Question 1

You are assessing a patient who is on long-term warfarin (Coumadin) therapy who has been diagnosed with a warfarin overdosage. What drug would you anticipate would be needed as the antidote for warfarin overdose?

Accepted Answer

A)  Paroxetine
B)  Phytonadione
C)  Protamine sulfate
D)  Prothrombin factor B

Question 2

The aPTT of a patient who is prescribed continuous intravenous (IV) heparin is two times the control value. What is your best action?

Accepted Answer

A)  Increase the IV rate as ordered.
B)  Decrease the IV rate as ordered.
C)  Leave the rate unchanged.
D)  Stop the infusion and notify the prescriber. C

Question 3

A patient has been prescribed a fibrinolytic drug. What response to the patient best describes the action of this class of drug?

Accepted Answer

A)  "This drug works to prevent blood clot formation."
B)  "This drug acts to reverse the effects of heparin."
C)  "This drug works to lyse existing blood clots."
D)  "This drug thins out the blood." C

Question 4

Which statement made by a patient with a recent coronary artery stent placement who is taking clopidogrel informs you that the patient requires further teaching about this drug?

Accepted Answer

A)  "I will avoid herbal supplements while taking this drug."
B)  "I will need to take this drug every day for 3 months."
C)  "I will report any abnormal bleeding."
D)  "I will take this drug with food."

Question 5

A patient taking a direct thrombin inhibitor (DTI) tells you he is going on vacation and will be taking his anticoagulant drug with him. What advice should you give to this patient related to this specific class of drugs?

Accepted Answer

A)  "Keep this drug in its original bottle while traveling."
B)  "Stop this drug while on vacation to avoid the risk of bleeding."
C)  "Take this drug with only a few sips of water to avoid GI upset."
D)  "Make sure you eat plenty of green vegetables while on vacation."

Question 6

A patient prescribed an anticoagulant asks you about potential drug interactions with this new drug. Which of the following drugs would you advise this patient to avoid while taking anticoagulants?

Accepted Answer

A)  Vitamin C
B)  Thiazide diuretics
C)  Proton pump inhibitor
D)  Nonsteroidal anti-inflammatory analgesics

Question 7

What signs or symptoms would you expect to see in a patient who develops bleeding as a result of anticoagulant therapy? (Select all that apply.)

Accepted Answer

A)  Hypertension
B)  Easy bruising
C)  Bleeding gums
D)  Tarry-colored stool
E)  Shortness of breathF) Decreased pulse rate

Question 8

You are teaching a patient who has been prescribed apixaban (Eliquis) about symptoms of drug overdose. What symptom should you alert the patient to report?

Accepted Answer

A)  Abnormal pulse rate
B)  Gastric upset after eating
C)  Excessive sleepiness during the day
D)  Bleeding from the gums while brushing the teeth

Question 9

You are preparing to give an injection of an erythropoietin stimulating agent to a patient. The patient asks you to explain the expected side effects of this injection. What is your best response?

Accepted Answer

A)  "Thickening of the blood"
B)  "Infection at the injection site"
C)  "Pain at the site of the injection"
D)  "Drowsiness and lack of concentration"

Question 10

A patient who is taking an anticoagulant informs you that the herbal supplement St. John's wort is taken daily for depression. What should you teach the patient about the use of herbal supplements with anticoagulant therapy?

Accepted Answer

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.

Question 11

A patient is suspected of having an overdose of heparin. What drug should you prepare for the healthcare provider to give?

Accepted Answer

A)  Naloxone
B)  Warfarin
C)  Acetylcysteine
D)  Protamine sulfate

Question 12

A patient is brought to the hospital with chest pain and shortness of breath is suspected of having an acute MI. Which assessment is a priority for this patient with a suspected acute MI who may be given a fibrinolytic drug as treatment?

Accepted Answer

A)  Ask the patient or family when the symptoms first began.
B)  Ask the patient or family for a list of all drugs taken that day.
C)  Ask the patient or family when the last meal took was eaten.
D)  Ask the patient or family to report any history of kidney disease present.

Question 13

A patient taking an oral anticoagulant has had an international normalized ratio (INR) drawn to check the therapeutic drug response. Which range represents the therapeutic INR range for a patient taking an oral anticoagulant?

Accepted Answer

A)  1.0 to 2.0
B)  2.0 to 3.0
C)  3.0 to 4.0
D)  4.0 to 5.0

Question 14

Which statement about fibrinolytic drugs is true?

Accepted Answer

A)  These high-alert drugs are given by IV infusion.
B)  These drugs can be used in the outpatient setting.
C)  These drugs increase cellular damage from clots blocking the arteries.
D)  These drugs are contraindicated in patients diagnosed with an acute MI.

Question 15

An older patient who takes a daily NSAID for arthritis pain has been prescribed aspirin as an antiplatelet agent. What information regarding risks associated with aspirin use should be included in this teaching plan?

Accepted Answer

A)  The risk for urinary retention
B)  The risk for cognitive decline
C)  The risk for gastrointestinal bleeding
D)  The risk for peripheral arterial disease

Question 16

A patient with a history of deep vein thrombosis is prescribed subcutaneous heparin before surgery. The patient asks you if the heparin can be taken orally instead of by injection. What is your best response?

Accepted Answer

A)  "Oral heparin is quite expensive, and not covered by insurance."
B)  "Heparin is given by injection because it cannot be absorbed orally."
C)  "Heparin is given by injection before surgery because it works faster."
D)  "Heparin cannot be given orally because you are fasting for your surgery."

Question 17

A young mother who is breast-feeding now requires treatment with heparin. The patient asks you if she should continue breast-feeding during her treatment. What is your best response?

Accepted Answer

A)  "You will need to stop breast-feeding during treatment with heparin."
B)  "Heparin is not found in breastmilk, so you may continue breast-feeding."
C)  "The half-life of heparin is short, so breastfeed before your daily heparin injection."
D)  "Pump your breasts to keep breastmilk flowing so you can resume breast-feeding later."

Question 18

You are reviewing the laboratory values of an outpatient who is on anticoagulant therapy. The laboratory tests show a less than desired level of anticoagulation. The patient states that the drug has been taken as prescribed. Which food would you advise the patient to avoid while on anticoagulant therapy?

Accepted Answer

A)  Spinach
B)  Bananas
C)  Tomatoes
D)  Sweet potatoes

Question 19

What category of anticoagulant drugs works by increasing the amount of the protein antithrombin III?

Accepted Answer

A)  Fibrinolytics
B)  Vitamin K antagonists
C)  Direct thrombin inhibitors
D)  Indirect thrombin inhibitors

Question 20

Which symptom when reported by a patient taking aspirin alerts you to a possible adverse reaction to the drug?

Accepted Answer

A)  Nausea
B)  Itching and hives
C)  Decreased vision
D)  Increased urination

Exam 14: Drugs Affecting the Hematologic System