Deck 9: Drugs Used in the Treatment of Blood Disorders

Question 1

You are treating and monitoring a patient for whom you have prescribed heparin therapy.You check the latest partial thromboplastin time (PTT)measurement and write an order for "no change." Which result most likely indicates this patient's PTT reading?

A)Less than 35 seconds
B)34 to 35 seconds
C)46 to 70 seconds
D)71 to 90 seconds
E)Greater than 90 seconds

Answer 1

46 to 70 seconds

Question 2

You are a physician assistant student on your internal medicine rotation when you are asked how you would order heparin to treat a patient with deep vein thrombosis (DVT)and possible pulmonary embolism (PE).Which response would be most appropriate?

A)Give 80 units/kg IV,then 18 units/kg/hour.
B)Give 60 units/kg IV,then 18 units/kg/hour.
C)Give 40 units/kg IV,then 18 units/kg/hour.
D)Give 5,000 units SC every 8 to 12 hours.
E)Give a bolus of 60 to 70 units/kg,then 1,000 units/hour.

Answer 2

Give 80 units/kg IV,then 18 units/kg/hour.

Question 3

Concomitant ingestion of iron and which vitamin will enhance the absorption of iron?

A)500 mg vitamin C
B)500 mg vitamin D
C)Vitamin B₁₂
D)Vitamin E

Answer 3

500 mg vitamin C

Question 4

You are treating a patient who has been recently diagnosed with pernicious anemia.What is the preferred method of supplementation?

A)IM injections of cyanocobalamin only
B)PO ingestion of cyanocobalamin only
C)IV administration of cyanocobalamin only
D)Either IM or PO administration cyanocobalamin

Question 5

You are treating a 25-year-old female who you have determined has iron deficiency anemia.She also has a history of gastroesophageal reflux disease for which you have prescribed a proton-pump inhibitor (PPI).In what way will this patient's history affect your treatment of her anemia?

A)It will have no effect on her treatment regimen.
B)The patient will need to take her iron supplement and the PPI at the same time.
C)The patient should take her iron supplement at a different time than her PPI.
D)The patient will need to discontinue her PPI while on iron supplementation.

Question 6

The appropriate therapeutic dose of oral ferrous sulphate for treating a patient with iron deficiency is:

A)275 mg once daily.
B)275 mg 2 to 4 times daily.
C)325 mg once daily.
D)325 mg 2 to 4 times daily.

Question 7

You are caring for a patient in chronic renal failure.The internist in your office wants to begin erythropoietin.Which lab is most important to obtain prior to beginning this type of treatment?

A)Serum iron
B)Hemoglobin
C)Hematocrit
D)Complete blood count
E)Electrolytes

Question 8

You have just begun treating a patient with iron deficiency anemia.Your instructions to the patient include advising her on the length of time she will be taking iron supplements.What is the usual duration?

A)1 to 2 months
B)2 to 4 months
C)3 to 6 months
D)6 to 9 months
E)12 months

Question 9

Which of the following is the most common etiology of B₁₂ deficiency in pernicious anemia?

A)Antibody interference with absorption
B)Patient's inability to split the R factor from B₁₂ in foods
C)Underproduction of B₁₂ in the large intestine
D)Underproduction of B₁₂ in the liver
E)Production of antibodies to intrinsic factor

Question 10

Which form of iron supplementation is typically used only for patients on hemodialysis?

A)Iron sucrose
B)Iron dextran
C)Iron polysaccharide complex
D)Gluconate
E)Sodium ferric

Question 11

What is the primary difference between unfractionated heparin and low-molecular-weight heparin (LMWH)?

A)Unfractionated heparin binds only to thrombin (factor II).
B)Unfractionated heparin binds only to factor X (Xa).
C)LMWH binds only to thrombin (factor II).
D)LMWH binds only to factor X (Xa).

Question 12

You have just examined a 62-year-old male who complains of fatigue and lethargy.His complete blood count (CBC)reveals microcytic,hypochromic anemia.What should be the next step in treating this patient?

A)Repeat his CBC immediately.
B)Immediately start him on oral iron supplementation.
C)Schedule him for a colonoscopy within 2 weeks.
D)Begin oral iron supplementation and repeat the CBC in 2 weeks.

Question 13

Which test is the gold standard for diagnosing iron deficiency anemia?

A)CBC
B)Hemoglobin level and hematocrit
C)Serum vitamin C level
D)Serum ferritin
E)Bone marrow biopsy

Question 14

Erythropoietin is typically used for treatment of chronic renal failure,human immunodeficiency virus (HIV)in patients being treated with zidovudine,and which other disorder?

A)Iron deficiency anemia
B)Acute blood loss anemia
C)Pernicious anemia
D)Cancer/chemotherapy anemia
E)Acute folate deficiency

Question 15

LMWHs carry which black box warning?

A)Never use in patients with an artificial valve.
B)Never use in combination with warfarin.
C)Never use to treat acute coronary syndrome.
D)Never use in a patient with a spinal or an epidural catheter.
E)Never use in a patient with an indwelling urinary catheter.

Question 16

You have just completed a history on a patient newly admitted to the internal medicine service at your hospital with an admitting diagnosis of DVT,r/o PE.The patient admits to taking an antihypertensive for blood pressure and ginseng,ginger,and gingko for memory improvement.How will this information affect his discharge orders?

A)No change to antihypertensive therapy;DC ginseng only
B)No change to antihypertensive therapy;DC gingko only
C)No change to antihypertensive therapy;DC ginseng and gingko
D)No change to antihypertensive therapy;DC ginseng,ginger,and gingko
E)No change needed for any of these meds;may continue after discharge

Question 17

You are treating a patient with suspected iron deficiency anemia.Which laboratory test would you order for its accuracy in rendering this diagnosis?

A)Serum ferritin level
B)Serum iron level
C)Vitamin B₁₂ level
D)Vitamin B₆ level

Question 18

When monitoring a patient with vitamin B₁₂ deficiency,which of the following labs would show the effects of supplementation first?

A)Hematocrit
B)Reticulocyte count
C)Folate level
D)Iron level
E)Ferritin level

Question 19

A 31-year-old female's labs reveal microcytic,hypochromic anemia.The patient has no previous medical or surgical history.What should be your recommended first line of treatment for this patient?

A)Erythropoietin
B)Folic acid
C)Vitamin B₁₂
D)Oral ferrous sulphate

Question 20

The most common side effects of oral iron supplementation are GI related.The most effective way to overcome these effects are to:

A)Instruct the patient to take Tums just prior to taking iron.
B)Instruct the patient to disregard the discomfort and continue the medication.
C)Instruct the patient to discontinue taking iron supplementation until the symptoms resolve.
D)Instruct the patient to take the lowest possible dose and slowly titrate the dose to a full dose over several days

Question 21

Warfarin (Coumadin)is indicated for which of the following conditions?

A)Treatment of atrial fibrillation only
B)Treatment of DVT only
C)Prophylaxis of DVT only
D)Prophylaxis of atrial fibrillation only
E)Prophylaxis of atrial fibrillation and DVT complications

Question 22

What dose of aspirin would you recommend for a patient with a positive family history of CV disease who is taking this medication to prevent either MI or Cerebral vascular aneurism (CVA)?

A)30 mg/day
B)150 mg/day
C)81 mg/day
D)101 mg/day
E)91 mg/day

Question 23

What medical advice would you give to a patient without any cardiovascular (CV)risk factors and no other positive medical history who wants to take aspirin prophylactically to prevent future heart problems?

A)Take a loading dose of 325 mg aspirin,them 81 mg daily.
B)Do not take aspirin because the risks outweigh the benefits.
C)Take 81 mg daily for 1 year.
D)Take 81 mg daily indefinitely.
E)Take aspirin/extended release dipyridamole (Aggrenox)instead of aspirin.

Question 24

Fibrinolytic agents are always indicated in which of the following situations,assuming there are no patient contraindications?

A)Any patient who presents to the emergency department with chest pain.
B)Any patient who presents with ST elevation on an electrocardiogram.
C)Any patient with STEMI who presents within 12 hours of onset.
D)Any patient under the age of 65 who presents with STEMI within 12 hours of onset.
E)Any patient who presents with ST depression within 12 hours of onset.Chapter 9.Drugs Used in the Treatment of Blood Disorders

Question 25

You have just examined a 78-year-old male patient new to your practice who recently moved to your area.He states he has a positive history of previous atrial fibrillation for the past 2 years.He does not have valvular disease atrial fibrillation to his knowledge and is otherwise healthy for his age,except for hypertension.Based on this information alone,what would be your preferred manner of treating this patient to reduce his stroke risk?

A)The patient would begin daily administration of aspirin.
B)The patient should begin heparin therapy and add warfarin.
C)The patient would begin daily administration of warfarin.
D)The patient is not at risk for a stroke,so no therapy is indicated at this time.
E)Give a loading dose of warfarin,then begin 5 mg daily.

Question 26

You are caring for a patient with both cardiovascular risk of MI and a history of a GI bleed from an ulcer.What would be the most effective plan of treatment for this patient?

A)enteric-coated aspirin 81 mg daily only.
B)aspirin 81 mg daily with clopidogrel (Plavix)75 mg daily.
C)clopidogrel 75 mg daily only.
D)aspirin 81 mg daily with esomeprazole (Nexium)20 mg daily.
E)esomeprazole (Nexium)20 mg daily only.

Question 27

Dipyridamole can be used for prevention of strokes and for which other situation?

A)Dipyridamole can be used for prevention of MI.
B)Dipyridamole is used IV for nonexercise cardiac stress testing.
C)Dipyridamole is primarily used in atrial fibrillation.
D)Dipyridamole is used only to treat an acute stroke.

Question 28

In which situation is the use of clopidogrel combined with low-dose aspirin recommended?

A)Prevention of CV events in an otherwise healthy patient
B)Acute coronary syndrome and/or history of CABG
C)Stroke or transient ischemic attack (TIA)from a noncardiac etiology
D)18 months postangioplasty without a stent

Question 29

You have been treating a patient for DVT and PE with heparin and plan to switch to warfarin (Coumadin).How will you monitor effective dosing of the warfarin?

A)Obtain PTT upon onset of treatment and daily thereafter.
B)Obtain PTT upon onset of treatment and weekly thereafter.
C)Obtain baseline International Normalized Ratio (INR);begin warfarin after first heparin dose;check INR daily.
D)Obtain INR and repeat daily.

Question 30

Which medication blocks platelet activation by irreversibly interfering with the binding of adenosine diphosphate (ADP)to platelets?

A)heparin
B)aspirin
C)warfarin
D)clopidogrel
E)alteplase

Question 31

A patient new to your practice has been taking dabigatran (Pradaxa).Which of the following drugs is contraindicated while taking this drug?

A)aspirin
B)rifampin (Rifadin)
C)ampicillin
D)methylphenidate (Ritalin)
E)amiodarone (Cordarone)

Question 32

The American College of Chest Physicians recommends which treatment regime for patients who have had a coronary artery bypass graft (CABG)?

A)aspirin 162 to 325 mg stat,then 75 to 100 mg daily indefinitely
B)clopidogrel 150 mg stat,then 75 mg daily
C)aspirin 75 to 100 mg daily if tolerated,indefinitely
D)clopidogrel 300 mg stat,then 150 mg daily indefinitely
E)aspirin 75 mg plus clopidogrel 75 mg daily indefinitely

Question 33

Which fibrinolytic agent,when used specifically for a PE,is dosed at 100 mg over 2 hours,then followed by heparin?

A)tenecteplase (TNKase)
B)alteplase (Activase)
C)reteplase (Retavase)
D)actinoplase

Question 34

What is the main indication for use of all fibrinolytic agents?

A)Treatment of any myocardial infarction
B)Treatment of MI and DVT
C)Treatment of MI,DVT,and PE
D)Treatment of ST segment elevation myocardial infarction (STEMI)
E)Treatment of acute hemorrhagic stroke

Question 35

You prescribe dabigatran for a patient who needs anticoagulation.Which step is essential for treating a patient with this drug?

A)Daily INR monitoring
B)Serial PTT monitoring
C)Discontinuation of any foods with vitamin K
D)Serum creatinine clearance monitoring
E)Loading heparin dose

Question 36

Which of the following is necessary for monitoring a patient on LMWH?

A)Regular International Normalized Ratio,at least monthly
B)PTT,daily
C)Bleeding time daily
D)Activated clotting time
E)None

Question 37

Which finding can be used to inform a patient that aspirin is too old to take?

A)Strong smell of vinegar from the bottle
B)Strong smell of citrus from the bottle
C)Opened longer than 6 months ago
D)None;aspirin does not deteriorate or expire

Question 38

What is the primary function of platelets in hemostasis?

A)Adhere to injured blood vessels
B)Combat infection
C)Provide autoimmunity
D)Adjust vessel dilatation

Question 39

A patient who is on aspirin daily for prevention of cardiovascular events asks you if he can take acetaminophen for his headaches.How should you reply?

A)"Yes,you can take both drugs at the same time."
B)"Yes,but you should take the acetaminophen 1 hour after the aspirin."
C)"Yes,but you should cut the aspirin dose in half."
D)"Yes,but you should cut the acetaminophen in half."
E)"No,you cannot take both medications at the same time."

Question 40

Which option describes the mechanism of action for warfarin?

A)Directly inhibits thrombin production
B)Inhibits vitamin K epoxide reductase
C)Inhibits cyclo-oxygenase (COX-1)
D)Prevents the conversion of prothrombin to thrombin