ATI-P ATI Pharmacology - Set 2 - Part 3

Correct Answer: Stop the heparin infusion

Black, tarry stools and bleeding gums indicate active bleeding from heparin. The nurse's first action is to stop the heparin infusion to prevent further blood loss, then notify the provider and prepare to give protamine if needed. Option a is incorrect because offering fluids does nothing to address active bleeding caused by the anticoagulant. The priority is to halt the heparin infusion, because continuing the drug while the client bleeds would only worsen the blood loss. Option b is incorrect because a warm compress will not control internal bleeding signaled by tarry stools, and it ignores the underlying cause. The first protective step is to stop the heparin, since the medication is driving the bleeding the client is experiencing. Option c is incorrect because charting the findings while letting the infusion run allows the bleeding to continue unchecked. The nurse must first stop the heparin, because ongoing anticoagulation is the source of the black stools and bleeding gums.

Correct Answer: Keep your intake of leafy green vegetables consistent

Vitamin K in leafy green vegetables opposes warfarin, so sudden changes in intake alter its effect. The nurse should teach the client to keep vitamin K intake consistent so the anticoagulant effect stays stable and predictable. Option b is incorrect because increasing leafy greens raises vitamin K and can reduce warfarin's effect, throwing off control. Rather than adding more, the client should hold intake steady so the drug's action does not fluctuate from day to day. Option c is incorrect because aspirin adds to bleeding risk and should be avoided while taking warfarin. The teaching that keeps therapy stable is consistent vitamin K intake, while pain relief should be discussed with the provider instead of using aspirin. Option d is incorrect because a firm-bristle toothbrush can cause the gums to bleed, so a soft-bristle brush is recommended. The key dietary instruction for warfarin is to keep vitamin K intake consistent, which protects the stability of the anticoagulant ef

Correct Answer: Vitamin K

Vitamin K reverses warfarin by promoting synthesis of clotting factors VII, IX, X, and prothrombin. The nurse should anticipate giving vitamin K to a client with a prolonged clotting time and active bleeding from warfarin. Option a is incorrect because protamine reverses heparin, not warfarin, because the two drugs work through different mechanisms. For warfarin-related bleeding with a prolonged clotting time, the reversal agent the nurse anticipates is vitamin K. Option b is incorrect because aminocaproic acid controls bleeding from excessive fibrinolysis after a thrombolytic, not from warfarin. The appropriate antidote for warfarin is vitamin K, which restores the clotting factors the drug suppressed. Option c is incorrect because idarucizumab reverses the direct thrombin inhibitor dabigatran and has no role with warfarin. Because warfarin blocks vitamin K dependent factors, the nurse anticipates administering vitamin K to counteract the bleeding.

Correct Answer: I will take aspirin when I have a headache

Aspirin increases bleeding risk and should be avoided with warfarin, so this statement shows the client needs more teaching. The nurse should clarify that the client must not take aspirin and should consult the provider for pain relief. Option a is incorrect because reporting bleeding gums is correct, because gum bleeding can be an early sign of excessive anticoagulation. This statement reflects appropriate understanding, so it does not indicate a need for further teaching. Option b is incorrect because using an electric razor lowers the chance of cuts and bleeding, which is exactly what a client on warfarin should do. This statement shows correct understanding rather than a gap that requires more teaching. Option d is incorrect because keeping appointments to monitor clotting time is essential for safe warfarin therapy and dose adjustment. This shows the client grasps the follow-up the drug requires, so it is appropriate rather than a teaching gap.

Correct Answer: Swallow the capsule whole

Dabigatran capsules must be swallowed whole, because opening or crushing them can greatly increase the amount absorbed and raise bleeding risk. The nurse should instruct the client to take the capsule whole, with or without food. Option a is incorrect because crushing the capsule can increase drug absorption and the risk of bleeding, so it is unsafe. The correct instruction is to swallow the dabigatran capsule whole to keep absorption and the anticoagulant effect predictable. Option b is incorrect because opening the capsule to sprinkle the contents alters absorption and increases bleeding risk, much like crushing it. The client should instead swallow the capsule intact, which is the safe way to take dabigatran. Option c is incorrect because doubling a missed dose raises the risk of dangerous bleeding and is never advised with an anticoagulant. The key administration teaching for dabigatran is to swallow the capsule whole rather than to make up missed doses.

Correct Answer: Unusual bruising or bleeding

Clopidogrel is an antiplatelet that prolongs bleeding time, so unusual bruising or bleeding may signal excessive effect. The nurse should instruct the client to report bruising or bleeding to the provider during therapy with this medication. Option a is incorrect because a brief, mild headache is not the priority concern with an antiplatelet and does not require special reporting. The finding the nurse stresses is unusual bruising or bleeding, which reflects the drug's effect on platelet function. Option b is incorrect because occasional dry mouth is not associated with clopidogrel and is not a reportable concern. Because this drug increases bleeding risk, the client should instead watch for and report unexpected bruising or bleeding. Option d is incorrect because a salt craving is unrelated to clopidogrel and signals nothing about its action. What the client truly needs to report is easy bleeding or bruising, a clue the antiplatelet effect has grown too strong.

Correct Answer: A sudden decrease in level of consciousness

Alteplase dissolves clots and carries a serious risk of bleeding, including intracranial hemorrhage. A sudden decrease in level of consciousness can signal bleeding in the brain, so the nurse should report this finding immediately. Option b is incorrect because a blood pressure in the expected range is reassuring and does not require urgent reporting. The finding that demands immediate attention with a thrombolytic is a drop in level of consciousness, which may indicate cerebral bleeding. Option c is incorrect because a mild rise in urine output is not a sign of the dangerous bleeding associated with alteplase. The nurse escalates a sudden decline in consciousness, because thrombolytic therapy can cause life-threatening intracranial hemorrhage. Option d is incorrect because slight redness at the IV site is a minor finding compared with the risk of internal bleeding from a thrombolytic. The change the nurse reports at once is a decreasing level of consciousness, signaling possible brain

Correct Answer: A rise in blood pressure

Epoetin alfa raises the hematocrit, which can increase blood pressure and the risk of thrombotic events. The nurse should report a rise in blood pressure so it can be controlled and the dose adjusted to keep the client safe. Option a is incorrect because a decrease in fatigue is a desired response, reflecting improved red blood cell production and oxygen delivery. Rather than an adverse effect, it shows the medication is working, so it is not what the nurse reports as a problem. Option b is incorrect because pink-tinged urine suggests bleeding and is not characteristic of epoetin alfa, which stimulates red cell production. The adverse effect tied to this drug is rising blood pressure from the increase in hematocrit, which the nurse reports. Option c is incorrect because an increase in appetite is not an adverse effect of epoetin alfa and would not be reported as a concern. The finding the nurse watches for and reports is elevated blood pressure, a known risk as the hematocrit climbs.

Correct Answer: A return of the neutrophil count toward normal

Filgrastim stimulates the bone marrow to produce neutrophils, reducing the risk of infection after chemotherapy. The nurse should identify a return of the neutrophil count toward normal as the therapeutic effect of this medication. Option a is incorrect because a rising platelet count is the goal of oprelvekin, a thrombopoietic growth factor, not filgrastim. Filgrastim targets neutrophils, so the therapeutic response the nurse looks for is an improvement in the neutrophil count. Option b is incorrect because an increase in red blood cells is the effect of epoetin alfa, which stimulates erythrocyte production. Filgrastim instead boosts neutrophils, so the expected benefit is a rising neutrophil count rather than more red cells. Option d is incorrect because a decrease in blood pressure is unrelated to filgrastim's action on the bone marrow. Because this drug stimulates neutrophil production, the therapeutic effect the nurse evaluates is the recovery of the neutrophil count.

Correct Answer: Stop the transfusion

Chills, fever, and low back pain suggest an acute hemolytic transfusion reaction, which is life-threatening. The nurse's first action is to stop the transfusion to limit the amount of incompatible blood infused, then keep the line open with sodium chloride. Option a is incorrect because slowing the rate still allows incompatible blood to enter the client, continuing the hemolytic reaction. The priority is to stop the transfusion completely, because even a reduced flow keeps the harmful blood entering the bloodstream. Option b is incorrect because giving an antipyretic treats the fever but does nothing to halt the dangerous reaction in progress. The first action is to stop the transfusion, since the source of the chills, fever, and back pain is the blood being infused. Option c is incorrect because rechecking the identification band is important, but it comes after the transfusion is stopped to protect the client. Stopping the infusion first prevents more incompatible blood from wo