A health care professional is caring for a patient who is about to begin iron dextran (INFeD) therapy. When administering the drug IM, the health care professional should take which of the following actions?
Administer a test dose is correct. Iron dextran can
cause a hypersensitivity reaction. It is essential to administer a
test dose to determine hypersensitivity prior to giving the full
dosage initially and to allow 1 hr for identifying any adverse
reactions.
Monitor blood pressure is correct. Iron dextran can
cause hypotension and hypersensitivity reactions, so it is important
to monitor blood pressure.
Have epinephrine available is correct. Iron dextran
can cause a hypersensitivity reaction. It is essential to have
epinephrine and resuscitation equipment available and to monitor for
skin rash, fever, and chills.
Premedicate with atropine is incorrect. Iron dextran
is more likely to cause tachycardia than bradycardia. Therefore, it is
unnecessary to premedicate with atropine.
Use the Z-track technique is correct. Health care
professionals giving the drug IM should use the Z-track technique to
make sure to deposit it deep into the buttocks. Superficial injection
can cause abscesses and brown discoloration of the skin.
A health care professional is caring for a patient who is about to
begin taking alteplase (Activase) to treat acute myocardial
infarction. The health care professional should understand the drug is
most effective when the patient receives it
a) 24 hour after clot formation
b) After initiation of
anticoagulation
c) Prior to clot formation
d) Within 3 hour
of symptom onset
within 3 hr of symptom onset.
Alteplase, a thrombolytic drug, is most effective in treating acute myocardial infarction if the patient receives it as soon as possible after the onset of symptoms.
A health care professional is caring for a patient who is about to
begin taking filgrastim (Neupogen) to treat neutropenia. The health
care professional should assess the patient for which of the following
adverse effects?
a) Dusky nails bed
b) Petechiae
c) Enlarged
spleen
d) Swollen calf
Enlarged spleen
With long-term use, filgrastim, a leukopoietic growth factor, can cause an enlarged spleen. Health care professionals should tell patients taking the drug to monitor and report abdominal pain or fullness.
A health care professional is preparing to administer the prescribed
dose of filgrastim (Neupogen) to a patient. The patient's laboratory
results indicate that the patient has a WBC count of 12,000 mm3. Which
of the following actions should the health care professional take?
a) Clarify the prescription within the provider.
b)
Administer the drug with an analgesic
c) Limit
venipunctures
d) Assess breath sounds
Clarify the prescription with the provider.
Leukocytosis can occur with filgrastim therapy. It is essential to monitor CBC twice per week and reduce the dosage or stop therapy for a WBC count above 10,000/mm3. The health care professional should notify the provider of the patient’s current WBC count and clarify the prescription prior to administration.
A health care professional administers epoetin alfa (Epogen)
subcutaneously to a patient who has renal failure. The health care
professional should monitor the patient for which of the following
adverse effects?
a) Hypertension
b) Muscle pain
c) Edema
d) Dry mouth
Hypertension
Epoetin alfa, an erythropoietic growth factor, can cause hypertension. The health care professional should monitor blood pressure and regulate it prior to initiating epoetin alfa therapy, then monitor it during therapy. For elevations, recommend a reduced dosage or antihypertensive drug therapy.
A health care professional is caring for a patient who is about to
begin taking oprelvekin (Neumega). The health care professional should
explain to the patient that the drug has which of the following effects?
a) Stimulates leukocyte maturation
b) Causes
myelosupression
c) Increases platelet production
d) Destroys
blood clots
Increases platelet production
Oprelvekin, a thrombopoietic growth factor, increases platelet production. It treats thrombocytopenia that is associated with myelosuppression.
A health care professional is caring for a patient who is about to
begin taking warfarin (Coumadin). The health care professional should
caution the patient about taking which of the following
over-the-counter drugs?
a) Diphenhydramine
b) Dimenhydrinate (Dramamine)
c)
Calcium carbonate (Tums)
d) Ibuprofen (Motrin)
Ibuprofen (Motrin)
NSAIDs, such as ibuprofen and especially aspirin, can increase the risk of bleeding for patients taking warfarin, an anticoagulant.
A health care professional is caring for a patient who is about to
begin taking oprelvekin (Neumega) to treat thrombocytopenia. The
healthc are professional should tell the patient to report which of
the following idications of an adverse reaction? (select all that apply).
a) Conjuctivitis
b) Tinnitus
c) Swollen ankles
d) Jaundice
Conjunctivitis is correct. Oprelvekin, a
thrombopoietic growth factor, can cause conjunctivitis, blurred
vision, and papilledema. Patients should report eye redness or blurred
vision.
Tinnitus is incorrect. Oprelvekin, a thrombopoietic
growth factor, is unlikely to cause tinnitus. Aspirin (Ecotrin) is a
drug that can cause tinnitus.
Swollen ankles is correct. Oprelvekin, a
thrombopoietic growth factor, can cause fluid retention. The health
care professional should monitor I&O and patients should report
edema or difficulty breathing.
Jaundice is incorrect. Oprelvekin, a thrombopoietic
growth factor, is unlikely to cause jaundice. However, it can cause
fever, rash, and hypotension.
Palpitations is correct. Oprelvekin, a thrombopoietic
growth factor, can cause cardiac dysrhythmias. Patients should report
palpitations or dizziness.
A health care professional is administering epoetin alfa (Epogen)
subcutaneously to a patient who has renal failure. The health care
professional should take which of the following actions?
a) Shake the vial before using
b) Insert the needle into
vial once
c) Dilute the drug first with normal saline
d)
Save the used vial for the next dose
Insert the needle into the vial once.
Instructions for administering the drug include inserting the needle into the vial only once. Health care professionals should also examine the solution and discard it if it is cloudy or discolored.
A health care professional is caring for patient who has mild
hemophilia A and is about to begin taking desmopressin (DDAVP) to
prevent bleeding. The health care professional should monitor for
which of the following adverse reactions?
a) Weight loss
b) Edema
c) Polyuria
d) Tachycardia
Edema
Desmopressin, an antidiuretic hormone, can cause fluid retention and edema. Health care professionals should monitor fluid intake and output for patients receiving the drug therapy.
A health care professional is caring for a patient who is about to
begin alteplase (Activase) therapy. The health care professional
should monitor the patient for which of the following indications of a
possible adverse effect?
a) Hives
b) Headache
c) Edema
d) Hypertension
Headache
Alteplase, a thrombolytic drug, can cause intracranial bleeding. Monitor patients receiving the drug for changes in level of consciousness, headache, one-sided weakness, and other indications of intracranial bleeding.
A health care professional is caring for a patient who is about to
begin taking asprin (Ecotrin) to reduce the risk of a cardiovascular
event. The health care professional should understand that the drug
inhibits platelet aggregation by which of the following mechanisms?
a) Activating thromboxane A2
b) Blocking adenosine
diphosphate receptor agonists
c) Supressing specific clotting
factors
d) Inhibiting cyclooxygenase action in platelets
Inhibiting cyclooxygenase action in platelets
Salicylates, such as aspirin, work by inhibiting platelet aggregation. They do this by blocking the action of cyclooxygenase on platelets. As a result, activation of thromboxane A2 does not occur.
A health care professional is caring for a patient who is about to
begin taking ferrous sulfate (Feosol) to treat iron-deficiency anemia.
When talking with the patient about the drug, the health care
professional should include which of the following instructions?
(Select all that apply)
a) Eat iron-enriched foods
b) Spread the dosage across each
day
c) Take the drug on an empty stomach
d) Report dark
green or black stools
e) Increase dietary fiber intake
Eat iron-enriched foods is correct. Patients who have
iron-deficiency anemia should increase iron intake with foods such as
egg yolks, wheat germ, meat, and fish to supplement ferrous sulfate.
Spread the dosage across each day is correct.
Spreading out the iron intake throughout patients' waking hours allows
the bone marrow to maximize the production of RBCs.
Take the drug on an empty stomach is correct. Food
reduces the absorption of ferrous sulfate. Patients should take the
drug on an empty stomach to increase drug absorption. If GI effects
are troublesome, patients can take the drug with food.
Report dark green or black stools is incorrect.
Health care professionals should tell patients to expect dark green or
black stools. It is not necessary to report this effect.
Increase dietary fiber intake is correct. Ferrous
sulfate can cause constipation. Patients should increase fiber and
fluid intake and exercise more often or more intensely.
A patient who is taking ferrous sulfate (Feosol) to treat
iron-deficiency anemia develops severe nausea and vomiting due to iron
toxicity. Which of the following drugs should the health care
professional use to treat this complication?
a) Flumazenil (Mazicon)
b) Acetylcysteine
(Acetadote)
c) Naloxone
d) Deferoxamine (Desferal)
Deferoxamine (Desferal)
Indications of iron toxicity include nausea, vomiting, and diarrhea. Iron toxicity can lead to acidosis and shock. A chelating agent, such as deferoxamine, binds to the iron to reduce toxicity.
A health care professional is caring for a patient who is about to
begin taking clopidogrel (Plavix) to prevent stent stenosis. The
health care professional should monitor the patient for which of the
following adverse reactions?
a) Thrombocytopenia
b)
Hyponatremia
c) Lymphocytopenia
d) Uricemia
Thrombocytopenia
Clopidogrel, an antiplatelet drug, can cause thrombotic thrombocytopenic purpura. The health care professional should monitor platelet count, bruising, bleeding gums, and petechiae.
A patient is about to begin therapy with recombinant factor IX
(BeneFix) to treat hemophilia B. The patient asks the health care
professional about the risk of disease transmission with recombinant
factor IX, as compared with plasma-derived factor IX. The health care
professional should explain that recombinant factor IX eliminates the
risk of which of the following?
a) HIV
b) Cytomegalovirus
c) Creutzfeldt-jakob
disease
d) Anaphylaxis
Creutzfeldt-Jakob disease
Recombinant factor IX is safer than the plasma-derived formulation because of the risk of Creutzfeldt-Jakob disease, a prion-transmitted infection, from human sources. Plasma-derived products also carry a minimal risk of acquiring hepatitis A and parvovirus B19.
A health care professional is caring for a patient who is about ot
begin taking folic acid to treat megaloblastic anemia. The health care
professional should monitor which of the following laboratory values?
a) Amylase level
b) Reticulocyte count
c) C-reactive
protein
d) Creatinine clearance
Reticulocyte count
A reticulocyte count measures the amount of immature RBCs. Folic acid, also called folate, is essential for erythropoiesis. Patients who have a folic acid deficiency require a baseline reticulocyte count, as well as a serum folate, Hgb, Hct, and RBC count and periodic monitoring during folic acid therapy to determine effectiveness.
A health care professional is caring for a patient who is about to
begin factor III (Advate) therapy to treat hemophilia A. When
administering factor VIII, which of the following actions should the
health care professional take?
a) Have emergency equipment ready
b) Premedicate with
aspirin (Ecotrin)
c) Administer via rapid IV bolus
d)
Administer the powdered form orally
Have emergency equipment ready
Factor VIII can cause a hypersensitive reaction and anaphylaxis. The health care professional should monitor for hives, fever, wheezing, and difficulty breathing, and have emergency equipment and drugs readily available.
A patient who is taking warfarin (Coumadin) arrives at the emergency
department and reports rectal bleeding. Which of the following drugs
should the health care professional have available?
a) Filgrastim (Neupogen)
b) Deferoxamine (Desferal)
c)
Protamine
d) Vitamin K
Vitamin K
Vitamin K reverses the effects of warfarin by promoting the synthesis of coagulation factors VI, IX, X, and prothrombin.
A health care professional is caring for a patient who is about ot
begin alteplase (Activase) therapy to treat pulmonary embolism. Which
of the following drugs should the health care professional have
available in the event of a severe adverse reaction?
a) Vitamin K
b) Aminocaproic acid (Amicar)
c)
Protamine
d) Deferoxamine (Deseferal)
Aminocaproic acid (Amicar)
Aminocaproic acid, a coagulator, inhibits fibrinolysis and stops fibrinolytic bleeding. For severe bleeding, patients often require blood replacement.
A health care professional is caring for a patient who is undergoing
bone marrow transplantation following high-dose chemotherapy. Which of
the following drugs should the health care professional expect the
primary care provider to prescribe the reduce the patient's risk of infection?
a) Epoetin alfa (Erythropoietin)
b) Oprelvekin
(Neumega)
c) Filgrastim (Neupogen)
d) Alteplase (Activase)
Filgrastim (Neupogen)
Filgrastim, a leukopoietic growth factor, stimulates production of neutrophils in the bone marrow. It helps reduce the risk for infection due to bone marrow transplantation, severe chronic neutropenia, and myelosuppressive chemotherapy.
A health care professional should assess a patient who has
megaloblastic anemia for indications of which of the following vitamin deficiencies?
a) Vitamin B12
b) Vitamin K
c) Vitamin C
d)
Vitamin D
Vitamin B12
Patients who have megaloblastic anemia have a deficiency of vitamin B12, folic acid, or both. Cyanocobalamin (Nascobal) treats moderate vitamin B12 deficiencies. Patients who have a severe vitamin B12 deficiency should take cyanocobalamin and folic acid.
A health care professional is caring for a patient who has a known
sensitivity to Escherichia coli-derived proteins. This sensitivity is
a contraindication for which of the following drugs?
a) Epoetin alfa (Erythropoietin)
b) Oprelvekin
(Neumega)
c) Filgrastim (Neupogen)
d) Alteplase (Activase)
Filgrastim (Neupogen)
Patients who have active internal bleeding or pericarditis should not receive alteplase, a thrombolytic.
A health care professional is caring for a patient who is about to
begin taking clopidogrel (Plavix) to prevent thrombus formation. The
health care professional should question the use of clopidogrel by a
patient who has which of the following?
a) Myocardial infarction
b) Peptic ulcer disease
c)
Pancreatitis
d) Myasthenia gravis
Peptic ulcer disease
Patients who have peptic ulcer disease should not take clopidogrel because it can cause gastric bleeding.
A health care professional is caring for a patient who is about to
begin taking epoetin alfa (Epogen). Which of the following laboratory
values should increase with effective therapy?
a) PT
b) WBC
c) Hgb
d) Platelets
Hgb
Epoetin alfa, an erythropoietic growth factor, increases the production of RBCs for patients who have anemia due to chronic renal failure or chemotherapy. Hgb and Hct should increase with effective therapy.