Chapter 33: Drugs Affecting Hematopoiesis

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 hematocrit, 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." "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 hemoglobin, causing less oxygen to be delivered to the tissues."

Ms. Ziem is prescribed filgrastim. The nurse provides education to Ms. Ziem about this therapy. Which statement would indicate the patient understood the teaching? "I will avoid crowds and people with illnesses." "Filgrastim will be discontinued when the neutrophil count drops unexpectedly." "Filgrastim will be discontinued to prevent excessively high neutrophil counts." "I will never refrigerate the drug."

"I will avoid crowds and people with illnesses."

A physician informs a patient who is a Jehovah's Witness that the patient needs epoetin alfa injections. The patient asks the nurse if any blood products are in this medication. What is the best response by the nurse? "Anyone can take this medication." "This medication is not considered a blood component by religious affiliations that object to transfusions." "Although blood products are in this medication, you will need it to treat the anemia." "If you do not take this medication, there will be severe complications from which you may not recover."

"This medication is not considered a blood component by religious affiliations that object to transfusions."

The nurse is preparing to administer filgrastim intravenously (IV) to a patient. What solution would the nurse mix the medication in prior to administration? Dextrose and 1/2 normal saline Normal saline Lactated Ringer's solution. 5% dextrose in water (D5W)

5% dextrose in water (D5W)

The nurse is working with a male client diagnosed with chronic renal disease. To increase compliance with the drug regimen, what should the nurse provide the patient who has been prescribed epoetin alfa? The telephone number of the pharmacy where the medication can be purchased A referral for community transportation An appointment card for each drug administration day A calendar to mark the days of the week the drug is to be administered

A calendar to mark the days of the week the drug is to be administered

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 A blood transfusion An iron supplement A folic acid supplement

An iron supplement

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

Impaired tissue oxygenation related to anemia

The nurse is caring for a client who is receiving epoetin alfa. What adjunct treatment will the nurse expect the physician to order for this client? Potassium supplement Sodium restriction Renal dialysis Iron supplement

Iron supplement

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 1 pound weight gain in 1 week 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

The essential components of the immune system are hematopoietic cells, barrier defenses, the nonspecific immune response, the specific immune response, and immunity. Which of the following describes barrier defenses? Choose all that apply. Hemoglobin carries oxygen to the cells. Skin is the first line of defense. The gastrointestinal tract provides an acid protector. Mucus is a barrier defense.

Skin is the first line of defense. Mucus is a barrier defense. The gastrointestinal tract provides an acid protector.

Biologic modulators, or biologic modifiers, are a group of biopharmaceuticals that are naturally occurring proteins used to alter the body's hematologic or immunologic responses. Which of the following best describes more about these biologic modulators? Choose all that apply. They stimulate immunologic activity to combat specific antigens. They are synthetic substances created to mimic the body's natural responses. They interfere with the body's ability to create new cells. There has been rapid growth of these therapies over the past decade.

There has been rapid growth of these therapies over the past decade. They stimulate immunologic activity to combat specific antigens.

The physiology instructor is talking with the students about the development of blood cells. What would the instructor tell the students causes a hemocytoblast to change into an immature RBC? Vitamin C Vitamin A Vitamin B12 Vitamin D

Vitamin B12

Mrs. Keen is treated for leukemia. Her most recent laboratory results show a decrease in her platelet level. The physician has prescribed oprelvekin to increase her platelet count. What is the main adverse effect of oprelvekin? Exfoliative dermatitis Eye hemorrhage Hyperthyroidism Weight gain/fluid retention, which can worsen heart failure

Weight gain/fluid retention, which can worsen heart failure

A pharmacology professor wants to know if the class has understood the lecture on hematopoietic cells. Which of the following statements would confirm the students understand the material presented? Choose all that apply. "Erythropoietin is produced by the kidneys in response to tissue hypoxia." "Thrombopoietin is produced in the liver." "No drugs are available that affect blood cells." "Iron is necessary to support erythropoiesis."

"Erythropoietin is produced by the kidneys in response to tissue hypoxia." "Iron is necessary to support erythropoiesis." "Thrombopoietin is produced in the liver."

The prototype drug used to create RBCs is epoetin alfa (Epogen, Procrit). Which of the following statements made by students proves they understand this drug? Choose all that apply. "The product does not contain the same amino acid sequence as natural erythropoietin." "It is used to treat anemia associated with chronic kidney disease." "It is recombinant human erythropoietin." "It is a 165-amino acid glycoprotein manufactured by recombinant DNA technology."

"It is a 165-amino acid glycoprotein manufactured by recombinant DNA technology." "It is recombinant human erythropoietin." "It is used to treat anemia associated with chronic kidney disease."

The nurse is mentoring a first-year nursing student while caring for a client with a disease that affects the hematopoietic system. The student looks confused and says "I've never heard of that system. What is it?" How would the nurse repond? "The hematopoietic system is composed of fluid, red blood cells, white blood cells, and fibrosis." "The hematopoietic system is composed of fluid, red blood cells, white blood cells, and fibrinogen." "The hematopoietic system is composed of fluid, red blood cells, white blood cells, and platelets." "The hematopoietic system is composed of fluid, red blood cells, white blood cells, and fibrin."

"The hematopoietic system is composed of fluid, red blood cells, white blood cells, and platelets."

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 Subcutaneous Intravenous B and C

B and C

Katie, a 45-year-old patient with breast cancer, is currently undergoing chemotherapy. She is started on epoetin alfa secondary to decreased hemoglobin and hematocrit levels. What rule is important when administering epoetin alfa, after reconstituting it? Shake the drug before use. Warm the drug before use. Do not shake the drug vigorously. Administer the drug immediately, without allowing time for the hematocrit to rise.

Do not shake the drug vigorously.

The nursing instructor is talking with a student about erythropoietin drug therapy. What is an adverse effect of erythropoietin drug therapy that the instructor would tell the student about? Hypotension Depression Constipation Edema

Edema

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? Neupogen Procrit Interferon gamma Penicillin

Procrit

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? Osteoarthritis Hypothyroidism Uncontrolled hypertension Diabetes mellitus

Uncontrolled hypertension

During maturation in the bone marrow, white blood cells (WBCs) differentiate into three main cell types. Which of the following are the cell types? monocytes granulocytes hemoglobin platelets lymphocytes

granulocytes monocytes lymphocytes

Red blood cells (RBCs) are mainly composed of _________________, which enables the cells to carry oxygen to the cells in the body. white blood cells platelets hematocrit hemoglobin potassium

hemoglobin

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? "It really helps the patient!" "The patient has increases in the number of natural killer cells." "The patient has decreased cytockine activity." "The patient gets really sick from flu-like symptoms and then gets better."

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

The essential components of the immune system are hematopoietic cells, barrier defenses, the nonspecific immune response, the specific immune response, and immunity. Which of the following describe the specific immune response? Choose all that apply. Hemoglobin enables cells to carry oxygen to the cells. It involves natural killer cells and lymphokine activated killer cells. The skin is the first line of defense. Bone marrow stem cells develop into two types of lymphocytes.

Bone marrow stem cells develop into two types of lymphocytes. It involves natural killer cells and lymphokine activated killer cells.

A patient with bipolar disorder taking lithium carbonate for mood stabilization is also taking filgrastim. What laboratory tests should the patient be instructed to have more than twice a week? CBC BUN and creatinine Lithium levels Potassium level

CBC

A 67-year-old patient who has a history of pleural and pericardial effusions is given sargramostim for the first time. What precaution should the nurse take when administering the first dose of the drug? Check for effects such as respiratory distress, hypotension, and syncope in the first 20 minutes. Administer diphenhydramine along with sargramostim to increase therapeutic effect. Rub ice gently at the injection site before and after injection. Rotate injection sites among the upper arms, abdomen, and thighs.

Check for effects such as respiratory distress, hypotension, and syncope in the first 20 minutes.

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 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 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 stimulates the production of red blood cells causing anemia. Epogen slows 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.

The patient with chronic renal failure requires an agent to increase red blood cell production. What drug does the nurse anticipate administering? Thrombopoetin Filgrastim Oprelvekin Epoetin alfa

Epoetin alfa

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. Erythrocytes are also called platelets. Erythrocytes are also called white blood cells. Erythrocytes are also called plasma.

Erythrocytes are also called red blood cells.

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? A blood transfusion Erythropoietin An increased dose of zidovudine Rocephin 1 GM IV

Erythropoietin

The mature red blood cell contains a nucleus. False True

False

A patient has been prescribed epoetin alfa. In reviewing this patient's history, what would the nurse know contraindicates the use of epoetin alfa? Irritable bowel syndrome Asthma Hypertension Shortness of breath

Hypertension

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

Increased RBC count

When the patient is taking filgrastim, what positive outcome does the nurse anticipate observing from the laboratory studies? Increased neutrophil count Improved tissue oxygenation Elevated red blood cell count levels Increased platelet count

Increased neutrophil count

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 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 supplements prevent depletion of hemoglobin cells from anxiety 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.

Ms. Ellis is treated for thrombocytopenia secondary to chemotherapy. As the nurse caring for Ms. Ellis, you are aware that during therapy for this condition, what ongoing assessment will be important? Monitor the blood pressure. Monitor the blood sugar levels. Check for any blood-related adverse effect. Monitor the platelet count.

Monitor the platelet count.

Which shape makes the RBCs flexible enough to maneuver through the small capillaries to deliver oxygen to the tissues? biconcave convex concave plano-concave

biconcave The biconcave disc shape of the RBCs makes them flexible enough to maneuver through the small capillaries to deliver oxygen to the tissues. The cell is concave on two sides, allowing for an increased rate in diffusion.