Chapter 49 pharm Anemia

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."

A pt DX with iron def anemia is learning about iron supplements. what additional information should the nurse include?

"if constipation of diarrhea become serve, call PCP"

Which client would likely be the most appropriate candidate for treatment with filgrastim?

A client whose acute myelogenous leukemia necessitated a bone marrow transplant

For which client would epoetin alfa NOT be indicated?

A client with a hemoglobin of 12, with shortness of breath.

A client has chronic renal failure. as the disease progresses, the client is experiencing SOB. the nurse suspects they are experiencing symptoms associated with?

Anemia

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

Deferoxamine

The mature red blood cell contains a nucleus.

False

An adult client has developed renal failure secondary to an overdose of a nephrotoxic drug. Which assessment finding would the nurse recognize as being most suggestive of impaired erythropoiesis

Fatigue and increased heart rate

The nurse is teaching a client about folinic acid rescue in chemotherapy. Which of the following information would the nurse include in the teaching plan?

Folinic acid rescue in chemotherapy includes leucovorin administration.

Which would a nurse identify as the primary issue associated with anemias

Ineffective red blood cells

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 Epoetin is not effective unless sufficient iron is presen

when administering Iron injections, what method would the nurse use?

Z-track IM

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

maintenance of myelin sheath

All hematopoietic and immune blood cells are derived from which cells in the bone marrow?

stem cells

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

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

Average lifespan of RBC

120 days

When assessing a patient with anemia, the nurse notes that the patient has developed peripheral numbness and poor coordination. The patient's family states that the patient appears to be confused at times at home. Neurologic symptoms most often accompany which type of anemia?

Pernicious anemia

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

Renal failure pg 862

A patient has completed 4 weeks of treatment with epoetin alfa. Which of the following assessment findings would most strongly indicate that treatment has been effective?

hmg level is 11g/dl

A nurse administers erythropoietin. What assessment finding is attributable to the increased effect of this hormone? Select all that apply.

increased RBC increased hmg

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

increased RBC count

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

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

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."

Approximately what percentage of the body's red blood cells (RBCs) is destroyed and replaced each day?

1%

Which would be appropriate for a client who is receiving iron therapy?

Cautioning the client that stool may be dark or green

When reviewing a patients record, the nurse sees the client received interferon alpha-2b, what disorder does she suspect is being treated?

Chronic Hep C

While reviewing a client's the record, the nurse sees that the client received a dose of interferon alpha-2b? For what disorder does the nurse suspect the client was being treated?

Chronic hep C

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

A client with chronic renal failure has a low hemoglobin level. Which medication(s) will the nurse anticipate being prescribed for this client? Select all that apply.

Epoetin alfa epoetin beta darbepoetin alfa

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

Increase the growth of specific types of blood cells

Which would the nurse expect the health care provider to prescribe for a client receiving methotrexate?

Leucovorin Leucovorin is used as a rescue medication following methotrexate therapy.

A client who is undergoing chemotherapy for the treatment of non-Hodgkin's lymphoma will soon begin treatment with epoetin alfa. The nurse should be aware that this drug may be administered by which route? Select all that apply.

SUBQ IV

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?

SubQ or IV

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

Mr. Lepp is a 63-year-old man who was diagnosed with colon cancer several weeks ago and who is scheduled to begin chemotherapy. He reports to the nurse that he read about the need for erythropoietin in an online forum for cancer patients and wants to explore the use of epoetin alfa with his oncologist. Which fact should underlie the nurse's response to Mr. Lepp?

The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients

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.

T/F Cyanocobalamin is a vitamin B12 in a nasal formulation.

True

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

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.

red meat and leafy green vegetable. For some clients, increasing intake of iron-rich foods may enhance ferritin levels sufficiently. Leafy greens and red meats are particularly rich in iron

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

"The drug promotes blood vessel growth around blocked areas in coronary arteries."

A client is receiving epoetin alfa. The nurse understands that this drug's duration of effect would be which amount of time?

24 hours

The nurse is teaching a male patient receiving epoetin alfa about the drug. The nurse informs the patient that he will receive the drug at which frequency?

3 times a week

A patient receives ferrous sulfate. The nurse would expect this drug to begin acting within which time frame?

4 days

Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy?

62 year old white male with cancer

The prototype drug used to create red blood cells (RBCs) is epoetin alfa (Epogen, Procrit). It has many indications for use. Which are selected indications? Select all that apply.

Anemia from chronic renal disease (CRD) Anemia related to zidovudine therapy in HIV-associated illness Anemia related to chemotherapy in patients with cancer

The nurse is doing patient teaching with a 30-year-old gravida 1 who has sickle cell anemia. She is not currently in crisis. Providing education on which topic is the highest nursing priority?

Avoidance of infection

The client is a woman, 79 years of age, prescribed an iron preparation for anemia. The client's daughter becomes alarmed and calls the provider before giving the iron after she reads the label, because she knows that her mother is also taking which medication?

Levothyroxine every day

A client with chronic renal failure is prescribed to begin subcutaneous epoetin alfa injections. Which laboratory value will the nurse ensure is measured before starting the medication?

serum ferritin -it is necessary to measure iron status, transferrin saturation, and serum ferritin before initiating the treatment and periodically during the course of the treatment.

T/F there is a risk of antibody production with the use of epoetin

true

A nurse preparing to administer an erythropoiesis-stimulating drug is aware that the drug can be given by which routes? Select all that apply.

IV SUBQ

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 pre-existing uncontrolled hypertension, which is a contraindication for the use of epoetin alfa

A male patient with cancer tells the nurse that a friend is receiving a medication, epoetin alfa for anemia. The patient wants to know why they are not able to receive the drug to help make them feel better from the anemia they have. What is the best response by the nurse?

"This drug can cause serious risks for you as well as shorten survival and increase the risk of recurrence of your tumor." The use of epoetin alfa during cancer may shorten survival and/or increase the risk of tumor progression or recurrence. Patients with cancer are at risk for serious cardiovascular and thrombovascular events and should use the lowest dose needed to avoid red blood cell transfusions.

A client with an allergy to epoetin alfa should be provided with education regarding the addition of what other medication?

epoetin beta

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 monitor for which adverse effect

flu-like 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 hour

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

B12

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. 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.

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. 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 22-year-old female client is seen in the primary care provider's office for follow-up. The client was diagnosed six weeks ago with iron deficiency anemia and has been taking the prescribed iron supplement when she notices that her stool has turned black. She tells the nurse that she fears that she is bleeding to death inside her belly. The nurse teaches the client about which expected outcome?

"Don't worry, iron supplements can cause black or dark stools because of the iron composition."

After teaching students about anemia, the instructor determines teaching was successful when the students identify what as a critical issue?

Altered RBC production or deficient functioning RBC

A patient with iron-deficiency anemia states that she has minimal energy and finds it difficult to manage the household and work. She also tells the nurse that the medicine makes her nauseated. What would be the most appropriate intervention for the nurse to take?

provide comfort measures

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

true

A client is prescribed oral ferrous sulfate solution. Which statement by the client indicates that the client understands how to take the drug?

"I should drink the solution through a straw so my teeth don't get stained."

The nurse would contact the prescriber immediately if interferon was prescribed for which client?

11-month-old female with HIV acquired from her mother. Interferon should not be administered to newborns or infant. A baby is considered an infant until 12 months of age.

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

RBC With the use of hematopoietic and immunostimulant drugs, RBC's, hemoglobin and hematocrit shoudl be monitored to gauge response and prevent avoidable adverse reactions

For what purpose would the nurse administer postoperative epoetin alfa to the client who is a Jehovah's Witness?

Reduce the need for allogenic blood transfusion

After reviewing the major types of anemia, students demonstrate understanding of the information when they identify what as an example of a hemolytic anemia?

Sickle cell