N121 PrepU Ch. 11: Drug Therapy for Hematopoietic Disorder

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

"I will avoid crowds and people with illnesses." Explanation: For therapy with filgrastim, the nurse should instruct the patient and those in contact with the patient to wash their hands frequently, avoid crowds, and avoid people with illnesses. To prevent any serious adverse effects, filgrastim is usually discontinued when the neutrophil count is excessively high or has reached its nadir (lowest) level. However, the patient should not be encouraged to make this decision on his or her own. When the patient self-administers the drug, it is advised that the drug be refrigerated but not frozen.

13. The nurse is caring for a client with a WBC of 700 cells/mm3. Which discharge instruction is most important for the nurse to share with this client? "Stay out of crowded places such as grocery stores." "Watch for signs of excessive bruising." "Eat foods rich in iron to increase your energy level." "Go for a walk in the mall everyday to increase your endurance."

"Stay out of crowded places such as grocery stores." Explanation: A client with a low WBC should avoid crowds to reduce the chance of coming into contact with a person who has an infection such as a cold, which could be very serious in a person who has little defense against infection.

2. 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 cytokine 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." Explanation: When interleukins are administered, there are increases in the numbers of natural killer cells and lymphocytes, in cytokine activity, and in the number of circulating platelets. Options A, C and D are incorrect answers.

4. What ordered dosage for epoetin alfa (Procrit) could the nurse administer without needing to question the order? 100 mg/d PO 1 mg/d IM 0.45 mcg/kg IV once per week 100 units/kg subcutaneously three times per week

100 units/kg subcutaneously three times per week Explanation: An appropriate dosage of epoetin alfa is 50 to 100 units/kg IV or subcutaneously, 3 days a week. Darbepoetin alfa can be administered by IV or subcutaneously once a week, and the usual dose is 0.45 mcg/kg. Folic acid is administered orally, IM, subcutaneously, or IV; the usual dosage is 1 mg. The usual dose of ferrous sulfate is 100 to 200 mg/d PO.

20. After the client undergoes bone marrow transfusion, the health care provider administers sargramostim. When would the nurse expect the first dose to be administered? 1 hour after the bone marrow infusion Immediately after the bone marrow infusion 2 to 4 hours after the bone marrow infusion 30 minutes after the bone marrow infusion

2 to 4 hours after the bone marrow infusion Explanation: When sargramostim is given to clients with cancer who have undergone bone marrow transplantation, the drug should be started 2 to 4 hours after the bone marrow infusion and at least 24 hours after the last dose of antineoplastic chemotherapy or 12 hours after the last radiotherapy treatment.

20. A child weighing 32 lb (14.5 kg) is to take ferrous sulfate 6 mg/kg/d PO. How many milligrams should the child receive per dose? Record the answer as a whole number. calculate

87 mg per dose Explanation: The nurse will administer 87 mg per dose. 14.5 kg x 6 mg/kg/day = 87 mg/day.

16. Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy? A 20-year-old female A 62-year-old male with cancer A 30-year-old pregnant woman A 40-year-old male with a high white blood cell count

A 62-year-old male with cancer Explanation: Older adults who have cancer and are receiving chemotherapy are especially vulnerable to the adverse effects of anemia as a result of chemotherapy and would therefore be the most likely candidates for epoetin alfa therapy. Young adults over age 18, pregnant women, and patients with a high white blood cell count are not as vulnerable to anemia and would not require epoetin alfa therapy.

10. 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 folic acid supplement An iron supplement A blood transfusion

An iron supplement Explanation: Patients taking epoetin alfa who require surgery may require iron supplementation.

12. The pharmacology instructor is talking about interferon. The instructor explains that agents such as interferons have more than one biologic function. What function is NOT associated with interferons? Immunomodulatory Antiviral Antiproliferative Antibacterial

Antibacterial Explanation: Interferons act to prevent virus particles from replicating inside cells. They also stimulate interferon receptor sites on noninvaded cells to produce antiviral proteins, which prevent viruses from entering the cell. In addition, interferons have been found to inhibit tumor growth and replication, to stimulate cytotoxic T-cell activity, and to enhance the inflammatory response. Interferons are not associated with the management of bacterial infections.

16. A patient has an elevated white blood cell (WBC) count. What is the nurse's primary action related to this finding? Assess the patient for other signs of infection. Place the patient in protective isolation. Protect the patient from other sources of infection. Assess the patient for exposure to antigens.

Assess the patient for other signs of infection. Explanation: The patient with an elevated WBC count may have an active infection. The nurse should first assess for other signs of infection so that treatment can be initiated. If the patient already has symptoms, assessing for exposure is not the priority. It would not be appropriate to place the patient in protective isolation unless the patient has other risks identified.

17. 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? Blood pressure Respirations Temperature Pulse

Blood pressure Explanation: The most important assessment is the blood pressure because epoetin can cause hypertension.

6. A nurse is monitoring a patient who has received an "interferon." What therapeutic effect will the nurse expect to find when assessing this patient? Increase in red blood cell production Decrease in viral load Increase in white blood cell production Decrease in pain response

Decrease in viral load Explanation: Interferons inhibit the ability of viruses to replicate and spread to uninfected cells. Interferons do not affect red or white blood cells, nor do they directly inhibit the pain response.

12. In learning about immunostimulants, what would you learn is an expected outcome of these medications? RBC of 3,000 mm3 Decreased numbers or severity of infections Increased life expectancy WBC of 20,000 mm3

Decreased numbers or severity of infections Explanation: Immunostimulants are designed to act as endogenous products in reducing the number and severity of infections. The other options are not correct.

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

Impaired tissue oxygenation related to anemia Explanation: The most appropriate priority nursing diagnosis is impaired tissue oxygenation related to anemia. The other diagnoses are not specific to the reason that epoetin is prescribed or the specific side effects of the medication.

2. Colony-stimulating factors (CSF) are administered to produce which therapeutic effect? Reduce side effects to a medication Decrease the patient's reaction to a chemotherapeutic medication Enhance immune system functioning Increase the growth of specific types of blood cells

Increase the growth of specific types of blood cells Explanation: Colony-stimulating factors control the production, growth, and differentiation of specific blood cell types, such as red blood cells and leukocyte stem cells. CSFs do not decrease the side effects to a medication or the patient's reaction to chemotherapeutic medications. Immune system functioning is not measurable and not the direct result of administration of a CSF. A CSF could enhance the production of RBCs or leukocyte stem cells. Colonies of granulocytes are stimulated by CSFs.

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

Increased RBC count Explanation: Epoetin is a hormone that stimulates bone marrow production of red blood cells.

3. A patient has just been told that her cancer has metastasized to the right kidney. An interferon has been prescribed to treat this metastasis. The patient asks why the interferon is ordered. What is the nurse's best response? It has been shown to protect autologous tumor cells. It has been shown to have a direct proliferative effect on renal tumors. It has been shown to enhance allogeneic stem-cell transplantation. It has been shown to inhibit tumor growth.

It has been shown to inhibit tumor growth. Explanation: Interferon activates human cellular immunity and inhibits tumor growth through increases in lymphocytes, platelets, and cytokines. It does not protect autologous tumor cells, enhance allogeneic stem-cell transplantation, or have a direct proliferative effect on renal tumors.

3. What medication would best meet the needs of a client whose anemia is associated with chronic renal failure? Hydroxyurea Levoleucovorin Ferrous sulfate exsiccated Methoxy polyethylene glycol-epoetin beta

Methoxy polyethylene glycol-epoetin beta Explanation: Both darbepoetin alfa and methoxy polyethylene glycol-epoetin beta are approved to treat forms of anemia associated with chronic renal failure, including in clients receiving dialysis. Ferrous sulfate exsiccated is used to treat iron deficiency. Levoleucovorin is administered to diminish toxicity and counteract the effects of impaired methotrexate elimination and of inadvertent overdose of folic acid antagonists after high-dose methotrexate therapy for osteosarcoma. Hydroxyurea is used to reduce the frequency of painful sickle cell crises and to decrease the need for blood transfusions in adults with sickle cell anemia.

15. 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 Explanation: All hematopoietic and immune blood cells are derived from stem cells in the bone marrow.

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5. A male client is prescribed interferon. What is his probable diagnosis? Viral hepatitis Hypertension Sepsis Bacteremia

Viral hepatitis Explanation: Interferons are used mainly for viral hepatitis and certain types of cancer.

4. 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? ankylosing spondylosis asthma bacterial pneumonia chronic hepatitis C

chronic hepatitis C Explanation: 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.

3. A client with chronic renal failure is prescribed subcutaneous epoetin alpha. Which information will the nurse include when teaching the client about this medication? Select all that apply. "Take the prescribed iron supplement with fruit juice that has vitamin C." "Take acetaminophen as needed for bone pain." "Take the calcium supplement as prescribed." "Do not place the vial in the freezer." "Avoid shaking the medication vial."

"Avoid shaking the medication vial." "Do not place the vial in the freezer." "Take the prescribed iron supplement with fruit juice that has vitamin C." Explanation: Teaching for epoetin alpha includes instructing the client to avoid shaking the vial and not placing the medication vial in the freezer. An iron supplement (not a calcium supplement) should be taken as prescribed with a fruit juice that contains vitamin C, as this will increase the absorption of iron. Because bone pain is not an adverse effect of epoetin alpha, teaching about acetaminophen is not required.

3. 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? Sodium restriction Renal dialysis Iron supplement Potassium supplement

Iron supplement Explanation: 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.

13. The nurse is caring for a female client in the home. The client is prescribed filgrastim. What would be included in the nurse's education plan? Dietary restrictions Exercise restrictions Techniques to reduce exposure to infection Fall prevention

Techniques to reduce exposure to infection Explanation: With filgrastim, the nurse may need to help the client and family with techniques to reduce exposure to infection.

9. After assessing the client receiving erythropoietin drug therapy, the nurse suspects what finding is an adverse effect of erythropoietin drug therapy? The client's blood pressure is 102/59 mm Hg. The client has not had a bowel movement for 4 days. The client has peripheral edema to the feet and lower legs. The client reports a "low," "sad" mood.

The client has peripheral edema to the feet and lower legs. Explanation: Potential adverse effects of erythropoietin drug therapy are edema, nausea, vomiting, chest pain, diarrhea, and hypertension. Changes in mood are not typically reported and would not likely be attributed directly to erythropoietin therapy.

10. A client has been prescribed epoetin alfa. What assessment finding may suggest that the drug is contraindicated? The client takes bupropion for the treatment of depression. The client's blood pressure is 161/107 mm Hg. The client frequently has loose stools. The client is short of breath on exertion.

The client's blood pressure is 161/107 mm Hg. Explanation: Erythropoiesis-stimulating agents are contraindicated in the presence of uncontrolled hypertension because of the risk of worsening hypertension when red blood cell counts increase and the pressure within the vascular system also increases. There is no contraindication to the use of erythropoiesis-stimulating agents for clients with chronic or acute diarrhea or activity intolerance or who take antidepressants

18. The nurse improves client compliance with the drug regimen of epoetin alfa by: helping the client set up a reminder system for days when the drug is to be administered. arranging a referral for community transportation. having the client pharmacy contact the client on days when the drug should be administered. providing the client with an appointment card for each drug administration day

helping the client set up a reminder system for days when the drug is to be administered. Explanation: The nurse should help the client establish a reminder system for when the dose is due. The pharmacy cannot perform this role and having cards on hand does not provide an active reminder. The client can be taught to self-administer the drug, so there is no need for an appointment or arranging transportation.

14. A client diagnosed with metastatic kidney cancer and prescribed aldesleukin discusses obtaining the medication in an outpatient chemotherapy unit. As part of client education, the nurse would include what statement? "You will require premedication if treated in the chemotherapy center." "Aldesleukin is highly toxic and given only to hospitalized clients." "Aldesleukin can be given in the centers, but you must remain overnight." "I will request an order for you to be treated in the outpatient center."

"Aldesleukin is highly toxic and given only to hospitalized clients." Explanation: Aldesleukin is highly toxic and is contraindicated in clients with preexisting serious cardiovascular or pulmonary impairment. It is given only to hospitalized clients and should be prescribed and administered by health professionals who are experienced in its use.

18. The nurse is caring for a client who just received a cancer diagnosis. The client tells the nurse, "I saw the commercials on TV and I want to start taking Procrit immediately so I don't get tired from chemotherapy." What is the nurse's best response? a. "Chemotherapy causes anemia and only when that happens will it be appropriate to prescribe Procrit for you." b. "Before the provider will order this drug, you will need to be found to have anemia so we will draw some blood for lab work while you're here." c. "The provider may order Procrit for you when it is appropriate, but now is not the appropriate time for you to take this drug." d. "Procrit is only effective if you develop anemia from chemotherapy that is caused by low levels of erythropoietin."

"Procrit is only effective if you develop anemia from chemotherapy that is caused by low levels of erythropoietin." Explanation: There is a risk of decreasing normal levels of erythropoietin if epoetin alfa (Procrit), or any of this classification of drug (erythropoiesis-stimulating agents), is given to clients who have normal renal functioning and adequate levels of erythropoietin. The client should be taught that the drug will only be prescribed if he or she develops anemia due to inadequate erythropoietin. Although it is true the doctor may prescribe the drug when it is appropriate, this answer does not explain why it is inappropriate to prescribe it now. Anemia alone is not sufficient cause for prescribing Procrit and not all chemotherapy results in anemia.

5. Mr. Harrison, 68 years old, who has renal carcinoma, is taking interleukin-2. What statement by this client leads you to believe that he has understood the teaching that you have done? "This drug can cause renal failure." "This drug will prevent me from developing a viral infection." "This drug will inhibit tumor growth." "This drug will decrease the number of T cells."

"This drug will inhibit tumor growth." Explanation: Interleukin-2 produces tumor necrosis factor and inhibits tumor growth.

20. The nurse would contact the prescriber immediately if interferon was prescribed for which client? 48-year-old female with hepatitis C 11-month-old female with HIV acquired from her mother 34-year-old male with chronic hepatitis B 72-year-old male with AIDS-related Kaposi's sarcoma

11-month-old female with HIV acquired from her mother Explanation: Interferon should not be administered to newborns or infant. A baby is considered an infant until 12 months of age.

4. The nurse is caring for a client who had a postpartum hemorrhage 2 weeks ago that resulted in anemia. The client has called the clinic after passing dark stools, stating, "I looked this up online, and I'm worried I might have stomach or intestinal bleeding." What is the nurse's best initial action? Potassium supplement Renal dialysis Sodium restriction Iron supplement

Ask the client whether she is taking iron supplements. Explanation: Iron supplements often cause black, tarry stool. This does not mean that the client should not be assessed further, but this is the most likely question to ask initially. The quantity of the client's blood loss postpartum is not a priority. The client would not have required erythropoietin for a hemorrhage. It is not a high priority to ask about the client's usual bowel pattern; the client has already indicated that this is a significant deviation.

14. In learning about immunostimulants, what would you learn is an expected outcome of these medications? Decreased numbers or severity of infections WBC of 20,000 mm3 RBC of 3,000 mm3 Increased life expectancy

Decreased numbers or severity of infections Explanation: Immunostimulants are designed to act as endogenous products in reducing the number and severity of infections. The other options are not correct.

18. A nurse is to use a single-dose 1 mL vial to administer 0.5 mL of epoetin alfa to a 39-year-old woman who is being treated for chemotherapy-induced anemia. Which of the following will the nurse do with the unused portion of the drug? Discard the unused portion of the drug. Refrigerate the medication for a future use. Store the medication in the drug cart for the next dose. Put the medication in the freezer compartment of the refrigerator.

Discard the unused portion of the drug. Explanation: The single-dose 1-mL vial does not have preservatives. In order to prevent contamination, the nurse will discard the unused portion of the drug. A 2-mL vial does have preservatives and would be stored at 2°C to 8°C to be used again. The 2-mL vial should be discarded 21 days after initial entry to prevent use of a possibly contaminated product.

8. A male client is self-administering epoetin in the home. The nurse encourages him to include what supplements as part of his daily medication regimen? Vitamin A Folic acid Vitamin C Iron

Iron Explanation: Epoetin is not effective unless sufficient iron is present, and most clients need an iron supplement. When an iron preparation is prescribed, the home care nurse may need to emphasize the importance of taking it.

10. Adverse effects of epoetin and darbepoetin include increased risks of what condition? Diabetes mellitus type 2 Hyperlipidemia Cirrhosis of the liver Myocardial infarction

Myocardial infarction Explanation: Adverse effects of epoetin and darbepoetin include increased risks of hypertension, myocardial infarction, and stroke, especially when used to increase hemoglobin above 12 g/dL.

6. 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 Explanation: 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.

11. For what purpose would the nurse administer postoperative epoetin alfa to the client who is a Jehovah's Witness? Treatment of HIV infection To prevent the need for chemotherapy Treatment of anemia associated with chronic renal failure Reduce the need for allogenic blood transfusion

Reduce the need for allogenic blood transfusion Explanation: Jehovah's Witnesses often refuse allogenic blood transfusions because of their religious beliefs. Indications for the use of epoetin alfa include treatment of anemia associated with chronic renal failure, related to treatment of HIV infection or to chemotherapy in cancer clients, to reduce the need for allogenic blood transfusions in surgical clients. There is no indication in this question that the client has chronic renal failure, HIV, or need for chemotherapy.

13. 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? Dry, nonproductive cough Reports of calf pain on dorsiflexion of the foot A rash under the breast 1 pound weight gain in 1 week

Reports of calf pain on dorsiflexion of the foot Explanation: 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.

8. Which symptom, if assessed after the administration of epoetin alfa (Epogen), would be cause for alarm? The patient displays weakness on one side of the body. The patient states the injection "hurts." The patient is tired. The patient reports "bone pain."

The patient displays weakness on one side of the body. Explanation: 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.

8. The nurse administers interferon alpha-2b to a patient. Which assessment finding will the nurse act on immediately? The patient has a form of leukemia. The patient reports feeling "fatigued." The patient administered the medication at home. The patient has elevated liver function tests.

The patient has elevated liver function tests. Explanation: Liver enzymes can become elevated in patients taking interferons. This may require discontinuing the drug. The patient can self-administer, and considering that the patient may have a chronic condition when receiving this drug, fatigue is often a symptom. The medication can be given to patients with leukemia. The nurse would have to act only on the assessment of elevated liver enzymes.

1. 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? The patient maintains an oxygen saturation of 92% on room air The patient's hemoglobin level is 11 g/dL The patient white blood cell level is within reference ranges Capillary refill in the patient's nail beds is less than or equal to 3 seconds

The patient's hemoglobin level is 11 g/dL Explanation: The most clinically significant indicator of the effectiveness of treatment with EPO is the patient's hemoglobin level. Respiratory status, peripheral circulation, and leukocyte levels are relevant to the patient's overall health status, but these do not directly suggest the success of failure of EPO treatment.

6. A client prescribed epoetin alfa requests changing the medication from the subcutaneous to the oral route. Which statement should the nurse use to formulate a response to this request? The oral route while more desirable is not as effective. The drug dose must be increased if being given via the oral route. This medication is likely to causes severe diarrhea if given orally. This drug is destroyed by acids found in the stomach.

This drug is destroyed by acids found in the stomach. Explanation: Epoetin alfa is given by subcutaneous or intravenous (IV) injection because it would be destroyed by digestive enzymes if given orally. None of the other options accurately describe why the oral route is not an option.

2. 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? thrombocytopenia anemia hypertension hypoglycemia

anemia Explanation: A common condition associated with chronic renal failure is anemia. Shortness of breath in a client with chronic renal failure (without obvious fluid balance issues) is likely due to anemia and its effect on the body's ability to transport oxygen. None of the other options would cause the client's symptoms.

7. A client has been receiving regular doses of epoetin alfa for several weeks, and the home care nurse has been monitoring the client's condition closely. When taking the client's vital signs, the nurse should pay particular attention to what assessment datum? temperature blood pressure respiratory rate heart rate

blood pressure Explanation: The most common adverse effect of epoetin alfa is hypertension. The nurse would critically examine all the client's vital signs, but blood pressure would be of particular concern.

12. A client, currently prescribed epoetin alfa, has recent blood work that reveals a hemoglobin level of 12.8 g/dL. What action does this assessment finding necessitate regarding the epoetin alfa? changing the route of administration requesting a change in the dosage administering an unscheduled dose temporarily withholding administration

temporarily withholding administration Explanation: Epoetin increases risks of myocardial infarction and stroke, especially if it is used to achieve hemoglobin levels greater than 12 g/dL (120 g/L). The U.S. Food and Drug Administration (FDA) has issued a black box warning advising prescribers to avoid using hematopoietic growth factors in clients with hemoglobin values of 12 g/dL (120 g/L). Administration of the drug should consequently be discontinued on a temporary basis. None of the other options would safely address the client's current health issue.

6. Mr. Singh is a 66-year-old man who is receiving chemotherapy for the treatment of lung cancer that has metastasized to his liver. In an effort to prevent infection, Mr. Singh has been prescribed filgrastim (Neupogen). Which of the nurse's following assessment questions most directly addresses a common adverse effect of filgrastim? "Have you had any shortness of breath lately?" "Are you experiencing any waves of cool, clammy skin?" "Have you noticed any bleeding in your gums or cheeks?" "Do you feel like you're having any pain in your bones?"

"Do you feel like you're having any pain in your bones?" Explanation: Medullary bone pain is a consistently observed adverse effect that can be attributed to drug therapy with filgrastim; it is mild to moderate in severity and is reported in 56% of patients taking the drug. Shortness of breath, mucosal bleeding, and cool, clammy skin are not adverse effects typical of filgrastim.

8. A patient has just received IV cytotoxic chemotherapy. Which patient statement indicates a need for further teaching about this therapy with filgrastim (Neupogen)? "I will tell my healthcare provider if I have breathing difficulties after receiving this medication." "I will take acetaminophen (Tylenol) if I have bone pain." "I am going to administer my Neupogen as soon as I get home today." "I will be careful and not stay around people who have infections."

"I am going to administer my Neupogen as soon as I get home today." Explanation: Neupogen should not be administered within 24 hours of receiving cytotoxic chemotherapy. The other actions and statements are appropriate.

4. A client prescribed epoetin alfa asks how the medication works. Which is the nurse's best response? "Stimulates the growth and development of white blood cells (WBC) to prevent neutropenia." "Decreases release of reticulocytes, which inhibits red blood cell (RBC) production." "Increases the release of cells to increase the hemoglobin and hematocrit levels." "Releases erythropoiesis from the kidneys to increase the number of platelets."

"Increases the release of cells to increase the hemoglobin and hematocrit levels." Explanation: Epoetin alfa induces erythropoiesis by stimulating erythroid progenitor cells. This causes the release of reticulocytes from the bone marrow, leading to an increase in hemoglobin and hematocrit levels. The medication does not assist with supplying either WBCs or platelets.

14. 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 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 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 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. Explanation: Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia. Epogen does not slow production of red blood cells or stimulate production of white blood cells.

1. The client has taken epoetin alfa (Epogen) with good results for several months. On this visit, the nurse analyzes the client's lab results and finds indications of severe anemia and cytopenia. What order will the nurse anticipate receiving? Change the client to another erythropoiesis-stimulating agent. Begin administering Epogen IV instead of subcutaneously. Discontinue Epogen. Increase the dosage of Epogen.

Discontinue Epogen. Explanation: In clients treated with Epogen or any drug in this class who develop severe anemia after improvement, the drug should be stopped and should not be changed to another drug in the class because it is likely due to client's development of neutralizing antibodies. Increasing the dosage will not help, and changing the route of administration will not reverse the process after antibodies have formed.

20. 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? Administer the drug immediately, without allowing time for the hematocrit to rise. Warm the drug before use. Shake the drug before use. Do not shake the drug vigorously.

Do not shake the drug vigorously. Explanation: To maintain the biologic activity of epoetin alfa, do not shake the drug after reconstituting it. Vigorous shaking may denature the glycoprotein, making it biologically inactive. Time should also be allowed for the hematocrit to rise before seeking an order to adjust the dose. In addition, the drug should not be heated.

19. What assessment finding does the nurse determine is a therapeutic outcome of administering filgrastim (Neupogen) to the patient? Elevation of white blood cell count (WBC) Increased red blood cell count (RBC)

Elevation of white blood cell count (WBC) Explanation: Filgrastim (Neupogen) increases or stimulates the production, maturation, and activation of neutrophils within bone marrow. It will not increase hemoglobin or RBC, or decrease heart rate.

19. 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? Epoetin alfa Penicillin Filgrastim Interferon gamma

Epoetin alfa Explanation: Epoetin alfa is a drug formulation of erythropoietin, a hormone from the kidney that stimulates bone marrow production of red blood cells. It is used to prevent or treat anemia associated with several conditions, including chronic renal failure and myelosuppressive anticancer chemotherapy (depresses bone marrow function). Filgrastim is given to increase blood cell production in clients undergoing bone marrow transplantation or chemotherapy. Interferon gamma is used to treat chronic granulomatous disease. Penicillin is an antibiotic.

10. To prevent febrile neutropenia in the older adult taking chemotherapy, what does the nurse anticipate administering prophylactically? Filgrastim Neumega Antibiotics Epoetin alfa

Filgrastim Explanation: Prophylactic administration of filgrastim or pegfilgrastim to prevent febrile neutropenia is as effective for older adults as for younger adults in reducing the severity and duration of neutropenia. Administering filgrastim during the first cycle of chemotherapy may be especially valuable for older adults.

18. A client comes to the clinic for epoetin alfa therapy. The nurse monitoring the client knows that blood will be drawn before the treatment begins, in order to evaluate which level? HCT Na+ Blood glucose WBC

HCT Explanation: The nurse knows that the hematocrit is usually measured before each dose of the drug. Blood glucose, white blood cell count, and sodium are not used to monitor the effects of epoetin alfa before or during administration.

1. The nurse has just admitted a client to the unit who is newly diagnosed with Kaposi's sarcoma. The health care provider has order an IV infusion of an interferon. What drug has the provider ordered? Peginterferon alfa-2b Interferon alfa-2b Interferon gamma-1b Interferon beta-1a

Interferon alfa-2b Explanation: Interferon alfa-2b indications: Hairy cell leukemia, malignant melanoma, AIDS-related Kaposi's sarcoma, chronic hepatitis B and C, intralesional treatment of condylomata acuminata in patients 18 years of age or older.

17. 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: Chemotherapy Iron levels Swelling of veins Renal failure

Iron levels Explanation: Monitoring iron and hematocrit levels may help the nurse track the progress and effectiveness of the epoetin alfa therapy. Chemotherapy is a cancer treatment, not an assessment that determines the success or effectiveness of the epoetin alfa therapy. Swelling of veins and renal failure are not normally monitored in an ongoing assessment of a patient who takes epoetin alfa.

19. A patient has just been told that her cancer has metastasized to the right kidney. An interferon has been prescribed to treat this metastasis. The patient asks why the interferon is ordered. What is the nurse's best response? It has been shown to enhance allogeneic stem-cell transplantation. It has been shown to inhibit tumor growth. It has been shown to protect autologous tumor cells. It has been shown to have a direct proliferative effect on renal tumors.

It has been shown to inhibit tumor growth. Explanation: Interferon activates human cellular immunity and inhibits tumor growth through increases in lymphocytes, platelets, and cytokines. It does not protect autologous tumor cells, enhance allogeneic stem-cell transplantation, or have a direct proliferative effect on renal tumors.

8. 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? 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. Treatment with epoetin alfa will likely begin 4 to 6 days before Mr. Lepp's first round of chemotherapy and continue indefinitely. Mr. Lepp's oncologist should have begun treatment with epoetin alfa immediately after he was diagnosed.

The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients. Explanation: 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.

9. A client is beginning darbepoetin therapy. How often does the nurse expect the hemoglobin to be measured? Every other day until stabilized Weekly until stabilized Monthly until stabilized Twice weekly until stabilized

Twice weekly until stabilized Explanation: With darbepoetin and epoetin, iron stores (transferrin saturation and serum ferritin) should be measured before and periodically during treatment. Hemoglobin should be measured twice weekly until the level is stabilized and maintenance drug doses are established.