NR 566 Test Bank
Questions for Weeks 5-7
Week 5: Ch. 18, 19, 27, 37
Week 6: Ch. 22, 31, 38, 44
Week 7: 48, 49, 50, 51
Week 5
Ch. 18 Drugs Affecting the Hematopoietic System
• Kenneth is taking warfarin and is asking about what he can take for minor aches and
pains. The best recommendation is:
• Ibuprofen 400 mg three times a day
• Acetaminophen, not to exceed 4 grams per day
• Prescribe acetaminophen with codeine
• Aspirin 640 mg three times a day
2. Juanita had a DVT and was on heparin in the hospital and was discharged on
warfarin. She asks her primary care provider NP why she was getting both
medications while in the hospital. The best response is to:
• Contact the hospitalist as this is not the normal guideline for
proscribing these two medications and she may have had a more
complicated case
• Explain that warfarin is often started while a patient is still on
heparin because warfarin takes a few days to reach
effectiveness
• Encourage the patient to contact the Customer Service
department at the hospital as this was most likely a medication
error during her admission
• Draw anticoagulation studies to make sure she does not have
dangerously high bleeding times
3. The safest drug to use to treat pregnant women who require anticoagulant therapy
is:
• Low molecular weight heparin
• Warfarin
• Aspirin
• Heparin
4. The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg
daily should be considered in which patients?
• Pregnant women
• Elderly men
• Overweight or obese patients
• Patients with multiple comorbidities
5. Cecil and his wife are traveling to Southeast Asia on vacation and he has come
into the clinic to review his medications. He is healthy with only mild
hypertension that is well controlled. He asks about getting “a shot” to prevent
blood clots like his friend Ralph did before international travel. The correct
, respond would be:
• Administer one dose of low-molecular weight heparin 24 hours before travel
• Prescribe one dose of warfarin to be taken the day of travel
• Consult with a hematologist regarding a treatment plan for Cecil
• Explain that Cecil is not at high risk of a blood clot and provide education
about
how to prevent blood clots while traveling
6. Robert, age 51 years, has been told by his primary care provider (PCP) to take an
aspirin a day.
Why would this be recommended?
• He has arthritis and this will help with the inflammation and pain.
• Aspirin has anti-platelet activity and prevents clots that cause heart attacks.
• Aspirin acidifies the urine and he needs this for prostrate health.
• He has a history of GI bleed, and one aspirin a day is a safe dose.
7. Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She
also takes aspirin four or more times a day for arthritis pain. What are the
symptoms of aspirin toxicity she would need to be evaluated for:
• Tinnitus
• Diarrhea
• Hearing loss
• Photosensitivity
8. Patient education when prescribing clopidogrel includes:
• Do not take any herbal products without discussing with the provider
• Monitor urine output closely and contact the provider if it decreases
• Clopidogrel can be constipating, use a stool softener if needed
• The patient will need regular anticoagulant studies while on clopidogrel
9. For patients taking warfarin INRs are best drawn:
• Monthly throughout therapy
• Three times a week throughout therapy
• Two hours after the last dose of warfarin to get an accurate peak level
• In the morning if the patient takes their warfarin at night
10. Patients receiving heparin therapy require monitoring of:
• Platelets every 2 to 3 days for thrombocytopenia that may
occur on Day 4 of therapy
• Electrolytes for elevated potassium levels in the first 24 hours of therapy
• INR throughout therapy to keep in the range around 2.0
• Blood pressure for hypertension that may occur in the first 2 days of treatment
11. The routine monitoring recommended for low molecular weight heparin is:
• INR every 2 days until stable then weekly
• aPTT every week while on therapy
• Factor Xa levels if patient is pregnant
, • White blood cell count every 2 weeks
12. When writing a prescription for warfarin it is common to write on the
prescription.
• OK to substitute for generic
• The brand name of warfarin and Do Not Substitute
• PRN refills
• Refills for 1 year
13. Education of patients who are taking warfarin includes discussing their diet.
Instructions include:
• Avoiding all vitamin K-containing foods
• Avoiding high vitamin K-containing foods
• Increasing intake of iron-containing foods
• Making sure they eat 35 grams of fiber daily
14. Patients who are being treated with epoetin alfa need to be monitored for the
development of:
• Thrombocytopenia
• Neutropenia
• Hypertension
• Gout
15. The FDA issued a safety announcement regarding the use of erythropoiesis-
stimulating agents (ESAs) in 2010 with the recommendation that:
• ESAs no longer be prescribed to patients with chronic renal failure
• The risk of tumor development be explained to cancer patients on ESA therapy
• Patients should no longer receive ESA therapy to prepare for allogenic
transfusions
• ESAs be prescribed only to patients younger than age 60 years
16. When patients are started on darbepoetin alfa (Aranesp) they need
monitoring of their blood counts to determine a dosage adjustment in:
• 6 weeks if they are a cancer patient
• 1 week if they have chronic renal failure
• 2 weeks if taking for allogenic transfusion
• Weekly throughout therapy
17. Jim is having a hip replacement surgery and would like to self-donate blood
for the surgery. In addition to being prescribed epogen alpha he should also be
prescribed:
• Folic acid to prevent megaloblastic anemia
• Iron, to start when the epogen starts
• An antihypertensive to counter the adverse effects of epogen
• Vitamin B12 to prevent pernicious anemia
18. Monitoring for a patient being prescribed iron for iron deficiency anemia includes:
• Reticulocyte count 1 week after therapy is started
Questions for Weeks 5-7
Week 5: Ch. 18, 19, 27, 37
Week 6: Ch. 22, 31, 38, 44
Week 7: 48, 49, 50, 51
Week 5
Ch. 18 Drugs Affecting the Hematopoietic System
• Kenneth is taking warfarin and is asking about what he can take for minor aches and
pains. The best recommendation is:
• Ibuprofen 400 mg three times a day
• Acetaminophen, not to exceed 4 grams per day
• Prescribe acetaminophen with codeine
• Aspirin 640 mg three times a day
2. Juanita had a DVT and was on heparin in the hospital and was discharged on
warfarin. She asks her primary care provider NP why she was getting both
medications while in the hospital. The best response is to:
• Contact the hospitalist as this is not the normal guideline for
proscribing these two medications and she may have had a more
complicated case
• Explain that warfarin is often started while a patient is still on
heparin because warfarin takes a few days to reach
effectiveness
• Encourage the patient to contact the Customer Service
department at the hospital as this was most likely a medication
error during her admission
• Draw anticoagulation studies to make sure she does not have
dangerously high bleeding times
3. The safest drug to use to treat pregnant women who require anticoagulant therapy
is:
• Low molecular weight heparin
• Warfarin
• Aspirin
• Heparin
4. The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg
daily should be considered in which patients?
• Pregnant women
• Elderly men
• Overweight or obese patients
• Patients with multiple comorbidities
5. Cecil and his wife are traveling to Southeast Asia on vacation and he has come
into the clinic to review his medications. He is healthy with only mild
hypertension that is well controlled. He asks about getting “a shot” to prevent
blood clots like his friend Ralph did before international travel. The correct
, respond would be:
• Administer one dose of low-molecular weight heparin 24 hours before travel
• Prescribe one dose of warfarin to be taken the day of travel
• Consult with a hematologist regarding a treatment plan for Cecil
• Explain that Cecil is not at high risk of a blood clot and provide education
about
how to prevent blood clots while traveling
6. Robert, age 51 years, has been told by his primary care provider (PCP) to take an
aspirin a day.
Why would this be recommended?
• He has arthritis and this will help with the inflammation and pain.
• Aspirin has anti-platelet activity and prevents clots that cause heart attacks.
• Aspirin acidifies the urine and he needs this for prostrate health.
• He has a history of GI bleed, and one aspirin a day is a safe dose.
7. Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She
also takes aspirin four or more times a day for arthritis pain. What are the
symptoms of aspirin toxicity she would need to be evaluated for:
• Tinnitus
• Diarrhea
• Hearing loss
• Photosensitivity
8. Patient education when prescribing clopidogrel includes:
• Do not take any herbal products without discussing with the provider
• Monitor urine output closely and contact the provider if it decreases
• Clopidogrel can be constipating, use a stool softener if needed
• The patient will need regular anticoagulant studies while on clopidogrel
9. For patients taking warfarin INRs are best drawn:
• Monthly throughout therapy
• Three times a week throughout therapy
• Two hours after the last dose of warfarin to get an accurate peak level
• In the morning if the patient takes their warfarin at night
10. Patients receiving heparin therapy require monitoring of:
• Platelets every 2 to 3 days for thrombocytopenia that may
occur on Day 4 of therapy
• Electrolytes for elevated potassium levels in the first 24 hours of therapy
• INR throughout therapy to keep in the range around 2.0
• Blood pressure for hypertension that may occur in the first 2 days of treatment
11. The routine monitoring recommended for low molecular weight heparin is:
• INR every 2 days until stable then weekly
• aPTT every week while on therapy
• Factor Xa levels if patient is pregnant
, • White blood cell count every 2 weeks
12. When writing a prescription for warfarin it is common to write on the
prescription.
• OK to substitute for generic
• The brand name of warfarin and Do Not Substitute
• PRN refills
• Refills for 1 year
13. Education of patients who are taking warfarin includes discussing their diet.
Instructions include:
• Avoiding all vitamin K-containing foods
• Avoiding high vitamin K-containing foods
• Increasing intake of iron-containing foods
• Making sure they eat 35 grams of fiber daily
14. Patients who are being treated with epoetin alfa need to be monitored for the
development of:
• Thrombocytopenia
• Neutropenia
• Hypertension
• Gout
15. The FDA issued a safety announcement regarding the use of erythropoiesis-
stimulating agents (ESAs) in 2010 with the recommendation that:
• ESAs no longer be prescribed to patients with chronic renal failure
• The risk of tumor development be explained to cancer patients on ESA therapy
• Patients should no longer receive ESA therapy to prepare for allogenic
transfusions
• ESAs be prescribed only to patients younger than age 60 years
16. When patients are started on darbepoetin alfa (Aranesp) they need
monitoring of their blood counts to determine a dosage adjustment in:
• 6 weeks if they are a cancer patient
• 1 week if they have chronic renal failure
• 2 weeks if taking for allogenic transfusion
• Weekly throughout therapy
17. Jim is having a hip replacement surgery and would like to self-donate blood
for the surgery. In addition to being prescribed epogen alpha he should also be
prescribed:
• Folic acid to prevent megaloblastic anemia
• Iron, to start when the epogen starts
• An antihypertensive to counter the adverse effects of epogen
• Vitamin B12 to prevent pernicious anemia
18. Monitoring for a patient being prescribed iron for iron deficiency anemia includes:
• Reticulocyte count 1 week after therapy is started
