Ch 11

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 had any shortness of breath lately?" b. "Have you noticed any bleeding in your gums or cheeks?" c. "Do you feel like you're having any pain in your bones?" d. "Are you experiencing any waves of cool, clammy skin?"

"Do you feel like you're having any pain in your bones?"

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? a. blood pressure b. temperature c. heart rate d. respiratory rate

blood pressure

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. "I will avoid crowds and people with illnesses." b. "Filgrastim will be discontinued when the neutrophil count drops unexpectedly." c. "Filgrastim will be discontinued to prevent excessively high neutrophil counts." d. "I will never refrigerate the drug."

"I will avoid crowds and people with illnesses."

A client prescribed epoetin alfa asks how the medication works. Which is the nurse's bestresponse? a. "Releases erythropoiesis from the kidneys to increase the number of platelets." b. "Decreases release of reticulocytes, which inhibits red blood cell (RBC) production." c. "Stimulates the growth and development of white blood cells (WBC) to prevent neutropenia." d. "Increases the release of cells to increase the hemoglobin and hematocrit levels."

"Increases the release of cells to increase the hemoglobin and hematocrit levels."

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."

"The patient has increases in the number of natural killer cells."

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 folic acid supplement b. An iron supplement c. A blood transfusion d. A protein supplement

An iron supplement

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

Antibacterial

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 bestinitial action? a. Determine if the client is taking iron supplements. b. Ask how much blood the client lost postpartum. c. Assess the client's usual bowel pattern. d. See if the client was treated with erythropoietin.

Determine if the client is taking iron supplements.

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. Put the medication in the freezer compartment of the refrigerator. b. Store the medication in the drug cart for the next dose. c. Discard the unused portion of the drug. d. Refrigerate the medication for a future use.

Discard the unused portion of the drug.

The client has taken epoetin alfa with good results for several months. On this visit, the nurse analyzes the client's lab results and finds indications of severe anemia and cytopenias. What prescription will the nurse anticipate receiving? a. Begin administering epoetin alfa intravenously instead of subcutaneously. b. Discontinue the use of epoetin alfa. c. Change the client to another erythropoiesis-stimulating agent. d. Increase the dosage of epoetin alfa.

Discontinue the use of epoetin alfa.

What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa? a. Alteration in nutrition due to poor intake of iron b. Altered skin integrity due to the disease process c. Impaired tissue oxygenation related to anemia d. Alteration in bowel elimination due to side effects of the medication

Impaired tissue oxygenation related to anemia

The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome? a. Decreased WBC count b. Increased WBC count c. Increased RBC count d. Decreased RBC count

Increased RBC count

Which would a nurse identify as the primary issue associated with anemias? a. Defective white blood cells b. Increased plasma proteins c. Ineffective red blood cells d. Lack of vitamin B12

Ineffective red blood cells

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 alfa-2b d. Interferon gamma-1b

Interferon alfa-2b

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: a. Iron levels b. Swelling of veins c. Chemotherapy d. Renal failure

Iron levels

Adverse effects of epoetin and darbepoetin include increased risks of what condition? a. Hyperlipidemia b. Myocardial infarction c. Cirrhosis of the liver d. Diabetes mellitus type 2

Myocardial infarction

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

Produce erythropoietin

For what purpose would the nurse administer postoperative epoetin alfa to the client who is a Jehovah's Witness? a. To prevent the need for chemotherapy b. Reduce the need for allogenic blood transfusion c. Treatment of HIV infection d. Treatment of anemia associated with chronic renal failure

Reduce the need for allogenic blood transfusion

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? a. Fall prevention b. Techniques to reduce exposure to infection c. Exercise restrictions d. Dietary restrictions

Techniques to reduce exposure to infection

Which symptom, if assessed after the administration of epoetin alfa (Epogen), would be cause for alarm? a. The patient displays weakness on one side of the body. b. The patient is tired. c. The patient reports "bone pain." d. The patient states the injection "hurts."

The patient displays weakness on one side of the body.

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 has elevated liver function tests. c. The patient administered the medication at home. d. The patient reports feeling "fatigued."

The patient has elevated liver function tests.

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 white blood cell level is within reference ranges b. The patient's hemoglobin level is 11 g/dL c. Capillary refill in the patient's nail beds is less than or equal to 3 seconds d. The patient maintains an oxygen saturation of 92% on room air

The patient's hemoglobin level is 11 g/dL

A male client is prescribed interferon. What is his probable diagnosis? a. Hypertension b. Viral hepatitis c. Bacteremia d. Sepsis

Viral hepatitis

A client is suspected of having impaired erythropoiesis. This client is most likely to exhibit signs and symptoms associated with what health problem? a. sepsis b. anemia c. disseminated intravascular coagulation (DIC) d. venous thromboembolism

anemia

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. hypoglycemia b. anemia c. thrombocytopenia d. hypertension

anemia

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. chronic hepatitis C b. bacterial pneumonia c. asthma d. ankylosing spondylosis

chronic hepatitis C

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. aspartate aminotransferase levels b. serum creatinine levels c. hematocrit and hemoglobin d. white cell differential

hematocrit and hemoglobin

A client with chronic kidney disease has been receiving epoetin alfa subcutaneous injections and has a hemoglobin level of 9.9 g/dl (99 g/L). Which treatment would the nurse anticipate being prescribed when the client reports new-onset fatigue? a. progressive activity program b. low-dose stimulant medication c. iron supplements d. oxygen therapy

iron supplements

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. temporarily withholding administration b. changing the route of administration c. administering an unscheduled dose d. requesting a change in the dosage

temporarily withholding administration

A patient has an elevated white blood cell (WBC) count. What is the nurse's primary action related to this finding? a. Assess the patient for exposure to antigens. b. Protect the patient from other sources of infection. c. Assess the patient for other signs of infection. d. Place the patient in protective isolation.

Assess the patient for other signs of infection.

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 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. c. Chronic kidney disease stimulates the production of red blood cells causing anemia. Epogen slows 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.

Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia.

What assessment finding does the nurse determine is a therapeutic outcome of administering filgrastim (Neupogen) to the patient? a. Heart rate decreased from 100 to 60 beats per minute b. Elevation of hemoglobin c. Increased red blood cell count (RBC) d. Elevation of white blood cell count (WBC)

Elevation of white blood cell count (WBC)

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. Epoetin alfa b. Filgrastim c. Penicillin d. Interferon gamma

Epoetin alfa

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. Erythropoietin c. Interferon d. Colony-stimulating factor

Erythropoietin