Deck 41: Pharmacotherapy of Hematopoietic Disorders

Question 1

A patient with chronic obstructive pulmonary disease demonstrates a consistently low pulse oximetry value.The nurse notes a ruddy facial color with purple undertones.The nurse recognizes that this patient is showing the effects of elevated blood levels of:
1)Erythropoietin and red blood cells.
2)Colony-stimulating factors and white blood cells.
3)Interleukin II and macrophage activity.
4)Colony-stimulating factor and serum ferritin.

Answer 1

1

Question 2

The nurse is researching the adverse effects of a chemotherapy drug.One unwanted effect noted is "depression of pluripotent stem cells." After a patient receives a dose of this drug, the nurse would anticipate what changes in lab values?
1)Abrupt decrease in hemoglobin and serum ferritin levels
2)Abrupt decrease in red blood cells, white cells and platelets
3)Gradual decrease in red blood cells with a gradual increase in white blood cells
4)Decrease in red blood cells only

Answer 2

2

Question 3

Lab work reveals that a patient has an extremely low neutrophil count.The nurse recognizes that CSF can increase the white blood cell count, provided that the patient has:
1)An adequately functioning kidney.
2)Functional bone marrow.
3)Normal liver function.
4)An intact and functioning gastrointestinal tract.

Answer 3

3

Question 4

The nurse is communicating with a patient who recently started chemotherapy and visited the oncologist for a follow-up consultation.The patient states, "The doctor told me my stem cells were down.A stem cells sounds like something on a flower! What did the doctor mean?" Which response by the nurse provides the best explanation?
1)"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."
2)"Bone marrow depression is a common side effect of chemotherapy, but it can be treated."
3)"The complete blood count you had yesterday showed a decrease in the number of stem cells.Your doctor is keeping you informed."
4)"Did the oncology nurse give you a copy of the pamphlet that discusses the unwanted effects of chemotherapy?"

Question 5

A tourist who just returned from an extended mountain climbing trip in the Andes is seen in a physician's office for a minor complaint.His blood work reveals a very high hemoglobin level and red blood cell count.The office nurse recognizes this abnormal blood work is associated primarily with:
1)Participation in a vigorous sport over a long time period.
2)Excess consumption of iron-rich raisins in trail mix.
3)Supplemental oxygen used during high-altitude climbing.
4)Chronic hypoxia due to low ambient oxygen at high altitudes.

Question 6

A patient is receiving a folic acid supplement to treat anemia.When recording the patient's baseline data, the nurse is most likely to encounter what?
1)A history of chronic heavy alcohol intake
2)A forearm A-V shunt and a schedule for dialysis three times weekly
3)A history of type 2 diabetes mellitus
4)A history of chronic heart failure with multiple exacerbations

Question 7

The nurse is reviewing the blood work of a patient newly diagnosed with anemia.Which lab value is most pertinent in determining that the patient has iron-deficiency anemia?
1)Serum ferritin 10 mg/ml
2)Hb 10.1 gm/dl
3)Red blood cell count 5,000,000
4)Platelet count 75,000

Question 8

A patient with a low level of intrinsic factor is seen by a hematologist.Upon examination of the report of a blood smear, the nurse would anticipate what findings to help confirm the medical diagnosis of pernicious anemia?
1)Red blood cells macrocytic and normochromic
2)Red blood cells normochromic and normochromic
3)Red blood cells microcytic and hypochromic
4)Red blood cells macrocytic and hypochromic

Question 9

The complete blood count of a patient with a wound infection demonstrates an increased white blood cell count.The nurse recognizes that an increased CSF level stimulates an increased neutrophil count primarily because of what wound-related phenomenon?
1)Increased antibody toxicity
2)Elevated level of serum antibodies
3)Slowed migration of leukocytes
4)Increased phagocytosis

Question 10

After major surgery, a patient's hemoglobin is 9.6 gm/dl.The nurse expects that the patient's erythropoietin output would go up, but recognizes that increased production is largely dependent on:
1)Normal serum ferritin levels.
2)Resumption of regular and balanced dietary intake.
3)Normal kidney function.
4)Normal bone marrow function.

Question 11

A patient with a dropping white blood cell count is to receive an exogenous CSF preparation.The nurse knows this drug should not be given within 24 hours of chemotherapy:
1)Due to an increased risk of adverse reaction to both drugs.
2)Because the actions of the two drugs will oppose each other.
3)Because the increase in the white blood cell count will occur too rapidly.
4)Due to the increased risk of liver damage.

Question 12

The therapeutic goal when administering parenteral epoetin alfa is to elevate the hemoglobin level.Which hemoglobin level would be considered excessive?
1)13-14 gm/dl
2)11-12 gm/dl
3)9-10 gm/dl
4)7-8 gm/dl

Question 13

A patient 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 patient's choice to avoid animal products.Which choices are most likely to contain sufficient iron to meet this patient's needs?
1)Whole-grain bread and pastas, and fortified cereal
2)Red and orange vegetables such as tomatoes, sweet potatoes, and carrots
3)Root vegetables such as potatoes, onions, and yams
4)Cruciferous vegetables such as broccoli and cauliflower

Question 14

A nurse is caring for a patient 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:
1)Colony-stimulating factor.
2)Erythropoietin.
3)An interferon.
4)Thrombopoietin.

Question 15

The nurse is assessing a patient who is quite pale and complains of constantly feeling tired.The patient says she gets dizziness when moving quickly from bed to chair, and the patient's heart increases whenever she exerts herself.The patient's medical diagnoses include possible anemia.Based on her assessment, the nurse would correctly conclude:
1)Pallor indicates the patient has iron-deficiency anemia.
2)Constant exhaustion indicates the patient is probably losing blood.
3)Blood work will indicate the patient has pernicious anemia.
4)The patient's signs and symptoms are typical of anemia.

Question 16

A pregnant female is receiving counseling related to proper nutrition for fetal development.When told than an iron supplement is advised, the woman says, "Why should I take iron? I was never told I was anemic." The nurse's most accurate response would be:
1)"More iron is eliminated from your body because of the increased urine output you experience during pregnancy.The supplement will prevent anemia."
2)"Your body does not absorb iron from food as readily because you are pregnant.A supplement will prevent anemia."
3)"Nausea will probably keep you from eating enough meat to keep your iron up, so the supplement will prevent anemia."
4)"Your body needs more iron than usual for the baby, and because you will temporarily have a greater blood volume."

Question 17

The oncology nurse recognizes the goal of CSF supplementation in chemotherapy patients is to:
1)Protect the patient from life-threatening infections.
2)Decrease the patient's risk of a fatal intracranial bleed.
3)Counteract a tendency toward peripheral edema.
4)Overcome the patient's fatigue and improve overall energy level.

Question 18

A nurse is caring for a patient 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:
1)An episode of acute bleeding.
2)A hereditary problem with the formation of the red blood cells.
3)Acute destruction of red blood cells within the body.
4)Lack of intrinsic factor in the gastrointestinal tract.

Question 19

A patient is admitted with pernicious anemia.The nurse caring for the patient understands that the patient's therapy will include medication to address the patient's lack of intrinsic factor.The nurse would anticipate administering:
1)An oral iron salt.
2)Intravenous iron.
3)Epoetin alfa subcutaneously.
4)Cyanocobalamin subcutaneously.

Question 20

A nurse is caring for an ambulatory elderly woman on a medical unit.The patient will be treated for pernicious anemia.The patient is weak and short of breath, and recently has become confused.The patient's 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?
1)Knowledge Deficit (anemia treatment)related a new medical diagnosis and its treatment
2)Injury, risk for (falls)related to confusion, weakness, and unfamiliar environment
3)Impaired Walking related to weakness, low blood pressure, and fast heart rate
4)Acute Confusion related to aging, and abnormal vital signs

Question 21

A patient with pre-existing 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 patient's leukemia?
1)Lithium carbonate
2)Carbamazepine (Tegretol)
3)Valproic acid (Depakene)
4)Clonazepam (Klonopin)

Question 22

The nurse is planning care for the patient who will be giving herself injections of cyanocobalamin once a month.Which goal is most appropriate?
1)The patient will understand the purpose of cyanocobalamin before the first dose.
2)The patient will be given cyanocobalamin monthly until the blood count improves.
3)The patient will safely self-administer cyanocobalamin as ordered every four weeks.
4)The patient will be taught about the possible side effects of cyanocobalamin by the home health nurse.

Question 23

The nurse has completed an assessment of a patient who is to receive filgrastim after bone marrow transplant.The nurse would attend most closely to which parameters on the complete blood count?
1)Total white cell count and neutrophil count
2)Hemoglobin and hematocrit
3)Platelet count and reticulocyte count
4)Band count and reticulocyte count

Question 24

A nurse is caring for a patient with severe pernicious anemia.The nurse is aware that permanent damage can occur if the disease is not corrected within the next six months to a year.If treatment is unsuccessful, the nurse would expect permanent deficits to the:
1)Tissues of the nervous system.
2)Tissues of the gastrointestinal tract.
3)Tissues of the cardiovascular system.
4)Tissue in the kidney.

Question 25

Teaching associated with managing the side effects of oral iron salts should include:
1)Take oral iron products with your largest meal.
2)Take oral iron products on empty stomach unless nausea results.
3)Take oral iron products just before bedtime.
4)Take oral iron products with plenty of fluid, such as milk, tea, or coffee.

Question 26

A nurse is assessing the electrolyte values of a patient who received her first dose of epoetin alfa (Epogen)two days ago.The nurse is most concerned about:
1)An increase in sodium and the potential for pulmonary edema.
2)A marked decrease in potassium and the potential for dangerous dysrhythmias.
3)A marked decrease in calcium and the risk of tetany.
4)A marked decrease in serum osmolality and the risk of cerebral edema.

Question 27

A nurse is delivering care to a dialysis patient who received epoetin alfa during the prior visit.Which nursing intervention assumes additional importance during this treatment?
1)Ensuring that the patient receives sufficient heparin after the day's dialysis is complete
2)Ensuring that sufficient water is removed during dialysis, based on body weight
3)Ensuring that the shunt is appropriately cleaned and dressed after the treatment
4)Ensuring that the patient understands the indications and expected outcomes of epoetin alfa therapy

Question 28

Mild folate deficiency can be managed with dietary interventions.What foods would the nurse recommend?
1)Bread and pastas, dried beans, and fresh greens
2)Lean meat, cheese, and milk
3)Fresh citrus fruits
4)Strawberries, melon, and blueberries

Question 29

A nurse is preparing a dose of parenteral iron (ferric gluconate)for a patient with severe resistant anemia.The nurse is aware of the major adverse reaction that can accompany intravenous ferric gluconate.The parameters the nurse will monitor closely are:
1)Temperature and muscle tone.
2)Respiratory status and blood pressure.
3)Level of consciousness and spontaneous movement.
4)Balance and mobility.

Question 30

As a nurse examines his assignment, he notes that one of his patients had a gastric bypass to reduce her large body mass index six months ago.The patient is profoundly anemic, and is complaining of memory loss and periodic hallucinations.A folate deficiency has been proposed.The nurse believes that this provisional diagnosis is invalid because:
1)Folate-deficiency anemia does not produce neurological symptoms.
2)Folic acid deficiency has only a minimal impact on red blood cell counts.
3)Iron-deficiency anemia is more common among gastric resection patients.
4)Folic acid absorption is usually enhanced during a rapid weight loss.

Question 31

A patient has an order for a dose of oprelvekin.Which nursing assessment should trigger a telephone call to the provider who wrote the order prior to administration of the drug?
1)Current platelet count of 25,000
2)Current hemoglobin 9.6 gm/dl
3)History of alcohol abuse
4)History of myelogenous leukemia