Prothrombin time (PT) Activated partial thromboplastin time (APTT) Haematocrit (Hct)

1. A nurse is providing instructions to a patient who is receiving Warfarin sodium (Coumadin). Which statement made by the patient indicates the need for further instruction ? Prothrombin time (PT) Activated partial thromboplastin time (APTT) Haematocrit (Hct) Haemoglobin (Hb) The answer is B. Activated partial thromboplastin assesses the therapeutic level of heparin. Option A : Assesses the therapeutic level of warfarin sodium (Coumadin). Option C and D : Measure the aspect of the red blood cells

2. A nurse is caring for a client receiving a heparin intravenous (IV) infusion. The nurse expects that which of the following laboratory will be prescribed to monitor the therapeutic effect of heparin? Prothrombin time (PT) Activated partial thromboplastin time (APTT) Hematocrit (Hct) Hemoglobin (Hb) The answer is B. Activated partial thromboplastin time assess the therapeutic level of heparin. Option A: Assess the therapeutic level of warfarin sodium (Coumadin). Options C and D: Measures the aspect of the red blood cells.

3. A patient with atrial fibrillation is receiving a continuous heparin infusion at 1,000 units/hr. The nurse observes that the patient is receiving the therapeutic effect base on which of the following results? Activated partial thromboplastin time of 30 seconds Activated partial thromboplastin time of 60 seconds Activated partial thromboplastin time of 120 seconds Activated partial thromboplastin time of 15 seconds The answer is B. The normal range for activated partial thromboplastin time is 20 – 60 seconds. The activated partial thromboplastin time must be 1.5 to 2.5 times the normal value, the patient’s APPT would be considered therapeutic if it is 60 seconds

4. A patient is receiving intravenous heparin therapy. The nurse ensures the availability of which of the following medication : Acetylcysteine (Mucomyst) Calcium gluconate Vitamin K (Mephyton) Protamine sulphate The answer is D. Protamine sulfate is the antidote that reverses the anticoagulant effects of heparin by binding to it. Option A is the antidote for acetaminophen toxicity. Option B is the antidote for magnesium sulfate toxicity. Option C is the antidote for warfarin sodium toxicity.

5. A patient is receiving a continuous infusion of streptokinase (Streptase). The patient suddenly complains of a difficulty in breathing, itchiness, and nausea. Which of the following should be the priority action of the nurse? Stop the infusion and notify the physician. Administer protamine sulphate and provide oxygen therapy. Administer antihistamine then continue the infusion. Slow the infusion and administer oxygen. The answer is A. Severe allergic reaction to streptokinase requires immediate discontinuation of Streptokinase,then notify the physician and administer an adrenergic, antihistamine, and/or corticosteroid agents as ordered.

6. A patient with deep vein thrombosis is receiving Streptokinase (Streptase). The nurse would notify the physician if which of the following assessment is noted? A temperature of 99.2° Fahrenheit A pulse rate of 99 beats per minute A respiratory rate of 25 breaths per minute. A blood pressure of 185/110 mm Hg The answer is D. Thrombolytic therapy is contraindicated with uncontrolled hypertension (systolic BP >180 mm Hg and/or diastolic BP >110 mm Hg) because of the risk of cerebral hemorrhage. Options A, B, and C may be present during the therapy but will not warrant the immediate knowledge of the physician before starting the therapy.

7. A client who is receiving streptokinase therapy suddenly had a nose bleeding. The nurse ensures the availability of which of the following medications? Vitamin K (Mephyton). Deferoxamine (Desferal). Aminocaproic acid (Amicar). Diphenhydramine (Benadryl). The answer is C. Bleeding can be reversed with the use of aminocaproic acid as an antidote for streptokinase. Option A is the antidote for warfarin sodium toxicity. Option B is the antidote for iron toxicity. Option D is an antihistamine that can be used for any allergic reaction.

8. A nurse is providing health teachings regarding antiplatelet medications.Which of the following is not true regarding the use of this medication? Antiplatelet medication inhibits the aggreagation of platelets in the clotting process, thereby prolonging bleeding time Antiplatelet medications cannot be used with anticoagulants Take the medication with food to prevent gastrointestinal upset A routine bleeding time is monitored during the therapy The answer is B. Antiplatelet and anticoagulant therapies are effective in preventing a clot from forming and growing. Both are not needed at the same time.

9. A patient is receiving Procainamide (Procanbid) for the treatment of ventricular arrhythmia. The patient suddenly complains of nausea and drowsiness. Whiich of the following interventions should the nurse do first? Check the blood pressure and heart rate Do a 12 lead ECG right away. Measure the heart rate on the rhythm strip. Give hydralazine (Apresoline) per orum The answer is A. The patient is experiencing signs of a procainamide toxicity. The priority nursing action is to obtain vital signs immediately. Options B and C are done after checking the vital signs. Option D will cause hypotension.

10. A patient with myocardial infarction is receiving tissue plasminogen activator, Alteplase (Activase, tPA). While on the therapy, the nurse plans to prioritize which of the following ? Observe for neurological changes Monitor for any signs of renal failure Check the food diary Observe for signs of bleeding The answer is D. Bleeding is a serious concern for a patient who is on thrombolytic medication.

11. A Nurse is caring for a patient who is taking digoxin (Lanoxin) 0.25 mg tab once a day. The patient suddenly complains of anorexia, nausea, vomiting, and diarrhoea. The physician is diagnosing a digoxin toxicity. As a nurse you know that the therapeutic level of digoxin in the blood is : 0.25-0.5 ng/ml. 0.5-2 ng/ml. 1.5-3 ng/ml. 3.5-4.5 ng/ml The answer is D. The therapeutic level of digoxin is 0.5 – 2 ng/mll

12. A Nurse is monitoring a patient who is taking Carvedilol. Which of the following assessment made by the nurse would warrant a possible complication with the use of this medicine? Baseline blood pressure of 160/100 mm Hg followed by a blood pressure of 120/70 mm Hg after 3 doses. Baseline heart rate of 97/mt followed by a heart rate of 62/mt after 3 doses Complaints of nightmares and insomnia Complaints of dyspnea The answer is D. Complaints of dyspnea is a sigh of bronchospasm which is one of the serious complication of beta blockers. Options A and B shows a decrease in the blood pressure and heart rate which are expected in this therapy. Option C is a side effect of this medication.

13. A nurse is interviewing a patient who is about to receive metoprolol. Upon the history takin, the patient is also taking insulin which of the following statements made by the nurse will correctly explain the possible interaction of these medications? This medication will maintain the blood sugar level on a normal range This medication will have no effect in the blood sugar level This medication may mask some of the symptoms of hypoglycemia such as tremor, palpitation and rapid heart beat This medication may mask some of the symptoms of hyperglycemia such as headache, increased thirst and blurred vision. The answer is C. Beta-blockers such as metoprolol may increase the risk of hypoglycemia in patients receiving insulin. In addition, beta-blockers may mask some of the symptoms of hypoglycemia such as tremors, palpitation, and rapid heart beat, making it more difficult to recognize an oncoming episode.

14. A patient is about to receive Metolazone (zaroxolyn). The nurse in charge understands that which of the following laboratory results are related to the administration of the medication? Hyperkalemia and hypocalcemia Hyperkalemia and hypoglycemia Hypouricemia and hypoglycemia Hypokalemia and hyperglycemia The answer is D. Metolazone is a thiazide diuretic that may put patients risk for hypokalemia, hyperglycemia, hyperlipidemia, hypercalcemia and hyperuricemia.

15. A patient with congestive heart failure is being treated with Torsemide (Demadex). The nurse obtains the following vital signs. Blood pressure of 100/65 mm Hg., pulse rate of 91 beats per minute, and respiration of 25 breaths per minute. Which of the following will be the priority assessment of the nurse after the initiation of the dose? Urine output Serum potassium and calcium Blood pressure Weight The answer is C. The priority assessment in this situation will be the monitoring of the blod pressure because hypotension poses a risk in this medication. Options A, B, and D are moitored but they are not the priority.

16. A nurse is giving instruction to a patient who is receiving Cholestyramine (Questran) for the treatment of hyperlipidemia. Which of the following statements made by the patient indicates the need for further instructions? This medication comes in a provider that must be mixed with juice or water before administration I will avoid eating foods rich in saturated fats I will continue taking nicotinic acid as part of the treatment. Constipation, belching and heartburn are some of the side effects. The answer is C. A combination of Cholestyramine and nicotinic acid damages the liver. Options A, B, and D are true regarding this medication.

17. A nurse is providing instructions to a client who is on nicotinic acid for the treatment of hyperlipidemia. Which statement made by the nurse indicates a comprehension of the instructions? I should take aspirin 30 minutes before nicotinic acid I will drink alcohol in moderation Yellowing of the skin is a common side effect This medication is taken on an empty stomach The answer is A. The use of aspirin or a nonsteroidal anti-inflammatory drug 30 minutes before decreases flushing which is a side effect of taking nicotinic acid. Option B : Drinking alcohol will cause liver abnormalities. Option C is a sign of liver dysfunction and should be immediately informed to the physician. Option D : this medication is taken with meals to decrease gastrointestinal upset

18. A nurse is monitoring a patient who is taking Digoxin (Lanoxin). All the following are the side effects of digoxin except : Anorexia Blurred vision Diarrhoea Tremors The answer is D. Signs of digoxin toxicity are as follows : anorexia, nausea, vomiting, diarrhea, and blurred vision. But tremors do not occur.

19. A nurse is interviewing a patient who is about to receive bumetanide (Bumex). Which of the following is a concern related to the administration of the medication? Penicillin allergy Sulfa allergy Soy content allergy Cephalosporin allergy The answer is B. Loop diuretics such as bumetanide are sulfa-based medications. A patient with sulfa allergy is at risk for an allergic reaction

20. A patient arrives in the emergency with complaints of chest pain, and is diagnosed with acute MI. a morphine 4 mg IV was given 5 minutes ago. Which of the following assessment made by the nurse indicates a further immediate action? Respiratory rate from 29/mt to 12/mt Blood pressure from 120/70 to 100/60 mmHg The patient still complains of chest pain with a pain scale of 2/10 Cardiac rate of 103/mt and a normal sinus rhythm of the ECG. The answer is C. The goal for the patient with an acute myocardial infarction is to eliminate the pain. Even pain related at a level of 2/10 should be managed with an additional dose of morphine. Options A, B and d , although hypotension, respiratory depression and tachycardia are the side effects of morphine but they do not require further action at this time.