Meds
Patients who are no longer able to produce enough erythropoietin in the kidneys may benefit from treatment with...
Erythropoiesis-Stimulating Agents such as epoetin alfa (Epogen, Procrit), darbepoetin alfa (Aranesp), and methoxy polyethylene glycol-epoetin beta (Mircera).
Rationale: pg. 862
To ensure maximum absorption, a nurse instructs a patient receiving oral iron therapy to avoid taking the iron with
a. protein.
b. antibiotics.
c. fats.
d. antiplatelet medications.
b. antibiotics.
The nurse is caring for a patient in end-stage renal failure and anemia. What is the cause of this patient’s anemia?
A) Low serum iron levels
B) Low erythropoietin levels
C) Inadequate oxygenation of tissue
D) Lack of B12 and folic acid intake
B) Low erythropoietin levels
A 2-year-old child weighing 32 pounds is to take ferrous sulfate (Feosol) 6 mg/kg/d PO. How many milligram will the child receive per dose?
A) 47 mg
B) 67 mgC) 87 mg
D) 107 mg
C) 87 mg
The nurse will administer 87 mg per dose. The child’s weight is first converted to kilograms by dividing 32 by 2.2, or 32/2.2 = 14.5 kg. Next, calculate the dose by multiplying weight times mg/kg/d or 14.5 × 6 = 87 mg.
A nurse caring for a 28-year-old woman with renal failure is to start the patient on epoetin alfa therapy for iron replacement. What will the nurse assess before initiating therapy?
A) Weight
B) Last menstrual period
C) Intake and output (I & O) for a 24-hour period
D) Blood type
B) Last menstrual period
Rationale pg. 862
Treatment of anemia associated with chronic renal failure can be seen with the use of what medication?
Epoetin Alfa
Rationale: Pg. 864
The nurse develops a care plan for a patient who has been prescribed a folic acid derivative that includes what priority nursing diagnosis?
A) Deficient knowledge regarding drug therapy
B) Monitor possibility of hypersensitivity reactions
C) Acute pain related to injection or nasal irritation
D) Risk for fluid volume imbalance related to cardiovascular effects
D) Risk for fluid volume imbalance related to cardiovascular effects
Nursing diagnoses related to drug therapy might include: Risk for fluid volume imbalance related to cardiovascular effects. pg. 874
A 62-year-old female patient is started on vitamin B12 for pernicious anemia. When the nurse develops the plan of care, what expected outcome will the nurse include?
A) Decreased bleeding
B) Increased hemoglobin
C) Decreased joint pain
D) Less fatigue
B) Increased hemoglobin
Vitamin B12 is essential for normal functioning of red blood cells (RBCs) so the drug would be evaluated as successful in treating the disorder if the patient’s hemoglobin and RBC count increased after administration
How often should epoetin alfa and/or darbepoetin be administered?
Give epoetin alfa three times per week, either IV or subcutaneously, to achieve appropriate therapeutic drug levels. Administer darbepoetin alfa once per week, subcutaneously or IV
What chelating agent (counteractive drug) is used for oral iron administration toxicity?
deferasirox (exjade)
Rationale: pg. 868 Box. 49.6
Before administering an iron preparation, what should the nurse assess?
A) Red blood cell count (RBC)
B) Hematocrit and hemoglobin
C) Aspartate aminotransferase levels
D) Serum creatinine levels
B) Hematocrit and hemoglobin
Rationale:
Hematocrit and hemoglobin levels should be assessed before administration because the drug will be evaluated for effectiveness by the response of these levels to drug treatment. pg. 865 and 869
A 50-year-old patient with pernicious anemia asks why she can’t just take a vitamin B12 pill instead of getting an injection. What is the nurse’s best response to her question?
A) Pernicious anemia is caused by the body’s inability to absorb vitamin B12.
B) Oral ingestion of vitamin B12 irritates the GI tract and bleeding could occur.
C) Pernicious anemia alters mucous membrane lining of the bowel and impairs absorption.
D) With severe deficiencies like yours, oral vitamin B12 does not work fast enough.
A) Pernicious anemia is caused by the body’s inability to absorb vitamin B12.
Vitamin B12 cannot be taken orally, because one problem with pernicious anemia is an inability by the patient to absorb vitamin B12 due to low levels of intrinsic factor. pg. 872
A patient who has anemia and a severe GI absorption disorder has been ordered iron dextran (INFeD). What is the most appropriate nursing diagnosis for the patient related to the administration of this drug?
A) Acute pain related to drug administration
B) Deficient knowledge regarding drug therapy
C) Risk for injury related to CNS effects
D) Disturbed body image related to drug staining of teeth
A) Acute pain related to drug administration
Rationale:
Iron dextran is a parenteral form of iron. It is given intramuscularly and must be given by the Z-track method. It can be very painful. Used to treat iron-deficiency anemia. Pg. 867
The drugs are usually given together to ensure proper absorption and the blood cells can be formed properly...
Folic acid and Vitamin b12.
Pg. 872
Used to treat megaloblastic anemia, in which the RBCs are large and immature and have a short lifespan.
After assessing the patient receiving erythropoietin drug therapy, the nurse suspects what finding is an adverse effect of erythropoietin drug therapy?
A) Constipation
B) Hypotension
C) Edema
D) Depression
C) Edema
Rationale: Nausea, vomiting, and diarrhea are also common effects. Cardiovascular (CV) symptoms can include hypertension, edema, and possible chest pain, all of which may be related to the increase in RBC numbers changing the balance within the CV system. pg. 864
The nurse instructs a patient taking oral iron preparations about which potential adverse effect?
A. Clay-colored stools
B. Hypotension
C. Constipation
Frequent flatus
C. Constipation
The most common adverse effects associated with oral iron supplements are related to direct GI irritation (e.g., GI upset, anorexia, nausea, vomiting, diarrhea, dark stools, and constipation). Pg. 867
A 22-year-old woman who has severe dysmenorrhea has been prescribed ferrous gluconate (Fergon) to treat iron deficiency anemia. What is it important for the nurse to instruct the patient to avoid when taking the drug?
A) Eggs
B) Chocolate
C) PorkD) Whole wheat
A) Eggs
Iron is not absorbed if taken with antacids, eggs, milk, coffee, or tea. These substances should not be administered concurrently. Pg. 868
Hydroxocobalamin must be given IM
A. Every day
B. Once a week
C. Every day for 5 to 10 days to build up levels and then once a month for life
D. Whenever fatigue and tiredness is brought on
C. Every day for 5 to 10 days to build up levels and then once a month for life
Pg. 872
Used to treat pernicious anemia
Serious CV effects and increased risk for deep vein thrombosis (DVT) have been seen when the hemoglobin becomes higher than...
A. 11 g/dL
B. 18 g/dL
C. 5 g/dL
D. 1 g/dL
A. 11 g/dL
Pg. 864
When providing patient teaching for a 30-year-old primigravida diagnosed with sickle cell anemia, but not currently in crisis, the priority teaching point is what?
A) Avoidance of infection
B) Constipation prevention
C) Control of pain
D) Iron-rich foods
A) Avoidance of infection
Severe, acute episodes of sickling with blood vessel occlusion may be associated with acute infections and the body’s reactions to the immune and inflammatory responses. Avoidance of infection is, then, a priority teaching point. pg. 860
What ordered dosage for epoetin alfa (Procrit) is appropriate for the nurse to give?
A) 0.45 mcg/kg IV once per week
B) 1 mg/d IM
C) 100 mg/d PO
D) 150 units/kg subcutaneously three times per week
D) 150 units/kg subcutaneously three times per week
Rationale: An appropriate dosage of epoetin alfa is 50 to 150 units/kg IV or subcutaneously, 3 days a week.
Table 49.1