Chapter 49

Stem cells

All hematopoietic and immune blood cells are derived from which cells in the bone marrow?

True

Cyanocobalamin is a vitamin B12 in a nasal formulation.

False

The mature red blood cell contains a nucleus.

Increased red blood cell count

The nurse administers epoetin alfa (Epogen). What is the therapeutic response the nurse expects to assess?

Reports of calf pain on dorsiflexion of the foot

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?

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

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 respond?

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

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?

Diarrhea Asthenia Vomiting

The nurse is teaching a patient who is to receive epoetin alfa about possible adverse effects. Which would the nurse include? (Select all that apply.)

Erythropoietin

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?

Uncontrolled hypertension

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?

"My stools might turn dark or green."

After teaching a patient who is receiving ferrous sulfate about the drug therapy regimen, which patient statement indicates that the teaching was successful?

serum ferritin

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?

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?

Viral hepatitis

A male client is prescribed interferon. What is his probable diagnosis?

Iron levels

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:

Vitamin B12

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?

iron deficiency anemia.

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:

Renal failure

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

The patient's hemoglobin level is 11 g/dL

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?

Erythropoietin

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?

Subcutaneous or Intravenous

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?

Myocardial infarction

Adverse effects of epoetin and darbepoetin include increased risks of what condition?

Impaired tissue oxygenation related to anemia

What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa?

Z-track intramuscular

When administering iron injections, which method would the nurse use?

A 62-year-old male with cancer

Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy?

120 days.

The average lifespan of a red blood cell (RBC) is approximately:

anemia

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:

This medication is destroyed in the stomach and can only be given by injection.

A client taking epoetin alfa requests changing the medication from the subcutaneous route to the PO route. How should the nurse respond?

Altered red blood cell production or deficient functioning of red blood cells

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?

Pernicious anemia

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?

The patient displays weakness on one side of the body.

Which symptom, if assessed after the administration of epoetin alfa (Epogen), would be cause for alarm?

Erythrocytes Leukocytes Platelets

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.)

Flulike symptoms

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?

Folic acid deficiency anemia occurs because of a dietary lack of folic acid, a component necessary in the formation of red blood cells.

A client 19 years of age who is a drug addict comes to the emergency department reporting extreme fatigue and shortness of breath. The nurse assesses the client and, after taking a complete history, determines that the client has malnutrition. The nurse knows that malnutrition can cause which type of anemia?

"If constipation or diarrhea become severe, call your primary care provider."

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?

Iron supplementation

A client is receiving epoetin alfa for anemia. Which adjunctive therapy is imperative with epoetin alfa?

Sickle cell anemia

After reviewing the major types of anemia, students demonstrate understanding of the information when they identify what as an example of a hemolytic anemia?

Iron supplement

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?