Focus on Nursing Pharmacology Instructor Test Bank

Chapter 49- Drugs Used to Treat Anemias The nurse is caring for a patient in end-stage renal failure and anemia. What is the cause 1. of this patient’s anemia? A) Low serum iron levels B) Low erythropoietin levels C) Inadequate oxygenation of tissue D) Lack of B12 and folic acid intake Ans: B Feedback: Anemia can occur if erythropoietin levels are low. This is seen in association with renal failure, when the kidneys are no longer able to produce erythropoietin. Low iron levels, hypoxia, and vitamin deficiency are not likely to be the primary cause of anemia in a patient with kidney failure. A 2-year-old child weighing 32 pounds is to take ferrous sulfate (Feosol) 6 mg/kg/d PO. 2. How many milligram will the child receive per dose? A) 47 mg B) 67 mg C) 87 mg D) 107 mg Ans: C Feedback: The nurse will administer 87 mg per dose. The child’s weight is first converted to kilograms by dividing 32 by 2.2, or 32/2.2 = 14.5 kg. Next, calculate the dose by multiplying weight times mg/kg/d or 14.5 × 6 = 87 mg. A nurse caring for a 28-year-old woman with renal failure is to start the patient on epoetin 3. alfa therapy for iron replacement. What will the nurse assess before initiating therapy? A) Weight B) Last menstrual period C) Intake and output (I & O) for a 24-hour period D) Blood type Ans: B Feedback: The use of epoetin alfa is not recommended during pregnancy or lactation because of potential adverse effects to the fetus or baby. It is important to determine that the patient is not pregnant before drug therapy has started so the nurse would assess when the patient last menstruated. The patient’s weight, I & O, and blood type are not important factors in determining whether the drug can be used. The nurse improves patient compliance with the drug regimen of epoetin alfa by 4. providing what? A) An appointment card for each drug administration day B) A calendar to mark the days of the week the drug is to be administered C) A referral for community transportation D) The telephone number of the pharmacy where the medication can be purchased Ans: B Feedback: The nurse should provide the patient with a calendar with the days the drug is to be administered marked clearly to remind her when the dose is due. The patient can be taught to self-administer the drug so there is no need for an appointment or arranging transportation. The patient can use her choice of pharmacy and would not need the telephone number. A patient who has anemia and a severe GI absorption disorder has been ordered iron dextran (INFeD). What is the most appropriate nursing diagnosis for the patient related to 5. the administration of this drug? A) Acute pain related to drug administration B) Deficient knowledge regarding drug therapy C) Risk for injury related to CNS effects D) Disturbed body image related to drug staining of teeth Ans: A Feedback: Iron dextran is a parenteral form of iron. It is given intramuscularly and must be given by the Z-track method. It can be very painful. Certainly, deficient knowledge and risk for injury are appropriate diagnoses for this patient but would not be related to the administration of the drug. Because this medication is not given orally, tooth staining would not be a concern. A 22-year-old woman who has severe dysmenorrhea has been prescribed ferrous 6. gluconate (Fergon) to treat iron deficiency anemia. What is it important for the nurse to instruct the patient to avoid when taking the drug? A) Eggs B) Chocolate C) Pork D) Whole wheat Ans: A Feedback: Iron is not absorbed if taken with antacids, eggs, milk, coffee, or tea. These substances should not be administered concurrently. Chocolate, pork, and whole wheat do not produce drugfood interactions when consumed with an iron supplement. The nurse develops a care plan for a patient who has been prescribed a folic acid 7. derivative that includes what priority nursing diagnosis? A) Deficient knowledge regarding drug therapy B) Monitor possibility of hypersensitivity reactions C) Acute pain related to injection or nasal irritation D) Risk for fluid volume imbalance related to cardiovascular effects Ans: D Feedback: Nursing diagnoses related to drug therapy might include: Risk for fluid volume imbalance related to cardiovascular effects. Deficient knowledge and acute pain might apply to this patient, but the priority nursing diagnosis this patient, but the priority nursing diagnosis for this patient is the risk for fluid imbalance related to cardiovascular effects. Monitoring for hypersensitivity is not a nursing diagnosis. 8. Before administering an iron preparation, what should the nurse assess? A) Red blood cell count (RBC) B) Hematocrit and hemoglobin C) Aspartate aminotransferase levels D) Serum creatinine levels Ans: B Feedback: Hematocrit and hemoglobin levels should be assessed before administration because the drug will be evaluated for effectiveness by the response of these levels to drug treatment. These levels are also used to determine dosage. Counting RBCs would indicate the number of blood cells per cubic millimeter but not iron or oxygen content. Aspartate aminotransferase levels are associated with liver function and serum creatinine levels are associated with renal function. What ordered dosage for epoetin alfa (Procrit) could the nurse administer without needing 9. to question the order? A) 0.45 mcg/kg IV once per week B) 1 mg/d IM C) 100 mg/d PO D) 150 units/kg subcutaneously three times per week Ans: D Feedback: 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 (Folvite) 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. After assessing the patient receiving erythropoietin drug therapy, the nurse suspects what 10. finding is an adverse effect of erythropoietin drug therapy? A) Constipation B) Hypotension C) Edema D) Depression Ans: C Feedback: Potential adverse effects of an erythropoietin are edema, nausea, vomiting, chest pain, diarrhea, and hypertension. Options A, B, and D are not associated with these drugs. A 62-year-old female patient is started on vitamin B12 for pernicious anemia. When the 11. nurse develops the plan of care, what expected outcome will the nurse include? A) Decreased bleeding B) Increased hemoglobin C) Decreased joint pain D) Less fatigue Ans: B Feedback: Vitamin B12 is essential for normal functioning of red blood cells (RBCs) so the drug would be evaluated as successful in treating the disorder if the patient’s hemoglobin and RBC count increased after administration. Expected outcomes do not include decreased bleeding, decreased joint pain, or less fatigue. A 50-year-old patient with pernicious anemia asks why she can’t just take a vitamin 12. B12pill instead of getting an injection. What is the nurse’s best response to her question? A) “Pernicious anemia is caused by the body’s inability to absorb vitamin B12. B) Oral ingestion of vitamin B12 irritates the GI tract and bleeding could occur. Pernicious anemia alters mucous membrane lining of the bowel and impairs C) absorption. With severe deficiencies like yours, oral vitamin B12 does not work fast D) enough. Ans: A Feedback: Vitamin B12 cannot be taken orally, because one problem with pernicious anemia is an inability by the patient to absorb vitamin B12 due to low levels of intrinsic factor. Other options are incorrect. The nurse instructs a patient taking oral iron preparations about which potential adverse 13. effect? A) Clay-colored stools B) Hypotension C) Constipation D) Frequent flatus Ans: C Feedback: The most common adverse effects associated with oral iron supplements are related to direct GI irritation (e.g., GI upset, anorexia, nausea, vomiting, diarrhea, dark stools, and constipation). Oral iron supplements do not cause hypotension, clay-colored stools, or frequent flatus. When providing patient teaching for a 30-year-old primigravida diagnosed with sickle 14. cell anemia, but not currently in crisis, the priority teaching point is what? A) Avoidance of infection B) Constipation prevention C) Control of pain D) Iron-rich foods Ans: A Feedback: Severe, acute episodes of sickling with blood vessel occlusion may be associated with acute infections and the body’s reactions to the immune and inflammatory responses. Avoidance of infection is, then, a priority teaching point. Pain would be a concern only if the patient is in crisis. Constipation prevention and iron-rich foods would not be the priority at this time. What drugs might the nurse administer that have been developed to stimulate 15. erythropoiesis? (Select all that apply.) A) Levoleucovorin Hydroxocobalamin B) C) Darbepoetin alfa D) Methoxy polyethylene glycol-epoetin beta E) Epoetin alfa Ans: C, D, E Feedback: Patients who are no longer able to produce enough erythropoietin in the kidneys may benefit from treatment with exogenous erythropoietin (EPO), which is available as the drugs epoetin alfa (Epogen, Procrit), darbepoetin alfa (Aranesp), and methoxy polyethylene glycol-epoetin beta (Mircera). Both darbepoetin alfa and methoxy polyethylene glycol-epoetin beta are approved to treat anemias associated with chronic renal failure, including patients receiving dialysis. Levoleucovorin and hydroxocobalamin are not erythropoiesis-stimulating agents. 16. What anemia does the nurse classify as a type of hemolytic anemia? A) Iron deficiency anemia Megaloblastic anemia B) C) Pernicious anemia D) Sickle cell anemia Ans: D Feedback: Another type of anemia is hemolytic anemia, which involves a lysing of red blood cells because of genetic factors or from exposure to toxins. Sickle cell anemia is a type of hemolytic anemia. Iron deficiency and megaloblastic anemias are different classifications of anemia. What medication does the nurse administer to treat anemia associated with chronic renal 17. failure? A) Methoxy polyethylene glycol-epoetin beta B) Ferrous sulfate exsiccated C) Levoleucovorin D) Hydroxyurea Ans: A Feedback: Both darbepoetin alfa and methoxy polyethylene glycol-epoetin beta are approved to treat forms of anemia associated with chronic renal failure, including in patients 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. The nurse is caring for a patient diagnosed with pernicious anemia and anticipates this 18. patient will require supplemental what? A) Iron B) Vitamin B12 C) Erythropoietin D) Oxygen Ans: B Feedback: Pernicious anemia occurs when the gastric mucosa cannot produce intrinsic factor and vitamin B12 cannot be absorbed. Other options are incorrect. When providing patient teaching the nurse warns the patient to avoid what triggers of an 19. episode of sickling? (Select all that apply.) A) Acute infections B) Immune response C) Exposure to heat D) Inflammatory responses E) Metabolic alkalosis Ans: A, B, D Feedback: Severe, acute episodes of sickling with occluded blood vessels may be associated with acute infections and the body’s reactions to the immune and inflammatory responses. Exposure to heat and metabolic alkalosis are not considered triggers. The nurse teaches hemodialysis patients that anemia occurs because damaged kidneys fail 20. to produce what? A) Erythropoietin B) Renin C) Angiotensin D) Urine Ans: A Feedback: People with chronic renal failure are often anemic because their kidneys are unable to produce erythropoietin. The production of renin and angiotensin impact the patient’s blood pressure. Anemia is not caused by lack of urine production. A patient has been prescribed epoetin alfa. The nurse determines the drug is 21. contraindicated as a result of what finding in the patient history? A) Asthma B) Irritable bowel syndrome C) Hypertension D) Shortness of breath Ans: C Feedback: 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 patients with asthma, irritable bowel syndrome, or shortness of breath. An older adult patient, diagnosed with pernicious anemia, asks the nurse what causes this disorder. The nurse’s best response is that there is a lack of intrinsic factor secreted 22. needed for absorption of vitamin B12 where? A) Large bowel B) Lower esophagus C) Stomach D) Small bowel Ans: D Feedback: Intrinsic factor, also secreted by the gastric mucosa, combines with dietary vitamin B12so that the vitamin can be absorbed in the ileum, located in the small bowel. Other options are incorrect. What genetic carrier screening would be appropriate for an African American couple 23. planning to begin a family? A) Renal failure B) Sickle cell anemia C) Iron deficiency anemia D) Vitamin B12 deficiency Ans: B Feedback: Sickle cell anemia is a chronic hemolytic anemia that occurs most commonly in people of African descent, so it would be appropriate to have genetic screening to determine the risk associated with having children. The other answers are incorrect because they are not associated with people of African descent. The nurse is caring for a child who is prescribed supplemental iron therapy in liquid form. 24. What is the priority parent teaching to be provided by the nurse? The iron should be taken through a straw. A) B) Positive results from treatment will be seen in 1 to 2 weeks. C) Results will be evaluated through the child’s appearance. D) Dosages are determined by serum iron levels. Ans: A Feedback: Iron doses for replacement therapy are determined by age. If a liquid solution is being used, the child should drink it through a straw to avoid staining the teeth. Periodic blood counts should be performed; it may take 4 to 6 months of oral therapy to reverse an iron deficiency. Remember that iron can be toxic to children, so that iron supplements should be kept out of their reach and administration monitored. The nurse admits a 26-year-old patient with sickle cell anemia. What drug does the nurse 25. anticipate administering? A) Hydroxyurea B) Methoxy polyethylene glycol-epoetin beta Vitamin B12 C) D) Leucovorin Ans: A Feedback: Indications for use of hydroxyurea include reducing the frequency of painful crises and the need for blood transfusions in adult patients with sickle cell anemia. Other options would not be used to treat a patient with sickle cell anemia. The nurse admits a child to the pediatric unit who has an abnormally high serum iron 26. level. What chelating agent will be appropriate to treat this child? A) Calcium disodium edetate B) Deferoxamine C) Dimercaprol D) Succimer Ans: B Feedback: Deferoxamine is given IM, IV, or subcutaneously to treat elevated iron levels. Calcium disodium edetate and succimer are used to treat elevated lead levels. Dimercaprol treats arsenic, gold, and mercury poisoning. The nurse is caring for a patient who just received a cancer diagnosis. The patient tells the nurse, I saw the commercials on TV and I want to start taking Procrit immediately so I 27. 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 A) by low levels of erythropoietin. Before the doctor will order this drug, you will need to be found to have anemia B) so we will draw some blood for lab work while you’re here. Chemotherapy causes anemia and only when that happens will it be appropriate C) to prescribe Procrit for you. The doctor may order Procrit for you when it is appropriate, but now is not the D) appropriate time for you to take this drug. Ans: A Feedback: 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 patients who have normal renal functioning and adequate levels of erythropoietin. The patient should be taught that the drug will only be prescribed if he 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. What drug used to treat anemia might the nurse administer as an antineoplastic drug 28. because it is cytotoxic? A) Epoetin alfa B) Ferrous sulfate C) Hydroxocobalamin D) Hydroxyurea Ans: D Feedback: Hydroxyurea is a cytotoxic antineoplastic drug that is also used to treat leukemia, ovarian cancer, and melanoma. The other options would not serve this purpose. The nurse is caring for a patient diagnosed with a megaloblastic anemia and administers 29. what drug? A) Folic acid B) Hydroxyurea C) Ferrous sulfate D) Epoetin alfa Ans: A Feedback: Folic acid and vitamin B12 are given as replacement therapy for dietary deficiencies, as replacement in high-demand conditions such as pregnancy and lactation, and to treat megaloblastic anemia. Hydroxyurea is used to treat sickle cell anemia. Ferrous sulfate is indicated for the treatment of iron deficiency anemia. Epoetin alfa is administered to treat anemias caused by inadequate erythropoietin production, such as in renal failure. The nurse is preparing the patient prescribed hydroxocobalamin for discharge and teaches 30. the patient to be alert for what adverse effects? (Select all that apply.) A) Itching B) Peripheral edema C) Hypotension D) Heart failure Constipation E) Ans: A, B, D Feedback: Hydroxocobalamin has been associated with itching, rash, and signs of excessive vitamin B12levels, which can also include peripheral edema and heart failure. Hypotension and constipation are not adverse effects of hydroxocobalamin therapy. The patient has taken epoetin alfa (Epogen) with good results for several months. On this visit, the nurse analyzes the patient’s lab results and finds indications of severe anemia 31. and cytopenias. What order will the nurse anticipate receiving? A) Increase the dosage of Epogen. B) Change the patient to another erythropoiesis-stimulating agent. C) Discontinue Epogen. D) Begin administering Epogen IV instead of subcutaneously. Ans: C Feedback: In patients 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 patient’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. The patient receiving epoetin alfa (Procrit) asks the nurse why it has to be administered IV because he read that it could be self-administered subcutaneously. What is the nurse’s 32. best response? A) Giving the drug IV reduces risk of a potentially serious response to the drug. B) Giving the drug by the IV route makes it begin working sooner. C) Only patients with renal disease can receive the drug subcutaneously. It is all determined by physician preference and this doctor prefers the IV D) route. Ans: A Feedback: It is now recommended that patients receive Procrit and other drugs in this classification intravenously rather than subcutaneously because this reduces the risk of antibody production that can result from severe anemia. This decision is not based on speed of onset, diagnosis, or physician preference. The nurse is administering an erythropoiesis-stimulating agent to a patient with renal 33. failure and anemia. What is the maximum hemoglobin level the nurse would want to assess when reviewing this patient’s lab results? A) 8 g/dL B) 10 g/dL C) 12 g/dL D) 14 g/dL Ans: C Feedback: In recent years, the Food and Drug Administration alerted providers to the importance of a target hemoglobin of no more than 12 g/dL when using erythropoiesis-stimulating agents. As a result, other options are either too low or too high. For what purpose would the nurse administer postoperative epoetin alfa to the patient who 34. is a Jehovah’s Witness? A) Reduce the need for allogenic blood transfusion B) Treatment of anemia associated with chronic renal failure C) Treatment of HIV infection D) To prevent the need for chemotherapy Ans: A Feedback: 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 patients, to reduce the need for allogenic blood transfusions in surgical patients. There is no indication in this question that the patient has chronic renal failure, HIV, or need for chemotherapy. For what purpose might the nurse administer folic acid to the patient? (Select all that 35. apply.) A) Nutritional deficiency B) Megaloblastic anemia C) Pregnancy or preparation for pregnancy D) Sickle cell anemia E) Renal failure Ans: A, B, C Feedback: Folic acid is indicated for the treatment of megaloblastic anemia caused by sprue and to replace a nutritional deficiency. It is also given to women who are, or plan to become, pregnant to reduce the risk of a neural tube disorder in the fetus. It is not indicated for the treatment of sickle cell anemia or renal failure.