Author Question: A patient taking warfarin (Coumadin) has just begun chemotherapy. The patient comes to the clinic ... (Read 34 times)

chads108 · **on:** Jul 23, 2018

A patient taking warfarin (Coumadin) has just begun chemotherapy. The patient comes to the clinic for a follow-up appointment and complains of blood in her urine. The nurse's most immediate action should be to

a. advise the patient that this is normal with this type of drugs.
b. check the platelet count for thrombocytopenia.
c. advise the patient that she will need to skip the next round of chemotherapy.
d. administer epoetin (Epogen) subcutaneously.

Question 2

A nurse is evaluating a patient who is receiving chemotherapy. The nurse checks the patient's neutrophil count and notes that it is 900 cells/mm3. What intervention by the nurse would be most appropriate?

a. Skip the next dose of chemotherapy and notify the prescriber.
b. Discontinue chemotherapy, because it is at a dangerous level.
c. Hospitalize the patient, because there is a risk of possible infection.
d. Continue to monitor the neutrophil count carefully, in case it continues to drop.

jesse.fleming · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: B
The nurse's immediate action should be to monitor the patient for thrombocytopenia by checking a platelet count.
Advising the patient that this is a normal response does not address the patient's concerns and the nurse should monitor a platelet count.
The patient may need to reduce warfarin dosages rather than skip the next round of chemotherapy.
Administration of Epogen is indicated for anemia.

Answer to Question 2

ANS: D
Neutrophil counts must be monitored. Normal counts range from 2500 to 7000 cells/mm3. If neutropenia is substantial (ie, an absolute neutrophil count below 500/mm3), chemotherapy should be withheld until the neutrophil count returns toward normal.
The next dose should not be skipped unless the neutrophil count is below 500/mm3.
The chemotherapy should not be discontinued, because the low neutrophil level is not considered substantial yet.
There is a risk for infection, but hospitalization is not indicated. The patient is safer in the home environment.