Cancer Treatments

1. 1. A platelet count of less than 100,000 is the definition of thrombocytopenia. The nurse should teach measures to prevent bleeding, such as using an electric razor. 2. This is good information to teach, but it is not based on the laboratory values. The client's WBC and absolute neutrophil counts are within normal range. 3. A platelet count of less than 100,000 is the definition of thrombocytopenia. If the client sustains a cut, the blood will not clot. 4. This is good information to teach, but it is not based on the laboratory values. Fatigue related to cancer and its treatment is real and should be addressed, and an Hgb and Hct of around 8 and 24 could cause fatigue, but the client's levels do not indicate this. 5. A platelet count of less than 100,000 is the definition of thrombocytopenia. The nurse should teach measures to prevent bleeding, such as using a soft-bristled toothbrush.

1. The client has received chemotherapy 2 days a week every 3 weeks for the past 8 months. The client's current lab values are Hgb and Hct 10.3 and 31, WBC 5.2, neutrophils 50, and platelets 89. Which information should the nurse teach the client? Select all that apply. 1. Use an electric razor when shaving. 2. Avoid individuals with colds or other infections. 3. Be careful when using sharp objects such as scissors. 4. Plan for periods of rest to prevent fatigue. 5. Use a soft-bristled toothbrush when brushing teeth.

10. 1. The client should receive whatever the client wishes to eat within the prescribed diet. The nurse should not autocratically decide the client should consume full liquids. 2. The client may wish to attempt to eat; the nurse should not autocratically decide the client should not eat. 3. The client may be able to tolerate meals if the client receives an antiemetic medication 30 minutes before each meal. The nurse can administer a PRN medication prior to each meal or request a routine medication order from the HCP. 4. The client will not become dehydrated while receiving intravenous fluids with the antineoplastic medications. Ice chips will not prevent nausea.

10. The client receiving intravenous chemotherapy was nauseated and vomited twice the day before. Which intervention should the nurse implement? 1. Ask the dietary department to provide full liquids. 2. Hold all meal trays until the client is not nauseated. 3. Premedicate the client before each meal. 4. Have the client suck on ice chips frequently.

11. 1. Neumega is a biologic response modifier that acts on the bone marrow to increase the production of platelets. It can also cause cardiovascular stimulation, tachycardia, vasodilation, palpitations, dysrhythmias, and edema. The client should report any of these symptoms and shortness of breath or blurred vision immediately. 2. Neumega is administered by subcutaneous injection. 3. Neumega does not affect blood glucose levels. 4. The client should notify the oncologist or HCP who ordered the Neumega immediately so the medication can be discontinued; the ophthalmologist need not be notified. The medication is causing the blurred vision.

11. Which instruction should the nurse teach the client receiving oprelvekin (Neumega), a hematopoietic growth factor? 1. Report any edema of arms, legs, or both. 2. Take the pill with food to prevent gastric distress. 3. Monitor the blood glucose levels daily. 4. See the ophthalmologist if vision becomes blurred.

12. 1. The medication is administered subcutaneously. 2. The medication stimulates the bone marrow to produce red blood cells. The bone marrow is located inside the bones. The client may experience aches and pains of the bony areas as a result. Tylenol usually will remedy this side effect. 3. Epogen stimulates the production of red blood cells, and the CBC should be monitored at regular intervals. 4. This should be done for any client with anemia to prevent fatigue. The medication is ordered to treat anemia. 5. Because the potential for seizures exists during periods of rapid hematocrit increase, the client should be warned not to drive or operate any heavy equipment for a period of 90 days until the hematocrit has stabilized.

12. The client diagnosed with chronic kidney disease is prescribed erythropoietin (Procrit). Which intervention should the nurse implement? Select all that apply. 1. Administer it intramuscularly in the deltoid. 2. Have the client take Tylenol, an analgesic, for pain. 3. Monitor the client's complete blood count. 4. Teach the client to pace activities. 5. Inform the client not to drive for 90 days.

13. 1. Intron A is useful for several disease processes because of its different mechanisms of action. Suppression of cell proliferation is the action that is desired in clients diagnosed with leukemia. 2. Intron A does not affect macrophages. 3. Intron A does not increase tumor suppressor genes. 4. Intron A reprograms virus-infected cells to inhibit viral replication. This is the reason that it is useful in treating hepatitis.

13. Which statement is the scientific rationale for administering the biologic response modifier interferon (Intron A) to a client diagnosed with hepatitis C? 1. Intron A suppresses cell proliferation in proliferative diseases. 2. Intron A decreases the production of cytotoxic macrophages. 3. Intron A increases the production of suppressor genes. 4. Intron A reprograms virus-infected cells to inhibit virus replication.

14. 1. Aranesp stimulates the production of red blood cells. The question does not give the client's RBC count. (The advantage of Aranesp over Procrit or Epogen, which also stimulate the production of RBCs, is that it is administered once a week, instead of daily.) 2. Neumega stimulates the production of platelets. The question does not refer to the client's platelet count. 3. Neupogen stimulates the production of white blood cells, and this client has a low white blood cell count and thus is at risk for an infection. The client's absolute neutrophil count is only 1738 (2.2 × 1000 = 2200, then multiply this number by 0.79 to get 1738). Clients with an absolute neutrophil count below 2500 are at risk for infection. 4. Epogen stimulates the production of red blood cells.

14. The client diagnosed with cancer has received several treatments of combination chemotherapy and has a WBC of 2.2 and neutrophil count of 79. Which hematopoietic growth factor should the nurse administer? 1. Darbepoetin, Aranesp. 2. Oprelvekin, Neumega. 3. Filgrastim, Neupogen. 4. Erythropoietin, Epogen.

15. 1. Cyanocobalamin is the treatment for pernicious anemia. The nurse would not question administering this medication. 2. Erythropoietin stimulates the bone marrow to produce more cells. Stimulation of the bone marrow is questioned when the cancer is in the bone marrow. 3. Stimulation of the bone marrow is not questioned in clients with solid tissue tumors. The nurse would not question administering this medication. 4. Heparin is part of the standard treatment regimen for disseminated intravascular coagulation (DIC).

15. The nurse on an oncology floor is administering morning medications. Which medication should the nurse question? 1. Cyanocobalamin (vitamin B12) to a client with pernicious anemia. 2. Erythropoietin (Epogen) to a client with chronic lymphocytic leukemia. 3. Filgrastim (Neupogen) to a client with a solid tissue tumor. 4. Heparin intravenously to a client with disseminated intravascular coagulation (DIC).

16. 1. The medication is administered subcutaneously with a 1-mL, 5/8-inch needle and the deltoid muscle is an appropriate area to administer the medication. 2. The medication comes in a vial 10-mg per mL already prepared. If mixed for an IV infusion, D5W is used. 3. The client receiving a red blood cell stimulant (Epogen, Procrit, Aranesp) should have the blood pressure monitored because rapid increases in the hematocrit will also increase the blood pressure, but this does not happen with Neulasta, which stimulates white blood cell production. 4. Neulasta stimulates the production of white blood cells. Cytotoxic chemotherapy acts on the bone marrow to decrease the production of white blood cells, an opposite response. The nurse should hold the medication and resume it 24 hours after the administration of the chemotherapy. 5. The nurse should monitor the WBC and absolute neutrophil count to determine if the Neulasta is effective.

16. The nurse is preparing to administer pegfilgrastim (Neulasta). Which interventions should the nurse implement when administering medication? Select all that apply. 1. Use a 1-mL, 5/8-inch syringe needle and administer in the deltoid muscle. 2. Mix the powder with sterile normal saline and administer within 1 hour. 3. Assess the client's blood pressure and pulse prior to administration. 4. Hold the medication 24 hours before or after chemotherapy. 5. Monitor the client's WBC count and the absolute neutrophil count.

17. 1. The aching in the back and legs is probably caused by hyperstimulation of the bone marrow to produce red blood cells, not by the flu. 2. The HCP does not need to see the client immediately. Tylenol will usually treat the problem. The HCP only needs to see the client if over-the-counter analgesic medications do not relieve the pain. 3. Hyperstimulation of the bone marrow is the probable cause of the aches and should be treated with over-the-counter pain medications. 4. The client's blood pressure should be monitored during the administration of medications that increase the hematocrit, but not taking blood pressure medication would not cause aches in the bones. MEDICATION MEMORY JOGGER: The nurse must be aware of the safety precautions when administering medications.

17. The client who received the hematopoietic growth factor darbepoetin (Aranesp) calls the clinic nurse and reports aching in the back and legs. Which statement is the nurse's best response? 1. "This is unrelated to the medication. You may be getting the flu." 2. "You should come to the clinic immediately to see the HCP." 3. "This is an expected side effect of the medication and can be treated." 4. "Have you taken your blood pressure medication today?"

18. 1. Epogen is frequently administered to clients in end-stage kidney disease to stimulate their bodies to produce red blood cells. The kidneys naturally produce erythropoietin to stimulate red blood cell production, but clients with renal disease may not be able to produce the cytokine erythropoietin. 2. A rapid increase in hematocrit, which may occur with Epogen, can result in uncontrolled hypertension. The client must have the hypertension well controlled for Epogen to be administered safely. The nurse would question this medication for this client. 3. The client diagnosed with lung cancer and metastasis would be a candidate for Epogen. The nurse would not question this medication. 4. Epogen is given to clients with anemia. Leukopenia will not be increased or decreased by the medication.

18. Which client should the nurse question receiving the hematopoietic growth factor erythropoietin (Epogen)? 1. The client diagnosed with end-stage renal disease. 2. The client diagnosed with essential hypertension. 3. The client diagnosed with lung cancer and metastasis. 4. The client diagnosed with anemia and leukopenia.

19. 1. Members of the Jehovah's Witness church refuse to allow blood and blood products. Procrit is not a blood product. There is no reason to question the medication on religious grounds. 2. The client in the hospital signs a permit to treat when admitted. There is no need for another consent form. 3. The laboratory does not need to confirm the data. 4. The nurse should administer the medication. Procrit is administered subcutaneously.

19. The client on the medical unit is a Jehovah's Witness and has anemia, and the HCP orders erythropoietin (Procrit). Which intervention should the nurse implement? 1. Question the order on religious grounds. 2. Have the client sign an informed consent. 3. Ask the laboratory to confirm the RBC. 4. Administer the medication subcutaneously

2. 1. A 3 is considered mild pain and could wait until the more emergent client is medicated. 2. Anticipatory nausea and vomiting are very difficult to control. It is important for the nurse to medicate the client to prevent the nausea from occurring. This client should be medicated first. 3. At 0900 the breakfast tray meal should have already been consumed. Administering a mucosal barrier agent after a meal places medication in the stomach that will coat the food, not the stomach lining. This medication should be retimed for 0730 and not administered until later in the morning after the breakfast meal has had a chance to leave the stomach. 4. This medication stimulates the bone marrow to produce red blood cells; the full effect of the medication will not be seen for 30-90 days. It could be administered after the antiemetic and the analgesic.

2. The nurse is preparing to administer 0900 medications on an oncology floor. Which medication should the nurse administer first? 1. An analgesic to a female client with a headache of 3 on the pain scale. 2. An antiemetic to a female client who thinks she might become nauseated. 3. A mucosal barrier agent to a male client who has peptic ulcer disease. 4. A biologic response modifier to a male client with low red blood cell counts.

20. 1. Deformities of the hands indicate rheumatoid arthritis. Anakinra (Interleukin 1) is used to treat rheumatoid arthritis in clients who have failed other treatments. 2. This medication suppresses the immune system and should not be administered to anyone with an infection. A temperature greater than 100°F indicates an infection. 3. The normal dosing schedule is every 2 days at the same time. 4. Tylenol does not interfere with Anakinra, and a headache would not indicate an infection.

20. The client is scheduled to receive anakinra (Kineret), an immunomodulator. Which data should make the nurse question administering the medication? 1. The client has joint deformities of the hands. 2. The client has a temperature of 100.4°F. 3. The client received a dose 2 days ago at the same time. 4. The client took Tylenol for a headache 2 hours ago.

21. 1. Tamoxifen and raloxifene have been researched in the Study of Tamoxifen and Raloxifene (STAR) trial and have proven efficacy in reducing the risk of breast cancer in women who have primary relatives with breast cancer. Lifestyle modifications such as consuming a low-fat diet and avoiding obesity are also recommended to reduce the risk of breast cancer. 2. There are lifestyle modifications and hormone-suppressing medications that can reduce the risk of developing breast cancer. 3. The client is asking for information and the nurse should provide the factual information. 4. This statement does not address the client's question.

21. The 45-year-old female client with a family history of breast cancer asks the nurse, "Is there anything I can do to improve my chances of not getting breast cancer like my sister and mother?" Which statement is the nurse's best response? 1. "There are medications and lifestyle changes to reduce the risk." 2. "No. Clients that have a strong family history just have to hope they don't get it." 3. "You sound worried. Would you like to talk about how you feel?" 4. "Do any other relatives have breast or other female cancers?"

22. 1. Hormone suppression therapy in a male client would decrease the client's libido and decrease the ability to sustain an erection. 2. Hormone suppression therapy does not destroy cancer cells; it works by changing the hormonal environment of the host and depriving the cancer of the hormones that stimulate its growth. 3. This is a true statement, but it is not the rationale for how the medications work in the body. 4. Gender-specific cancers may replicate better in the presence of the hormones specific to that sex. Suppressing the androgens produced in the testes results in a reduction in the growth rate of the tumor.

22. The male client diagnosed with prostate cancer is prescribed hormone suppression therapy. Which statement is the scientific rationale for administering this medication? 1. Statement suppression therapy will increase the client's libido and the ability to maintain an erection. 2. Hormone suppression therapy shrinks the prostate tissue by destroying tumor cells during replication. 3. Hormone suppression therapy will cause the client to experience menopausal-like symptoms. 4. Hormone suppression therapy changes the internal host environment to decrease cell growth.

23. 1. The medication is an implant that slowly dissolves over a month's time. The drug is formulated in a pellet that is dispensed through a 16-gauge needle. 2. Lupron LA is an implant that slowly dissolves over a month's time. The drug is formulated in a pellet that is dispensed through a 16-gauge needle under the skin of the abdomen. 3. This is not a suppository. 4. The medication does not cause peptic ulcer disease and is not administered orally.

23. The male client diagnosed with prostate cancer is receiving leuprolide (Lupron LA), a GnRH agonist, implant. Which procedure is the correct method of administration? 1. Use a tuberculin syringe and administer subcutaneously. 2. Insert the 16-gauge needle at a 30-degree angle into the abdomen. 3. Place the medication into the rectal vault using a nonsterile glove. 4. Administer with an antacid to prevent peptic ulcer disease.

24. 1. Aromatase inhibitors block the production of estrogen and androgen precursors, but they do not have any positive effect on body image. The client may experience a negative effect on body image if she develops facial hair (hirsutism). 2. Aromatase inhibitors are not antidepressants and would not affect the client's ability to express her feelings. 3. Aromatase inhibitors are used to treat postmenopausal breast cancer. Two prime metastasis sites for breast cancer are the lungs and bones. Negative findings in these areas indicate the medication is effective. 4. DNA ploidy tests are conducted on the tumor cells at the beginning of treatment to determine the prognosis of the disease. The test is not used to monitor the progress of therapy.

24. The postmenopausal client with breast cancer is placed on the aromatase inhibitor anastrozole (Arimidex). Which data indicates the medication is effective? 1. The client reports a positive body image. 2. The client is able to discuss her feelings openly. 3. The client's bone and lung scans are negative. 4. The client's DNA ploidy tests show diploid cells.

7. 1. The maximum dose of Imodium per day is 16 mg; this would exceed the recommended dose per day. 2. Clear liquids will not provide the needed bulk to the stools and will not provide sufficient calories to prevent malnutrition. 3. Phenergan is an antiemetic, not an antidiarrheal, and any medication administered by the rectal route would probably be expelled before absorbing into the client's system. 4. Clients with diarrhea need to add bulk to the diet in the form of fiber supplements or dietary intake to decrease the liquid nature of the stools.

7. The client diagnosed with cancer has developed diarrhea after the third round of chemotherapy. Which intervention should the clinic nurse implement? 1. Have the client take up to 12 Imodium 2-mg tablets per day. 2. Place the client on a clear liquid diet. 3. Medicate the client with Phenergan suppositories. 4. Discuss adding a fiber supplement to the client's diet.

25. 1. Kaposi's lesions are normally light brown to a purple color; this does not indicate effectiveness of the medication. 2. Megace is an antineoplastic hormone used to treat metastatic cancer of the breast and endometrium. Side effects of the medication include an increased appetite. It is prescribed in an unlabeled use for increasing the appetite in clients diagnosed with AIDS under the name of Appetrol. 3. Megace does not treat nausea. 4. Megace would not affect the ability to perform activities of daily living, except indirectly by increasing the client's nutritional intake. MEDICATION MEMORY JOGGER: The nurse must be aware that some medications are used for other than the original purpose. Megace is one of those medications.

25. The male client diagnosed with acquired immunodeficiency syndrome (AIDS) is prescribed megestrol (Megace), an antineoplastic hormone. Which data indicates the medication is effective? 1. The Kaposi's lesions have become light brown. 2. The client ate 90% of the meals served him. 3. The client experiences a decrease in nausea. 4. The client is able to complete activities of daily living.

26. 1. All steroids can cause gastric upset; the client should take the medication with food. 2. Steroids usually increase the appetite, increasing the client's weight gain. 3. Decadron is a steroid, and when discontinuing a steroid, the client should be informed about tapering the medication. Decadron is the steroid of choice for disease processes occurring in the skull. 4. The client may have a headache because of increased intracranial pressure from the tumor growth. Decadron decreases the edema surrounding the tumor and would help to prevent a headache. 5. Decadron is administered orally not subcutaneously.

26. The client diagnosed with a brain tumor is prescribed dexamethasone (Decadron), a glucocorticoid hormone. Which instructions should the nurse teach? Select all that apply. 1. Take the medication with food. 2. The medication may increase the appetite. 3. Do not abruptly stop taking the medication. 4. Decadron may cause a headache and nystagmus. 5. Demonstrate how to perform subcutaneous injection.

27. 1. DES is a pregnancy category X drug, meaning that definite harm can occur to the fetus. Females exposed to DES in utero are at high risk for developing cervical cancer, but DES should not affect the sperm. 2. DES suppresses the male androgens and the client may experience hot flashes and gynecomastia (breast development in men). 3. DES can cause osteoporosis; therefore, the client should increase his intake of calcium. 4. DES will not cause the client's hair to grow faster or change texture.

27. The nurse is discharging the male client diagnosed with cancer of the prostate with a prescription for diethylstilbestrol (DES), an estrogen. Which information should the nurse teach the client? 1. The client should not father any children while taking the medication. 2. The client may experience hot flashes and breast enlargement. 3. The client should decrease calcium intake while taking DES. 4. The client's body hair will grow at a faster rate and will be coarse.

28. 1. This lab data indicates that the client's tumors grow best in the presence of estrogen and progesterone. Supplemental estrogen and progesterone would encourage tumor growth. 2. The adrenal hormones are not indicated by this lab data. 3. GnRH medications are used to suppress male androgens in clients diagnosed with prostate cancer. 4. Estrogen and progesterone receptor assays are interpreted as follows: greater than 20% is favorable to the growth of the tumor; 11%-20% is borderline; and less than 10% is unfavorable. A favorable finding indicates that the client's tumor responds well to the presence of estrogen and progesterone. Suppressing or removing the ability to produce these hormones slows the tumor growth. Antiestrogen/ progesterone hormone medications would accomplish this.

28. The 45-year-old female client has had a left breast biopsy that revealed carcinoma of the breast and the following laboratory report regarding estrogen and progesterone influence on the tumor. Which medications should the nurse discuss with the client? 1. Supplemental estrogen and progesterone hormone. 2. Glucocorticoid and mineral corticoid hormones. 3. Gonadotropin-releasing hormone agonists (GnRH). 4. Antiestrogen/progesterone hormone medications.

29. 1. This is a false statement; the risk increases with prolonged use. 2. This is a false statement; evidence indicates that the risk increases for women who take HRT. 3. The risk of developing breast cancer increases each year the client takes hormone replacement therapy. Current research also implicates hormone replacement therapy in the development of cardiovascular disease. 4. This is a false statement; the risk increases with prolonged use.

29. The 60-year-old female client has taken hormone replacement therapy for control of menopausal symptoms for the last 9 years. Which statement by the nurse indicates the client's risk for developing breast cancer? 1. "The risk of getting cancer decreases each year that the client takes hormones." 2. "The risk is the same as for women who do not take hormone replacement." 3. "The risk increases each year the client is taking hormone replacement therapy." 4. "The risk is only slightly greater while taking hormone replacement."

3. 1. This is not normal and could indicate that the client is developing a neuropathy from the medications. The danger is that the innervation to the small bowel may be compromised as well. It will not go away when the therapy is complete. 2. This is not a minor side effect of the medication; it may indicate that the client must be changed to a different antineoplastic agent. 3. This may indicate a potential life-altering complication of the chemotherapy. The client may have nerve damage caused by the plant alkaloid medications. The nerves of the intestines may also be compromised, causing decreased peristalsis. The nurse should assess the situation and notify the HCP. 4. Plant alkaloid medications do not cause orthostatic hypotension.

3. The male client receiving plant alkaloid antineoplastic medications for cancer complains to the clinic nurse that he has been "so clumsy lately that I can't even pick up a dime." Which statement is the nurse's best response? 1. "This is normal and will resolve when your therapy is complete." 2. "There is no reason to worry about a minor side effect of the drugs." 3. "Have you also noticed a difference in your bowel movements?" 4. "Are you also weak and dizzy when you try to stand up?"

30. 1. Nolvadex will cause menopausal symptoms, but this is not the most important consideration to teach the client. 2. Nolvadex may cause vaginal discharge and nausea, but this is not the most important consideration to teach the client. 3. The fact that Nolvadex slows the growth of estrogen-positive tumors is the scientific rationale for administering this medication, but it is not the most important consideration to teach the client. 4. Tamoxifen increases the client's risk of developing endometrial cancer. Tamoxifen acts as an estrogen agonist at receptors in the uterus, causing proliferation of endometrial tissue that may result in endometrial cancer. For this reason, it is important that the client see the gynecologist regularly. This is the most important information to teach the client.

30. The 39-year-old client diagnosed with breast cancer is prescribed the antiestrogen hormone tamoxifen (Nolvadex). Which information is most important for the nurse to teach the client? 1. The medication will cause menopause symptoms. 2. Nolvadex may cause vaginal discharge and nausea. 3. Tamoxifen will slow the growth of estrogen-positive tumors. 4. It is important to see the gynecologist regularly.

31. 1. Explaining the risks and benefits of the medication to the client is the HCP's responsibility, not the nurse's. 2. The nurse should administer the medication per the protocol but not until the nurse knows what the mechanism of action and potential side effects are. 3. The nurse cannot administer the medication until it is available, but this is not the first action. 4. The nurse must know what the drug is, how it works in the body, and the potential side effects to assess for before administering any medication, especially an investigational medication. MEDICATION MEMORY JOGGER: If the test taker placed the options in order of performance, then the test taker could eliminate options 2 and 3.

31. The client is scheduled to receive an investigational medication for the treatment of cancer. Which intervention is the nurse's first intervention? 1. Explain the risks and benefits of the medication to the client. 2. Administer the medication per the protocol. 3. Contact the pharmacy to deliver the medication to the unit. 4. Find information on administration procedures and side effects.

32. 1. The HCP will enroll clients that fit the protocol requirements. An investigational protocol is one that is being tried to determine the efficacy of the treatment, weighing the risks and benefits to the client. The investigation part is to determine what the risks and benefits are. It is not necessarily the best chance for a cure. 2. Ethically, oncology clients will not be enrolled in a protocol if the standard therapy regimens have a good chance of providing an extension of life or quality of life for the client. If the client has received conventional therapy and has not responded well, then the HCP may suggest an investigational protocol. Usually this means the client has a poor prognosis before an investigational protocol is discussed. 3. Investigational protocol medication- and treatment-related expenses are provided at no cost to the client, but this is not the primary reason to place the client in a study. 4. This may be a reason the client chooses to participate in a study, but it is not the primary reason for enrolling the client in an investigational study.

32. Which statement is the primary reason to enroll a client in an investigational protocol for the treatment of cancer? 1. The HCP feels that the investigational drug has the best chance of a cure. 2. The client has failed conventional treatment and there is a poor prognosis. 3. The HCP can provide care at a reduced rate because of subsidies. 4. The client does not like the standard treatment regimen for his or her disease.

33. 1. An experienced oncology nurse familiar with the investigational protocol should care for this client; a licensed practical nurse should not. 2. Measuring and recording client output is an appropriate delegation. 3. A new graduate nurse can care for a client receiving packed red blood cells. This is an appropriate assignment. 4. Care of a client who is seriously ill and taking an investigational drug can be assigned to a registered nurse.

33. The nurse is caring for clients on an oncology unit. Which task is an inappropriate delegation or assignment by the nurse? 1. Have the licensed practical nurse administer the IV investigational medication. 2. Request the unlicensed assistive personnel measure and record the client output. 3. Assign a new graduate nurse to care for a client receiving packed red blood cells. 4. Delegate care of a client who is seriously ill and taking an investigational drug to a registered nurse.

34. 1. Placebos are not unethical as long as the clients have been informed of the possibility of receiving a placebo and of being randomly placed in a control group. 2. A placebo is an inactive substance resembling a medication that may be given experimentally or for its psychologic effect. 3. Clients in investigational studies are informed that there are control groups that receive an inert medication for comparison to the medication group to determine the statistical effectiveness of the medication in treating the disease being studied. 4. Clients are not allowed to request this; no client wants to "not be treated." In a true investigational protocol, the clients are randomly selected for the medication group and the control group.

34. The nurse is working in a clinic that uses investigational protocols to determine the effectiveness of new medications. Which information regarding the use of placebo medications should the nurse teach the clients? 1. Placebos are not used in investigational protocols because of ethical considerations. 2. The placebo will contain the active ingredient under study in the protocol. 3. Clients in the control group will receive a medication that does not help the disease. 4. Clients should insist on not being placed in the group that gets the placebo pill.

35. 1. The nurse should ask what has been prescribed for the client and how the client responded to the medications. 2. Herbs and over-the-counter medications may affect the client's response to proposed medication; therefore, this is an appropriate question to ask the client. 3. Soaps and clothing dyes should not affect the administration of a systemic medication for arthritis. 4. The client's response to the investigational medication for an immune system disease (rheumatoid arthritis) could be affected by a comorbid immune system disease. The nurse should assess this. 5. Medications, required laboratory tests, and HCP visits are free to the client in an investigational protocol. The ability to pay for the medication is not an issue.

35. The nurse working in an outpatient clinic is screening clients for inclusion in an investigational medication protocol for rheumatoid arthritis. Which screening questions should the nurse include? Select all that apply. 1. Which medications has the client been prescribed for arthritis? 2. Which herbs and over-the-counter medications has the client taken? 3. Is the client allergic to any soaps or clothing dyes? 4. Does the client have any other immune system disease? 5. Does the client have insurance to pay for the medication?

36. 1. This is not for the nurse to determine. The client should be assessed by the HCP to decide if the side effect of nausea can be controlled. 2. The client has a real physiologic problem, not a psychologic one that requires a therapeutic conversation. 3. The client should be assessed by the HCP to determine if the side effect of nausea can be controlled. In any event, the side effects experienced by the client must be documented by the HCP. This is the nurse's best response. 4. This is a misleading and possibly false statement.

36. The male client participating in an investigational protocol calls the clinic and tells the nurse that the medications have made him "sick to my stomach all night." Which statement is the nurse's best response? 1. "You should consider whether or not you want to be in the study." 2. "This must be uncomfortable for you. Let's talk about your feelings." 3. "Come to the clinic to see the HCP. You may be reacting to the drug." 4. "This is a temporary problem and will go away with future doses."

37. 250 mL. Intravenous infusion pumps are set at an hourly rate. The nurse is to infuse 1000 mL in 4 hours. 1000 ÷ 4 = 250 mL/hour.

37. The client receiving an investigational medication protocol must be hydrated with at least 1000 mL of IV fluid in the immediate 4 hours before the infusion of the investigational medication. At which rate would the nurse set the pump?

38. 1. The client may want to leave "now," but this does not make the client the priority to receive their medication. 2. The nurse cannot administer the medication until the client has signed the protocol permit. This is not the first client to receive the medication. 3. Any medication that requires specific timing should be administered at the time required. This medication has priority. 4. A medication that is to be infused over 24 hours could wait to be administered until after the timed medication.

38. The nurse is administering medications on a medical unit. Which medication should the nurse administer first? 1. The investigational medication to a client who wants to go home now. 2. The investigational medication to the client who has not signed a permit. 3. The investigational medication that must be administered at a specific time. 4. The investigational medication that must infuse over 24 hours.

39. 1. Investigational studies use control groups for comparison to the medication group to determine statistical effectiveness of the medication in treating the disease being studied. 2. The control group should not develop the side effects produced by the medication being studied. A control group could not prove that a side effect of the study medication is not being caused by "anything" else. There are too many variables. 3. The researcher determines effectiveness by several means. The researcher may use a control group but will also use laboratory and radiologic data and client report of symptoms. 4. The researcher uses the study group and previous trials to determine the amount of medication required to treat the disease.

39. Which statement is the scientific rationale for a control group of participants in an investigational protocol? 1. A control group is used to compare the responses to the medication group for efficacy of the medication. 2. The control group is used to prove that the side effects of the medication are not caused by anything else. 3. The researcher cannot determine effectiveness of the medication unless there is a control group. 4. The researcher uses the control group to gauge the amount of medication needed to treat the disease.

4. 1. The client should be given information regarding potential complications of therapy and when to notify the HCP. A temperature of 100°F or greater should be immediately brought to the attention of the HCP. The client could be developing an infection and must be treated as soon as possible. 2. The client may or may not need dietary supplements at this time. The client should be referred to a dietitian for a consultation regarding nutritional status, but dietary supplements three times a day would not allow the client to enjoy normal foods. This would be recommended if the client were not tolerating any normal dietary intake. 3. Clients should not isolate themselves from enjoying the extended family. They should be told to avoid clients with known contagious illness. 4. If the client has a tender vein that has been assessed by the HCP and found not to be an extravasation of the medication, the client can apply intermittent warm packs. Ice packs restrict blood flow to the area. MEDICATION MEMORY JOGGER: Usual discharge instructions include teaching the client to notify the HCP in case of a fever. The test taker might choose this option based on standard procedure.

4. The client has received the second dose of chemotherapy and is ready for discharge. Which information should the nurse teach the client? 1. Tell the client to notify the HCP of a temperature of 100°F. 2. Have the client drink dietary supplements three times a day. 3. Encourage the client to stay away from all people outside of the home. 4. Apply a continuous ice pack to the intravenous site.

40. 1. The client is expressing a hope in the treatment; this is not a reason to question administering the medication. 2. This client is having doubts about continuing the treatment. Until the client decides that he or she wishes to continue the treatment, the nurse should hold the medication and have the HCP discuss the client's concerns. The nurse would question administering this medication. The client has the right to withdraw from a protocol at any time. 3. The HCP should never guarantee a positive response for any treatment. The nurse would not question administering the medication. 4. The nurse should explain the side effects of the medication to the client. Unless the client has concerns after the nurse teaches the client about the side effects, the nurse would administer the medication.

40. The nurse on an oncology unit is administering morning medications. Which medication should the nurse question administering? The investigational protocol medication to the client who states: 1. "I am sure I am getting better every day." 2. "I'm not sure I want to continue this treatment." 3. "The doctor told me there were no guarantees." 4. "Can you explain the side effects of the medication?"

41. 1. Forcefully instilling anything into the port will push a clot into the client's body, and heparin is an anticoagulant, not a thrombolytic. It will not dissolve a clot. Anticoagulants prevent clot formation. 2. Flushing anything will infuse a clot into the client's body, possibly resulting in a stroke, pulmonary embolus, or myocardial infarction. 3. Urokinase is a thrombolytic. Instilling a small amount into the lumen of the implanted port and allowing the medication to sit in the catheter may dissolve the clot. The procedure may need to be repeated more than once to dissolve the entire clot. 4. The HCP is the person who determines if a new port should be placed and then schedules the procedure with the surgical staff. MEDICATION MEMORY JOGGER: The nurse should learn medication by specific classifications. Anticoagulants do not dissolve clots; only thrombolytics dissolve clots. The "ase" ending in urokinase should clue the test taker to choose this option because thrombolytics are enzymes and enzymes usually end in "ase."

41. The client has had an implanted port placed to receive chemotherapy. When the nurse attempts to access the device, there is no backflow of blood and the nurse meets resistance when flushing. Which intervention should the nurse take to access the implanted port? 1. Forcefully insert 3 mL of heparin into the port. 2. Flush the implanted port with 5-10 mL of normal saline. 3. Instill a prescribed amount of urokinase into the port. 4. Schedule the client for a newly implanted port placement.

42. 5, 1, 2, 3, 4 5. The nurse should always inform the client of procedures prior to beginning to attempt to complete the procedure. The nurse should wash hands on entering the room. 1. The next step is to prepare the equipment and sterile field for the procedure to begin. Central line dressing kits contain sterile gloves for the nurse to use when performing the procedure. 2. Central line dressing kits include antiseptic solutions to be used to cleanse the skin. The nurse should know and follow the facility's procedure for accessing central line intravenous catheters. 3. Implanted ports can be palpated through the skin to determine where the diaphragm of the port is. The nurse then places a finger on each side of the diaphragm to maintain the correct placement target. 4. The diaphragm of the implanted port is designed to be punctured repeatedly over months to years. A noncoring needle (Huber) is used to prevent damage to the diaphragm. The nurse places the needle between the fingers and inserts it until the needle strikes the back of the reservoir.

42. The nurse is accessing a newly implanted port intravenous line. Which interventions should the nurse implement? Rank in order of performance. 1. Set up the sterile field and don sterile gloves. 2. Cleanse the skin with antiseptic skin prep. 3. Palpate the rim of the port with two fingers. 4. Insert a noncoring needle between the fingers. 5. Explain the procedure to the client and wash hands

43. 1. The Whipple procedure removes the islet cells of the pancreas, thus creating diabetes. The client must be knowledgeable about how to treat diabetes and administer insulin. 2. The client should be instructed to notify the HCP of an elevated temperature, not mask the symptoms of an infection. 3. The client should be taught to change the dressing daily. Waiting until once a week to change the dressing could result in the client having an undiscovered wound infection. 4. The client will now have diabetes and should follow a calorie-controlled diet.

43. The client diagnosed with cancer of the head of the pancreas has had a Whipple procedure (pancreatoduodenectomy). Which discharge instructions should the nurse teach the client? 1. Administer insulin subcutaneously. 2. Take acetaminophen for an elevated temperature. 3. Change the surgical dressing weekly. 4. Increase the calories and protein in the diet.

44. 1. This should be done, but the nurse cannot wait until the wound care nurse arrives to implement skin protection for the client. 2. The nurse should apply a skin barrier paste to protect the skin around the stoma after cleansing the stoma and surrounding skin with a mild soap and water. 3. The skin barrier paste will not adhere to fecal-contaminated skin. The nurse should first gently cleanse the skin. Mild soap acts as an abrasive to remove feces and old barrier paste. 4. The pouch is replaced after the skin has been cleaned and protected.

44. The nurse assesses excoriated skin surrounding the colostomy stoma of a client diagnosed with cancer of the colon. Which intervention should the nurse implement first? 1. Request a consult from a wound ostomy continence nurse. 2. Apply a skin barrier protectant paste around the stoma. 3. Gently cleanse the area with mild soap and water. 4. Replace the pouch with one that is 1/3 inch larger than the stoma.

45. 1. An Ommaya reservoir is similar to an implanted venous access device except that it is implanted directly into the ventricles of the brain. Medications can then be administered to the brain without the problem of being blocked by the blood-brain barrier. 2. An Ommaya reservoir is implanted into the ventricle of the brain, not into a vein. 3. Direct instillation of chemotherapy into the brain can cause more nausea. 4. Sustained-release medications are usually oral preparations; medications instilled into the Ommaya reservoir are liquid and are used immediately by the body.

45. The client diagnosed with metastatic brain tumors has an Ommaya reservoir placed for delivery of chemotherapy. Which statement is the scientific rationale for the placement of this device? 1. Use of this device bypasses the blood-brain barrier to deliver the medication. 2. The implanted port provides venous access for the client receiving chemotherapy. 3. There is less nausea and vomiting associated with the use of an Ommaya access. 4. Ommaya reservoirs are used to deliver sustained-release medications over time

46. 1. The client may need a warmed blanket in the PACU, but not a heating device. 2. If the anesthetic agent reaches the upper thoracic and cervical spinal cord, the client's respiratory muscles may be temporarily paralyzed. Keeping the head of the bed slightly elevated will prevent paralysis from occurring. 3. This would not be a safety measure; it is a pain control measure. 4. The anesthesiologist or nurse anesthetist is responsible for removing the catheter, not the PACU nurse.

46. The client diagnosed with cancer of the prostate has had prostate surgery using spinal anesthesia. Which safety precaution should the postanesthesia care nurse use? 1. Cover the client with a heating device to avoid hypothermia. 2. Keep the head of the bed elevated until the feeling returns to the legs. 3. Medicate the client with intravenous narcotic analgesics for pain. 4. Hold pressure on the epidural insertion site for at least 5 minutes.

47. 1. The advantage of implanted ports is that the client does not have to care for the port at home. The port should be flushed monthly at the time of the therapy sessions. The skin forms a natural barrier from infection. 2. This is done when the client is being prepared to receive the chemotherapy, not when the client is being discharged. 3. The nurse should make sure that all the chemotherapy is infused into the client by flushing the port with normal saline. Instilling heparin into the port, reservoir, and catheter will help to prevent clot formation in the catheter. 4. This is done when the client is being prepared to receive the chemotherapy, not when the client is being discharged.

47. The client with an implanted port has completed the chemotherapy medications and is ready for discharge. Which intervention should the nurse take to prepare the client for discharge? 1. Teach the client how to manage the port at home. 2. Insert a sterile, noncoring needle into the port. 3. Flush the port with saline followed by heparin. 4. Scrub the port access with povidone-iodine (Betadine).

48. 1. These lab tests monitor kidney function and are not needed to monitor TPN. 2. TPN solution contains high concentrations of glucose, proteins, lipids, and electrolytes. The nurse should monitor this lab data. 3. Urine and serum osmolality levels are monitored for diabetes insipidus, not TPN. 4. CA-125 and carcinoembryonic antigen (CEA) levels may be monitored to follow the progress of the disease, but they are not daily tests and are not used for TPN.

48. The client diagnosed with cancer of the ovary had an extensive resection of the bowel and is receiving total parenteral nutrition (TPN). Which laboratory data should the nurse monitor daily? 1. Blood urea nitrogen and creatinine levels. 2. Sodium, potassium, and glucose levels. 3. Urine and serum osmolality levels. 4. CA-125 and carcinoembryonic antigen (CEA).

49. 1. This should be done before the nurse leaves the client with the nurse call light access button, but it is not the first action. 2. This is done when a new cartridge is needed. The client should have a new cartridge in the pump because the pump came with the client from the operating room. 3. Determining the level of pain relief obtained is necessary but not until the nurse determines that the medication is being administered correctly. 4. The nurse is still responsible for determining that the client is receiving the right dose of the right medication at the right time. The nurse should compare the settings to the HCP orders before the other steps.

49. The client who had a right upper lobectomy for cancer of the lung returns to the intensive care unit with a patient-controlled analgesia (PCA) pump for pain control. Which intervention should the nurse implement first? 1. Show the client how to use the PCA pump. 2. Obtain a new cartridge of medication. 3. Determine the level of pain relief obtained. 4. Check the HCP orders against the settings.

5. 1. The client has a low white blood cell count, which is 2.4 times 103, or 2400 actual white blood cells counted. Of this amount only 40% are mature neutrophils capable of fighting a bacterial invasion. Multiply 2400 times 40% (0.4) and determine that the absolute neutrophil count is 960. This count, far below the normal of 2500-7500, puts the client at risk for an infection. The nurse should assess the client for infection. 2. The client's platelet count is less than normal (150,000-400,000), but it is still greater than 100,000. Less than 100,000 is thrombocytopenia. Critical values begin at 50,000. 3. The client's hemoglobin is less than normal but not critically low. This client might fatigue easily because of oxygen demands on the body but should not be short of breath with this hemoglobin. 4. This hemoglobin and hematocrit are below normal in values but not enough for the client to become pale as a result. MEDICATION MEMORY JOGGER: The nurse must be aware of which laboratory values should be monitored for specific medication administration.

5. The nurse is reviewing the laboratory data of a male client receiving chemotherapy. Which intervention should the nurse implement? 1. Assess for an infection. 2. Assess for bleeding. 3. Assess for shortness of breath. 4. Assess for pallor.

50. 1. This blood gas indicates metabolic acidosis. Normal saline at a keep-open rate would not treat metabolic acidosis. 2. Clients who have had the islet cells removed are at risk for complications of diabetes mellitus. The blood gas results indicate metabolic ketoacidosis, and the treatment is continuous infusion of regular insulin. 3. Bicarbonate infusion to correct acidosis is avoided because it can precipitate a sudden (and potentially fatal) decrease in serum potassium. 4. Humulin N insulin is not administered by sliding scale, and for acidosis the treatment is the more rapid-acting Humulin R insulin.

50. The client who had a Whipple resection (pancreatoduodenectomy) for cancer of the pancreas has arterial blood gases of pH 7.29, PCO2 40, HCO3 18, and PaO2 100. Which medication should the nurse prepare to administer? 1. Intravenous normal saline at a keep-open rate. 2. Intravenous insulin by continuous infusion. 3. Sodium bicarbonate intravenously. 4. Sliding-scale Humulin N subcutaneous.

51. 1. The nurse should tell the client to notify the hospice staff if the client is not receiving adequate pain relief. 2. The nurse should teach the client to take the pain medications as soon as the client begins to feel uncomfortable. Waiting to take the medication can make it difficult to get the pain under control. 3. This would isolate the client unnecessarily. The client may always need medications to control the pain. The visitors should be sensitive to the client, and if the client becomes drowsy from the medication, then they should sit quietly near the client. 4. The client is terminally ill; addiction is not an issue.

51. The client diagnosed with terminal cancer is experiencing significant pain. Which information is most important for the hospice nurse to teach the client and significant other? 1. If the pain medications are not working, try to divert the client's attention. 2. Take the pain medications at the onset of pain before it becomes severe. 3. Do not allow family or friends to visit when the client is in pain. 4. Too much narcotic pain medication will cause the client to become addicted.

52. 1. Chronic pain is difficult to describe to persons not experiencing the pain. It is demoralizing and can result in clinical depression. Clients have to adjust to living with the pain and try to be as normal as possible. This is a classic picture of chronic pain. Pain is whatever the client says it is and occurs whenever the client says it does. The nurse should not judge the client; the nurse should administer the pain medication. 2. The nurse should not confront the client's behavior. If the nurse is concerned that the client is exhibiting narcotic-seeking behavior, the nurse should discuss this with the HCP. 3. The client is in pain now; the nurse should not wait to administer the medication. 4. The nurse should administer the pain medication, not substitute a different medication. MEDICATION MEMORY JOGGER: The nurse should remember basic tenets of nursing, for example, that pain is whatever the client says it is. Then, the answer to this question is obvious.

52. The client calls the nursing station and requests pain medication. When the nurse enters the room with the narcotic medication, the nurse finds the client laughing and talking with visitors. Which intervention should the nurse implement? 1. Administer the client's prescribed pain medication. 2. Confront the client's narcotic-seeking behavior. 3. Wait until the visitors leave to administer any medication. 4. Check the MAR to see if there is a nonnarcotic medication ordered.

53. 1. The nurse should teach the client to take the pain medications as soon as the client begins to feel uncomfortable. Waiting to take the medication can make it difficult to get the pain under control. 2. The nurse should instruct the client to avoid using other forms of acetaminophen (Tylenol). The maximum daily adult dose is 4 grams. Each Vicodin tablet contains 500 mg of Tylenol, and Vicodin HP contains 660 mg. 3. The client needs to notify the HCP only if the pain is unrelieved. 4. Hydrocodone slows peristalsis; the client should increase fluids and roughage in the diet to prevent constipation.

53. Which discharge instructions should the nurse provide for the client diagnosed with cancer who is taking hydrocodone with acetaminophen (Vicodin) PRN for pain? 1. Take the medication only when the pain is severe. 2. Use Tylenol for any pain unrelieved by the Vicodin. 3. Notify the HCP if the medication relieves the pain. 4. Increase the intake of fluids and roughage in the diet.

54. 1. The client in chronic pain is often unable to localize the pain and may describe it as "all over" or "taking over my whole body." This is not important. 2. The nurse should administer the pain medication without further delay. 3. The client does not need a referral based on the information given. 4. There is no need to use a different scale; the client has rated the pain for the nurse.

54. The client diagnosed with cancer notifies the nurse of pain of an 11 on the pain scale but is unable to localize the pain to a specific area or tell when the pain began. Which intervention should the nurse implement? 1. Discuss the importance of knowing where the pain is located. 2. Prepare to administer the prescribed narcotic pain medication. 3. Refer the client to a chaplain or social worker for counseling. 4. Ask the client to use the faces pain scale to rate the pain.

55. 1. The client is receiving increasing amounts of narcotic without relief. The nurse should determine if there is some spiritual distress affecting the client's perception of the pain. An increased dose schedule has been tried without success. 2. Distraction techniques would not be successful with this level of pain. 3. The nurse should determine if there is some spiritual distress affecting the client's perception of the pain. Increasing the client's pain medications has been tried without success. Therapeutic communication techniques are designed to allow the client to ventilate feelings. 4. The client will not be willing or able to cooperate with any teaching until the pain has been controlled.

55. The terminally ill client complains that despite hourly intravenous narcotic pain medication administered in increasingly higher doses, the pain is getting progressively worse. Which intervention should the nurse implement? 1. Request an increase in the dosage of medication from the HCP. 2. Ask the significant other to try to distract the client. 3. Use therapeutic communication to discuss the client's concerns. 4. Teach the client nonpharmacologic pain control measures.

56. 1. Stronger medications would only make the client feel drowsier. The nurse should discuss ways of helping the client get the rest needed at night. 2. The client is not discussing feelings. The client is talking about not getting rest at night. 3. Sleeping medication (sedatives or hypnotics) are better options to induce the sleep the client needs at night. A combination of pain relief and sleep medication might be needed to allow the client to rest. 4. The nurse should not discourage the client from taking the medication needed to improve the quality of life. The nurse should teach the client how to cope with the side effects of all medications. MEDICATION MEMORY JOGGER: The test taker should know the medications by the specific classifications. Medications in the same classification usually share the same side effects and adverse effects and the same interventions are needed to administer the medications safely.

56. The male client diagnosed with cancer tells the nurse that he hates feeling "doped up" during the day but needs pain medication to be able to rest at night. Which statement is the nurse's best response? 1. "Sometimes it is necessary to take as much medication as you can to get to sleep. Ask the HCP for stronger medications." 2. "I am sure that this must be uncomfortable for you. You need to talk about how you are feeling." 3. "We could try to balance your pain medications with sleeping medications to help you get comfortable at night." 4. "Too much pain medication will cause you to have many other complications and should be avoided."

57. 1. Keeping the eyes closed and drapes drawn would not indicate the pain medication is effective. These actions may be the client's way of dealing with the pain. 2. Using guided imagery is an excellent method to assist with the control of pain, but it does not indicate effectiveness of the medication. 3. Because pain is whatever the client says it is and occurs whenever the client says it does, a client report of reduced pain indicates the medication is effective. 4. This action may be the client's way of dealing with the pain, but it does not indicate the medication is effective.

57. The nurse administered a narcotic pain medication to a client diagnosed with cancer and assesses the client 30 minutes later. Which data indicates the medication was effective? 1. The client keeps his or her eyes closed and the drapes drawn. 2. The client uses guided imagery to help with pain control. 3. The client states that the pain has gone down 5 points on the scale. 4. The client is lying as still as possible in the bed.

58. 1. The client should be told that there are many different methods of relieving pain, and all of the available methods would have to have failed for this to be true. 2. This is not true, but it is what many clients believe to be true. Neighborhood pharmacies are usually willing to provide the medications their clientele require, but they may need advanced notice to obtain the amount of narcotic needed to fill a prescription for a client with cancer. 3. Narcotic prescriptions need triplicate forms and are only good for 24 hours at a time. The client should try to anticipate when the medication needs to be refilled or he or she may run out over a weekend or holiday. Hospice will arrange to obtain any medication at any time for clients receiving their service. 4. The client's pain has not been cured; it has only been controlled. The client will have pain if he or she does not take the medications as prescribed. The client should only notify the HCP if the pain becomes uncontrollable again on the prescribed pain control regimen.

58. The client admitted with intractable pain from osteosarcoma is being discharged. Which information should the nurse emphasize with the client? 1. The client will need to accept some pain as part of the disease process. 2. Most pharmacies will be able to fill the medication whenever it is needed. 3. Be sure to have an adequate supply of medication on weekends and holidays. 4. The client should return to the hospital if the pain returns.

59. 1. The client is nauseated. Roxanol can be taken orally or sublingually, but this could increase the nausea and cause vomiting. MS can be combined with an antiemetic to provide pain and nausea relief. 2. Compazine and morphine are compatible in the same syringe. Using two syringes is not cost effective and would take more time to administer the medications. 3. The Zofran has not relieved the client's nausea. The nurse should try IV Compazine. The client is nauseated. Roxanol can be taken orally or sublingually, but this could increase the nausea and cause vomiting. 4. Compazine and morphine are compatible in the same syringe. Morphine (for the pain) should be administered over 5 minutes; Compazine (for the nausea) should be administered at a rate of 5 mg per minute. The nurse could administer both medications in one syringe over 5 minutes safely.

59. The nurse is caring for a client diagnosed with cancer. At 1000 the client is complaining of pain and nausea. Based on the Medication Administration Record, which intervention should the nurse implement? 1. Administer Roxanol 10 mg orally and hold any antiemetic medication. 2. Administer the Compazine and morphine but use separate syringes. 3. Administer the Roxanol now and the Zofran in 3 hours. 4. Administer 2 mg of morphine combined with 10 mg of Compazine IV.

6. 1. Compazine Spansules are used before meals to assist in control of nausea so the client can eat. This did not take care of the nausea; the nurse should discuss the situation with the HCP. 2. The client is having unrelieved nausea and the night nurse has already tried to control the nausea with all the medication the HCP has ordered. It is time to notify the HCP to discuss alternative medications or increasing the dose of Zofran. 3. Clients who are experiencing discomfort are not ready to be taught anything. This client needs to know that control of the nausea is possible in the hospital before the client will be ready to learn how to control it at home. 4. The stem of the question did not say the client was sedated. There is no reason to position the client on the side.

6. At 1000 the client diagnosed with cancer and receiving chemotherapy is complaining of unrelieved nausea. Which intervention should the nurse implement? 1. Administer another Compazine Spansule. 2. Discuss the nausea medications with the HCP. 3. Teach the client how to control nausea at home. 4. Turn the client on his or her side to prevent aspiration.

60. 1. MS Contin is a sustained-release formulation and is administered routinely every 6-8 hours to control chronic pain. Roxanol is administered sublingually to treat breakthrough pain. This is the correct administration procedure. 2. MS Contin is not a PRN medication for pain. 3. MS Contin is not a PRN medication for pain and Roxanol is absorbed very quickly through the veins under the tongue. The dosing for Roxanol is more frequently than every 4 hours. 4. MS Contin will not control breakthrough pain because of its sustained-release formulation. The Roxanol should not be held.

60. The client with chronic pain is prescribed both MS Contin and liquid morphine (Roxanol), narcotic analgesics. Which statement best describes how to administer the medications? 1. Administer the MS Contin at prescribed intervals and the Roxanol PRN. 2. Administer both medications PRN for the client's chronic pain. 3. Administer the Roxanol every 4 hours and the MS Contin PRN pain. 4. Administer the MS Contin for breakthrough pain and hold the Roxanol.

61. 1. It is not fine for the client not to be able to eat. The client needs a positive nitrogen balance if the client is to respond well to the treatment. 2. This is a suggestion to alleviate the pain caused by mouth ulcerations resulting from chemotherapy. The antacid coats the tender mucosal lining. If this does not work, then there are numbing medications that the HCP can prescribe. 3. This will cause pain and result in the client's dreading mealtime. There are interventions that can help the client with the problem. 4. This may be expected as a result of the chemotherapy and it will go away when the client's immune system has a chance to recover from the insult caused by the chemotherapy, but it is not the best response. The nurse should try to help the client deal with the mouth ulcers.

61. The client who is post-chemotherapy calls the clinic nurse and reports mouth ulcers that make it difficult for the client to eat. Which statement is the nurse's best response? 1. "It is fine if you are not able to eat for a while. Just be sure to drink." 2. "Try swishing a teaspoon of antacid in your mouth before meals." 3. "You must force yourself to get some nourishment, even if it hurts." 4. "This is expected and will go away in a week to 10 days."

62. 1. Ondansetron will help the nausea, but it will not have any effect on the client's nervousness. 2. Morphine is capable of producing analgesia and has bronchodilating effects, but it will not treat nausea or nervousness. 3. Lorazepam is a sedative hypnotic that has antiemetic and antianxiety properties. The nurse should administer this medication to treat both of the client's complaints. 4. Prochlorperazine will treat the nausea but not the nervousness. This is not the best medication for the nurse to administer. MEDICATION MEMORY JOGGER: The test taker should know the medications by the specific classifications. Medications in the same classification usually share the same side effects and adverse effects, and the same interventions are needed to administer the medications safely.

62. The client about to receive chemotherapy is complaining of nausea and nervousness. Based on the MAR, which of the PRN medications should the nurse administer? 1. Ondansetron (Zofran) IVP. 2. Morphine IVP. 3. Lorazepam (Ativan) IVP. 4. Prochlorperazine (Compazine) IVP.

63. 1. Determining optimum dosing, scheduling, and toxicity of a medication is the purpose of a Phase I clinical trial. Clients participating in Phase I and II trials are not placed in the trials unless their cancers have failed to respond to standard treatment procedures. 2. Determining the effectiveness of a medication against specific tumor types is the purpose of a Phase II clinical trial. 3. Comparing a new medication with the standard treatment procedures is the purpose of a Phase III clinical trial. 4. Further investigation to determine if a medication may have other uses is the purpose of a Phase IV clinical trial.

63. The client is participating in a Phase III clinical trial for a new antineoplastic agent. Which scientific rationale is the purpose of this phase of the pharmacology trials? 1. Determine optimum dosing, scheduling, and toxicity of the medication. 2. Determine effectiveness against specific tumor types. 3. Compare the new medication with the standard treatment procedures. 4. Further investigate to determine if the medication may have other uses.

64. 1. To prevent nausea the client should take an antiemetic 30 minutes before attempting to eat. Maintaining the client's nutritional status is the most important information for the nurse to discuss. 2. There is no reason for the client to keep a record of the nausea. If the nausea is not controlled, the client should report it to the HCP. 3. Reporting to the HCP that a client has become dehydrated is important, but if the nurse is able to assist with interventions to maintain the client's nutritional status, the client will also be able to maintain his or her hydration status. 4. The client should not try to eat favorite foods when nauseated. Doing so may create an aversion to the foods, and then the favorite foods will not be useful if dealing with anorexia.

64. The client diagnosed with cancer complains of frequent nausea. Which information is most important for the nurse to discuss with the client? 1. Teach the client to take an antiemetic 30 minutes before meals. 2. Have the client keep a record of the nausea to discuss with the HCP. 3. Notify the health-care provider if the client becomes dehydrated. 4. The significant other should provide the client with his or her favorite foods.

65. 1. Procrit is administered to increase the production of red blood cells. The client's levels are below normal. The nurse would not question administering this medication. 2. Neumega is administered to increase the production of platelets. The client's levels are below normal. The nurse would not question administering this medication. 3. Interferon would not be questioned on the basis of information provided by a complete blood count. 4. Neupogen is administered to increase the production of white blood cells. It is discontinued when the WBC is 10,200, or 10.2 × 103. The nurse should hold this medication and notify the HCP of the client's laboratory values.

65. The nurse is reviewing the laboratory report of a client diagnosed with cancer. Which biologic response modifier medication should the nurse question? 1. Erythropoietin (Procrit). 2. Oprelvekin (Neumega). 3. Interferon (Intron A). 4. Filgrastim (Neupogen).

66. 1. The client is neutropenic despite the number of white blood cells. The absolute neutrophil count is only 708 (5900 × 0.12 = 708); normal is greater than 2500. This client is at great risk of developing an infection. The nurse would hold the chemotherapy and discuss the absolute neutrophil count with the HCP 2. This client's laboratory data indicates a great risk for infection. The nurse should assess the client for any sign of an infection. 3. This is an intervention for thrombocytopenia, not neutropenia. 4. The client may need to be prescribed antibiotic therapy, but aminoglycoside antibiotics are used mainly for methicillin-resistant Staphylococcus aureus infections (MRSA).

66. The client diagnosed with a solid tissue tumor scheduled to receive chemotherapy has a white blood cell count of 5.9 (103) with 12% neutrophils. Which intervention should the nurse implement first? 1. Administer the chemotherapy as ordered. 2. Assess the client's temperature and lung sounds. 3. Provide the client with a soft-bristled toothbrush. 4. Premedicate the client with an aminoglycoside antibiotic.

67. 1. The medication is usually mixed in small volumes of fluid because the nurse should not leave the client during the administration of a vesicant. 2. The nurse should not leave the client; the nurse can observe this complication directly. 3. Infusion pumps are controversial because the pump could force the vesicant medication into the client's tissue and cause more extensive damage. 4. When administering a vesicant medication into a peripheral intravenous line, the nurse must know that the vein is patent and that there is little likelihood of a leak-back phenomenon occurring— that is, a leaking of minute amounts of the medication into the tissue because the catheter has been in the vein too long and an enlarging of the insertion site has occurred. The nurse should start a new IV site.

67. The nurse is preparing to administer a vesicant antineoplastic medication through a peripheral IV catheter. Which intervention is the priority intervention? 1. Have the medication mixed in a large volume of IV fluid. 2. Tell the client to let the nurse know if the IV site becomes red. 3. Place the infusion on an intravenous infusion pump. 4. Start a new intravenous access before beginning the administration.

68. 1. Steroid medications are particularly useful in the treatment of lymphomas because they exert direct toxicity on lymphoid tissue by suppressing mitosis of the cancer cells and dissolution of lymphocytes. 2. Steroids do suppress inflammation, but this is not the reason to administer these medications to clients with a lymphoma. 3. This is a belittling statement and does not address the client's concerns. 4. Other medications that are prescribed have side effects also; the nurse should not undermine the HCP by suggesting this.

68. The client receiving chemotherapy for non-Hodgkin's lymphoma asks the nurse, "Why do I need to take steroids? I've heard they can cause problems." Which statement is the nurse's best response? 1. "Steroids suppress replication of lymphoid tissue and cause cell death." 2. "Steroids will decrease the inflammation caused by the tumor cells." 3. "The problems caused by the steroids are nothing compared to cancer." 4. "It is possible to have the HCP order different medications for the cancer."

69. 1. Shaving the entire head would not create comfort. Hair keeps heat in the body and is aesthetic. 2. Wearing a wig that matches the client's hair color and style will allow the client to appear in public without having comments made about her loss of hair. 3. This is assuming that the client wants to discuss feelings about her body image. 4. The nurse should warn the client about being in the sun without covering her head, but it is not the most helpful information.

69. The client receiving doxorubicin (Adriamycin), an antineoplastic antibiotic, for cancer of the breast has developed alopecia. Which information is most helpful for the nurse to provide the client? 1. Have the client shave the entire head as a comfort measure. 2. Encourage the client to purchase a wig that matches her own hair. 3. Try to get the client to discuss her feelings about the alopecia. 4. Discuss measures to prevent sunburn of the scalp.

70. 1. Ketoconazole is an anti-infective medication that treats yeast infections. White, patchy areas in the mouth indicate oral candidiasis, a yeast infection. The correct administration procedure is to have the client swish the medication around in the mouth and then swallow the medication to treat areas in the esophagus as well. 2. Metronidazole treats intestinal amoebae, vaginal trichomonas, and anaerobic bacteria, not yeast infections. 3. Miconazole is used to treat yeast infections, but applying a topical cream to the oral mucosa would cause pain and would not adhere to the mucosal lining. 4. Doxycycline would further destroy the good bacteria needed to keep the yeast in check. This would increase the client's problem.

70. The client taking chemotherapy has developed a white, patchy area on the tongue and buccal mucosa. Which medication is the best treatment for this condition? 1. Ketoconazole (Nizoral), an anti-infective, to swish and swallow. 2. Metronidazole (Flagyl), a GI anti-infective, by mouth. 3. Miconazole (Monistat), an anti-infective, topically. 4. Doxycycline (Vibramycin), an antibiotic, orally.

71. 1. Clients are not transfused unless the hemoglobin is less than 8 and the hematocrit is less than 24. There is no reason to type and cross-match the client. 2. The client's absolute neutrophil count— 3456—is higher than 2500, indicating that the client has adequate circulating neutrophils to protect against infection. 3. Thrombocytopenia is defined as a platelet count of less than 100,000. If it is less than 50,000, the client is at risk for bleeding; if it is less than 20,000, the client is at great risk for hemorrhage. This client's platelet count is 13,000. The nurse should prepare to infuse platelets to prevent hemorrhage. 4. The client's absolute neutrophil count is higher than 2500 so the client has adequate circulating neutrophils to protect against infection. The client does not need to be placed in reverse isolation (neutropenic precautions).

71. Today's laboratory report for a client receiving chemotherapy is H and H 11.2 and 34.0, WBC 4.8 (103), neutrophils 72, and platelets 13 (103). Which intervention should the nurse implement? 1. Have the lab draw a type and cross-match. 2. Request an order for antibiotics from the HCP. 3. Prepare to transfuse 10 units of platelets. 4. Place the client on neutropenic precautions.

72. 1. This may be an important question for the business manager to ask, but this is not the nurse's responsibility. The nurse should be concerned with administering the medications safely. 2. How the client deals with fatigue is not important when deciding if it is safe to administer the chemotherapy. 3. Using up a prescription is not the most important question when assessing the client for side effects or adverse effects of chemotherapy. 4. The medications' full effect will not occur until between the treatments. Nadir counts of white blood cells and other clinical manifestations relating to the chemotherapy should be assessed. The nurse should assess for stomatitis, infections, and nutritional status. A fever would indicate an infection, and difficulty swallowing could indicate mouth inflammation (stomatitis) or ulcerations.

72. The nurse is assessing the client prior to initiating the seventh round of chemotherapy. Which question is most important for the nurse to ask the client before beginning the treatment? 1. "Has your insurance company precertified you to receive more than six treatments?" 2. "How have you dealt with the fatigue that occurs with the cancer treatments?" 3. "Did you take all of the prescription for anti-nausea medications?" 4. "Have you experienced any difficulty swallowing or had a temperature?"

73. 1. The nurse should address the client's concern with information. The client did say, "I am afraid," but accurate information can alleviate the fear. This is not the best response. 2. The nurse should inform the client about pain control options; after the client has accurate information, the nurse can address the fear, if it still exists. 3. This does not give the client the information the client is seeking. 4. Addiction should not be a concern of the client. Although it is a remote possibility, usually the client will taper the dose of the medication if it is too high. This client is worried about dying in pain, and addiction need not be a concern for a client who is terminally ill.

73. The client diagnosed with cancer tells the clinic nurse, "I am so afraid that I will die a horribly painful death." Which statement is the nurse's best response? 1. "That is a concern. Let's sit down and discuss your concerns. I am here to talk if you need to." 2. "Pain does not occur for everyone, but if it does, your HCP can prescribe medications to control it." 3. "This does happen sometimes and it is a valid concern. I hope this does not happen to you." 4. "There are medications that can be prescribed to control the pain, but they can cause you to become addicted."

74. 1. Rescue medications are specifically timed to prevent life-threatening complications. The nurse should administer this medication first. 2. Pain is a priority, but it is not life threatening if the client has to wait for a few minutes to receive the pain medication. 3. An antiemetic medication is a priority, but it is not life threatening if the client has to wait for a few minutes to receive the antiemetic medication. 4. The client has already had two doses of the medication. This is not the priority medication to administer. MEDICATION MEMORY JOGGER: The classification of "rescue factor" should provide the test taker with a clue about priority.

74. The nurse is caring for clients on an oncology unit. Which medication should the nurse administer first? 1. The scheduled dose of leucovorin (folinic acid), a rescue factor. 2. The narcotic pain medication for a client with pain of 10 on the pain scale. 3. The antiemetic to a client complaining of nausea and an emesis of 200 mL. 4. The third dose of an aminoglycoside antibiotic to a client who has a fever.

9. 1. This client may have metastasis to the spinal column, and this information should be immediately reported to the HCP for emergency evaluation or the client could become paralyzed. 2. Body image suffers when a client has alopecia (hair loss) from the antineoplastic agents, but it is not life threatening or permanent. 3. Being able to resume nutritional intake after 2 days is not a cause for immediate intervention by the nurse. 4. Treatments are scheduled every 3-4 weeks, and a 2-pound weight loss is not significant in this time period.

9. Which statement by the client receiving adjunct chemotherapy for breast cancer warrants immediate intervention by the nurse? 1. The client complains of numbness and tingling in her feet. 2. The client complains that she feels unattractive without hair. 3. The client says she is unable to eat for 2 days after a treatment. 4. The client tells the nurse she has lost 2 pounds since the last treatment.

75. 2, 5, 3, 1, 4 2. The first step should be to assess the client for signs of fluid volume overload. Crackles in the lungs would indicate to the nurse to infuse the PRBCs as slowly as possible. 5. Blood products require two nurses to verify that the correct product is being administered. This is the second step. 3. Administering infusions is safer when the nurse uses a pump. Infusion devices prevent inadvertent rapid administration of fluids, and pumps also prevent the transfusion from slowing down (blood is very thick) and not infusing within the time period. 1. Blood should initially be transfused at a very slow rate. The most common time for a life-threatening complication to occur is within the first 15 minutes of the transfusion. The nurse should not leave the client being given the transfusion for 15 minutes and should perform vital signs every 5 minutes. If at the end of the 15 minutes the client has not experienced any difficulty with the blood product, then the nurse should adjust the infusion rate to transfuse the PRBCs within 4 hours. 4. Setting the transfusion to infuse within the time period is the final step before the nurse leaves the client's room.

75. The HCP has ordered two units of packed red blood cells (PRBC) for the client diagnosed with cancer and anemia. Which interventions should the nurse implement? Rank in order of performance. 1. Initiate the transfusion at 10 mL per hour. 2. Assess the client's lung sounds. 3. Place the blood on an infusion pump. 4. Run the transfusion at a 4-hour rate. 5. Check the blood with another nurse.

76. 1. Darbepoetin stimulates red blood cell production. Monitoring the white blood cell count would be appropriate for clients receiving Neupogen and Neulasta, both of which stimulate white blood cell production. 2. Darbepoetin will not affect the client's lung capacity. 3. Darbepoetin stimulates red blood cell production. When the hematocrit rises, it can result in an increase in blood pressure. The nurse should monitor the client's blood pressure. 4. Darbepoetin stimulates red blood cell production. Monitoring platelet counts would be appropriate for a client receiving Neumega, which stimulates platelet production.

76. The client diagnosed with a solid tissue tumor is prescribed darbepoetin (Aranesp), a hematopoietic growth factor. Which data should the nurse monitor? 1. The white blood cell counts. 2. The client's lung capacity. 3. The client's blood pressure. 4. The platelet counts.

77. 1. Many clients take digoxin and do fine during surgery. The HCP should be aware of the client's cardiac status when he or she performed the history and physical. The nurse does not have to notify the surgeon about this medication. 2. The client stopped taking the aspirin last week. The nurse does not have to notify the surgeon about this medication. 3. Clopidogrel is an antiplatelet medication the client has been taking. It should be discontinued at least 7 days before surgery. The nurse should notify the surgeon because the surgery will need to be rescheduled. 4. Many clients become nauseated following anesthesia. The nurse would not have to notify the surgeon.

77. The client diagnosed with cancer is being prepared for surgery. Which information should the outpatient surgery nurse convey to the surgeon immediately? 1. The client takes digoxin (Lanoxin) for heart problems. 2. The client stopped taking acetylsalicylic acid (aspirin) last week. 3. The client has been taking clopidogrel (Plavix) every day. 4. The client becomes nauseated after receiving anesthesia.

78. 1. Because this client will be monitoring the intravenous injection site, the nurse should teach the client about signs of phlebitis (for a peripheral IV) or an infection and what to do if they occur. 2. The client will not receive the medication from the hospital pharmacy; the client will obtain the medication from a neighborhood pharmacy or from a home healthcare agency pharmacy. 3. There is no need for the client to self-document the pain. 4. Arrangements for follow-up care should be made with a home care agency. 5. The medications will be administered using a pump designed for this purpose. The nurse should make sure the client is able to operate the pump.

78. The nurse is preparing a client for discharge with intractable pain and a home infusion pump with a narcotic medication. Which information should the nurse include? Select all that apply. 1. Teach the client signs of phlebitis or infection. 2. Have the client sign out the medication. 3. Remind the client to document the pain for the HCP. 4. Refer the client to a home health agency. 5. Discuss the use of the infusion pump.

79. 1. The nurse cannot delegate administration of medications in this setting and cannot delegate this particular type of medication in any setting. 2. The nurse cannot delegate teaching to a UAP. 3. The nurse must document what he or she does. This cannot be delegated. 4. The UAP could apply a topical over-the-counter preparation.

79. Which intervention should the nurse in an oncology physician's office delegate to the unlicensed assistive personnel (UAP)? 1. Administer the premedications for the chemotherapy. 2. Provide discharge instructions to the client. 3. Document the antineoplastic agents the client received. 4. Apply A+D ointment to the head of a client who has alopecia.

8. 1. The client's hair will grow back when treatments are discontinued and sometimes during the treatments, but this does not indicate the medications are killing cancer cells. 2. Nausea during or after the treatments is not a measure of cell kill. 3. The client being able to tolerate activity indicates the client has adequate lung capacity. This indicates the lung cancer has not enveloped the entire lung fields and the medications are effective. Lung cancer has a poor prognosis, and the treatment goal is to improve or maintain quality of life. 4. The client's lung fields being clear does not indicate quality of life or cell kill.

8. The client has received five treatments of combination chemotherapy for cancer of the lung. Which data indicates the medications are effective? 1. The client's hair has begun to grow back in again. 2. The client only has nausea during the treatments. 3. The client reports being able to ambulate around the block. 4. The client's lung sounds are clear.

80. 1. Stomatitis is an inflammation of the buccal mucosa. A social worker would not be able to help with this client. 2. Stomatitis is an inflammation of the buccal mucosa. A dietitian can help the client by providing foods the client can swallow without too much chewing and at the same time receive adequate nutrition. The nurse should refer the client to the dietitian. 3. Stomatitis is not a terminal process. Hospice nurses care for the terminally ill. 4. Stomatitis is an inflammation of the buccal mucosa. A physical therapist would not be able to help with this client. MEDICATION MEMORY JOGGER: The test taker must know medical terminology.

80. The client receiving chemotherapy has developed stomatitis. Which referral should the nurse implement? 1. Refer to a social worker. 2. Refer to a dietician. 3. Refer to a hospice nurse. 4. Refer to a physical therapist.