Author Question: A patient with cancer is taking rasburicase (Elitek) to treat hyperuricemia and develops neutropenia ... (Read 78 times)

scienceeasy · **on:** Jul 23, 2018

A patient with cancer is taking rasburicase (Elitek) to treat hyperuricemia and develops neutropenia with fever and respiratory distress on the fourth day of treatment. The nurse caring for this patient will expect to:

a. administer allopurinol instead of rasburicase.
b. continue giving the drug and monitor the patient's symptoms closely.
c. tell the patient that this drug should never be used again.
d. tell the patient that these symptoms indicate severe sepsis.

Question 2

A previously healthy patient develops sepsis. The patient's lab tests reveal deterioration of renal and hepatic function, and the provider orders drotrecogin alfa (Xigris) to be given intravenously at a rate of 1,440 mcg per hour for 96 hours.

The patient, who weighs 60 kg, has a history of myocardial infarction and takes 81 mg of aspirin daily. What will the nurse do?
a. Administer the medication and monitor vital signs, level of consciousness, and abdominal discomfort.
b. Contact the provider and request discontinuation of the order since drotrecogin alfa is contraindicated with aspirin.
c. Notify the provider that the patient takes aspirin and ask that the medication dose be decreased to 720 mcg per hour.
d. Prepare to administer infusions of platelets while giving the drotrecogin alfa.

qytan · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: B
Rasburicase is used for management of hyperuricemia in patients undergoing treatment with chemotherapy for leukemias, lymphomas, and solid tumors. Fever and respiratory distress may occur; patients should be monitored closely. These symptoms do not warrant stopping the drug, and they do not indicate severe sepsis.

Answer to Question 2

ANS: A
Patients should take drotrecogin alfa with caution if they have used more than 650 mL of aspirin within 7 days. This patient has used less than that, so the medication should be given as ordered while monitoring for signs of bleeding, which may occur as a side effect of the drug. Drotrecogin alfa is not contraindicated with aspirin but should be used with caution with higher doses. It is not necessary to decrease the dose of drotrecogin alfa with this dose of aspirin. Platelets are not indicated.