CH 11 Prep U Hematology
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 hemoglobin, causing less oxygen to be delivered to the tissues."
The clinic nurse receives a call from a male client who has been taking interferon alfa for 7 days. The client states that he has become very sad and wonders if life is worth living. What is the best response by the nurse to this client?
"Come to the clinic as soon as possible."
The clinic nurse receives a call from a male client who has been taking interferon alfa for 7 days. The client states that he has become very sad and wonders if life is worth living. What is the bestresponse by the nurse to this client?
"Come to the clinic as soon as possible."
A patient has just received IV cytotoxic chemotherapy. Which patient statement indicates a need for further teaching about this therapy with filgrastim (Neupogen)?
"I am going to administer my Neupogen as soon as I get home today."
A nurse has taught a patient about filgrastim (Neupogen) and epoetin alfa (Epogen) administration. Which patient statement indicates teaching was effective?
"I should tell my healthcare provider if I feel depressed."
A client prescribed epoetin alfa asks how the medication works. Which is the nurse's best response?
"Increases the release of cells to increase the hemoglobin and hematocrit levels."
The nurse is caring for a client with a WBC of 700 cells/mm3. Which discharge instruction is most important for the nurse to share with this client?
"Stay out of crowded places such as grocery stores."
An adult client has been diagnosed with ischemic heart disease, and a family member has asked for information about the action of G-CSF drugs. Which response best answers the request for information?
"The drug promotes blood vessel growth around blocked areas in coronary arteries."
The nurse is mentoring a first-year nursing student while caring for a client with a disease that affects the hematopoietic system. The student looks confused and says "I've never heard of that system. What is it?" How would the nurse respond?
"The hematopoietic system is composed of fluid, red blood cells, white blood cells, and platelets."
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?
"The patient has increases in the number of natural killer cells."
Mr. Harrison, 68 years old, who has renal carcinoma, is taking interleukin-2. What statement by this client leads you to believe that he has understood the teaching that you have done?
"This drug will inhibit tumor growth."
The nurse would contact the prescriber immediately if interferon was prescribed for which client?
11-month-old female with HIV acquired from her mother
What ordered dosage for epoetin alfa (Procrit) could the nurse administer without needing to question the order?
150 units/kg subcutaneously three times per week
The nurse is teaching a male patient receiving epoetin alfa about the drug. The nurse informs the patient that he will receive the drug at which frequency?
3 times a 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
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 62-year-old male with cancer
For which client would Procrit NOT be indicated?
A client with a hemoglobin of 12, with shortness of breath.
A patient with chronic renal failure receiving epoetin alfa will be having a total left hip arthroplasty. What supplementation should the patient receive prior to surgery?
An iron supplement
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.
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?
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.
A patient has an elevated white blood cell (WBC) count. What is the nurse's primary action related to this finding?
Assess the patient for other signs of infection.
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
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?
Blood pressure
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 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.
A nurse is monitoring a patient who has received an "interferon." What therapeutic effect will the nurse expect to find when assessing this patient?
Decrease in viral load
In learning about immunostimulants, what would you learn is an expected outcome of these medications?
Decreased numbers or severity of infections
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?
Discard the unused portion of the drug.
What assessment finding does the nurse determine is a therapeutic outcome of administering filgrastim (Neupogen) to the patient?
Elevation of white blood cell count (WBC)
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?
Erythropoietin
To prevent febrile neutropenia in the older adult taking chemotherapy, what does the nurse anticipate administering prophylactically?
Filgrastim
A client comes to the clinic for epoetin alfa therapy. The nurse monitoring the client knows that blood will be drawn before the treatment begins, in order to evaluate which level?
HCT
During recovery from a gastrointestinal bleed, a client has been prescribed an iron preparation. Prior to beginning therapy, what assessment should the nurse prioritize?
Hematocrit and hemoglobin
The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome?
Increased RBC count
The nurse administers epoetin alfa (Epogen). What is the therapeutic response the nurse expects to assess?
Increased red blood cell count
Which would a nurse identify as the primary issue associated with anemias?
Ineffective red blood cells
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 alfa-2b
The nurse is caring for a client who is receiving epoetin alfa. What adjunct treatment will the nurse expect the health care provider to order for this client?
Iron supplement
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.
What medication would best meet the needs of a client whose anemia is associated with chronic renal failure?
Methoxy polyethylene glycol-epoetin beta
Adverse effects of epoetin and darbepoetin include increased risks of what condition?
Myocardial infarction
A client is receiving darbepoetin alfa. The nurse would inform the client that he will be receiving this drug at which frequency?
Once a week
A nurse is caring for a 73-year-old male client scheduled to undergo chemotherapy. What drug would the nurse expect to be ordered to prevent infection in this client?
Pegfilgastim (Neulasta)
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?
Procrit
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
A nurse is preparing to administer epoetin alfa to a client. Which tests should the nurse review prior to administration? Select all that apply.
Red blood cell (RBC) count Hemoglobin
For what purpose would the nurse administer postoperative epoetin alfa to the client who is a Jehovah's Witness?
Reduce the need for allogenic blood transfusion
Cytokines regulate the immune response by stimulating or inhibiting the activation, proliferation, and differentiation of various cells and by what other action?
Regulating the secretion of antibodies
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?
Techniques to reduce exposure to infection
A patient has completed 4 weeks of treatment with epoetin alfa. Which of the following assessment findings would most strongly indicate that treatment has been effective?
The patient's hemoglobin level is 11 g/dL
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?
The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients.
A nurse preparing to teach a client about their newly prescribed cancer treatment should consider addressing which primary reason for non-adherence to the medication regimen? Select all that apply.
The route of medication administration Adverse effects of medications
Which statement is true regarding the actions of the hematopoietic and immunostimulant drugs?
They are synthetic versions of endogenous cytokines.
A male client is diagnosed with severe neutropenia and is prescribed filgrastim. What is the desired effect?
To increase white blood cells
The nurse is admitting a client who has neutropenia. The nurse would expect to document which findings when taking the nursing history? (Select all that apply.)
Upper respiratory infection three times in last 4 months Thrush infection of the mouth twice in last 4 weeks.
A male client is prescribed interferon. What is his probable diagnosis?
Viral Hepatitis
To evaluate immune function, the nurse should look most closely at which laboratory value?
White blood cells
The nurse will appraise the success or failure of treatment of filgrastim therapy by regularly monitoring the results of what diagnostic test?
absolute neutrophil count
A client is suspected of having impaired erythropoiesis. This client is most likely to exhibit signs and symptoms associated with what health problem?
anemia
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?
blood pressure
What is the role of interferons in the normal function of the immune system?
countering the replication and spread of viruses
An older adult client diagnosed with chronic renal failure has begun experiencing increasing fatigue. The nurse would anticipate educating the client on what likely medication prescription?
epoetin alfa
The nurse improves client compliance with the drug regimen of epoetin alfa by:
helping the client set up a reminder system for days when the drug is to be administered.
A client has been diagnosed with genital warts. Which medication would the nurse anticipate being prescribed?
interferon alfa-2b
A male client is self-administering epoetin in the home. The nurse encourages him to include what supplements as part of his daily medication regimen?
iron
Interferon beta is used for:
multiple sclerosis
What are the primary factors that contribute to the body's ability to fight off infection? Select all that apply.
normal hematopoiesis normal immune system function normal cardiovascular function
All hematopoietic and immune blood cells are derived from which cells in the bone marrow?
stem cells
A client, currently prescribed epoetin alfa, has recent blood work that reveals a hemoglobin level of 12.8 g/dL. What action does this assessment finding necessitate regarding the epoetin alfa?
temporarily withholding administration
A client has been prescribed epoetin alfa. What assessment finding may suggest that the drug is contraindicated?
The client's blood pressure is 161/107 mm Hg.
What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa?
Impaired tissue oxygenation related to anemia
Ms. Ziem is prescribed filgrastim. The nurse provides education to Ms. Ziem about this therapy. Which statement would indicate the patient understood the teaching?
"I will avoid crowds and people with illnesses."
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?
Hold the medication
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