Question 1

An 80-year-old patient who has persistent AF takes warfarin (Coumadin)for anticoagulation therapy.The patient has an INR of 3.5.The primary care NP should consider:

Accepted Answer

A)  lowering the dose of warfarin. 
B)  rechecking the INR in 1 week. 
C)  omitting a dose and resuming at a lower dose. 
D)  omitting a dose and administering 1 mg of vitamin K. 
A)  lowering the dose of warfarin. 
B)  rechecking the INR in 1 week. 
C)  omitting a dose and resuming at a lower dose. 
D)  omitting a dose and administering 1 mg of vitamin K. B

Question 2

A patient who is taking an oral anticoagulant is in the clinic in the late afternoon and reports having missed the morning dose of the medication because the prescription was not refilled.The primary care NP should counsel this patient to:

Accepted Answer

A)  avoid foods that are high in vitamin K for several days. 
B)  take a double dose of the medication the next morning. 
C)  refill the prescription and take today's dose immediately. 
D)  skip today's dose and resume a regular dosing schedule in the morning. 
A)  avoid foods that are high in vitamin K for several days. 
B)  take a double dose of the medication the next morning. 
C)  refill the prescription and take today's dose immediately. 
D)  skip today's dose and resume a regular dosing schedule in the morning. D

Question 3

A patient who will undergo surgery in implant a biosynthetic heart valve asks the primary care NP whether any medications will be necessary postoperatively.The NP should tell the patient that it will be necessary to take:

Accepted Answer

A)  daily low-dose aspirin for 1 year. 
B)  heparin injections as needed based on activated partial thromboplastin time levels. 
C)  lifelong warfarin combined with enoxaparin as needed. 
D)  warfarin for 3 months postoperatively plus long-term aspirin. 
A)  daily low-dose aspirin for 1 year. 
B)  heparin injections as needed based on activated partial thromboplastin time levels. 
C)  lifelong warfarin combined with enoxaparin as needed. 
D)  warfarin for 3 months postoperatively plus long-term aspirin. D

Question 4

A patient who has atrial fibrillation (AF)has been taking warfarin (Coumadin).The primary care nurse practitioner (NP)plans to change the patient's medication to dabigatran (Pradaxa).To do this safely,the NP should:

Accepted Answer

A)  initiate dabigatran when the patient's international normalized ratio (INR) is less than 2. 
B)  start dabigatran 7 to 14 days after discontinuing warfarin. 
C)  begin giving dabigatran 1 week before discontinuing warfarin. 
D)  order frequent monitoring of the patient's INR after dabigatran therapy begins. 
A)  initiate dabigatran when the patient's international normalized ratio (INR) is less than 2. 
B)  start dabigatran 7 to 14 days after discontinuing warfarin. 
C)  begin giving dabigatran 1 week before discontinuing warfarin. 
D)  order frequent monitoring of the patient's INR after dabigatran therapy begins.

Question 5

A patient comes to the clinic with a complaint of gradual onset of left-sided weakness.The primary care NP notes slurring of the patient's speech.A family member accompanying the patient tells the NP that these symptoms began 4 or 5 hours ago.The NP will activate the emergency medical system and expect to administer:

Accepted Answer

A)  325 mg of chewable aspirin. 
B)  LMWH. 
C)  intravenous alteplase and aspirin. 
D)  warfarin (Coumadin) and aspirin. 
A)  325 mg of chewable aspirin. 
B)  LMWH. 
C)  intravenous alteplase and aspirin. 
D)  warfarin (Coumadin) and aspirin.

Question 6

A patient in the clinic develops sudden shortness of breath and tachycardia.The primary care NP notes thready pulses,poor peripheral perfusion,and a decreased level of consciousness.The NP activates the emergency medical system and should anticipate that this patient will receive:

Accepted Answer

A)  intravenous alteplase. 
B)  low-dose aspirin and warfarin. 
C)  low-molecular-weight heparin (LMWH). 
D)  unfractionated heparin (UFH) and warfarin. 
A)  intravenous alteplase. 
B)  low-dose aspirin and warfarin. 
C)  low-molecular-weight heparin (LMWH). 
D)  unfractionated heparin (UFH) and warfarin.

Question 7

A patient who has disabling intermittent claudication is not a candidate for surgery.Which of the following medications should the primary care NP prescribe to treat this patient?

Accepted Answer

A)  Cilostazol (Pletal) 
B)  Warfarin (Coumadin) 
C)  Pentoxifylline (Trental) 
D)  Low-dose, short-term aspirin 
A)  Cilostazol (Pletal) 
B)  Warfarin (Coumadin) 
C)  Pentoxifylline (Trental) 
D)  Low-dose, short-term aspirin

Question 8

A patient who has had a new onset of AF the day prior will undergo cardioversion that day.The primary care NP will expect the cardiologist to:

Accepted Answer

A)  give clopidogrel after administering cardioversion. 
B)  administer cardioversion without using anticoagulants. 
C)  give warfarin and aspirin before attempting cardioversion. 
D)  give low-dose aspirin before administering cardioversion. 
A)  give clopidogrel after administering cardioversion. 
B)  administer cardioversion without using anticoagulants. 
C)  give warfarin and aspirin before attempting cardioversion. 
D)  give low-dose aspirin before administering cardioversion.

Question 9

A patient who is at risk for DVT tells the primary care NP she has just learned she is pregnant.The NP should expect that this patient will use which of the following anticoagulant medications?

Accepted Answer

A)  Aspirin 
B)  Heparin 
C)  Dabigatran 
D)  Warfarin 
A)  Aspirin 
B)  Heparin 
C)  Dabigatran 
D)  Warfarin

Question 10

A patient who is obese is preparing to have surgery.To help prevent venous thromboembolism (VTE),the primary care NP should prescribe:

Accepted Answer

A)  low-dose aspirin once daily. 
B)  clopidogrel (Plavix) 75 mg once daily. 
C)  enoxaparin (Lovenox) 30 mg twice daily. 
D)  warfarin (Coumadin) titrated to achieve an INR of 3.5. 
A)  low-dose aspirin once daily. 
B)  clopidogrel (Plavix) 75 mg once daily. 
C)  enoxaparin (Lovenox) 30 mg twice daily. 
D)  warfarin (Coumadin) titrated to achieve an INR of 3.5.

Exam 25: Agents that Act on Blood

An 80-year-old patient who has persistent AF takes warfarin (Coumadin)for anticoagulation therapy.The patient has an INR of 3.5.The primary care NP should consider:

A patient who is taking an oral anticoagulant is in the clinic in the late afternoon and reports having missed the morning dose of the medication because the prescription was not refilled.The primary care NP should counsel this patient to:

A patient who will undergo surgery in implant a biosynthetic heart valve asks the primary care NP whether any medications will be necessary postoperatively.The NP should tell the patient that it will be necessary to take:

A patient who has atrial fibrillation (AF)has been taking warfarin (Coumadin).The primary care nurse practitioner (NP)plans to change the patient's medication to dabigatran (Pradaxa).To do this safely,the NP should:

A patient in the clinic develops sudden shortness of breath and tachycardia.The primary care NP notes thready pulses,poor peripheral perfusion,and a decreased level of consciousness.The NP activates the emergency medical system and should anticipate that this patient will receive:

A patient who has disabling intermittent claudication is not a candidate for surgery.Which of the following medications should the primary care NP prescribe to treat this patient?

A patient who has had a new onset of AF the day prior will undergo cardioversion that day.The primary care NP will expect the cardiologist to:

A patient who is at risk for DVT tells the primary care NP she has just learned she is pregnant.The NP should expect that this patient will use which of the following anticoagulant medications?

A patient who is obese is preparing to have surgery.To help prevent venous thromboembolism (VTE),the primary care NP should prescribe:

Prescriptive Authority and Role Implementation: Tradition vs.Change

Historical Review of Prescriptive Authority: The Role of Nurses (NPs, CNMs, CRNAs, and CNSs)and Physician Assistants

General Pharmacokinetic and Pharmacodynamic Principles

Special Populations: Geriatrics

Special Populations: Pediatrics

Special Populations: Pregnant and Nursing Women

Over-the-Counter Medications

Complementary and Alternative Therapies

Establishing the Therapeutic Relationship

Practical Tips on Writing Prescriptions

Evidence-Based Decision Making and Treatment Guidelines

Design and Implementation of Patient Education

Dermatologic Agents

Eye, Ear, Throat, and Mouth Agents

Upper Respiratory Agents

Asthma and Chronic Obstructive Pulmonary Disease Medications

Hypertension and Miscellaneous Antihypertensive Medications

Coronary Artery Disease and Antianginal Medications

Heart Failure and Digoxin

Beta-Blockers

Calcium Channel Blockers

ACE Inhibitors and Angiotensin Receptor Blockers

Antiarrhythmic Agents

Antihyperlipidemic Agents

Antacids and the Management of GERD

Histamine-2 Blockers and Proton Pump Inhibitors

Laxatives

Antidiarrheals

Antiemetics

Medications for Irritable Bowel Syndrome and Other Gastrointestinal Problems

Diuretics

Male Genitourinary Agents

Drugs for Urinary Incontinence and Urinary Analgesia

Acetaminophen

Aspirin and Nonsteroidal Antiinflammatory Drugs

Disease-Modifying Antirheumatic Drugs and Immune Modulators

Gout Medications

Osteoporosis Treatment

Muscle Relaxants

Medications for Attention Deficit/Hyperactivity Disorder

Medications for Dementia

Analgesia and Pain Management

Migraine Medications

Antiepileptics

Antiparkinson Agents

Antidepressants

Antianxiety and Insomnia Agents

Antipsychotics

Substance Abuse

Glucocorticoids

Thyroid Medications

Diabetes Mellitus Agents

Contraceptives

Hormone Replacement Therapy

Drugs for Breast Cancer

Principles for Prescribing Antiinfectives

Treatment of Specific Infections and Miscellaneous Antibiotics

Penicillins

Cephalosporins

Tetracyclines

Macrolides

Fluoroquinolones

Aminoglycosides

Sulfonamides

Antitubercular Agents

Antifungals

Antiretroviral Medications

Antiviral and Antiprotozoal Agents

The Immune System and Immunizations

Weight Management