Question 1

One of the adverse effects of a chemotherapy drug being administered to a client is depression of pluripotent stem cells.Which change in this client's lab values would the nurse expect after treatment is initiated?

Accepted Answer

Pluripotent stem cells are responsible for producing all three types of blood cells -red blood cells, white blood cells, and platelets. Therefore, the depression of these cells would result in an abrupt decrease in all three types of blood cells. Option A is not correct as depression of pluripotent stem cells would affect all blood cells, not just red blood cells. Option B is not correct as it only mentions hemoglobin and serum ferritin levels, which are only markers of iron stores and do not directly relate to the production of blood cells. Option D is not correct as a gradual decrease in red blood cells with a gradual increase in white blood cells does not account for the abrupt decrease in platelets that would also be expected with depression of pluripotent stem cells.

Question 2

Lab work reveals that a client has an extremely low neutrophil count.The nurse recognizes that colony-stimulating factors (CSFs)can increase the white blood cell count,provided that the client has normal function of which organ?

Accepted Answer

Colony-stimulating factors (CSFs) act on the bone marrow to increase production and differentiation of white blood cells, including neutrophils. Therefore, the client must have normal bone marrow function in order for CSFs to increase their white blood cell count.

Question 3

The nurse is reviewing laboratory results for a client with a low level of intrinsic factor.Which blood smear report would help confirm the medical diagnosis of pernicious anemia?

Accepted Answer

Pernicious anemia is a type of megaloblastic anemia caused by a low level of intrinsic factor, which leads to inadequate absorption of vitamin B12. Therefore, the blood smear report for pernicious anemia typically reveals macrocytic red blood cells that are larger than normal and normochromic, meaning they have a normal amount of hemoglobin. Option B, macrocytic and normochromic red blood cells, is the correct choice for confirming the diagnosis of pernicious anemia.

Question 4

A nurse who works in an outpatient chemotherapy unit has received an order to administer filgrastim (Neupogen)to a client who received chemotherapy this morning.The client's white blood cell count is dropping rapidly.The nurse asks the client to return to the unit tomorrow for the filgrastim.What is the rationale for the nurse's request?

Accepted Answer

Filgrastim (Neupogen) is a granulocyte colony-stimulating factor that stimulates the production of white blood cells. Administering it immediately after chemotherapy could counteract the effect of chemotherapy drugs, which often work by suppressing the bone marrow (and thus lowering white blood cell counts). The rationale for waiting is to allow the chemotherapy to exert its full effect before attempting to mitigate one of its side effects (low white blood cell count) with filgrastim.

Question 5

A client with chronic obstructive pulmonary disease (COPD)demonstrates a consistently low pulse oximetry value.The nurse notes a ruddy facial color with purple undertones and recognizes the effects of which elevated blood levels?

Accepted Answer

The elevated blood levels that are likely causing the ruddy facial color with purple undertones are probably an excess of erythropoietin and red blood cells. This can occur in COPD as a compensatory mechanism due to chronically low oxygen saturation levels, in an attempt to increase the amount of oxygen-carrying hemoglobin in the blood. The excess red blood cells can lead to a ruddy complexion with purple undertones.

Question 6

A pregnant client is receiving counseling related to proper nutrition for fetal development.When told that an iron supplement is advised,the woman says,"Why should I take iron? I was never told I was anemic." Which is the nurse's best response?

Accepted Answer

During pregnancy, a woman's body requires more iron due to the increased blood volume and the need to supply oxygen to the fetus. Iron supplements help prevent anemia by supporting this increased demand.

Question 7

The nurse is caring for a client with a very low platelet count.The nurse recognizes that a resurgence in the platelet count is most likely to occur in response to a higher circulating level of which substance?

Accepted Answer

Thrombopoietin is a hormone produced by the liver and kidneys that stimulates the production of platelets in the bone marrow. Therefore, a higher circulating level of thrombopoietin is most likely to result in a resurgence in platelet count. Colony-stimulating factors, interferons, and erythropoietin do not directly stimulate platelet production.

Question 8

A client who is a vegetarian is having difficulty maintaining a hemoglobin level over 12 gm/dL.The nurse understands that this problem is primarily related to the client's choice to avoid animal products.Which food choices contain sufficient iron to meet this client's needs?

Accepted Answer

Whole-grain bread and pastas, as well as fortified cereals, are often enriched with iron and are good sources of non-heme iron which can help maintain hemoglobin levels in vegetarian clients. Red and orange vegetables, cruciferous vegetables, and root vegetables contain some iron but not enough to meet the needs of a client struggling to maintain hemoglobin levels.

Question 9

A client recently started on chemotherapy states,"The doctor told me my stem cells were down.A stem cell sounds like something on a flower! What did the doctor mean?" Which response by the nurse provides the best explanation?

Accepted Answer

This response provides a clear and concise explanation of what stem cells are, where they are found, and how they are affected by chemotherapy. It also explains the reason for the client's decrease in stem cells.

Question 10

The nurse is assessing a client who is pale and complains of dizziness and chronic fatigue.The client's heart rate increases with exertion.The medical diagnoses include possible anemia.Based on this assessment,which conclusion can the nurse draw?

Accepted Answer

The client's symptoms of pale skin, dizziness, chronic fatigue, and increased heart rate with exertion are all common signs of anemia. However, without further assessment and laboratory testing, it is not possible to determine the exact type of anemia the client may have.

Question 11

The nurse is reviewing the blood work of a client newly diagnosed with iron-deficiency anemia.Because of the way iron is stored in the body,the nurse pays closest attention to which lab value?

Accepted Answer

Serum ferritin is the most sensitive indicator of iron stores in the body. In iron-deficiency anemia, the serum ferritin level is usually low. Red blood cell count, hemoglobin level, and platelet count may also be affected in iron-deficiency anemia, but they are not as specific to iron stores as serum ferritin.

Question 12

An oncology nurse is administering colony-stimulating factors (CSFs)to a client who has been receiving chemotherapy.How should the nurse explain the expected effect of this medication?

Accepted Answer

Colony-stimulating factors (CSFs) are medications that stimulate the production of white blood cells in the bone marrow, which can help protect against infections. Therefore, the best explanation is that this medication will help protect you from developing severe infections.

Question 13

A client is hospitalized for pharmacologic management of a hematopoietic disorder secondary to chemotherapy treatment.The client states,"This sounds really bad.How will I be treated for this problem?" Which responses by the nurse are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

Accepted Answer

Option B and D are appropriate responses because they provide the client with a clear understanding of the treatment plan. The nurse should explain that medications can be given to stimulate the production of blood cells and that these medications are similar to substances produced by the body. Option A and E are incorrect because blood transfusions and radiation treatments are not typically used to treat hematopoietic disorders caused by chemotherapy. Option C is incorrect because there are no medications that can reverse the effects of chemotherapy once they have occurred.

Question 14

The nurse is caring for a client diagnosed with aplastic anemia.The nurse recognizes that the medical management of this type of anemia is based on the fact that it is triggered by which event?

Accepted Answer

Aplastic anemia is primarily caused by the acute destruction of red blood cells within the body, which can result from autoimmune diseases, exposure to toxic chemicals, radiation, or certain medications. This condition leads to bone marrow failure, where the marrow stops producing enough new blood cells.

Question 15

A client has a surgical wound infection.The nurse recognizes that a healthy body will respond by rapidly increasing colony-stimulating factors (CSFs)in the blood.How does this increase help in fighting the infection?

Accepted Answer

Colony-stimulating factors (CSFs) are responsible for stimulating the bone marrow to produce more white blood cells, including leukocytes that are involved in phagocytosis, the process by which bacteria and other foreign substances are engulfed and destroyed by white blood cells. This results in an increased number of phagocytic cells, which are critical in fighting infections. Increased migration of leukocytes to the site of the infection, as opposed to slowed migration, is also important in the body's response to infection. Elevated levels of serum antibodies and decreased antibody toxicity are not primarily related to the action of CSFs in fighting infection.

Question 16

Morphology reports on a blood smear from a client who has documented anemia show normocytic-normochromic red blood cells.Which assessment questions should the nurse ask to further identify the etiology of this anemia? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

Accepted Answer

Normocytic-normochromic anemia is characterized by red blood cells that are normal in size and hemoglobin content, suggesting causes other than nutritional deficiencies. Question B is relevant because bleeding can lead to anemia without affecting the size or hemoglobin content of red blood cells. Question E is pertinent because exposure to strong chemicals can lead to anemia through bone marrow suppression or hemolysis, neither of which necessarily involves changes in cell size or hemoglobin content initially. Questions A, C, and D relate to nutritional deficiencies that typically cause microcytic-hypochromic anemia (iron deficiency) or macrocytic anemia (folate or vitamin B12 deficiency), not normocytic-normochromic anemia.

Question 17

A client who has just returned from an extended mountain-climbing trip in the Andes is seen in a clinic for an elective procedure.Preprocedure blood work reveals a very high hemoglobin level and red blood cell count.Which action should the nurse take?

Accepted Answer

A high hemoglobin level and red blood cell count can be expected in individuals who have been exposed to high altitudes, such as mountain climbers. This is due to the body's response to the decreased oxygen levels at higher altitudes. It is important to document this finding in the client's chart for the health care provider to review prior to any procedure, to ensure that there are no contraindications or complications related to the high hemoglobin levels. Asking about iron-rich foods, supplemental oxygen use, or repeating the test would not provide additional information or change the management plan.

Question 18

Exogenous erythropoietin in the form of epoetin alfa (Epogen)is administered to a chronic dialysis client.How can the nurse best describe the action of this drug to the client?

Accepted Answer

Epoetin alfa (Epogen) is a synthetic version of erythropoietin, a hormone that stimulates the production of red blood cells in the bone marrow. By increasing the concentration of these oxygen-carrying cells, epoetin alfa helps to alleviate the anemia associated with chronic kidney disease and dialysis.

Question 19

After major surgery,a client's hemoglobin is 9.6 gm/dL.The nurse expects that the client's erythropoietin output would go up,but recognizes that increased production is largely dependent on which factor?

Accepted Answer

Erythropoietin is primarily produced and released by the kidneys in response to decreased oxygen levels in the blood. Therefore, normal kidney function is crucial for increased production of erythropoietin, which in turn stimulates the bone marrow to produce more red blood cells. Resuming regular and balanced dietary intake, maintaining normal serum ferritin levels, and normal bone marrow function are all important for overall health, but they are not the primary factors affecting erythropoietin production.

Question 20

A client whose hemoglobin level was 6 gm/dL 2 days ago has received parenteral epoetin alfa.A hemoglobin level has just been drawn to evaluate therapy.The nurse would consider which hemoglobin lab result as most problematic?

Accepted Answer

The most problematic hemoglobin lab result would be a level of 13-14 gm/dL, as it would indicate an overcorrection of the anemia and potentially increase the risk of adverse effects such as thromboembolic events. The goal of epoetin alfa therapy is typically to raise hemoglobin levels to a target range of 9-10 gm/dL, so levels exceeding 12 gm/dL would be considered too high. The other options listed are all within or below the target range, and would be considered acceptable outcomes of therapy.

Quiz 39: Pharmacotherapy of Hematopoietic Disorders