain Lip numbness Somnolence - correct answer ✔✔Muscle pain A nurse is teaching a client who has a new prescription for quinidine. Which of the following statements should the nurse include? Monitor pulse rate and report changes Remain upright after 30 mins of taking this med This med can decrease digoxin levels This med can cause urinary incontinence - correct answer ✔✔Monitor pulse rate and report changes A nurse is caring for a client who will begin using transdermal nitroglycerin to treat angina pectoris. When speaking to the client about the drug which of the following instructions should the nurse include? Apply the patch to a hairless area and rotate sites Apply a new patch when you start your day Remove patches for 10 to 12 hr each day Apply a new patch on the onset of anginal pain Apply the patch to dry skin and cover the area with plastic wrap - correct answer ✔✔Apply the patch to a hairless area and rotate sites Apply a new patch when you start your day Remove patches for 10 to 12 hr each day A nurse should recognize that milrinone is contraindicated for a client who has which of the following conditions?

Acute myocardial infarction Peripheral vascular disease ulcerative colitis ventricular tachycardia - correct answer ✔✔Acute myocardial infarction A nurse is caring for a client who has a glomerular filtration rate of 10 mL/min and a reduced urine output. The nurse should clarify a prescription for hydrochlorothiazide for this client because of which of the following characteristics of the drug? The drug can cause hypoglycemia The drug does not reduce BP The drug can increase the risk of pulmonary edema The drug does not promote diuresis for clients who have renal insufficiency - correct answer ✔✔The drug does not promote diuresis for clients who have renal insufficiency A nurse is caring for a client who is taking spironolactone to treat HTN. The nurse should recognize that which of the following client lab values requires immediate intervention? Sodium 140 mEq/L Potassium 5.2 mEq/L Chloride 100 mEq/L Magnesium 1.9 mEq/L - correct answer ✔✔Potassium 5.2 mEq/L A nurse should identify that which of the following drugs is only used short term for cardiac dysthymia due to its serious adverse effects? Quinidine Procainamide Nitroglycerin

Verapamil - correct answer ✔✔Procainamide A nurse is reviewing new prescriptions with a client who has heart disease. The nurse should instruct the client that which of the following drugs is prescribed to treat hypercholesterolemia? Simvastatin Furosemide Losartan Nitroglycerin - correct answer ✔✔Simvastatin A nurse is caring for a client who has a new prescription for dobutamine. The nurse should clarify the prescription w the provider if the client is receiving which of the following types of drugs? (Select all that apply) -MAOI -General anesthetic -Tricyclic Antidepressant (TCA) -Beta blocker -ACE inhibitor - correct answer ✔✔-MAOI -General anesthetic -Tricyclic Antidepressant (TCA) -Beta blocker A nurse is teach a client who has a new prescription for nitroglycerin. The nurse should instruct the client that which of the following manifestations is a potential adverse effect of this drug? Headache Constipation Hypetension Hyperglycemia - correct answer ✔✔Headache

A nurse is caring for a client who is taking atorvastatin and has a new prescription for gemfibrozil. The nurse should recognize that this drug combo places the client at an increased risk for which of the following adverse effects? Myopathy Hypoglycemia Irregular pulse Kidney failure - correct answer ✔✔Myopathy A nurse is caring for a client who has a depressive disorder and requires a prescription drug to treat HTN. The nurse should recognize that which of the following antihypertensive drugs is contraindicated for this client? Reserpine Captopril Hydralazine Epleperone - correct answer ✔✔Reserpine A nurse is caring for a client who is about to begin captopril therapy. Which of the following adverse effects should the nurse instruct the client to report because it can indicate a need to discontinue drug therapy? (Select all that apply)

• Rash
• Distorted taste
• Swelling of the tongue
• Dry cough -Photosensitivity - correct answer ✔✔- Rash
• Distorted taste
• Swelling of the tongue
• Dry cough

The nurse is caring for a client who is taking amiodarone to treat atrial fibrillation. Which of the following should the nurse instruct the client to avoid while taking the drug? Grapefruit juice NSAIDS Milk Foods high in K - correct answer ✔✔Grapefruit juice A nurse is caring for a client who has a new prescription for aliskiren to treat HTN. The nurse should monitor the client for which of the following findings as an adverse effect of the drug? (Select all that apply) -Hyperkalemia -Throat swelling -Cough -Constipation -Joint pain - correct answer ✔✔-Hyperkalemia -Throat swelling -Cough A nurse is teaching a client who has a new prescription for gemfibrozil. Which of the following instructions should the nurse include? (Select all that apply)

• Report any new intolerance to friends foods
• Report muscle tenderness
• Expect periodic liver function testing
• Take the drug once each day
• Take the drug with food - correct answer ✔✔- Report any new intolerance to frieds foods
• Report muscle tenderness
• Expect periodic liver function testing

A nures is caring for a client who is taking a diuretic. The nurse should instruct the client to include which of the following foods in their diet to increase potassium intake? -Eggs -Cabbage -Cheese -Raisins - correct answer ✔✔-Raisins A nurse is caring for a client who is taking carvedilol and has a prescription for an oral anti diabetic drug to manage their new diagnosis of type 2 diabetes mellitus. By taking both drugs concurrently, the nurse should identify that the client is at an increased risk for which for the following conditions? -Hyperglycemia -Bradycardia -Hypotension -Hypoglycemia - correct answer ✔✔-Hypoglycemia A nurse is caring for a client who has a new prescription for propranolol to treat tachydysrhythmia. The nurse should instruct the client to avoid taking which of the following types of OTC drugs while taking propranolol? NSAIDs Antihistamines Potassium supplements Vitamin C - correct answer ✔✔NSAIDS A nurse is caring for a client who is taking digoxin and develops changes on the ECG tracing and other manifestations that indicate the client has severe digoxin toxicity. Which of the following drugs should the nurse expect to administer to treat this complication? Deferoxamine Antigen-binding fragments

Flumazenil - correct answer ✔✔Antigen-binding fragments The nurse is assessing a client who is taking a loop diuretic and is experiencing a thready, irregular pulse, orthostatic hypotension, and confusion. The nurse should identify that these manifestations indicate which of the following adverse effects? Hypokalemia Hyponatremia Hypouricema Hypoglycemia - correct answer ✔✔Hypokalemia A nurse is administering hydrochlorothiazide to a client who has gouty arthritis. The nurse should monitor the client for which of the following findings that indicates an adverse effect of this drug? Hyperuricemia Hyperkalemia Hypernatremia Hypoglycemia - correct answer ✔✔Hyperuricemia The nurse is caring for a client who has a new prescription for verapamil. The nurse should clarify the prescription with the provider if the client has a history of which of the following conditions?Migraine headaches Pancreatitis Second-degree AV block Angina pectoris - correct answer ✔✔Second-degree AV block A nurse is providing teaching to a client who has a new prescription for losartan to treat HTN. The nurse should instruct that client that which of the following findings could indicate an adverse reaction to the drug and needs to be reported? Facial edema

Sleepiness Peripheral edema Constipation - correct answer ✔✔Facial edema A nurse is caring for client who has a new prescription for verapamil to treat atrial fibrillation. The nurse should instruct the client to avoid drinking grapefruit juice while taking verapamil because it can cause the client to experience which of the following conditions? Tachycardia Dehydration Diarrhea Hypotension - correct answer ✔✔Hypotension A client asks the nurse how epoetin alfa (Epogen) will help their anemia. Which response should the nurse provide the client? A. "The prescription stimulates your body to make red blood cells." B. "This prescription contains red blood cells." C. "This prescription prevents the destruction of the red blood cells." D. "This prescription increases the iron binding capacity of the red blood cells." - correct answer ✔✔A. "The prescription stimulates your body to make red blood cells." The educator is reviewing red blood cell formation with a nurse. Which statement made by the nurse indicates an understanding? A. "Red blood cell formation is regulated through chemicals called colony-stimulating factors." B.

"Red blood cell formation is regulated through specific liver enzymes and a process called hemochromatosis." C. "Red blood cell formation is regulated through messages from the hormone erythropoietin." D. "Red blood cell formation is regulated through messages from the hormone secretin, which is located in the kidney." - correct answer ✔✔C. "Red blood cell formation is regulated through messages from the hormone erythropoietin." A client asks the nurse how epoetin alfa (Procrit) is related to their chemotherapy. Which response should the nurse provide? A. "This prescription will help prevent anemia that can be caused by your chemotherapy." B. "This prescription is administered to enhance the effectiveness of the chemotherapy." C. "This prescription will stimulate the immune system to help kill the cancer cells." D. "This prescription helps to counteract the nausea and vomiting caused by chemotherapy." - correct answer ✔✔A. "This prescription will help prevent anemia that can be caused by your chemotherapy." Which describes the nurse's understanding of the purpose for choosing the names for the colony- stimulating factors? A. Named according to the type of neurotransmitters that are stimulated. B. Named according to the type of hormones they stimulate. C. Named according to the type of blood cells they stimulate.

D.

Named according to the interleukins they stimulate. - correct answer ✔✔C. Named according to the type of blood cells they stimulate. Which describes the primary actions of Filgrastim (Granix)? A. Increases the production of basophils B. Enhances cytotoxic function of the neutrophil C. Enhances phagocytic activity of the neutrophil D. Enhances the action of the basophils E. Increases neutrophil production - correct answer ✔✔B. Enhances cytotoxic function of the neutrophil C. Enhances phagocytic activity of the neutrophil E. Increases neutrophil production A client receiving cyanocobalamin (Nascobal) with a history of a gastrectomy tells the nurse that they have stopped taking the prescription months ago. Which assessment findings should the nurse anticipate? A. A gradual decrease in red blood cell counts B. Jaundice and tarry stools C.

Low hemoglobin and hematocrit counts D. Memory loss, numbness in the limbs, and depression - correct answer ✔✔D. Memory loss, numbness in the limbs, and depression A client with chronic alcoholism asks the nurse why they should take folic acid. Which response should the nurse provide the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A. "The alcohol decreases your folic acid level." B. "The alcohol interferes with folate metabolism in the liver." C. "The folic acid will improve your vitamin B12 deficiency." D. "Your dietary intake of folic acid is decreased when you drink alcohol." E. "The folic acid can help reverse some of the liver damage that has occurred from the alcohol abuse." - correct answer ✔✔B. "The alcohol interferes with folate metabolism in the liver." D. "Your dietary intake of folic acid is decreased when you drink alcohol." Which is the priority nursing assessment for a client prescribed epoetin alfa (Epogen)? A. Oxygen saturation B. Blood pressure

C.

Apical pulse D. Temperature - correct answer ✔✔B. Blood pressure Which should the nurse anticipate to be included in the client's treatment plan during the intravenous sargramostim (Leukine)? A. ECG monitoring B. Insertion of indwelling urinary catheter C. Administration of an antiemetic D. Administration of oxygen - correct answer ✔✔A. ECG monitoring A pregnant client prescribed cyanocobalamin (Nascobal) asks the prescription will hurt her baby. Which response should the nurse provide the client? A. "This prescription is safe during pregnancy." B. "The prescription is safe in the third trimester of pregnancy." C. "The prescription is safe when administered as an injection." D. "This prescription is safe if taken in the form of a pill during pregnancy." - correct answer ✔✔A. "This prescription is safe during pregnancy."

A client receiving ferrous sulfate (Feosol) tells the nurse they are experiencing constipation. Which intervention should the nurse recommend? A. Laxatives B. Increase exercise C. Self-administer Fleet's enemas. D. Increase fluids and high fiber foods in the diet. - correct answer ✔✔D. Increase fluids and high fiber foods in the diet. The nurse has provided education for a client prescribed oprelvekin (Neumega). Which statement made by the client indicates an understanding of the information? A. "This prescription will help increase my platelet count." B. "This prescription will help increase my red blood cell count." C. "This prescription will help my chemotherapy work better." D. "This prescription will help me regain the weight I have lost." - correct answer ✔✔A. "This prescription will help increase my platelet count." Which contributes to the regulation of hematopoiesis? A. Hematopoietic stem cells B.

Hormones C. Essential vitamins and nutrients D. White bone marrow - correct answer ✔✔B. Hormones Which is most important for the nurse to monitor a client receiving erythropoiesis-stimulating agents? A. Thromboembolism B. Transient ischemic attack C. Myocardial infarction D. Cerebral vascular accident - correct answer ✔✔A. Thromboembolism Which information should the nurse include in the teaching for a client prescribed ferrous sulfate (Feosol) tablets? A. Take this prescription with milk. B. Take this prescription with meals. C. Take this prescription with orange juice. D. Take this prescription before bedtime. - correct answer ✔✔C. Take this prescription with orange juice.

Which describes the classification system for anemias? A. Based on the amount of oxygen carried by the erythrocytes. B. Based on the number of erythrocytes present. C. Based on the shape of erythrocytes. D. Based on the size and color of the erythrocytes. - correct answer ✔✔D. Based on the size and color of the erythrocytes. The nurse reviewing a client's record notes the morphology of the client's erythrocytes is reported to be microcytic-hypochromic. Which anemia should the nurse associate with the morphology? A. Pernicious anemia B. Hemolytic anemia C. Sickle-cell anemia D. Iron-deficiency anemia - correct answer ✔✔D. Iron-deficiency anemia A client asks why the nurse why the healthcare provider has prescribed darbepoetin alfa (Aranesp) instead of epoetin alpha (Epogen). Which response should the nurse provide the client? A. "Darbepoetin alfa is more effective." B.

"Darbepoetin alfa has a longer duration of action." C. "Darbepoetin alfa has less side effects." D. "Darbepoetin alfa is less expensive." - correct answer ✔✔B. "Darbepoetin alfa has a longer duration of action." Which assessment findings indicate the treatment for a client prescribed an erythropoiesis-stimulating factor is successful? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A. The client's hemoglobin is increased. B. The client reports less shortness of breath on exertion. C. The client has not had an episode of epistaxis in over 3 weeks. D. The client reports enjoying a light exercise. E. The client has not had a fever since treatment began. - correct answer ✔✔A. The client's hemoglobin is increased. B. The client reports less shortness of breath on exertion. D. The client reports enjoying a light exercise. Which time frame in conjunction with chemotherapy should the nurse administer prescribed Filgrastim (Neupogen)?

A.

Twenty-four hours prior to the chemotherapy B. Immediately before the chemotherapy C. At the time of the chemotherapy infusion D. Immediately following the chemotherapy - correct answer ✔✔A. Twenty-four hours prior to the chemotherapy After reviewing a client's blood work, the nurse suspects the client is experiencing iron-deficiency anemia. Which questions should the nurse ask the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A. "Have you had a significant dietary change in the last 6 months?" B. "Do you handle chemicals in your new job?" C. "Have your stools changed in appearance?" D. "Have you been eating more carbohydrates than usual?" E. "Are your menstrual periods heavier than normal for you?" - correct answer ✔✔A. "Have you had a significant dietary change in the last 6 months?" B. "Do you handle chemicals in your new job?" C. "Have your stools changed in appearance?"

E.

"Are your menstrual periods heavier than normal for you?" Which should the nurse consider when administering an injection of ferrous sulfate intramuscularly to a client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A. Give the injection in the deltoid muscle. B. Iron is best absorbed if given subcutaneously. C. Iron is irritating to the tissues. D. The z-track method should be used. E. Iron preparations should be administered through a needle gauge 16 or larger. - correct answer ✔✔C. Iron is irritating to the tissues. D. The z-track method should be used. Which affect does colony-stimulating factors have on the body? A. Stimulate stem cells production B. Stimulate white blood cell production C. Stimulate platelet production D.