Question 1

Which statement about fibrinolytic drugs is true?

Accepted Answer

Fibrinolytic drugs are high-alert drugs that are usually administered by IV infusion in a hospital setting. They are not typically used in outpatient settings. These drugs work to dissolve blood clots but can increase cellular damage if used improperly. They are contraindicated in some patients, including those with a history of certain bleeding disorders or recent surgery, but are commonly used in patients experiencing an acute MI.

Question 2

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?

Accepted Answer

Phytonadione, also known as vitamin K1, is the antidote for warfarin overdose. It helps restore the body's clotting factors that are inhibited by warfarin. Paroxetine is an antidepressant and would not be used to treat warfarin overdose. Protamine sulfate is an antidote for heparin, not warfarin. Prothrombin factor is not a specific antidote for warfarin overdose.

Question 3

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?

Accepted Answer

Pain at the site of the injection is a common side effect of injections. Thickening of the blood, infection, drowsiness, and lack of concentration are not expected side effects of erythropoietin stimulating agents.

Question 4

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?

Accepted Answer

Heparin is a large molecule that does not cross into breastmilk, so it is safe to continue breast-feeding while receiving heparin therapy. Option C is a reasonable suggestion, as the half-life of heparin is relatively short, but it is not necessary to interrupt breast-feeding for this reason. Option D is not necessary in this situation, as breast-feeding can continue uninterrupted.

Question 5

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.)

Accepted Answer

Internal bleeding can cause abdominal pain, dizziness, and tachycardia. Warmer, flushed skin and hypertension are not typical symptoms of internal bleeding.

Question 6

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?

Accepted Answer

Obese, menopausal women have an increased risk for developing skin necrosis as an adverse effect when starting warfarin therapy. This is due to their increased body weight and decreased production of endogenous estrogen, which can lead to lower protein C and S levels, making them more susceptible to clotting. Skin necrosis typically presents within the first 10 days of therapy and is characterized by painful, purplish lesions that can progress to skin necrosis and ulceration. Close monitoring of skin integrity is crucial during the initiation of warfarin therapy in this population.

Question 7

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.)

Accepted Answer

Heparin should not be aspirated or massaged after injection to prevent bruising. The dose should be verified with another nurse for safety. A 25-gauge needle is appropriate for subcutaneous injections.

Question 8

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

Accepted Answer

Fibrinolytic drugs are used to dissolve blood clots, which makes them appropriate for conditions like ischemic stroke (A), acute arterial occlusion (C), acute pulmonary embolism (D), and to limit cellular damage from a myocardial infarction (MI) (E). They are not used for hypotensive crisis (B) or to treat warfarin overdose (F).

Question 9

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

Accepted Answer

Epoetin alfa can increase blood pressure and cause hypertension as a side effect. Therefore, monitoring the patient's blood pressure closely is important to prevent complications from this drug. While monitoring other parameters such as urine output, blood glucose level, and serum potassium level may be important in certain situations, they are not the most critical for preventing complications from epoetin alfa.

Question 10

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

Accepted Answer

Fibrinolytic drugs work to dissolve or lyse existing blood clots by activating the body's natural fibrinolytic (clot-dissolving) system. This can be useful in treating conditions such as heart attacks or strokes, where a blood clot is obstructing blood flow.

Question 11

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?

Accepted Answer

Knowing when the symptoms first began is crucial information when considering the eligibility and timing of fibrinolytic therapy. Fibrinolytic therapy is most effective when given within the first 6 hours of symptom onset.

Question 12

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.)

Accepted Answer

Bleeding as a result of anticoagulant therapy can present as easy bruising, bleeding gums, tarry-colored stool, and shortness of breath. Hypertension and decreased pulse rate are not typical symptoms of bleeding caused by anticoagulant therapy.

Quiz 14: Drugs Affecting the Hematologic System