A patient has been receiving heparin while in the hospital to treat deep vein thromboses and
will be discharged home with a prescription for enoxaparin [Lovenox]. The nurse provides
teaching for the nursing student who asks about the advantages of enoxaparin over heparin.
Which statement by the student indicates a need for further teaching?
B.
A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes
that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats/minute. The
patient’s most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The
nurse will request an order for:
A.
Heparin overdose may cause hemorrhage, which can be characterized by low blood pressure, tachycardia, and lumbar pain.
A nursing student who is preparing to care for a postoperative patient with deep vein
thrombosis asks the nurse why the patient must take heparin rather than warfarin. Which
response by the nurse is correct?
C.
A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the
lower leg, which feels warm to the touch. The nurse will anticipate giving which medication?
B.
A patient who is taking warfarin [Coumadin] has just vomited blood. The nurse notifies the
provider, who orders laboratory work revealing a PT of 42 seconds and an INR of 3.5. The nurse
will expect to administer:
C.
A patient who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the
second postoperative day, the nurse assesses the patient and notes an oxygen saturation of 83%,
pleuritic chest pain, shortness of breath, and hemoptysis. The nurse will contact the provider
to report possible and request an order for .
C.
A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the
patient’s INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider
and:
C.
A postoperative patient will begin anticoagulant therapy with rivaroxaban [Xarelto] after knee
replacement surgery. The nurse performs a history and learns that the patient is taking
erythromycin. The patient’s creatinine clearance is 50 mL/minute. The nurse will:
C.
Patients with impaired renal function who are taking macrolide antibiotics will experience
increased levels of rivaroxaban, increasing the risk of bleeding.
A patient who is taking clopidogrel [Plavix] calls the nurse to report black, tarry stools and
coffee-ground emesis. The nurse will tell the patient to:
B.
Patients who experience bleeding should be warned not to stop taking the clopidogrel until the
prescriber says they should, since abrupt withdrawal may precipitate a thrombotic event.
A patient has been taking warfarin [Coumadin] for atrial fibrillation. The provider has ordered
dabigatran etexilate [Pradaxa] to replace the warfarin. The nurse teaches the patient about the
change in drug regimen. Which statement by the patient indicates understanding of the
teaching?
a. “I may need to adjust the dose of dabigatran after weaning off the warfarin.”
b. “I should continue to take the warfarin after beginning the dabigatran until my INR is
greater than 3.”
c. “I should stop taking the warfarin 3 days before starting the dabigatran.”
d. “I will stop taking the warfarin and will start taking the dabigatran when my INR is less
than 2.”
d
A 50-year-old female patient asks a nurse about taking aspirin to prevent heart disease. The
patient does not have a history of myocardial infarction. Her cholesterol and blood pressure
are normal, and she does not smoke. What will the nurse tell the patient?
A.
ASA is used for primary prevention of myocardial infarction (MI) in men and in women older than
65 years.
A patient who takes warfarin [Coumadin] is brought to the emergency department after
accidentally taking too much warfarin. The patient’s heart rate is 78 beats/minute and the blood
pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any
obvious hematoma or petechiae and does not complain of pain. The nurse will anticipate an
order for:
C.
A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats/minute and a blood pressure of 110/72 mm Hg. The patient’s fingertips are purplish in
color. A stat CBC shows a platelet count of less than 100,000 mm3. The nurse will:
A.
This patient is showing signs of heparin-induced thrombocytopenia, so the heparin should be discontinued immediately and the provider should be notified.
A patient will begin taking dabigatran etexilate [Pradaxa] to prevent stroke. The nurse will
include which statement when teaching this patient?
A.
A patient is admitted to the hospital with unstable angina and will undergo a percutaneous
coronary intervention. Which drug regimen will the nurse expect to administer to prevent
thrombosis in this patient?
C.
A patient who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The
nurse will anticipate an order to:
A.
Carbamazepine is a powerful inducer of hepatic drug-metabolizing enzymes and can accelerate warfarin degradation.
A nurse has just received an order for tenecteplase [TNKase] for a patient experiencing an
acute myocardial infarction. The nurse should administer this drug:
B.
A patient is admitted to the emergency department with chest pain. An electrocardiogram shows changes consistent with an evolving myocardial infarction. The patient’s cardiac enzymes are pending. The nurse caring for this patient will expect to:
A.
When alteplase is given within 2 hours after symptom onset, the death rate for MI has been shown to be 5.4%, compared with 9.4% if given 4 to 6 hours after symptom onset.
ASA may be given at the first sign of MI; it is not necessary to wait for cardiac enzyme results.
Tenecteplase may be given more than 2 hours after onset of symptoms.
A nurse is taking a medication history on a newly admitted patient. The patient reports taking
folic acid and vitamin B12. The nurse notifies the provider because of the concern that folic acid can:
D.
Folic acid can reverse the hematologic effects of vitamin B12 deficiency, but it does not reverse the neurologic effects, so it is important to determine the degree of B12 deficiency to treat it.
A nurse is caring for a patient after hip replacement surgery. The patient has been receiving iron replacement therapy for 2 days. The nurse notes that the patient’s stools appear black. The patient is pale and complains of feeling tired. The patient’s heart rate is 98 beats/minute, respirations are 20 breaths/minute, and the blood pressure is 100/50 mm Hg. The nurse will contact the provider to:
C.
This patient is showing signs of iron deficiency anemia, as manifested by tachycardia and pallor. Because this patient’s blood pressure is low, the anemia probably has occurred secondary to blood loss, a common occurrence with hip replacement surgery. The first response should be to obtain an H&H to assess the anemia.
GI hemorrhage is not a concern in this patient
black stools are an expected effect of oral iron administration.
A 12-year-old female patient is admitted to the hospital before sinus surgery. The nurse preparing to care for this patient notes that the admission hemoglobin is 10.2 gm/dL, and the hematocrit is 32%. The nurse will ask the child’s parents which question about their daughter?
D.
The most common cause of iron deficiency anemia in adolescent females is heavy periods, so
asking about menses is an appropriate first question when evaluating the cause of low iron in young females. Iron deficiency only rarely occurs because of poor dietary intake.
A patient with renal failure is undergoing chronic hemodialysis. The patient’s hemoglobin is 10.6 gm/dL. The provider orders sodium–ferric gluconate complex (SFGC [Ferrlecit]). What will the nurse expect to do?
B.
SFGC is given parenterally for iron deficiency anemia in patients undergoing chronic hemodialysis. It is always used in conjunction with erythropoietin to stimulate the production of red blood cells (RBCs).
A test dose is given only with the initial dose and is not necessary with subsequent doses.
Anaphylaxis is not a common side effect.
The drug should be infused slowly
A patient tells a nurse that she is thinking about getting pregnant and asks about nutritional supplements. What will the nurse recommend?
B.
The current recommendation is that all women of childbearing age receive folic acid supplementation to prevent the development of neural tube defects that can occur early in pregnancy. Dietary folic acid is not sufficient to provide this amount. Iron supplements are given when pregnancy occurs and are not necessary before becoming pregnant.
A patient who has recently immigrated to the United States from an impoverished country appears malnourished. The patient’s folic acid levels are low, and the vitamin B12 levels are normal. The nurse expects this patient’s treatment to include:
B.
If a folic acid deficiency is caused by poor diet, it should be corrected with dietary measures, not supplements.
A patient is admitted to the hospital. The patient’s initial laboratory results reveal megaloblastic anemia. The patient complains of tingling of the hands and appears confused. The nurse suspects what in this patient?
A.
When patients present with megaloblastic anemia, it is essential to distinguish between folic acid
deficiency and vitamin B12 deficiency. If neurologic deficits are observed, vitamin B12 deficiency
is more likely to be the cause.
A nurse is reviewing a patient’s most recent blood count and notes that the patient has a hemoglobin of 9.6 gm/dL and a hematocrit of 33%. The nurse will notify the provider and will
expect initial treatment to include:
B.
What are the indications for administration of a parenteral iron preparation?
Select all that apply.
a. Blood loss of 750 mL/week
b. Celiac disease with anemia
c. History of alcoholism
d. Intestinal disease impairing absorption
e. Megaloblastic anemia
ANS: A , B , D
A patient was given a 30-day supply of Feosol and has been taking the drug for 4 weeks for iron deficiency anemia. The patient’s initial hemoglobin was 8.9 gm/dL. The nurse notes that the hemoglobin has risen to 9.7 gm/dL. What will the nurse ask the patient about?
C.
When therapy is successful, the hemoglobin level increases by 2 gm/dL within 1 month. If the
hemoglobin does not increase as expected, patients should be asked about compliance. If a patient
reports that the prescription does not need to be refilled, the medication probably has not been
taken as prescribed.
A patient is receiving oral iron for iron deficiency anemia. Which antibiotic drug, taken concurrently with iron, would most concern the nurse?
A.
A patient with vitamin B12 deficiency is admitted with symptoms of hypoxia, anemia, numbness of hands and feet, and oral stomatitis. The nurse expects the prescriber to order which of the following therapies?
C.
A patient who has been prescribed oral ferrous sulfate reports taking extra doses for the past few months. The patient’s serum iron level is 560 mcg/dL. What will the nurse expect the provider to order for this patient?
A.
If the plasma level of iron is high (above 500 mcg/dL), it should be lowered with parenteral
deferoxamine. This level is toxic and must be treated.
A patient is diagnosed with moderate vitamin B12 deficiency. The nurse reviews the laboratory work and notes that the plasma B12 is low; also, a Schilling test reveals B12 malabsorption. The provider orders oral cyanocobalamin 500 mcg/day. The nurse will contact the provider to:
B.
Patients with vitamin B12 deficiency associated with B12 malabsorption need increased doses of oral cyanocobalamin of 1000 to 10,000 mcg/day. It is not necessary to give this drug intramuscularly. Folic acid is indicated when B12 deficiency is severe. Platelets are given when
B12 deficiency is severe.
Drugs that increase the effects of warfarin. Select all that apply
a. ketoconazole
b. trimethoprim-sulfamethoxazole
c. cephalexin
d. carbamazepine
e. ciprofloxacin
a, b, c
Drugs that decrease the effects of warfarin. Select all that apply.
a. carbamazepine
b. oral contraceptives
c. phenytoin
d. Cholestyramine
e. Rifampin
all of the above
Combined use with dabigatran and the following P-glycoprotein inhibitors can cause bleeding from excessive dabigatran levels: Select all that apply.
a. ketoconazole
b. warfarin
c. amiodarone
d. verapamil
e. quinidine
a, c, d, e
The following drugs inhibit CYP3A4 and also inhibit P-glycoprotein can raise rivaroxaban levels enough to increase the risk for bleeding.
a. ketoconazole
b. amiodarone
c. adenosine
d. diltiazem
e. azithromycin
a, b, d, e
The following drugs induce CYP3A4 and also induce P-glycoprotein may reduce rivaroxaban levels enough to increase the risk for thrombotic events
a. carbamazepine
b. phenytoin
c. rifampin
d. St. John's wort
e. quinidine
a, b, c, d
What is the reversal agent for Xarelto and Eliquis?
A.
What is the reversal agent for dabigatran?
C.
Author
BodeS
ID
363589
Card Set
CH 46 & 47
Description
Chapter 46, "Anticoagulant, Antiplatelet, and Thrombolytic Drugs"
Chapter 47, “Drugs for Deficiency Anemias”
