Nursing Practice and Pharmacological Safety Answer Key Part 2

14. The nurse discovers a client receiving warfarin is bleeding. What drug should the nurse prepare to counteract this drug? ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● A) Vitamin E B) Vitamin K C) Protamine sulfate D) Calcium gluconate Ans: B Feedback: Injectable vitamin K is used to reverse the effects of warfarin. Protamine sulfate is used to reverse the effects of heparin. Vitamin E reduces effects of warfarin but is not used for that purpose. Calcium gluconate would not be indicated for this client. 14. The nurse is providing care for a client who has sickle cell anemia and who is being treated with hydroxyurea. When providing health education, what topic should the nurse prioritize? A) Management of gastrointestinal irritation B) The importance of keeping immunizations up to date C) Dietary sources of iron D) Foods that are high in vitamin B12 Ans: A Feedback: Hydroxyurea is cytotoxic and is associated with adverse effects associated with the death of cells, especially in cells that are rapidly turning over. GI effects include anorexia, nausea, vomiting, stomatitis, diarrhea, or constipation. Increased intake of vitamin B12 or iron does not relieve symptoms of sickle cell disease. Immunizations are important because infections can precipitate an acute crisis. However, for most clients, the immediate concern will be dealing with the varied and pervasive GI effects. 15. What drugs might the nurse administer that have been developed to stimulate the formation of red blood cells? Select all that apply. A) Levoleucovorin B) Hydroxocobalamin C) Darbepoetin alfa D) Methoxy polyethylene glycol-epoetin beta E) Epoetin alfa Ans: C, D, E Feedback: Clients who are no longer able to produce enough erythropoietin in the kidneys may benefit from treatment with exogenous erythropoietin (EPO), which is available as the drugs epoetin alfa (Epogen , Procrit), darbepoetin alfa, and methoxy polyethylene glycol-epoetin beta. Both darbepoetin alfa and methoxy polyethylene glycol-epoetin beta are approved to treat anemias associated with chronic renal failure, including clients receiving dialysis. Levoleucovorin and hydroxocobalamin are not erythropoiesis-stimulating agents. 15. The nurse is providing care for a client who has been prescribed cholestyramine for the treatment of hyperlipidemia. During the client’s latest clinic visit, the client states, “It seems like bruise from the lightest little bumps or scrapes? What is the nurse’s best action? A) Reassure the client that this is an expected adverse effect of the medication. B) Teach the client safety measures so that the risk for injury is reduced. C) Inform the care provider, so laboratory testing can be performed. ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● D) Tell the client to stop taking the medication until the next appointment with the care provider. Ans: C Feedback: The nurse should follow-up the client’s risk for bleeding by informing the care provider and facilitating coagulation tests. Education about safety would be a relevant, but not sufficient, response. Reassurance does not address the client’s actual problem. The nurse should not independently instruct the client to stop taking a medication. 15. The nurse evaluates that additional client teaching is needed regarding anticoagulants when the client states what intention?” A) “I’ll start wearing a MedicAlert bracelet.” B) “I plan to report to the lab for my follow-up blood work.” C) “I’ll use acetaminophen if I get arthritis pain.” D) “I’ll use disposable razors to shave and use each razor only once.” Ans: D Feedback: The client should use an electric razor to shave rather than a disposable razor that could nick the skin and increase the risk of bleeding. Carrying a MedicAlert card, getting regular follow-up lab work, and use of acetaminophen would all be appropriate actions that would not indicate the need for further teaching. 16. A client with coronary artery disease has been prescribed fluvastatin. When reviewing this client’s more recent laboratory values, what finding should the nurse attribute to adverse effects of this medication? A) Decreased hemoglobin and hematocrit B) Increased neutrophil levels C) Decreased serum potassium levels D) Increased liver enzyme levels Ans: D Feedback: Increased concentration sofliver enzymes commonly occur, andacute liver failure has been reported with the use of atorvastatin and fluvastatin. These medications are not normally associated with increased white cell levels, hypokalemia, or anemia. 16. The nurse determines that teaching about warfarin is successful when the client makes what statement? A) “If I miss a dose, I will take two pills the next day.” B) “I will check with my provider before taking any herbal supplements.” C) “I will minimize my physical activity, so I don’t start bleeding.” D) “I will make sure to get this annual flu vaccine this fall.” Ans: B Feedback: Warfarin is involved in many drug–drug and drug–herb interactions,so the clients statement about checking with the doctor before starting any new drugs or supplements would be correct. The other statements made by the client indicate the need for further teaching because he or she should not take two pills after missing a dose. The client should make an effort to avoid preventable injuries, but minimizing physical activity in general would not be necessary or beneficial. Vaccinations are beneficial but not to any greater extent than with a client who is not taking warfarin. 16. What anemia does the nurse classify as a type of hemolytic anemia? A) Iron deficiency anemia B) Megaloblastic anemia C) Pernicious anemia D) Sickle cell anemia Ans: D Feedback: Another type of anemia is hemolytic anemia, which involves a lysing of red blood cells because of genetic factors or from exposure to toxins. Sickle cell anemia is a type of hemolytic anemia. Iron deficiency and megaloblastic anemias are different classifications of anemia. ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 17. The nurse explains to a client the action of a hydroxymethylglutaryl– coenzyme A (HMG–CoA) reductase inhibitor. What enzyme does the nurse state this drug inhibits? A) An enzyme that controls the production of cellular cholesterol B) An enzyme used immediately for energy C) An enzyme that combines with proteins to become chylomicrons D) An enzyme used to make bile acids Ans: A Feedback: HMG–CoA reductase is an enzyme that controls the final step in production of cellular cholesterol. Some fats are used immediately for energy. Bile acids act like detergents to break down or metabolize fats into small molecules called micelles, which are absorbed into the intestinal wall and combined with proteins to become chylomicrons, to allow transport throughout the circulatory system. Cholesterol is a fat that is used make bile acids. 17. The nurse assesses blood in the urine of the 73-year-old client receiving warfarin this morning. What actions will the nurse take? Select all that apply. A) Assess prothrombin time (PT). B) Assess international normalized ratio (INR). C) Expect to administer protamine sulfate. D) Expect to administer vitamin K. E) Assess partial thromboplastin time (PTT). Ans: A, B, D Feedback: Vitamin K is the antidote for warfarin. PT and INR are used to assess therapeutic levels of warfarin. PTT is used to assess therapeutic levels of heparin. Protamine sulfate is given as an antidote for heparin. 17. What medication would best meet the needs of a client whose anemia is associated with chronic renal failure? A) Methoxy polyethylene glycol-epoetin beta B) Ferrous sulfate exsiccated C) Levoleucovorin D) Hydroxyurea Ans: A Feedback: Bothdarbepoetinalfaandmethoxypolyethyleneglycol-epoetinbeta are approved to treat forms of anemia associated with chronic renal failure, including in clients receiving dialysis. Ferrous sulfate exsiccated is used to treat iron deficiency. Levoleucovorin is administered to diminish toxicity and counteract the effects of impaired methotrexate elimination and of inadvertent overdose of folic acid antagonists after high-dose methotrexate therapy for osteosarcoma. Hydroxyurea is used to reduce the frequency of painful sickle cell crises and to decrease the need for blood transfusions in adults with sickle cell anemia. 18. The nurse has completed a comprehensive assessment of a new client. What assessment findings would support a diagnosis of metabolic syndrome? Select all that apply. A) Waist measurement 107 cm (42 in) B) High-density lipoprotein 1.29 mmol/L (50 mg/dL) C) Blood pressure 148/93 mm Hg D) Resting heart rate 77 beats/min E) Fasting blood glucose 7.2 mmol/L (121 mg/dL) ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● Ans: A, B, C, E Feedback: This client’s waist circumference, blood pressure,HDL,and blood glucose levels are all significant for metabolic syndrome. Heart rate is not a component of the syndrome, and a resting heart rate of 77 beats/min is within norms for an adult. 18. The nurse is caring for a client following repeat coronary artery bypass grafting who has excessive bleeding. What systemic hemostatic drug will the nurse expect to administer? A) Thrombin recombinant B) Microfibrillar collagen C) Human fibrin sealant D) Aminocaproic acid Ans: D Feedback: The hemostatic drug that is used systemically is aminocaproic acid. Topical hemostatic agents include absorbable gelatin, human fibrin sealant, microfibrillar collagen, thrombin, and thrombin recombinant. 18. The nurse is caring for a client diagnosed with pernicious anemia and anticipates this client will require: A) iron supplements. B) vitamin B12. C) erythropoietin. D) hydroxyurea. Ans: B Feedback: Pernicious anemia occurs when the gastric mucosa cannot produce intrinsic factor and vitamin B12 cannot be absorbed. Iron, erythropoietin, and hydroxyurea will not compensate for this specific deficiency. 19. A client with coronary artery disease has been prescribed a medication that inhibits peripheral breakdown of lipids, reduces low-density lipoproteins (LDLs), and increases high-density lipoprotein (HDL) concentrations. What is this client most likely taking? A) Fenofibrate B) Niacin C) Atorvastatin D) Gemfibrozil Ans: D Feedback: Gemfibrozilinhibitsperipheralbreakdownoflipids,reducesproduction of triglycerides and LDLs, and increases HDL concentrations. It is associated with gastrointestinal (GI) and muscle discomfort. Fenofibrate, niacin, and atorvastatin do not increase HDL concentrations. 19. A postsurgical client is being sent home on enoxaparin. The nurse should describe what benefit of this medication? A) Inhibiting the formation of clots B) Stimulating production of certain clotting factors C) Enhancing the flow of blood in peripheral vessels D) Dissolving any clots that form Ans: A Feedback: Low molecular weight the parins inhibit thrombusand clot formation by blocking factors Xa and IIa. Because of the size and nature of the molecules, these drugs do not greatly affect thrombin, clotting, or the PT; therefore, they cause fewer systemic adverse effects. Enoxaparin does not dissolve existing clots or directly enhance blood flow. It does not stimulate the production of clotting factors. ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 19. The nurse is working with a hospitalized client who has a diagnosis of sickle cell anemia. What action should the nurse perform to reduce the client’s likelihood of a sickle cell crisis? A) Adhere closely to standard precautions. B) Encourage the client’s fluid intake. C) Maintain a cool room temperature, if possible. D) Ensure that the client is turned every 2 hours. Ans: A Feedback: Sickle cell crisis can be precipitated by infections, and the nurse should take action to ensure that infection control measures are adhered to. Fluid imbalances and warm temperatures do not cause sickle cell crisis. Turning is only necessary if a client is wholly immobile and has minimal bearing on a client’s risk for infection. 20. The nurse is caring for a client who had a postpartum hemorrhage 2 weeks ago that resulted in anemia. The client has called the clinic after passing dark stools, stating, “I looked this up online, and I’m worried I might have stomach or intestinal bleeding.” What is the nurse’s best initial action? A) Assess whether the client was given erythropoietin. B) Ask the client is she knows how much blood she lost postpartum. C) Assess the client’s usual bowel pattern. D) Ask the client whether she is taking iron supplements. Ans: D Feedback: Iron supplements often cause black, tarry stool. This does not mean that the client should not be assessed further, but this is the most likely question to ask initially. The quantity of the client’s blood loss postpartum is not a priority. 20. A client with hyperlipidemia has been taking atorvastatin for several months. How can the therapeutic effect of the medication be best determined? A) Assessing the client’s resting heart rate and postural blood pressures B) Reviewing the client’s laboratory blood work results C) Assessing the client’s exercise tolerance and activities of daily living D) Performing a focused cardiac assessment Ans: B Feedback: The benefits of lipid-lowering agents are frequently not perceived by the client and do not often change the client’s day-to-day cardiac function or activity level. They are most often assessed by reviewing the client’s cholesterol levels. 20. What intervention does the nurse include in the plan of care for a client receiving a continuous intravenous infusion of heparin? A) Avoiding intramuscular injections B) Assessing for symptoms of respiratory depression C) Measuring hourly urinary outputs D) Monitoring BP hourly Ans: A Feedback: The most commonly encountered adverse effect of the anticoagulants is bleeding, ranging from bleeding gums during toothbrushing to severe internal hemorrhage. Avoid all invasive procedures, including giving IM injections, while the client is on heparin therapy. It would not be necessary to assess for respiratory depression, measure hourly output, or monitor the BP hourly as related because of heparin administration. 21. A client has been prescribed epoetin alfa. What assessment finding may suggest that the drug is contraindicated? A) The client takes bupropion for the treatment of depression. B) The client frequently has loose stools. C) The client’s blood pressure is 161/107 mm Hg. ● ● ● ● ● ● ● ● ● ● ● ● ● ● D) The client is short of breath on exertion. Ans: C Feedback: Erythropoiesis-stimulating agents are contraindicated in the presence of uncontrolled hypertension because of the risk of worsening hypertension when red blood cell counts increase and the pressure within the vascular system also increases. There is no contraindication to the use of erythropoiesis-stimulating agents for clients with chronic or acute diarrhea or activity intolerance or who take antidepressants. 21. The client is admitted to the acute care facility with a diagnosis of acute renal failure. While collecting the client’s history, the nurse discovers that the client was taking pravastatin to reduce lipid levels and enjoyed a glass of grapefruit juice every morning. The client reports muscle pain. What does the nurse suspect caused this client’s renal failure? A) Gastric ulceration B) Rhabdomyolysis C) Congestive heart failure D) Drug toxicity Ans: D Feedback: Grapefruit juice increases the risks of toxicity and rhabdomyolysis. However, toxicity would cause liver damage, whereas the breakdown of muscle that occurs with rhabdomyolysis results in kidney damage and acute renal failure. The client identified no symptoms related to gastric ulceration or congestive heart failure. 21. The nurse is sending a client home who will remain on anticoagulant therapy. What should the nurse teach the client about taking this drug? Select all that apply. A) “Brush your teeth gently with soft bristle brush.” B) “Wear or carry a MedicAlert notification.” C) “Warning signs of bleeding include fatigue, pallor, and increased heart rate.” D) “Treat minor side effects with over-the-counter (OTC) medications.” E) “Obtain follow-up lab work regularly as ordered.” Ans: A, B, C, E Feedback: Clients should be taught to avoid bleeding risk by brushing teeth gently, using electric razors, and avoiding dangerous activities or falls that could cause bleeding. The client should have a MedicAlert to notify other healthcare providers of anticoagulant therapy. Teach clients to recognize the signs of blood loss and stress the importance of follow-up lab work. Clients should be taught to avoid adding any new medication, prescription, or OTC, without first talking to the healthcare provider or pharmacist to ensure safety. 22. An older adult client, diagnosed with pernicious anemia, asks the nurse what causes this disorder. The nurse’s best response is that there is a lack of intrinsic factor secreted needed for absorption of vitamin B12 where? A) Large bowel B) Lower esophagus C) Stomach D) Small bowel Ans: D Feedback: Intrinsic factor, also secreted by the gastric mucosa, combines with dietary vitamin B12 so that the vitamin can be absorbed in the ileum, located in the small bowel. Other options are incorrect. 22. The client receives a prescription for a lipid-lowering medication from the healthcare provider. The nurse knows that additional lifestyle modifications would ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● enhance the management of the client’s lipid levels. What recommendations should the nurse make? Select all that apply. A) Quitting smoking B) Exercising regularly C) Following a low-sodium diet D) Reducing stress E) Abstaining from alcohol F) Increasing fluid intake Ans: A, B, D Feedback: Lifestyle changes including low-fat diet, exercise, smoking cessation, and stress reduction should be tried before any antihyperlipidemic drug is used. Avoiding alcohol is not indicated as a means to lower serum lipid levels, though excessive intake can cause adverse effects of lipid-lowering therapy. Although a low-sodium diet is a healthy choice, it is not associated with elevating lipid levels. Increasing fluid intake does not have an effect on managing lipid levels. 22. Indications for the nurse to administer heparin include what? Select all that apply. A) Treatment of hemophilia B) Prevention and treatment of pulmonary emboli C) Treatment of atrial fibrillation with embolization D) Prevention and treatment of venous thrombosis E) Diagnosis and treatment of disseminated intravascular coagulation (DIC) Ans: B, C, D, E Feedback: Indications include prevention and treatment of venous thrombosis and pulmonary emboli, treatment of atrial fibrillation with embolization, and diagnosis and treatment of DIC. Heparin is not given to clients with hemophilia because the drug would worsen bleeding. 23. A client is diagnosed as having an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries begins as what? A) Fatty streaks B) White blood cells (WBCs) C) Foam cells D) Platelets and fibrin Ans: A Feedback: Coronary artery disease is characterized by the progressive growth of atheromatous plaques, or atheromas, in the coronary arteries. These plaques, which begin as fatty streaks in the endothelium, eventually injure the endothelial lining of the artery, causing an inflammatory reaction. This inflammatory process triggers the development of characteristic foam cells, containing fats and WBCs that further injure the endothelial lining. Over time, platelets, fibrin, other fats, and remnants collect on the injured vessel lining and cause the atheroma to grow, further narrowing the interior of the blood vessel and limiting blood flow. 23. What genetic carrier screening would be appropriate for an African American couple planning to begin a family? A) Renal failure B) Sickle cell anemia C) Iron deficiency anemia D) Vitamin B12 deficiency Ans: B Feedback: Sickle cell anemia is a chronic hemolytic anemia that occurs most commonly in people of African descent, so it would be appropriate to have genetic screening to determine the risk associated with having children. The other answers are incorrect because they are not associated with people of African descent. ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 23. The nurse is caring for a child who needs anticoagulation therapy. What drug is approved for pediatric use? A) Heparin B) Dabigatran C) Rivaroxaban D) Low molecular weight heparins Ans: A Feedback: Heparin is approved for pediatric use. If heparin is used, the dosage should be carefully calculated based on weight and age. It should be verified by another person before the drug is administered. Dabigatran and rivaroxaban are not approved for use in children. The safety of low molecular weight heparins has not been established in children. 24. The nurse is caring for a child who is prescribed supplemental iron therapy in liquid form. What is the priority parent teaching to be provided by the nurse? A) The iron should be taken through a straw. B) Positive results from treatment will be seen in 1 to 2 weeks. C) Results will be evaluated through the child’s appearance. D) Dosages are determined by serum iron levels. Ans: A Feedback: Iron doses for replacement therapy are determined by age. If a liquid solution is being used, the child should drink it through a straw to avoid staining the teeth. Periodic blood counts should be performed, the results of which will determine the success of therapy; it may take 4 to 6 months of oral therapy to reverse an iron deficiency. 24. When the nurse administers warfarin, it is expected that the drug will have what effect on the body? A) Decrease in production of vitamin K–dependent clotting factors B) Increase in prothrombin C) Increase in vitamin K–dependent factors in the liver D) Increase in procoagulation factors Ans: A Feedback: Warfarin, an oral anticoagulant drug, causes a decrease in the production of vitamin K–dependent clotting factors in the liver. The eventual effect is a depletion of these clotting factors and a prolongation of clotting times. It is used to maintain a state of anticoagulation in situations in which the client is susceptible to potentially dangerous clot formation. It does not increase prothrombin, vitamin K–dependent factors in the liver, or procoagulation factors. 25. The nurse admits a 26-year-old client with sickle cell anemia. What drug should the nurse most likely administer? A) Hydroxyurea B) Methoxy polyethylene glycol-epoetin beta C) Vitamin B12 D) Leucovorin Ans: A Feedback: Indications for use of hydroxyurea include reducing the frequency of painful crises and the need for blood transfusions in adult clients with sickle cell anemia. The other options would not be used to treat a client with sickle cell anemia. 26. The nurse admits a child to the pediatric unit who has an abnormally high serum iron level after eating a family member’s supplements. What is the nurse’s intervention? A) Obtain a blood sample for type and cross-match. ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● B) Administer deferoxamine as prescribed. C) Monitor the client for changes in bowel function. D) Administer hydroxyurea as prescribed. Ans: B Feedback: DeferoxamineisgivenIM,IV,orsubcutaneouslytotreatelevatediron levels. Hydroxyurea treats sickle cell anemia, not iron overdose. There is no obvious indication that a blood transfusion will be necessary, so type and cross- match is not a high priority. Bowel function is a lower priority than administering a chelating agent. 25. The nurse teaches the client at risk for coronary artery disease (CAD) that some risk factors can be controlled or modified. What modifiable factors would the nurse include? A) Gender, obesity, family history, and smoking B) Inactivity, stress, gender, and smoking C) Obesity, inactivity, diet, and smoking D) Stress, family history, and obesity Ans: C Feedback: The risk factors for CAD that can be controlled or modified include obesity, inactivity, diet, stress, and smoking. Gender and family history are risk factors that cannot be controlled. 25. A client has presented to the emergency department with a new onset of unilateral weakness and visual disturbances. The care team suspects that the client has had a cerebrovascular accident and the administration of alteplase is being considered. What is the care priority prior to administering alteplase? A) Assessing the client’s allergy status B) Ruling out a hemorrhagic stroke C) Determining whether the client takes beta-adrenergic blockers or aminoglycoside antibiotics D) Determining the client’s blood type Ans: B Feedback: Administration of alteplase would exacerbate a hemorrhagic stroke by increase bleeding. For this reason, a hemorrhagic stroke must be ruled out. With regard to alteplase administration, this is a priority over the client’s allergy status or blood type. Beta-blockers and aminoglycosides do not contraindicate the use of alteplase. 26. The nurse is caring for a client with high serum cholesterol and triglyceride levels. In teaching the client about therapeutic lifestyle changes and the use of medications, the nurse explains that the desired goal for cholesterol levels is what? A) Increased high-density lipoprotein (HDL) values and increased triglyceride values B) 1:1:1 ratio of LDL, HDL, and total cholesterol C) Elevated blood lipids and fasting glucose less than 5.6 mmol/L (100 mg/dL) D) Reduced low-density lipoprotein (LDL) values and increased HDL values Ans: D Feedback: The desired goal for cholesterol readings is for a client to have low LDL and high HDL values. Consequently, a 1:1:1 ratio of LDL, HDL, and total cholesterol would not be desirable. HDL serves as a protective mechanism to reduce cholesterol, so higher levels are desirable. Elevated blood lipids are never desirable, but control of blood sugar levels reduces CAD risk. 26. A 3-year-old boy has been diagnosed with hemophilia A. The nurse is planning his discharge teaching for the child’s parents and includes what teaching point? A) The rationale for using aspirin rather than acetaminophen for mild pain ● ● ● ● ● ● ● ● ● ● ● B) Strategies for preventing trauma or injury C) The necessity of daily vitamin K injections D) The necessity of weekly transfusions of packed red blood cells Ans: B Feedback: The prevention of trauma is important in people with hemophilia due to the risk of bleeding. The child would require regular administration of clotting factors, not vitamin K or packed red cells. Aspirin could exacerbate the child’s risk for bleeding 27. The nurse cares for a client who is in her second trimester of pregnancy with extremely high serum cholesterol levels. What lipid-lowering medication would be appropriate for the nurse to administer to this client? A) Colesevelam B) Pravastatin C) Simvastatin D) Atorvastatin Ans: A Feedback: Bile acid sequestrants are the drug of choice for pregnant women if a lipid-lowering agent is needed. Women of childbearing age should not take betahydroxy-beta-methylglutaryl–coenzyme A (HMG–CoA) reductase inhibitors because they are in pregnancy category X. Pravastatin, simvastatin, and atorvastatin are all HMG–CoA reductase inhibitors. 27. The nurse is caring for a client who just received a cancer diagnosis. The client tells the nurse, “I saw the commercials on TV and I want to start taking Procrit immediately so I don't get tired from chemotherapy.” What is the nurse’s best response? A) “Procrit is only effective if you develop anemia from chemotherapy that is caused by low levels of erythropoietin.” B) “Before the doctor will order this drug, you will need to be found to have anemia, so we will draw some blood for lab work while you’re here.” C) “Chemotherapy causes anemia and only when that happens will it be appropriate to prescribe Procrit for you.” D) “The doctor may order Procrit for you when it is appropriate, but now is not the appropriate time for you to take this drug.” Ans: A Feedback: There is a risk of decreasing normal levels of erythropoietin if epoetin alfa (Procrit), or any of this classification of drug (erythropoiesis-stimulating agents), is given to clients who have normal renal functioning and adequate levels of erythropoietin. The client should be taught that the drug will only be prescribed if he or she develops anemia due to inadequate erythropoietin. Although it is true the doctor may prescribe the drug when it is appropriate, this answer does not explain why it is inappropriate to prescribe it now. Anemia alone is not sufficient cause for prescribing Procrit and not all chemotherapy results in anemia. 27. The nurse admits a 32-year-old woman who takes oral contraceptives; she is expected to need aminocaproic acid postoperatively. The nurse recognizes this client is at risk for what? A) Hypercoagulation B) Bleeding C) Pregnancy D) Infertility Ans: A Feedback: Aminocaproic acid is associated with the development of hypercoagulation states if it is combined with oral contraceptives or estrogens. Oral contraceptives do not increase the risk of pregnancy, bleeding, or infertility.