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Introduction to Clinical Pharmacology 8th Edition Edmunds Test Bank
ISBN: 9780323187657
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Chapter 17: Hematologic Products
Edmunds: Introduction to Clinical Pharmacology, 8th Edition
MULTIPLE CHOICE
- What is the purpose of anticoagulant therapy?
| a. | Thin the blood |
| b. | Lyse existing clots |
| c. | Increase viscosity of the blood |
| d. | Prevent new clot formation |
ANS: D
All anticoagulants prevent the formation of blood clots, or thrombi, interfering with the complex clotting mechanism of blood and increasing the time it takes for blood to clot.
DIF: Cognitive Level: Remember REF: pp. 346-347 OBJ: 2
TOP: Anticoagulants KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
- After drawing up heparin from a vial, what is the next thing the nurse should do before giving this medication to the patient?
| a. | Check the syringe size and needle again. |
| b. | Look at the color of the solution. |
| c. | Let another nurse check the dosage. |
| d. | Check the order one more time. |
ANS: C
Because of severe adverse effects if inaccurate doses are given, once the heparin is drawn into a syringe, double-check the dosage with another nurse.
DIF: Cognitive Level: Apply REF: p. 350 OBJ: 2
TOP: Anticoagulants KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
- Which is an early indication of anticoagulant overdose?
| a. | Abdominal pain |
| b. | Bleeding gums |
| c. | Low blood pressure |
| d. | Pallor |
ANS: B
An early sign of overdose is bleeding from the gums while brushing teeth.
DIF: Cognitive Level: Understand REF: p. 353 OBJ: 4
TOP: Anticoagulants KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
- Which therapy could potentiate the effect of anticoagulants?
| a. | Vitamin K |
| b. | Thiazide diuretics |
| c. | Nonsteroidal antiinflammatory analgesics |
| d. | Vitamin C |
ANS: C
Nonsteroidal antiinflammatory drugs (NSAIDs) will increase the risk of bleeding and hemorrhage in a patient receiving heparin.
DIF: Cognitive Level: Understand REF: p. 347 OBJ: 2
TOP: Drug Interactions with Anticoagulants KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- A 50-year-old male patient is started on aspirin (ASA) 80-mg tablets once daily as an antiplatelet agent. The nurse explains to this patient that ASA is the drug of choice for reducing the risk of which condition?
| a. | Hemorrhagic stroke |
| b. | Ischemic stroke |
| c. | Gastric inflammation |
| d. | Cellular formation |
ANS: B
In men over 50 years of age, ASA is a drug of choice for reducing the risk of ischemic stroke. It plays no role in hemorrhagic stroke.
DIF: Cognitive Level: Apply REF: p. 345 OBJ: 2
TOP: Antiplatelet Agents KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
- Which tests will the nurse evaluate after the physician makes an adjustment in a patient’s heparin dose in order to determine the effect of the change?
| a. | aPTT |
| b. | PT |
| c. | INR |
| d. | DIC panel |
ANS: A
The dose of heparin is adjusted based on the activated partial thromboplastin time (aPTT) result, determined from blood drawn 8 hours after the start of heparin infusion.
DIF: Cognitive Level: Understand REF: p. 349 | p. 353
OBJ: 2 TOP: Coagulation KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity
- A patient is receiving both heparin and Coumadin (warfarin). Which is most likely to be true about this case?
| a. | The physician has made an error. |
| b. | The patient is being weaned from Coumadin. |
| c. | The patient will soon be taken off heparin. |
| d. | The patient may be experiencing a paradoxical effect to one of the medications. |
ANS: C
If anticoagulant therapy is started with heparin and a Coumadin or indanedione derivative, it is recommended that both drugs be given until the PT or INR results indicate an adequate response to the Coumadin or indanedione derivative.
DIF: Cognitive Level: Apply REF: p. 347 OBJ: 2
TOP: Anticoagulant Therapy KEY: Nursing Process Step: Diagnosis
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
- In checking the chart of an elderly female outpatient on anticoagulant therapy, the LPN/LVN notes that the patient’s lab values are abnormal. The patient says she takes her medication as prescribed, so the nurse asks about her dietary intake. Which food might have an effect on anticoagulant therapy?
| a. | Broccoli |
| b. | Eggplant |
| c. | Oranges |
| d. | Grapes |
ANS: A
The patient should eat a normal, balanced diet but should avoid excessive amounts of foods high in vitamin K (broccoli, cabbage, green onions, dark leafy greens, beef liver, soybean oil).
DIF: Cognitive Level: Apply REF: p. 349 |Box 17-1
OBJ: 2 TOP: Anticoagulant Therapy
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
- Which range represents the therapeutic INR range for a patient taking Coumadin?
| a. | 1.0 to 2.0 |
| b. | 2.0 to 3.0 |
| c. | 3.0 to 4.0 |
| d. | 4.0 to 5.0 |
ANS: B
The specific INR goal recommendations for each clinical indication is typically 2.0 to 3.0, except in cases of cardiac valve replacement, for which it is higher.
DIF: Cognitive Level: Remember REF: p. 349 OBJ: 2
TOP: Anticoagulant Dosage KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity
- A patient is started on warfarin (Coumadin) that is adjusted with the results of the INR and/or PT. The nurse expects the physician to start an initial dose that is within which dosage range?
| a. | 2 to 5 mg |
| b. | 0.5 to 1 mg |
| c. | 6 to 8 mg |
| d. | 8 to 9 mg |
ANS: A
Individualized dosage is usually initiated at 2 to 5 mg/day, with dosage adjustments based on the results of the INR and/or PT.
DIF: Cognitive Level: Apply REF: Table 17-1 OBJ: 2
TOP: Anticoagulants KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
- Which statement should the nurse include when teaching a patient about anticoagulant therapy?
| a. | “If you are cut, and you are still bleeding after 10 minutes, call the doctor.” |
| b. | “Over-the-counter medications may be taken with this drug.” |
| c. | “A diet high in green, leafy vegetables is recommended.” |
| d. | “Black, tarry stools are common with this medication.” |
ANS: A
Pressure should be used to stop bleeding from accidental cuts or scrapes. If bleeding persists after 10 minutes, the nurse, physician, or other health care provider should be contacted.
DIF: Cognitive Level: Apply REF: p. 353 OBJ: 3
TOP: Patient Education KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
- Which is the antidote for heparin overdose?
| a. | Aspirin |
| b. | Packed red blood cells |
| c. | Vitamin K |
| d. | Protamine sulfate |
ANS: D
Protamine sulfate is a strongly basic (alkaline) protein that acts as an antagonist to neutralize (reverse) the actions of heparin.
DIF: Cognitive Level: Remember REF: p. 354 OBJ: 4
TOP: Heparin Antagonists KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- Thrombolytic agents have which actions?
| a. | They prevent clot formation. |
| b. | They lyse existing clots. |
| c. | They increase the blood’s viscosity. |
| d. | They thin the blood. |
ANS: B
Thrombolytics convert plasminogen to the enzyme plasmin, which breaks down fibrin clots, fibrinogen, and other plasma proteins. These products are used for lysis (dissolving) of thrombi.
DIF: Cognitive Level: Understand REF: p. 354 OBJ: 2
TOP: Thrombolytic Agents KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- Protamine sulfate should be given which health care professional?
| a. | A physician |
| b. | A trained IV nurse |
| c. | An OR nurse |
| d. | Any trained medical professional |
ANS: A
Protamine sulfate should be given only a physician. An LPN/LVN may assemble the medications but must allow the physician to draw up and administer the dose.
DIF: Cognitive Level: Understand REF: p. 354 OBJ: 3
TOP: Protamine Sulfate KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- A patient comes into the emergency department with complaints of chest pains. An ECG reveals an acute myocardial infarction taking place. The nurse would expect the physician to take which action?
| a. | Send the patient directly to the cardiac unit for follow-up care. |
| b. | Give the patient one aspirin and repeat the ECG. |
| c. | Administer a thrombolytic agent for lysis of thrombi. |
| d. | Administer heparin only to prevent potential bleeding of coronary arteries. |
ANS: C
Thrombolytic agents are used in acute myocardial infarction for lysis of thrombi blocking coronary arteries.
DIF: Cognitive Level: Analyze REF: pp. 354-355 OBJ: 2
TOP: Thrombolytic Agents KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
- A patient on anticoagulant therapy should avoid excessive amounts of which vitamin?
| a. | Vitamin C |
| b. | Vitamin D |
| c. | Vitamin E |
| d. | Vitamin K |
ANS: D
The patient should eat a normal, balanced diet but should avoid eating excessive amounts of foods such as leafy, green vegetables high in the water-soluble vitamin K.
DIF: Cognitive Level: Understand REF: p. 353 OBJ: 3
TOP: Patient Education KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
- Once anticoagulation therapy has ended, what should the nurse advise the patient to do?
| a. | Go back to using a razor for shaving as before therapy. |
| b. | Use caution for a while after therapy has ended. |
| c. | Remove the Medic-Alert bracelet at the end of therapy. |
| d. | Resume alcohol consumption after therapy has ended. |
ANS: B
After anticoagulation therapy has been stopped, the patient should use caution until the body recovers its blood-clotting abilities.
DIF: Cognitive Level: Understand REF: p. 354 OBJ: 3
TOP: Patient Education KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
- The dosage of heparin is considered adequate when the whole blood clotting time is at approximately which level?
| a. | 2 to 3 times the control value |
| b. | 0.1 to 1 times the control value |
| c. | 1 to 2 times the control value |
| d. | 0.5 to 1 times the control value |
ANS: A
The dosage of heparin is considered adequate when the whole blood clotting time is approximately 2 to 3 times the control value.
DIF: Cognitive Level: Apply REF: p. 349 OBJ: 2
TOP: Anticoagulation KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
- Laboratories commonly report the PT values with which measurement?
| a. | ISI |
| b. | PTT |
| c. | DIC |
| d. | INR |
ANS: D
Laboratories commonly report both numbers (PT/INR) when a PT is ordered.
DIF: Cognitive Level: Remember REF: pp. 348-349 OBJ: 2
TOP: Coagulation Studies KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
- In intermittent IV heparin therapy, the blood for the activated partial thromboplastin time (aPTT) should be drawn at which time?
| a. | 1 hour before the next dose |
| b. | 2 hours after the last dose |
| c. | 30 minutes before the next dose |
| d. | 2 hours before the next dose |
ANS: C
If intermittent IV heparin therapy is being given, blood for determination of aPTT should be drawn 30 minutes before the next dose is given.
DIF: Cognitive Level: Understand REF: p. 350 OBJ: 1
TOP: Coagulation Studies KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
- Heparin therapy is based on the patient’s body weight in kilograms. Which represents the rate used for an IV bolus infusion?
| a. | 80 units/kg |
| b. | 65 units/kg |
| c. | 5 units/kg |
| d. | 18 units/kg |
ANS: A
Weight-based dosing uses the patient’s body weight in kilograms with a calculated IV bolus infusion rate of 80 units/kg.
DIF: Cognitive Level: Remember REF: p. 348 OBJ: 1
TOP: Anticoagulation Therapy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
- Aside from excessive bleeding, heparin therapy may increase the risk of a patient developing which condition?
| a. | A decrease in urination |
| b. | An increase in thirst |
| c. | An increase in hypertension |
| d. | A decrease in visual acuity |
ANS: C
An adverse reaction of heparin sodium is hypertension (high blood pressure).
DIF: Cognitive Level: Remember REF: p. 348 OBJ: 3
TOP: Adverse Reactions KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
- To reduce the risk of gastrointestinal bleeding in older adult patients, the nurse must be aware of giving anticoagulants with which drug?
| a. | Tylenol |
| b. | Ibuprofen |
| c. | Vitamin C |
| d. | Vitamin E |
ANS: B
Ibuprofen is an example of a medication that increases the risk of GI bleeding in older adult patients.
DIF: Cognitive Level: Understand REF: p. 349 OBJ: 2
TOP: Geriatric Considerations KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
- Which of the following is a heparin antagonist?
| a. | Vitamin D |
| b. | Vitamin E |
| c. | Folic acid |
| d. | Protamine sulfate |
ANS: D
Protamine sulfate is a heparin antagonist.
DIF: Cognitive Level: Remember REF: p. 354 OBJ: 4
TOP: Anticoagulants KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
- A patient is on an anticoagulant. The patient also occasionally takes goldenseal for cold symptoms. What should the nurse teach the patient about the use of herbal drugs and 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. |
ANS: B
Goldenseal, as well as other herbal drugs, may increase the risk of bleeding in patients on anticoagulants.
DIF: Cognitive Level: Apply REF: p. 346| Box 17-1
OBJ: 3 TOP: Patient Education
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
MULTIPLE RESPONSE
- Thrombolytic agents are used in which conditions? (Select all that apply.)
| a. | Acute pulmonary embolism |
| b. | Ischemic stroke |
| c. | Cellular damage |
| d. | Hypotensive crisis |
| e. | Acute arterial occlusion |
ANS: A, B, E
Thrombolytic agents are used in acute myocardial infarction for lysis of thrombi that block coronary arteries, in acute pulmonary embolism for clot lysis when the patient is hemodynamically unstable, in acute ischemic stroke, and in acute arterial occlusion. Use of thrombolytics reduces the extent of cellular damage from blockage.
DIF: Cognitive Level: Understand REF: p. 354 OBJ: 4
TOP: Thrombolytic Agents KEY: Nursing Process Step: Diagnosis
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
- Which drugs are used to prevent myocardial infarction in men? (Select all that apply.)
| a. | Vitamin K (AquaMEPHYTON) |
| b. | Dipyridamole (Persantine) |
| c. | Ticlopidine (Ticlid) |
| d. | Clopidogrel (Plavix) |
| e. | Aspirin |
ANS: B, C, D, E
Antiplatelet agents such as dipyridamole (Persantine), ticlopidine (Ticlid), and clopidogrel (Plavix) are used to prevent myocardial infarction in men.
DIF: Cognitive Level: Understand REF: p. 345 | Table 17-1
OBJ: 2 TOP: Antiplatelet Agents
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
