PrepU Chapter 11: Drug Therapy for Hematopoietic Disorders
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 patient has just received IV cytotoxic chemotherapy. Which patient statement indicates a need for further teaching about this therapy with filgrastim (Neupogen)?
"I am going to administer my Neupogen as soon as I get home today."
A nurse has taught a patient about filgrastim (Neupogen) and epoetin alfa (Epogen) administration. Which patient statement indicates teaching was effective?
"I should tell my healthcare provider if I feel depressed."
Ms. Ziem is prescribed filgrastim. The nurse provides education to Ms. Ziem about this therapy. Which statement would indicate the patient understood the teaching?
"I will avoid crowds and people with illnesses."
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."
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?
"Procrit is only effective if you develop anemia from chemotherapy that is caused by low levels of erythropoietin."
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?
"The hematopoietic system is composed of fluid, red blood cells, white blood cells, and platelets."
What ordered dosage for epoetin alfa (Procrit) could the nurse administer without needing to question the order?
100 units/kg subcutaneously three times per week
The nurse would contact the prescriber immediately if interferon was prescribed for which client?
11-month-old female with HIV acquired from her mother
The nurse is teaching a male patient receiving epoetin alfa about the drug. The nurse informs the patient that he will receive the drug at which frequency?
3 times a week
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 epoetin alfa NOT be indicated?
A client with a hemoglobin of 12, with shortness of breath.
The nurse is caring for a client who has been prescribed filgrastim. What lab value will the nurse use to assess the effectiveness of treatment?
Absolute neutrophil count
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?
Antibacterial
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?
Ask the client whether she is taking iron supplements.
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 nurse is administering a medication to enhance hematopoiesis. Which statement indicates the nurse understands the role of cytokines in hematopoiesis?
Cytokines are produced by the bone marrow and white blood cells to enhance formation of blood cells.
In learning about immunostimulants, what would you learn is an expected outcome of these medications?
Decreased numbers or severity of infections
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)
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
The patient with chronic renal failure requires an agent to increase red blood cell production. What drug does the nurse anticipate administering?
Epoetin alfa
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?
Erythropoietin
What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa?
Impaired tissue oxygenation related to anemia
Colony-stimulating factors (CSF) are administered to produce which therapeutic effect?
Increase the growth of specific types of blood cells
The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome?
Increased RBC 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
Which would a nurse identify as the primary issue associated with anemias?
Ineffective red blood cells
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?
Interferon alfa-2b
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 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
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
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 inhibit tumor growth.
The nurse is caring for a client whose diabetic nephropathy has resulted in anemia. What is the cause of this client's anemia?
Low erythropoietin levels
What medication would best meet the needs of a client whose anemia is associated with chronic renal failure?
Methoxy polyethylene glycol-epoetin beta
The client with what condition is most likely to benefit from treatment with interferon beta?
Multiple sclerosis
Adverse effects of epoetin and darbepoetin include increased risks of what condition?
Myocardial infarction
A client is receiving darbepoetin alfa. The nurse would inform the client that he will be receiving this drug at which frequency?
Once a week
A nurse is caring for a 73-year-old male client scheduled to undergo chemotherapy. What drug would the nurse expect to be ordered to prevent infection in this client?
Pegfilgrastim (Neulasta)
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?
Produce erythropoietin
For what purpose would the nurse administer postoperative epoetin alfa to the client who is a Jehovah's Witness?
Reduce the need for allogenic blood transfusion
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
What information is accurate when teaching about interleukins?
Some interleukins stimulate the growth of stem cell precursors of blood cells.
All hematopoietic and immune blood cells are derived from which cells in the bone marrow?
Stem cells
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 nurse administers interferon alpha-2b to a patient. Which assessment finding will the nurse act on immediately?
The patient has elevated liver function tests.
When planning care for a patient who is receiving filgrastim (Neupogen) for a nonmyeloid malignancy, the nurse should formulate which of the following patient outcomes? (Select all that apply.)
The patient will not develop an infection. The patient will not experience bone pain. The patient will be able to self-administer filgrastim at home. The patient will not develop febrile neutropenia.
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's hemoglobin level is 11g/dL
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?
This drug is destroyed by acids found in the stomach.
A client taking epoetin alfa requests changing the medication from the subcutaneous route to the PO route. How should the nurse respond?
This medication is destroyed in the stomach and can only be given by injection.
A male client is prescribed interferon. What is his probable diagnosis?
Viral hepatitis
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
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
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?
chronic hepatitis C
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.
The prototype drug used to create red blood cells (RBCs) is epoetin alfa (Epogen, Procrit). The pharmacokinetics include which of the following? Choose all that apply.
intravenous subcutaneous
The nurse is caring for a client receiving aldesleukin as treatment for kidney cancer. Which assessment finding will the nurse report to the health care provider before administering the next dose?
lethargy
A client diagnosed with chronic renal failure is being treated with epoetin alfa in a home setting. The community health nurse should encourage the client to maintain a high intake of which food to supplement the intended action of the medication? Select all that apply.
red meat leafy green vegetables
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?
"The patient has increases in the number of natural killer cells."
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 signs of infection.
The client is a woman, 69 years of age, seen in the clinic for anemia and administration of epoetin alfa. Before giving the drug, the nurse takes a complete history and reviews the client's EMR, because the nurse knows that epoetin alfa is contraindicated for which conditions? (Select all that apply.)
Clients with uncontrolled hypertension Clients needing an emergency transfusion Clients with a hypersensitivity to human albumin
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.
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
During recovery from a gastrointestinal bleed, a client has been prescribed an iron preparation. Prior to beginning therapy, what assessment should the nurse prioritize?
Hematocrit and hemoglobin
The nurse is caring for a client who has been receiving filgrastim. The nurse expects to perform which action concerning this drug on the day prior to the client's chemotherapy treatment?
Hold the medication
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?
Techniques to reduce exposure to infection
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.
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?
serum ferritin
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.
87
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?
Do not shake the drug vigorously.
After assessing the client receiving erythropoietin drug therapy, the nurse suspects what finding is an adverse effect of erythropoietin drug therapy?
The client has peripheral edema to the feet and lower legs.
A client has been prescribed epoetin alfa. What assessment finding may suggest that the drug is contraindicated?
The client's blood pressure is 161/107 mm Hg.
