NCLEX REVIEW Pharmacology: Hematological Medications

NCLEX REVIEW Pharmacology: Hematological

Medications Leave the first rating Students also studied Terms in this set (48) University of Saint Francis-Fort Wayne NURS 375 Save

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Teacher 119 terms pinayRN7Preview Pharmacology Hesi Practice 2 67 terms lbpeters14Preview Dementia Sherpath SimChart 15 terms lizi54Preview Saunde 82 terms Sha A home care nurse is visiting a client who was discharged to home with a prescription for continued administration of enoxaparin (Lovenox) subcutaneously. What is the nurse's priority assessment for this client?

• Constipation
• Fear of needles
• Nausea or vomiting
• Bleeding gums or bruising
• Bleeding gums or bruising

Enoxaparin is an anticoagulant. An adverse effect of anticoagulant therapy is bleeding. Accordingly, the nurse questions the client about signs and symptoms that could indicate bleeding, such as bleeding gums, bruising, hematuria, or dark tarry stools.The nurse is assigned to care for a client who was just admitted to the hospital for the treatment of iron overload. The nurse anticipates that the health care provider will prescribe which medication to treat the iron overload?

• Granisetron
• Ketoconazole
• Deferoxamine
• Terbinafine (Lamisil)
• Deferoxamine

Deferoxamine is a medication used to treat iron overload. Granisetron is an antiemetic. Ketoconazole and terbinafine are antifungal medications.

Epoetin alfa (Epogen, Procrit) has been prescribed for a client with chronic kidney disease who is being cared for by a nursing student. The nursing instructor determines that the student understands the procedure for administering the medication when the student states that which route of administration is acceptable?

• Oral
• Z-track
• Intramuscular
• Subcutaneous
• Subcutaneous

Epoetin alfa is administered parenterally by the intravenous or subcutaneous route. It cannot be given orally because it is a glycoprotein and would be degraded in the gastrointestinal tract.Enoxaparin sodium (Lovenox) is prescribed for a client after hip replacement surgery. What should the nurse prepare to have available in the event that an overdose of the medication occurs?

• Adrenalin
• Vitamin K
• Epinephrine
• Protamine sulfate
• Protamine sulfate

Enoxaparin sodium is an anticoagulant. Accidental overdose of this medication may lead to bleeding complications. The antidote is protamine sulfate. Adrenalin is a trademarked preparation of epinephrine, which normally is used to treat hypersensitivity reactions or acute bronchial asthma attacks and bronchospasms.Vitamin K is the antidote for warfarin sodium (Coumadin).A client with a subarachnoid hemorrhage needs to have surgery delayed until a stable clinical condition is achieved. The nurse prepares to administer which medication as prescribed to prevent clot breakdown and dissolution?

• Alteplase (Activase)
• Warfarin (Coumadin)
• Heparin sodium (Heparin)
• Aminocaproic acid (Amicar)
• Aminocaproic acid (Amicar)

Aminocaproic acid (Amicar) is an antifibrinolytic agent that prevents clot breakdown or dissolution. It is commonly prescribed after subarachnoid hemorrhage if surgery is delayed or contraindicated, to prevent further hemorrhage. Alteplase is a fibrinolytic that actively breaks down clots. Warfarin and heparin sodium are anticoagulants that interfere with propagation or growth of a clot.A client is taking ticlopidine hydrochloride (Ticlid). The nurse should tell the client to avoid which substance while taking this medication?

• Vitamin C
• Vitamin D
• Acetaminophen (Tylenol)
• Acetylsalicylic acid (aspirin)
• Acetylsalicylic acid (aspirin)

Ticlopidine hydrochloride is a platelet aggregation inhibitor. It is used to decrease the risk of thrombotic stroke in clients with precursor symptoms. Because it is an antiplatelet agent, other medications that precipitate or aggravate bleeding should be avoided during its use. Therefore, aspirin or any aspirin-containing product should be avoided. The substances in options 1, 2, and 3 are safe to consume.

A client is admitted to the hospital emergency department with an acute anterior wall myocardial infarction. The nurse discusses streptokinase (Streptase) therapy with the client and spouse. The spouse is concerned about the dangers of this treatment. Which statement by the nurse is appropriate?

• "There is no reason to worry. We use this medication all

the time."

• "I'm certain you made the correct decision to use this

medication."

• "You have concerns about whether this treatment is the

best option."

• "Your loved one is very ill. The health care provider has

made the best decision for you."

• "You have concerns about whether this treatment is the best option."

Paraphrasing is restating the client's or family members' own words. This allows the client and family members to express their concerns and talk through the decisions that have been made. Option 1 is offering false reassurance. In option 2, the nurse is expressing approval, which can be harmful to the client-nurse or family-nurse relationship. Option 4 represents a communication block that denies the client's right to an opinion.A decision has just been made to give tissue plasminogen activator (t-PA) (Activase) to a client. The nurse should obtain which supply for standard use as part of safe nursing care related to this medication?

• Flashlight
• Pulse oximeter
• Suction equipment
• Occult blood test strips
• Occult blood test strips

Activase is a thrombolytic medication that dissolves thrombi or emboli. Bleeding is a frequent and potentially severe adverse effect of therapy. The nurse assesses for signs of bleeding in clients receiving this therapy using occult blood test strips to test urine, stool, or nasogastric drainage. A flashlight is used for pupil assessment as part of the neurological examination in the client who is neurologically impaired. Pulse oximeter and suction equipment would be needed if the client had evidence of oxygenation or respiratory problems.A nurse has provided discharge instructions to a client being placed on long-term anticoagulant therapy with warfarin (Coumadin). Adequate learning would be evident if the client makes which statements? Select all that apply.

• "I will inform my dentist that I am taking Coumadin."
• "I may take over-the-counter medications as needed."
• "I should alternate the timing of my daily dose of

Coumadin."

• "I should use a firm-bristled toothbrush to prevent the

side effects of Coumadin."

• "I will have my blood levels checked as prescribed by

my health care provider (HCP)."

• "I will report any signs of blood in my urine or stool to

my health care provider (HCP)."

1, 5, 6

Clients need to notify all health care providers that they are on warfarin (Coumadin) therapy. Dental procedures may put the client at risk for increased bleeding, so this should direct you to option 1. Knowing that the effectiveness of warfarin is based on maintaining a therapeutic blood level will direct you to select option 5. Awareness of bleeding as a primary complication will direct you to option 6.A home care nurse is preparing to administer filgrastim (Neupogen) to a client. The nurse plans to administer the medication by which route?

• Oral
• Subcutaneous
• Intramuscular
• Intravenous bolus
• Subcutaneous

Filgrastim (Neupogen) is a granulocyte colony-stimulating factor produced by human recombinant DNA technology. It is given by subcutaneous injection or continuous intravenous infusion.

The nurse is providing instructions to the parent of a child with iron deficiency anemia about the administration of a liquid oral iron supplement. Which statement, if made by the parent, indicates an understanding of the administration of this medication?

• "I should give the iron with food."
• "I can mix the iron with cereal to give it."
• "I should add the iron to the formula in the baby's

bottle."

• "I should use a medicine dropper and place the iron

near the back of the throat."

• "I should use a medicine dropper and place the iron near the back of the

throat." An oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth because it will stain the teeth. The parents should be instructed to brush or wipe the teeth after administration. Iron is administered between meals because absorption is decreased if there is food in the stomach. Iron requires an acidic environment to facilitate its absorption in the duodenum.The nurse medicates a client with phytonadione (vitamin K). The nurse should assess which laboratory value 24 hours after administering vitamin K?

• Prothrombin time
• Blood ammonia level
• Direct serum bilirubin
• Serum potassium level
• Prothrombin time

Vitamin K is needed for adequate blood clotting. Therefore checking the prothrombin time is necessary 24 hours after injection of vitamin K. Blood ammonia levels are assessed to determine the conversion of ammonia to urea that normally occurs in the liver. Bilirubin is a measurement of the ability of the liver to conjugate and excrete bilirubin. Serum potassium is an electrolyte and is not affected by the injection of vitamin K.The nurse has a prescription to give heparin sodium 5000 units subcutaneously. The nurse should plan to take which action to administer this medication?

• Inject via an infusion device.
• Inject ½ inch from the umbilicus.
• Massage the injection site after administration.
• Change the needle after withdrawing the medication

from the vial.

• Change the needle after withdrawing the medication from the vial.

After heparin sodium is drawn up from the vial, the needle is changed before injection to prevent contact of the medication with tissue along the needle track.Heparin sodium administered subcutaneously does not require an infusion device and is injected at least 2 inches from the umbilicus or any scar tissue. The needle is withdrawn rapidly, and the site is not massaged (although pressure is applied).The nurse is caring for a postpartum client with a diagnosis of deep vein thrombosis who is receiving a continuous intravenous infusion of heparin sodium. Which laboratory result will the nurse specifically review to determine whether an appropriate dose of heparin is being delivered?

• Platelet count
• Prothrombin time (PT)
• International normalized ratio (INR)
• Activated partial thromboplastin time (aPPT)
• Activated partial thromboplastin time (aPPT)

Anticoagulation therapy may be used to prevent the extension of thrombus by delaying the clotting time of the blood. The aPTT time should be monitored, and the heparin dose should be adjusted to maintain a therapeutic level of 1.5 to 2.5 times the control. The platelet count cannot be used to determine an adequate dosage for the heparin infusion. The PT and the INR are used to monitor coagulation time when warfarin (Coumadin) is used.A nurse provides dietary instructions to a client who will be taking warfarin sodium (Coumadin). The nurse should tell the client to avoid which food item?

• Grapes
• Spinach
• Watermelon
• Cottage cheese
• Spinach

Warfarin sodium is an anticoagulant. Anticoagulant medications act by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K often are omitted from the diet.Vitamin K-rich foods include green leafy vegetables, fish, liver, coffee, and tea.