PrepU CH 29: Drugs used to treat anemias
Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy? A. A 20-year-old female B. A 62-year-old male with cancer C. A 40-year-old male with a high white blood cell count D. A 30-year-old pregnant woman
B. A 62-year-old male with cancer
A client has suffered from a gastrointestinal hemorrhage. Which agent will assist in raising the hemoglobin? A. Pentoxifylline B. Estazolam (Prosom) C. Epoetin alfa D. Dextromethorphan hydrobromide
C. Epoetin alfa
Which symptom, if assessed after the administration of epoetin alfa (Epogen), would be cause for alarm? A. The patient displays weakness on one side of the body. B. The patient reports "bone pain." C. The patient is tired. D. The patient states the injection "hurts."
A. The patient displays weakness on one side of the body.
Cyanocobalamin is a vitamin B12 in a nasal formulation. A. True B. False
A. True
A male client is prescribed interferon. What is his probable diagnosis? A. Viral hepatitis B. Bacteremia C. Sepsis D. Hypertension
A. Viral hepatitis
The mature red blood cell contains a nucleus. A. True B. False
B. False
The component of the red blood cell that is not recycled is bilirubin. A. False B. True
B. True
Which would a nurse identify as the primary issue associated with anemias? A. Ineffective red blood cells B. Increased plasma proteins C. Defective white blood cells D. Lack of vitamin B12
A. Ineffective red blood cells
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. A folic acid supplement B. An iron supplement C. A blood transfusion D. A protein supplement
B. An iron supplement
There is a risk of antibody production with the use of epoetin. A. False B. True
B. True
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? A. "If darkening of the stools appears, call your primary care provider." B. "If you get a little thirsty, call your primary care provider." C. "If constipation or diarrhea become severe, call your primary care provider." D. "If you have an increased appetite, call your primary provider."
C. "If constipation or diarrhea become severe, call your primary care provider."
A patient is to be administered an erythropoiesis-stimulating agent. Which of the following drugs would the nurse administer? A. Folic acid B. Ferrous sulfate C. Epoetin alfa D. Hydroxyurea
C. Epoetin alfa
The nurse is teaching a nursing student about anemia and knows that it is important to include why anemia occurs. Which statement is true about why anemia occurs? A. Anemia occurs due to acute illnesses or specific deficiencies such as vitamin D. B. Anemia occurs due to chronic illnesses or specific deficiencies such as vitamin C. C. Anemia occurs due to chronic illnesses or specific deficiencies such as vitamin A. D. Anemia occurs due to chronic illnesses or specific deficiencies such as iron.
D. Anemia occurs due to chronic illnesses or specific deficiencies such as iron.
A client is experiencing iron toxicity. Which agent would the nurse expect to be given? A. Dimercaprol B. Succimer C. Edetate calcium disodium D. Deferoxamine
D. Deferoxamine
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: A. Chemotherapy B. Swelling of veins C. Renal failure D. Iron levels
D. Iron levels
A client with iron deficiency anemia has begun taking daily supplements of oral ferrous sulfate. The nurse should add what nursing diagnosis to the nursing care plan? A. Risk for peripheral neurovascular dysfunction related to use of iron supplements B. Risk for excess fluid volume related to use of iron supplements C. Risk for unstable blood glucose related to use of iron supplements D. Risk for constipation related to use of iron supplements
D. Risk for constipation related to use of iron supplements
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? A. Oral only B. Subcutaneous or Oral C. Oral or Intravenous D. Subcutaneous or Intravenous
D. Subcutaneous or Intravenous
The nurse is administering epoetin alfa (Epogen). Which administration technique would not be considered appropriate for the patient identified? A. The nurse administers epoetin alfa (Epogen) into the patient's central IV line. B. The nurse administers epoetin alfa (Epogen) as a bolus injection as the patient completes dialysis. C. The nurse administers the epoetin alfa (Epogen) into the patient's peripheral IV line. D. The nurse administers epoetin alfa (Epogen) via IM injection.
D. The nurse administers epoetin alfa (Epogen) via IM injection.
A client taking epoetin alfa requests changing the medication from the subcutaneous route to the PO route. How should the nurse respond? A. This medication causes severe diarrhea if given orally. B. The drug dose must be increased if being given via the oral route. C. The oral route is not as effective. D. This medication is destroyed in the stomach and can only be given by injection.
D. This medication is destroyed in the stomach and can only be given by injection.
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: A. hypertension. B. hypoglycemia. C. thrombocytopenia. D. anemia.
D. anemia.
What are the primary factors that contribute to the body's ability to fight off infection? Select all that apply. - normal cardiovascular function - increased platelet cell production - normal immune system function - normal hematopoiesis - decreased exposure to microorganisms
- normal cardiovascular function - normal immune system function - normal hematopoiesis
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? A. Iron B. Vitamin C C. Vitamin A D. Folic acid
A. Iron
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? A. Vitamin B12 B. Vitamin C C. Vitamin D D. Folic acid
A. Vitamin B12
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? A. blood pressure B. respiratory rate C. temperature D. heart rate
A. blood pressure
For which client would epoetin alfa NOT be indicated? A. A client with a hemoglobin of 11, with shortness of breath. B. A client with a hemoglobin of 12, with shortness of breath. C. A client with a hemoglobin of 8, who is asymptomatic. D. A client with a hemoglobin of 10, who is asymptomatic.
B. A client with a hemoglobin of 12, with shortness of breath.
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? A. "Anemia is a condition caused by reduced amounts of platelets, causing less oxygen to be delivered to the tissues." B. "Anemia is a condition caused by reduced amounts of protein, causing less oxygen to be delivered to the tissues." C. "Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues." D. "Anemia is a condition caused by reduced amounts of hematocrit, causing less oxygen to be delivered to the tissues."
C. "Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues."
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? A. A blood transfusion B. Rocephin 1 GM IV C. Erythropoietin D. An increased dose of zidovudine
C. Erythropoietin
A female client is seen in the clinic for iron deficiency anemia and the nurse provides comprehensive discharge instructions about allergic reactions. The client appears nervous, then demands to see another nurse. The nurse asks the client why she is distressed. The client replies, "because I have had a bad reaction to iron supplements before and almost died." The nurse asks for an order to change the prescription for which reason? A. The client is in need of antianxiety medication instead. B. The client is in need of a placebo instead to prevent the same complication from occurring again. C. The client is in need of bipolar disease medication instead. D. Iron is contraindicated in clients with known hypersensitivity to the drug, or any component of the drug.
D. Iron is contraindicated in clients with known hypersensitivity to the drug, or any component of the drug.
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? A. Altered red blood cell production or deficient functioning of red blood cells B. Decreased levels of platelets C. A defect in white blood cell function D. A deficiency of vitamin B12
A. Altered red blood cell production or deficient functioning of red blood cells
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. An iron supplement B. A folic acid supplement C. A protein supplement D. A blood transfusion
A. An iron supplement
Adverse effects of epoetin and darbepoetin include increased risks of what condition? A. Myocardial infarction B. Cirrhosis of the liver C. Diabetes mellitus type 2 D. Hyperlipidemia
A. Myocardial infarction
The anemia that occurs with chronic renal failure is caused by the kidneys themselves. What inability of the kidneys causes anemia in chronic renal failure? A. Produce erythropoietin B. Produce rennin C. Produce angiotensin D. Inactivate vitamin D
A. Produce erythropoietin
All hematopoietic and immune blood cells are derived from which cells in the bone marrow? A. Stem cells B. Alfa cells C. Beta cells D. Theta cells
A. Stem cells
A patient has been receiving intramuscular injections of hydroxocobalamin as treatment for pernicious anemia. Which statement by the patient indicates that he understands the therapy? A. "I will get the injection for a week and then stop." B. "I will need these injections monthly for the rest of my life." C. "I need the injections now, but then I can switch to a pill." D. "Once my levels are up, I won't need the drug anymore."
B. "I will need these injections monthly for the rest of my life."
A client prescribed epoetin alfa asks how the medication works. Which is the nurse's best response? A. "Decreases release of reticulocytes, which inhibits red blood cell (RBC) production." B. "Increases the release of cells to increase the hemoglobin and hematocrit levels." C. "Releases erythropoiesis from the kidneys to increase the number of platelets." D. "Stimulates the growth and development of white blood cells (WBC) to prevent neutropenia."
B. "Increases the release of cells to increase the hemoglobin and hematocrit levels."
A client diagnosed with iron deficiency has been taking oral ferrous sulfate for the past several days. When the nurse is assessing for therapeutic effects, what question is most warranted? A. "Is your skin feeling itchy when you're at rest?" B. "Are you having any leg spasms or restless legs at night?" C. "How is your energy level compared with a few days ago?" D. "Do you feel like you're able to see a bit more clearly now?"
C. "How is your energy level compared with a few days ago?"
A client is receiving ferrous sulfate as treatment for iron deficiency anemia. After teaching the client, which statement indicates the need for additional teaching? A. "I need to avoid taking the drug with coffee or tea." B. "I need to make sure that I eat enough foods containing iron." C. "I need to take an antacid with the pill to prevent an upset stomach." D. "It might take several months before my iron levels get back to normal."
C. "I need to take an antacid with the pill to prevent an upset stomach."
What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa? A. Altered skin integrity due to the disease process B. Alteration in bowel elimination due to side effects of the medication C. Impaired tissue oxygenation related to anemia D. Alteration in nutrition due to poor intake of iron
C. Impaired tissue oxygenation related to anemia
The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome? A. Decreased WBC count B. Increased WBC count C. Increased RBC count D. Decreased RBC count
C. Increased RBC count
Which patient will the nurse assess first? A. The patient with anemia B. The patient with a decreased RBC count C. The patient with a decreased WBC count D. The patient with elevated erythropoietin
C. The patient with a decreased WBC count
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? A. requesting a change in the dosage B. changing the route of administration C. temporarily withholding administration D. administering an unscheduled dose
C. temporarily withholding administration
After teaching a patient who is receiving ferrous sulfate about the drug therapy regimen, which patient statement indicates that the teaching was successful? A. "I need to watch the amount of fiber I eat." B. "My stools might turn dark or green." C. "I need to eat three large meals every day." D. "I must take the drug on an empty stomach."
B. "My stools might turn dark or green."
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? A. Decreased level of consciousness B. Flulike symptoms C. Cyanosis and pallor D. Profound diaphoresis
B. Flulike symptoms
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? A. Dry, nonproductive cough B. Reports of calf pain on dorsiflexion of the foot C. A rash under the breast D. 1 pound weight gain in 1 week
B. Reports of calf pain on dorsiflexion of the foot
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? A. Folic acid deficiency anemia B. Pernicious anemia C. Sickle cell anemia D. Iron deficiency anemia
B. Pernicious anemia
A client's current medical condition is suggestive of impaired erythropoiesis. Which laboratory study would be most clinically relevant in diagnosing this health problem? A. D-dimer and C-reactive protein B. RBC, hemoglobin, and hematocrit C. INR and aPTT D. White blood cell count with differential
B. RBC, hemoglobin, and hematocrit
A patient has been prescribed epoetin alfa. The nurse recognizes that this medication is indicated for treatment of anemia associated with which disease process? A. Liver failure B. Renal failure C. Heart failure D. Lung failure
B. Renal failure
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? A. asthma B. chronic hepatitis C C. ankylosing spondylosis D. bacterial pneumonia
B. chronic hepatitis C
