Question 1 of 9
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Which response would the nurse provide when the patient asks, “What does alteplase do and why did my doctor order it?”
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- “Alteplase is a drug that dissolves blood clots.”Alteplase is a fibrinolytic drug that dissolves clots by activating plasminogen to form plasmin.
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- “The drug was ordered to begin to thin your blood so you don’t get any blood clots.”Alteplase is used to act on an existing clot; it is not given proactively to prevent clots from forming.
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- “Alteplase will stop the enzymes released to form a clot.”Alteplase does not stop enzymes needed for final activation of vitamin K like vitamin K antagonists do.
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- “Alteplase will increase the proteins to help thin the blood.”Alteplase is not an indirect thrombin inhibitor, a drug that increases the amount and action of the protein antithrombin III to reduce clot formation.
Question 2 of 9
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Which side effect would the nurse attribute to a fibrinolytic drug?
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- NosebleedsFibrinolytic drugs dissolve clots rapidly. All signs of bleeding, including nosebleeds, must be monitored and reported immediately because it is attributed to fibrinolytic therapy.
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- HypertensionHypotension, not hypertension, is a side effect of fibrinolytic drugs.
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- DysuriaDysuria is not attributed to fibrinolytic therapy.
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- Elevated temperatureAn elevated temperature may be because of an infection and is not directly related to fibrinolytic drugs.
Question 3 of 9
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Which nursing intervention is necessary for a patient receiving fibrinolytic therapy? Select all that apply. One, some, or all responses may be correct.
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- Remind the patient that headaches are normal side effects.Patients on fibrinolytics should be monitored for severe headaches or changes in level of consciousness because these symptoms may be indicative of a stroke from a brain bleed.
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- Monitor patients for symptoms of allergic reactions.All patients on fibrinolytic therapy should be monitored closely for allergic reactions, such as rash, facial swelling, hives, low blood pressure, or difficulty breathing.
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- Monitor coagulation laboratory tests after initial dose.The healthcare provider should make adjustments to the drug dosage or the need for additional drugs based on the results of these tests.
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- Ensure the patient has no history of hypotension.The nurse should ensure the patient does not have a blood pressure greater than 200/120 mm Hg because it is an absolute contraindication for fibrinolytic therapy. Hypotension would not be a concern.
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- Avoid giving intramuscular (IM) injectable drugs.IM injections increase the risk of bleeding in patients on fibrinolytic drugs.
Question 4 of 9
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Which statement about erythropoiesis-stimulating agents (ESAs) is accurate? Select all that apply. One, some, or all responses may be correct.
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- An ESA is a synthetic form of the hormone erythropoietin.Erythropoietin has been synthetically produced using recombinant DNA technology for treatment of certain types of anemia.
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- ESAs stimulate the bone marrow to make more white blood cells (WBCs) quicker.ESAs stimulates the bone marrow to make more red blood cells (RBCs), not WBCs, at a faster rate.
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- ESAs are usually given to patients who have a condition that causes anemia and need to increase the production of RBCs.Patients with chronic kidney disease are commonly prescribed ESAs to stimulate the production of RBCs.
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- Erythropoietin is naturally produced by the liver.Erythropoietin is naturally produced by the kidneys, not the liver.
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- These drugs reduce the need for transfusions and reduce the complications of transfusions, such as fluid overload.Patients who are anemic from the effects of chemotherapy on the bone marrow also may not be able to tolerate infusions and the complications from them, so ESAs are prescribed to avoid transfusions.
Question 5 of 9
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Which drug is an example of an erythropoiesis-stimulating agent (ESA)? Select all that apply. One, some, or all responses may be correct.
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- Epoetin alfaEpoetin alfa is an ESA that is commonly used to treat anemia.
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- Tissue plasminogen activatorTissue plasminogen activator is a fibrinolytic used to dissolve blood clots in patients who have had a heart attack. It is not an ESA.
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- DabigatranDabigatran is a direct thrombin inhibitor, not an ESA.
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- TicagrelorTicagrelor is a platelet inhibitor that prevents formation of new clots. It is not an ESA.
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- Darbepoetin alfaDarbepoetin alfa is an ESA that helps the body make more red blood cells by stimulating the bone marrow.
Question 6 of 9
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Which nursing intervention would the nurse include for a patient on erythropoiesis-stimulating agents (ESAs)? Select all that apply. One, some, or all responses may be correct.
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- Monitor blood counts, such as hemoglobin (hgb) levels.The blood counts, such as hemoglobin levels, will help determine drug effectiveness.
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- Follow directions carefully for drug mixing and preparation of ESAs.The products of ESAs vary and the preparation of them can vary and drug effectiveness depends on the correct mixing and preparation.
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- Monitor for hypotension and report abnormalities.The patient should be monitored for hypertension, not hypotension, because there may be an increase due to increased blood viscosity (thickness), headaches, body aches, fever, or chills.
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- Check for signs or symptoms of allergic reactions.Because there is a risk of severe allergic reactions to ESAs, patients need to be closely monitored for signs or symptoms of allergic reactions, which are possible adverse effects of these drugs.
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- Instruct the patient that numbness in the face is a common side effect and will go away after 12 hours.Patients should be instructed to immediately report chest pain or shortness of breath, drooping face, or numbness in face or extremities and to call an ambulance for transport to the emergency department because these are signs of heart attack or stroke, and ESAs increase the risk of these health problems.
Question 7 of 9
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Which statement about iron deficiency anemia is accurate? Select all that apply. One, some, or all responses may be correct.
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- Iron deficiency anemia develops when there is not enough iron in the blood.Iron is a key component of hemoglobin in RBCs. Iron deficiency anemia develops when there is not enough iron available for maintaining tissue oxygenation and the body’s supply of stored iron gets used up.
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- Iron deficient anemia is commonly caused by respiratory distress.Common causes of iron deficiency anemia, including bleeding, inability to absorb iron, and pregnancy.
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- Signs of iron deficiency anemia include weakness, shortness of breath, and fast heart rate.Patients with iron deficiency anemia complain of weakness, shortness of breath, palpitations, tachycardia, and pale skin and mucous membranes.
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- Iron products are only given orally.Iron supplements are most commonly given orally for iron deficiency anemia. However, parenteral iron can be given to patients who cannot tolerate oral iron.
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- Iron is needed for RBC production.Iron is a key component of hemoglobin in RBCs. Most iron is incorporated into hemoglobin.
Question 8 of 9
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Which response would the nurse provide when a patient receiving ferrous sulfate for the past week, says to the nurse, “My stools are very dark black”?
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- “I will call your healthcare provider immediately.”Black stool is not a severe side effect that requires notifying the healthcare provider.
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- “Having dark black stools are normal when you are taking ferrous sulfate.”Dark black stools are a common and normal side effect of treatment with ferrous sulfate.
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- “It will be fine. I will just hold your next two doses.”There is nothing abnormal to warrant holding the doses without a healthcare provider’s order.
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- “I am not sure why that is happening. It could be what is in your diet.”It may be possible there may be iron in the patient’s diet, but given they have been taking ferrous sulfate, that is most likely the reason for the black stool.
Question 9 of 9
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Which action would the nurse take before giving the first infusion of iron dextran?
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- Obtain a urine specimen.A urinalysis is not required to obtain before giving an infusion of iron dextran.
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- Prepare the infusion to run with dextrose.Iron dextran infusion should only be diluted with normal saline, never dextrose and water.
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- Give an antacid before giving iron dextran infusion.Antacids should be avoided when patients are receiving iron dextran.
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- Give a small test dose.Iron dextran can cause severe and sometimes fatal allergic reactions so a “test dose” is prescribed by the healthcare provider and should be given before the first infusion.