Hematology-Meds Saunders Evolve

A client with a subarachnoid hemorrhage needs to have surgery delayed until a stable clinical condition is achieved. The nurse prepares to administer which medication as prescribed to prevent clot breakdown and dissolution? 1. Alteplase (Activase) 2. Warfarin (Coumadin) 3. Heparin sodium (Heparin) 4. Aminocaproic acid (Amicar)

4 Rationale: Aminocaproic acid (Amicar) is an antifibrinolytic agent that prevents clot breakdown or dissolution. It is commonly prescribed after subarachnoid hemorrhage if surgery is delayed or contraindicated, to prevent further hemorrhage. Alteplase is a fibrinolytic that actively breaks down clots. Warfarin and heparin sodium are anticoagulants that interfere with propagation or growth of a clot.

The home care nurse is making a monthly visit to a client with a diagnosis of pernicious anemia who has been receiving a monthly injection of cyanocobalamin (vitamin B12). Before administering the injection, the nurse evaluates the effects of the medication and determines that a therapeutic effect is occurring if the client makes which statement? 1. "I feel really lightheaded." 2. "I no longer have any nausea." 3. "I have not had any pain in a month." 4. "I feel stronger and have a much better appetite."

4 Rationale: Cyanocobalamin is essential for DNA synthesis. It can take up to 3 years for the vitamin B12stores to be depleted and for symptoms of pernicious anemia to appear. Symptoms can include weakness, fatigue, anorexia, loss of taste, and diarrhea. To correct deficiencies, a crystalline form of vitamin B12, cyanocobalamin, can be given intramuscularly. The client statements in options 1, 2, and 3 do not identify a therapeutic effect of the medication.

The nurse is monitoring a client who is receiving epoetin alfa (Epogen, Procrit) for adverse effects of the medication. Which finding indicates an adverse effect? 1. Diarrhea 2. Depression 3. Bradycardia 4. Hypertension

4 Rationale: Epoetin alfa generally is well tolerated. The most significant adverse effect is hypertension. Occasionally a tachycardia may occur as a side effect. This medication also may cause an improved sense of well-being.

Epoetin alfa (Epogen, Procrit) has been prescribed for a client with chronic kidney disease who is being cared for by a nursing student. The nursing instructor determines that the student understands the procedure for administering the medication when the student states that which route of administration is acceptable? 1. Oral 2. Z-track 3. Intramuscular 4. Subcutaneous

4 Rationale: Epoetin alfa is administered parenterally by the intravenous or subcutaneous route. It cannot be given orally because it is a glycoprotein and would be degraded in the gastrointestinal tract.

A home care nurse is preparing to administer filgrastim (Neupogen) to a client. The nurse plans to administer the medication by which route? 1. Oral 2. Subcutaneous 3. Intramuscular 4. Intravenous bolus

2 Rationale: Filgrastim (Neupogen) is a granulocyte colony-stimulating factor produced by human recombinant DNA technology. It is given by subcutaneous injection or continuous intravenous infusion.

A client is prescribed a liquid iron preparation that has the potential to stain the teeth. The nurse should instruct the client to take which action to prevent staining of the teeth? 1. Brush the teeth before drinking the iron. 2. Drink the iron undiluted for maximal effect. 3. Dilute more than the amount prescribed to obtain the correct dosage. 4. Dilute the iron in juice, drink it through a straw, and rinse the mouth afterward.

4 Rationale: Liquid iron preparations will stain the teeth. The best advice for the client who needs liquid iron is to dilute the iron in juice or water, drink it through a straw, and rinse the mouth well afterward. Brushing before taking the liquid iron would not be of any benefit. The nurse would not instruct a client to take more than the prescribed amount.

The nurse is assigned to care for a client who was just admitted to the hospital for the treatment of iron overload. The nurse anticipates that the health care provider will prescribe which medication to treat the iron overload? 1. Granisetron 2. Ketoconazole 3. Deferoxamine 4. Terbinafine (Lamisil)

3 Rationale: Deferoxamine is a medication used to treat iron overload. Granisetron is an antiemetic. Ketoconazole and terbinafine are antifungal medications.

The client in chronic kidney disease is receiving epoetin alfa (Epogen). The nurse should monitor this client for which adverse effect of this medication? 1. Fever 2. Depression 3. Bradycardia 4. Hypertension

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Epoetin alfa (Epogen, Procrit) by the subcutaneous route is prescribed for a client. Which is the correct action for the nurse to implement? 1. Shake the vial before use. 2. Freeze the medication before use. 3. Refrigerate the medication until used. 4. Obtain syringes with 1½-inch needles from the pharmacy.

3 Rationale: Epoetin alfa (Epogen, Procrit) should be refrigerated at all times. The bottle should not be shaken and the medication should not be frozen because this will affect the chemical composition. Syringes with a 5/6-inch needle are used for subcutaneous injection. A 1½-inch needle may be used for intramuscular injection.

The nurse is evaluating the results of laboratory studies for a client receiving epoetin alfa (Epogen, Procrit). When should the nurse expect to note a therapeutic effect of this medication? 1. Immediately 2. 3 days after therapy 3. 2 weeks after therapy 4. After 1 week of therapy

3 Rationale: Epoetin alfa stimulates erythropoiesis. It takes 2 to 6 weeks after initiation of therapy before a clinically significant increase in hematocrit is observed. Therefore this medication is not intended for clients who require immediate correction of severe anemia, and it is not a substitute for emergency blood transfusions.

A client with chronic kidney disease was started on epoetin alfa (Epogen, Procrit) 2 months earlier. In evaluating the therapeutic effectiveness of the medication, the nurse should expect the client to exhibit which finding? 1. A decrease in blood pressure 2. An increase in white blood cells 3. An increase in serum hematocrit 4. A decrease in serum creatinine levels

3 Rationale: Epoetin alfa stimulates red blood cell production. Initial effects should be seen within 1 to 2 weeks, and the hematocrit reaches normal levels (30% to 33%) in 2 to 3 months.

The nurse is providing instructions to the parent of a child with iron deficiency anemia about the administration of a liquid oral iron supplement. Which statement, if made by the parent, indicates an understanding of the administration of this medication? 1. "I should give the iron with food." 2. "I can mix the iron with cereal to give it." 3. "I should add the iron to the formula in the baby's bottle." 4. "I should use a medicine dropper and place the iron near the back of the throat."

4 Rationale: An oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth because it will stain the teeth. The parents should be instructed to brush or wipe the teeth after administration. Iron is administered between meals because absorption is decreased if there is food in the stomach. Iron requires an acidic environment to facilitate its absorption in the duodenum.

The nurse is preparing to administer filgrastim (Neupogen) to a client with a diagnosis of agranulocytosis. The client asks the nurse about the purpose of the medication. The nurse explains that this medication will have which action? 1. Prevent bleeding. 2. Prolong the clotting time. 3. Increase the red blood cell count. 4. Promote the growth of neutrophils.

4 Rationale: Filgrastim is a granulocyte colony-stimulating factor produced by human recombinant DNA. It is administered to clients with agranulocytosis to promote the growth of neutrophils and enhance the function of mature neutrophils. Options 1, 2, and 3 are not actions of this medication.

A nurse has a prescription to administer a dose of iron by a parenteral route to an assigned client. Which would the nurse implement to administer this medication correctly via the intramuscular route? Select all that apply. 1. Use a Z-track method. 2. Administer the medication only in the deltoid. 3. Aspirate for blood after the needle is inserted. 4. Use an air lock when drawing up the medication. 5. Change the needle after drawing up the dose and before injection. 6. Massage the injection site well after injection to hasten absorption.

1,3,4,5 Rationale: An air lock and a Z-track technique should both be used when administering iron by the intramuscular route. Proper technique includes changing the needle after drawing up the medication but before giving it to prevent staining of skin. The dorsogluteal site should be used only after proper identification of appropriate landmarks. After the needle is inserted, the nurse should aspirate for the presence of blood and should proceed with the administration if no blood is aspirated. The site should not be massaged after injection because massaging could cause staining of the skin.

A client is diagnosed with iron deficiency anemia, and ferrous sulfate (Feosol) is prescribed. The nurse should tell the client that it would be best to take the medication with which food? 1. Milk 2. Boiled egg 3. Tomato juice 4. Pineapple juice

3 Ferrous sulfate is an iron preparation, and the client is instructed to take the medication with orange juice or another vitamin C-containing product or product high in ascorbic acid to increase the absorption of the iron. Among the options presented, tomato juice is highest in vitamin C and ascorbic acid. Milk and eggs inhibit absorption of iron.

A client with chronic kidney disease is receiving ferrous sulfate (Feosol). The nurse instructs the client that which finding is a common side effect associated with this medication? 1. Fatigue 2. Headache 3. Weakness 4. Constipation

4 Rationale: Feosol is an iron supplement used to treat anemia. Constipation is a frequent and uncomfortable side effect associated with the administration of oral iron supplements. Stool softeners often are prescribed to prevent constipation. Options 1, 2, and 3 are not side effects associated with this medication.

The nurse is reviewing the laboratory test results for a client who is receiving filgrastim (Neupogen). Which reported value would indicate an effectiveresponse to this medication? 1. Hematocrit of 42% 2. Blood glucose level of 120 mg/dL 3. Platelet count of 150,000 cells/mm3 4. Neutrophil count of 10,000 cells/mm3

4 Rationale: Filgrastim (Neupogen) is used to promote the growth of neutrophils and enhance the function of mature neutrophils. Treatment is continued until the absolute neutrophil count reaches 10,000 cells/mm3. Options 1, 2, and 3 are unrelated to the action of this medication.

The nurse is providing dietary instructions to the client with anemia. The client tells the nurse that the iron pills are very expensive and it will be difficult to pay for the pills and buy the proper food. What is the most appropriate nursing response? 1. "You will have to find a way to afford both." 2. "You will be fine as long as you take the iron pills." 3. "Why don't you ask your family to help you out financially?" 4. "Would you like for me to check into some other options for you?"

4 Rationale: Option 4 is correct because it validates the client's issue with cost. The nurse offers help in a nonthreatening manner that will allow the client to accept or decline. Option 2 is incorrect because the client needs to consume a proper diet. Options 1 and 3 block the communication process and are nontherapeutic and nonhelpful statements.