PrepU Ch 11 Drug Therapy for Hematopoietic Disorders
A child weighing 32 lb (14.5 kg) is to take ferrous sulfate 6 mg/kg/d PO. How many milligrams should the child receive per dose? Record the answer as a whole number.
87
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. anemia b. thrombocytopenia c. hypertension d. hypoglycemia
a
During recovery from a gastrointestinal bleed, a client has been prescribed an iron preparation. Prior to beginning therapy, what assessment should the nurse prioritize? a. Hematocrit and hemoglobin b. White cell differential c. Serum creatinine levels d. Aspartate transaminase levels
a
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? a. Produce erythropoietin b. Produce rennin c. Produce angiotensin d. Inactivate vitamin D
a
The nurse is caring for a client who has been receiving filgrastim. The nurse expects to perform which action concerning this drug on the day prior to the client's chemotherapy treatment? a. Hold the medication b. Give the medication both morning and evening c. Administer IV instead of SC d. Ensure that the client's diet has no herbs
a
Which symptom, if assessed after the administration of epoetin alfa (Epogen), would be cause for alarm? a. The patient states the injection "hurts." b. The patient reports "bone pain." c. The patient displays weakness on one side of the body. d. The patient is tired.
c
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? a. Reports of calf pain on dorsiflexion of the foot b. A rash under the breast c. Dry, nonproductive cough d. 1 pound weight gain in 1 week
a
What assessment finding does the nurse determine is a therapeutic outcome of administering filgrastim (Neupogen) to the patient? a. Elevation of white blood cell count (WBC) b. Elevation of hemoglobin c. Heart rate decreased from 100 to 60 beats per minute d. Increased red blood cell count (RBC)
a
You are precepting a nursing student and together you are caring for a patient who is to receive interleukins. The student nurse asks you what happens physiologically when a patient receives interleukins. What would be your best response? a. "It really helps the patient!" b. "The patient has increases in the number of natural killer cells." c. "The patient has decreased cytokine activity." d. "The patient gets really sick from flu-like symptoms and then gets better."
b
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. A protein supplement b. A folic acid supplement c. A blood transfusion d. An iron supplement
d
Adverse effects of epoetin and darbepoetin include increased risks of what condition? a. Cirrhosis of the liver b. Diabetes mellitus type 2 c. Hyperlipidemia d. Myocardial infarction
d
In learning about immunostimulants, what would you learn is an expected outcome of these medications? a. WBC of 20,000 mm3 b. Increased life expectancy c. RBC of 3,000 mm3 d. Decreased numbers or severity of infections
d
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? a. Respirations b. Temperature c. Pulse d. Blood pressure
d
The nurse administers interferon alpha-2b to a patient. Which assessment finding will the nurse act on immediately? a. The patient has a form of leukemia. b. The patient administered the medication at home. c. The patient reports feeling "fatigued." d. The patient has elevated liver function tests.
d
The nurse has just admitted a client to the unit who is newly diagnosed with Kaposi's sarcoma. The health care provider has order an IV infusion of an interferon. What drug has the provider ordered? a. Peginterferon alfa-2b b. Interferon beta-1a c. Interferon gamma-1b d. Interferon alfa-2b
d
The nurse is caring for a client who had a postpartum hemorrhage 2 weeks ago that resulted in anemia. The client has called the clinic after passing dark stools, stating, "I looked this up online, and I'm worried I might have stomach or intestinal bleeding." What is the nurse's best initial action? a. Ask the client is she knows how much blood she lost postpartum. b. Assess the client's usual bowel pattern. c. Assess whether the client was given erythropoietin. d. Ask the client whether she is taking iron supplements.
d
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? a. Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia. b. Chronic kidney disease stimulates the production of red blood cells causing anemia. Epogen slows the production of red blood cells to cause anemia. c. 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. d. 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.
a
What medication would best meet the needs of a client whose anemia is associated with chronic renal failure? a. Methoxy polyethylene glycol-epoetin beta b. Hydroxyurea c. Ferrous sulfate exsiccated d. Levoleucovorin
a
What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa? a. Impaired tissue oxygenation related to anemia b. Altered skin integrity due to the disease process c. Alteration in bowel elimination due to side effects of the medication d. Alteration in nutrition due to poor intake of iron
a
Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy? a. A 62-year-old male with cancer b. A 40-year-old male with a high white blood cell count c. A 20-year-old female d. A 30-year-old pregnant woman
a
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. Hodgkin's disease c. Metastatic melanoma skin cancer d. Liver cancer e. Metastatic bone cancer
a, c
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. administering an unscheduled dose b. temporarily withholding administration c. requesting a change in the dosage d. changing the route of administration
b
A male client is diagnosed with multiple myeloma. What treatment regimen would the nurse expect the health care provider to order? a. Sargramostim b. Interferon alfa c. Epoetin d. Filgrastim
b
A male client is prescribed interferon. What is his probable diagnosis? a. Hypertension b. Viral hepatitis c. Sepsis d. Bacteremia
b
A nurse is to use a single-dose 1 mL vial to administer 0.5 mL of epoetin alfa to a 39-year-old woman who is being treated for chemotherapy-induced anemia. Which of the following will the nurse do with the unused portion of the drug? a. Store the medication in the drug cart for the next dose. b. Discard the unused portion of the drug. c. Put the medication in the freezer compartment of the refrigerator. d. Refrigerate the medication for a future use.
b
For what purpose would the nurse administer postoperative epoetin alfa to the client who is a Jehovah's Witness? a. Treatment of HIV infection b. Reduce the need for allogenic blood transfusion c. To prevent the need for chemotherapy d. Treatment of anemia associated with chronic renal failure
b
Ms. Ziem is prescribed filgrastim. The nurse provides education to Ms. Ziem about this therapy. Which statement would indicate the patient understood the teaching? a. "Filgrastim will be discontinued when the neutrophil count drops unexpectedly." b. "I will avoid crowds and people with illnesses." c. "I will never refrigerate the drug." d. "Filgrastim will be discontinued to prevent excessively high neutrophil counts."
b
The nurse would contact the prescriber immediately if interferon was prescribed for which client? a. 72-year-old male with AIDS-related Kaposi's sarcoma b. 11-month-old female with HIV acquired from her mother c. 34-year-old male with chronic hepatitis B d. 48-year-old female with hepatitis C
b
The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome? a. Increased WBC count b. Increased RBC count c. Decreased RBC count d. Decreased WBC count
b
Which would a nurse identify as the primary issue associated with anemias? a. Defective white blood cells b. Ineffective red blood cells c. Lack of vitamin B12 d. Increased plasma proteins
b
A patient has just been told that her cancer has metastasized to the right kidney. An interferon has been prescribed to treat this metastasis. The patient asks why the interferon is ordered. What is the nurse's best response? a. It has been shown to enhance allogeneic stem-cell transplantation. b. It has been shown to have a direct proliferative effect on renal tumors. c. It has been shown to inhibit tumor growth. d. It has been shown to protect autologous tumor cells.
c
All hematopoietic and immune blood cells are derived from which cells in the bone marrow? a. Theta cells b. Alfa cells c. Stem cells d. Beta cells
c
Mr. Singh is a 66-year-old man who is receiving chemotherapy for the treatment of lung cancer that has metastasized to his liver. In an effort to prevent infection, Mr. Singh has been prescribed filgrastim (Neupogen). Which of the nurse's following assessment questions most directly addresses a common adverse effect of filgrastim? a. "Have you noticed any bleeding in your gums or cheeks?" b. "Have you had any shortness of breath lately?" c. "Do you feel like you're having any pain in your bones?" d. "Are you experiencing any waves of cool, clammy skin?"
c
The nurse improves client compliance with the drug regimen of epoetin alfa by: a. having the client pharmacy contact the client on days when the drug should be administered. b. arranging a referral for community transportation. c. helping the client set up a reminder system for days when the drug is to be administered. d. providing the client with an appointment card for each drug administration day.
c
The nurse is caring for a client with a WBC of 700 cells/mm3. Which discharge instruction is most important for the nurse to share with this client? a. "Watch for signs of excessive bruising." b. "Eat foods rich in iron to increase your energy level." c. "Stay out of crowded places such as grocery stores." d. "Go for a walk in the mall everyday to increase your endurance."
c
The nurse is teaching a client about erythrocytes. Which information would the nurse include in the teaching plan? a. Erythrocytes are also called platelets. b. Erythrocytes are also called plasma. c. Erythrocytes are also called red blood cells. d. Erythrocytes are also called white blood cells.
c
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? a. "Anemia is a condition caused by reduced amounts of hematocrit, causing less oxygen to be delivered to the tissues." b. "Anemia is a condition caused by reduced amounts of platelets, causing less oxygen to be delivered to the tissues." c. "Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues." d. "Anemia is a condition caused by reduced amounts of protein, causing less oxygen to be delivered to the tissues."
c
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? a. Interleukins b. Colony-stimulating factor c. Erythropoietin d. Interferon
c
The nurse is admitting a client who has neutropenia. The nurse would expect to document which findings when taking the nursing history? (Select all that apply.) a. Shortness of breath when walking b. Bleeding from gums when brushing teeth c. Thrush infection of the mouth twice in last 4 weeks. d. Bruising more easily e. Upper respiratory infection three times in last 4 months
c, e
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? a. Penicillin b. Filgrastim c. Interferon gamma d.Epoetin alfa
d
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
A client prescribed epoetin alfa asks how the medication works. Which is the nurse's best response? a. "Decreases release of reticulocytes, which inhibits red blood cell (RBC) production." b. "Stimulates the growth and development of white blood cells (WBC) to prevent neutropenia." c. "Releases erythropoiesis from the kidneys to increase the number of platelets." d. "Increases the release of cells to increase the hemoglobin and hematocrit levels."
d
A client prescribed epoetin alfa requests changing the medication from the subcutaneous to the oral route. Which statement should the nurse use to formulate a response to this request? a. The drug dose must be increased if being given via the oral route. b. The oral route while more desirable is not as effective. c. This medication is likely to causes severe diarrhea if given orally. d. This drug is destroyed by acids found in the stomach.
d
A patient has an elevated white blood cell (WBC) count. What is the nurse's primary action related to this finding? a. Place the patient in protective isolation. b. Protect the patient from other sources of infection. c. Assess the patient for exposure to antigens. d. Assess the patient for other signs of infection.
d
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? a. The patient maintains an oxygen saturation of 92% on room air b. The patient white blood cell level is within reference ranges c. Capillary refill in the patient's nail beds is less than or equal to 3 seconds d. The patient's hemoglobin level is 11 g/dL
d
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? a. Sodium restriction b. Renal dialysis c. Potassium supplement d. Iron supplement
d
The pharmacology instructor is talking about interferon. The instructor explains that agents such as interferons have more than one biologic function. What function is NOT associated with interferons? a. Immunomodulatory b. Antiviral c. Antiproliferative d. Antibacterial
d
What ordered dosage for epoetin alfa (Procrit) could the nurse administer without needing to question the order? a. 0.45 mcg/kg IV once per week b. 100 mg/d PO c. 1 mg/d IM d. 100 units/kg subcutaneously three times per week
d
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? a. ankylosing spondylosis b. asthma c. bacterial pneumonia d. chronic hepatitis C
d
