Abrams Chapter 11 NCLEX
The nurse is caring for a client who has been prescribed filgrastim. What lab value will the nurse use to assess the effectiveness of treatment? A. Absolute neutrophil count B. Platelet count C. Serum ammonia levels D. Red blood cell count and hemoglobin
A. Absolute neutrophil count The nurse assesses the client receiving filgrastim for a decreased incidence of infection and maintenance of the ANC within a target range of 1500 to 10,000 cells/mm3. Filgrastim does not directly influence RBC, platelet, or ammonia levels.
A client is taking aldesleukin. The nurse knows that this medication is used to treat what condition? Select all that apply. A. Metastatic kidney cancer B. Metastatic melanoma skin cancer C. Hodgkin's disease D. Liver cancer E. Metastatic bone cancer
A. Metastatic kidney cancer B. Metastatic melanoma skin cancer Aldesleukin activates cellular immunity; produces tumor necrosis factor, interleukin-1, and interferon gamma; and inhibits tumor growth. It is used to treat metastatic kidney cancer and metastatic melanoma skin cancer. The drug is highly toxic and is contraindicated in clients with preexisting serious cardiovascular or pulmonary impairment. It is given only to hospitalized clients and should be prescribed and administered by health professionals (e.g., oncology nurses) who are experienced in its use.
What are the primary factors that contribute to the body's ability to fight off infection? Select all that apply. A. Normal immune system function B. Increased platelet cell production C. Normal cardiovascular function D. Normal hematopoiesis E. Decreased exposure to microorganisms
A. Normal immune system function C. Normal cardiovascular function D. Normal hematopoiesis Adequate blood cell production, or hematopoiesis; normal immune system function, or immunocompetence; and normal cardiovascular function are vital processes in the human body's ability to fight harmful invaders. Platelet production is associated with the body's ability to support a normal clotting process. A decrease in harmful microorganisms is a factor in health, but the body's ability to react to such exposure is of primary importance.
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? A. Temporarily withholding administration B. Requesting a change in the dosage C. Changing the route of administration D. Administering an unscheduled dose
A. Temporarily withholding administration 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.
For which client would epoetin alfa NOT be indicated? A. A client with a hemoglobin of 10, who is asymptomatic B. A client with a hemoglobin of 12, with shortness of breath C. A client with a hemoglobin of 8, who is asymptomatic D. A client with a hemoglobin of 11, with shortness of breath
B. A client with a hemoglobin of 12, with shortness of breath Erythropoiesis-stimulating drugs have been used to raise the hemoglobin and reduce the need for blood transfusions in many clients with anemia. However, studies indicate an increased risk of serious cardiovascular problems and death in clients with chronic renal failure and an increased risk of tumor progression and death in clients with cancer. These problems became evident when the drugs were used to achieve normal hemoglobin levels of 12 to 14 g/dL. These results led the FDA to issue a black box warning advising prescribers to avoid using the drugs in clients with hemoglobin values of 12 g/dL or above. In addition, when the drugs are used, the lowest dose effective should be prescribed to raise hemoglobin levels just enough to avoid the need for blood transfusion, and hemoglobin levels should be monitored regularly until they stabilize
A client has been diagnosed with 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? A. Penicillin B. Epoetin alfa C. Interferon gamma D. Filgrastim
B. Epoetin alfa Epoetin alfa is a drug formulation of erythropoietin, a hormone from the kidney that stimulates bone marrow production of red blood cells. It is used to prevent or treat anemia associated with several conditions, including chronic renal failure and myelosuppressive anticancer chemotherapy (depresses bone marrow function). Filgrastim is given to increase blood cell production in clients undergoing bone marrow transplantation or chemotherapy. Interferon gamma is used to treat chronic granulomatous disease. Penicillin is an antibiotic.
A client's medication history reveals having been previously treated with aldesleukin. The nurse should know that this client likely has a history of what form of cancer? Select all that apply. A. Metastatic lung cancer chronic myelogenous leukemia B. Metastatic melanoma skin cancer C. Non-Hodgkin's lymphoma D. Metastatic kidney cancer E. Prostate cancer
B. Metastatic melanoma skin cancer D. Metastatic kidney cancer Aldesleukin activates cellular immunity; produces tumor necrosis factor, interleukin-1, and interferon gamma; and inhibits tumor growth. It is used to treat metastatic kidney cancer and metastatic melanoma skin cancer. None of the other cancers mentioned are prescribed aldesleukin.
The client with what condition is most likely to benefit from treatment with interferon beta? A. Hepatitis A B. Multiple sclerosis C. Cognition impairment due to Alzheimer's disease D. Parkinson's disease
B. Multiple sclerosis Interferon beta-1a and 1b are used for multiple sclerosis, an autoimmune neurologic disorder in which the drug slows progression of neurologic dysfunction, prolongs remissions, and reduces the severity of relapses. There is no known benefit to support the use of interferon beta therapy to treat hepatitis A, Parkinson's disease, or Alzheimer's disease since none are autoimmune disorders that share the pathophysiology of multiple sclerosis.
An adult client has been diagnosed with ischemic heart disease, and a family member has asked for information about the action of granulocyte colony-stimulating factor (G-CSF) drugs. Which response by the nurse best answers the request for information? A. ''The drug acts as a clot buster while simultaneously preventing the formation of new clots.'' B. ''The drug increases the amount of red blood cells available to the heart.'' C. ''The drug promotes blood vessel growth around blocked areas in coronary arteries.'' D. ''The drug is used to fight bacterial infections and is not recommended for use in heart disease.''
C. ''The drug promotes blood vessel growth around blocked areas in coronary arteries.'' G-CSF drugs can reduce the incidence and severity of infections in neutropenic clients. These drugs are also used to collect stem cells for transplantation and to promote growth of blood vessels (angiogenesis) in clients with ischemic heart disease. These drugs apparently promote growth of arterioles around blocked areas in coronary arteries. They are not associated with bacterial infections, clot formation, or red blood cell production.
A client taking epoetin alfa requests changing the medication from the subcutaneous route to the PO route. How should the nurse respond? A. ''This medication causes severe diarrhea if given orally.'' B. ''The oral route is not as effective.'' C. ''This medication is destroyed in the stomach and can only be given by injection.'' D. ''The drug dose must be increased if being given via the oral route.''
C. ''This medication is destroyed in the stomach and can only be given by injection.'' Exogenous cytokines are given by subcutaneous or intravenous injection because they are proteins that would be destroyed by digestive enzymes if given orally.
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? A. Hypoglycemia B. Thrombocytopenia C. Anemia D. Hypertension
C. 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. 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 dat A. Temperature B. Heart rate C. Blood pressure D. Respiratory rate
C. Blood pressure 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.
What is the role of interferons in the normal function of the immune system? A. Interfering with the expression of antigens by foreign cells B. Performing phagocytosis of bacteria C. Countering the replication and spread of viruses D. Activating T cells while they are sequestered in the thymus
C. Countering the replication and spread of viruses Interferons ''interfere'' with the ability of viruses in infected cells to replicate and spread to uninfected cells. They also inhibit reproduction and growth of other cells, including tumor cells, and activate natural killer (NK) cells. They do not activate T cells, perform phagocytosis, or interfere with antigen expression.
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? A. Filgrastim B. Interferon gamma C. Epoetin alfa D. Penicillin G
C. Epoetin alfa Epoetin alfa is a drug formulation of erythropoietin, a hormone from the kidney that stimulates bone marrow production of red blood cells. It is used to prevent or treat anemia associated with several conditions, including chronic renal failure and myelosuppressive anticancer chemotherapy. Filgrastim is prescribed for the management of chemotherapy and/or bone marrow transplantation side effects. Interferon gamma is used to treat chronic granulomatous disease, which involves impaired phagocytosis of ingested microbes and frequent infections. Benzylpenicillin, also known as penicillin G, is an antibiotic used to treat several bacterial infections.
A client has been diagnosed with genital warts. Which medication would the nurse anticipate being prescribed? A. Pegfilgrastim B. Epoetin alfa C. Interferon alfa-2b D. Darbepoetin alfa
C. Interferon alfa-2b 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. Epoetin alfa is a man-made form of a protein that helps the body to produce red blood cells. Uses for pegfilgrastim include prevention of infection in neutropenia induced by cancer chemotherapy as well as treatment of bone marrow transplantation for Hodgkin's disease, non-Hodgkin's lymphoma, or acute lymphoblastic leukemia. Darbepoetin alfa is another ESA used in the prevention or treatment of anemia associated with several conditions, including chronic kidney disease and myelosuppressive (depressed bone marrow function) anticancer chemotherapy.
A client diagnosed with chronic renal failure is being treated with epoetin alfa in a home setting. The community health nurse should encourage the client to maintain a high intake of which food to supplement the intended action of the medication? Select all that apply. A. Low-fat dairy products B. Poultry C. Red meat D. Citrus fruits E. Leafy green vegetables
C. Red meat E. Leafy green vegetables Epoetin alfa is not effective unless sufficient iron is present; therefore, client teaching may need to emphasize the importance of taking an iron supplement. For some clients, increasing intake of iron-rich foods may enhance ferritin levels sufficiently. Leafy greens and red meats are particularly rich in iron. While all the options should be included in a healthy diet, the remaining options are not good sources of iron.
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? A. ''I will request an order for you to be treated in the outpatient center.'' B. ''You will require premedication if treated in the chemotherapy center.'' C. ''Aldesleukin can be given in the centers, but you must remain overnight.'' D. ''Aldesleukin is highly toxic and given only to hospitalized clients.''
D. ''Aldesleukin is highly toxic and given only to hospitalized clients.'' Aldesleukin is highly toxic and is contraindicated in clients with preexisting serious cardiovascular or pulmonary impairment. It is given only to hospitalized clients and should be prescribed and administered by health professionals who are experienced in its use.
A client is suspected of having impaired erythropoiesis. This client is most likely to exhibit signs and symptoms associated with what health problem? A. Disseminated intravascular coagulation (DIC) B. Venous thromboembolism C. Sepsis D. Anemia
D. Anemia Clinical manifestations of inadequate erythropoiesis include anemia. This results in a decrease in the oxygen-carrying capacity of blood and consequently a decreased oxygen availability to the tissues. Signs of hypercoagulation (venous thromboembolism or DIC) or infection (sepsis) are not expected.