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 red blood cells, white blood cells, and platelets. Depression of these stem cells would result in a significant decrease in all three types of blood cells, leading to an abrupt decrease in red blood cells, white cells, and platelets. Hemoglobin and serum ferritin levels may also decrease, but this would be a secondary effect of the chemotherapy drug's impact on the stem cells. Option A is incorrect as only RBCs are not affected by the depression of pluripotent stem cells. Option B is incorrect as the abrupt decrease in hemoglobin and serum ferritin levels is not the primary effect of chemotherapy drugs on pluripotent stem cells. Option D is incorrect as a gradual decrease in red blood cells with a gradual increase in white blood cells does not reflect the adverse effect of chemotherapy drugs on pluripotent stem cells.

Question 2

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?
Select all that apply.

Accepted Answer

Options A, C, and E are incorrect because they are either not appropriate treatment options or provide incorrect information. Option B is accurate as many hematopoietic medications are designed to mimic substances already produced in the body. Option D is also accurate as medications can be used to stimulate the production of blood cells.

Question 3

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) increase the production of white blood cells in the bone marrow. Therefore, normal function of bone marrow is necessary to increase white blood cell count with CSFs.

Question 4

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 signs and symptoms are typical of anemia, including pale skin, dizziness, and chronic fatigue, and an increased heart rate with exertion. Without further information or test results, it cannot be concluded which type of anemia the client may have.

Question 5

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 6

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, contain added iron. These foods would be the best choice to meet the iron needs of a vegetarian who is having difficulty maintaining a hemoglobin level over 12 gm/dL. While vegetables do contain some iron, it may not be sufficient for some individuals who require higher amounts, such as those with difficulty maintaining their hemoglobin levels.

Question 7

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?
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 8

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 the hormone that is primarily responsible for regulating platelet production. When platelet counts are low, the body can boost production by increasing the amount of thrombopoietin in circulation. Colony-stimulating factors and interferons primarily affect the production of white blood cells, while erythropoietin stimulates the production of red blood cells.

Question 9

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 a type of medication given to patients receiving chemotherapy to help protect them from developing severe infections. CSFs stimulate the production of white blood cells in the bone marrow, which help fight off infections.

Question 10

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 are expected findings in individuals who have been at high altitudes for a prolonged period due to the body's compensatory response to decreased oxygen availability. Therefore, the nurse should place the lab results in the chart for the healthcare provider to review prior to the procedure. There is no need to repeat the test or ask about iron-rich foods, but it may be pertinent to ask if the client used supplemental oxygen during high-altitude climbing.

Question 11

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?

Accepted Answer

Pernicious anemia is caused by a lack of intrinsic factor, which is needed for the absorption of vitamin B12. Cyanocobalamin is a form of vitamin B12 and is the drug of choice for treating pernicious anemia. It is given subcutaneously to bypass the need for intrinsic factor. Intravenous iron and oral iron salts are used to treat iron-deficiency anemia, not pernicious anemia. Epoetin alfa is used to stimulate the production of red blood cells in certain types of anemia but is not indicated for pernicious anemia.

Question 12

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 13

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 gives the client a clear and concise explanation of what stem cells are, where they are found, and why their decrease is a cause for concern in the context of chemotherapy.

Question 14

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

A hemoglobin level of 13-14 gm/dL would indicate a rapid increase in hemoglobin levels, which could raise concerns for the development of thrombotic events or hypertensive crisis. It is important for the hemoglobin levels to increase gradually and within a certain range to avoid these complications. A hemoglobin level of 7-8 gm/dL could also be problematic as it indicates a low hemoglobin level, but it would not be as concerning as a rapid increase in hemoglobin levels. Hemoglobin levels of 9-12 gm/dL are within an acceptable range for patients receiving epoetin alfa therapy.

Question 15

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 ruddy facial color with purple undertones is likely due to erythrocytosis, or an elevated red blood cell count. This condition is a common complication of COPD due to chronic hypoxemia, which stimulates the production of erythropoietin and subsequent increases in red blood cell production. The elevated red blood cell levels can cause a bluish or purple discoloration of the skin (cyanosis) and can also affect pulse oximetry readings by giving a falsely elevated value.

Question 16

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

Epogen, which contains erythropoietin, is a hormone that stimulates the bone marrow to produce more red blood cells. This increases the concentration of the oxygen carrier (hemoglobin) in the blood, allowing for better delivery of oxygen to the tissues. It does not change the shape or size of the red blood cells or alter the molecular structure of hemoglobin.

Question 17

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 18

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 19

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

Accepted Answer

Chronic alcohol intake can lead to folate deficiency, which can cause anemia. Therefore, a client with a history of chronic heavy alcohol intake would be most likely to require a folic acid supplement to treat anemia.

Question 20

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) help to increase the production and maturation of white blood cells, which include phagocytes. Phagocytes are responsible for engulfing and destroying invading pathogens, thereby helping the body to fight off infection. Therefore, an increase in CSFs would result in an increased number of phagocytes, leading to an increased rate of phagocytosis and ultimately helping the body to combat the wound infection.

Quiz 39: Pharmacotherapy of Hematopoietic Disorders

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 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? Select all that apply.

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?

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?

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 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?

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? Select all that apply.

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?

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?