Drugs Affecting the Hematopoietic System
1. Kenneth is taking warfarin and is asking about what he can take for minor aches and pains. The best recommendation is:
a) Ibuprofen 400 mg three times a day
b) Acetaminophen, not to exceed 4 grams per day
c) Prescribe acetaminophen with codeine
d) Aspirin 640 mg three times a day
Answer. Acetaminophen, not to exceed 4 grams per day
2. Juanita had a deep vein thrombosis (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:
a) Contact the hospitalist as this is not the normal guideline for prescribing these two medications and she may have had a more complicated case.
b) Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness.
c) Encourage the patient to contact the Customer Service department at the hospital as this was most likely a medication error during her admission.
d) Draw anticoagulation studies to make sure she does not have dangerously high bleeding times.
Answer. Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness. Drugs Affecting the Hematopoietic System.
3. The safest drug to use to treat pregnant women who require anticoagulant therapy is:
a) Low-molecular-weight heparin
b) Warfarin
c) Aspirin
d) Heparin
Answer. 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?
a) Pregnant women
b) Elderly men
c) Overweight or obese patients
d) Patients with multiple comorbidities
Answer. Overweight or obese patients
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:
a) Administer one dose of low-molecular weight heparin 24 hours before travel.
b) Prescribe one dose of warfarin to be taken the day of travel.
c) Consult with a hematologist regarding a treatment plan for Cecil.
d) Explain that Cecil is not at high risk of a blood clot and provide education about how to prevent blood clots while traveling.
Answer. 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?
a) He has arthritis and this will help with the inflammation and pain.
b) Aspirin has anti-platelet activity and prevents clots that cause heart attacks.
c) Aspirin acidifies the urine and he needs this for prostrate health.
d) He has a history of GI bleed, and one aspirin a day is a safe dosage.
Answer. Aspirin has anti-platelet activity and prevents clots that cause heart attacks. Drugs Affecting the Hematopoietic System.
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 for which she would need to be evaluated?
a) Tinnitus
b) Diarrhea
c) Hearing loss
d) Photosensitivity
Answer. Tinnitus
8. Patient education when prescribing clopidogrel includes:
a) Do not take any herbal products without discussing it with the provider.
b) Monitor urine output closely and contact the provider if it decreases.
c) Clopidogrel can be constipating, use a stool softener if needed.
d) The patient will need regular anticoagulant studies while on clopidogrel.
Answer. Do not take any herbal products without discussing it with the provider.
9. For patients taking warfarin, INRs are best drawn:
a) Monthly throughout therapy
b) Three times a week throughout therapy
c) Two hours after the last dose of warfarin to get an accurate peak level
d) In the morning if the patient takes their warfarin at night
Answer. In the morning if the patient takes their warfarin at night. Drugs Affecting the Hematopoietic System.
10. Patients receiving heparin therapy require monitoring of:
a) Platelets every 2 to 3 days for thrombocytopenia that may occur on day 4 of therapy
b) Electrolytes for elevated potassium levels in the first 24 hours of therapy
c) INR throughout therapy to stay within the range of 2.0
d) Blood pressure for hypertension that may occur in the first 2 days of treatment
Answer. Platelets every 2 to 3 days for thrombocytopenia that may occur on day 4 of therapy
11. The routine monitoring recommended for low molecular weight heparin is:
a) INR every 2 days until stable, then weekly
b) aPTT every week while on therapy
c) Factor Xa levels if the patient is pregnant
d) White blood cell count every 2 weeks
Answer. Factor Xa levels if the patient is pregnant
12. When writing a prescription for warfarin it is common to write _________ on the prescription.
a) OK to substitute for generic
b) The brand name of warfarin and Do Not Substitute. Drugs Affecting the Hematopoietic System.
c) PRN refills
d) Refills for 1 year
Answer. The brand name of warfarin and Do Not Substitute
13. Education of patients who are taking warfarin includes discussing their diet. Instructions include:
a) Avoiding all vitamin K-containing foods
b) Avoiding high-vitamin K-containing foods
c) Increasing intake of iron-containing foods
d) Making sure they eat 35 grams of fiber daily
Answer. Avoiding high-vitamin K-containing foods
14. Patients who are being treated with epoetin alfa need to be monitored for the development of:
a) Thrombocytopenia
b) Neutropenia
c) Hypertension
d) Gout
Answer. Thrombocytopenia
15. The FDA issued a safety announcement regarding the use of erythropoiesis-stimulating agents
(ESAs) in 2010 with the recommendation that:
a) ESAs no longer be prescribed to patients with chronic renal failure. Drugs Affecting the Hematopoietic System.
b) The risk of tumor development be explained to cancer patients on ESA therapy
c) Patients should no longer receive ESA therapy to prepare for allogenic transfusions
d) ESAs be prescribed only to patients younger than age 60 years
Answer. The risk of tumor development be explained to cancer patients on ESA
16. When patients are started on darbepoetin alfa (Aranesp) they need monitoring of their blood counts to determine a dosage adjustment in:
a) 6 weeks if they are a cancer patient
b) 1 week if they have chronic renal failure
c) 2 weeks if they are taking it for allogenic transfusion
d) Each week throughout therapy
Answer. 6 weeks if they are a cancer patient
17. Jim is ha Answer. ving 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:
a) Folic acid to prevent megaloblastic anemia
b) Iron, to start when the epogen starts
c) An antihypertensive to counter the adverse effects of epogen
d) Vitamin B12 to prevent pernicious anemia
Answer. Iron, to start when the epogen starts
18. Monitoring for a patient being prescribed iron for iron deficiency anemia includes:
a) Reticulocyte count 1 week after therapy is started
b) Complete blood count every 2 weeks throughout therapy
c) Hemoglobin level at 1 week of therapy
d) INR weekly throughout therapy
Answer. Reticulocyte count 1 week after therapy is started. Drugs Affecting the Hematopoietic System.
19. Patient education regarding taking iron replacements includes:
a) Doubling the dose if they miss a dose to maintain therapeutic levels
b) Taking the iron with milk or crackers if it upsets their stomach
c) Iron is best taken on an empty stomach with juice
d) Antacids such as Tums may help the upset stomach caused by iron therapy
Answer. Iron is best taken on an empty stomach with juice
20. Patients with pernicious anemia require treatment with:
a) Iron
b) Folic acid
c) Epogen alpha
d) Vitamin B12
Answer. Vitamin B12
21. The first laboratory value indication that vitamin B12 therapy is adequately treating pernicious anemia is:
a) Hematocrit levels start to rise
b) Hemoglobin levels return to normal
c) Reticulocyte count begins to rise
d) Vitamin B12 levels return to normal
Answer. Hemoglobin levels return to normal. Drugs Affecting the Hematopoietic System.
22. Patients who are beginning therapy with vitamin B12 need to be monitored for:
a) Hypertensive crisis that may occur in the first 36 hours
b) Hypokalemia that occurs in the first 48 hours
c) Leukopenia that occurs at 1 to 3 weeks of therapy
d) Thrombocytopenia that may occur at any time in therapy
Answer. Leukopenia that occurs at 1 to 3 weeks of therapy
