Ch 11 Drug Therapy for Hematopoietic Disorders

You are precepting a nursing student and together you are caring for a patient who is to receive interleukins. The student nurse asks you what happens physiologically when a patient receives interleukins. What would be your best response? "It really helps the patient!" "The patient has increases in the number of natural killer cells." "The patient has decreased cytokine activity." "The patient gets really sick from flu-like symptoms and then gets better."

"The patient has increases in the number of natural killer cells."

What ordered dosage for epoetin alfa (Procrit) could the nurse administer without needing to question the order? 100 mg/d PO 1 mg/d IM 0.45 mcg/kg IV once per week 100 units/kg subcutaneously three times per week

100 units/kg subcutaneously three times per week

A child weighing 32 lb (14.5 kg) is to take ferrous sulfate 6 mg/kg/d PO. How many milligrams should the child receive per dose? Record the answer as a whole number.

87

Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy? A 20-year-old female A 30-year-old pregnant woman A 62-year-old male with cancer A 40-year-old male with a high white blood cell count

A 62-year-old male with cancer

Which of the following patients is most likely to benefit from the administration of epoetin alfa? A 66-year-old woman with type 1 diabetes who is experiencing the effects of diabetic nephropathy A 44-year-old man who suffered a workplace accident resulting in musculoskeletal trauma and massive blood loss An 80-year-old woman who experienced an ischemic stroke that was attributable to atrial fibrillation A toddler who has just been diagnosed with hemophilia A

A 66-year-old woman with type 1 diabetes who is experiencing the effects of diabetic nephropathy

The nurse is teaching a nursing student about anemia and knows that it is important to include why anemia occurs. Which statement is true about why anemia occurs? Anemia occurs due to chronic illnesses or specific deficiencies such as iron. Anemia occurs due to chronic illnesses or specific deficiencies such as vitamin C. Anemia occurs due to chronic illnesses or specific deficiencies such as vitamin A. Anemia occurs due to acute illnesses or specific deficiencies such as vitamin D.

Anemia occurs due to chronic illnesses or specific deficiencies such as iron.

The pharmacology instructor is talking about interferon. The instructor explains that agents such as interferons have more than one biologic function. What function is NOT associated with interferons? Immunomodulatory Antiviral Antiproliferative Antibacterial

Antibacterial

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? Ask the client whether she is taking iron supplements. Ask the client is she knows how much blood she lost postpartum. Assess whether the client was given erythropoietin. Assess the client's usual bowel pattern.

Ask the client whether she is taking iron supplements.

The home care nurse is caring for a client who is self-administering epoetin. What assessment is most important for the nurse to complete during the visit? Blood pressure Respirations Pulse Temperature

Blood pressure *The most important assessment is the blood pressure because epoetin can cause hypertension.*

The client is a woman 65 years of age being treated for anemia secondary to chronic kidney disease. The nurse explains to the client that she will be getting a prescription for Epogen. Which of the following additional information would the nurse provide? Chronic kidney disease has an affect on the production of red blood cells causing anemia. Epogen minimizes the effect on the production of red blood cells to cause anemia. Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia. Chronic kidney disease has no affect on the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia. Chronic kidney disease stimulates the production of red blood cells causing anemia. Epogen slows the production of red blood cells to cause anemia.

Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia.

The nurse is administering a medication to enhance hematopoiesis. Which statement indicates the nurse understands the role of cytokines in hematopoiesis? Cytokines are produced by the bone marrow and white blood cells to enhance formation of blood cells. Cytokines are the stimulators of all functions of hematopoiesis. Cytokines are substances that block the production of white blood cells. Cytokines form an insoluble complex that blocks the interaction of blood cells and the immune system.

Cytokines are produced by the bone marrow and white blood cells to enhance formation of blood cells.

A client has chronic renal failure. As the disease progresses, the client is experiencing increasing shortness of breath, due to anemia. The nurse would anticipate which medication order? Interferon gamma Penicillin Filgrastim Epoetin alfa

Epoetin alfa

The nurse notes a decreased red blood cell (RBC) count, decreased hemoglobin and hematocrit, as well as a decreased mean corpuscular volume. This could be attributable to a decrease in secretion of what hormone? Interleukins Interferon Colony-stimulating factor Erythropoietin

Erythropoietin

The nurse has just admitted a client to the unit who is newly diagnosed with Kaposi's sarcoma. The health care provider has order an IV infusion of an interferon. What drug has the provider ordered? Interferon beta-1a Interferon gamma-1b Interferon alfa-2b Peginterferon alfa-2b

Interferon alfa-2b *Interferon alfa-2b indications: Hairy cell leukemia, malignant melanoma, AIDS-related Kaposi's sarcoma, chronic hepatitis B and C, intralesional treatment of condylomata acuminata in patients 18 years of age or older.*

A nurse has been assigned to a 43-year-old man who is to receive epoetin alfa therapy. The patient is HIV-positive and has anemia related to zidovudine therapy. The nurse will monitor: Iron levels Chemotherapy Swelling of veins Renal failure

Iron levels

What does the nurse understand about why patients are more compliant with pegfilgrastim therapy versus filgrastim therapy? Pegfilgrastim works more rapidly and requires a shorter course of therapy. Pegfilgrastim may be taken by mouth and filgrastim is taken by IV or SC injection. Pegfilgrastim only has to be administered once per chemotherapy cycle instead of daily. Pegfilgrastim has fewer side effects that filgrastim.

Pegfilgrastim only has to be administered once per chemotherapy cycle instead of daily.

The anemia that occurs with chronic renal failure is caused by the kidneys themselves. What inability of the kidneys causes anemia in chronic renal failure? Produce erythropoietin Produce rennin Produce angiotensin Inactivate vitamin D

Produce erythropoietin

The nurse is caring for a patient with chronic kidney disease who is receiving epoetin alfa. Which assessment finding would be of greatest concern for the nurse? Dry, nonproductive cough A rash under the breast Reports of calf pain on dorsiflexion of the foot 1 pound weight gain in 1 week

Reports of calf pain on dorsiflexion of the foot

What information is accurate when teaching about interleukins? Interleukins create immeasurable effects in the body. Interleukins are inhibited by leukocytes. Some interleukins stimulate the growth of stem cell precursors of blood cells. Interleukins are produced and acted on only by leukocytes.

Some interleukins stimulate the growth of stem cell precursors of blood cells.

All hematopoietic and immune blood cells are derived from which cells in the bone marrow? Alfa cells Beta cells Theta cells Stem cells

Stem cells

The nurse is caring for a female client in the home. The client is prescribed filgrastim. What would be included in the nurse's education plan? Fall prevention Techniques to reduce exposure to infection Dietary restrictions Exercise restrictions

Techniques to reduce exposure to infection

After assessing the client receiving erythropoietin drug therapy, the nurse suspects what finding is an adverse effect of erythropoietin drug therapy? The client's blood pressure is 102/59 mm Hg. The client has peripheral edema to the feet and lower legs. The client reports a "low," "sad" mood. The client has not had a bowel movement for 4 days.

The client has peripheral edema to the feet and lower legs.

A client has been prescribed epoetin alfa. What assessment finding may suggest that the drug is contraindicated? The client frequently has loose stools. The client's blood pressure is 161/107 mm Hg. The client is short of breath on exertion. The client takes bupropion for the treatment of depression.

The client's blood pressure is 161/107 mm Hg.

Which symptom, if assessed after the administration of epoetin alfa (Epogen), would be cause for alarm? The patient is tired. The patient reports "bone pain." The patient states the injection "hurts." The patient displays weakness on one side of the body.

The patient displays weakness on one side of the body.

A client taking epoetin alfa requests changing the medication from the subcutaneous route to the PO route. How should the nurse respond? The oral route is not as effective. The drug dose must be increased if being given via the oral route. This medication is destroyed in the stomach and can only be given by injection. This medication causes severe diarrhea if given orally.

This medication is destroyed in the stomach and can only be given by injection.

A client is suspected of having impaired erythropoiesis. This client is most likely to exhibit signs and symptoms associated with what health problem? venous thromboembolism disseminated intravascular coagulation (DIC) anemia sepsis

anemia

The nurse is caring for Ms. Johnson, a 62-year-old woman with a history of diabetes mellitus and diabetic nephropathy. The health care provider orders sargramostim as part of her treatment. What laboratory result would be anticipated secondary to the administration of this medication? Increase in the irregularity of arrhythmias Elevation of serum creatinine level Increase in lymph in the lymph nodes Abrupt increase in the WBC count

levation of serum creatinine level *In some clients with preexisting renal or hepatic dysfunction, sargramostim has induced elevation of serum creatinine or bilirubin and hepatic enzyme levels.*

A client receiving chemotherapy has a low white blood cell count. For which reason will the nurse provide the client with filgrastim as prescribed? prevent stomatitis prevent infection treat nausea improve appetite

prevent infection

A client diagnosed with metastatic kidney cancer and prescribed aldesleukin discusses obtaining the medication in an outpatient chemotherapy unit. As part of client education, the nurse would include what statement? "Aldesleukin is highly toxic and given only to hospitalized clients." "Aldesleukin can be given in the centers, but you must remain overnight." "I will request an order for you to be treated in the outpatient center." "You will require premedication if treated in the chemotherapy center."

"Aldesleukin is highly toxic and given only to hospitalized clients."

The nurse is teaching a nursing student about anemia and knows that it is important to start by explaining the causes of anemia. Which statement is true about the cause of anemia? "Anemia is a condition caused by reduced amounts of protein, causing less oxygen to be delivered to the tissues." "Anemia is a condition caused by reduced amounts of hematocrit, causing less oxygen to be delivered to the tissues." "Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues." "Anemia is a condition caused by reduced amounts of platelets, causing less oxygen to be delivered to the tissues."

"Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues."

A client prescribed epoetin alfa asks how the medication works. Which is the nurse's best response? "Decreases release of reticulocytes, which inhibits red blood cell (RBC) production." "Increases the release of cells to increase the hemoglobin and hematocrit levels." "Stimulates the growth and development of white blood cells (WBC) to prevent neutropenia." "Releases erythropoiesis from the kidneys to increase the number of platelets."

"Increases the release of cells to increase the hemoglobin and hematocrit levels."

A nurse is to use a single-dose 1 mL vial to administer 0.5 mL of epoetin alfa to a 39-year-old woman who is being treated for chemotherapy-induced anemia. Which of the following will the nurse do with the unused portion of the drug? Refrigerate the medication for a future use. Discard the unused portion of the drug. Store the medication in the drug cart for the next dose. Put the medication in the freezer compartment of the refrigerator.

Discard the unused portion of the drug.

During recovery from a gastrointestinal bleed, a client has been prescribed an iron preparation. Prior to beginning therapy, what assessment should the nurse prioritize? White cell differential Hematocrit and hemoglobin Aspartate transaminase levels Serum creatinine levels

Hematocrit and hemoglobin

The nurse is caring for a client who has been receiving filgrastim. The nurse expects to perform which action concerning this drug on the day prior to the client's chemotherapy treatment? Give the medication both morning and evening Hold the medication Administer IV instead of SC Ensure that the client's diet has no herbs

Hold the medication

What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa? Impaired tissue oxygenation related to anemia Alteration in nutrition due to poor intake of iron Altered skin integrity due to the disease process Alteration in bowel elimination due to side effects of the medication

Impaired tissue oxygenation related to anemia

The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome? Decreased RBC count Increased WBC count Increased RBC count Decreased WBC count

Increased RBC count

A patient has just been told that her cancer has metastasized to the right kidney. An interferon has been prescribed to treat this metastasis. The patient asks why the interferon is ordered. What is the nurse's best response? It has been shown to inhibit tumor growth. It has been shown to have a direct proliferative effect on renal tumors. It has been shown to protect autologous tumor cells. It has been shown to enhance allogeneic stem-cell transplantation.

It has been shown to inhibit tumor growth.

When planning care for a patient who is receiving filgrastim (Neupogen) for a nonmyeloid malignancy, the nurse should formulate which of the following patient outcomes? (Select all that apply.) The patient will not experience bone pain. The patient will be able to self-administer filgrastim at home. The patient will not develop an infection. The patient will not develop febrile neutropenia. The patient will not retain fluid.

The patient will not develop an infection. The patient will not experience bone pain. The patient will be able to self-administer filgrastim at home. The patient will not develop febrile neutropenia.

Mr. Lepp is a 63-year-old man who was diagnosed with colon cancer several weeks ago and who is scheduled to begin chemotherapy. He reports to the nurse that he read about the need for erythropoietin in an online forum for cancer patients and wants to explore the use of epoetin alfa with his oncologist. Which fact should underlie the nurse's response to Mr. Lepp? Epoetin alfa is normally contraindicated in patients who are receiving radiotherapy or chemotherapy. Mr. Lepp's oncologist should have begun treatment with epoetin alfa immediately after he was diagnosed. The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients. Treatment with epoetin alfa will likely begin 4 to 6 days before Mr. Lepp's first round of chemotherapy and continue indefinitely.

The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients.

A client, diagnosed with chronic renal failure, has begun experiencing increasing shortness of breath. The nurse suspects that the client is experiencing symptoms associated with which resulting condition? thrombocytopenia hypertension anemia hypoglycemia

anemia *A common condition associated with chronic renal failure is anemia. Shortness of breath in a client with chronic renal failure (without obvious fluid balance issues) is likely due to anemia and its effect on the body's ability to transport oxygen.*

A client has been receiving regular doses of epoetin alfa for several weeks, and the home care nurse has been monitoring the client's condition closely. When taking the client's vital signs, the nurse should pay particular attention to what assessment datum? respiratory rate temperature heart rate blood pressure

blood pressure

The nurse improves client compliance with the drug regimen of epoetin alfa by: providing the client with an appointment card for each drug administration day. helping the client set up a reminder system for days when the drug is to be administered. having the client pharmacy contact the client on days when the drug should be administered. arranging a referral for community transportation.

helping the client set up a reminder system for days when the drug is to be administered.

Mr. Singh is a 66-year-old man who is receiving chemotherapy for the treatment of lung cancer that has metastasized to his liver. In an effort to prevent infection, Mr. Singh has been prescribed filgrastim (Neupogen). Which of the nurse's following assessment questions most directly addresses a common adverse effect of filgrastim? "Do you feel like you're having any pain in your bones?" "Are you experiencing any waves of cool, clammy skin?" "Have you had any shortness of breath lately?" "Have you noticed any bleeding in your gums or cheeks?"

"Do you feel like you're having any pain in your bones?"

Which would a nurse identify as the primary issue associated with anemias? Defective white blood cells Lack of vitamin B12 Increased plasma proteins Ineffective red blood cells

Ineffective red blood cells

Ms. Ziem is prescribed filgrastim. The nurse provides education to Ms. Ziem about this therapy. Which statement would indicate the patient understood the teaching? "Filgrastim will be discontinued to prevent excessively high neutrophil counts." "I will avoid crowds and people with illnesses." "I will never refrigerate the drug." "Filgrastim will be discontinued when the neutrophil count drops unexpectedly."

"I will avoid crowds and people with illnesses."