ATI Pharmacology End of Chapter 26

4. A nurse is assessing a client who has chronic neutropenia and who has been receiving filgastim. Which of the following actions should the nurse take to assess for an adverse effect of filgastim? a. Assess for bone pain. b. Assess for right lower quadrant pain. c. Auscultate for crackles in the bases of the lungs. d. Auscultate the chest to listen for a heart murmur.

Answer is A (Bone pain is a dose-related adverse effect of filgastim. It can be treated with acetaminophen and, if necessary, an opioid analgesic)

3. Nurse is monitoring a client who is receiving epoetin alfa for adverse effects. Which of the following is an adverse effect to this medication? a. Leukocytosis b. Hypertension c. Edema d. Blurred vision

Answer is B (Hypertension is an adverse effect of epoetin alfa that the nurse should monitor for throughout treatment)

1. A nurse is caring for a client who is receiving daily doses of oprelvekin. Which of the following laboratory values should the nurse monitor to determine effectiveness of this medication? a. Hemoglobin b. Absolute neutrophil count c. Platelet count d. Total white blood count

Answer is C (The expected outcome for oprelvekin is a platelet count greater than 50,000/mm3)

2. A nurse is preparing to administer filgastim for the first time to a client who has just undergone a bone marrow transplant. Which of the following interventions is appropriate? a. Administer intramuscularly in a large muscle mass to prevent injury. b. Ensure that the medication is refrigerated until just prior to administration. c. Shake vial gently to mix well before withdrawing dose. d. Discard vial after removing one dose of the medication.

Answer is D (Only one dose of filgrastim should be withdrawn from the vial and the vial should then be discarded)

A nurse is teaching a client who has chronic kidney injury and who is starting subcutaneous epoetin alfa three times weekly. What should the nurse teach the client about this medication? c. Diagnostic tests: Describe two the nurse should monitor periodically.

Baseline iron levels, CBC with differential, and platelet count. Hgb and Hct twice weekly until blood counts stabilize.

A nurse is teaching a client who has chronic kidney injury and who is starting subcutaneous epoetin alfa three times weekly. What should the nurse teach the client about this medication? d. Nursing actions: Describe two.

Calculate dosages carefully. Both subcutaneous and IV epoetin alfa have dosages based on the clietn's weight. Do not shake the epoetin alfa vial, and discard vial after one dose is removed. Monitor blood pressure carefully and report increases to the provider. Question client about frequency and severity of headaches, which could be an indication of increasing BP or a simple adverse effect.

A nurse is teaching a client who has chronic kidney injury and who is starting subcutaneous epoetin alfa three times weekly. What should the nurse teach the client about this medication? b. Adverse effects: Identify two the client should watch for.

Headaches and myalgia (body aches). Thrombotic events, such as myocardial infarction and cerebral vascular accident. Hypertension (common, sometimes serious). A too-rapid increase (Hgb greater than 1g/dL over 2 weeks, or Hgb above 10 or 11 g/dL) can worsen hypertension, increase risk of thrombosis, and cause seizures.

5. A nurse is teaching a client who has chronic kidney injury and who is starting subcutaneous epoetin alfa three times weekly. What should the nurse teach the client about this medication? a. Therapeutic use: Identify for epoetin alfa in this client.

i. Erythropoietin, a substance that stimulates bone marrow to produce red blood cells, is produced by the kidney. In clients who have kidney failure, erythropoietin is no longer present and anemia results. Epoetin alfa stimulates production of red blood cells in these clients.