The client receives epoetin alfa (Epogen) subcutaneously, and says to the nurse, "My doctor said I have anemia. Are there little red blood cells in that shot?" What are the best responses by the nurse?
1. "Your kidney makes more erythropoietin if it doesn't get enough oxygen."
2. "Erythropoietin also helps your body make hemoglobin."
3. "This stimulates your kidney to make more red blood cells."
4. "It is similar to a kidney hormone, erythropoietin, and helps your body make more red blood cells."
5. "Your kidney makes more erythropoietin when you have too much fluid in your body."
Correct Answer: 1,2,4
Rationale 1: Erythropoiesis is regulated by the kidney hormone, erythropoietin. The primary signal for increased secretion is a reduction in oxygen reaching the kidney.
Rationale 2: This hormone reacts with receptors on hematopoietic stem cells to increase erythrocyte production. It also stimulates production of hemoglobin.
Rationale 3: Red blood cells are manufactured in the bone marrow, not in the kidney.
Rationale 4: Epoetin alfa is identical to the natural hormone erythropoietin and stimulates the production of red blood cells in the same manner.
Rationale 5: Reduced oxygen, not over-hydration is the stimulus for the kidney to produce additional erythropoietin.
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