Author Question: A patient with chronic renal failure who is on dialysis receives an ESA. The nurse caring for this ... (Read 33 times)

V@ndy87 · **on:** Jul 23, 2018

A patient with chronic renal failure who is on dialysis receives an ESA. The nurse caring for this patient during dialysis notes that the patient's hemoglobin is 11.3 gm/dL, up from the 10.4 gm/dL recorded 2 weeks ago.

The patient's blood pressure is 120/80 mm Hg. The nurse will contact the provider to suggest:
a. adding an antihypertensive drug.
b. discontinuing the ESA.
c. giving heparin.
d. reducing the dose of the ESA.

Question 2

A patient is about to undergo a procedure to harvest hematopoietic stem cells from the bone marrow. Which medication will the nurse anticipate giving before this procedure?

a. Filgrastim (Neupogen)
b. Pegfilgrastim (Neulasta)
c. Oprelvekin (Neumega)
d. Sargramostim (Leukine)

amandalm · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: C
Patients with CRF on dialysis can benefit from heparin to prevent clotting in the artificial kidney. There is no indication for an antihypertensive drug, because the patient's blood pressure is normal. The patient's hemoglobin is less than 12 gm/dL and has risen less than 1 gm/dL in 2 weeks; therefore, neither reducing the ESA dose nor stopping the ESA is indicated.

Answer to Question 2

ANS: A
Filgrastim is given before harvesting of hematopoietic stem cells (HSCs), because it increases the number of circulating HSCs. Pegfilgrastim is used only to reduce the incidence of infection in patients undergoing chemotherapy of nonmyeloid malignancies. Oprelvekin is used to minimize thrombocytopenia and to reduce the need for platelet transfusion. Sargramostim is used to accelerate myeloid recovery in patients who have undergone autologous bone marrow transplantation.