Prep You Chapter 49
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?
Iron
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 acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia.
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:
Iron levels
Which client is most likely to benefit from treatment with interferon beta?
a 51-year-old woman being treated for multiple sclerosis
A client is receiving ferrous sulfate as treatment for iron deficiency anemia. After teaching the client, which statement indicates the need for additional teaching?
"I need to take an antacid with the pill to prevent an upset stomach."
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?
An iron supplement
A patient is receiving hydroxyurea. The nurse understands that this drug is used to treat:
Sickle cell anemia
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.
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?
blood pressure
A 67-year-old man who is being treated for prostate cancer is taking epoetin alfa. The nurse will instruct the patient to:
schedule an appointment to measure hemoglobin twice a week for at least 2 to 6 weeks.
Which would the nurse encourage a client to consume to prevent folic acid anemia? (Select all that apply.)
Broccoli Milk Liver
What would a nurse identify as a contraindication for iron therapy? (Select all that apply.)
Hemolytic anemia Peptic ulcer disease Colitis
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 hemoglobin, causing less oxygen to be delivered to the tissues."
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?
"If constipation or diarrhea become severe, call your primary care provider."
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 platelets."
The average lifespan of a red blood cell (RBC) is approximately:
120 days.
Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy?
A 62-year old male with cancer
For which client would Procrit NOT be indicated?
A client with a hemoglobin of 12, with shortness of breath.
An instructor is teaching a group of students about possible drug interactions with iron preparations. The instructor states that which drug should be separated from the administration of iron at least 2 hours? (Select all that apply.)
Antacids Tetracycline Norfloxacin
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
Which would the nurse expect the health care provider to prescribe for a client receiving methotrexate?
Leucovorin
Adverse effects of epoetin and darbepoetin include increased risks of what condition?
Myocardial infarction
All hematopoietic and immune blood cells are derived from which cells in the bone marrow?
Stem cells
Cyanocobalamin is a vitamin B12 in a nasal formulation. (T/F)
TRUE
A male client is diagnosed with severe neutropenia and is prescribed filgrastim. What is the desired effect?
To increase white blood cells
A client prescribed epoetin alfa asks how the medication works. Which is the nurse's best response?
"Increases the release of cells to increase the hemoglobin and hematocrit levels."
A client with a diagnosis of renal failure is being treated for anemia with epoetin alfa. Frequent assessment of which laboratory values should be prioritized before and during treatment?
CBC
Which would be appropriate for a client who is receiving iron therapy?
Cautioning the client that stool may be dark or green
The client is a 39-year-old male seen in the clinic for anemia. The nurse knows that ESAs are drugs used to treat anemia associated with which conditions? (Select all that apply.)
Chronic kidney disease Chemotherapy for cancer treatment AZT therapy for HIV Postsurgical blood replacement in place of allogenic transfusions
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?
Erythropoietin
A nurse is reviewing the chart of a patient with megaloblastic anemia. What might be used in the treatment of this patient? (Select all that apply.)
Folic acid Vitamin B12
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?
Folic acid deficiency anemia occurs because of a dietary lack of folic acid, a component necessary in the formation of red blood cells.
A patient has been diagnosed with hairy cell leukemia. The patient is to begin taking Interferon alfa-2b. What will the nurse include in instructions to the patient concerning this drug?
Increase fluid intake while taking the drug.
Colony-stimulating factors (CSF) are administered to produce which therapeutic effect?
Increase the growth of specific types of blood cells
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?
Iron supplement
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?
Pernicious anemia
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?
Procrit
After reviewing the major types of anemia, students demonstrate understanding of the information when they identify what as an example of a hemolytic anemia?
Sickle cell anemia
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?
Subcutaneous / Intravenous
The component of the red blood cell that is not recycled is bilirubin. (T/F)
TRUE
There is a risk of antibody production with the use of epoetin. (T/F)
TRUE
A nurse preparing to teach a client about their newly prescribed cancer treatment should consider addressing which primary reason for non-adherence to the medication regimen? Select all that apply.
The route of medication administration Adverse effects of medications
A male client is taking Procrit. He requests changing his medication from the IM to the PO route. The nurse's best response is:
This medication is destroyed in the stomach and can only be given IM.
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?
Uncontrolled hypertension
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?
Vitamin B12
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?
anemia
An older adult client diagnosed with chronic renal failure has begun experiencing increasing fatigue. The nurse would anticipate educating the client on what likely medication prescription?
epoetin alfa
A client has been diagnosed with genital warts. Which medication would the nurse anticipate being prescribed?
interferon alfa-2b
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?
temporarily withholding administration
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.
The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome?
Increased RBC count
The nurse administers epoetin alfa (Epogen). What is the therapeutic response the nurse expects to assess?
Increased red blood cell count
A nurse administers erythropoietin. What assessment finding is attributable to the increased effect of this hormone? Select all that apply.
Increased red blood cell count Increased hemoglobin
The nurse is teaching a client about folinic acid rescue in chemotherapy. Which of the following information would the nurse include in the teaching plan?
Folinic acid rescue in chemotherapy includes leucovorin administration.
A male client is diagnosed with multiple myeloma. What treatment regimen would the nurse expect the health care provider to order?
Interferon alfa
The mature red blood cell contains a nucleus. (T/F)
FALSE
What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa?
Impaired tissue oxygenation related to anemia
A patient has been prescribed epoetin alfa. The nurse recognizes that this medication is indicated for treatment of anemia associated with which disease process?
Renal failure
Which patient should not receive epoetin alfa (Epogen) as ordered at 9 am?
The patient who has a blood pressure of 240/120 mm Hg
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.
The prototype drug used to create red blood cells (RBCs) is epoetin alfa (Epogen, Procrit). It has many indications for use. Which are selected indications? Select all that apply.
Anemia from chronic renal disease (CRD) Anemia related to zidovudine therapy in HIV-associated illness Anemia related to chemotherapy in patients with cancer
Which would a nurse identify as the primary issue associated with anemias?
Ineffective red blood cells
Cytokines regulate the immune response by stimulating or inhibiting the activation, proliferation, and differentiation of various cells and by what other action?
Regulating the secretion of antibodies
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
A 69-year-old female 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?
flu-like symptoms
