J: Chapter 49: Drugs Used to Treat Anemias

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." Explanation: The nurse teaches the student that anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues; hemoglobin carries oxygen to the cells of the body. Protein, hematocrit, and platelets do not carry oxygen to the tissues.

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?

"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.

After teaching a patient who is receiving ferrous sulfate about the drug therapy regimen, which patient statement indicates that the teaching was successful?

"My stools might turn dark or green." Explanation: The patient needs to know that his stools may become dark or green. Small frequent meals with snacks can help minimize nausea and GI upset associated with this drug. The patient may take the drug with meals as long as those meals do not include eggs, milk, coffee, and tea. Constipation is possible, so the patient needs to increase the fiber in his diet.

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 Explanation: Older adults who have cancer and are receiving chemotherapy are especially vulnerable to the adverse effects of anemia as a result of chemotherapy and would therefore be the most likely candidates for epoetin alfa therapy. Young adults over age 18, pregnant women, and patients with a high white blood cell count are not as vulnerable to anemia and would not require epoetin alfa therapy.

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?

Altered red blood cell production or deficient functioning of red blood cells Explanation: Anemias are disorders that involve too few or ineffective red blood cells that alter the ability of the blood to carry oxygen. They result from some alteration in erythropoiesis or the process of red blood cell production. White blood cells are associated with the immune response. Lack of vitamin B12 is associated with a specific type of anemia. Platelets are associated with blood clotting.

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 Explanation: Patients taking epoetin alfa who require surgery may require iron supplementation.

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 Explanation: The most important assessment is the blood pressure because epoetin can cause hypertension.

A client with a diagnosis of renal failure is being treated for anemia with epoetin alfa. Frequent assessment of which laboratory values should be prioritized before and during treatment?

CBC Explanation: With the use of hematopoietic and immunostimulant drugs, a CBC with WBC differential and platelet count should be done before and during treatment to monitor response and prevent avoidable adverse reactions. It is not imperative to monitor liver enzymes or renal function.

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. 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.

A client is experiencing iron toxicity. Which agent would the nurse expect to be given?

Deferoxamine Explanation: Deferoxamine is the antidote for iron toxicity. Dimercaprol is used for arsenic, gold, or mercury poisoning. Succimer and edetate calcium disodium can be used to treat lead poisoning.

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?

Epoetin alfa Explanation: 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.

What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa?

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.

Colony-stimulating factors (CSF) are administered to produce which therapeutic effect?

Increase the growth of specific types of blood cells Explanation: Colony-stimulating factors control the production, growth, and differentiation of specific blood cell types, such as red blood cells and leukocyte stem cells. CSFs do not decrease the side effects to a medication or the patient's reaction to chemotherapeutic medications. Immune system functioning is not measurable and not the direct result of administration of a CSF. A CSF could enhance the production of RBCs or leukocyte stem cells. Colonies of granulocytes are stimulated by CSFs.

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 Explanation: Epoetin is not effective unless sufficient iron is present, and most clients need an iron supplement. When an iron preparation is prescribed, the home care nurse may need to emphasize the importance of taking it.

A client who was diagnosed with iron deficiency anemia is worried because she does not know why she was prescribed iron supplements. The nurse teaches the client about which action of oral iron administration?

Iron acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia. Explanation: Iron acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia. Iron supplements do not treat anxiety, infection, or bleeding.

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 Explanation: Iron supplementation is used adjunctively with epoetin to increase RBCs. The nurse would not expect a potassium supplement, sodium restriction or renal dialysis to be ordered.

When describing the function of vitamin B12, what would be appropriate to include?

Maintenance of myelin sheath Explanation: Vitamin B12 is important for maintaining the myelin sheath. Folic acid is important in preventing neural tube defects and is essential for cell division in all types of tissues. RBCs are important for transporting oxygen to the tissues.

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 Explanation: Darbepoetin alfa is administered once a week. Epoetin alfa is administered three times/week. Methoxy polyethylene glycol-epoetin alfa is administered once every 2 weeks or once a month.

After teaching a group of students about therapy for iron toxicity, the instructor determines that the students need additional teaching when they identify that the antidote can be administered by which route?

Oral Explanation: The antidote for iron toxicity, deferoxamine, can be administered IM, IV, or subcutaneously.

A client's current medical condition is suggestive of impaired erythropoiesis. Which laboratory study would be most clinically relevant in diagnosing this health problem?

RBC, hemoglobin, and hematocrit Explanation: Parameters used to measure erythropoiesis include RBC count, hemoglobin concentration and, hematocrit, and mean corpuscular volume. Tests related to immune function, hemostasis, and inflammation are not used to diagnose erythropoiesis.

A patient has been prescribed epoetin alfa. The nurse recognizes that this medication is indicated for treatment of anemia associated with which disease process?

Renal failure Explanation: Epoetin alfa acts like the natural glycoprotein erythropoietin to stimulate the production of red blood cells (RBCs) in the bone marrow. It is often used in the treatment of anemia related to renal failure.

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?

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 client with iron deficiency anemia has begun taking daily supplements of oral ferrous sulfate. The nurse should add what nursing diagnosis to the nursing care plan?

Risk for constipation related to use of iron supplements Explanation: Constipation is a common adverse effect of iron supplements. Neurovascular dysfunction, fluid volume excess, and unstable blood glucose are unlikely to result from iron supplements.

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?

Subcutaneous or Intravenous Explanation: These drugs can be given by the SC or IV routes. They are proteins that would be destroyed by digestive enzymes if given orally.

Which symptom, if assessed after the administration of epoetin alfa (Epogen), would be cause for alarm?

The patient displays weakness on one side of the body. Explanation: Epoetin increases the risk of myocardial infarction and stroke. Any symptoms that could indicate these conditions would be cause for alarm. Weakness on one side of the body could indicate a stroke. The nurse should continue with a neurological assessment and alert the health care provider. Bone pain and pain at the injection site are expected side effects and not cause for alarm. Patients who have anemia, the condition which this medication treats, typically report feeling tired and fatigued, and this is not cause for alarm

Which patient should not receive epoetin alfa (Epogen) as ordered at 9 am?

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 taking epoetin alfa requests changing the medication from the subcutaneous route to the PO route. How should the nurse respond?

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.

The component of the red blood cell that is not recycled is bilirubin.

True Explanation: The only part of the RBC that cannot be recycled is the toxic pigment bilirubin, which is conjugated in the liver, passed into the bile, and excreted from the body in the feces or the urine.

There is a risk of antibody production with the use of epoetin.

True Explanation: Use of any therapeutic protein brings with it the risk of antibody production. All of the erythropoietic proteins now carry a warning about the potential for this problem.

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?

Uncontrolled hypertension Explanation: The nurse should determine whether the patient has pre-existing uncontrolled hypertension, which is a contraindication for the use of epoetin alfa.

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?

Vitamin B12 Explanation: Vitamin B12 is necessary for the formation and maintenance of the myelin sheath in the CNS and for the health of RBCs.

When administering iron injections, which method would the nurse use?

Z-track intramuscular Explanation: The Z-track method is used when injecting iron to reduce the risks of subcutaneous staining and irritation.

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?

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?

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.

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:

iron deficiency anemia. Explanation: Monitor the results of laboratory tests including CBC, hematocrit, hemoglobin, and serum ferritin assays to determine drug effectiveness and identify toxic levels.

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 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.

A 50-year-old client is reporting that the client's oral B12 is not working. The nurse knows that the vitamin may have a decreased absorption rate when taken with other substances. The nurse would begin the history by asking which questions? (Select all that apply.)

"Do you use neomycin?" "Do you drink alcohol?" "Do you take colchicine?" Explanation: Alcohol, neomycin, and colchicine may decrease the absorption level of oral vitamin B12. Constipation would not affect the absorption level of oral vitamin B12.

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?

"I will need these injections monthly for the rest of my life." Explanation: Hydroxocobalamin must be given intramuscularly every day for 5 to 10 days to build up levels and then once a month for life. It cannot be taken orally because the problem with pernicious anemia is the inability to absorb vitamin B12 secondary to low levels of intrinsic factor.

A patient is to be administered an erythropoiesis-stimulating agent. Which of the following drugs would the nurse administer?

Epoetin alfa Explanation: Epoetin alfa is an erythropoiesis-stimulating agent. Ferrous sulfate is used in the treatment of iron-deficiency anemia. Megaloblastic anemia is treated with folic acid. Hydroxyurea is used in the treatment of sickle-cell anemia.

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 Explanation: Erythropoietin is a hormone responsible for increasing hemoglobin, red blood cell counts, and mean corpuscular volume. Decreases in any of these could be attributed to a decrease in erythropoietin. The other hormones listed will not have the same effect on the blood studies.

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?

Erythropoietin Explanation: Epoetin alfa is also used to treat anemia related to zidovudine therapy in HIV-positive patients. It is used when the endogenous erythropoietin levels are 500 mU/mL or less and the dose of zidovudine is 4,200 mg/wk or less.

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?

Flulike symptoms Explanation: In the majority of clients, flulike symptoms (e.g., fever, chills, fatigue, muscle aches, headache, tachycardia) develop within 2 hours of administration of interferon alfa-2b and last up to 24 hours. Diaphoresis, changes in LOC, and changes in oxygenation are not associated with the use of interferon alfa-2b.

The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome?

Increased RBC count Explanation: Epoetin is a hormone that stimulates bone marrow production of red blood cells.

A client is receiving epoetin alfa for anemia. Which adjunctive therapy is imperative with epoetin alfa?

Iron supplementation Explanation: When administering darbepoetin and epoetin, an adequate intake of iron is required for drug effectiveness and an iron supplement is usually necessary. It is not necessary to provide the client with potassium supplements, restrict sodium, or place the client on renal dialysis.

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 Explanation: Persons with chronic renal failure often are anemic because of an inability of the kidneys to produce erythropoietin. This anemia usually is managed by the administration of a recombinant erythropoietin (epoetin alfa) produced through DNA technology, to stimulate erythropoiesis. Options B, C, and D are incorrect.

A male client is prescribed interferon. What is his probable diagnosis?

Viral hepatitis Explanation: Interferons are used mainly for viral hepatitis and certain types of cancer.

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?

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.

A client diagnosed with iron deficiency anemia is learning about her prescribed iron supplement. Which additional information would the nurse include in the client's teaching plan?

"If constipation or diarrhea become severe, call your primary care provider." Explanation: The nurse knows to teach the client that if constipation or diarrhea become severe, to call the primary care doctor. Darkening of the stools is an expected outcome of iron administration. The nurse would teach the client to increase fluid for thirst (if not contraindicated) before calling the provider. Increased appetite is not an adverse reaction to iron; poor appetite would trigger a call to the provider.

Folic acid is necessary for cell growth and maintenance of the myelin sheath.

False Explanation: Folic acid is necessary for cell growth and development; vitamin B12 is necessary for maintenance of the myelin sheath.

Cyanocobalamin is a vitamin B12 in a nasal formulation.

True Explanation: Vitamin B12 includes hydroxocobalamin (generic), an injectable drug, and cyanocobalamin (Nascobal), a nasal spray.