Drugs Affecting the Hematological System Exam: NURS3310/ NURS 3310 Complete Questions and Answers + Rationale | A+ Graded Already (Latest Fall 2025/26) -Hunter College - CUNY.

Drugs Affecting the Hematological System Exam Q&A’s + Rationales 2025-26. Question 1. A patient taking warfarin for a history of deep vein thrombosis presents with an international normalized ratio (INR) of 4.2. His examination shows no evidence of bleeding. Which action taken by the APN is most appropriate? 1.Hold one or more doses, recheck the INR and adjust the dose accordingly. 2.Treat with 2 mg of vitamin K and adjust the dose accordingly. 3.Treat with protamine sulfate and adjust the dose accordingly. 4.Stop the warfarin and begin treatment with a direct factor Xa inhibitor. Option 1:Toxicity and overdose are usually treated by withholding one or two doses of warfarin. Option 2:Vitamin K is not needed in this situation. Option 3:Protamine sulfate is the antidote for heparin toxicity or overdose. Option 4:This situation is most often remedied by dose adjustment. Question 2. The anticoagulation effects of warfarin (Coumadin) often do not occur for 3 to 4 days after initiating treatment. Which of these is the reason for this phenomenon? 1.The effects of warfarin are dependent on depletion of clotting factors. 2.Warfarin is not well absorbed from the gastrointestinal (GI) tract. 3.Metabolism of warfarin may be delayed in the presence of kidney disease. 4.Foods containing vitamin K interfere with absorption of warfarin from the gastrointestinal (GI) tract. Option 1:The half-life of clotting factors influenced by warfarin, including factor IIa, may be up to 72 hours. Option 2:Warfarin is rapidly and completely absorbed when taken orally. Option 3:Warfarin is metabolized by hepatic micro enzymes and excreted by the kidneys. Option 4:Vitamin K has an antagonistic effect on warfarin, decreasing the drug's effectiveness, but this is not the reason for this phenomenon. Question 3. The APN is reviewing labs for a patient with suspected iron deficiency anemia (IDA). Which finding would the APN document in the chart after reviewing a complete blood count with differential? 1.Microcytic hypochromic 2.Macrocytic normochromic 3.Normocytic normochromic 4.Macrocytic Option 1:Anemias are categorized by size, shape, and color. IDA is typically identified as a microcytic hypochromic anemia. Option 2:Macrocytic normochromic is seen in patients who have folic acid deficiency or pernicious anemia. Option 3:Normocytic normochromic is seen in 75% of the patients identified with anemia of chronic disease (ACD) or those who have sickle cell disease (SCD). Option 4:Macrocytic anemia is seen in patients with folic acid deficiency or pernicious anemia and is associated with large cell size. Question 4. Which recommendation should the APN provide to a parent of a child diagnosed with sickle cell disease (SCD) being treated with hydroxyurea? 1.Inspect oral mucosa daily 2.If you miss a dose, then double up on the next dose 3.Limit fluid intake to 1,000 mL per day 4.Do not take the medication if nausea or vomiting occurs Option 1:Inspect oral mucosa for erythema and ulceration Option 2:If a dose is missed, do not take it at all; do not double the dose. Option 3:Hydration is critical in managing SCD. Encourage intake of 2 to 3 L of noncaffeinated fluid daily. Option 4:Take the drug exactly as prescribed, even if nausea, vomiting, or diarrhea occurs. Question 5. Interference of the effectiveness of factor Xa inhibitors such as rivaroxaban (Xarelto) can occur when given with some drugs. Which drug should be avoided when rivaroxaban is in use? 1.Phenytoin 2.Penicillin 3.Acetaminophen 4.Digitalis Option 1:Phenytoin and carbamazepine are strong inducers of CYP3A4 and should be avoided when rivaroxaban is prescribed. Option 2:Penicillin can alter platelet aggregation, causing increased risk for bleeding when used in combination with heparin, not rivaroxaban. Option 3:Concomitant use of acetaminophen with warfarin may potentiate its action causing increased risk for bleeding, but it has no effect when taken with rivaroxaban. Option 4:Digitalis may interfere with the anticoagulation effects of heparin, but it has no effect when taken with rivaroxaban. Question 6. There is little risk associated with administration of epoetin alpha; however, monitoring is necessary to prevent complications. Which of these is a major adverse effect of epoetin alpha? 1.Hypertension 2.Fatigue 3.Dyspnea 4.Rash Option 1:The major adverse reaction associated with epoetin alpha and darbepoetin alpha is hypertension. Option 2:Fatigue is often reduced with administration epoetin alpha and darbepoetin alpha when anemia is successfully treated. Option 3:Anemia with associate dyspnea is improved with treatment of these agents. Adult respiratory distress syndrome (ARDS) may occur in patients with sepsis receiving filgrastim. Option 4:Although it is a reported adverse reaction to filgrastim, rash is uncommon with use of epoetin alpha or darbepoetin alpha. Question 7. An adult male patient has been receiving ongoing therapy for treatment of pernicious anemia (PA). Which lab value would indicate a potential complication? 1.Potassium level 2.0 mEq/L 2.Hemoglobin 15.8 g/dL 3.Hematocrit 48% 4.Sodium 138 mEq/L Option 1:The APN should be alert for the potential for hypokalemia as this can occur with replacement therapies. This value indicates significant hypokalemia which can also predispose the patient towards cardiac manifestations. Option 2:This finding indicates a normal range for hemoglobin. Option 3:This finding indicates a normal range for hematocrit. Option 4:This finding indicates a normal range for serum sodium level. Question 8. The APN is evaluating a patient diagnosed with deficiency anemia (IDA), who has been on iron therapy for 3 months. Which finding requires intervention? 1.Report of dark color stools 2.Reports occasional constipation 3.Takes iron pill in the morning upon awakening 4.Includes vitamin C in the diet Option 1:This is a normal finding found during iron therapy. Option 2:This is a normal finding found during iron therapy. Option 3:Iron pills should be taken with food to minimize gastrointestinal side effects. Option 4:Vitamin C enhances the absorption of iron in the diet. Question 9. The APN is reviewing health information for an adult male patient with a history of congestive heart failure (CHF) who is taking prescribed lisinopril. Lab values indicate that the patient has normocytic normochromic anemia. Which type of anemia does the APN suspect that the patient has? 1.Iron deficiency anemia (IDA) 2.Anemia of chronic disease (ACD) 3.Pernicious anemia (PA) 4.Folic acid deficiency Option 1:Due to the medical history of CHF and use of ACE inhibitor, it is likely that the patient has ACD rather than IDA. IDA morphology is microcytic in nature. Option 2:Patients with heart failure may have anemia due to inflammation, dilutional anemia, IDA, or anemia caused by medications such as angiotensin-converting enzyme inhibitors (Colucci, 2018). Lisinopril is an ACE inhibitor. ACD is typically seen as normocytic normochromic anemia. Option 3:Due to the medical history of CHF and use of ACE inhibitor, it is likely that the patient has ACD rather than IDA. There is no evidence of neurological deficits which would be consistent with PA. PA morphology is macrocytic in nature. Option 4:Due to the medical history of CHF and use of ACE inhibitor, it is likely that the patient has ACD rather than IDA. Folic acid deficiency morphology is macrocytic in nature. Question 10. An elderly patient with a history of atrial fibrillation on dabigatran presents with gastrointestinal bleeding. The APN reviews the patient's current medications. Which medication is most likely to cause a significantly increased risk for bleeding when combined with dabigatran? 1.Aspirin taken for arthritis pain 2.Metoprolol taken for heart rate control 3.Hydrochlorothiazide taken to reduce blood pressure 4.Diltiazem used for heart rate control Option 1:Drugs that affect platelet functioning, including aspirin, increase risk for bleeding with any anticoagulant. Option 2:There is no identified interaction between dabigatran and metoprolol. Option 3:There is no identified interaction between dabigatran and hydrochlorothiazide. Option 4:There is no identified interaction between dabigatran and diltiazem. Question 11. Which recommendation should the APN make to a pregnant patient about folic acid supplementation? 1.Folic acid supplementation should continue throughout pregnancy 2.Folic acid intake can be managed effectively by dietary intake during pregnancy 3.Absorption of folic acid is limited when taken via the oral route, therefore injections are necessary 4.0.4 mg daily dosage is recommended Option 1:Because of the potential teratogenic effects of folate deficiency in pregnant women, women of childbearing age should take prophylactic doses of 0.4 to 0.8 mg daily and continue this dose throughout any pregnancy Option 2:Maintaining an adequate folic acid level during pregnancy cannot be achieved through dietary intake alone and supplementation is recommended. Option 3:Oral folic acid is well absorbed; therefore, injections are not needed. Option 4:Prophylactic doses of 0.4 to 0.8 mg daily are recommended throughout pregnancy. Question 12. Which agent is categorized as a direct thrombin inhibitor? 1.Dabigatran (Pradaxa) 2.Fondaparinux (Arixtra) 3.Rivaroxaban (Xarelto) 4.Low molecular weight heparin (LMWH) Option 1:Dabigatran works as a direct thrombin inhibitor to prevent conversion of fibrinogen to fibrin to prevent thrombus formation. Option 2:Fondaparinux is a selective antithrombin III inhibitor and factor Xa inhibitor. Option 3:Rivaroxaban is a factor Xa inhibitor and selectively inactivates circulating factor Xa, reducing thrombin formation. Option 4:LMWH potentiates activity of antithrombin III and inactivates factors Xa and IIa (thrombin). Question 13. Which statement provides the best explanation for why NSAIDs are contraindicated when anticoagulants are prescribed? 1.There is inference with platelet aggregation. 2.There is direct inhibition of thrombin. 3.There is acceleration of antithrombin III. 4.There is inhibition of hepatic synthesis of clotting factors. Option 1:Aspirin and NSAIDs disrupt the cyclooxygenase pathway interfering with platelet aggregation. Option 2:Dabigatran (Pradaxa) is a direct thrombin inhibitor but NSAIDs are not. Option 3:Heparin and low-molecular-weight heparin (LMWH) accelerate activity of antithrombin III but NSAIDs do not. Option 4:Warfarin inhibits hepatic synthesis of clotting factors but NSAIDs do not. Question 14. Which of the lab values would be associated with anemia of chronic disease (ACD)? 1.Normal ferritin 2.Decreased reticulocyte count 3.Increased folate 4.Decreased vitamin B12 Option 1:Lab values seen in ACD are decreased hemoglobin, hematocrit and normal reticulocyte count, ferritin, vitamin B12, and folate. Option 2:Reticulocyte count would be within the normal range in ACD. Option 3:Folate level would be within the normal range in ACD. Option 4:Vitamin B12 would be within the normal range in ACD. Question 15. Which drug is recommended for anticoagulation in a patient with a prosthetic heart valve? 1.Warfarin (Coumadin) 2.Low molecular weight heparin (LMWH) 3.Clopidogrel (Plavix) 4.Aspirin Option 1:Warfarin is the drug of choice for patients with prosthetic heart valves as well as those with recurrent embolism. Option 2:Although recommended for pregnant women with prosthetic heart valves when warfarin is contraindicated, it is not the drug of choice for most cases. Option 3:Clopidogrel is beneficial in prevention of myocardial infarction in patients with coronary artery disease, but it is not recommended for anticoagulation in patients with mechanical heart valves Option 4:Aspirin is used as antithrombotic therapy in patients with atrial fibrillation but low risk for stroke; thus, it is not appropriate for anticoagulation in the presence of a mechanical heart valve. Question 16. The APN is performing a health physical on an older adult patient who has complaints of tingling, paresthesia in hands and feet, and feelings of sadness. Patient states, "I am not as sharp as I used to be" and reports limited dietary intake of meat, fresh fruits, and vegetables. Which clinical diagnosis should the APN consider? 1.Pernicious anemia (PA) 2.Iron deficiency anemia (IDA) 3.Electrolyte imbalance 4.Sepsis Option 1:Findings of neuropathy, feelings of sadness, decrease in mental acuity, and lack of sufficient dietary intake may contribute to nutritional anemias such as vitamin B12 and/or pernicious anemia. Option 2:IDA is not associated with neurological deficits; therefore, suspicion of nutritional anemias would be suspected. Option 3:There is insufficient clinical data to indicate an electrolyte imbalance. Option 4:There is insufficient clinical data to indicate sepsis. Question 17. A cancer patient with a long-term implanted venous access device is being considered for anticoagulation. Which condition would exclude the patient from having any anticoagulant prescribed? 1.Stage 4 hypertension 2.Hyperkalemia 3.Renal insufficiency 4.Hypersensitivity to NSAIDs Option 1:All anticoagulants are contraindicated in severe hypertension. Option 2:Hyperkalemia may occur with heparin but would not preclude use of other anticoagulants. Option 3:Warfarin should be used with caution in people with liver dysfunction; heparin use in patients with renal insufficiency requires careful monitoring. Option 4:Hypersensitivity to NSAIDs may carry a cross-sensitivity to aspirin but does not preclude use of other anticoagulants. Question 18. Which recommendation would the APN make for a toddler who has slightly decreased iron levels? 1.Iron chewable supplement 2.Monthly iron injection 3.Increase consumption of milk 4.Increase in apple juice Option 1:Children aged 1 to 3 years who do not have adequate dietary intake of iron should receive daily supplementation with iron in liquid, chewable, or, if in Canada, sprinkle form (Baker et al, 2010). Option 2:Iron injections are not recommended for supplementation for slightly decreased iron levels in this population. Option 3:Increased milk consumption can lead to decreased iron absorption. Option 4:Apple juice is not considered to be a good source of iron. Question 19. The APN is examining an adult patient and finds a beefy red tongue and reports mood swings. Which type of anemia does the APN suspect that the patient has? 1.Pernicious anemia (PA) 2.Iron deficiency anemia (IDA) 3.Folic acid deficiency 4.Anemia of chronic disease (ACD) Option 1:Vague early symptoms of PA (e.g., infections; mood swings; and GI, cardiac, or kidney problems) are often ignored. A glossy red tongue is a consistent finding with PA. Option 2:The tongue can become red and sore, but it does not appear as a beefy red tongue. Option 3:Common symptoms of folic acid deficiency are glossitis, stomatitis, nausea and anorexia, and diarrhea. Option 4:There is insufficient clinical data to determine if the patient is experiencing ACD. Question 20. A patient is scheduled for elective surgery and wishes to donate her own blood prior to the procedure. Which medication is indicated to increase baseline hemoglobin prior to blood donation? 1.Epoetin alfa 2.Filgrastim (G-CSF) 3.Ferrous sulfate 4.Ferrous gluconate Option 1:Epoetin is indicated for this process when iron stores are intact. Option 2:Filgrastim is indicated for neutropenia. Option 3:Oral iron preparations are indicated for treatment of iron deficiency anemia. Option 4:Oral iron preparations are indicated for treatment of iron deficiency anemia. Question 1. There are several side effects associated with hematopoietic growth factors. Which side effect is common to all? 1.Bone pain 2.Tachycardia 3.Fluid retention 4.Diarrhea Option 1:Bone pain is common to all hematopoietic growth factors because of the increase in bone marrow activity. Pain may be severe and require analgesia. Option 2:Tachycardia may be seen in hypersensitivity reactions to some of the white blood cell growth factors. Option 3:Fluid retention has been reported in a small number of patients receiving sargramostim. Option 4:Diarrhea is typically a side effect of hematopoietic growth factors. Question 2. A patient receiving heparin for treatment of deep vein thrombosis (DVT) has an elevated activated partial thromboplastin time (aPTT) slightly over the therapeutic range. He has no evidence of bleeding. Which action is recommended to reduce risk for bleeding and achieve a therapeutic level? 1.Temporarily holding the drug and reducing the dose 2.Administering protamine sulfate 1 mg for every 100 units 3.Administering vitamin K 4.Administering platelets Option 1:Because heparin's half-life is short, heparin overdose is usually treated with withdrawal of the drug. Option 2:Treatment with protamine sulfate is not required in this situation. Option 3:Vitamin K is the antidote for warfarin toxicity. Option 4:This is not a recommended treatment. Question 3. A patient taking warfarin for treatment of deep vein thrombosis (DVT) presents to the clinic with a fungal infection requiring treatment with antifungal agent. The APN recognizes that there is an interaction between many antifungal agents and warfarin. Which action by the APN is most appropriate? 1.Adjust the dose of warfarin and monitor the patient's international normalized ratio (INR) more frequently while the patient is taking the new medication. 2.Increase the dose of warfarin to counteract the effects of the new medication. 3.Hold the warfarin until the patient completes the new medication. 4.Discontinue the warfarin and start a different anticoagulant for the time the patient is taking the antifungal medication. Option 1:Data suggest that these drugs potentiate the action of warfarin, causing increased risk for bleeding. Option 2:Increasing the dose of warfarin without evidence of need based on international normalized ratio (INR) is not a safe practice. Option 3:There is an increased risk of clotting if the warfarin is held. Option 4:Although this is an option, it may be more difficult for the patient given the increased cost of other agents. Question 4. Which patient taking warfarin should be considered for "bridging" with heparin in the perioperative period? 1.A patient having a skin biopsy 2.A patient with history of stroke with atrial fibrillation 3.A patient with remote history of deep vein thrombosis 4.A patient having cataract surgery Option 1:Warfarin can be continued in this situation because bleeding risk is low. Option 2:This patient is at high risk for recurrent stroke, and anticoagulation should be continued. Option 3:Risk for stroke in this patient is relatively low. Option 4:This patient is at low risk for bleeding with this procedure. Question 5. A patient on iron therapy for a few weeks continues to have decreased hemoglobin and hematocrit levels at the 2-month follow-up visit. Which test should the APN consider ordering at this time? 1.Barium enema 2.CT of the abdomen 3.Stool specimens for occult blood, ova, and parasites 4.Urine culture Option 1:There is no clinical indication for a barium enema based on the presented clinical data. Option 2:There is no clinical indication for imaging studies at this time based on presented clinical data. Option 3:Persistent, unrecognized blood loss should be assessed with stool specimens for occult blood, ova, and parasites. Option 4:There is no clinical indication for a urine culture at this time based on presented clinical data. Question 6. A patient presents with a transient ischemic attack (TIA) and needs long-term anticoagulation. He reports an allergy to aspirin. Which other medication is recommended by the American College of Chest Physicians (ACCP)? 1.Clopidogrel 75 mg daily 2.Warfarin daily 3.Dipyridamole 200 mg daily 4.Low molecular weight heparin Option 1:Clopidogrel is a recommended option instead of aspirin. Option 2:Warfarin daily is not a recommended therapy. Option 3:Dipyridamole is recommended for use in combination with aspirin. Option 4:Low molecular weight heparin is not a recommended therapy. Question 7. Which iron preparation is most effective for an otherwise healthy 24- year-old woman on a limited income with iron deficiency associated with menorrhagia? 1.Ferrous sulfate tablets 2.Sustained release ferrous gluconate tablets 3.Fer-In-Sol 4.Ferrous gluconate chewable tablets Option 1:Ferrous sulfate is most readily absorbed, and tablets are the least expensive formulation. Option 2:Sustained release tablets are not recommended. They are more costly and not absorbed as well. Option 3:Fer-In-Sol is an oral solution most often prescribed for infants and small children. It is the most expensive form of oral ferrous sulfate. Option 4:Ferrous sulfate is most readily absorbed, and tablets are the least expensive formulation. Chewable tablets are most often used in children. Question 8. Which organ is most at risk for complications when a patient has been diagnosed with sickle cell disease? 1.Stomach 2.Bladder 3.Kidney 4.Thymus Option 1:The organs at greatest risk for damage are those with venous sinuses in which blood flow is low and oxygen tension and pH are low (spleen and bone marrow) and those with a limited terminal arterial blood supply (eye and head of the femur and humerus). The kidney is also at risk, especially as the patient ages. Option 2:The organs at greatest risk for damage are those with venous sinuses in which blood flow is low and oxygen tension and pH are low (spleen and bone marrow) and those with a limited terminal arterial blood supply (eye and head of the femur and humerus). The kidney is also at risk, especially as the patient ages. Option 3:The organs at greatest risk for damage are those with venous sinuses in which blood flow is low and oxygen tension and pH are low (spleen and bone marrow) and those with a limited terminal arterial blood supply (eye and head of the femur and humerus). The kidney is also at risk, especially as the patient ages. Option 4:The organs at greatest risk for damage are those with venous sinuses in which blood flow is low and oxygen tension and pH are low (spleen and bone marrow) and those with a limited terminal arterial blood supply (eye and head of the femur and humerus). The kidney is also at risk, especially as the patient ages. Question 9. A patient is taking clopidogrel for its antiplatelet effect. Which medication is known to increase clopidogrel's effectiveness? 1.Cimetidine 2.Omeprazole 3.Vitamin K supplements 4.Aspirin Option 1:Proton pump inhibitors, and not histamine blockers, decrease the effectiveness of clopidogrel. Option 2:Proton pump inhibitors are known to decrease the effectiveness of clopidogrel. Option 3:Vitamin K inhibits the action of warfarin. Option 4:Aspirin may enhance the effectiveness of clopidogrel and may increase risk for bleeding. Question 10. When adjusting the dose of warfarin for a patient with a mechanical heart valve, how should the APN proceed? 1.Adjust the weekly dose up or down by 10% in most cases. 2.Adjust the weekly dose up or down by 15% in most cases. 3.Adjust the weekly dose up or down by 20% in most cases. 4.Adjust the weekly dose up or down by 5% in most cases. Option 1:It is best to avoid large variations in anticoagulation. Changes of 10% in weekly doses are preferred unless the international normalized ratio (INR) is too far out of the desired range. Option 2:It is best to avoid large variations in anticoagulation. Changes of 10% in weekly doses are preferred unless the international normalized ratio (INR) is too far out of the desired range. Option 3:It is best to avoid large variations in anticoagulation. Changes of 10% in weekly doses are preferred unless the international normalized ratio (INR) is too far out of the desired range. A 20% change is typically much higher than recommended. Option 4:A 5% change is usually not enough to make a significant difference when the international normalized ratio (INR) is out of the desired range. Question 11. The APN is performing a physical assessment on an elderly male patient who has previously been diagnosed with folic acid deficiency. Which finding would specifically indicate a vitamin B12 deficiency state? 1.Decreased vibratory sensation of the feet 2.Systolic ejection murmur 3.Pale skin 4.Shallow breathing Option 1:Peripheral neuropathies will be present only if vitamin B12 is also deficient. Option 2:This finding would be consistent with folic acid deficiency, not vitamin B12 deficiency. Option 3:This finding would be consistent with all types of anemia and would not directly correlate with only vitamin B12. Option 4:Increased respiratory rate would be seen in a vitamin B12 deficiency state. Question 12. When educating a patient who is taking oral iron supplements for anemia, which advice is most appropriate for the APN to offer? 1.Always take this supplement with food. 2.Taking this medication with milk or other dairy products will improve absorption. 3.It is best to take this medication on an empty stomach. 4.There is no need to keep the medication away from children because it is harmless. Option 1:Food interferes with the absorption of iron. Option 2:Milk decreases absorption of iron from the gastrointestinal tract. Option 3:Oral iron is best absorbed on an empty stomach. Option 4:Acute iron toxicity can occur in children after taking as few as 10 tablets of an iron supplement. Question 13. Which of these is a potential side effect of ticlopidine? 1.Neutropenia 2.Tinnitus 3.Deep vein thrombosis 4.Constipation Option 1:Neutropenia can occur with ticlopidine and can lead to increased risk for infection. Option 2:Tinnitus is a reported effect of aspirin toxicity, not ticlopidine. Option 3:Deep vein thrombosis is not a side effect of ticlopidine. Option 4:Diarrhea, but not constipation, is a recognized side effect of ticlopidine. Question 14. Which regimen is American College of Chest Physicians (ACCP)- recommended for prevention of myocardial infarction (MI) for a patient who has had acute coronary syndrome (ACS) and placement of a stent? 1.Ticagrelor (Brilinta) 90 mg twice daily and aspirin 75 to 100 mg daily 2.Clopidogrel (Plavix) 75 mg daily 3.Aspirin 100 mg daily 4.Warfarin with target international normalized ratio (INR) of 2.0 to 3.0 Option 1:Ticagrelor and aspirin in combination is the preferred treatment recommendation for prevention of MI in patients who have had ACS. Option 2:Clopidogrel alone is inadequate in this situation. Patients with ACS should be treated with both aspirin and ticagrelor; clopidogrel with aspirin may be adequate but is not the primary recommendation. Option 3:Aspirin alone is inadequate in this situation. This is recommended for adults over 50 without symptoms of cardiovascular disease (CVD). Option 4:Postanterior MI patients with risk for thrombus with stenting are treated with warfarin and aspirin 75 to 100 mg. Question 15. A female patient has delivered a male child at 32 weeks. Which information would the APN consider related to prescribing iron supplementation to the newborn? 1.Iron supplementation should be started 2.Iron supplementation can be started at 6 months of age 3.No need for iron supplementation as the newborn is being fed breast milk 4.Passage of meconium facilitates iron absorption Option 1:Preterm infants may have only 3 months of iron stores and they grow at a more rapid rate, which compounds the problem of insufficient iron stores. Option 2:Due to lack of sufficient iron stores in preterm infants, iron supplementation must be started earlier than 6 months. Option 3:Even though breast milk is a good source of iron, preterm infants have decreased iron stores and need additional iron as they grow at a more rapid rate. Option 4:Meconium is the first stool of the newborn and does not impact absorption of iron. Question 16. Which client is at lowest risk for folic acid deficiency? 1.A 45-year-old male with alcohol abuse disorder 2.A 23-year-old female who recently delivered a baby and is breastfeeding 3.A 15-year-old female who has celiac disease 4.A 50-year-old man who is a vegetarian Option 1:Individuals with alcohol abuse may have insufficient folate stores. Option 2:Increased demands for folic acid associated with pregnancy and breastfeeding may lead to deficiency. Option 3:Impaired absorption of folic acid due to impaired absorption associated with celiac disease may lead to deficiency and anemia. Option 4:Folic acid is present in many foods typically found in a vegetarian diet including beans, legumes, and green vegetables; however, a vegetarian diet may lack vitamin B12. Question 17. A patient with breast cancer presents to the emergency department with deep vein thrombosis (DVT) in her right leg. She will require anticoagulation. Which regimen is most appropriate for this patient? 1.Rivaroxaban 2.Warfarin for 3 months in 3.Dabigatran for 3 months 4.Dabigatran for 6 months Option 1:In patients who have cancer and develop a DVT of the leg or PE, an oral Xa inhibitor (rivaroxaban, apixaban, or edoxaban) is recommended as initiation and long-term (3-month) treatment over warfarin or LMWH (Stevens et al., 2021). Option 2:In patients with cancer who develop DVT or pulmonary embolus (PE), warfarin is not the most appropriate long-term therapy. Option 3:In patients with cancer who develop DVT or pulmonary embolus (PE), dabigatran is not the most appropriate long-term therapy. Option 4:In patients with cancer who develop DVT or pulmonary embolus (PE), dabigatran is not the most appropriate long-term therapy. Question 18. A 60-year-old male with a history of ongoing alcohol abuse disorder and an acute flare of gout needs treatment for megaloblastic anemia associated with vitamin B12 deficiency. Which is the most efficacious and cost-effective way to administer vitamin B12 to this patient? 1.Orally 2.Intravenously 3.Intramuscularly 4.Intranasally Option 1:Colchicine used for acute gout may interfere with absorption of vitamin B12. Option 2:Because vitamin B12 is available in multiple other forms, intravenous dosing is not indicated. Option 3:This form is well tolerated, avoids problems associated with decreased absorption, and is cost effective. Option 4:Although this formulation is an option, it is more costly than injectable form of vitamin B12. Question 19. Which of these might explain a failure to maintain a response to regular doses of epoetin alfa in a patient with chronic renal disease? 1.Iron supplementation 2.Occult blood loss 3.Folate supplementation 4.Discontinuation of an antacid containing aluminum Option 1:Iron supplementation is expected to improve anemia and typically enhances epoetin alfa treatment if iron deficiency is present. Option 2:Occult blood loss may be associated with persistent anemia despite use of epoetin alfa. Option 3:Folate is expected to improve anemia related to folate deficiency and not interfere with epoetin alfa treatment. Option 4:Aluminum toxicity is associated with anemia in patients with renal disease. Discontinuation of a medication containing aluminum would be expected to improve the hematologic picture. Question 20. In which patient with anemia might the APN suspect folic acid deficiency? 1.A patient taking phenytoin for a seizure disorder 2.A patient eating excessive amounts of raw, green, leafy vegetables 3.A patient taking nitrofurantoin for a urinary tract infection 4.A patient with hypothyroidism Option 1:Phenytoin can impair folic acid absorption. Option 2:Green, leafy vegetables, especially when raw, contain high amounts of folic acid. Option 3:Utilization of folic acid may be impaired with use of trimethoprim but not nitrofurantoin. Option 4:The demand for folic acid is increased with hyperthyroidism, not with hypothyroidism.