Author Question: A patient with lung cancer receives filgrastim (Neupogen) after chemotherapy to reduce neutropenia. ... (Read 64 times)

jake · **on:** Jul 23, 2018

A patient with lung cancer receives filgrastim (Neupogen) after chemotherapy to reduce neutropenia. The patient reports a moderate degree of bone pain. What will the nurse do?

a. Obtain an order to administer acetaminophen.
b. Request an order for a complete blood count (CBC).
c. Request an order to reduce the dose of filgrastim.
d. Suspect metastasis of the cancer to the bone.

Question 2

A patient with CRF who will begin receiving an erythropoiesis stimulating agent (ESA) is admitted to the hospital.

The nurse notes that the patient's heart rate is 82 beats per minute, and the blood pressure is 140/100 mm Hg. A complete blood count reveals a hemoglobin of 8 gm/dL and a hematocrit of 29. What will the nurse do?
a. Administer the ESA and request an order for a blood transfusion.
b. Withhold the ESA and request an order for an antihypertensive medication.
c. Request an order to increase the dose of ESA to raise the hemoglobin more quickly.
d. Suggest initiating dialysis while giving the ESA.

jaygar71 · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: A
Bone pain occurs in about 25 of patients receiving filgrastim. It can be treated with a nonopioid analgesic and, if necessary, an opioid analgesic. Leukocytosis can occur, but bone pain is not a symptom of this, so a CBC is not indicated. Bone pain is not an indication for reducing the dose of filgrastim. Because moderate bone pain is a common adverse effect, metastasis to the bone is less likely.

Answer to Question 2

ANS: B
In patients with CRF, treatment with epoetin alfa is often associated with an increase in blood pressure, so patients with hypertension should be treated before beginning treatment with epoetin alfa. There is no indication for a blood transfusion, an increased dose of ESA, or dialysis.