Deck 15: Drugs Affecting the Hematological System

Question 1

A patient had a deep vein thrombosis (DVT) and was on heparin and warfarin in the hospital and discharged home on warfarin. She asks her primary care nurse practitioner (NP) why she was getting both medications while in the hospital. The best response is to:

A)Contact the hospitalist as this is not the normal guideline for prescribing these two medications and she may have had a more complicated case.
B)Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness.
C)Encourage the patient to contact the customer service department at the hospital, as this was most likely a medication error during her admission.
D)Draw anticoagulation studies to make sure she does not have dangerously high bleeding times.

Answer 1

Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness.

Question 2

For patients taking warfarin, international normalized ratios (INRs) are best drawn:

A)Monthly throughout therapy
B)Three times a week throughout therapy
C)Two hours after the last dose of warfarin to get an accurate peak level
D)In the morning if the patient takes their warfarin at night

Answer 2

In the morning if the patient takes their warfarin at night

Question 3

A patient has been prescribed aspirin 320 mg per day for their atrial fibrillation. They also take aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity for which they would need to be evaluated?

A)Tinnitus
B)Diarrhea
C)Hearing loss
D)Photosensitivity

Answer 3

Tinnitus

Question 4

Patients receiving heparin therapy require monitoring of:

A)Platelets every two to three days for thrombocytopenia that may occur on day four of therapy
B)Electrolytes for elevated potassium levels in the first 24 hours of therapy
C)INR throughout therapy to stay within the range of 2.0
D)Blood pressure for hypertension that may occur in the first two days of treatment

Question 5

Education of patients who are taking warfarin includes discussing their diet. Instructions include:

A)Avoid any food containing vitamin K.
B)Avoid foods high in vitamin K .
C)Increase intake of iron-containing foods.
D)Eat 35 grams of fiber daily.

Question 6

The routine monitoring recommended for low-molecular-weight heparin is:

A)INR every two days until stable, then weekly
B)Activated partial thromboplastin time (aPTT) every week while on therapy
C)Factor Xa levels if the patient is pregnant
D)White blood cell count every 2 weeks

Question 7

Patient education when prescribing clopidogrel includes:

A)Do not take any herbal products without first discussing this with the provider.
B)Monitor urine output closely and contact the provider if it decreases.
C)Clopidogrel can be constipating; use a stool softener if needed.
D)The patient will need regular anticoagulant studies while on clopidogrel.

Question 8

Patients who are being treated with epoetin alfa need to be monitored for the development of:

A)Thrombocytopenia
B)Neutropenia
C)Hypertension
D)Gout

Question 9

A patient is having hip replacement surgery and would like to self-donate blood for the surgery. In addition to being prescribed epogen alfa he should also be prescribed:

A)Folic acid to prevent megaloblastic anemia
B)Iron, to start when the epogen starts
C)An antihypertensive to counter the adverse effects of epogen
D)Vitamin B₁₂ to prevent pernicious anemia

Question 10

Monitoring for a patient prescribed iron for iron deficiency anemia includes:

A)Reticulocyte count one week after therapy is started
B)Complete blood count every two weeks throughout therapy
C)Hemoglobin level at one week of therapy
D)INR weekly throughout therapy

Question 11

A patient is traveling to Southeast Asia on vacation and has come into the clinic to review their medications. They are healthy with only mild hypertension that is well controlled. They ask about getting "a shot" to prevent blood clots like their friend did before international travel. The correct response would be to:

A)Administer one dose of low-molecular-weight heparin 24 hours before travel.
B)Prescribe one dose of warfarin to be taken the day of travel.
C)Consult with a hematologist regarding a treatment plan for the patient.
D)Explain that they are not at high risk of a blood clot and provide education about how to prevent blood clots while traveling.

Question 12

When writing a prescription for warfarin it is common to write _________ on the prescription.

A)"OK to substitute for generic"
B)The brand name of warfarin and "do not substitute"
C)"PRN refills"
D)"Refills for 1 year"

Question 13

The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should be considered in which patients?

A)Pregnant women
B)Elderly men
C)Overweight or obese patients
D)Patients with multiple comorbidities

Question 14

The first laboratory value indication that vitamin B₁₂ therapy is adequately treating pernicious anemia is:

A)Hematocrit levels start to rise.
B)Hemoglobin levels return to normal.
C)Reticulocyte count begins to rise.
D)Vitamin B₁₂ levels return to normal.

Question 15

Patients with pernicious anemia require treatment with:

A)Iron
B)Folic acid
C)Epogen alfa
D)Vitamin B₁₂

Question 16

The safest drug to use to treat pregnant women who require anticoagulant therapy is:

A)Low-molecular-weight heparin
B)Warfarin
C)Aspirin
D)Heparin

Question 17

If a patient is taking darbepoetin alfa (Aranesp), their blood counts should be monitored to determine if a dosage adjustment is needed. How soon should this be done after starting the drug?

A)Six weeks if they are a cancer patient
B)One week if they have chronic renal failure
C)Two weeks if they are taking it for allogenic transfusion
D)Each week throughout therapy

Question 18

A patient is taking warfarin and is asking about what they can take for minor aches and pains. The best recommendation is:

A)Ibuprofen 400 mg three times a day
B)Acetaminophen, not to exceed 4 grams per day
C)Prescription acetaminophen with codeine
D)Aspirin 640 mg three times a day

Question 19

Patient education regarding taking iron replacements includes:

A)Double the dose if they miss a dose to maintain therapeutic levels.
B)Take the iron with milk or crackers if it upsets their stomach.
C)Iron is best taken on an empty stomach with juice.
D)Antacids such as Tums may help an upset stomach caused by iron therapy.

Question 20

A 51-year-old male has been told by his PCP to take an aspirin a day. Why would this be recommended?

A)He has arthritis and this will help with the inflammation and pain.
B)Aspirin has antiplatelet activity and prevents clots that cause strokes.
C)Aspirin acidifies the urine and he needs this for prostrate health.
D)He has a history of gastrointestinal (GI) bleed, and one aspirin a day is a safe dosage.

Question 21

Patients who are beginning therapy with vitamin B₁₂ need to be monitored for:

A)Hypertensive crisis that may occur in the first 36 hours
B)Hypokalemia that occurs in the first 48 hours
C)Leukopenia that occurs at one to three weeks of therapy
D)Thrombocytopenia that may occur at any time in therapy

Question 22

A patient taking carbamazepine needs to be started on a direct factor Xa inhibitor for antithrombotic therapy. Which of the direct factor Xa inhibitors should be avoided due to drug interactions?

A)Betrixaban
B)Apixaban
C)Rivaroxaban
D)Edoxaban

Question 23

The recommended long-term antithrombotic therapy for a patient with a DVT in their leg is:

A)Low-molecular-weight heparin
B)Warfarin, tapered monthly
C)Aspirin, 325 mg daily
D)Direct factor Xa inhibitor
E) Drugs Affecting the Hematological System