pharm 49 & 51
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
A 50-year-old female patient who has pernicious anemia asks you why vitamin B12 must be administered parenterally. What is the best response to her question?
"Oral forms of vitamin B12 will not be absorbed."
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.
Hydrochlorothiazide works by what mechanism of action?
Increasing the excretion of sodium and chloride in the distal tubule
A nurse is providing patient teaching for a 62-year-old woman who is taking triamterene. The nurse will teach the patient to avoid what in her diet?
avocados
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?
produce erythropoeitin
For what purpose would the nurse administer postoperative epoetin alfa to the client who is a Jehovah's Witness?
reduce the need for allogenic blood transfusion
What would contraindicate the use of indapamide?
renal disease
A patient has been prescribed epoetin alfa. The nurse recognizes that this medication is indicated for treatment of anemia associated with which disease process?
renal failure
Which diuretic will most likely be the initial drug of choice when a client demonstrates dyspnea related to pulmonary edema?
furosemide
When describing where bumetanide acts, what would the nurse include?
loop of henle
A client asks, "Why is my prescription being switched from furosemide to spironolactone?" What is the nurse's best response?
"You will lose less potassium with spironolactone than with furosemide."
The nurse is doing patient teaching with a 30-year-old gravida 1 who has sickle cell anemia. She is not currently in crisis. Providing education on which topic is the highest nursing priority?
avoidance of infection
The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome?
increased RBC count
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
A patient with chronic heart failure has begun treatment with epoetin alfa, which she will receive in her own home from a home health nurse. The nurse should teach the patient to supplement this treatment with a diet that is high in
iron-rich foods such as beans and leafy green vegetables.
A client is admitted to the emergency department with pulmonary edema. What diuretic does the nurse expect the health care provider to prescribe to achieve rapid therapeutic effect?
loop diuretic
When describing the function of vitamin B12, what would be appropriate to include?
maintenance of myelin sheath
What substance is reabsorbed in the ascending limb of the loop of Henle?
sodium
The nurse is teaching a client about erythrocytes. Which information would the nurse include in the teaching plan?
Erythrocytes are also called red blood cells.
A nurse is caring for a patient with edema due to congestive heart failure (CHF). The physician has prescribed indapamide to the patient. The patient is also undergoing treatment with digitalis glycoside. Which intervention should the nurse perform when caring for this patient?
Frequently monitor the patient's pulse rate and rhythm.
A client prescribed both an ACE inhibitor and a beta-blocker for the treatment of hypertension has been consistently obtaining blood pressure readings in the vicinity of 145/90 mm Hg. As a result, the client's primary health care provider has prescribed furosemide. What order would be most consistent with this client's health needs?
Furosemide 40 mg PO BID
A client with renal impairment is in need of a diuretic. Because of the renal problem, potassium-sparing diuretics are contraindicated but may be used if there is no other option. If they are used at all, what nursing intervention would be most important for this client?
Monitoring of serum electrolytes, creatinine, and BUN
When assessing a patient with anemia, the nurse notes that the patient has developed peripheral numbness and poor coordination. The patient's family states that the patient appears to be confused at times at home. Neurologic symptoms most often accompany which type of anemia?
Pernicious anemia
The pharmacology instructor is discussing the differences among the various diuretic agents. Which would the instructor cite as a difference between spironolactone and hydrochlorothiazide?
Potassium losses are greater with hydrochlorothiazide than with spironolactone.
An older adult client with a history of heart failure has presented to the emergency department in respiratory distress. Assessment reveals the presence of pulmonary edema, and an infusion of IV furosemide has been prescribed. For the duration of treatment, the nurse should prioritize assessments related to which expected age-related dysfunctions? Select all that apply.
Renal function Hepatic function cardiac function
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.
Mr. Lepp is a 63-year-old man who was diagnosed with colon cancer several weeks ago and who is scheduled to begin chemotherapy. He reports to the nurse that he read about the need for erythropoietin in an online forum for cancer patients and wants to explore the use of epoetin alfa with his oncologist. Which fact should underlie the nurse's response to Mr. Lepp?
The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients.
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 b12
A hospital client with a diagnosis of liver failure has been prescribed a low dose of spironolactone in order to treat ascites. The nurse who is providing this client's care should prioritize assessments for the signs and symptoms of what health problem?
hepatic encephalopathy
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?
hgb 11
A 91-year-old client, who is being prepared for discharge, has been prescribed the diuretic spironolactone. While teaching the client about the drug, what major adverse effect should the nurse be sure to mention?
hyperkalemia
An older adult client has a complex medical history that includes heart failure, type 1 diabetes, and diabetic nephropathy. The nurse has questioned a health care provider's prescription for oral spironolactone because the client's health problems would contribute to a high risk of which adverse reaction?
hyperkalemia
A client who has been taking hydrochlorothiazide arrives at the clinic for his 1-month follow-up appointment. The client tells the nurse that he feels weaker since he began taking the drug. What should the nurse consider as a possible cause of these symptoms?
hypokalemia
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?
iron
A patient comes to the clinic reporting fatigue and pica. Laboratory findings reveal a low serum iron level and a low ferritin level. Upon evaluation of this assessment and laboratory data, the nurse suspects that the patient will be diagnosed with:
iron deficiency anemia
A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered?
mannitol
The nurse is caring for a client who is experiencing elevated intracranial pressure following neurosurgery. The health care provider orders an osmotic diuretic to reduce pressure. Which medication would the nurse expect to be ordered?
mannitol
Which would the nurse expect to find in a client receiving acetazolamide?
metabolic acidosis
After teaching a patient who is receiving ferrous sulfate about the drug therapy regimen, which patient statement indicates that the teaching was successful?
my stools might turn dark or green
A client with chronic renal failure is prescribed to begin subcutaneous epoetin alfa injections. Which laboratory value will the nurse ensure is measured before starting the medication?
serum ferritin
After reviewing the major types of anemia, students demonstrate understanding of the information when they identify what as an example of a hemolytic anemia?
sickle cell anemia
A male client has cirrhosis and is receiving diuretic therapy. The nurse knows that what drug will help prevent metabolic alkalosis or hypokalemia in this client?
spironolactone
A student nurse is caring for a client who is receiving a hematopoietic agent. To test the student's understanding, the nursing instructor states that the drug could be administered by what route?
sq or iv
A male patient with cancer tells the nurse that a friend is receiving a medication, epoetin alfa for anemia. The patient wants to know why they are not able to receive the drug to help make them feel better from the anemia they have. What is the best response by the nurse?
this drug an cause serious risks for you as well as shorten survival and increase the recurrence of your tumor
The nurse is reviewing the diet of a patient with folic acid deficiency. What would the nurse identify as a poor choice for increasing folic acid in the diet?
yellow veggies
When administering iron injections, which method would the nurse use?
z track IM
After teaching a group of students about therapy for iron toxicity, the instructor determines that the students need additional teaching when they identify that the antidote can be administered by which route?
oral
A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed?
osmotic diuretic
What is the term for the action of a diuretic in a patient with glaucoma?
osmotic pull
A patient is to be administered an erythropoiesis-stimulating agent. Which of the following drugs would the nurse administer?
epoetin alfa
A client with chronic renal failure has a low hemoglobin level. Which medication(s) will the nurse anticipate being prescribed for this client? Select all that apply.
epoetin alfa epoetin beta darbepoetin 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?
erythropoietin
A client is receiving a diuretic and tells the nurse that he has decreased his fluid intake so that he does not have to make so many trips to the bathroom. The nurse realizes the client is at risk for:
fluid rebound
A 69-year-old client has been diagnosed with malignant melanoma. The care team has collaborated with the client and her family and agreed on a plan of care that includes administration of interferon alfa-2b. After administering interferon alfa-2b, the oncology nurse should anticipate that the client may develop which adverse effect?
flulike symptoms
The nurse is teaching a 62-year-old client about hydrochlorothiazide, which the health care provider has prescribed for treatment of hypertension. What statement, made by the client, suggests that the client understands the teaching?
i will need to stand slowly
A physician has prescribed triamterene to a client with renal disease. The client informs the nurse that they are taking potassium supplements to address some heart problems. The nurse would be alert for which of the following?
increased risk for hyperkalemia
A health care provider has prescribed a loop diuretic for a client with hypertension. The client also has diabetes mellitus. What condition should the nurse monitor for in this client after administering the prescribed drug?
increased blood glucose levels
An adult client with a diagnosis of hypertension has been prescribed oral furosemide. What goal should the nurse identify when planning this client's medication teaching session?
The client will identify strategies for limiting sodium intake.
Which drugs cause diuresis by inhibiting re-absorption of sodium and chloride ions in the distal and proximal tubules and in the loop of Henle? (Select all that apply.)
Furosemide (Lasix) Bumetanide (Bumex)
The nurse would contact the prescriber immediately if interferon was prescribed for which client?
11-month-old female with HIV acquired from her mother
The nurse is caring for a 68-year-old female client with type 1 diabetes mellitus whose health care provider has ordered hydrochlorothiazide. As a consequence of taking the diuretic, the client may need to:
increase her insulin dose
What would be a contraindication to the use of carbonic anhydrase inhibitors?
allergy to sulfonamides
A client is prescribed oral ferrous sulfate solution. Which statement by the client indicates that the client understands how to take the drug?
"I should drink the solution through a straw so my teeth don't get stained."
A client diagnosed with iron deficiency anemia is learning about her prescribed iron supplement. Which additional information would the nurse include in the client's teaching plan?
"If constipation or diarrhea become severe, call your primary care provider."
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."
Which instruction would be most appropriate for a client who is taking a diuretic?
it's okay to take with your food
A nurse obtains an allergy history from a client based on the understanding that which class is associated with a cross-sensitivity reaction with sulfonamides?
thiazide diuretics
A client with chronic renal failure is prescribed subcutaneous epoetin alpha. Which information will the nurse include when teaching the client about this medication? Select all that apply.
"Avoid shaking the medication vial." "Do not place the vial in the freezer." "Take the prescribed iron supplement with fruit juice that has vitamin C."
A client is receiving epoetin alfa. The nurse understands that this drug's duration of effect would be which amount of time?
24 hours
Adverse effects of epoetin and darbepoetin include increased risks of what condition?
MI
Approximately what percentage of the body's red blood cells (RBCs) is destroyed and replaced each day?
1%
The client with what condition is most likely to benefit from treatment with interferon beta?
MS
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?
chronic hep C
After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states:
"I need to make sure I don't eat too many high potassium foods."
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."
What would a nurse identify as a contraindication for iron therapy? (Select all that apply.)
Hemolytic anemia Peptic ulcer disease Colitis
A client is receiving hydrochlorothiazide. The nurse would expect this drug to begin acting within which time frame?
2 hours
The nurse is teaching a male patient receiving epoetin alfa about the drug. The nurse informs the patient that he will receive the drug at which frequency?
3 times a week
A nurse notes that a newly admitted client is currently prescribed both a loop diuretic as well as a thiazide diuretic. The nurse understands what primary rationale for the concurrent use of these two drugs?
increased diuretic effect
Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy?
62 yo male with cancer
A client receives a dose of furosemide intravenously at 8:00 AM. The nurse would expect this drug to exert is peak effects at which time?
830am
A nurse is caring for a client with acute renal failure. The health care provider has prescribed a diuretic therapy for the client to promote dieresis. What intervention should the nurse perform to prevent the inconvenience caused by increased urination?
Administer the drug early in the day.
After teaching a group of students about anemias, the instructor determines that the teaching was effective when the students identify what as the critical issue?
Altered red blood cell production or deficient functioning of red blood cells
The home care nurse is caring for a client who is self-administering epoetin. What assessment is most important for the nurse to complete during the visit?
BP
A client has been prescribed furosemide. What medication education should the nurse provide this client? (Select all that apply.)
Be aware that standing up quickly can cause you to be dizzy. Notify your health care provider if you have more than a 3-pound weight change in one day. The medication will cause you to urinate larger amounts of urine than you are accustom to. You should try to avoid excessive intake of salt.
A client has chronic renal failure. As the disease progresses, the client is experiencing increasing shortness of breath. The nurse suspects that the client is experiencing symptoms associated with:
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?
anemia
The nurse is teaching a client about folinic acid rescue in chemotherapy. Which of the following information would the nurse include in the teaching plan?
Folinic acid rescue in chemotherapy includes leucovorin administration.
A client presents with ascites, secondary to cirrhosis. What mechanism is involved in this fluid shift?
Decreased plasma oncotic pressure
What type of diet should a patient taking diuretics have?
Eat potassium-rich or low-potassium diet as appropriate
A client prescribed epoetin alfa requests changing the medication from the subcutaneous to the oral route. Which statement should the nurse use to formulate a response to this request?
This drug is destroyed by acids found in the stomach.
A nurse demonstrates understanding of diuretics when identifying which medication as exerting its effect by inhibiting the enzyme carbonic anhydrase?
acetazolamide
The nurse is caring for an older adult client who receives furosemide on a regular basis. The nurse should prioritize assessments related to what health problem?
dehydration
A client has been prescribed both digoxin and furosemide. The nurse should monitor the client for development of what adverse effect?
digoxin toxicity
A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which?
eat potassium rich foods
The health care provider indicates that a client experiencing renal failure is not a candidate for therapy with potassium-sparing diuretics. How will the nurse respond when the client's family member asks why this is the case?
they may cause hyperkalemia
A male client is prescribed interferon. What is his probable diagnosis?
viral hepatitis
