Pharmacology Ch 49 (3)

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." Rationale: 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.

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.)

- Erythrocytes - Platelets - Leukocytes

The average lifespan of a red blood cell (RBC) is approximately:

120 days.

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

24 hours

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

4 days

For which client would Procrit NOT be indicated?

A client with a hemoglobin of 12, with shortness of breath. Rationale: Epoetin alfa (Procrit) is indicated in anemia associated with chemotherapy. In recent years, the U.S. Food and Drug Administration alerted providers to the importance of a target hemoglobin of no more than 11 g/dL when using these drugs. Higher levels have been associated with CV events, including death, and increased rates of tumor progression death in cancer patients in whom the drug was being used to treat anemia associated with toxic drug therapy. Monitoring the hemoglobin levels is critical for safe and therapeutic use of the erythropoiesis-stimulating agents. An increase in tumor growth was also found in cancer patients treated with these drugs when hemoglobin levels were not kept within the guidelines of no more than 11 g/dL. This has been added to the black box warnings for these drugs to alert caregivers to carefully monitor hemoglobin levels to assure patient safety.

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

Deferoxamine

A patient has suffered from a gastrointestinal hemorrhage. Which agent will assist in raising the hemoglobin?

Epoetin alfa (Epogen, Procrit)

A client 19 years of age who is a drug addict comes to the emergency department reporting extreme fatigue and shortness of breath. The nurse assesses the client and, after taking a complete history, determines that the client has malnutrition. The nurse knows that malnutrition can cause which type of anemia?

Folic acid deficiency anemia occurs because of a dietary lack of folic acid, a component necessary in the formation of red blood cells.

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.

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

Increased RBC count

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

Maintenance of myelin sheath

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 Rationale: 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.

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 is receiving hydroxyurea. The nurse understands that this drug is used to treat:

Sickle cell anemia

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. Rationale: 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.

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

Viral hepatitis

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

A client taking epoetin alfa requests changing the medication from the sub-Q to the PO route. How should the nurse respond?

This medication is destroyed in the stomach and can only be given by injection.