Your cancer patient has bone marrow suppression from their chemotherapy treatments, and is scheduled to receive Epoetin Alfa shots 3 times per week. Which of the following lab values would cause you to hold the administration of the medication for safety concerns?
Hgb of less than 11
aPTT of 120 seconds
Hgb of more than 11
PT/INR of 3.5
The Correct Answer is C
A. Epoetin Alfa is typically used to treat anemia, and it is often indicated when hemoglobin (Hgb) levels are below 11 g/dL. Therefore, if the Hgb is less than 11, it would be appropriate to administer the medication to help increase red blood cell production.
B. Do not hold. An activated partial thromboplastin time (aPTT) of 120 seconds indicates a prolonged coagulation time, which increases the risk of bleeding. However, Epoetin Alfa does not have a direct impact on coagulation, so this value alone would not warrant holding the medication.
C. Epoetin Alfa is generally not indicated if the Hgb level is already above 11 g/dL, particularly if there’s a risk of increasing the Hgb above the recommended therapeutic range (often above 12 g/dL). If the Hgb exceeds this level, the medication should be held to prevent complications such as thromboembolic events.
D. A PT/INR of 3.5 indicates a significantly prolonged prothrombin time, suggesting a high risk of bleeding. However, Epoetin Alfa does not directly cause bleeding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Timolol is a beta-blocker used primarily to treat glaucoma by reducing intraocular pressure. It would not address the issues presented by this patient, who is likely dealing with alcohol-related complications.
B. Acetaminophen is used to relieve pain and reduce fever. While the patient reports a severe headache, administering acetaminophen may not be advisable due to potential liver damage from alcohol use, especially if the patient has not eaten properly. Chronic alcohol use can also increase the risk of hepatotoxicity with acetaminophen.
C. Aspirin is another pain reliever that could potentially be used for headaches. However, like acetaminophen, it carries risks for patients with alcohol use, particularly gastrointestinal bleeding. Additionally, aspirin should be used cautiously in cases of possible liver impairment.
D. A "banana bag" is a term for an intravenous solution often used in patients with alcohol use disorder to provide hydration and essential vitamins, especially thiamine, which can prevent Wernicke's encephalopathy. It typically contains normal saline or dextrose, electrolytes, and vitamins (including B1, B6, and B12).
Correct Answer is B
Explanation
A. Osteoarthritis (OA) typically presents with joint pain and stiffness, but it is usually unilateral and does not cause the same types of deformities seen in RA. OA also tends to develop over time without the systemic symptoms associated with RA.
B. The combination of bilateral pain and morning stiffness in the hands, along with the presence of large nodules (likely rheumatoid nodules), swan-neck deformities, and ulnar deviation, is characteristic of rheumatoid arthritis (RA). RA is an autoimmune disorder that affects joints symmetrically and commonly leads to these specific deformities.
C. Lupus arthritis can cause joint pain and swelling, but it is often accompanied by other systemic symptoms like skin rashes (butterfly rash), fatigue, and organ involvement. The specific deformities noted (swan-neck and ulnar deviation) are more closely aligned with RA than lupus.
D. Gout is characterized by sudden, severe attacks of pain, often in the big toe or foot, and is caused by the deposition of urate crystals in the joints. It does not typically present with the deformities or patterns seen in the described patient.
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