Deck 39: Pharmacotherapy of Hematopoietic Disorders

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?

A)Decrease in red blood cells only
B)Abrupt decrease in hemoglobin and serum ferritin levels
C)Abrupt decrease in red blood cells,white cells,and platelets
D)Gradual decrease in red blood cells with a gradual increase in white blood cells

Answer 1

Abrupt decrease in red blood cells,white cells,and platelets

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?

A)Liver
B)Bone marrow
C)Kidney
D)Gastrointestinal tract

Answer 2

Bone marrow

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?

A)Macrocytic and hypochromic red blood cells
B)Macrocytic and normochromic red blood cells
C)Microcytic and hypochromic red blood cells
D)Normocytic and normochromic red blood cells

Answer 3

Macrocytic and normochromic red blood cells

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?

A)If given today,the increase in the white blood cell count will occur too rapidly.
B)The actions of the filgrastim and chemotherapy drugs will oppose each other.
C)If the filgrastim is given today,the risk of liver damage will increase.
D)There is an increased risk of adverse reaction to both drugs.

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?

A)Colony-stimulating factors and white blood cells
B)Erythropoietin and red blood cells
C)Interleukin II and macrophage activity
D)Colony-stimulating factors and serum ferritin

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?

A)"Your body needs more iron than usual for the baby,and you will temporarily have a greater blood volume."
B)"Your body does not absorb iron from food as readily because you are pregnant.A supplement will prevent anemia."
C)"More iron is eliminated from your body because of the increased urine output you experience during pregnancy.The supplement will prevent anemia."
D)"Nausea will probably keep you from eating enough meat to keep your iron up,so the supplement will prevent anemia."

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?

A)Thrombopoietin
B)Colony-stimulating factors
C)An interferon
D)Erythropoietin

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?

A)Red and orange vegetables such as tomatoes,sweet potatoes,and carrots
B)Cruciferous vegetables such as broccoli and cauliflower
C)Root vegetables such as potatoes,onions,and yams
D)Whole-grain bread and pastas,and fortified cereal

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?

A)"Stem cells are found in your bone marrow.They can turn into red blood cells,white blood cells,or platelets,depending on what your body needs at the time.Right now,your body is producing fewer than it should."
B)"Did the oncology nurse give you a copy of the pamphlet that discusses the unwanted effects of chemotherapy?"
C)"Bone marrow depression is a common side effect of chemotherapy,but it can be treated."
D)"The complete blood count you had yesterday showed a decrease in the number of stem cells.Your doctor is keeping you informed."

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?

A)The client's signs and symptoms are typical of anemia.
B)Pallor indicates the client has iron-deficiency anemia.
C)Blood work will indicate the client has pernicious anemia.
D)Constant exhaustion indicates the client is probably losing blood.

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?

A)Serum ferritin 10 mg/mL
B)Red blood cell count of 5,000,000
C)Hb 10.1 gm/dL
D)Platelet count of 75,000

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?

A)"This medication will help overcome your fatigue and improve your overall energy level."
B)"This medication will help reduce the possibility of bleeding in the brain."
C)"This medication will help to counteract the tendency of chemotherapeutic agents to cause peripheral edema."
D)"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.

A)"You will probably need multiple blood transfusions."
B)"In many cases we can give you medications that are very similar to substances already produced in your body."
C)"We will give you medications to reverse your chemotherapy."
D)"Since you are low on some blood cells,we will give you medications to increase your body's production of those cells."
E)"You will need several radiation treatments to slow down production of your blood cells."

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?

A)Acute destruction of red blood cells within the body.
B)A hereditary problem with the formation of red blood cells.
C)An episode of acute bleeding.
D)Lack of intrinsic factor in the gastrointestinal tract.

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?

A)Slowed migration of leukocytes
B)Elevated level of serum antibodies
C)Increased phagocytosis
D)Decreased antibody toxicity

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.

A)"Do you eat enough foods that contain iron?"
B)"Have you experienced any episodes of bleeding?"
C)"Do you follow a strict vegetarian diet?"
D)"Do you get enough folate in your diet?"
E)"Do you work around any strong chemicals?"

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?

A)Ask if the client ate a lot of iron-rich raisins in trail mix on the journey.
B)Place the lab results in the chart for the health care provider to review prior to the procedure.
C)Ask if the client used supplemental oxygen during high-altitude climbing.
D)Call the lab and have the test repeated.

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?

A)"Epogen will change the shape of your red blood cells to increase their flexibility."
B)"Epogen changes the molecular structure of your hemoglobin,making it carry more oxygen."
C)"Epogen helps to increase the concentration of the oxygen carrier in your blood."
D)"Epogen makes your red blood cells bigger around."

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?

A)Resumption of regular and balanced dietary intake
B)Normal kidney function
C)Normal bone marrow function
D)Normal serum ferritin levels

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?

A)13-14 gm/dL
B)7-8 gm/dL
C)11-12 gm/dL
D)9-10 gm/dL

Question 21

A client who had gastric bypass six months ago is profoundly anemic.The client has memory loss and periodic hallucinations.A diagnosis of folate deficiency has been proposed.Why would the nurse provisional diagnosis?

A)Iron-deficiency anemia is the anemia that occurs among gastric resection clients.
B)Folic acid absorption is usually enhanced during a rapid weight loss.
C)Folate-deficiency anemia does not produce neurological symptoms.
D)Folic acid deficiency has only a minimal impact on red blood cell counts.

Question 22

The nurse is caring for an ambulatory client who requires treatment for pernicious anemia on a medical unit.The client is weak and short of breath,and recently has become confused.Vital signs at rest are temperature 98.0°F,pulse 98 BPM,respirations 22/minute,blood pressure 96/60,and pulse oximetry 95%.Which nursing diagnosis has the highest priority?

A)Confusion,Acute related to aging,and abnormal vital signs
B)Falls,Risk for related to confusion,weakness,and unfamiliar environment
C)Knowledge,Deficient (anemia treatment)related to a new medical diagnosis and its treatment
D)Walking,Impaired related to weakness,low blood pressure,and fast heart rate

Question 23

A client is admitted with pernicious anemia.The nurse understands that therapy will include medication to address the client's lack of intrinsic factor.Which drug would the nurse anticipate administering?

A)Intravenous iron
B)An oral iron salt
C)Epoetin alfa subcutaneously
D)Cyanocobalamin subcutaneously

Question 24

A client who is a strict vegetarian is prescribed cyanocobalamin (Nascobal)for vitamin B₁₂ deficiency.Which information should the nurse provide for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"Your medication is in the form of a nasal spray."
B)"Nutrient-fortified breakfast cereals will help support your vitamin B₁₂ levels."
C)"Your health care provider may want to do an intradermal test dose of the medication before you start taking it."
D)"Adverse effects of this drug are rare."
E)"Constipation is a concern with this drug."

Question 25

A client received a first dose of cyanocobalamin (Nascobal)2 days ago.The nurse is monitoring the client's electrolytes because of the possibility of which clinical manifestation?

A)A marked decrease in serum osmolality and the risk of cerebral edema.
B)A marked decrease in calcium and the risk of tetany.
C)A marked decrease in potassium and the potential for dangerous dysrhythmias.
D)A decrease in sodium and the potential for renal failure.

Question 26

A client is prescribed a dose of oprelvekin.Prior to administration of the drug,which nursing assessment should trigger a telephone call to the provider who wrote the order?

A)Current platelet count of 25,000
B)History of myelogenous leukemia
C)History of alcohol abuse
D)Current hemoglobin of 9.6 gm/dL

Question 27

The nurse is developing teaching materials on managing the side effects of oral iron salts for distribution in a free clinic.Which information should be included?

A)Take oral iron products with the largest meal of the day.
B)Take oral iron products just before bedtime.
C)Take oral iron products with plenty of fluid,such as milk,tea,or coffee.
D)Take oral iron products on an empty stomach unless nausea results.

Question 28

A client is receiving the first dose of sargramostim (Leukine).Which assessment findings should the nurse evaluate as indicating a possible serious adverse effect of this drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Increased blood pressure
B)Tachycardia
C)Difficulty breathing
D)Yellowing of the mucous membranes
E)Rash on the palms

Question 29

The nurse is reviewing lab work prior to administering a client's regularly scheduled subcutaneous injection of epoetin alfa.The nurse notes that the client's hematocrit has dropped from the last time lab was drawn.Which action by the nurse is the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Discuss this finding with the client's health care provider immediately.
B)Schedule another hematocrit test tomorrow.
C)Give the epoetin alfa and hold pressure on the injection site for 5 minutes.
D)Ask the client,"How have you been feeling?"
E)Ask the lab to verify the lab results.

Question 30

A client with severe pernicious anemia tells the nurse,"I do not understand why everyone is so excited about a little anemia.Lots of people are anemic." The nurse responds that long-term pernicious anemia can cause severe damage to the tissues of the system?

A)Nervous system
B)Renal system
C)Cardiovascular system
D)Gastrointestinal system

Question 31

The nurse is delivering care to a dialysis client who received epoetin alfa during the previous visit.Which nursing intervention is most important during this treatment?

A)Ensuring that the client understands the indications and expected outcomes of epoetin alfa therapy
B)Ensuring that sufficient water is removed during dialysis,based on body weight
C)Ensuring that the shunt is appropriately cleaned and dressed after the treatment
D)Ensuring that the client receives sufficient heparin after the day's dialysis is complete

Question 32

A client with preexisting bipolar disorder is receiving filgrastim (Neupogen)for the management of neutropenia following chemotherapy treatments for lymphocytic leukemia.The oncology nurse recognizes that which preparation for bipolar disorder could complicate the management of the client's leukemia?

A)Clonazepam (Klonopin)
B)Valproic acid (Depakene)
C)Carbamazepine (Tegretol)
D)Lithium carbonate

Question 33

The nurse completes an assessment of a client who is prescribed filgrastim after a bone marrow transplant.The nurse would attend most closely to which parameters on the complete blood count?

A)Platelet count and reticulocyte count
B)Band count and reticulocyte count
C)Hemoglobin and hematocrit
D)Total white cell count and neutrophil count

Question 34

A client says to the nurse,"My sister's doctor told her to start taking ferrous sulfate tablets.Do you think that would help me feel better?" Which client history would be of concern to the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)An episode of shingles last winter
B)Ulcerative colitis controlled by diet
C)Peptic ulcer disease
D)Frequent falls
E)Daily use of a proton pump inhibitor

Question 35

Which client is most likely to require a folic acid supplement to treat anemia?

A)A client who has a forearm arterial-venous shunt and is scheduled for dialysis three times weekly
B)A client who has a history of chronic heart failure with multiple exacerbations
C)A client who has a history of chronic heavy alcohol intake
D)A client who has a history of type 2 diabetes mellitus

Question 36

Mild folate deficiency can be managed with dietary interventions.Which foods would the nurse recommend?

A)Lean meat,cheese,and milk
B)Bread and pastas,dried beans,and fresh greens
C)Strawberries,melon,and blueberries
D)Fresh citrus fruits

Question 37

The nurse is planning care for a client who will be administering injections of cyanocobalamin once a month.Which goal is most appropriate?

A)The client will safely self-administer cyanocobalamin as ordered every 4 weeks.
B)The client will be taught about the possible side effects of cyanocobalamin by the home health nurse.
C)The client will understand the purpose of cyanocobalamin before the first dose.
D)The client will be given cyanocobalamin monthly until the blood count improves.

Question 38

The nurse has instructed a client on the self-administration of oral iron tablets.Which client statement indicates the need for further clarification?

A)"I should take this medication with meals,along with a big glass of milk."
B)"If I get constipated while I am taking this drug,I need to talk to my provider."
C)"I will have blood drawn after 3 or 4 weeks to see if this drug is improving my red blood cell count."
D)"The medicine will help my body build red blood cells."

Question 39

The health care provider has ordered darbepoetin alfa (Aranesp)for a client who has anemia secondary to chemotherapy.What teaching should the nurse provide to the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"This medication will help to increase your red blood cell count."
B)"You can take this medication by mouth."
C)"You will need to come in once a week for this medication."
D)"This drug has fewer side effects than the epoetin alfa we used to give."
E)"You should see maximum results from this medication in 2 to 4 weeks."

Question 40

The nurse is preparing a dose of parenteral iron (iron dextran)for a client with severe resistant anemia.The nurse is aware of the major adverse reaction that can accompany intravenous ferric gluconate.Which assessment parameters will the nurse attend to most closely?

A)Respiratory status and blood pressure
B)Balance and mobility
C)Level of consciousness and spontaneous movement
D)Temperature and muscle tone

Question 41

A client and nurse have set this goal: "The client will verbalize precautions required while taking medications to reverse neutropenia by date of discharge." Which client statements would the nurse evaluate as indicating this goal is not met? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"I should eat plenty of fresh fruits and vegetables while on this drug."
B)"I should expect my stools to be light in color."
C)"I will avoid going to the shopping mall until my therapy is complete."
D)"I will call my health care provider's office if my temperature goes over 100.5°F."
E)"If I develop a cough,I will call my health care provider's office."

Question 42

A client will be on long-term oral iron therapy.When discussing this therapy,the nurse mentions that a slow-release,enterically coated preparation may be advisable for the client.Which rationales would the nurse have for this suggestion? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)The client has children at home.
B)This form is less expensive.
C)The enteric coating may reduce gastrointestinal upset.
D)This form reduces problems with constipation.
E)This preparation can be taken with coffee or milk.

Question 43

The client and nurse have set a goal that the client will demonstrate proper technique for self-administration of epoetin alfa (Epogen)before the client is discharged from the hospital.Which client actions would the nurse evaluate as indicating this goal is met? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)The client shakes the vial prior to drawing up the medication.
B)The client warms the vial by holding it for a few minutes before drawing up the medication.
C)The client draws the appropriate amount of medication into the syringe.
D)The client saves the remaining medication in the vial for the next dose.
E)The client verbalizes a plan to keep the medication vials in a cabinet out of the reach of children.