ch 49: anemias
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 avoid taking the drug with coffee or tea." "I need to take an antacid with the pill to prevent an upset stomach." "It might take several months before my iron levels get back to normal." "I need to make sure that I eat enough foods containing iron."
"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.
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." "I can mix the dose with a small amount of yogurt to make it taste better." "I should drink a big glass of water after swallowing the solution." "I'll mix the dose with orange juice to make it easier to swallow."
"I should drink the solution through a straw so my teeth don't get stained." Oral liquid iron solution can stain the teeth; therefore, it should be taken through a straw to prevent this from occurring. Orange juice is acidic, and although it may enhance the absorption of the medication, it should not be used concurrently. The risk of staining would still be present. Drinking a big glass of water after swallowing the solution would not reduce the risk of staining the teeth. The dose should not be mixed with other foods, especially dairy products such as yogurt, which can interfere with absorption.
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 you get a little thirsty, call your primary care provider." "If you have an increased appetite, call your primary provider." "If constipation or diarrhea become severe, call your primary care provider." "If darkening of the stools appears, call your primary care provider."
"If constipation or diarrhea become severe, call your primary care provider." The nurse knows to teach the client that if constipation or diarrhea become severe, to call the primary care doctor. Darkening of the stools is an expected outcome of iron administration. The nurse would teach the client to increase fluid for thirst (if not contraindicated) before calling the provider. Increased appetite is not an adverse reaction to iron; poor appetite would trigger a call to the provider.
Approximately what percentage of the body's red blood cells (RBCs) is destroyed and replaced each day? 4% 3% 2% 1%
1% Erythropoiesis is a constant process by which approximately 1% of the body's RBCs are destroyed and replaced each day.
A client is receiving epoetin alfa. The nurse understands that this drug's duration of effect would be which amount of time? 48 hours 36 hours 24 hours 12 hours
24 hours Epoetin alfa has a duration of effect of usually 24 hours.
A patient receives ferrous sulfate. The nurse would expect this drug to begin acting within which time frame? 4 days 2 days 6 days 8 days
4 days Ferrous sulfate has an onset of action of 4 days.
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? Respirations Pulse Blood pressure Temperature
Blood pressure The most important assessment is the blood pressure because epoetin can cause hypertension.
After teaching a patient about the adverse effects of iron therapy, the patient demonstrates understanding of the information when the patient identifies what adverse effects? (Select all that apply.) Constipation Anorexia Fatigue Dark stools Dizziness
Constipation Anorexia Dark stools Adverse effects of iron therapy include dark stools, constipation, anorexia, diarrhea, vomiting, and GI upset.
A client has suffered from a gastrointestinal hemorrhage. Which agent will assist in raising the hemoglobin? Estazolam (Prosom) Dextromethorphan hydrobromide Epoetin alfa Pentoxifylline
Epoetin alfa Epoetin alfa is used to raise the hemoglobin and reduce the need for blood transfusions in clients with anemia. Pentoxifylline is used for intermittent claudication to maintain the flexibility of red blood cells. Estazolam is a benzodiazepine agent used short term for insomnia. Dextromethorphan hydrobromide is used to relieve cough.
A nurse is reviewing the chart of a patient with megaloblastic anemia. What might be used in the treatment of this patient? (Select all that apply.) Folic acid Procrit Iron dextran Epogen Vitamin B12
Folic acid Vitamin B12 Megaloblastic anemia is treated with folic acid and vitamin B12. Procrit and Epogen are erythropoiesis-stimulating agents. Iron dextran is used in the treatment of iron-deficiency anemia
A male client is diagnosed with multiple myeloma. What treatment regimen would the nurse expect the health care provider to order? Filgrastim Sargramostim Interferon alfa Epoetin
Interferon alfa Interferon alfa has demonstrated antitumor effects in multiple myeloma, renal cell carcinoma, and others.
When describing the function of vitamin B12, what would be appropriate to include? Oxygen transport to the tissues Prevention of neural tube defects Important role in cell division Maintenance of myelin sheath
Maintenance of myelin sheath Vitamin B12 is important for maintaining the myelin sheath. Folic acid is important in preventing neural tube defects and is essential for cell division in all types of tissues. RBCs are important for transporting oxygen to the tissues.
A client is receiving darbepoetin alfa. The nurse would inform the client that he will be receiving this drug at which frequency? Monthly Once a week Two to three times/week Every other week
Once a week Darbepoetin alfa is administered once a week. Epoetin alfa is administered three times/week. Methoxy polyethylene glycol-epoetin alfa is administered once every 2 weeks or once a month.
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? 1 pound weight gain in 1 week Reports of calf pain on dorsiflexion of the foot A rash under the breast 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.
After reviewing the major types of anemia, students demonstrate understanding of the information when they identify what as an example of a hemolytic anemia? Folic acid deficiency anemia Sickle cell anemia Iron deficiency anemia Pernicious anemia
Sickle cell anemia Sickle cell anemia is an example of a hemolytic anemia that involves lysing of RBCs because of genetic factors or from exposure to toxins. Iron deficiency anemia is a deficiency anemia. Pernicious anemia and folic acid deficiency anemia are examples of megaloblastic anemia.
Which symptom, if assessed after the administration of epoetin alfa (Epogen), would be cause for alarm? The patient is tired. The patient states the injection "hurts." The patient displays weakness on one side of the body. The patient reports "bone pain."
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.
Which patient will the nurse assess first? The patient with a decreased WBC count The patient with elevated erythropoietin The patient with anemia The patient with a decreased RBC count
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.
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? Mr. Lepp's oncologist should have begun treatment with epoetin alfa immediately after he was diagnosed. Treatment with epoetin alfa will likely begin 4 to 6 days before Mr. Lepp's first round of chemotherapy and continue indefinitely. The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients. Epoetin alfa is normally contraindicated in patients who are receiving radiotherapy or chemotherapy.
The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients. In patients with cancer, epoetin alfa should only be used when anemia is due to concomitant myelosuppressive chemotherapy and should be discontinued when the chemotherapy course is completed. The use of epoetin alfa during cancer may shorten survival and/or increase the risk of tumor progression or recurrence. Patients with cancer are also at risk for serious cardiovascular and thrombovascular events. Consequently, the benefits of treatment must be considered in light of these potentially adverse effects.
The component of the red blood cell that is not recycled is bilirubin. False True
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.
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.
Cyanocobalamin is a vitamin B12 in a nasal formulation. True False
True Vitamin B12 includes hydroxocobalamin (generic), an injectable drug, and cyanocobalamin (Nascobal), a nasal spray.
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? asthma chronic hepatitis C ankylosing spondylosis bacterial pneumonia
chronic hepatitis C Interferon alfa-2b is a biologic response modifier that binds to cell surfaces and alters intracellular activities in viral infections. As a result, viruses are less able to enter uninfected cells and reproduce. Interferon alfa-2b is used to treat chronic hepatitis C and other diseases caused by viruses. Interferon alfa-2b is not used to treat asthma, bacterial pneumonia, or ankylosing spondylosis.
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? iron supplements oxygen therapy progressive activity program low-dose stimulant medication
iron supplements Patients taking epoetin alfa who require surgery may require iron supplementation.
The nurse would contact the prescriber immediately if interferon was prescribed for which client? 72-year-old male with AIDS-related Kaposi's sarcoma 34-year-old male with chronic hepatitis B 48-year-old female with hepatitis C 11-month-old female with HIV acquired from her mother
11-month-old female with HIV acquired from her mother Interferon should not be administered to newborns or infant. A baby is considered an infant until 12 months of age.
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? Control of pain Iron-rich foods Avoidance of infection Constipation prevention
Avoidance of infection Patients with sickle cell anemia are treated with antibiotics, to help fight the infections that can occur when blood flow is decreased to any area. Maintaining adequate hydration, avoiding infection, getting adequate rest, and eating a balanced diet are all common sense strategies that decrease the risk of a crisis.
A nurse administers erythropoietin. What assessment finding is attributable to the increased effect of this hormone? Select all that apply. Increased red blood cell count Increased hemoglobin Increased urinary output Anemia Decreased oxygenation in the bloodstream
Increased red blood cell count Increased hemoglobin Erythropoietin stimulates the bone marrow and increases the production of red blood cells and hemoglobin. It does not increase urinary output or decrease oxygenation. It would actually increase the oxygen-carrying capacity of the blood. Anemia is a condition that erythropoietin might be used to treat, but it is not an assessment finding caused by this hormone.
All hematopoietic and immune blood cells are derived from which cells in the bone marrow? Theta cells Alfa cells Stem cells Beta cells
Stem cells All hematopoietic and immune blood cells are derived from stem cells in the bone marrow.
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? Oral only Subcutaneous or Oral Oral or Intravenous Subcutaneous or Intravenous
Subcutaneous or Intravenous These drugs can be given by the SC or IV routes. They are proteins that would be destroyed by digestive enzymes if given orally.
For which client would epoetin alfa NOT be indicated? A client with a hemoglobin of 11, with shortness of breath. A client with a hemoglobin of 12, with shortness of breath. A client with a hemoglobin of 8, who is asymptomatic. A client with a hemoglobin of 10, who is asymptomatic.
A client with a hemoglobin of 12, with shortness of breath. Erythropoiesis-stimulating drugs have been used to raise the hemoglobin and reduce the need for blood transfusions in many clients with anemia. However, studies indicate an increased risk of serious cardiovascular problems and death in clients with chronic renal failure and an increased risk of tumor progression and death in clients with cancer. These problems became evident when the drugs were used to achieve normal hemoglobin levels of 12 to 14 g/dL. These results led the FDA to issue a black box warning advising prescribers to avoid using the drugs in clients with hemoglobin values of 12 g/dL or above. In addition, when the drugs are used, the lowest dose effective should be prescribed to raise hemoglobin levels just enough to avoid the need for blood transfusion, and hemoglobin levels should be monitored regularly until they stabilize.
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. Folinic acid rescue in chemotherapy includes Lipitor administration. Folinic acid rescue in chemotherapy includes levothyroxine administration. Folinic acid rescue in chemotherapy includes Levophed administration.
Folinic acid rescue in chemotherapy includes leucovorin administration. Folinic acid rescue in chemotherapy includes leucovorin administration. Levophed, Lipitor, and levothyroxine are not part of the acid rescue because the goal is to save cells.
A client is receiving hydroxocobalamin for treatment of pernicious anemia. The nurse would administer this agent by which route? Oral Intramuscular Subcutaneous Intravenous
Intramuscular Hydroxocobalamin is administered intramuscularly for 5 to 10 days and then monthly.
A nurse preparing to administer an erythropoiesis-stimulating drug is aware that the drug can be given by which routes? Select all that apply. Intravenous (IV) Oral Intradermal Subcutaneous Transdermal
Intravenous (IV) Subcutaneous These drugs must be given IV or by subcutaneous injection. Patients must have an adequate supply of the other components of red blood cells (RBCs), including iron, for these drugs to be effective.
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? Potassium supplement Sodium restriction Renal dialysis Iron supplement
Iron supplement 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 client is a woman, 79 years of age, prescribed an iron preparation for anemia. The client's daughter becomes alarmed and calls the provider before giving the iron after she reads the label, because she knows that her mother is also taking which medication? Vitamin A every week One NSAID as needed Levothyroxine every day A statin drug every day
Levothyroxine every day Administering iron with levothyroxine causes a drug interaction that decreases absorption of the levothyroxine drug. There is no known interaction with iron and NSAIDs, and statins. Vitamin A is not a drug.
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? Iron deficiency anemia Pernicious anemia Thalassemia major Folic acid deficiency
Pernicious anemia Pernicious anemia is a lack of vitamin B12, which is also used by the body to maintain the myelin sheath on nerve axons. If vitamin B12 is lacking, these neurons will degenerate and cause many CNS effects.
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? Folic acid deficiency anemia Sickle cell anemia Iron deficiency anemia Pernicious 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.
What are the primary factors that contribute to the body's ability to fight off infection? Select all that apply. normal immune system function normal cardiovascular function normal hematopoiesis decreased exposure to microorganisms increased platelet cell production
normal immune system function normal cardiovascular function normal hematopoiesis 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.
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." "Oral ingestion of vitamin B12 causes irritation and bleeding." "Pernicious anemia causes changes in the mucous membrane lining and impairs absorption." "With severe deficiencies like yours, oral vitamin B12 is not effective."
"Oral forms of vitamin B12 will not be absorbed." It cannot be taken orally, because the problem with pernicious anemia is the inability to absorb vitamin B12 secondary to low levels of intrinsic factor.
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 can cause serious risks for you as well as shorten survival and increase the risk of recurrence of your tumor." "We just need to ask your doctor. There is no reason you can't take that drug to help with your anemia." "This drug is very dangerous and cannot be used for everyone." "Your doctor knows what drugs to use to treat you. Not all drugs are used the same for each patient."
"This drug can cause serious risks for you as well as shorten survival and increase the risk of recurrence of your tumor." In patients with cancer, epoetin alfa should only be used when anemia is due to concomitant myelosuppressive chemotherapy and should be discontinued when the chemotherapy course is completed The use of epoetin alfa during cancer may shorten survival and/or increase the risk of tumor progression or recurrence. Patients with cancer are at risk for serious cardiovascular and thrombovascular events and should use the lowest dose needed to avoid red blood cell transfusions.
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 potassium serum glucose serum ferritin serum albumin
serum ferritin Epoetin alpha injections are appropriate in the treatment of clients with chronic renal failure. With epoetin alfa, it is necessary to measure iron status, transferrin saturation, and serum ferritin before initiating the treatment and periodically during the course of the treatment. There is no reason to evaluate the client's serum glucose, albumin, or potassium levels before starting the epoetin alpha injections.