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A cancer patient is receiving drug therapy with epoetin alfa. The nurse knows that the medication must be stopped if which laboratory result is noted?
- A. White blood cell count of 550 cells/mm?³
- B. Hemoglobin level of 12 g/dL
- C. Potassium level of 4.2 mEq/L
- D. Glucose level of 78 mg/dL
Correct Answer: B
Rationale: If epoetin is continued when hemoglobin levels are above 11 g/dL, patients may experience serious adverse events, including heart attack, stroke, and death. Caution must be used when hemoglobin levels are above 10 g/dL for cancer patients and 11 g/dL for renal patients.
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A patient is to receive iron dextran injections. Which technique is appropriate when the nurse is administering this medication?
- A. Intravenous administration mixed with 5% dextrose
- B. Intramuscular injection in the upper arm
- C. Intramuscular injection using the Z-track method
- D. Subcutaneous injection into the abdomen
Correct Answer: C
Rationale: Intramuscular iron is given using the Z-track method deep into a large muscle mass. If given intravenously, it is given with normal saline, not 5% dextrose.
The nurse is administering liquid oral iron supplements. Which intervention is appropriate when administering this medication?
- A. Have the patient take the liquid iron with milk.
- B. Instruct the patient to take the medication through a plastic straw.
- C. Have the patient sip the medication slowly.
- D. Have the patient drink the medication, undiluted, from the unit-dose cup.
Correct Answer: B
Rationale: Liquid oral forms of iron need to be taken through a plastic straw to avoid discoloration of tooth enamel. Milk may decrease absorption.
A patient has been taking iron supplements for anemia for 2 months. During a follow-up assessment, the nurse will observe for which therapeutic response?
- A. Decreased weight
- B. Increased activity tolerance
- C. Decreased palpitations
- D. Increased appetite
Correct Answer: B
Rationale: Absence of fatigue, increased activity tolerance and well-being, and improved nutrition status are therapeutic responses to iron supplementation.
A patient will be receiving epoetin alfa (Epogen) 8000 units IV three times a week. The medication is available in a vial that contains 10,000 units/mL. How many milliliters will the nurse draw up for this dose?
Correct Answer: 0.8 mL
Rationale: Calculate volume: 10,000 units:1 mL::8000 units:x mL. (10,000 ?? x) = (1 ?? 8000); 10,000x = 8000; x = 0.8 mL.
A patient will be taking oral iron supplements at home. The nurse will include which statements in the teaching plan for this patient? (Select all that apply.)
- A. Take the iron tablets with meals to reduce GI upset.
- B. Take the iron tablets on an empty stomach 1 hour before meals.
- C. Take the iron tablets with an antacid to prevent heartburn.
- D. Drink 8 ounces of milk with each iron dose.
- E. Taking iron supplements with orange juice enhances iron absorption.
- F. Stools may become loose and light in color.
- G. Stools may become black and tarry.
Correct Answer: A,E,G
Rationale: Iron tablets need to be taken with meals to reduce gastrointestinal distress, but antacids and milk interfere with absorption. Orange juice enhances the absorption of iron. Stools may become black and tarry in patients who are on iron supplements. Tablets need to be taken whole, not crushed, and the patient needs to be encouraged to eat foods high in iron.