Chapter 49

A pt. is receiving ferrous sulfate as treatment for iron deficiency anemia. After teaching the pt., 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 and tea"

"i need to take an antacid with the pill to prevent an upset stomach"

A pt. is prescribed oral ferrous sulfate solution. Which statement by the pt. indicates that he understands how to take the drug? "i"ll mix the dose with orange juice to make it easier to swallow" "i should drink a big glass of water after swallowing the solution" "I can mix the dose with a samll maount yogurt to make it taste better" "i should drink the solution through a straw so my teeth don't get stained"

"i should drink the solution through a straw so my teeth don't get stained'

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

24hrs

3. Which of the following would the nurse include in the teaching plan when describing anemia to a patient? A decreased number of or abnormal RBCs. A lack of iron in the body. A lack of vitamin B12 in the body. An excessive number of platelets.

A decreased number of or abnormal RBCs.

Erythrocytes

AKA RBCs

Leukocytes

AKA WBC (White Blood Cells)

Megaloblastic anemia

Anemia cause by lack of vitamin B12 and/or folic acid

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

Cautioning the pt. that stool may be dark or green

A patient is experiencing iron toxicity. Which agent would the nurse expect to be given? Dimercaprol Succimer Deferoxamine Edetate calcium disodium

Deferoxamine

Treatment for iron toxicity

Deferoxamine mesylate

Anemia

Disorder involving too few red blood cells or ineffective RBCs

Erythropoietin (drug)

Epoetin Alfa Action: acts like the natural glycoprotein erythropoietin to stimulate the production of RBCs in bone marrow Indications: treats anemia associated w/ chronic renal failure to reduce the need for allogenic blood trnasfusions in surgery Contraindications: uncontrolled hypertension, allergy to mammalian cell-derived, allergy to human albumin Adverse effects: headache, fatigue, asthenia, dizziness, seizure, N/V/D, hypertension, edema, chest pain Considerations: abused drugs with athletes

Erythropoietins

Epoetin Alfa: treats anemia associated with renal failure and AIDS, decreases need for blood transfusions in surgery patients Darbopoetin Alfa: treats anemia associated with chronic renal failure, including dialysis pt Metthoxy Polyethylene Glycol-Epoetin Beta: treats anemias associated with chronic renal failure, including dialysis pt

Iron Preparations

Ferrous sulfate Actions: elevates the serum iron concentration Indications: treatment of iron deficiency Contraindications: hemochromatosis, hemolytic anemia, normal iron balance, peptic ulcer colitis, regional enteritis Adverse effects: GI irritation, CNS toxicity, anaphylactic reactions, local irritation, tissue staining, phlebitis Considerations: use Z-track method. Do not admin with meals that include eggs, coffee, milk, or tea. Stool may be dark or green

Folic acid derivatives and Vitamin B12

Folic acid and Hydroxocobalamin Action: essential for cell growth and division fot the production of a strong stroma in RBCs Indications: replacement therapy for dietary deficiencies. (folic acid) rescue drug for cells exposed to some toxic chemotherapeutic agent Contraindications: standard Adverse effects: pain at injection site, nasal irritation with spray, excess Vitamin B levels, peripheral edema, HF

A patient is diagnosed with sickle cell anemia. Which agent would the nurse expect to be ordered? Hydroxyurea Epoetin alfa Ferrous sulfate Iron dextran

Hydroxyurea

Agent for Sickle Cell anemia

Hydroxyurea

Which of the following would the nurse expect the health care provider to prescribe for a pt. receiving methotraxate? Cyanocobalamin Leucovorin Hydroxyurea Iron sucrose

Hydroxyurea

8. After teaching a patient with pernicious anemia about vitamin B12, therapy, which patient statement would indicate that the teaching was successful? I can take this pill with breakfast. I should take this pill at bedtime. I need to inject this drug subcutaneously every day. I need to inject this drug intramuscularly every 5 to 10 days.

I need to inject this drug intramuscularly every 5 to 10 days.

A pt. is prescribed iron therapy using iron dextran. The nurse would administer this drug by which route? Oral Subcutaneous IM IV

IM

A pt. is receiving hydroxocobalamin for treatment of pernicious anemia. The nurse would administer this agent by which route? Oral Subcutaneous IM IV

IM

Which of the following would a nurse identify as the primary issue associated with anemia? Defective white blood cells Increased plasma proteins Ineffective RBCs Lack of vitamin B12

Ineffective RBCs

Iron deficiency anemia

Low RBC count with low iron

When describing the function of vitamin B12, which of the following would be appropriate to include? Maintenance of myelin sheath Prevention of neural tube defects Important role in cell division O2 transport to the tissues

Maintenance of myelin sheath

A pt. is receiving darbepoetin alfa. The nurse would inform the pt. that he will be receiving this drug at which frequency? Once a week two to three times a week Every other week Monthly

Once a week

Erythropoiesis

Process of making RBCs

Reticulocyte

RBC that has lost its nucleus Not yet fully matures

2. RBCs must be continually produced by the body because...? the iron within the RBC wears out and must be replaced. RBCs cannot maintain themselves and wear out. RBCs are continuously entering and being lost from the gastrointestinal (GI) tract. RBCs are processed into bile salts and must be replaced.

RBCs cannot maintain themselves and wear out.

4. Megaloblastic anemia is a result of insufficient folic acid or vitamin B12, affecting which of the following? White blood cell production Vegetarians Rapidly turning over cells Slow-growing cells

Rapidly turning over cells

After reviewing the major types of anemia, students demonstrate understanding of the info when they identify which of the following as an example of a hemolytic anemia? Iron deficiency anemia Pernicious anemia Folic acid deficiency anemia Sickle cell anemia

Sickle cell anemia

Pernicious anemia

Type of megaloblastic anemia characterized by lack of vitamin B12

Which of the following would the nurse encourage a pt. to consume to prevent folic acid anemia? select all that apply Fruits fish broccoli milk liver

broccoli milk liver

7. To ensure maximum absorption, a nurse instructs a patient receiving oral iron therapy to avoid taking the iron with protein. antibiotics. dairy products. any other drugs.

dairy products.

1. After teaching a group of students about red blood cell (RBC) production, the instructor determines that the teaching was effective when the group states that the rate of RBC production is controlled by iron. folic acid. erythropoietin. vitamin B12.

erythropoietin.

5. The nurse would expect the physician to prescribe epoetin alfa (Epogen) as the drug of choice for acute blood loss during surgery. to replace blood loss from traumatic injury. for treatment of anemia during lactation. for treatment of anemia associated with renal failure.

for treatment of anemia associated with renal failure.

Which of the following would be least important in producing healthy, efficient RBCs? select all that apply Iron carbs WBC amino acids plasma

iron carbs amino acids

6. A patient with anemia who is given iron salts could expect to show a therapeutic increase in hematocrit within 72 hours. within 2 to 3 weeks. within 6 to 10 months. within 1 to 2 weeks.

within 6 to 10 months.

2. In a healthy person, very little iron is needed on a daily basis. Loss of iron is associated with which of the following? Heavy menstrual flow Bile duct obstruction Internal bleeding Penetrating traumatic injury Bone marrow suppression Alcoholic cirrhosis

Heavy menstrual flow Internal bleeding Penetrating traumatic injury

Cultural Considerations

Hemoglobin/Hematocrit: levels in african americans are usually 1g lower Serum transferrin levels: african american levels are 22mg/mL higher

Erythropoietin (definition)

Glycoprotein produced by the kidneys Stimulates RBC production

1. Clients are often given iron pills by their clinic. Instructions in giving these pills should include...? taking the drug with milk to avoid GI problems. the potential for constipation. keeping these potentially toxic pills away from children. taking the drug with antacids to alleviate GI upset. having periodic blood tests to evaluate the drug effect. being aware that stools may be colored green.

the potential for constipation. keeping these potentially toxic pills away from children. having periodic blood tests to evaluate the drug effect. being aware that stools may be colored green.