Question 1

A nurse assessing a client on a heparin drip notes bloody drainage in the nasogastric tube and indwelling urinary catheter. A stat partial thromboplastin time (PTT) is drawn according to heparin protocol. The result is 140 seconds. Which action by the nurse is the most appropriate?

Accepted Answer

A PTT of 140 seconds indicates the client is at high risk for bleeding due to excessive anticoagulation from the heparin drip. Protamine sulfate is the antidote for heparin and should be administered immediately to reverse the anticoagulant effects and prevent further bleeding. The other options are not appropriate for this situation.

Question 2

The nurse is providing discharge teaching regarding anticoagulant therapy. Which statements by the client would the nurse evaluate as indicating the need for further instruction? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

Accepted Answer

The answer of The nurse is providing discharge teaching regarding...

Question 3

A nurse who works in an outpatient chemotherapy unit has received an order to administer filgrastim (Neupogen) to a client who received chemotherapy this morning. The client's white blood cell count is dropping rapidly. The nurse asks the client to return to the unit tomorrow for the filgrastim. What is the rationale for the nurse's request?

Accepted Answer

Filgrastim (Neupogen) is a granulocyte colony-stimulating factor that stimulates the production of white blood cells. Administering it immediately after chemotherapy could counteract the effect of chemotherapy drugs, which often work by suppressing the bone marrow (and thus lowering white blood cell counts). The rationale for waiting is to allow the chemotherapy to exert its full effect before attempting to mitigate one of its side effects (low white blood cell count) with filgrastim.

Question 4

The nurse is planning care for a client prescribed enoxaparin (Lovenox). Which interventions should be included? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

Accepted Answer

The answer of The nurse is planning care for a...

Question 5

Alteplase (Activase) is prescribed for a client with an acute myocardial infarction. Which is the priority nursing intervention for this client?

Accepted Answer

The priority nursing intervention for a client receiving alteplase (Activase) for an acute myocardial infarction is to monitor the client's level of consciousness (LOC) due to the risk of bleeding in the brain (intracranial hemorrhage). While monitoring APTT and injection sites is important, they are not a priority over monitoring LOC. PT/INR monitoring is not necessary for clients receiving alteplase (Activase).

Question 6

As the nurse is completing the physical assessment of a client receiving heparin therapy for deep vein thrombosis (DVT), the client complains of severe lumbar pain. Which is the nurse's priority action?

Accepted Answer

Severe lumbar pain can indicate a serious complication of heparin therapy, such as spinal hematoma. The nurse should immediately evaluate further and report any findings to the healthcare provider. Comfort measures and pain medication can be implemented after the source of the pain is identified and treated. Documenting the finding is important, but it should not be the nurse's priority action in this situation.

Question 7

A client has been taking oral anticoagulant therapy for a number of years secondary to atrial fibrillation. He asks about taking Ibuprofen to manage arthritic pain in his knees. What is a reason that Ibuprofen should be avoided? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

Accepted Answer

Ibuprofen and warfarin both bind to plasma proteins, and taking them together can increase the risk of bleeding as they compete for the same binding sites, leading to higher levels of free warfarin.

Question 8

A client with a newly placed prosthetic heart valve will be maintained on long-term anticoagulant therapy. Which medication does the nurse anticipate being used for this purpose?

Accepted Answer

Warfarin (Coumadin) is commonly used for long-term anticoagulation and it is regularly monitored with lab work to adjust dosages as needed. Enoxaparin and Dalteparin are low molecular weight heparins that are used for short-term anticoagulant therapy or as a bridge therapy, but are not typically used for long-term management. Heparin is another anticoagulant that is commonly used in acute settings, but it also has a shorter half-life and is not used for long-term maintenance therapy.

Question 9

An adult client is brought to the emergency department (ED) and diagnosed with a thrombotic stroke. The team plans to administer alteplase (Activase). The client makes the following comments to a nurse. Which information is critical for the nurse to relay to the health care provider?

Accepted Answer

C) The information about the client falling and hitting their head last week is critical for the nurse to relay to the healthcare provider because alteplase (Activase) is a thrombolytic agent that dissolves blood clots and increases the risk of bleeding. A recent head injury could significantly increase the risk of intracranial hemorrhage if thrombolytic therapy is administered.

Question 10

A hospitalized client is prescribed warfarin (Coumadin). The nurse teaches the client to avoid which food on the lunch selection menu?

Accepted Answer

Broccoli is high in vitamin K, which can counteract the effects of warfarin (Coumadin), a medication used to prevent blood clots. Warfarin works by inhibiting vitamin K-dependent clotting factors, so consuming foods high in vitamin K can decrease its effectiveness.

Question 11

An oncology nurse is administering colony-stimulating factors (CSFs) to a client who has been receiving chemotherapy. How should the nurse explain the expected effect of this medication?

Accepted Answer

Colony-stimulating factors (CSFs) are medications that stimulate the production of white blood cells, which can help protect the patient from developing severe infections. This is especially important for patients who are receiving chemotherapy, as the treatment can suppress the immune system and increase the risk of infection.

Question 12

Exogenous erythropoietin in the form of epoetin alfa (Epogen) is administered to a chronic dialysis client. How can the nurse best describe the action of this drug to the client?

Accepted Answer

Epogen is a form of erythropoietin, a hormone naturally produced by the kidneys that stimulates the production of red blood cells in the bone marrow. In clients with chronic kidney disease who require dialysis, the kidneys are unable to produce enough erythropoietin, resulting in a reduction in the concentration of the oxygen carrier (hemoglobin) in the blood. Epogen helps to increase the concentration of hemoglobin in the blood, leading to an improvement in oxygen delivery to tissues. Therefore, choice C is the best option as it accurately describes the action of epoetin alfa.

Question 13

A client is being treated for a thromboembolic disorder. If the goal is to prevent clot formation, the nurse anticipates the client will be treated with which classifications of drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

Accepted Answer

Anticoagulants and antiplatelet agents are both used to prevent clot formation in thromboembolic disorders. Hemostatics, thrombolytics, and clotting factor concentrates are used to promote clotting and would not be appropriate in this situation.

Question 14

A client's intravenous heparin drip rate is increased at 1400. What time does the nurse plan to draw the next aPTT?

Accepted Answer

The nurse should plan to draw the next aPTT at 2000, which is 6 hours after the rate change. Heparin has a rapid onset of action, so it is important to monitor the patient's aPTT frequently after a rate change to ensure that the therapeutic range is achieved and maintained. Waiting until the next morning (option D) is too long to wait for the next aPTT. Option A is incorrect because an immediate draw is not necessary, but rather monitoring at regular intervals is required. Option C is incorrect because it is not standard practice to draw the next aPTT only 1.5 hours after a rate change.

Question 15

The client prescribed heparin therapy asks how the "blood thinner" works. Which response by the nurse is the most appropriate?

Accepted Answer

Heparin prevents clots from forming by inhibiting the formation of fibrin, a protein necessary for blood clotting. Heparin does not dissolve existing clots, decrease the number of platelets, or make the blood less viscous.

Question 16

A client whose hemoglobin level was 60gm/L 2 days ago has received parenteral epoetin alfa. A hemoglobin level has just been drawn to evaluate therapy. The nurse would consider which hemoglobin lab result as most problematic?

Accepted Answer

A hemoglobin level of 130-140 gm/L would be the most problematic as it indicates an excessive response to epoetin alfa therapy, which could increase the risk of adverse effects such as thromboembolism and hypertension. The goal of epoetin alfa therapy is to gradually increase hemoglobin levels to a target range of 90-100 gm/L, as higher levels may be associated with increased mortality in some patient populations. Hemoglobin levels of 70-80 gm/L, 90-100 gm/L, and 110-120 gm/L would be within the expected range of response to therapy.

Question 17

A client is maintained on warfarin (Coumadin) therapy secondary to refractory atrial fibrillation. Which statement by the client would alert the nurse to a possible problem with this therapy?

Accepted Answer

The answer of A client is maintained on warfarin (Coumadin)...

Question 18

A client is seen in the pre-op clinic two weeks before elective bowel surgery. for a bowel resection. When does the physician advise this client to stop his daily Clopidogrel (Plavix)?

Accepted Answer

The answer of A client is seen in the pre-op...

Question 19

One of the adverse effects of a chemotherapy drug being administered to a client is depression of pluripotent stem cells. Which change in this client's lab values would the nurse expect after treatment is initiated?

Accepted Answer

Pluripotent stem cells give rise to all three blood cell lines - red blood cells, white blood cells, and platelets. Therefore, depression of these cells would result in an abrupt decrease in all three types of blood cells. Option A is incorrect because it only involves a decrease in red blood cells. Option B is incorrect because ferritin levels reflect the body's iron stores and are not specific to blood cell production. Option D is incorrect because a gradual decrease in red blood cells with a gradual increase in white blood cells would not be expected in this case.

Question 20

MCSA A nurse is planning care for a 72 year old client admitted with a myocardial infarction. The physician orders alteplase( Activase) to be given. In what order does the nurse prioritize her care?

Accepted Answer

The answer of MCSA A nurse is planning care for...

Quiz 11: Pharmacology of Alterations in the Cardiovascular System

A nurse assessing a client on a heparin drip notes bloody drainage in the nasogastric tube and indwelling urinary catheter. A stat partial thromboplastin time (PTT) is drawn according to heparin protocol. The result is 140 seconds. Which action by the nurse is the most appropriate?

The nurse is planning care for a client prescribed enoxaparin (Lovenox) . Which interventions should be included? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply.