NUR 426 EXAM 1 VOIT ASU SPRING 2024 QUESTIONS AND CORRECT
ANSWERS
You cshould cknow cthe csignificance cof cthe cfollowing c(why cwould cit cbe chigh cvs clow), cbut cdo cnot cneed cto cmemorize cnormal
cranges c- cCORRECT cANS✔✔The cconcept cof c"therapeutic cranges" c(pertaining cto cPT/INR, caPTT, cPTT)
PT/INR→ c(high=longer ctime cin csec cto cform cclot) cwarfarin, cvitamin cK cdeficiency, crisk cfor cbleeding; c(low= cshorter ctime cin csec
cto cform cclot) cvitamin cK csupplementation, cdiet chigh cin cvitamin cK, cbirth ccontrol, crisk cfor cclots
aPTT/PTT→ c(high=longer ctime cin csec cto cform cclot) cheparin, chemophilia, crisk cfor cbleeding; c(low= cshorter ctime cin csec cto cform
cclot) cvitamin cK csupplementation, crisk cfor cclots→ clead cto cMI cor cstroke
Fibrinogen→ c(high) clots cof cclotting→ clead cto cstroke cor cMI; c(low) cno cclotting, cDIC, ccancer
Clotting cfactors→ c(high) csmoking, coverweight, cpregnancy; c(low) chemophilia, chemorrhage
D-dimer→ c(high) cDVT, csmoking, cinfection, cclotting cdisorder; c(low) cinc crisk cfor cbleeding
Platelet ccount→ c(high) cinflammation, cinfection, csplenectomy, cautoimmune; c(low) cbleeding, cthrombocytopenia, cB12 cdeficiency
RBCs→ c(high) cCOPD, ccongenital cheart cdisease, cdehydration, crecent ctransfusion; c(low) cbleeding, canemia, cB12 cdeficiency,
cfolate cdeficiency
Hemoglobin→ c(high) cchronically clow cblood cO2 clevels cdue cto cheart cor clung cissue; c(low) cbleeding, ciron cdeficiency, cpregnancy,
cASA
Hematocrit→ c(high) cdehydration; c(low) cbleeding, canemia
WBCs→ c(high) cinfection, cinflammation; c(low) cimmunocompromised, ccancer, cchemotherapy, cmalnutrition
ANC c(Absolute cNeutrophil cCount)→ c(high) cautoimmune creaction; c(low) cimmunocompromised, cneutropenia, cTB, csepsis
Factor cVIII c- cCORRECT cANS✔✔Indications→ cdeficiency cof cfactor c8 c(Hemophilia cA)
Side ceffects→ callergic crxn, crash c(Benadryl), canaphylaxis c(epi)
Considerations→ cNSAIDs
Hydroxyurea c- cCORRECT cANS✔✔Indications→ cinc cproduction cof cHb cF c(these ccells cdo cnot csickle), creduce cadhesion cand
cimprove chydration cof csickle ccells
Side ceffects→ csuppress cblood ccells cin cgeneral c(bleeding cand cinfection), cN/V, cmouth csores, cbleeding
Considerations→ cdec cWBC cand cplatelets c(protective cprecautions), cdec cvasoconstriction c(monitor cBP), cincreases cHb
Desmopressin c- cCORRECT cANS✔✔Indications→ cmild chemophilia c(stimulates cinc cin cfactor c8); ca cform cof cADH; conly ceffective
cif cone ccan cproduce cfactor c7
Side ceffects→ cfluid cretention, chyponatremia, cHA, cnausea, cGI cupset
Considerations→ cmonitor cI&Os, cdiuretics cfor cfluid cretention
Aspirin c(ASA) c- cCORRECT cANS✔✔Indications→ cinflammation csuppression, cfever creduction, cinhibit cplatelet caggregation
Side ceffects→ cGI cupset, cheartburn, ckidney cdysfunction, cbleeding
Considerations→ crisk cfor cbleeding cespecially cwhen ccombined cwith cblood cthinners
Ibuprofen c- cCORRECT cANS✔✔Indications→ cmild cpain cand cinflammation
Side ceffects→ cheadache, cdrowsiness, cGI cbleeds
Considerations→ crisk cfor cbleeding
Celecoxib c- cCORRECT cANS✔✔Indications→ cinflammation csuppression, cfever creduction, cmild cto cmod cpain
Side ceffects→ cGI cupset, ckidney cdysfunction
Considerations→ crisk cof cbleeding cwith cwarfarin cand cglucocorticoids
Acetaminophen c- cCORRECT cANS✔✔Indications→ cfever, cmild cpain
Side ceffects→ cliver cdamage, cHTN cin ceveryday cuse
Considerations→ cmonitor cfor cOD, cmax cdose c4g/day, cavoid calcohol
, Diphenhydramine c- cCORRECT cANS✔✔Indications→ cmild callergic creaction, cmotion csickness
Side ceffects→ cdrowsiness, cnausea, canaphylaxis
Considerations→ cassess cfor curinary cretention, cCBC, ccough, crespiratory cstatus
Dornase cAlfa c- cCORRECT cANS✔✔Indications→ cCF, cto cimprove cpulmonary cfunction
Side ceffects→ cchest cpain, crash, cdyspnea, cfever
Considerations→ cgiven cvia cnebulizer
The cfollowing cadditional cdrugs/drug ccategories ccould cbe ctested cas cpotential cdrug cinteractions. cBe cable cto cidentify chow cthese
cmedications/drug ccategories cwould cinteract cwith cmedications crelated cto cyour cPharmacology cMade cEasy cmodules c-
cCORRECT cANS✔✔All cother cdrugs creviewed cin cthe cHematologic cSystem cmodule c(eg. chow cdo cthese cdrugs cinteract cwith
ceach cother)→ canticoagulants/antiplatelets/antithrombotics→ cinc cbleeding; cfactor c8 cand cdesmopressin→ chelp cwith cfibrinogen
cproduction; cfolic cacid, ciron cpreps, cand cB12→ ctx cfor canemias
NSAIDS→ cbleeding cwhen ccombined cwith cblood cthinners/alcohol; cdec cASA ceffects
Glucocorticoids→ ccelecoxib cinc cbleeding
Vitamin cK→ cWarfarin cantidote
Aspirin→ cbleeding cwhen ccombined cwith cblood cthinners/alcohol; cibuprofen cdec cASA ceffects
Live cVaccines→ cinc cin cclotting?
Caffeine→ cwarfarin ceffects cenhanced
Acetaminophen→ cinc crisk cof cbleeding cw/Warfarin
Discuss cthe cpharmacokinetic cand cpharmacodynamic cconcepts cof chematologic cdrugs cincluding: cmechanisms cof caction,
cadverse cdrug creactions, cdrug cand cfood cinteractions, cnursing cimplications, cand cclient ceducation. c- cCORRECT cANS✔✔-
Mechanism cof cAction→ cworks con ccoagulation ccascade; canticoagulants cprevent cclots; cthrombolytics cdissolve cclots
-Heparin c(anticoagulants ctarget cintrinsic cpathway) cworks cquickly
-Warfarin c(works con cextrinsic cpathway) cworks cslowly
-Adverse cReactions→ cbleeding cfrom cover ctoxicity; cbruising cis cexpected cbut cexcessive cbruising cis cnot
-Flu-like csymptoms cand cbruising ctogether cis ca cmedical cemergency
-Interactions→ cvitamin cK c(Warfarin), cNSAIDs, cAspirin, canticoagulants, cantiplatelets, cthrombolytics
-Nursing cInterventions→ cmonitor cfor csigns cof cbleeding c(HOTN, ctachycardia, cpetechiae, cpurpura, cALOC, crestlessness); clabs
c(Hgb, cHct, cRBCs ctrending cdown)
-Heparin cand cWarfarin ccan cbe cgiven ctogether
-Monitor cwith cHeparin→ caPTT/PTT, cplatelets, cpotassium
-remember c3 cPs cof cHeparin!!
-Monitor cwith cWarfarin→ cPT
-Tx cfor coverdose→ ctransfuse cclotting cfactors cfor creplacement c(ex. cFFP, ccryoprecipitate) c+ cany cadditional creversal cagents
-Client cEducation→ csoft cbristled ctoothbrush, cfall crisk, csigns cof cbleeding
Apply cknowledge cof cthe cpathophysiology cof cDisseminated cIntravascular cCoagulation c(DIC) cto cproviding cquality cnursing ccare.
c(includes cetiology) c- cCORRECT cANS✔✔-Trigger→ cDIC→ cincrease cin cclotting cfactor c(excessive cclotting)→ cincrease cin cfibrin
c(not cneeded)→ cdecrease cin cplatelets cand cclotting cfactor→ cturn coff cclotting cfactor→ cclot cbreakdown→ cFSP c(fibrin csplit
cproducts) cwhich cinhibit cnormal ccoagulation→ cinability cto cclot cwhen cneeded→ cBLEED cOUT
-DIC cbegins cas ca cclotting cproblem cwhich cleads cto ca cbleeding cproblem cdue cto coverconsumption cof cclotting cfactors
-Causes→ c(1) cdiffuse ccoagulation-microclots, ccaused cby cunderlying ccondition ctriggering cwide-spread ccoagulation; c(2) cprofuse
cbleeding cfrom cdepletion cof cclotting cfactors cand cplatelets
-Septic cshock ccan ccause cDIC
-Hemorrhage cin cDIC: cexcessive cclotting→ cactivates cfibrinolytic csystem c(breaks cdown cnewly cformed cclot) c→ cclot cbreakdown
ccauses cFSPs cto cform→ cFSP cinhibit cnormal cclotting→ cFSP caccumulation cand cclotting cfactor cdepleted→ cinability cto cclot→
cBLEED cOUT
-Thrombus→ cinjury/malignancy→ crelease cof ctissue cfactor cand cenhances cnormal cclotting cmechanisms→ cenhances cplatelet
caggregation→ ccauses cwidespread cfibrin cand cplatelet cdepletion→ cthrombus cand cMOF
Prioritize cclinical cmanifestations cof cDIC c- cCORRECT cANS✔✔-Thrombosis
-Neuro: cconfusion, cALOC, cfacial cdrooping, cunilateral cweakness, cslurred cspeech
-Skin: ccyanosis, cgangrene
-Lungs: cSOB, csense cof cdoom, cPE
-Cardio: cSTEMI c(ST celevation), cshoulder cpain, cchest cpain
-GI: cabdominal cdistention, cno/little cbowel csounds
-GU: cdec coutput
-MS: cnumbness cin ctoes
-Hemorrhage
-Neuro: cconfusion, cvision cchanges
-Skin: cbruising, cpetechiae
-Lungs: ccoughing cup cblood, ccrackles, cSOB
-Cardio: ctachycardia
-GI: cbloody cstools, cbloody cvomit
-GU: chematuria
-MS: cpain
-Labs cValues
-Low cHgb
-Waste cvalues c(high cvalues)→ cschistocytes, cFSP, cD-dimer
-Raw cvalues c(low cvalues)→ cclotting cfactors
-Time cvalues c(high cvalues) cin cseconds→ caPTT, cPTT, cPT/INR
-Low curine coutput
-Low cfibrinogen
ANSWERS
You cshould cknow cthe csignificance cof cthe cfollowing c(why cwould cit cbe chigh cvs clow), cbut cdo cnot cneed cto cmemorize cnormal
cranges c- cCORRECT cANS✔✔The cconcept cof c"therapeutic cranges" c(pertaining cto cPT/INR, caPTT, cPTT)
PT/INR→ c(high=longer ctime cin csec cto cform cclot) cwarfarin, cvitamin cK cdeficiency, crisk cfor cbleeding; c(low= cshorter ctime cin csec
cto cform cclot) cvitamin cK csupplementation, cdiet chigh cin cvitamin cK, cbirth ccontrol, crisk cfor cclots
aPTT/PTT→ c(high=longer ctime cin csec cto cform cclot) cheparin, chemophilia, crisk cfor cbleeding; c(low= cshorter ctime cin csec cto cform
cclot) cvitamin cK csupplementation, crisk cfor cclots→ clead cto cMI cor cstroke
Fibrinogen→ c(high) clots cof cclotting→ clead cto cstroke cor cMI; c(low) cno cclotting, cDIC, ccancer
Clotting cfactors→ c(high) csmoking, coverweight, cpregnancy; c(low) chemophilia, chemorrhage
D-dimer→ c(high) cDVT, csmoking, cinfection, cclotting cdisorder; c(low) cinc crisk cfor cbleeding
Platelet ccount→ c(high) cinflammation, cinfection, csplenectomy, cautoimmune; c(low) cbleeding, cthrombocytopenia, cB12 cdeficiency
RBCs→ c(high) cCOPD, ccongenital cheart cdisease, cdehydration, crecent ctransfusion; c(low) cbleeding, canemia, cB12 cdeficiency,
cfolate cdeficiency
Hemoglobin→ c(high) cchronically clow cblood cO2 clevels cdue cto cheart cor clung cissue; c(low) cbleeding, ciron cdeficiency, cpregnancy,
cASA
Hematocrit→ c(high) cdehydration; c(low) cbleeding, canemia
WBCs→ c(high) cinfection, cinflammation; c(low) cimmunocompromised, ccancer, cchemotherapy, cmalnutrition
ANC c(Absolute cNeutrophil cCount)→ c(high) cautoimmune creaction; c(low) cimmunocompromised, cneutropenia, cTB, csepsis
Factor cVIII c- cCORRECT cANS✔✔Indications→ cdeficiency cof cfactor c8 c(Hemophilia cA)
Side ceffects→ callergic crxn, crash c(Benadryl), canaphylaxis c(epi)
Considerations→ cNSAIDs
Hydroxyurea c- cCORRECT cANS✔✔Indications→ cinc cproduction cof cHb cF c(these ccells cdo cnot csickle), creduce cadhesion cand
cimprove chydration cof csickle ccells
Side ceffects→ csuppress cblood ccells cin cgeneral c(bleeding cand cinfection), cN/V, cmouth csores, cbleeding
Considerations→ cdec cWBC cand cplatelets c(protective cprecautions), cdec cvasoconstriction c(monitor cBP), cincreases cHb
Desmopressin c- cCORRECT cANS✔✔Indications→ cmild chemophilia c(stimulates cinc cin cfactor c8); ca cform cof cADH; conly ceffective
cif cone ccan cproduce cfactor c7
Side ceffects→ cfluid cretention, chyponatremia, cHA, cnausea, cGI cupset
Considerations→ cmonitor cI&Os, cdiuretics cfor cfluid cretention
Aspirin c(ASA) c- cCORRECT cANS✔✔Indications→ cinflammation csuppression, cfever creduction, cinhibit cplatelet caggregation
Side ceffects→ cGI cupset, cheartburn, ckidney cdysfunction, cbleeding
Considerations→ crisk cfor cbleeding cespecially cwhen ccombined cwith cblood cthinners
Ibuprofen c- cCORRECT cANS✔✔Indications→ cmild cpain cand cinflammation
Side ceffects→ cheadache, cdrowsiness, cGI cbleeds
Considerations→ crisk cfor cbleeding
Celecoxib c- cCORRECT cANS✔✔Indications→ cinflammation csuppression, cfever creduction, cmild cto cmod cpain
Side ceffects→ cGI cupset, ckidney cdysfunction
Considerations→ crisk cof cbleeding cwith cwarfarin cand cglucocorticoids
Acetaminophen c- cCORRECT cANS✔✔Indications→ cfever, cmild cpain
Side ceffects→ cliver cdamage, cHTN cin ceveryday cuse
Considerations→ cmonitor cfor cOD, cmax cdose c4g/day, cavoid calcohol
, Diphenhydramine c- cCORRECT cANS✔✔Indications→ cmild callergic creaction, cmotion csickness
Side ceffects→ cdrowsiness, cnausea, canaphylaxis
Considerations→ cassess cfor curinary cretention, cCBC, ccough, crespiratory cstatus
Dornase cAlfa c- cCORRECT cANS✔✔Indications→ cCF, cto cimprove cpulmonary cfunction
Side ceffects→ cchest cpain, crash, cdyspnea, cfever
Considerations→ cgiven cvia cnebulizer
The cfollowing cadditional cdrugs/drug ccategories ccould cbe ctested cas cpotential cdrug cinteractions. cBe cable cto cidentify chow cthese
cmedications/drug ccategories cwould cinteract cwith cmedications crelated cto cyour cPharmacology cMade cEasy cmodules c-
cCORRECT cANS✔✔All cother cdrugs creviewed cin cthe cHematologic cSystem cmodule c(eg. chow cdo cthese cdrugs cinteract cwith
ceach cother)→ canticoagulants/antiplatelets/antithrombotics→ cinc cbleeding; cfactor c8 cand cdesmopressin→ chelp cwith cfibrinogen
cproduction; cfolic cacid, ciron cpreps, cand cB12→ ctx cfor canemias
NSAIDS→ cbleeding cwhen ccombined cwith cblood cthinners/alcohol; cdec cASA ceffects
Glucocorticoids→ ccelecoxib cinc cbleeding
Vitamin cK→ cWarfarin cantidote
Aspirin→ cbleeding cwhen ccombined cwith cblood cthinners/alcohol; cibuprofen cdec cASA ceffects
Live cVaccines→ cinc cin cclotting?
Caffeine→ cwarfarin ceffects cenhanced
Acetaminophen→ cinc crisk cof cbleeding cw/Warfarin
Discuss cthe cpharmacokinetic cand cpharmacodynamic cconcepts cof chematologic cdrugs cincluding: cmechanisms cof caction,
cadverse cdrug creactions, cdrug cand cfood cinteractions, cnursing cimplications, cand cclient ceducation. c- cCORRECT cANS✔✔-
Mechanism cof cAction→ cworks con ccoagulation ccascade; canticoagulants cprevent cclots; cthrombolytics cdissolve cclots
-Heparin c(anticoagulants ctarget cintrinsic cpathway) cworks cquickly
-Warfarin c(works con cextrinsic cpathway) cworks cslowly
-Adverse cReactions→ cbleeding cfrom cover ctoxicity; cbruising cis cexpected cbut cexcessive cbruising cis cnot
-Flu-like csymptoms cand cbruising ctogether cis ca cmedical cemergency
-Interactions→ cvitamin cK c(Warfarin), cNSAIDs, cAspirin, canticoagulants, cantiplatelets, cthrombolytics
-Nursing cInterventions→ cmonitor cfor csigns cof cbleeding c(HOTN, ctachycardia, cpetechiae, cpurpura, cALOC, crestlessness); clabs
c(Hgb, cHct, cRBCs ctrending cdown)
-Heparin cand cWarfarin ccan cbe cgiven ctogether
-Monitor cwith cHeparin→ caPTT/PTT, cplatelets, cpotassium
-remember c3 cPs cof cHeparin!!
-Monitor cwith cWarfarin→ cPT
-Tx cfor coverdose→ ctransfuse cclotting cfactors cfor creplacement c(ex. cFFP, ccryoprecipitate) c+ cany cadditional creversal cagents
-Client cEducation→ csoft cbristled ctoothbrush, cfall crisk, csigns cof cbleeding
Apply cknowledge cof cthe cpathophysiology cof cDisseminated cIntravascular cCoagulation c(DIC) cto cproviding cquality cnursing ccare.
c(includes cetiology) c- cCORRECT cANS✔✔-Trigger→ cDIC→ cincrease cin cclotting cfactor c(excessive cclotting)→ cincrease cin cfibrin
c(not cneeded)→ cdecrease cin cplatelets cand cclotting cfactor→ cturn coff cclotting cfactor→ cclot cbreakdown→ cFSP c(fibrin csplit
cproducts) cwhich cinhibit cnormal ccoagulation→ cinability cto cclot cwhen cneeded→ cBLEED cOUT
-DIC cbegins cas ca cclotting cproblem cwhich cleads cto ca cbleeding cproblem cdue cto coverconsumption cof cclotting cfactors
-Causes→ c(1) cdiffuse ccoagulation-microclots, ccaused cby cunderlying ccondition ctriggering cwide-spread ccoagulation; c(2) cprofuse
cbleeding cfrom cdepletion cof cclotting cfactors cand cplatelets
-Septic cshock ccan ccause cDIC
-Hemorrhage cin cDIC: cexcessive cclotting→ cactivates cfibrinolytic csystem c(breaks cdown cnewly cformed cclot) c→ cclot cbreakdown
ccauses cFSPs cto cform→ cFSP cinhibit cnormal cclotting→ cFSP caccumulation cand cclotting cfactor cdepleted→ cinability cto cclot→
cBLEED cOUT
-Thrombus→ cinjury/malignancy→ crelease cof ctissue cfactor cand cenhances cnormal cclotting cmechanisms→ cenhances cplatelet
caggregation→ ccauses cwidespread cfibrin cand cplatelet cdepletion→ cthrombus cand cMOF
Prioritize cclinical cmanifestations cof cDIC c- cCORRECT cANS✔✔-Thrombosis
-Neuro: cconfusion, cALOC, cfacial cdrooping, cunilateral cweakness, cslurred cspeech
-Skin: ccyanosis, cgangrene
-Lungs: cSOB, csense cof cdoom, cPE
-Cardio: cSTEMI c(ST celevation), cshoulder cpain, cchest cpain
-GI: cabdominal cdistention, cno/little cbowel csounds
-GU: cdec coutput
-MS: cnumbness cin ctoes
-Hemorrhage
-Neuro: cconfusion, cvision cchanges
-Skin: cbruising, cpetechiae
-Lungs: ccoughing cup cblood, ccrackles, cSOB
-Cardio: ctachycardia
-GI: cbloody cstools, cbloody cvomit
-GU: chematuria
-MS: cpain
-Labs cValues
-Low cHgb
-Waste cvalues c(high cvalues)→ cschistocytes, cFSP, cD-dimer
-Raw cvalues c(low cvalues)→ cclotting cfactors
-Time cvalues c(high cvalues) cin cseconds→ caPTT, cPTT, cPT/INR
-Low curine coutput
-Low cfibrinogen
