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Hematologic Drugs. Electrolytes Essay

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A client who uses St. Johns wort is receiving warfarin. The nurse would be alert for which of the following?
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Increased risk of bleeding
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For optimal therapeutic effect a thrombolytic medication should be administered as soon as possible after the formation of a thrombus, preferably w/n how many hours?
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4-6 hour
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why thin blood?
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DVT Stroke PE MI
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T or F Bleeding time is usually unaffected by Heparin
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True clotting time is prolonged by full therapeutic doses
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How does one administer Enoxaparin (Lovenox)?
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Subcutaneous Injection
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For a client prescribed warfarin, which herbal remedy may be problematic?
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Garlic Ginger Gingko Biloba Ginseng Green Tea
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Client is prescribed warfarin for venous thrombosis. The nurse suspects overdose d/t what?
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Melena -blood in the stool
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Assessment of a client receiving an anticoagulant reveals abdominal pain, coffee ground stools, black tarry stool, hematuria, joint pain and is coughing up blood. What may be happening?
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Internal bleeding
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What inhibits the synthesis of Vit. K – dependent coagulation factors VII, IX, X and II
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Coumadin
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What is administered for a overdose of warfarin?
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Phytonadione (Vitamin K)
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What are used to precent the formation and extension of a thrombus?
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Anticoagulants
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Do anticoagulants thin blood?
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No!!!! They prevent additional clots from forming.
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People with PEs will be put on what?
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Coumadin
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what is the most common oral anticoagulant?
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Warfarin
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When is the peak activity reached with warfarin?
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1.5-3 days after therapy is started
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What is a mixture of high and low molecular weight drugs?
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Heparin such as? Dalteparin (Fragmin) Enoxaparin (Lovenox)
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What is used to prevent DVT in pts. undergoing hip, knee, or abdominal surgery?
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Desirudin (Iprivask) Fondaparinux (Arixtra)
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A client is receiving anticoagulant therapy and has an INR done. Which result would indicate as being therapeutic?
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2.4 When anticoagulant therapy is used, INR between 2-3 is maintained.
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A client receiving warfarin therapy. The nurse instructs the client and family certain foods must be ingested consistently bc of the possible interference with the effect of which therapy. Which food must be taken in limited quantity?
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food rich in Vit K
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If someone is taking warfarin, and also uses Chamomile… what may happen?
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Increased risk for bleeding
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The nurse would anticipate administering fondaparinux to a client with which of the following?
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DVT Prophylaxis
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Someone receiving subcutaneous heparin at 8am, and is scheduled for the next dose at 8pm. When would the nurse obtain a specimen for an aPTT test at what time?
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2pm you want to do it 4-6 hours after the injection
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When preparing to administer a thrombolytic drug to a pt. The nurse understands that this class of drugs would be contraindicated in clients with which of the following?
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Active bleeding HX of aneurysm HX of stroke Pregnancy
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AR of thrombolytics?
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cardiac arrhythmias bleeding (Most common)
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What would a nurse administer as an antiplatlet drug?
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Clopidogrel (Plavix)
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When are vitals taken for Thrombolytics?
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q 15 mins, and q 30 mins in the following 6 hrs and fianlly q 60 mins for 16 hrs
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Thrombolytic drugs?
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Ateplase Reteplase (END IN ASE)
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A nurse is educating a group of clients about the contraindications of warfarin (Coumadin) therapy. Which of the following statements is appropriate to include in the teaching?
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Clients who are pregnant should not take Coumadin.
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A nurse is caring for a client diagnosed with thrombophlebitis who has a swollen and inflamed right calf. The client is started on a continuous heparin infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give?
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“Heparin does not dissolve clots, it stops new clots from forming.”
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Most common side effect of anticoagulants?
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Bleeding is the most common side effect, and may present in a variety of ways: epistaxis, gum bleeding, hemoptysis, hematuria, melena or hemorrhage
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Heparin CI?
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Contraindications: • Severe thrombocytopenia • Uncontrollable active bleeding state • Pregnancy, Nursing Mothers
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Heparin Nursing intervention?
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•Nursing: Monitor for bleeding. •Check color of urine, occult blood in stool, • Check for changes in vital signs.
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Factor Xa Inhibitor does what?
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Inhibits factor Xa in clotting cascade which prevents the conversion of prothrombin to thrombin
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Factor Xa Inhibitor drugs
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rivaroxaban, apixaban, dabigatran
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Factor Xa Inhibitor does what? prevents what?
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Prevents deep vein thrombosis (DVT) and pulmonary embolus (PE)
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Factor Xa Inhibitor CI?
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Contraindications • Active pathological bleeding • Pregnancy • Patients taking other anticoagulant, antiplatelet, thrombolytic drugs
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Thrombolytics indications?~
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Treatment of acute MI, pulmonary embolism, and acute ischemic stroke.
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Thrombolyics CI?
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Contraindications • Known bleeding disorder Recent trauma/surgery • Acute liver disease • Cerebrovascular accident within 2mo. • GI ulcers. • Pregnancy
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when should thrombolytics be given?
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Time frame for administration: treatment within 3 hours of onset is crucial
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Thrombolytics Nursing….
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Nursing: • Status is assessed every 15 minutes, and every 30 minutes in the following 6 hours, and finally every 60 minutes for 16 hours • Essential not to give anticoagulants or antiplatelet agents for 24 hours.
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What is Erythropoietin?
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•Erythropoietin (EPO) is a hormone produced by the kidney. •Erythropoietin promotes the formation of red blood cells by the bone marrow.
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Protamine is used to treat overdose of which of the following medications? Select all that apply.
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Heparin Enoxaparin (Lovenox)
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After teaching a group of nursing students about heparins, the instructor determines that the teaching was successful when the students identify which of the following as an example of a low-molecular-weight heparin (LMWH)? Select all that apply.
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Dalteparin Enoxaparin Tinzaparin
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when discussing anticoagulants to a client, which of the following would the nurse include?
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Anticoagulants prevent formation of a thrombus Anticoagulants prevent extension of a thrombus
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When reviewing the medical records of several clients, the nurse understands that the use of anticoagulants is contraindicated in clients with which of the following medical conditions? Select all that apply.
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Leukemia TB GI ulcers
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A client is being discharged from the hospital with a prescription for clopidogrel. The nurse would instruct the client about which of the following as a possible adverse reaction? Select all that apply.
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Bleeding Heart palipatations Constipation Skin rash
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Which assessment would the nurse obtain before administering an anticoagulant to a client with DVT? Select all that apply.
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Test for a pos. Homans sign Examine extremity for skin temp. Assess pain check for pedal pulse
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When teaching a class about parenterally administered heparin, which of the following would the nurse include? Select all that apply.
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Onset of action is almost immediate Max effect occurs within 10 mins. Clotting time returns to NL within 4 hours
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8. A client is receiving a heparin infusion. The nurse should check the needle site for the heparin infusion for signs of which of the following? Select all that apply.
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pain inflammation tenderness
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When teaching a client how to inject heparin subcutaneously, which of the following would the nurse include? Select all that apply.
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Pinch a fold of skin Apply firm pressure after inj. Change sites for ea. dose hold the needle at 90 degrees
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Which of the following may be ordered periodically during therapy with anticoagulants? Select all that apply.
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platelet count blood count stool analysis
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11. A client is prescribed an anticoagulant. In which of the following situations would the nurse hold the drug and notify the physician? Select all that apply.
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PT exceeds 1.5 times the control value. Evidence of bleeding INR greater than 3.0
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A client is being discharged on warfarin therapy. Which of the following would the nurse include in the teaching plan for the client? Select all that apply.
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Be consistent with your intake of foods containing vitamin K. Do not change brands of warfarin without consulting the physician. Take the drug at the same time every evening. Do not take or stop taking other medications except on the advice of the physician. Inform the dentist of therapy with warfarin prior to any treatment or procedure.
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A client is receiving streptokinase. The nurse understands that which of the following would occur? Select all that apply.
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Breakdown of existing thrombi Reopening of occluded blood vessels Prevention of tissue necrosis
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The nurse instructs a client receiving warfarin about the importance of consistent intake of dietary vitamin K to decrease fluctuations in PT/INR. The nurse determines that the client understands the instructions when he identifies which foods as containing vitamin K? Select all that apply.
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Broccoli Cauliflower Fish Yogurt
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A female client is prescribed warfarin. The client also uses oral contraceptives. The nurse would assess the client closely for which of the following? Select all that apply.
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Subtherapeutic INR Calf pain and warmth
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A nurse is conducting a seminar on thrombosis. What information would the nurse include about the cause of arterial thrombosis?
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arrhythmias
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A client with thrombotic stroke is administered ticlopidine. The nurse would assess the client for which of the following?
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Dyspepsia
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What is an AR of protamine?
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Bradycardia Dyspnea
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A client with intermittent claudication is prescribed cilostazol by the primary health care provider. The nurse would expect to administer this drug cautiously if the client’s history reveals which of the following?
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Pancytopenia
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Anticoagulants are used for the prevention and treatment of ?
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pulmonary emboli the adjuvant treatment of myocardial infarction and the treatment of intermittent claudication.
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A client is prescribed warfarin. The client also takes a diuretic for the treatment of cardiac problems. The nurse would anticipate which of the following?
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Decreased effectiveness of the anticoagulant
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A client is receiving heparin by continuous IV infusion. Which of the following would be most appropriate for the nurse to do?
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Perform blood coagulation tests every 4 hours.
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When administering heparin by the subcutaneous route what is done?
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an APTT test is performed 4 to 6 hours after the injection.
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A nurse is caring for a client receiving the anticoagulant drug warfarin. Which assessment would be most appropriate before administering the drug?
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Assess prothrombin time (PT) and INR.
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A female client is receiving an anticoagulant to prevent the formation and extension of blood clots. What instruction should the nurse include in the teaching plan for the client?
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use a reliable contraceptive
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A client in a health care facility is receiving the thrombolytic drug reteplase. Which nursing diagnosis would be most likely?
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Anxiety
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A nurse is caring for a client prescribed warfarin. The nurse would instruct the client that which of the following foods are high in vitamin K?
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Green leafy vegetables
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A nurse is conducting an in-service presentation about hemostasis. The nurse determines that the teaching was successful when the class identifies a thrombus as which of the following?
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Formation of a blood clot
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A nurse is reviewing a journal article about antiplatelet agents. Which of the following would the nurse expect to be discussed? Select all that apply.
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Abciximab Anagrelide Dipyridamole
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A client is experiencing an overdosage of heparin. The nurse would expect to administer which of the following?
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Protamine
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Clients on blood-thinning meds should be monitored for bleeding. Which of the following may indicate internal bleeding?
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Decreased BP Red spots on skin black, tarry stools
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Why would dalteparin be prescribed?
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to prevent a DVT
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hemostasis is best described as what?
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Events forming a clot, stopping bleeding
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Evaluating a client who is taking an antocoagulant for blood loss would usually include assessing for which of the following?
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1. The presence of petechiae 2. Bleeding gums while brushing the teeth 3.Dark colored urine 4.The presence of ecchymotic areas 5. Loss of hair
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The nurse is caring for a patient who is being treated with one of the coagulation modifier drugs. The patient tells the nurse that he has developed a rash. What is the nurse’s highest priority action?
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Notify the provider; the medication will need to be discontinued.
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Cilostazol (Pletal) belongs to which drug class?
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antiplatelet
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A patient who is on enoxaparin (Lovenox) therapy has hematuria, melena, petechiae, and bleeding from the gums. Which treatment strategy will be most beneficial for the patient?
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Administering protamine sulfate (Protamine sulfate)
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The nurse is administering tenecteplase (TNKase) therapy to a patient experiencing an acute myocardial infarction. What will the nurse teach the patient about this therapy?
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“This therapy will dissolve the clot that caused the heart attack.”
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What are glycoproteins that stimulate and regulate the production of erythrocytes?
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Erythropoiesis- Stimulating agents
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two drugs to tx anemia associated with chronic illness are?
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Epoetin alfa (Epogen) Darbepoetin (Aranesp)
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AR of erythropoietin drugs?
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Hypertension HA N/V/D Rashes Fatigue Arthralgia and skin reaction at Inj. site.
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Epoetin alfa is CI in who?
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uncontrolled hypertension emergency transfusion hypersensitivity to human albumin
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Darbepoetin alfa is CI in who?
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uncontrolled HBP
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What can occur if the hemoglobin is not carefully monitored and the dosage is too high?
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polycythemia
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what is the component in hemoglobin that picks up oxygen from lungs and delivers to body tissues?
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Iron
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What may happen if Iron is delivered as IM?
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Brownish color on skin
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When monitoring a patient taking epoetin alfa, which of the following laboratory results would be most important for the nurse to report immediately?
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any increase in hematocrit of 4 points within a 2 wk period
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When teaching a patient about the use of vitamin b 12, the nurse would include which of the following statements?
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you will require vitamin b12 injections monthly for life
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which drug can be used to treat ITP?
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Romiplostim
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most common type of anemia?
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Iron deficiency anemia
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Which substance would decrease the absorption of oral iron?
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antacids
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Filgrastim is CI in which condition?
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hypothyroidism
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Fluid and electrolytes make up what percentage of the body?
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50%
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Which is the following of fluid overload?
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Behavioral changes
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What may indicate hypocalcemia?
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tetany
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What may indicate Hypernatremia?
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fever increased thirst
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Common metabolic complication of TPN?
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hyperglycemia
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When monitoring a client with an IV line, the nurse observes that the area around the needle insertion site is swollen and red. the first action would be to what?
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check for further possible extravastion
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Which of the following IV solutions must be typed and crossmatched for administration?
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whole blood
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a nurse administers calcium IV slowly based on the understanding that rapid IV administration of calcium can lead to which AR?
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Hypotension Bradycardia Cardiac arrest
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A nurse caring for a client prescribed fat emulsions. The nurse would be alert for the development of which of the following?
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Increased body temp. chest and back pain slight pressure over eyes
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What is a major intracellular fluid electrolyte?
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Potassium
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Preparing to administer plasma protein fraction to a pt. The nurse understands that that drug is used to treat which of the following?
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hypovolemic shock
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What is a major extracellular fluid electrolyte?
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Sodium
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What may happen if Total parenteral nutrition (TPN) is being infused too rapidly?
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Hyperglycemia
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If one has hypercalcemic syndrome, which of the following would support suspicion?
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Weakness Severe vomiting lethargy
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What electrolyte is necessary for the transmission of impulses and contraction of smooth, cardiac, and skeletal muscles?
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Potassium
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A pt. w/ chronic renal failure is prescribed darbepoetin alfa. After administration of the drug, the RN would assess for which AR?
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Arthragia Hypertension Rashes
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Filgrastim (Neupogen) should be cautiously used in which people?
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Those with hypothyroidism
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Oprelvekin (Neumega) is a drug that stimulates the process of making which following blood cell?
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platelets
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What drug stimulates thrombopoiesis?
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Oprelvekin (Neumega)
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Pt. with iron deficiency anemia who is prescribed iron. Which of the following should the nurse confirm to ensure that iron compunds are not contraindicated in this client?
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The pt. does not have hemochromatosis.
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pt. dev. neutropenia secondary to chemotherapy. the RN would identify that this pt. is at risk for what?
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Infection
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A pt. diagnosed with anemia. The nurse understands that anemia can result is which of the following?
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Decreased platelet production
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Epoetin afla (Epoetin) is CI in which medical condition?
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Uncontrolled hypertension
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A pt. suffering from anemia resulting from chronic kidney disease might be treated with which drug?
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Epoetin alfa (Epogen)
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a client is prescribed which drug that acts on the hematopoietic cells to stimulate proliferation, differentiation, and maturation of WBC?
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Filgrastim (Neupogen)
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A patient has been administered iron preparation for treating iron deficiency anemia. The patient has informed the nurse that she has also been taking ascorbic acid. Which of the following conditions should the nurse monitor for as a result of the interaction between iron and ascorbic acid?
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increased absorption of iron
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A patient with megaloblastic anemia is to be administered leucovorin. For which of the following conditions is leucovorin contraindicated in this patient?
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pernicious anemia
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A nurse is caring for a patient with hypertension who is prescribed epoetin for anemia. Which of the following interventions should the nurse perform when administering epoetin to this patient?
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Note the hematocrit value before each dose during therapy
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A patient who was treated for anemia is being discharged. The patient has been instructed to continue with epoetin alfa for a week. Which of the following points should the nurse include in the teaching plan for therapy on an outpatient basis?
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Report to the primary health care provider on experiencing signs of joint pain
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A patient is receiving folic acid for the treatment of megaloblastic anemia. The patient also tells the nurse she is takes hydantions. What does the nurse monitor for interactions of these two drugs
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increased seizure activity
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a patient with chronic renal failure is prescribed darbepoetin alfa. What are the adverse effects.
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Rash, hypertension, arthralgia, headache, nausea, vomiting, fatigue, diarrhea
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A patient with iron deficiency is prescribed Iron Dextan, the nurse should administer it cautiously under what conditions
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if the patient has asthma, allergies