807 CH 11: Hematopoetic Disorders
The nurse would contact the prescriber immediately if interferon was prescribed for which client? 72-year-old male with AIDS-related Kaposi's sarcoma 11-month-old female with HIV acquired from her mother 48-year-old female with hepatitis C 34-year-old male with chronic hepatitis B
11-month-old female with HIV acquired from her mother Explanation: Interferon should not be administered to newborns or infant. A baby is considered an infant until 12 months of age.
A client with chronic renal failure is prescribed subcutaneous epoetin alpha. Which information will the nurse include when teaching the client about this medication? Select all that apply. "Take acetaminophen as needed for bone pain." "Avoid shaking the medication vial." "Take the calcium supplement as prescribed." "Take the prescribed iron supplement with fruit juice that has vitamin C." "Do not place the vial in the freezer."
"Avoid shaking the medication vial." "Do not place the vial in the freezer." "Take the prescribed iron supplement with fruit juice that has vitamin C." Teaching for epoetin alpha includes instructing the client to avoid shaking the vial and not placing the medication vial in the freezer. An iron supplement (not a calcium supplement) should be taken as prescribed with a fruit juice that contains vitamin C, as this will increase the absorption of iron. Because bone pain is not an adverse effect of epoetin alpha, teaching about acetaminophen is not required.
The nurse is caring for a client who has been newly diagnosed with cancer. The client tells the nurse, "I saw advertisements on epoetin alfa and I want to start taking it immediately so I don't get tired from chemotherapy." What is the nurse's best response? "The primary health care provider may order epoetin alfa for you when it is appropriate, but now is not the time." "Epoetin alfa is only effective if you develop anemia from chemotherapy that is caused by low levels of erythropoietin." "Chemotherapy causes anemia and only when that happens will it be appropriate to prescribe epoetin alfa for you." "Being anemic is a requirement for this medication, so I will draw some blood for lab work while you're here."
"Epoetin alfa is only effective if you develop anemia from chemotherapy that is caused by low levels of erythropoietin." Explanation: There is a risk of decreasing normal levels of erythropoietin if epoetin alfa, 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 the client develops anemia due to inadequate erythropoietin. Although it is true the primary health care provider 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 epoetin alfa, and not all chemotherapy results in anemia.
A client diagnosed with iron deficiency has been taking oral ferrous sulfate for the past several days. When the nurse is assessing for therapeutic effects, what question is most warranted? "Do you feel like you're able to see a bit more clearly now?" "Is your skin feeling itchy when you're at rest?" "Are you having any leg spasms or restless legs at night?" "How is your energy level compared with a few days ago?"
"How is your energy level compared with a few days ago?" Explanation: The nurse should assess for increased energy, vigor, and feeling of well-being. Pruritus, visual changes, and restless legs do not accompany iron deficiency and would not be addressed in follow-up assessments.
"I will never refrigerate the drug." "Filgrastim will be discontinued to prevent excessively high neutrophil counts." "Filgrastim will be discontinued when the neutrophil count drops unexpectedly." "I will avoid crowds and people with illnesses."
"I will avoid crowds and people with illnesses." Explanation: For therapy with filgrastim, the nurse should instruct the patient and those in contact with the patient to wash their hands frequently, avoid crowds, and avoid people with illnesses. To prevent any serious adverse effects, filgrastim is usually discontinued when the neutrophil count is excessively high or has reached its nadir (lowest) level. However, the patient should not be encouraged to make this decision on his or her own. When the patient self-administers the drug, it is advised that the drug be refrigerated but not frozen.
A client prescribed epoetin alfa asks how the medication works. Which is the nurse's best response? "Releases erythropoiesis from the kidneys to increase the number of platelets." "Decreases release of reticulocytes, which inhibits red blood cell (RBC) production." "Stimulates the growth and development of white blood cells (WBC) to prevent neutropenia." "Increases the release of cells to increase the hemoglobin and hematocrit levels."
"Increases the release of cells to increase the hemoglobin and hematocrit levels." Explanation: Epoetin alfa induces erythropoiesis by stimulating erythroid progenitor cells. This causes the release of reticulocytes from the bone marrow, leading to an increase in hemoglobin and hematocrit levels. The medication does not assist with supplying either WBCs or platelets.
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." "Watch for signs of excessive bruising." "Eat foods rich in iron to increase your energy level." "Go for a walk in the mall everyday to increase your endurance."
"Stay out of crowded places such as grocery stores." Explanation: A client with a low WBC should avoid crowds to reduce the chance of coming into contact with a person who has an infection such as a cold, which could be very serious in a person who has little defense against infection.
The nurse providing drug education to a client prescribed an immunostimulant will place priority on which statement to help assure expected outcomes? "Take the medication exactly as prescribed." "It is best to take the medication at bedtime." "The medication must be taken with food." "Be sure to limit your intake of fats when taking this drug."
"Take the medication exactly as prescribed." Explanation: Obtaining beneficial effects and decreasing adverse effects depend largely on how the drugs are taken. Although this is important with all medications, it is especially important with this class of drugs. It would be inappropriate to encourage that the medication be taken with food, at bedtime, or to limit fat intake since those instructions are unique to the specific drug.
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." Explanation: When interleukins are administered, there are increases in the numbers of natural killer cells and lymphocytes, in cytokine activity, and in the number of circulating platelets. Options A, C and D are incorrect answers.
What prescribed dosage for epoetin alfa would the nurse administer to a client without needing to clarify the order? 0.45 mcg/kg intramuscular once per week 100 units/kg subcutaneously three times per week 100 mg/d orally each day 1 mg/d intramuscular twice a week
*100 units/kg subcutaneously three times per week Explanation: An appropriate dosage of epoetin alfa is 50 to 100 units/kg intravenously (IV) or subcutaneously, 3 days a week. The medication is not administered intramuscular (IM). Darbepoetin alfa can be administered by IV or subcutaneously once a week, and the usual dose is 0.45 mcg/kg. Folic acid is administered orally, IM, subcutaneously, or IV; the usual dosage is 1 mg. The usual dose of ferrous sulfate is 100 to 200 mg/d orally.*
An immunostimulant has been ordered for a chemotherapy client. The client asks the nurse why they need to take this drug. The nurse explains that the medication is given to increase the WBC count to at least what level? 20,000-24,000 mm3 15,000-20,000 mm3 500-10,000 mm3 200-500 mm3
500-10,000 mm3 Explanation: Clients are at highest risk for infection when neutrophil counts fall below 500/mm3, and immunostimulants should be stopped when neutrophil counts exceeds 10,000 mm3.
A 2-year-old client weighing 32 lb (14.5 kg) is prescribed ferrous sulfate 6 mg/kg/d PO. How many milligrams will the nurse administer to the client per dose?
87 Explanation: The nurse will administer 87 mg per dose. The nurse will calculate the dose by multiplying weight times mg/kg/d or 14.5 × 6 = 87 mg
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 A protein supplement A blood transfusion A folic acid supplement
An iron supplement Explanation: Patients taking epoetin alfa who require surgery may require iron supplementation.
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 Explanation: Interferons act to prevent virus particles from replicating inside cells. They also stimulate interferon receptor sites on noninvaded cells to produce antiviral proteins, which prevent viruses from entering the cell. In addition, interferons have been found to inhibit tumor growth and replication, to stimulate cytotoxic T-cell activity, and to enhance the inflammatory response. Interferons are not associated with the management of bacterial infections.
A patient has an elevated white blood cell (WBC) count. What is the nurse's primary action related to this finding? Place the patient in protective isolation. Assess the patient for exposure to antigens. Assess the patient for other signs of infection. Protect the patient from other sources of infection.
Assess the patient for other signs of infection. Explanation: The patient with an elevated WBC count may have an active infection. The nurse should first assess for other signs of infection so that treatment can be initiated. If the patient already has symptoms, assessing for exposure is not the priority. It would not be appropriate to place the patient in protective isolation unless the patient has other risks identified.
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 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.
Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia. Explanation: Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia. Epogen does not slow production of red blood cells or stimulate production of white blood cells.
The client has taken epoetin alfa with good results for several months. On this visit, the nurse analyzes the client's lab results and finds indications of severe anemia and cytopenias. What prescription will the nurse anticipate receiving? Change the client to another erythropoiesis-stimulating agent. Discontinue the use of epoetin alfa. Increase the dosage of epoetin alfa. Begin administering epoetin alfa intravenously instead of subcutaneously.
Discontinue the use of epoetin alfa. Explanation: In clients treated with epoetin alfa or any drug in this class who develop severe anemia after improvement, the drug should be stopped and should not be changed to another drug in the class because it is likely due to client's development of neutralizing antibodies. Increasing the dosage will not help, and changing the route of administration will not reverse the process after antibodies have formed.
What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa? 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 Alteration in nutrition due to poor intake of iron
Impaired tissue oxygenation related to anemia Explanation: The most appropriate priority nursing diagnosis is impaired tissue oxygenation related to anemia. The other diagnoses are not specific to the reason that epoetin is prescribed or the specific side effects of the medication.
The nurse administers epoetin alfa (Epogen). What is the therapeutic response the nurse expects to assess? Elevated white blood cell count Elevated heart rate Increased red blood cell count Increased resistance to infection
Increased red blood cell count Explanation: Epoetin alfa is the recombinant form of human erythropoietin, which increases the body's ability to produce red blood cells (RBCs). The patient's RBCs should increase in response. This medication will not increase white blood cells or the patient's resistance to infection. The patient's heart rate would not increase in response to this medication.
A nurse administers erythropoietin. What assessment finding is attributable to the increased effect of this hormone? Select all that apply. Increased red blood cell count Decreased oxygenation in the bloodstream Increased urinary output Anemia Increased hemoglobin
Increased red blood cell count Increased hemoglobin Erythropoietin stimulates the bone marrow and increases the production of red blood cells and hemoglobin. It does not increase urinary output or decrease oxygenation. It would actually increase the oxygen-carrying capacity of the blood. Anemia is a condition that erythropoietin might be used to treat, but it is not an assessment finding caused by this hormone.
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 gamma-1b Interferon alfa-2b Interferon beta-1a Peginterferon alfa-2b
Interferon alfa-2b Explanation: 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.
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? Peginterferon alfa-2b Interferon gamma-1b Interferon alfa-2b Interferon beta-1a
Interferon alfa-2b Explanation: 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.
Your client has been diagnosed with genital warts. Which of the following medications would you anticipate being ordered? Interferon alfa-2b Lorazepam Monistat Procrit
Interferon alfa-2b Explanation: Interferon alfa-2b is approved for the treatment of genital warts (condylomata) associated with infection by human papillomavirus, non-Hodgkin's lymphoma, and malignant melanoma. None of the other options are used for that diagnosis.
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 enhance allogeneic stem-cell transplantation. It has been shown to protect autologous tumor cells.
It has been shown to inhibit tumor growth. Explanation: Interferon activates human cellular immunity and inhibits tumor growth through increases in lymphocytes, platelets, and cytokines. It does not protect autologous tumor cells, enhance allogeneic stem-cell transplantation, or have a direct proliferative effect on renal tumors.
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? A rash under the breast Dry, nonproductive cough 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 Explanation: The nurse should determine whether the patient has pre-existing vascular disease, because it may increase the patient's risk for developing thrombotic adverse effects.
A 67-year-old man who is being treated for prostate cancer with darbepoetin alfa, will be given what instruction by the nurse? Schedule an appointment to check if the patient has a high WBC count. Begin taking a calcium channel blocker to treat hypertension, which usually develops as an adverse effect of epoetin alfa therapy. Schedule an appointment to measure hemoglobin twice a week for at least 2 to 6 weeks. Stop taking the drug after a 2-week period.
Schedule an appointment to measure hemoglobin twice a week for at least 2 to 6 weeks. Explanation: After each dose adjustment, the nurse should ensure that the patient makes an appointment to have the hemoglobin measured twice a week for at least 2 to 6 weeks to verify that it is in the normal range. A high WBC count and hypertension have not been identified as adverse effects of epoetin alfa.
All hematopoietic and immune blood cells are derived from which cells in the bone marrow? Alfa cells Stem cells Theta cells Beta cells
Stem cells Explanation: All hematopoietic and immune blood cells are derived from stem cells in the bone marrow.
After assessing the client receiving erythropoietin drug therapy, the nurse suspects what finding is an adverse effect of erythropoietin drug therapy? The client reports a "low, sad" mood. The client has peripheral edema to the feet and lower legs. The client has not had a bowel movement for 4 days. The client's blood pressure is 102/59 mm Hg.
The client has peripheral edema to the feet and lower legs. Explanation: Potential adverse effects of erythropoietin drug therapy are edema, nausea, vomiting, chest pain, diarrhea, and hypertension. Changes in mood are not typically reported and would not likely be attributed directly to erythropoietin therapy.
A client has been prescribed epoetin alfa. What assessment finding may suggest to the nurse that the drug is contraindicated for this client? The client takes bupropion for the treatment of depression. The client is short of breath on exertion. The client frequently has loose stools. The client's blood pressure is 161/107 mm Hg.
The client's blood pressure is 161/107 mm Hg. Explanation: 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.
The nurse is administering epoetin alfa (Epogen). Which administration technique would not be considered appropriate for the patient identified? The nurse administers the epoetin alfa (Epogen) into the patient's peripheral IV line. The nurse administers epoetin alfa (Epogen) into the patient's central IV line. The nurse administers epoetin alfa (Epogen) via IM injection. The nurse administers epoetin alfa (Epogen) as a bolus injection as the patient completes dialysis
The nurse administers epoetin alfa (Epogen) via IM injection. Explanation: The nurse can administer epoetin alfa (Epogen) into IV lines or dialysis lines; however, it is administered via subcutaneous injection instead of IM injection.
Which patient should not receive epoetin alfa (Epogen) as ordered at 9 am? The patient with a heart rate of 100 beats per minute The patient who is "too tired to get out of bed" The patient who has a blood pressure of 240/120 mm Hg The patient who has missed a round of chemotherapy
The patient who has a blood pressure of 240/120 mm Hg Explanation: Hypertension is the most common adverse effect of administration of epoetin alfa (Epogen). Patients with uncontrolled hypertension should not receive the medication. Administering to patients whose heart rate is elevated or who verbalize fatigue is acceptable, because the medication should decrease the symptoms. Patients receiving chemotherapy often need to halt chemotherapy while their red blood cells have a chance to rebound. Administration of Epogen is commonly done when patients are awaiting chemotherapy.
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? The drug dose must be increased if being given via the oral route. This drug is destroyed by acids found in the stomach. The oral route while more desirable is not as effective. This medication is likely to causes severe diarrhea if given orally.
This drug is destroyed by acids found in the stomach. Explanation: Epoetin alfa is given by subcutaneous or intravenous (IV) injection because it would be destroyed by digestive enzymes if given orally. None of the other options accurately describe why the oral route is not an option.
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. Explanation: Exogenous cytokines are given by subcutaneous or intravenous injection because they are proteins that would be destroyed by digestive enzymes if given orally.
A male client is prescribed interferon. What is his probable diagnosis? Sepsis Bacteremia Viral hepatitis Hypertension
Viral hepatitis Explanation: Interferons are used mainly for viral hepatitis and certain types of cancer.
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? hypertension hypoglycemia anemia thrombocytopenia
anemia Explanation: 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. None of the other options would cause the client's symptoms.
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? temperature respiratory rate heart rate blood pressure
blood pressure Explanation: The most common adverse effect of epoetin alfa is hypertension. The nurse would critically examine all the client's vital signs, but blood pressure would be of particular concern.
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? ankylosing spondylosis bacterial pneumonia asthma chronic hepatitis C
chronic hepatitis C Explanation: Interferon alfa-2b is a biologic response modifier that binds to cell surfaces and alters intracellular activities in viral infections. As a result, viruses are less able to enter uninfected cells and reproduce. Interferon alfa-2b is used to treat chronic hepatitis C and other diseases caused by viruses. Interferon alfa-2b is not used to treat asthma, bacterial pneumonia, or ankylosing spondylosis.
During recovery from a gastrointestinal bleed, a client has been prescribed an iron preparation. Prior to beginning therapy, what assessment should the nurse prioritize? serum creatinine levels aspartate aminotransferase levels white cell differential hematocrit and hemoglobin
hematocrit and hemoglobin Explanation: Hematocrit and hemoglobin levels should be assessed before administration because the drug will be evaluated for effectiveness by the response of these levels to drug treatment. These levels are also used to determine dosage. Aspartate aminotransferase levels are associated with liver function, and serum creatinine levels are associated with renal function; neither of these are high priorities because iron supplements are not significantly hepatotoxic or nephrotoxic. The client's white cell differential would not be affected unless an infection was present.
During recovery from a gastrointestinal bleed, a client has been prescribed an iron preparation. Prior to beginning therapy, what assessment should the nurse prioritize? serum creatinine levels white cell differential hematocrit and hemoglobin aspartate aminotransferase levels
hematocrit and hemoglobin Explanation: Hematocrit and hemoglobin levels should be assessed before administration because the drug will be evaluated for effectiveness by the response of these levels to drug treatment. These levels are also used to determine dosage. Aspartate aminotransferase levels are associated with liver function, and serum creatinine levels are associated with renal function; neither of these are high priorities because iron supplements are not significantly hepatotoxic or nephrotoxic. The client's white cell differential would not be affected unless an infection was present.
A client with chronic kidney disease has been receiving epoetin alfa subcutaneous injections and has a hemoglobin level of 9.9 g/dl (99 g/L). Which treatment would the nurse anticipate being prescribed when the client reports new-onset fatigue? low-dose stimulant medication iron supplements progressive activity program oxygen therapy
iron supplements Explanation: Epoetin alfa is an erythropoiesis-stimulating drug used to stimulate the bone marrow to produce more red blood cells (RBCs). The client must have an adequate supply of iron for the medication to be effective. Fatigue could indicate an inadequate amount of iron and would be the treatment the nurse would anticipate being prescribed. There is no evidence that the client needs oxygen therapy. The fatigue is not due to insufficient activity but rather insufficient iron, which is needed for the formation of RBCs. Stimulant medication would not be indicated because the reason for the fatigue is insufficient iron stores to support the production of RBCs.
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 requesting a change in the dosage changing the route of administration administering an unscheduled dose
temporarily withholding administration Explanation: Epoetin increases risks of myocardial infarction and stroke, especially if it is used to achieve hemoglobin levels greater than 12 g/dL (120 g/L). The U.S. Food and Drug Administration (FDA) has issued a black box warning advising prescribers to avoid using hematopoietic growth factors in clients with hemoglobin values of 12 g/dL (120 g/L). Administration of the drug should consequently be discontinued on a temporary basis. None of the other options would safely address the client's current health issue.
