Pharm Chapter 49 - Drugs that treat Anemia
Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy? A 20-year-old female A 30-year-old pregnant woman A 62-year-old male with cancer A 40-year-old male with a high white blood cell count
A 62-year-old male with cancer 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.
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? Oral Subcutaneous Intravenous B and C
B and C These drugs can be give by the SC or IV routes. They are proteins that would be destroyed by digestive enzymes if given orally.
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? heart rate temperature blood pressure respiratory rate
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.
A patient is to be administered an erythropoiesis-stimulating agent. Which of the following drugs would the nurse administer? Ferrous sulfate Epoetin alfa Folic acid Hydroxyurea
Epoetin Alfa Epoetin alfa is an erythropoesis-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.
What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa? Impaired tissue oxygenation related to anemia Alteration in nutrition due to poor intake of iron 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
Which would a nurse identify as the primary issue associated with anemias? Defective white blood cells Increased plasma proteins Ineffective red blood cells Lack of vitamin B12
Ineffective red blood cells Anemias are disorders that involve too few or ineffective RBCs that alter the ability of the blood to carry oxygen. White blood cells are associated with the immune response. Plasma proteins are important in the immune response and blood clotting. Lack of vitamin B12 is associated with a specific type of anemia.
A male client is taking Procrit. He requests changing his medication from the IM to the PO route. The nurse's best response is: 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 IM. This medication causes severe diarrhea if given orally.
This medication is destroyed in the stomach and can only be given IM. Exogenous cytokines are given by subcutaneous or intravenous (IV) injection because they are proteins that would be destroyed by digestive enzymes if given orally.
The nurse will teach a patient who is receiving oral iron supplements to watch for which expected adverse effects? a. Palpitations b. Drowsiness and dizziness c. Black, tarry stools d. Orange-red discoloration of the urine
c. Black, tarry stools Black, tarry stools and other gastrointestinal disturbances may occur with the administration of iron preparations. The other options are incorrect.
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? filgrastim penicillin G epoetin alfa interferon gamma
epoetin alfa
A client is receiving ferrous sulfate as treatment for iron deficiency anemia. After teaching the client, which statement indicates the need for additional teaching? "I need to take an antacid with the pill to prevent an upset stomach." "I need to make sure that I eat enough foods containing iron." "It might take several months before my iron levels get back to normal." "I need to avoid taking the drug with coffee or tea."
"I need to take an antacid with the pill to prevent an upset stomach." Iron is not absorbed if taken with antacids, so the client should avoid this combination. Adequate iron intake is necessary to assist in regaining a positive iron balance. It can take 2 to 3 weeks to see an improvement and up to 6 to 10 months to return to a stable iron level once a deficiency exists. Iron absorption also is altered if it is taken with milk, eggs, coffee, or tea. These substances should be avoided.
A client prescribed epoetin alfa asks how the medication works. Which is the nurse's best response? "Increases the release of cells to increase the hemoglobin and hematocrit levels." "Decreases release of reticulocytes, which inhibits red blood cell (RBC) production." "Stimulates the growth and development of white blood cells (WBC) to prevent neutropenia." "Releases erthyropoiesis from the kidneys to increase the number of platelets."
"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 mentoring a first-year nursing student while caring for a client with a disease that affects the hematopoietic system. The student looks confused and says "I've never heard of that system. What is it?" How would the nurse respond? "The hematopoietic system is composed of fluid, red blood cells, white blood cells, and fibrosis." "The hematopoietic system is composed of fluid, red blood cells, white blood cells, and fibrinogen." "The hematopoietic system is composed of fluid, red blood cells, white blood cells, and platelets." "The hematopoietic system is composed of fluid, red blood cells, white blood cells, and fibrin."
"The hematopoietic system is composed of fluid, red blood cells, white blood cells, and platelets." The nurse would teach the student that the hematopoietic system is composed of fluid, red blood cells, white blood cells, and platelets. Fibrin and fibrinogen are part of the clotting cascade, and fibrosis is scar tissue.
The average lifespan of a red blood cell (RBC) is approximately: 30 days. 60 days. 90 days. 120 days.
120 days The average lifespan of an RBC is 120 days. At that time, the elderly RBC is lysed in the liver, spleen, or bone marrow.
A client is receiving epoetin alfa. The nurse understands that this drug's duration of effect would be which amount of time? 12 hours 24 hours 36 hours 48 hours
24 hours Epoetin alfa has a duration of effect of usually 24 hours.
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? A protein supplement An iron supplement A blood transfusion A folic acid supplement
An iron supplement Patients taking epoetin alfa who require surgery may require iron supplementation.
Which would be appropriate for a client who is receiving iron therapy? Ensuring that the client consumes three large meals per day Cautioning the client that stool may be dark or green Encouraging the client to take the drug on an empty stomach Advising the client to limit the amount of fiber in his diet
Cautioning the client that stool may be dark or green. The client needs to be informed that his stools may become dark or green. Small frequent meals with snacks can help minimize nausea. The client may take the drug with meals as long as those meals do not include eggs, milk, coffee, or tea. Constipation is possible, so the client needs to increase the fiber in his diet.
The patient with chronic renal failure requires an agent to increase red blood cell production. What drug does the nurse anticipate administering? Epoetin alfa Filgrastim Oprelvekin Thrombopoietin
Epoetin alfa Epoetin alfa (Epogen, Procrit), a hematopoietic hormone, is the prototype drug for stimulating red blood cell production.
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 Rocephin 1 GM IV A blood transfusion An increased dose of zidovudine
Erythropoietin Epoetin alfa is also used to treat anemia related to ziduovudine 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.
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? Interleukins Interferon Erythropoietin Colony-stimulating factor
Erythropoietin 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 male client is diagnosed with multiple myeloma. What treatment regimen would the nurse expect the health care provider to order? Interferon alfa Sargramostim Filgrastim Epoetin
Interferon alfa Interferon alfa has demonstrated antitumor effects in multiple myeloma, renal cell carcinoma, and others.
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. Iron supplements prevent depletion of hemoglobin cells from anxiety to treat anemia. Iron supplements prevent infection so hemoglobin cells grow back faster to treat anemia. Iron supplements prevent bleeding to replenish hemoglobin cells faster to treat anemia.
Iron acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia. 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? Potassium supplement Sodium restriction Iron supplement Renal dialysis
Iron supplement 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.
Nursing students are reviewing the anatomy and physiology of the hematopoietic system. Which would they correctly identify as the formed elements of blood? (Select all that apply.) Nerve cells Plasma Leukocytes Platelets Erythrocytes
Leukocytes Platelets Erythrocytes Blood is composed of liquid and formed elements. The liquid part is called plasma. The formed elements include leukocytes, erythrocytes, and platelets.
Adverse effects of epoetin and darbepoetin include increased risks of what condition? Hyperlipidemia Diabetes mellitus type 2 Myocardial infarction Cirrhosis of the liver
Myocardial Infarction Adverse effects of epoetin and darbepoetin include increased risks of hypertension, myocardial infarction, and stroke, especially when used to increase hemoglobin above 12 g/dL.
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? Pernicious anemia Iron deficiency anemia Sickle cell anemia Folic acid deficiency anemia
Pernicious Anemia Pernicious anemia occurs when the gastric mucosa cannot produce the intrinsic factor and vitamin B12 cannot be absorbed. Iron deficiency anemia occurs when blood is lost or the diet is insufficient in supplying adequate iron. Sickle cell anemia results from a genetically inherited hemoglobin S. Folic acid deficiency anemia results from inadequate folic acid intake or malabsorption.
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 A rash under the breast 1 pound weight gain in 1 week Dry, nonproductive cough
Reports of calf pain on dorsiflexion of the foot. 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.
There is a risk of antibody production with the use of epoetin. True False
TRUE 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 component of the red blood cell that is not recycled is bilirubin. True False
True 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.
The component of the RBC that is not recycled is bilirubin. True False
True 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.
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? Diabetes mellitus Hypothyroidism Osteoarthritis Uncontrolled hypertension
Uncontrolled hypertension The nurse should determine whether the patient has pre-existing uncontrolled hypertension, which is a contraindication for the use of epoetin alfa.
When administering iron injections, which method would the nurse use? Subcutaneous Z-Track intramuscular Intradermal This medication is not to be given as an injection.
Z-Track intramuscular 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 hypoglycemia hypertension thrombocytopenia
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 patient has been receiving epoetin alfa (Epogen) for severe iron-deficiency anemia. Today, the provider changed the order to darbepoetin (Aranesp). The patient questions the nurse, "What is the difference in these drugs?" Which response by the nurse is correct? a. "There is no difference in these two drugs." b. "Aranesp works faster than Epogen to raise your red blood cell count." c. "Aranesp is given by mouth, so you will not need to have injections." d. "Aranesp is a longer-acting form, so you will receive fewer injections."
d. "Aranesp is a longer-acting form, so you will receive fewer injections." Darbepoetin (Aranesp) is longer-acting than epoetin alfa (Epogen); therefore, fewer injections are required. The other options are incorrect.
The nurse is teaching a patient with iron-deficiency anemia about foods to increase iron intake. Which food may enhance the absorption of oral iron forms? a. Milk b. Yogurt c. Antacids d. Orange juice
d. Orange juice Orange juice contains ascorbic acid, which enhances the absorption of oral iron forms; antacids, milk, and yogurt may interfere with absorption.
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. pernicious anemia. sickle cell anemia. hemolytic anemia.
iron deficiency anemia. Monitor the results of laboratory tests including CBC, hematocrit, hemoglobin, and serum ferritin assays to determine drug effectiveness and identify toxic levels.
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 Produce rennin Produce angiotensin Inactivate vitamin D
Produce erythropoietin 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 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 C Folic acid Vitamin B12 Vitamin D
Vit. B12 Vitamin B12 is necessary for the formation and maintenance of the myelin sheath in the CNS and for the health of RBCs.
An oral iron supplement is prescribed for a patient. The nurse would question this order if the patient's medical history includes which condition? a. Decreased hemoglobin b. Hemolytic anemia c. Weakness d. Concurrent therapy with erythropoietics
b. Hemolytic anemia Hemolytic anemia is a contraindication to the use of iron supplements. Decreased hemoglobin and weakness are related to iron-deficiency anemia. Iron supplements are given with erythropoietic drugs to aid in the production of red blood cells.
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." "I need to eat three large meals every day." "I must take the drug on an empty stomach." "I need to watch the amount of fiber I eat."
"My stools might turn dark or green." 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.
The client is a woman, 69 years of age, seen in the clinic for anemia and administration of epoetin alfa. Before giving the drug, the nurse takes a complete history and reviews the client's EMR, because the nurse knows that epoetin alfa is contraindicated for which conditions? (Select all that apply.) Clients with uncontrolled hypertension Clients needing an emergency transfusion Clients with a hypersensitivity to human albumin Clients with a recent infection Clients with exposure to anthrax
Clients with uncontrolled hypertension Clients needing an emergency transfusion Clients with a hypersensitivity to human albumin Epoetin alfa is contraindicated in clients with uncontrolled hypertension, clients needing an emergency transfusion, and clients with a hypersensitivity to human albumin. There is no research to support withholding administration of epoetin alfa to clients exposed to anthrax, or clients with a recent infection.
A patient has been prescribed epoetin alfa. The nurse recognizes that this medication is indicated for treatment of anemia associated with which disease process? Lung failure Heart failure Renal failure Liver failure
Renal Failure 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.
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. The patient reports "bone pain." The patient is tired. The patient states the injection "hurts."
The patient displays weakness on one side of the body. 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 will the nurse assess first? The patient with a decreased RBC count The patient with a decreased WBC count The patient with anemia The patient with elevated erythropoietin
The patient with a decreased WBC count The patient with a decreased WBC count may have difficulty fighting infection and may be at risk for a contagious disease. The patient with a decreased RBC and anemia would be the second priority and the patient with the elevated counts would be the lowest priority, as erythropoietin is a hormone secreted by the kidneys that should stimulate RBC production.
A male client is prescribed interferon. What is his probable diagnosis? Hypertension Viral hepatitis Sepsis Bacteremia
Viral hepatitis Interferons are used mainly for viral hepatitis and certain types of cancer.
The nurse is administering liquid oral iron supplements. Which intervention is appropriate when administering this medication? a. Have the patient take the liquid iron with milk. b. Instruct the patient to take the medication through a plastic straw. c. Have the patient sip the medication slowly. d. Have the patient drink the medication, undiluted, from the unit-dose cup.
b. Instruct the patient to take the medication through a plastic straw. Liquid oral forms of iron need to be taken through a plastic straw to avoid discoloration of tooth enamel. Milk may decrease absorption
What are the primary factors that contribute to the body's ability to fight off infection? Select all that apply. normal hematopoiesis normal immune system function normal cardiovascular function increased platelet cell production decreased exposure to microorganisms
normal hematopoiesis normal immune system function normal cardiovascular function Adequate blood cell production, or hematopoiesis, and normal immune system function, or immunocompetence, 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.
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 protein, causing less oxygen to be delivered to the tissues." "Anemia is a condition caused by reduced amounts of hematocrit, causing less oxygen to be delivered to the tissues." "Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues." "Anemia is a condition caused by reduced amounts of platelets, causing less oxygen to be delivered to the tissues."
"Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues." 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 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? Profound diaphoresis Decreased level of consciousness Flulike symptoms Cyanosis and pallor
Flulike symptoms 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.
Colony-stimulating factors (CSF) are administered to produce which therapeutic effect? Reduce side effects to a medication Enhance immune system functioning Increase the growth of specific types of blood cells Decrease the patient's reaction to a chemotherapeutic medication
Increase the growth of specific types of blood cells 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.
The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome? Decreased RBC count Increased RBC count Increased WBC count Decreased WBC count
Increased RBC count Epoetin is a hormone that stimulates bone marrow production of red blood cells.
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." "If darkening of the stools appears, call your primary care provider." "If you get a little thirsty, call your primary care provider." "If you have an increased appetite, call your primary provider."
"If constipation or diarrhea become severe, call your primary care provider." 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.
A patient will be taking oral iron supplements at home. The nurse will include which statements in the teaching plan for this patient? (Select all that apply.) a. Take the iron tablets with meals. b. Take the iron tablets on an empty stomach 1 hour before meals. c. Take the iron tablets with an antacid to prevent heartburn. d. Drink 8 ounces of milk with each iron dose. e. Taking iron supplements with orange juice enhances iron absorption. f. Stools may become loose and light in color. g. Stools may become black and tarry. h. Tablets may be crushed to enhance iron absorption.
ANS: A, E, G Iron tablets need to be taken with meals to reduce gastrointestinal distress, but antacids and milk interfere with absorption. Orange juice enhances the absorption of iron. Stools may become black and tarry in patients who are on iron supplements. Tablets need to be taken whole, not crushed, and the patient needs to be encouraged to eat foods high in iron.
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. 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 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 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 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. Epogen does not slow production of red blood cells or stimulate production of white blood cells.
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: Iron Levels Chemotherapy Renal failure Swelling of veins
Iron Levels Monitoring iron and hematocrit levels may help the nurse track the progress and effectiveness of the epoetin alfa therapy. Chemotherapy is a cancer treatment, not an assessment that determines the success or effectiveness of the epoetin alfa therapy. Swelling of veins and renal failure are not normally monitored in an ongoing assessment of a patient who takes epoetin alfa.
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 administering an unscheduled dose changing the route of administration requesting a change in the dosage
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 cancer patient is receiving drug therapy with epoetin alfa (Epogen). The nurse knows that the medication must be stopped if which laboratory result is noted? a. White blood cell count of 550 cells/mm3 b. Hemoglobin level of 12 g/dL c. Potassium level of 4.2 mEq/L d. Glucose level of 78 mg/dL
b. Hemoglobin level of 12 g/dL If epoetin is continued when hemoglobin levels are above 11 g/dL, patients may experience serious adverse events, including heart attack, stroke, and death. Guidelines now recommend that the drug be stopped when the hemoglobin level reaches 10 g/dL for cancer patients. For renal patients, the target hemoglobin level is 11 g/dL for patients on dialysis and 10 g/dL for chronic renal patients not on dialysis.
The nurse is reviewing the medical record of a patient before giving a new order for iron sucrose (Venofer). Which statement regarding the administration of iron sucrose is correct? a. The medication is given with food to reduce gastric distress. b. Iron sucrose is contraindicated if the patient has renal disease. c. A test dose will be administered before the full dose is given. d. The nurse will monitor the patient for hypotension during the infusion.
d. The nurse will monitor the patient for hypotension during the infusion. Iron sucrose (Venofer) is an injectable iron product indicated for the treatment of iron-deficiency anemia in patients with chronic renal disease. It is also used for patients without kidney disease. Its risk of precipitating anaphylaxis is much less than that of iron dextran, and a test dose is not required. Hypotension is the most common adverse effect and appears to be related to infusion rate. Low-weight elderly patients appear to be at greatest risk for hypotension.
The nurse is administering folic acid to a patient with a new diagnosis of anemia. Which statement about treatment with folic acid is true? a. Folic acid is used to treat any type of anemia. b. Folic acid is used to treat iron-deficiency anemia. c. Folic acid is used to treat pernicious anemia. d. The specific cause of the anemia needs to be determined before treatment.
d. The specific cause of the anemia needs to be determined before treatment. Folic acid should not be used to treat anemias until the underlying cause and type of anemia have been identified. Administering folic acid to a patient with pernicious anemia may correct the hematologic changes of anemia, but the symptoms of pernicious anemia (which is due to a vitamin B12 deficiency, not a folic acid deficiency) may be deceptively masked. The other options are incorrect.
A client has been diagnosed with genital warts. Which medication would the nurse anticipate being prescribed? epoetin alfa pegfilgrastim darbepoetin alfa interferon alfa-2b
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 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.
