Deck 14: Drugs Affecting the Hematologic System

Question 1

You are reviewing the laboratory values of a patient whose heparin dose has been changed by the healthcare provider. Which laboratory value will inform you about effect of the dose change on this anticoagulant therapy?

A)PT
B)INR
C)aPTT
D)DIC panel

Answer 1

aPTT

Question 2

A patient prescribed subcutaneous heparin tells you that her menstrual bleeding is heavier than usual. What is your best response?

A)"I will hold the drug and notify your healthcare provider."
B)"This is a fairly common and expected side effect of the drug."
C)"Heavy menstrual bleeding indicates the drug is working properly."
D)"I will have to give you a shot of protamine sulfate to reverse the drug's action."

Answer 2

"I will hold the drug and notify your healthcare provider."

Question 3

You are teaching a patient who has been prescribed apixaban (Eliquis) about symptoms of drug overdose. What symptom should you alert the patient to report?

A)Abnormal pulse rate
B)Gastric upset after eating
C)Excessive sleepiness during the day
D)Bleeding from the gums while brushing the teeth

Answer 3

Bleeding from the gums while brushing the teeth

Question 4

A patient prescribed an anticoagulant asks you about potential drug interactions with this new drug. Which of the following drugs would you advise this patient to avoid while taking anticoagulants?

A)Vitamin C
B)Thiazide diuretics
C)Proton pump inhibitor
D)Nonsteroidal anti-inflammatory analgesics

Question 5

An older patient who takes a daily NSAID for arthritis pain has been prescribed aspirin as an antiplatelet agent. What information regarding risks associated with aspirin use should be included in this teaching plan?

A)The risk for urinary retention
B)The risk for cognitive decline
C)The risk for gastrointestinal bleeding
D)The risk for peripheral arterial disease

Question 6

A patient with atrial fibrillation has been prescribed the drug dabigatran (Pradaxa). The patient asks you what the advantage of this drug may be over warfarin (Coumadin). What is your best response?

A)"This drug is taken only once daily."
B)"This drug does not carry a risk for excessive bleeding."
C)"This drug does not require frequent laboratory testing."
D)"This drug does not interact with other drugs you may be taking."

Question 7

You are caring for a patient who is taking an indirect thrombin inhibitor following surgery. What laboratory value should you monitor for possible adverse effects of this therapy?

A)Platelet count
B)Potassium level
C)Serum calcium level
D)White blood cell count

Question 8

A patient taking a direct thrombin inhibitor (DTI) tells you he is going on vacation and will be taking his anticoagulant drug with him. What advice should you give to this patient related to this specific class of drugs?

A)"Keep this drug in its original bottle while traveling."
B)"Stop this drug while on vacation to avoid the risk of bleeding."
C)"Take this drug with only a few sips of water to avoid GI upset."
D)"Make sure you eat plenty of green vegetables while on vacation."

Question 9

A patient with a history of deep vein thrombosis is prescribed subcutaneous heparin before surgery. The patient asks you if the heparin can be taken orally instead of by injection. What is your best response?

A)"Oral heparin is quite expensive, and not covered by insurance."
B)"Heparin is given by injection because it cannot be absorbed orally."
C)"Heparin is given by injection before surgery because it works faster."
D)"Heparin cannot be given orally because you are fasting for your surgery."

Question 10

A patient with a clotting disorder is prescribed an anticoagulant and asks you to explain the purpose of anticoagulant therapy. What is your best response?

A)Anticoagulants are used to lyse existing clots.
B)Anticoagulants are used to increase the flow of blood.
C)Anticoagulants are used to prevent new clot formation.
D)Anticoagulants are used to thin the viscosity of the blood.

Question 11

You are reviewing the laboratory values of an outpatient who is on anticoagulant therapy. The laboratory tests show a less than desired level of anticoagulation. The patient states that the drug has been taken as prescribed. Which food would you advise the patient to avoid while on anticoagulant therapy?

A)Spinach
B)Bananas
C)Tomatoes
D)Sweet potatoes

Question 12

A patient is suspected of having an overdose of heparin. What drug should you prepare for the healthcare provider to give?

A)Naloxone
B)Warfarin
C)Acetylcysteine
D)Protamine sulfate

Question 13

A patient taking an oral anticoagulant has had an international normalized ratio (INR) drawn to check the therapeutic drug response. Which range represents the therapeutic INR range for a patient taking an oral anticoagulant?

A)1.0 to 2.0
B)2.0 to 3.0
C)3.0 to 4.0
D)4.0 to 5.0

Question 14

The aPTT of a patient who is prescribed continuous intravenous (IV) heparin is two times the control value. What is your best action?

A)Increase the IV rate as ordered.
B)Decrease the IV rate as ordered.
C)Leave the rate unchanged.
D)Stop the infusion and notify the prescriber.

Question 15

What category of anticoagulant drugs works by increasing the amount of the protein antithrombin III?

A)Fibrinolytics
B)Vitamin K antagonists
C)Direct thrombin inhibitors
D)Indirect thrombin inhibitors

Question 16

You are taking the drug history of a patient who will be starting on an anticoagulant. Which of the following drug categories from this patients' drug list would potentially interfere with an anticoagulant?

A)Beta blockers
B)Loop diuretics
C)Oral contraceptives
D)Inhaled corticosteroids

Question 17

You are preparing to draw up a dose of heparin to give subcutaneously to a patient. Which of the following represents the best procedure in preparing this injection?

A)Roll the vial between your hands in order to distribute the solution.
B)Insert the needle, then turn the vial upside down to distribute the drug
C)Shake the vial vigorously to adequately distribute the drug molecules.
D)Carefully draw the solution up from the vial without disturbing the contents.

Question 18

A patient who is taking an anticoagulant informs you that the herbal supplement St. John's wort is taken daily for depression. What should you teach the patient about the use of herbal supplements with anticoagulant therapy?

A)Herbal drugs may decrease clotting times.
B)Herbal drugs may increase the risk of bleeding.
C)There are no risks associated with this drug combination.
D)They are safe to take together if you take them an hour apart.

Question 19

Which statement made by a patient with a recent coronary artery stent placement who is taking clopidogrel informs you that the patient requires further teaching about this drug?

A)"I will avoid herbal supplements while taking this drug."
B)"I will need to take this drug every day for 3 months."
C)"I will report any abnormal bleeding."
D)"I will take this drug with food."

Question 20

Which symptom when reported by a patient taking aspirin alerts you to a possible adverse reaction to the drug?

A)Nausea
B)Itching and hives
C)Decreased vision
D)Increased urination

Question 21

Which statement about fibrinolytic drugs is true?

A)These high-alert drugs are given by IV infusion.
B)These drugs can be used in the outpatient setting.
C)These drugs increase cellular damage from clots blocking the arteries.
D)These drugs are contraindicated in patients diagnosed with an acute MI.

Question 22

You are assessing a patient who is on long-term warfarin (Coumadin) therapy who has been diagnosed with a warfarin overdosage. What drug would you anticipate would be needed as the antidote for warfarin overdose?

A)Paroxetine
B)Phytonadione
C)Protamine sulfate
D)Prothrombin factor

Question 23

You are preparing to give an injection of an erythropoietin stimulating agent to a patient. The patient asks you to explain the expected side effects of this injection. What is your best response?

A)"Thickening of the blood"
B)"Infection at the injection site"
C)"Pain at the site of the injection"
D)"Drowsiness and lack of concentration"

Question 24

A young mother who is breast-feeding now requires treatment with heparin. The patient asks you if she should continue breast-feeding during her treatment. What is your best response?

A)"You will need to stop breast-feeding during treatment with heparin."
B)"Heparin is not found in breastmilk, so you may continue breast-feeding."
C)"The half-life of heparin is short, so breastfeed before your daily heparin injection."
D)"Pump your breasts to keep breastmilk flowing so you can resume breast-feeding later."

Question 25

You suspect a patient taking warfarin (Coumadin) has developed internal bleeding. What symptoms of this condition would you expect the patient to exhibit? (Select all that apply.)

A)Abdominal pain
B)Dizziness
C)Tachycardia
D)Warm, flushed skin
E)Hypertension

Question 26

An obese, menopausal woman is beginning warfarin (Coumadin) therapy. Which adverse effect should you monitor this patient for in the first 10 days of drug therapy?

A)Neutropenia
B)Skin necrosis
C)Severe diarrhea
D)Pulmonary edema

Question 27

You are preparing to give an injection of heparin to a patient. Which of the following steps represent the correct procedure? (Select all that apply.)

A)Insert the needle, pull back the plunger, and aspirate before injecting.
B)Give subcutaneous heparin in the same general area each time.
C)Do not massage the injection site after injecting the heparin.
D)Draw up the heparin and check the dose with another nurse.
E)Use a 25-gauge needle to give heparin subcutaneously.
F)Give the heparin IM ventrogluteal muscle.

Question 28

For which conditions would the use of fibrinolytic drugs be appropriate? (Select all that apply.)

A)Ischemic stroke
B)Hypotensive crisis
C)Acute arterial occlusion
D)Acute pulmonary embolism
E)Cellular damage from an MI
F)Treatment of warfarin overdose

Question 29

A patient is about to begin treatment with epoetin alfa. Which patient assessment parameter should you monitor closely to prevent complications from this drug?

A)The patient's urine output
B)The patient's blood pressure
C)The patient's blood glucose level
D)The patient's serum potassium level

Question 30

A patient has been prescribed a fibrinolytic drug. What response to the patient best describes the action of this class of drug?

A)"This drug works to prevent blood clot formation."
B)"This drug acts to reverse the effects of heparin."
C)"This drug works to lyse existing blood clots."
D)"This drug thins out the blood."

Question 31

A patient is brought to the hospital with chest pain and shortness of breath is suspected of having an acute MI. Which assessment is a priority for this patient with a suspected acute MI who may be given a fibrinolytic drug as treatment?

A)Ask the patient or family when the symptoms first began.
B)Ask the patient or family for a list of all drugs taken that day.
C)Ask the patient or family when the last meal took was eaten.
D)Ask the patient or family to report any history of kidney disease present.

Question 32

What signs or symptoms would you expect to see in a patient who develops bleeding as a result of anticoagulant therapy? (Select all that apply.)

A)Hypertension
B)Easy bruising
C)Bleeding gums
D)Tarry-colored stool
E)Shortness of breath
F)Decreased pulse rate