Karch PrepU: Chapter 49 - Drugs that treat Anemia

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

"Increases the release of cells to increase the hemoglobin and hematocrit levels." Explanation: Epoetin alfa induces erythropoiesis by stimulating erythroid progenitor cells. This causes the release of reticulocytes from the bone marrow, leading to an increase in hemoglobin and hematocrit levels. The medication does not assist with supplying either WBCs or platelets.

The average lifespan of a red blood cell (RBC) is approximately: 30 days. 60 days. 90 days. 120 days.

120 days The average lifespan of an RBC is 120 days. At that time, the elderly RBC is lysed in the liver, spleen, or bone marrow.

A client is receiving epoetin alfa. The nurse understands that this drug's duration of effect would be which amount of time? 12 hours 24 hours 36 hours 48 hours

24 hours Epoetin alfa has a duration of effect of usually 24 hours.

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 protein supplement An iron supplement A blood transfusion A folic acid supplement

A protein supplement Patients taking epoetin alfa who require surgery may require iron supplementation.

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? heart rate temperature blood pressure respiratory rate

Blood Pressure 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 patient is to be administered an erythropoiesis-stimulating agent. Which of the following drugs would the nurse administer? Ferrous sulfate Epoetin alfa Folic acid Hydroxyurea

Epoetin Alfa Epoetin alfa is an erythropoesis-stimulating agent. Ferrous sulfate is used in the treatment of iron-deficiency anemia. Megaloblastic anemia is treated with folic acid. Hydroxyurea is used in the treatment of sickle-cell anemia.

A patient who is HIV positive is receiving zidovudine 4,2000 mg/week and has an endogenous erythropoietin level of 350 mU/mL. What does the nurse anticipate will be administered for this patient? Erythropoietin Rocephin 1 GM IV A blood transfusion An increased dose of zidovudine

Erythropoietin Epoetin alfa is also used to treat anemia related to ziduovudine therapy in HIV-positive patients. It is used when the endogenous erythropoietin levels are 500 mU/mL or less and the dose of zidovudine is 4,200 mg/wk or less.

A patient is taking bumetanide (Bumex) and spironolactone (Aldactone). You should explain that using the drugs together may reduce the risk of which of the following adverse effects?

Hypokalemia Spironolactone, a potassium-sparing diuretic, causes retention of potassium. This reduces the risk of hypokalemia due to potassium loss from bumetanide, a high-ceiling loop diuretic. Using the two drugs together will not affect sodium, glucose, or chloride levels. Hyperglycemia, hyponatremia, and hypochloremia remain risks with the use of bumetanide. Hyponatremia remains a risk with the use of spironolactone.

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: Iron Levels Chemotherapy Renal failure Swelling of veins

Iron Levels Monitoring iron and hematocrit levels may help the nurse track the progress and effectiveness of the epoetin alfa therapy. Chemotherapy is a cancer treatment, not an assessment that determines the success or effectiveness of the epoetin alfa therapy. Swelling of veins and renal failure are not normally monitored in an ongoing assessment of a patient who takes epoetin alfa.

A client who was diagnosed with iron deficiency anemia is worried because she does not know why she was prescribed iron supplements. The nurse teaches the client about which action of oral iron administration? Iron acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia. Iron supplements prevent depletion of hemoglobin cells from anxiety to treat anemia. Iron supplements prevent infection so hemoglobin cells grow back faster to treat anemia. Iron supplements prevent bleeding to replenish hemoglobin cells faster to treat anemia.

Iron acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia. Iron acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia. Iron supplements do not treat anxiety, infection, or bleeding.

Nursing students are reviewing the anatomy and physiology of the hematopoietic system. Which would they correctly identify as the formed elements of blood? (Select all that apply.) Nerve cells Plasma Leukocytes Platelets Erythrocytes

Leukocytes Platelets Erythrocytes Blood is composed of liquid and formed elements. The liquid part is called plasma. The formed elements include leukocytes, erythrocytes, and platelets.

A patient has been prescribed epoetin alfa. The nurse recognizes that this medication is indicated for treatment of anemia associated with which disease process? Lung failure Heart failure Renal failure Liver failure

Renal Failure Epoetin alfa acts like the natural glycoprotein erythropoietin to stimulate the production of red blood cells (RBCs) in the bone marrow. It is often used in the treatment of anemia related to renal failure.

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? Reports of calf pain on dorsiflexion of the foot A rash under the breast 1 pound weight gain in 1 week Dry, nonproductive cough

Reports of calf pain on dorsiflexion of the foot. The nurse should determine whether the patient has pre-existing vascular disease, because it may increase the patient's risk for developing thrombotic adverse effects.

There is a risk of antibody production with the use of epoetin. True False

TRUE Use of any therapeutic protein brings with it the risk of antibody production. All of the erythropoietic proteins now carry a warning about the potential for this problem.

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

The patient displays weakness on one side of the body. Epoetin increases the risk of myocardial infarction and stroke. Any symptoms that could indicate these conditions would be cause for alarm. Weakness on one side of the body could indicate a stroke. The nurse should continue with a neurological assessment and alert the health care provider. Bone pain and pain at the injection site are expected side effects and not cause for alarm. Patients who have anemia, the condition which this medication treats, typically report feeling tired and fatigued, and this is not cause for alarm.

A male client is taking Procrit. He requests changing his medication from the IM to the PO route. The nurse's best response is: The oral route is not as effective. The drug dose must be increased if being given via the oral route. This medication is destroyed in the stomach and can only be given IM. This medication causes severe diarrhea if given orally.

This medication is destroyed in the stomach and can only be given IM. Exogenous cytokines are given by subcutaneous or intravenous (IV) injection because they are proteins that would be destroyed by digestive enzymes if given orally.

The component of the RBC that is not recycled is bilirubin. True False

True The only part of the RBC that cannot be recycled is the toxic pigment bilirubin, which is conjugated in the liver, passed into the bile, and excreted from the body in the feces or the urine.

The patient is being prescribed epoetin alfa for the treatment of anemia related to the renal failure. The patient also has a history of diabetes mellitus, uncontrolled hypertension, osteoarthritis, and hypothyroidism. Which of these conditions should the nurse bring to the physician's attention prior to administering the medication? Diabetes mellitus Hypothyroidism Osteoarthritis Uncontrolled hypertension

Uncontrolled hypertension The nurse should determine whether the patient has pre-existing uncontrolled hypertension, which is a contraindication for the use of epoetin alfa.

When administering iron injections, which method would the nurse use? Subcutaneous Z-Track intramuscular Intradermal This medication is not to be given as an injection.

Z-Track intramuscular The Z-track method is used when injecting iron to reduce the risks of subcutaneous staining and irritation.

What are the primary factors that contribute to the body's ability to fight off infection? Select all that apply. normal hematopoiesis normal immune system function normal cardiovascular function increased platelet cell production decreased exposure to microorganisms

normal hematopoiesis normal immune system function normal cardiovascular function Adequate blood cell production, or hematopoiesis, and normal immune system function, or immunocompetence, are vital processes in the human body's ability to fight harmful invaders. Platelet production is associated with the body's ability to support a normal clotting process. A decrease in harmful microorganisms is a factor in health, but the body's ability to react to such exposure is of primary importance.

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? "Anemia is a condition caused by reduced amounts of protein, causing less oxygen to be delivered to the tissues." "Anemia is a condition caused by reduced amounts of hematocrit, causing less oxygen to be delivered to the tissues." "Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues." "Anemia is a condition caused by reduced amounts of platelets, causing less oxygen to be delivered to the tissues."

"Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues." The nurse teaches the student that anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues; hemoglobin carries oxygen to the cells of the body. Protein, hematocrit, and platelets do not carry oxygen to the tissues.

A client is receiving ferrous sulfate as treatment for iron deficiency anemia. After teaching the client, which statement indicates the need for additional teaching? "I need to take an antacid with the pill to prevent an upset stomach." "I need to make sure that I eat enough foods containing iron." "It might take several months before my iron levels get back to normal." "I need to avoid taking the drug with coffee or tea."

"I need to take an antacid with the pill to prevent an upset stomach." Iron is not absorbed if taken with antacids, so the client should avoid this combination. Adequate iron intake is necessary to assist in regaining a positive iron balance. It can take 2 to 3 weeks to see an improvement and up to 6 to 10 months to return to a stable iron level once a deficiency exists. Iron absorption also is altered if it is taken with milk, eggs, coffee, or tea. These substances should be avoided.

Which would be appropriate for a client who is receiving iron therapy? Ensuring that the client consumes three large meals per day Cautioning the client that stool may be dark or green Encouraging the client to take the drug on an empty stomach Advising the client to limit the amount of fiber in his diet

Cautioning the client that stool may be dark or green. The client needs to be informed that his stools may become dark or green. Small frequent meals with snacks can help minimize nausea. The client may take the drug with meals as long as those meals do not include eggs, milk, coffee, or tea. Constipation is possible, so the client needs to increase the fiber in his diet.

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

Myocardial Infarction Adverse effects of epoetin and darbepoetin include increased risks of hypertension, myocardial infarction, and stroke, especially when used to increase hemoglobin above 12 g/dL.

A nursing instructor is teaching students about the myelin sheath of the central nervous system (CNS). The nurse knows that teaching has been effective when a student identifies which vitamin as necessary for the formation of the myelin sheath in the CNS? Vitamin C Folic acid Vitamin B12 Vitamin D

Vit. B12 Vitamin B12 is necessary for the formation and maintenance of the myelin sheath in the CNS and for the health of RBCs.

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? temporarily withholding administration administering an unscheduled dose changing the route of administration requesting a change in the dosage

Temporarily withholding administration Explanation: Epoetin increases risks of myocardial infarction and stroke, especially if it is used to achieve hemoglobin levels greater than 12 g/dL (120 g/L). The U.S. Food and Drug Administration (FDA) has issued a black box warning advising prescribers to avoid using hematopoietic growth factors in clients with hemoglobin values of 12 g/dL (120 g/L). Administration of the drug should consequently be discontinued on a temporary basis. None of the other options would safely address the client's current health issue.

After teaching a group of students about the types of anemia, the instructor determines that the teaching was successful when the students identify which anemia results from an inability to produce the intrinsic factor? Pernicious anemia Iron deficiency anemia Sickle cell anemia Folic acid deficiency anemia

Pernicious Anemia Pernicious anemia occurs when the gastric mucosa cannot produce the intrinsic factor and vitamin B12 cannot be absorbed. Iron deficiency anemia occurs when blood is lost or the diet is insufficient in supplying adequate iron. Sickle cell anemia results from a genetically inherited hemoglobin S. Folic acid deficiency anemia results from inadequate folic acid intake or malabsorption.

Which patient will the nurse assess first? The patient with a decreased RBC count The patient with a decreased WBC count The patient with anemia The patient with elevated erythropoietin

The patient with a decreased WBC count The patient with a decreased WBC count may have difficulty fighting infection and may be at risk for a contagious disease. The patient with a decreased RBC and anemia would be the second priority and the patient with the elevated counts would be the lowest priority, as erythropoietin is a hormone secreted by the kidneys that should stimulate RBC production.

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

Chronic kidney disease slows 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. Epogen does not slow production of red blood cells or stimulate production of white blood cells.

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? Interleukins Interferon Erythropoietin Colony-stimulating factor

Erythropoietin 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.

Colony-stimulating factors (CSF) are administered to produce which therapeutic effect? Reduce side effects to a medication Enhance immune system functioning Increase the growth of specific types of blood cells Decrease the patient's reaction to a chemotherapeutic medication

Increase the growth of specific types of blood cells Colony-stimulating factors control the production, growth, and differentiation of specific blood cell types, such as red blood cells and leukocyte stem cells. CSFs do not decrease the side effects to a medication or the patient's reaction to chemotherapeutic medications. Immune system functioning is not measurable and not the direct result of administration of a CSF. A CSF could enhance the production of RBCs or leukocyte stem cells. Colonies of granulocytes are stimulated by CSFs.