Hematological Pharm

The home care nurse is making a monthly visit to a client with a diagnosis of pernicious anemia who has been receiving a monthly injection of cyanocobalamin. Before administering the injection, the nurse evaluates the effects of the medication and determines that a therapeutic effect is occurring if the client makes which statement? 1. "I feel really lightheaded." 2. "I no longer have any nausea." 3. "I have not had any pain in a month." 4. "I feel stronger and have a much better appetite."

"I feel stronger and have a much better appetite."

The nurse has provided instruction to a client with chronic kidney disease who has a prescription for epoetin alfa. Which statement by the client term-46indicates that teaching was effective? 1. "I have to receive this medication subcutaneously." 2. "I will receive this medication through intramuscular injection." 3. "This medication has to be administered using the Z-track method." 4. "I will take this medication orally with the rest of my morning pills."term-62

"I have to receive this medication subcutaneously."

The nurse is providing instructions to the parent of a child with iron deficiency anemia about the administration of a liquid oral iron supplement. Which statement, if made by the parent, indicates an understanding of the administration of this medication? 1. "I should give the iron with food." 2. "I can mix the iron with cereal to give it." 3. "I should add the iron to the formula in the baby's bottle." 4. "I should use a medicine dropper and place the iron near the back of the throat."

"I should use a medicine dropper and place the iron near the back of the throat."

Epoetin alfa is prescribed for a client diagnosed with chronic kidney disease. The client asks the nurse about the purpose of the medication. Which response by the nurse is most appropriate? 1. "It is used to treat anemia." 2. "It is used to lower your blood pressure." 3. "It will help to increase the potassium level in your body." 4. "It is an anticonvulsant medication given to all clients after dialysis to prevent seizure activity."

"It is used to treat anemia."

The nurse is providing dietary instructions to the client with anemia. The client tells the nurse that the iron pills are very expensive, and it will be difficult to pay for the pills and buy the proper food. What is the most appropriate nursing response? 1. "You will have to find a way to afford both." 2. "You will be fine as long as you take the iron pills." 3. "Why don't you ask your family to help you out financially?" 4. "Would you like for me to check into some other options for you?"

"Would you like for me to check into some other options for you?"

Heparin/Enoxaparin Sodium Considerations

-Baseline VS and labs CBC, platelet count, and hct. -SQ or IV, usually q 12 hr. -IV pump for continuous IV administration; monitor rate of infusion every 30 to 60 min. -Monitor aPTT every 4 to 6 hr initially, then daily. Keep aPTT at one and a half to two times the baseline value. -Administer deep SQ in the abdomen at least 2 inches from the umbilicus

A nurse is teaching a client about taking ferrous sulfate to treat iron-deficiency anemia. Which of the following instructions should the nurse include? (Select all that apply.)

-Eat iron-enriched foods -Spread the dosage across each day -Take the drug on an empty stomach -Increase dietary fiber intake

Ferrous Sulfate Considerations

-Expect dark green or black stools Increase fiber, fluid, end exercise prevent constipation. -Rinse mouth, hard candy or gum for metallic taste. -Dilute in liquid when giving to infants. Give through straw if possible. -Iron dextran-Give test dose first - follow with prescribed dose 1 hour later due to possibility of anaphylaxis. Have epinephrine available for hypersensitivity reaction. -Administer using 2- to 3-inch-long needle using Z-track technique. IV doses no faster than 50 mg/min or dilute the dose for intermittent infusion in 200 to 1,000 milliliters of 0.9% NaCl (NS) -Monitor BP, Hgb, Hct, and reticulocyte count. -The antidote is deferoxamine (Desferal) parenterally

Alteplase Considerations

-Give ASAP within onset of symptoms (less than 2 hr for MI, 3-4.5 hr for CVA). -Obtain baseline platelet counts, Hgb, Hct, aPTT, PT, INR, and fibrinogen levels, and monitor periodically. -Baseline VS, monitor continuously. -Watch for s/s of intracranial bleeding (level of consciousness, headache, unilateral weakness). -Ensure IV access for emergency drugs; emergency equipment available. -Following thrombolytic therapy, administer heparin or aspirin to reduce the risk of repeat thrombosis. Use a special form (Cathflo Activase) to open occluded IV catheters. -For severe bleeding, discontinue the drug and administer blood products. If bleeding continues, administer aminocaproic acid (Amicar).

Folic Acid Considerations

-Give orally, IM, or IV. -Check vit B12 to confirm not deficient. -Baseline folate, hgb, hct, RBC & reticulocyte count & periodically. -Hct improvement within 2 weeks. -Report rash. -Encourage diet high in folic acid.

Epoetin Alfa Considerations

-IV or subcutaneously 3xs a week or 1x for some chemo tx. -Vial for one use only. Do not shake or mix with other drugs. -Obtain base BP, CVC, Hgb, BUN, uric acid, phosphorus, K+, creatinine, transferrin saturation, and ferritin concentration and monitor periodically. -HIV clients get erythropoietin levels. -Monitor Iron levels, folic acid, and vit B12 (RBC growth). -Do not give if client has cancer and Hgb above 10 g/dL.

Cyanocobalamin Considerations

-Most clients can absorb adequate amounts of vitamin B12 if large oral doses are given. -Give w/ food to enhance absorption. Other routes for those who have malabsorption syndrome. -Intranasally 1 hr before or after clients eat hot foods to avoid removal from nasal passages before absorption. -Obtain baseline Vit B12 Hgb, Hct, RBC, & reticulocyte count, then q 3 to 6 mths. -Expect lifelong tx for clients who have irreversible B12 deficiencies, such as pernicious anemia, usually parenterally. -Encourage dietary intake of foods high in vitamin B12 (dairy products, enriched cereal, egg yolks, some seafood) -Report muscle weakness, nausea, palpitations, or paresthesia.

Clopidogrel Considerations

-Orally, w/w/o food depending on GI upset. -Check platelet counts periodically, and discontinue 1 week before surgery. -Report GI irritation/bleeding, sudden severe HA, weakness, numbness, paralysis, vision changes, nausea, vomiting, or seizures

Warfarin Considerations

-Report bruising, petechiae, hematomas, or black tarry stools. -Obtain baseline VS (hypotension, tachycardia) -Monitor PT & INR daily and eventually every 2-4 weeks (reduced dosage for INR above 2-3 and increased for below this range). -Anticoagulant effect 8-12 hr/full effect 3-5 days. -Vit K (promotes the synthesis of coagulation factors VII, IX, X, and prothrombin) for overdose (administer slowly/diluted/small doses and Plasma or whole blood if Vit K ineffective.

A nurse is administering epoetin intravenously to a client who has renal failure. Which of the following actions should the nurse take?

Administer via IV bolus over 1 to 3 min

The nurse is evaluating the results of laboratory studies for a client receiving epoetin alfa. When should the nurse expect to note a therapeutic effect of this medication? 1. Immediately 2. After 3 days of therapy 3. After 1 week of therapy 4. After 2 weeks of therapy

After 2 weeks of therapy

A nurse is caring for a client who is experiencing an acute ischemic cerebrovascular event due to a thrombus in a cerebral vessel. Which of the following drugs should the nurse expect to administer?

Alteplase

A nurse is caring for a client who is about to begin alteplase therapy to treat pulmonary embolism. Which of the following drugs should the nurse have available in the event of a severe adverse reaction?

Aminocaproic acid

A client with chronic kidney disease is receiving epoetin alfa for the past 2 months. What should the nurse determine is an indicator that this therapy is effective? 1. A decrease in blood pressure 2. An increase in white blood cells 3. An increase in serum hematocrit 4. A decrease in serum creatinine level

An increase in serum hematocrit

A nurse is preparing to administer a prescribed dose of desmopressin to a client who has hemophilia A. The client's laboratory results indicate that the client has a sodium level of 130 mEq/L. Which of the following actions should the nurse take?

Clarify the prescription with the provider

Ferrous Sulfate (Feosol)

Class: Iron Preparations Use: Treat iron-deficiency anemia replacing iron deficiency and restoring the body's ability to carry oxygen

A nurse is caring for a client who has chronic stable angina. The nurse should identify that which of the following drugs inhibits the action of adenosine diphosphate receptors (ADP) on platelets and can be prescribed to reduce the client's risk for myocardial infarction?

Clopidogrel

A client with chronic kidney disease is receiving ferrous sulfate. The nurse instructs the client that which finding is a common side/adverse effect associated with this medication? 1. Fatigue 2. Headache 3. Weakness 4. Constipation

Constipation

A nurse is monitoring a client following ferrous sulfate administration. The nurse should monitor the client for which of the following adverse effects?

Constipation

Ferrous Sulfate

Contraindications: Hemolytic anemia, Severe liver disease, alcoholism, severe renal impairment Peptic ulcer disease, ulcerative colitis, regional enteritis Hemochromatosis. Side Effects: Nausea, constipation, epigastric pain, diarrhea, metallic taste in mouth (iron dextran), staining of teeth (liquid form), fatal iron toxicity (overdose in children), and Iron dextran-Anaphylactic reactions or seizures.

Clopidogrel

Contraindications: Peptic ulcer disease, bleeding disorders, thrombocytopenia, and intracranial bleeding. Side Effects: GI (abdominal pain, diarrhea, nausea, gastric ulceration/bleeding (less than aspirin) Thrombotic thrombocytopenic purpura (rare)

Alteplase

Contraindications: Prior ICH, structural cerebral vascular lesion (arteriovenous malformation, aneurysm), suspected aortic dissection, active internal bleeding, history of significant closed head or facial trauma in the past 3 months, acute pericarditis or brain tumor. Side Effects: Bleeding (intracranial, needle puncture sites, wounds)

Cyanocobalamin

Contraindications: Sensitivity to vitamin B12 and other cobalamins, hereditary optic nerve atrophy, renal dysfunction, and concurrent infections. Cardiovascular disease, pulmonary disease, other types of anemia, and concurrent folic acid use Side Effects: Erythema, hypertension, and hypokalemia

Warfarin

Contraindications: Teratogenic, vit k deficiency, thrombocytopenia, liver disease, alcoholism, surgical procedures, threatened spontaneous abortion Side Effects: Hemorrhage and Toxicity (OD)-Client should stop taking if s/s of hemorrhage (bruising gums, abdominal pain, nosebleeds, coffee ground emesis, tarry stools).

Heparin/Enoxaparin Sodium

Contraindications: Uncontrollable bleeding, severe thrombocytopenia, during lumbar puncture, regional anesthesia, or surgery that involves the brain, eyes, or spinal cord, or threatened spontaneous abortion. Side Effects: Bleeding leading to hemorrhage. Thrombocytopenia (low platelet count). Heparin is derived from animal cells so some hypersensitivity reactions can occur such as itching, rash, or hives.

Epoetin Alfa

Contraindications: Uncontrolled hypertension, Cancer - dependent upon overall treatment protocol, and Iron-deficiency anemia. Side Effects: Hypertension, seizures, cardiovascular and cerebrovascular events (myocardial infarction, heart failure, cerebrovascular accident, cardiac arrest. Malignancy progression.

Folic Acid

Contraindications: Vit B12 deficiency (after initial stabilization), other types of anemia, and neonates. Side Effects: Increased yellowing of urine, masks B12 deficiency in high doses, and increased risk of developing colorectal or prostate cancer (long-term use).

A nurse is caring for a client who is about to begin therapy with recombinant factor IX to treat hemophilia B. The client asks the nurse about the risk of disease transmission with recombinant factor IX as compared with plasma-derived factor IX. The nurse should explain that recombinant factor IX practically eliminates the risk for which of the following?

Creutzfeldt-jakob disease

A nurse is caring for a client who is taking ferrous sulfate to treat iron-deficiency anemia and develops iron toxicity. Which of the following drugs should the nurse expect to use to treat this complication?

Deferoxamine

NCLEX Don't Need to Know The nurse is caring for a client who was just admitted to the hospital for the treatment of iron overload. The nurse anticipates that the primary health care provider will prescribe which medication to treat the iron overload? 1. Terbinafine 2. Granisetron 3. Ketoconazole 4. Deferoxamine

Deferoxamine

A nurse is teaching a client who is starting treatment with warfarin. The nurse should plan to include information on which of the following topics to promote the effectiveness of the drug?

Dietary modifications

A client is prescribed a liquid iron preparation that has the potential to stain the teeth. The nurse should instruct the client to take which action to prevent staining of the teeth? 1. Brush the teeth before drinking the iron. 2. Drink the iron undiluted for maximal effect. 3. Dilute more than the amount prescribed to obtain the correct dosage. 4. Dilute the iron in juice, drink it through a straw, and rinse the mouth afterward.

Dilute the iron in juice, drink it through a straw, and rinse the mouth afterward.

The nurse is preparing to administer filgrastim by intravenous (IV) infusion. Which nursing action is the most appropriate for administering this medication? 1. Shake the solution before drawing it up. 2. Dilute the medication in normal (0.9%) saline. 3. Discard the medication if it has been refrigerated. 4. Dilute the medication in 5% dextrose in water (D5W).

Dilute the medication in 5% dextrose in water (D5W).

A nurse is caring for a client who has hemophilia A and is about to begin taking desmopressin to prevent bleeding. The nurse should monitor the client for which of the following adverse reactions?

Edema

A nurse is caring for a client who is taking filgrastim to treat neutropenia. The nurse should assess the client for which of the following adverse effects?

Enlarged spleen

A nurse is caring for a client who is about to begin factor VIII therapy to treat hemophilia A. When administering factor VIII, which of the following actions should the nurse take?

Have emergency equipment ready

A nurse is caring for a client who recently started alteplase therapy. The nurse should monitor the client for which of the following adverse effects?

Headache

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 33% (0.33) 2. Platelet count of 400,000 mm3 (400 × 109/L) 3. White blood cell count of 6000 mm3 (6.0 × 109/L) 4. Blood urea nitrogen level of 15 mg/dL (5.25 mmol/L)

Hematocrit of 33% (0.33)

A nurse is reviewing the medication record of a client who is receiving alteplase following an acute myocardial infarction (MI). Which of the following medications should the nurse expect the client to be taking in addition to the alteplase?

Heparin

A nurse is caring for a client who is about to begin taking epoetin. An increase in which of the following laboratory values should indicate to the nurse that the therapy is effective?

Hgb

A nurse is caring for a client who has renal failure and is receiving epoetin. The nurse should monitor the client for which of the following adverse effects?

Hypertension

The client in chronic kidney disease is receiving epoetin alfa. The nurse should monitor this client for which side/adverse effect of this medication? 1. Fever 2. Depression 3. Bradycardia 4. Hypertension

Hypertension

The nurse is monitoring a client who is receiving epoetin alfa for adverse effects of the medication. Which finding indicates a side/adverse effect? 1. Diarrhea 2. Depression 3. Bradycardia 4. Hypertension

Hypertension

A nurse is caring for a client who is about to begin taking aspirin to reduce the risk of a cardiovascular event. The nurse should identify that the drug inhibits platelet aggregation by which of the following mechanisms?

Inhibiting cyclooxygenase action in platelets

NCLEX Don't Need to Know The nurse is preparing to administer filgrastim to a client with a diagnosis of agranulocytosis. The client asks the nurse about the purpose of the medication. Which information should the nurse include in the response regarding action of this medication? 1. It prevents bleeding. 2. It prolongs the clotting time. 3. It increases the red blood cell count. 4. It promotes the growth of neutrophils.

It promotes the growth of neutrophils.

The nurse is reviewing the laboratory test results for a client who is receiving filgrastim. Which reported value would indicate an effective response to this medication? 1. Hematocrit of 42% (0.42) 2. Platelet count of 150,000 mm3 (150 × 109/L) 3. Blood glucose level of 110 mg/dL (6 mmol/L) 4. Neutrophil count of 10,000 mm3 (10 × 109/L)

Neutrophil count of 10,000 mm3 (10 × 109/L)

A nurse should identify that clopidogrel is contraindicated for clients who have which of the following conditions?

Peptic ulcer disease

A nurse is monitoring a client who is undergoing anticoagulant therapy with heparin. Which of the following findings should the nurse identify as a possible indication of hemorrhage?

Rapid pulse

Epoetin alfa by the subcutaneous route is prescribed for a client. What is the most appropriate nursing action? 1. Shake the vial before use. 2. Freeze the medication before use. 3. Refrigerate the medication until used. 4. Obtain syringes with 1½-inch (3.8 cm) needles for administration.

Refrigerate the medication until used.

A nurse is caring for a client who is about to begin taking folic acid to treat megaloblastic anemia. The nurse should monitor which of the following laboratory values to determine therapeutic effectiveness?

Reticulocyte count

NCLEX Don't Need to Know The nurse is preparing to administer filgrastim to the client. Which route of administration should the nurse determine is the most appropriate for this medication? 1. Oral 2. Subcutaneous 3. Intramuscular 4. Intravenous bolus

Subcutaneous

A client with chronic kidney disease has a medication prescription for epoetin alfa. The nurse should plan to administer this medication by which method? 1. Subcutaneously 2. Intramuscularly 3. With a full glass of water 4. Diluted in juice to enhance taste

Subcutaneously

A nurse is caring for a client who is taking clopidogrel to prevent stent restenosis. The nurse should monitor the client for which of the following adverse reactions?

Thrombocytopenia

A client is diagnosed with iron deficiency anemia, and ferrous sulfate is prescribed. The nurse should tell the client that it would be best to take the medication with which food? 1. Milk 2. Boiled egg 3. Tomato juice 4. Pineapple juice

Tomato juice

A nurse is caring for a client who is scheduled for an outpatient surgical procedure and reports taking aspirin 81 mg daily, including this morning. The nurse should identify that this places the client at risk for which of the following complications?

Uncontrolled bleeding

The nurse has a prescription to administer a dose of iron by the intramuscular route to the client. What are the most appropriate nursing actions? Select all that apply. 1. Use a Z-track method. 2. Administer the medication only in the deltoid. 3. Aspirate for blood after the needle is inserted. 4. Use an air lock when drawing up the medication. 5. Change the needle after drawing up the dose and before injection. 6. Massage the injection site well after injection to hasten absorption.

Use a Z-track method. Use an air lock when drawing up the medication. Change the needle after drawing up the dose and before injection.

Folic Acid

Uses: : Treats folate deficiency secondary to alcoholism or malabsorption syndrome, such as celiac disease. Class: Antianemics

Alteplase (Activase)

Uses: Acute myocardial infarction, pulmonary emboli, ischemic cerebrovascular accidents, deep vein thrombosis, and reestablishing patency of occluded central IV catheters. Class: Thrombolytic

Heparin/Enoxaparin Sodium (Lovenox)

Uses: Cerebrovascular accidents and prevent development of additional emboli, prophylactically, and controlling hemorrhages caused by disseminated intravascular coagulation (DIC). Class: Antithrombotic

Warfarin (Coumadin)

Uses: Helps prevent venous thrombosis and recurrence of MI. Class: Anticoagulants or Vitamin K Antagonist

Clopidogrel (Plavix)

Uses: Reduces risk of MI, ischemic cerebrovascular accident, and angina, prevents occlusion of stents. Class: Adenosine Diphosphate Receptor Inhibitor (ADP)

Epoetin alfa (Epogen)

Uses: Supports production of erythrocytes in chronic renal failure, preoperative anemia, chemotherapy, zidovudine (Retrovir) therapy for HIV. Class: Erythropoiesis Stimulating Agents

Cyanocobalamin (Vitamin B12)

Uses: To treat pernicious anemia and those with a B12 deficiency. Class: Vitamins

A nurse should assess a client who has megaloblastic anemia for indications of which of the following vitamin deficiencies?

Vitamin B12

A nurse in an emergency department is assessing a client who has been taking warfarin and is experiencing rectal bleeding. Which of the following drugs should the nurse expect to administer to the client?

Vitamin K