Chapter 56 Hematopoietic Agents

Chapter 56: Hematopoietic Agents Test Bank MULTIPLE CHOICE 1. A nursing student asks a nurse why patients with chronic renal failure (CRF) have low erythrocyte counts. Which response by the nurse is correct? a. “Damage to the renal tubules increases serum blood loss.” b. “Dialysis accelerates the breakdown of red blood cells.” c. “Erythropoietin is no longer produced by cells in the kidneys.” d. “Patients with CRF are deficient in iron, folic acid, and vitamin B12.” ANS: C Erythropoietin is normally produced by peritubular cells in the proximal tubules of the kidneys, but it is not produced in patients with CRF. Erythropoietin stimulates red blood cell (RBC) production; therefore, when it is absent, RBC production is compromised. Blood loss in damaged renal tubules does not cause low blood counts in patients with CRF. Dialysis does not contribute to low blood counts. Patients with CRF are not more likely to be deficient in iron, folic acid, and vitamin B12. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 656 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. A nurse is teaching a patient who has chronic renal failure who will begin receiving epoetin alfa [Epogen] about this drug therapy. Which statement by the patient indicates understanding of the teaching? a. “If I have to start dialysis, I will have to stop taking this drug.” b. “Taking this drug will not eliminate my need for blood transfusions.” c. “Taking this medication will prevent the need for dialysis in the future.” d. “When I take this, my serum ferritin levels will increase.” ANS: B Epoetin alfa virtually reduces, but does not eliminate, the need for blood transfusions in patients with CRF. Dialysis is not a contraindication for taking this drug. Epoetin alfa does not prevent the need for dialysis. Epoetin alfa does not raise the serum ferritin level. PTS: 1 DIF: Cognitive Level: Application REF: p. 656 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. The nurse is caring for a patient who begins to complain of shortness of breath. The nurse assesses the patient and notes 3+ pitting edema bilaterally in the lower extremities. Which medication taken by the patient causes the most concern? a. Epoetin alfa b. Filgrastim (granulocyte colony– stimulating factor) c. Oprelvekin (interleukin-11) d. Sargramostim (granulocyte-macrophage colony-stimulating factor) ANS: C Oprelvekin causes the kidneys to retain sodium and water, which causes peripheral edema and expansion of plasma volume. Some patients experience dyspnea. Fluid retention is not an adverse effect of epoetin alfa, filgrastim, or sargramostim. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 661 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. A prescriber has ordered filgrastim (granulocyte colony–stimulating factor) for a patient undergoing myelosuppressive chemotherapy. The nurse will prepare the patient for which potential side effect? a. Bone pain b. Fatigue c. Headache d. Hemorrhage ANS: A Filgrastim causes bone pain in about 25% of patients. The pain is dose related and usually mild to moderate. Fatigue, bleeding, and headache are not common side effects of filgrastim. PTS: 1 DIF: Cognitive Level: Application REF: p. 659 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. A patient with CRF who will begin receiving an erythropoiesis stimulating agent (ESA) is admitted to the hospital. The nurse notes that the patient’s heart rate is 82 beats per minute, and the blood pressure is 140/100 mm Hg. A complete blood count reveals a hemoglobin of 8 gm/dL and a hematocrit of 29%. What will the nurse do? a. Administer the ESA and request an order for a blood transfusion. b. Withhold the ESA and request an order for an antihypertensive medication. c. Request an order to increase the dose of ESA to raise the hemoglobin more quickly. d. Suggest initiating dialysis while giving the ESA. ANS: B In patients with CRF, treatment with epoetin alfa is often associated with an increase in blood pressure, so patients with hypertension should be treated before beginning treatment with epoetin alfa. There is no indication for a blood transfusion, an increased dose of ESA, or dialysis. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 656 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 6. A patient with chronic renal failure who is on dialysis receives an ESA. The nurse caring for this patient during dialysis notes that the patient’s hemoglobin is 10.9 gm/dL, up from the 10.2 gm/dL recorded 2 weeks ago. The patient’s blood pressure is 120/80 mm Hg. The nurse will contact the provider to suggest: a. adding an antihypertensive drug. b. discontinuing the ESA. c. giving heparin. d. increasing the dose of the ESA. ANS: C Patients with CRF on dialysis can benefit from heparin to prevent clotting in the dialysis machine. The risk of clotting is greatest when the hemoglobin level exceeds 11 gm/dL. There is no indication for an antihypertensive drug, because the patient’s blood pressure is normal. The patient’s hemoglobin is less than 12 gm/dL and has risen less than 1 gm/dL in 2 weeks; therefore, neither reducing the ESA dose nor stopping the ESA is indicated. PTS: 1 DIF: Cognitive Level: Application REF: pp. 656-657 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 7. A patient with a hemoglobin of 7.2 gm/dL begins therapy with an ESA. Two weeks later the patient’s hemoglobin is 8.3 gm/dL. The nurse anticipates that the provider will: a. reduce the ESA dose. b. discontinue the ESA. c. order a blood transfusion. d. order heparin. ANS: A The patient’s hemoglobin has risen just over 1 gm/dL in 2 weeks, so the dose of ESA should be reduced. The ESA should be discontinued when the hemoglobin is greater than 13 gm/dL. A blood transfusion is not indicated. Heparin is used when patients are undergoing dialysis. PTS: 1 DIF: Cognitive Level: Application REF: pp. 656-657 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 8. A patient with lung cancer receives filgrastim [Neupogen] after chemotherapy to reduce neutropenia. The patient reports a moderate degree of bone pain. What will the nurse do? a. Obtain an order to administer acetaminophen. b. Request an order for a complete blood count (CBC). c. Request an order to reduce the dose of filgrastim. d. Suspect metastasis of the cancer to the bone. ANS: A Bone pain occurs in about 25% of patients receiving filgrastim. It can be treated with a nonopioid analgesic and, if necessary, an opioid analgesic. Leukocytosis can occur, but bone pain is not a symptom of this, so a CBC is not indicated. Bone pain is not an indication for reducing the dose of filgrastim. Because moderate bone pain is a common adverse effect, metastasis to the bone is less likely. PTS: 1 DIF: Cognitive Level: Application REF: p. 659 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 9. A patient is about to undergo a procedure to harvest hematopoietic stem cells from the bone marrow. Which medication will the nurse anticipate giving before this procedure? a. Filgrastim [Neupogen] b. Pegfilgrastim [Neulasta] c. Oprelvekin [Neumega] d. Sargramostim [Leukine] ANS: A Filgrastim is given before harvesting of hematopoietic stem cells (HSCs), because it increases the number of circulating HSCs. Pegfilgrastim is used only to reduce the incidence of infection in patients undergoing chemotherapy of nonmyeloid malignancies. Oprelvekin is used to minimize thrombocytopenia and to reduce the need for platelet transfusion. Sargramostim is used to accelerate myeloid recovery in patients who have undergone autologous bone marrow transplantation. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 659 | pp. 660-661 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 10. The nurse is preparing to administer a dose of epoetin alfa to a patient and notes that the patient has a hemoglobin level of 11.7 gm/dL. Which action by the nurse is correct? a. Administer the dose as ordered. b. Hold the dose and notify the provider. c. Request an order for a reduced dose. d. Suggest that the provider increase the dose. ANS: B Because the risks of severe cardiovascular events and death are higher in patients whose hemoglobin levels exceed 11 gm/dL, the nurse should hold the dose and notify the provider of this level. It is not correct to administer the dose. Reducing the dose and increasing the dose are not correct because the patient’s hemoglobin level is already too high. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 656 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential MULTIPLE RESPONSE 1. Which patients are eligible to receive erythropoiesis stimulating agents? (Select all that apply.) a. All patients with nonmyeloid malignancies who require transfusions b. All patients with nonmyeloid malignancies whose chemotherapy is palliative c. All patients whose goal of therapy is curative d. All patients with nonmyeloid malignancies and chemotherapy-induced anemia e. All patients with leukemias or myeloid malignancies ANS: A, B, D Patients who have nonmyeloid malignancies who require transfusions, whose therapy is considered palliative, and who have chemotherapy-induced anemia are eligible for ESAs. Because ESAs are potentially lethal drugs, giving them to patients who expect a cure is not recommended. ESAs also are not given to patients with leukemias or myeloid malignancies, because the drugs can stimulate proliferation of these cancers. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 656 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies