NUR 3420 - PrepU Ch 11 - Exam 4
blood pressure Explanation: 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 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?
Iron Explanation: Epoetin is not effective unless sufficient iron is present, and most clients need an iron supplement. When an iron preparation is prescribed, the home care nurse may need to emphasize the importance of taking it.
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?
500-10,000 mm3 Explanation: Clients are at highest risk for infection when neutrophil counts fall below 500/mm3, and immunostimulants should be stopped when neutrophil counts exceeds 10,000 mm3
An immunostimulant has been ordered for a chemotherapy client. The client asks the nurse why they need to take this drug. The nurse explains that the medication is given to increase the WBC count to at least what level?
Hematocrit and hemoglobin Explanation: Hematocrit and hemoglobin levels will indicate drug effectiveness and could be used to determine dosage. Immature RBCs lose their nucleus and enter circulation as a reticulocyte. A measure of RBCs would indicate the number of blood cells per cubic millimeter and does not indicate iron or O2 content. The hemoglobin count represents the iron-containing pigment of the RBC, which carries oxygen from the lungs to the tissue. The hematocrit represents the volume of solids (iron) and plasma in the blood. These two measures indicate the basis for a diagnosis of anemia. Aspartate transminase levels are associated with liver function and serum creatinine levels are associated with renal function.
Prior to administration of an iron preparation, what should a nurse assess?
Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia. Explanation: 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.
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?
Increased red blood cell count Explanation: Epoetin alfa is the recombinant form of human erythropoietin, which increases the body's ability to produce red blood cells (RBCs). The patient's RBCs should increase in response. This medication will not increase white blood cells or the patient's resistance to infection. The patient's heart rate would not increase in response to this medication.
The nurse administers epoetin alfa (Epogen). What is the therapeutic response the nurse expects to assess?
Iron supplement Explanation: 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.
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 62-year-old male with cancer Explanation: 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
Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy?
Ineffective red blood cells Explanation: 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.
Which would a nurse identify as the primary issue associated with anemias?
Assess the patient for other signs of infection. Explanation: The patient with an elevated WBC count may have an active infection. The nurse should first assess for other signs of infection so that treatment can be initiated. If the patient already has symptoms, assessing for exposure is not the priority. It would not be appropriate to place the patient in protective isolation unless the patient has other risks identified.
A patient has an elevated white blood cell (WBC) count. What is the nurse's primary action related to this finding?
Hypertension Explanation: All three of these drugs are contraindicated in the presence of uncontrolled hypertension, because of the risk of even further hypertension when RBC numbers increase and the pressure within the vascular system increases. There is no contraindication to the use of erythropoeisis-stimulating agents for patients with asthma, irritable bowel syndrome, or shortness of breath
A patient has been prescribed epoetin alfa. In reviewing this patient's history, what would the nurse know contraindicates the use of epoetin alfa?
An iron supplement Explanation: Patients taking epoetin alfa who require surgery may require iron supplementation.
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?
Stem cells Explanation: All hematopoietic and immune blood cells are derived from stem cells in the bone marrow.
All hematopoietic and immune blood cells are derived from which cells in the bone marrow?
Produce erythropoietin Explanation: 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
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?
Ask the client whether she is taking iron supplements Explanation: Iron supplements often cause black, tarry stool. This does not mean that the client should not be assessed further, but this is the most likely question to ask initially. The quantity of the client's blood loss post-partum is not a priority. The client would not have required erythropoietin for a hemorrhage. It is not a high priority to ask about the client's usual bowel pattern; the client has already indicated that this is a significant deviation.
The nurse is caring for a client who had a post-partum hemorrhage two 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?
Techniques to reduce exposure to infection Explanation: With filgrastim, the nurse may need to help the client and family with techniques to reduce exposure to infection.
The nurse is caring for a female client in the home. The client is prescribed filgrastim. What would be included in the nurse's education plan?
"The hematopoietic system is composed of fluid, red blood cells, white blood cells, and platelets." Explanation: 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 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 repond?
Erythrocytes are also called red blood cells. Explanation: Erythrocytes are also called red blood cells. White blood cells, plasma, and platelets are not erythrocytes
The nurse is teaching a client about erythrocytes. Which information would the nurse include in the teaching plan?
A calendar to mark the days of the week the drug is to be administered Explanation: The nurse should provide the patient with a calendar of the days the drug is to be administered. This will serve as a reminder that the patient has to get to the clinic or that the home health nurse will be coming. This would encourage compliance by being at the clinic or being available at home on the days of administration. An appointment card given to him each time he is to have a dose would be easy to loose and would not help with compliance. More than likely the patient will not be purchasing the drug himself. Therefore, the telephone number of the pharmacy would not be helpful. If needed the information concerning community transportation could be useful, but the patient would have to know the days he would need transportation to the clinic.
The nurse is working with a male client diagnosed with chronic renal disease. To increase compliance with the drug regimen, what should the nurse provide the patient who has been prescribed epoetin alfa?
Erythropoietin Explanation: 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.
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?
