HEMATOLOGY DRUGS
A patient is diagnosed with anemia and asks the nurse why the provider has ordered vitamin B12 instead of iron. Which answer by the nurse is correct? A "Vitamin B12 is given to improve your overall energy level." B "Vitamin B12 is necessary for the development of red blood cells." C "Vitamin B12 prevents excess iron loss to reduce demand." D "Vitamin B12 will help you absorb iron more efficiently.
Answer: B Vitamin B12 is essential for DNA synthesis and aids in the conversion of folic acid to its active form and is also needed for the development of red blood cells. It does not directly improve energy level and does not affect iron loss or iron absorption.
A 52-year-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states, "I A need to start eating more red meat and liver." B will stop having a glass of wine with dinner." C could choose nasal spray rather than injections of vitamin B12." D will need to take a proton pump inhibitor like omeprazole (Prilosec)."
Answer: C
A 9-month-old infant has been prescribed iron supplements. The nurse teaches the infant's parents the measures to follow. During follow-up visits, the nurse observes that the iron deficiency anemia in the infant has not improved despite the treatment regimen. Which action of the parents does the nurse expect to be the reason for the lack of improvement? A Administering iron supplements through a straw B Administering iron supplements along with orange juice C Administering iron supplements with whole cow's milk D Administering iron supplements at the back of the mouth
Answer: C
A practitioner prescribes supplemental oral iron therapy for a child with iron-deficiency anemia. What side effect should the nurse tell the parents to anticipate? A Bloody stool B Orange urine C Greenish-black stool D Staining of the mouth
Answer: C
A nurse provides teaching regarding vitamin B12 injections to a client with pernicious anemia. The nurse concludes that the teaching was understood when the client states, "I must take the drug: A When feeling fatigued." B Until my symptoms subside." C Monthly, for the rest of my life." D During exacerbations of anemia."
C
Which of the following interventions should the nurse implement when preparing to administer filgrastim for the first time to a client who has just undergone a bone marrow transplant? A admin IM in a large muscle mass to prevent injury B give Orally with a meal or snack to prevent GI upset C shake vial gently to mix well before withdrawing dose D discard vial after removing one dose of the medication
D Filgrastim is dispensed in a vial for a single dose use and any inside portion should be discarded. The medication is admin subQ and IV only, vial should not be shaken because it can cause damage.
The nurse monitors the patient taking filgrastim (Neupogen) for which adverse side effect? A Bone pain B Neutropenia C Thrombocytopenia D Bone marrow suppression
Answer: A Bone pain occurs in approximately 25% of patients receiving filgrastim. This bone pain may be treated with acetaminophen or, for severe pain, opioids. Filgrastim is used in the treatment of neutropenia. It has no affect on platelets.
A parent calls the nurse to report that a 5-year-old child has taken five children's vitamins. Which action will the nurse take first? A Ask whether the vitamins contain iron. B Reassure the parent that over-the-counter vitamins are not toxic. C Recommend that the parent take the child to the emergency department (ED). D Tell the parent to watch for tarry stools and report them immediately.
Answer: A Iron toxicity is a serious cause of poisoning in children, and as few as 10 to 12 tablets of ferrous sulfate can be fatal within 12 to 48 hours. The nurse should first determine whether the vitamins contain iron. If so, the family should take the child to the ED.
The nurse is teaching a patient who has iron-deficiency anemia about iron supplementation. Which statement by the patient indicates understanding of the teaching? A "I may improve iron absorption by taking this with orange juice." B "I should take iron tablets with an antacid to reduce gastrointestinal upset." C "Nausea and vomiting are minor side effects and will decrease over time." D "Taking iron with food will help to increase the amount absorbed."
Answer: A Orange juice, which is high in vitamin C, increases the absorption of iron in the stomach. Antacids interfere with iron absorption. Nausea and vomiting should be reported since they are signs of toxicity. Food slows absorption but is sometimes recommended to reduce gastrointestinal upset.
A female patient who has a history of heavy menstrual periods is experiencing shortness of breath with exertion, pallor, and fatigue. Her hemoglobin and hematocrit levels are both lower than normal, and her CBC reveals microcytic and hypochromic erythrocytes. What will the nurse do? A Contact the provider to discuss an order for 600 mg of PO ferrous sulfate BID. B Recommend an over-the-counter folic acid supplement of 400 mcg/day. C Suggest an over-the-counter iron supplement of 325 mg/day. D Tell her to consult a dietician about including iron-rich foods in her diet.
Answer: A This patient has positive findings for iron-deficiency anemia and will need therapeutic doses of iron, which is 600 to 1200 mg/day in divided doses. Her lab tests are not consistent with folic acid deficiency. Iron supplementation of 300 to 325 mg/day is correct for prophylactic supplementation. When deficiency is present, it is very difficult to obtain the necessary amount of iron from food sources alone.
During chemotherapy, the physician writes an order for the patient to begin receiving epoetin (erythropoietin) injections. The nurse knows that this drug is used to: A stimulate production of neutrophils. B stimulate production of red blood cells. C reduce the dose-limiting side effects of nausea and vomiting. D protect the kidneys from damage.
Answer: B Epoetin (erythropoietin) is a hormone that stimulates the production of red blood cells.
A patient is receiving epoetin alfa (Procrit) and asks what the medication is for. What is the nurse's best response? A "It will increase the oxygen-carrying capacity of red blood cells." B "It helps to maintain erythrocyte counts in vulnerable patients." C "It will facilitate increased iron storage in red blood cells." D "It slows down degradation of red blood cells."
Answer: B Epoetin alfa is used to maintain erythrocyte counts in patients with chronic renal failure, HIV-infected patients taking zidovudine, patients with nonmyeloid malignancies, and in patients about to undergo surgery who are anemic.
The nurse knows that filgrastim (Neupogen) is used in the treatment of which condition? A Anemia B Neutropenia C Leukocytosis D Thrombocytopenia
Answer: B Filgrastim is a leukopoietic growth factor that is used to treat cancer-related neutropenia and severe chronic neutropenia.
A patient asks the nurse about whether it is necessary to take vitamin supplements. The patient is a 26-year-old female who is contemplating pregnancy. The nurse will recommend which supplement? A Calcium and vitamin D B Folic acid (folate) C Iron D Vitamin C
Answer: B Folic acid deficiency during the first trimester of pregnancy can affect the development of the CNS of the fetus, so women of childbearing age are encouraged to take folic acid. Other supplements are not necessary with a well-balanced diet unless a deficiency is noted.
The nurse is checking the laboratory results of a patient taking epoetin alfa (Procrit). Which finding requires immediate intervention? A Hematocrit 30 B Hemoglobin 14 C Platelets 150,000 D RBC count of 3.8
Answer: B Patients taking epoetin alfa are at increased risk for cardiovascular events, including cardiac arrest, hypertension, congestive heart failure, and thrombotic events. This risk is exacerbated when the hemoglobin rises to 11 or greater, which requires the drug to be temporarily stopped.
An 11-month-old infant with iron-deficiency anemia is started on an oral iron supplement. What information should the nurse include when teaching the parents about the side effects of iron supplements? A The urine may turn red. B The skin will turn yellow. C The teeth may become stained. D The stools will take on a clay color.
Answer: C
When discussing the therapeutic regimen of vitamin B12 for pernicious anemia with a client, the nurse explains that: A Weekly Z-track injections provide needed control B Daily intramuscular injections are required for control C Intramuscular injections once a month will maintain control D Oral tablets of vitamin B12 taken daily will provide symptom control
Answer: C
The nurse should question an order for epoetin alfa (Procrit) for the patient with which condition? A Chemotherapy-induced anemia B Megaloblastic anemia C Leukemia D AIDS
Answer: C Epoetin alfa is not approved for use in patients with leukemias and other myeloid malignancies because it may stimulate growth of these cancers.
During therapy with erythropoetic drugs such as epoetin, which laboratory result is the most important parameter that the nurse should monitor in a client who is receiving this drug and has renal failure? A Blood urea nitrogen B Iron level C Hemoglobin D Red blood cell count
Answer: C This should be monitored for all renal failure clients, but there is another answer that is the best answer. The nurse should monitor the hemoglobin level because of the increased risk for death and serious cardiovascular events when administered to increase hemoglobin levels to greater than 12 g/dl.
A client with severe anemia has a new order for epoetin. The nurse assesses the client's history for contraindications to epoetin therapy, such as: A hyperthyroidism. B diabetes mellitus. C chronic renal failure. D uncontrolled hypertension.
Answer: D Epoetin and darbepoetin are contraindicated if the client has uncontrolled hypertension since they both can raise the blood pressure. The blood pressure must be controlled before beginning the new medication.
