Question 1

You are preparing to give an injection of heparin to a patient. Which of the following steps represent the correct procedure? (Select all that apply.)

Accepted Answer

A) Insert the needle, pull back the plunger, and aspirate before injecting. 
B) Give subcutaneous heparin in the same general area each time. 
C) Do not massage the injection site after injecting the heparin. 
D) Draw up the heparin and check the dose with another nurse. 
E) Use a 25-gauge needle to give heparin subcutaneously.
F)Give the heparin IM ventrogluteal muscle.

Question 2

A patient prescribed subcutaneous heparin tells you that her menstrual bleeding is heavier than usual. What is your best response?

Accepted Answer

A) "I will hold the drug and notify your healthcare provider." 
B) "This is a fairly common and expected side effect of the drug." 
C) "Heavy menstrual bleeding indicates the drug is working properly." 
D) "I will have to give you a shot of protamine sulfate to reverse the drug's action."

Question 3

A patient with a clotting disorder is prescribed an anticoagulant and asks you to explain the purpose of anticoagulant therapy. What is your best response?

Accepted Answer

A) Anticoagulants are used to lyse existing clots. 
B) Anticoagulants are used to increase the flow of blood. 
C) Anticoagulants are used to prevent new clot formation. 
D) Anticoagulants are used to thin the viscosity of the blood.

Question 4

You suspect a patient taking warfarin (Coumadin) has developed internal bleeding. What symptoms of this condition would you expect the patient to exhibit? (Select all that apply.)

Accepted Answer

A) Abdominal pain 
B) Dizziness 
C) Tachycardia 
D) Warm, flushed skin 
E) Hypertension

Question 5

You are preparing to draw up a dose of heparin to give subcutaneously to a patient. Which of the following represents the best procedure in preparing this injection?

Accepted Answer

A) Roll the vial between your hands in order to distribute the solution. 
B) Insert the needle, then turn the vial upside down to distribute the drug 
C) Shake the vial vigorously to adequately distribute the drug molecules. 
D) Carefully draw the solution up from the vial without disturbing the contents.

Question 6

You are reviewing the laboratory values of a patient whose heparin dose has been changed by the healthcare provider. Which laboratory value will inform you about effect of the dose change on this anticoagulant therapy?

Accepted Answer

A) PT 
B) INR 
C) aPTT 
D) DIC panel

Question 7

You are taking the drug history of a patient who will be starting on an anticoagulant. Which of the following drug categories from this patients' drug list would potentially interfere with an anticoagulant?

Accepted Answer

A) Beta blockers 
B) Loop diuretics 
C) Oral contraceptives 
D) Inhaled corticosteroids

Question 8

You are caring for a patient who is taking an indirect thrombin inhibitor following surgery. What laboratory value should you monitor for possible adverse effects of this therapy?

Accepted Answer

A) Platelet count 
B) Potassium level 
C) Serum calcium level 
D) White blood cell count

Question 9

A patient is about to begin treatment with epoetin alfa. Which patient assessment parameter should you monitor closely to prevent complications from this drug?

Accepted Answer

A) The patient's urine output 
B) The patient's blood pressure 
C) The patient's blood glucose level 
D) The patient's serum potassium level

Question 10

An obese, menopausal woman is beginning warfarin (Coumadin) therapy. Which adverse effect should you monitor this patient for in the first 10 days of drug therapy?

Accepted Answer

A) Neutropenia 
B) Skin necrosis 
C) Severe diarrhea 
D) Pulmonary edema

Question 11

A patient with atrial fibrillation has been prescribed the drug dabigatran (Pradaxa). The patient asks you what the advantage of this drug may be over warfarin (Coumadin). What is your best response?

Accepted Answer

A) "This drug is taken only once daily." 
B) "This drug does not carry a risk for excessive bleeding." 
C) "This drug does not require frequent laboratory testing." 
D) "This drug does not interact with other drugs you may be taking."

Question 12

For which conditions would the use of fibrinolytic drugs be appropriate? (Select all that apply.)

Accepted Answer

A) Ischemic stroke 
B) Hypotensive crisis 
C) Acute arterial occlusion 
D) Acute pulmonary embolism 
E) Cellular damage from an MI
F)Treatment of warfarin overdose

Exam 14: Drugs Affecting the Hematologic System