Lilley Chapter 55: Anemia Drugs Flashcards
When administering ferrous sulphate (iron) to a patient, the nurse plans to give this medication with which fluid to increase absorption of the iron?
A.120 mL of milk
B. Black tea
C. Orange juice
D. 240 mL of water
C. Orange juice
The absorption of iron can be enhanced when it is given with ascorbic acid (vitamin C), which is present in orange juice.
The nurse will plan to inject iron dextran by which technique?
A. Subcutaneous injection with a 12-mm 27-gauge needle
B. IM injection with a 12-mm 12-gauge needle
C. Intramuscular (IM) injection using the Z-track method
D. Intradermal injection with a sunburst technique of administration
C. Intramuscular (IM) injection using the Z-track method
Iron dextran should be administered deep in a large muscle mass, using the Z-track method to prevent skin irritation and potential necrosis.
The nurse is educating a patient on dietary sources of folic acid. The nurse should teach the patient that which food source has the highest amount of folic acid?
A. Dried beans
B. Apples
C. Swiss cheese
D. Steak
A. Dried beans
Dried beans, green vegetables, and oranges are some of the common folate-containing foods.
Iron supplementation has which common adverse effect?
A. Flatus
B. Constipation
C. Heartburn
D. Fatigue
B. Constipation
Constipation and a change in the colour of stool to green or darker stool are the most common reports about iron supplementation and are expected adverse effects.
The formation of erythrocytes and the maturation of red blood cells (RBCs) are driven by what hormone?
A. Progesterone
B. Free thyroxin
C. Erythropoietin
D. Testosterone
C. Erythropoietin
Erythropoiesis is the process of erythrocyte formation; this involves the maturation of a nucleated RBC precursor into a hemoglobin-filled, nucleus-free erythrocyte. This process is driven by the hormone erythropoietin, which is produced by the kidneys. Erythropoietin is also produced commercially and is used to treat anemia in certain specific circumstances.
The nurse is caring for a patient who is prescribed epoetin alfa (Epogen®). What does the nurse expect to be the reason for the use of this medication in this patient?
A. To treat anemia due to renal failure
B. To manage pregnancy-associated anemia
C. To cure or reverse kidney failure
D. To replace blood loss from surgery
A. To treat anemia due to renal failure
Epoetin alfa (Epogen) is the biosynthetic form of erythropoietin and is a hormone produced by the kidneys in response to a decrease in erythrocytes. The patient in renal failure has impaired kidney function and therefore may have this medication prescribed to treat anemia that is associated with end-stage renal disease that results from the lack of the natural production of this hormone.
A patient states to the nurse, “I must take my iron supplement with a meal to avoid stomach upset.” To increase the uptake of oral iron, which food group should the patient avoid?
A. Fruits
B. Protein containing foods
C. Dairy products
D. Vegetables
C. Dairy products
Many individuals find that they need to take oral iron products with meals or food because of the commonly encountered adverse effect of gastrointestinal upset, even though altered absorption occurs. If antacids or milk products are used, schedule them at least 1 to 2 hours before or after the oral dosage of iron, or avoid taking them with dairy products.
The nurse would question the prescription for epoetin alfa (Epogen) in a patient who has which of the following conditions?
A. End-stage renal disease
B. Uncontrolled hypertension
C. Acquired immunodeficiency syndrome (AIDS)
D. Chemotherapy-induced anemia
B. Uncontrolled hypertension
Hypertension is a frequent adverse effect of epoetin; hence, the drug should not be given to patients with uncontrolled hypertension. End-stage renal disease, chemotherapy-induced anemia, and anemia associated with zidovudine treatment for AIDS are indications for the therapeutic use of epoetin.
When developing a nursing care plan for a patient receiving epoetin alfa (Epogen), the nurse will include monitoring for which adverse effect?
A. Change in level of consciousness
B. Chronic diarrhea
C. Severe hypotension
D. Impaired liver function
A. Change in level of consciousness
Epoetin alfa creates an increased risk of thrombolic events. A change in the patient’s level of consciousness might be a sign of a stroke or myocardial infarction. Patients taking this medication need assessment and monitoring for this possibility.
What are known contraindications for the use of erythropoiesis-stimulating agents (ESAs) in patients? (Select all that apply.)
Select all that apply.
A. Hemoglobin level of 150 mmol/L
B. End-stage renal disease
C. Cancer of the neck
D. Uncontrolled hypertension
E. History of thrombosis
A, C, D, E.
Contraindications for ESAs include known drug allergy. The use of epoetin and darbepoetin is contraindicated in cases of uncontrolled hypertension and when hemoglobin levels are above 100 mmol/L for patients with cancer and 130 mmol/L for patients with renal disease. Use in patients with head or neck cancers or patients who are at risk for thrombosis is controversial because these medications increase tumour growth and the risk for thrombosis.
Which groups of individuals are at highest risk for the development of iron deficiency anemia? (Select all that apply.)
Select all that apply.
A. Women aged 12 to 40 years
B. Men older than 50 years of age
C. Pregnant women
D. Men aged 20 to 40 years
E. Children
A, C, E.
Individuals who require the highest amount of iron are women (especially pregnant women) and children, and they are the groups most likely to develop iron deficiency anemia. For women, this is partly because of ongoing menstrual blood losses. Most vitamin supplements for men contain little or no iron because men are much less likely to develop iron deficiency anemia.
