PHARM2 exam2 module6
"Oral forms of vitamin B12 will not be absorbed."
A 50-year-old female patient who has pernicious anemia asks you why vitamin B12 must be administered parenterally. What is the best response to her question?
Flulike symptoms
A 69-year-old client has been diagnosed with malignant melanoma. The care team has collaborated with the client and her family and agreed on a plan of care that includes administration of interferon alfa-2b. After administering interferon alfa-2b, the oncology nurse should anticipate that the client may develop which adverse effect?
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?
Epoetin alfa
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?
anemia.
A client has chronic renal failure. As the disease progresses, the client is experiencing increasing shortness of breath. The nurse suspects that the client is experiencing symptoms associated with:
Deferoxamine
A client is experiencing iron toxicity. Which agent would the nurse expect to be given?
Iron supplementation
A client is receiving epoetin alfa for anemia. Which adjunctive therapy is imperative(=vital 긴요한, 반드시해야하는) with epoetin alfa?
"I need to take an antacid with the pill to prevent an upset stomach."
A client is receiving ferrous sulfate as treatment for iron deficiency anemia. After teaching the client, which statement indicates the need for additional teaching?
"Increases the release of cells to increase the hemoglobin and hematocrit levels."
A client prescribed epoetin alfa asks how the medication works. Which is the nurse's best response?
This drug is destroyed by acids found in the stomach.
A client prescribed epoetin alfa requests changing the medication from the subcutaneous to the oral route. Which statement should the nurse use to formulate a response to this request?
This medication is destroyed in the stomach and can only be given by injection.
A client taking epoetin alfa requests changing the medication from the subcutaneous route to the PO route. How should the nurse respond?
RBC, hemoglobin, and hematocrit
A client's current medical condition is suggestive of impaired erythropoiesis. Which laboratory study would be most clinically relevant in diagnosing this health problem?
temporarily withholding administration
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?
anemia
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?
Interferon alfa
A male client is diagnosed with multiple myeloma. What treatment regimen would the nurse expect the health care provider to order?
Viral hepatitis
A male client is prescribed interferon. What is his probable diagnosis?
Viral hepatitis Interferon is a powerful drug used to treat hepatitis types B, C, and D. It can prevent serious liver damage, but it also has many side effects, some of them serious. Interferon is the drug of choice for treating several chronic forms of viral hepatitis, including hepatitis B and C.
A male client is prescribed interferon. What is his probable diagnosis?
Iron levels
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:
Folic acid Vitamin B12 Megaloblastic anemia is a condition in which the bone marrow produces unusually large, structurally abnormal, immature red blood cells (megaloblasts). Bone marrow, the soft spongy material found inside certain bones, produces the main blood cells of the body -red cells, white cells, and platelets.
A nurse is reviewing the chart of a patient with megaloblastic anemia. What might be used in the treatment of this patient? (Select all that apply.)
Vitamin B12
A nursing instructor is teaching students about the myelin sheath of the central nervous system (CNS). The nurse knows that teaching has been effective when a student identifies which vitamin as necessary for the formation of the myelin sheath in the CNS?
iron deficiency anemia.
A patient comes to the clinic reporting fatigue and pica. Laboratory findings reveal a low serum iron level and a low ferritin level. Upon evaluation of this assessment and laboratory data, the nurse suspects that the patient will be diagnosed with:
"I will need these injections monthly for the rest of my life."
A patient has been receiving intramuscular injections of hydroxocobalamin as treatment for pernicious anemia. Which statement by the patient indicates that he understands the therapy?
The patient's hemoglobin level is 11 g/dL
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?
Sickle cell anemia
A patient is receiving hydroxyurea. The nurse understands that this drug is used to treat:
Epietin alfa
A patient is to be administered an erythropoiesis-stimulating agent. Which of the following drugs would the nurse administer?
Erythropoietin
A patient who is HIV positive is receiving zidovudine 4,2000 mg/week and has an endogenous erythropoietin level of 350 mU/mL. What does the nurse anticipate will be administered for this patient?
Subcutaneous or Intravenous
A student nurse is caring for a client who is receiving a hematopoietic agent. To test the student's understanding, the nursing instructor states that the drug could be administered by what route?
Vitamins and Dietary Supplements Thiamin (Vitamin B1)
Actions •Coenzyme for carbohydrate metabolism •Requirements increased slightly during pregnancy and breast feeding Deficiency •Beriberi •Wernicke Korsakoff syndrome Wernicke Korsakoff syndrome •Alcoholism: most common cause of thiamin deficiency in United States •Serious CNS disorder (neurologic and psychologic) -Nystagmus, diplopia, ataxia, inability to remember the recent past
Ferrous Sulfate -Iron deficiency
Adverse effects -GI disturbances -Staining of teeth -Toxicity Interactions -Antacids -Tetracycline -Ascorbic acid
Myocardial infarction
Adverse effects of epoetin and darbepoetin include increased risks of what condition?
Sickle cell anemia
After reviewing the major types of anemia, students demonstrate understanding of the information when they identify what as an example of a hemolytic anemia?
Altered red blood cell production or deficient functioning of red blood cells
After teaching a group of students about anemias, the instructor determines that the teaching was effective when the students identify what as the critical issue?
Pernicious anemia
After teaching a group of students about the types of anemia, the instructor determines that the teaching was successful when the students identify which anemia results from an inability to produce the intrinsic factor?
"My stools might turn dark or green."
After teaching a patient who is receiving ferrous sulfate about the drug therapy regimen, which patient statement indicates that the teaching was successful?
Stem cells
All hematopoietic and immune blood cells are derived from which cells in the bone marrow?
Vitamin B 12 Deficiencies **Intrinsic factor is a protein produced by a type of specialized cells that line the stomach wall known as parietal cells. During digestion, stomach acids release vitamin B12 from food and bind to intrinsic factor to form a complex.
Causes • impaired absorption •Regional enteritis •Celiac disease •Absence of intrinsic factor**
Folic Acid Deficiency Anemia
Causes •Poor diet (malnutrition and alcoholism) •Malabsorption syndrome Consequences for developing fetus •Neural tube defects •400 to 800 mcg of supplemental folate daily, in addition to dietary sources
Vitamins and Dietary Supplements Vitamins
Classification of vitamins •Fat soluble -Vitamins A, D, E, K •Water soluble -Vitamin C -Vitamin B complex thiamin, niacin,folic acid, cyanocobalamin
Vitamin B 12 Deficiencies
Consequences •Megaloblastic anemia •Neurologic damage -Demyelination of neurons •GI disturbances
True
Cyanocobalamin is a vitamin B12 in a nasal formulation.
Regulating the secretion of antibodies
Cytokines regulate the immune response by stimulating or inhibiting the activation, proliferation, and differentiation of various cells and by what other action?
Hematopoietic Agents Epoetin Alfa (Erythropoietin)
Dosage •Use minimum needed •Hemoglobin not exceed 12 g/dL Monitoring •Monitor hemoglobin level twice weekly
Hematopoietic Agents CAUTION
Epoetin alfa, filgrastim, and oprelvekin stimulate proliferation of bone marrow cells. USE WITH GREAT CAUTION, if at all, for patients with cancers of bone marrow origin.
Reduce the need for allogenic blood transfusion
For what purpose would the nurse administer postoperative epoetin alfa to the client who is a Jehovah's Witness?
Vitamins and Dietary Supplements Additional Supplements
Gingko: enhance memory •May lower blood glucose •Increase risk of bleeding Glucosamine: arthritis •Use with caution in patients with shellfish allergy •Increased risk for bleeding
Hematopoietic Agents: Epoetin Alfa (Erythropoietin)
Hematopoietic growth factor Uses •Anemia associated with chronic renal failure •Chemotherapy induced anemia •For HIV infected patients taking zidovudine •Anemia pre op
Vitamins and Dietary Supplements Vitamin A (Retinol)
Multiple functions in the eyes •Toxicity -Birth defects, liver injury, bone related disorders •Deficiency causes -Night blindness -Xerophthalmia : dry eyes -Keratomalacia : eye damage lack vit A -Blindness
Vitamin B 12 Preparations
Oral, parenteral, intranasal •Adverse effects -Hypokalemia •Long term treatment -Lack of intrinsic factor, vitamin B 12 therapy lifelong -Potentially masks folic acid deficiency
Vitamins and Dietary Supplements Ginger Root
Primary uses •To treat vertigo •To suppress nausea and vomiting caused by motion sickness or morning sickness; to suppress postoperative nausea and vomiting •For cancer chemotherapy Can suppress platelet aggregation
Hematopoietic Agents Filgrastim (Neupogen)
Reduces the incidence of severe neutropenia Reduces the incidence of infection, -hospitalization and intravenous antibiotic use
120 days.
The average lifespan of a red blood cell (RBC) is approximately:
Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia.
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?
True
The component of the red blood cell that is not recycled is bilirubin.
Blood pressure
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?
False
The mature red blood cell contains a nucleus.
Iron supplement
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?
Reports of calf pain on dorsiflexion of the foot
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?
Erythropoietin MCV is a number that describes the average size of red blood cells circulating in the bloodstream. Thus, a high MCV would mean that the red blood cells are larger than average. Conversely, a low MCV would mean they are smaller than average.
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?
Uncontrolled hypertension
The patient is being prescribed epoetin alfa for the treatment of anemia related to the renal failure. The patient also has a history of diabetes mellitus, uncontrolled hypertension, osteoarthritis, and hypothyroidism. Which of these conditions should the nurse bring to the physician's attention prior to administering the medication?
Increased RBC count
The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome?
TRUE
There is a risk of antibody production with the use of epoetin.
True
There is a risk of antibody production with the use of epoetin.
true
There is a risk of antibody production with the use of epoetin.
Hematopoietic Agents Oprelvekin [Neumega]
Thrombopoietic growth factor Minimize thrombocytopenia and the need for platelet transfusions Adverse effects •Fluid retention •Cardiac dysrhythmias •Effects on the eye •Sudden death
Vitamins and Dietary Supplements Echinacea
Used orally and topically •May have antiviral, anti inflammatory, and immunostimulant effects •Widely taken, but effectiveness is highly questionable •Interactions -May interfere with immunosuppressant drugs
Hematopoietic Agents Filgrastim (Neupogen)
Uses •Cancer •Severe chronic neutropenia Adverse effects •Bone pain •Leukocytosis
Vitamins and Dietary Supplements Vitamins D and E
Vitamin D •Regulates calcium and phosphorus •Deficiency causes rickets or osteomalacia •Renal disease Vitamin E •Antioxidant properties •Dietary sources fresh greens, seeds, oils •Toxicity may increase risk for bleeding
Impaired tissue oxygenation related to anemia
What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa?
Z-track intramuscular
When administering iron injections, which method would the nurse use?
Pernicious anemia
When assessing a patient with anemia, the nurse notes that the patient has developed peripheral numbness and poor coordination. The patient's family states that the patient appears to be confused at times at home. Neurologic symptoms most often accompany which type of anemia?
Maintenance of myelin sheath
When describing the function of vitamin B12, what would be appropriate to include?
A 62-year-old male with cancer
Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy?
The patient displays weakness on one side of the body.
Which symptom, if assessed after the administration of epoetin alfa (Epogen), would be cause for alarm?
Ineffective red blood cells
Which would a nurse identify as the primary issue associated with anemias?
chronic hepatitis C
While reviewing a client's the record, the nurse sees that the client received a dose of interferon alpha-2b? For what disorder does the nurse suspect the client was being treated?
module6
the point: meds for Anemia, Hematopoietic, vitamins/dietary supplement as
Vitamin B 12 (Cobalamin)
•Essential for synthesis of DNA •Intrinsic factor •Dietary sources -Animal products (liver, dairy products) -Fortified foods
Parenteral Iron
•Iron dextran •Adverse effects -Anaphylactic reactions -Hypotension -Persistent pain with IM injection
Vitamins and Dietary Supplements Vitamin C
•Production of collagen, healing •Sources -Citrus fruits/juices, tomatoes, potatoes, strawberries,melons,spinach, broccoli •Has antioxidant properties •Facilitates iron absorption •Deficiency can lead to scurvy
Vitamins and Dietary Supplements Vitamin K
•Required for synthesis of prothrombin and other clotting factors •Deficiency produces bleeding •Adverse effects -Hypersensitivity reaction -Hyperbilirubinemia in parenteral administration to newborns •Therapeutic use -overdose
Vitamins and Dietary Supplements Garlic
•To reduce levels of triglyceride and LDL and to raise HDL •Also used to reduce blood pressure •Suppress platelet aggregation •Increase arterial elasticity, and decrease formation of atherosclerotic plaque •A ntimicrobial and anticancer effects
Vitamins and Dietary Supplements Black Cohosh
•Used to treat symptoms of menopause •Mechanism of action (MOA) unknown •Effectiveness -Some studies have shown it to be as effective as estrogen -Has not been evaluated for long term use •Drug interactions -May potentiate antihypertensives and the hypoglycemic effect of oral agents and insulin Adverse effects •Safe for routine use •GI effects are most common •Rash, headache, dizziness, weight gain, and cramps
Vitamins and Dietary Supplements St. John's Wort
•Widely used to treat depression •Limited clinical studies show that St. John's wort is useful for mild to moderate depression, not for severe depression •Interacts adversely with many drugs -Intensification of serotonin effects SSRIs -Bleeding risk