Pharm Exam 3 Practice Questions

A patient has had great difficulty controlling hypertension with standard drug therapy. She says, "My neighbor couldn't get her blood pressure down until the doctor started her on hydralazine (Apresoline). Which response, by the nurse, is indicated? Select all that apply. 1. "Because you had rheumatic fever that damaged your heart, this is not a good drug for you." 2. "Your neighbor must be over age 70." 3. "Your lupus diagnosis keeps us from using that drug." 4. "You should not use that drug because you have rheumatoid arthritis." 5. "We try to avoid using hydralazine (Apresoline) because it causes constant coughing."

1. "Because you had rheumatic fever that damaged your heart, this is not a good drug for you." 3. "Your lupus diagnosis keeps us from using that drug." Rationale: Rheumatic heart disease and lupus are contraindictations to the use of hydralazine (Apresoline).

A client is prescribed methotrexate (Rheumatrex) for treatment of osteogenic sarcoma. The client says, "My friend took methotrexate, but she has never had cancer." How should the nurse respond to this statement? Select all that apply. 1. "Does your friend have rheumatoid arthritis?" 2. "She must have had cancer and not told you." 3. "Methotrexate is used to treat some autoimmune disorders as well." 4. "You must have misinterpreted what your friend said." 5. "Methotrexate is used to treat some forms of liver disease."

1. "Does your friend have rheumatoid arthritis?" 3. "Methotrexate is used to treat some autoimmune disorders as well." Rationale: Methotrexate has powerful immunosuppressant properties and is used to treat rheumatoid arthritis, ulcerative colitis, lupus, and psoriasis.

A student visits the college health nurse and asks, "I am concerned about when I should start getting Pap tests." What questions should the nurse ask? Select all that apply. 1. "How old are you?" 2. "Do you drink alcohol?" 3. "Is there a history of cancer in your family?" 4. "Do you use tobacco?" 5. "Are you sexually active?"

1. "How old are you?" 5. "Are you sexually active?" Rationale: All women should start having Pap tests at age 21. Women who are sexually active should have Pap tests earlier than those who are not.

The nurse who is presenting community education about cancer prevention would evaluate understanding of the message when he overhears which statements at the break? Select all that apply. 1. "I've been thinking about trying a vegetarian diet. Now may be a good time." 2. "I am going to call my doctor and schedule a pap smear." 3. "I think I will start taking vitamin A and selenium." 4. "I've never been a drinker, but I am going to start drinking a glass of wine with dinner." 5. "I am going to read the label on that new bottle of sunscreen I bought."

1. "I've been thinking about trying a vegetarian diet. Now may be a good time." 2. "I am going to call my doctor and schedule a pap smear." 5. "I am going to read the label on that new bottle of sunscreen I bought." Rationale: It is not necessary to become a vegetarian, but following a plant-based diet may help to reduce risk of cancer. Regular screenings will help catch changes that may become malignant. Sunscreen use is recommended to help prevent skin cancer.

A patient says, "Since I started taking metoprolol (Lopressor), I have been having problems having sex. I think I am going to stop taking it." What nursing responses are indicated? Select all that apply. 1. "Sexual dysfunction is a common problem with this drug." 2. "Perhaps it would be better if you took atenolol (Tenormin)." 3. "I cannot stop you from discontinuing the drug." 4. "Stopping the drug all at once may make your blood pressure get higher." 5. "Try taking the drug early in the morning."

1. "Sexual dysfunction is a common problem with this drug." 4. "Stopping the drug all at once may make your blood pressure get higher." Rationale: One of the major causes of noncompliance is the effect of beta blockers have on male sexual function. Abrupt cessation of beta-blocker therapy can result in rebound HTN.

The nurse teaches a family support group about the causes of cancer. The nurse evaluates that learning has occurred when the clients make which statements? Select all that apply. 1. "Some cancers have a strong genetic component." 2. "Cancer often results from an injury such as a bruise." 3. "Cancers have a very strong environmental component." 4. "Cancer can result from suppressed anger and rage." 5. "Cancer can result from damaged tumor-suppressor genes."

1. "Some cancers have a strong genetic component." 3. "Cancers have a very strong environmental component." 5. "Cancer can result from damaged tumor-suppressor genes." Rationale: There is no evidence to support that anger, rage, and injuries such as bruises result in cancer.

The client receives tamoxifen (Nolvadex) for treatment of breast cancer. She asks the nurse why the medicine works. What is the best response by the nurse? 1. "Tamoxifen (Nolvadex) works by blocking estrogen receptors on breast tissue." 2. "Tamoxifen (Nolvadex) works by inhibiting the cellular mitosis of breast cancer." 3. "Tamoxifen (Nolvadex) works by inhibiting the metabolism of breast cancer cells." 4. "Tamoxifen (Nolvadex) works by binding to the DNA of breast cancer cells."

1. "Tamoxifen (Nolvadex) works by blocking estrogen receptors on breast tissue." Rationale: Breast cancer is dependent on estrogen for growth. Tamoxifen (Nolvadex) acts by blocking estrogen receptors; the tumor is deprived of estrogen.

The nurse is caring for an African American male who has just been diagnosed with hypertension and mild heart failure. The nurse anticipates that this patient will be started on which medications?Select all that apply. 1. A combination drug like hydralazine and isosorbide dinitrate 2. A calcium channel blocker like nifedipine (Adalat) 3. An ACE inhibitor like enalapril (Vasotec) 4. A beta-adrenergic antagonist like atenolol (Tenormin) 5. An angiotensin-II receptor blocker like clonidine (Catapres)

1. A combination drug like hydralazine and isosorbide dinitrate 2. A calcium channel blocker like nifedipine (Adalat) Rationale: The combination drug BiDil, a fixed dose combination of hydralazine and isosorbide dinitrate is used to treat heart failure African American patients appear to show an enhanced response to this medication. Calcium channel blockers seem to provide the greatest blood pressure reduction in this population.

The client receives cisplatin (Platinol) as therapy for cancer. Which assessment finding would prompt the nurse to contact the client's physician immediately? 1. A temperature greater than 101°F 2. An elevation in blood glucose 3. Nausea and projectile vomiting 4. A complaint of painful leg cramps

1. A temperature greater than 101°F Rationale: A temperature greater than 101°F can indicate an infection, which can be life threatening because low WBCs are an adverse effect of cisplatin.

A patient is brought to the emergency department in hypertensive crisis. The nurse plans care to protect which bodily systems that are most implicated in compensating for this crisis? Select all that apply. 1. Cardiac 2. Respiratory 3. Integumentary 4. Gastrointestinal 5. Renal

1. Cardiac 5. Renal Rationale: The heart responds to hypertension by decreasing heart rate and stroke volume. The kidney responds to hypertension by increasing urine output to decrease blood volume.

A young female patient is being treated for hypertension. The nurse would be most concerned if the patient became pregnant while taking which drug? 1. Enalapril (Vasotec) 2. Potassium supplement 3. Doxazosin (Cardura) 4. Hydrochlorothiazide (HCTZ)

1. Enalapril (Vasotec) Rationale: : Enalapril is a Pregnancy Category D drug that has a higher fetal risk than do the other drugs listed.

The patient has been recently diagnosed with hypertension with a sustained blood pressure of 144/90 mmHg. The patient is concerned about effects on the body. What effects of hypertension on the body will the nurse include in her education of this patient? Select all that apply. 1. Kidney damage 2. Stroke 3. Liver failure 4. Heart failure 5. Blindness

1. Kidney damage 2. Stroke 4. Heart failure 5. Blindness Rationale: The kidneys, the heart, and the retina are affected by hypertension. Stroke is a common effect of hypertension.

Which interventions would be indicated and take highest priority for a 30-year-old female with a BMI of 20 who smokes and has a blood pressure of 137/88? 1. Smoking-cessation program 2. Diuretic therapy 3. Weight-loss program 4. Stress management

1. Smoking-cessation program Rationale: Smoking-cessation is the priority.

The client has recently been diagnosed with cancer. The nurse develops a plan to teach the client about the most effective treatments for cancer. What treatment options will the nurse include in this teaching? Select all that apply. 1. Surgery 2. Chemotherapy 3. Nutrition therapy 4. Alternative medicine 5. Radiation therapy

1. Surgery 2. Chemotherapy 5. Radiation therapy Rationale: Surgery continues to be a *primary* treatment for cancer. Pharmacologic controls for cancer, or chemotherapy, is one of the standard effective treatments for cancer. Radiation is one of the three primary treatments for cancer.

The client receives cyclophosphamide (Cytoxan) as treatment for cancer and is experiencing oral irritation as an adverse effect. What does the best plan by the nurse include as it relates to providing oral comfort? 1. Teach the client to avoid extreme temperatures of food selections. 2. Teach good oral hygiene, including the use of an antiseptic mouthwash. 3. Administer megestrol (Megace ES) to the client. 4. Teach the client to inspect the mouth weekly.

1. Teach the client to avoid extreme temperatures of food selections. Rationale: Avoiding extreme temperatures of foods will help prevent further trauma and discomfort to the mouth.

The nurse assesses several clients for their potential risk for developing cancer. Which client does the nurse assess to be at highest risk for developing cancer? 1. The client who drinks alcohol daily and eats red meat at most meals 2. The client who is 10 pounds overweight but exercises regularly 3. The client who usually applies sunscreen when arriving at the beach 4. The client who frequently forgets self-breast exams but has routine mammograms

1. The client who drinks alcohol daily and eats red meat at most meals Rationale: Alcoholism and consuming large amounts of red meat are lifestyle factors that put this client at risk for developing cancer.

A nurse has just initiated a patient's first dose of doxorubicin (Adriamycin). Which assessment finding would cause the nurse to stop the infusion and seek immediate collaboration with the oncologist? Select all that apply. 1. The patient's cardiac monitor reveals sinus bradycardia. 2. The patient reports being nauseated. 3. The patient mentions drinking green tea for breakfast. 4. The patient becomes dyspneic. 5. The patient becomes pale.

1. The patient's cardiac monitor reveals sinus bradycardia. 4. The patient becomes dyspneic. Rationale: Bradycardia may indicate cardiac toxicity, which is the major dose-limiting effect. Dyspnea may indicate heart failure.

The nurse is caring for a patient recently diagnosed with hypertension. The patient asks what medications may be used to treat the condition. The nurse begins by discussing the primary antihypertensive agents, includes which of the following? Select all that apply. 1. thiazide diuretics. 2. angiotensin-II receptor blockers (ARBs). 3. beta-adrenergic antagonists. 4. direct-acting vasodilators. 5. peripheral adrenergic antagonists.

1. thiazide diuretics. 2. angiotensin-II receptor blockers (ARBs). Rationale: Diuretics and ARBs are considered primary antihypertensive agents and should be discussed with this patient.

A nurse is managing the care of a patient who is approaching nadir during the first round of chemotherapy. The nurse evaluates that neutropenia has occurred when the patient's white blood cell count reaches _________ cells/mL.

1500 Rationale: Nadir is the lowest point to which the erythrocyte, neutrophil, or platelet count is depressed by the chemotherapy drug. Once a patient's WBC count falls to 1500 cells/mL, the patient is considered neutropenic and is at great risk of developing infection.

The client has cancer. He asks the nurse where cancer comes from. What is the best explanation by the nurse? 1. "Cancer is genetic; you inherited the predisposition for your cancer." 2. "Cancer cells are your body's cells that have lost the ability to control their growth." 3. "Cancer is caused primarily by viruses in the environment." 4. "Cigarette smoking and second-hand smoke are the primary causes of cancer."

2. "Cancer cells are your body's cells that have lost the ability to control their growth." Rationale: Cancer is thought to result from damage to the genes controlling cell growth.

The patient receives hydrochlorothiazide (Microzide). He tells the nurse he is urinating a lot and questions how this drug affects his blood pressure. What is the best response by the nurse? 1. "Hydrochlorothiazide (Microzide) enhances kidney function causing you to urinate more and that decreases your blood pressure." 2. "Hydrochlorothiazide (Microzide) decreases the fluid in your bloodstream and this lowers your blood pressure." 3. "Hydrochlorothiazide (Microzide) dilates your blood vessels so you urinate more and your blood pressure decreases." 4. "Hydrochlorothiazide (Microzide) increases your heart rate; this pumps blood faster to your kidneys so you urinate more and your blood pressure decreases."

2. "Hydrochlorothiazide (Microzide) decreases the fluid in your bloodstream and this lowers your blood pressure." Rationale: Blood volume is one of the three factors influencing blood pressure. Diuretics like hydrochlorothiazide (Microzide) decrease blood pressure by decreasing total blood volume.

A patient has been prescribed nifedipine (Adalat CC) as treatment for hypertension. The nurse would evaluate medication instruction as effective if the patient makes which statements? Select all that apply. 1. "If I drink alcohol while taking this medication, I will get very sick to my stomach." 2. "I should stop taking my melatonin sleep medication." 3. "I should no longer drink grapefruit juice." 4. "I should no longer drink sports drinks with caffeine in them." 5. "I should stop taking my vitamin C supplement."

2. "I should stop taking my melatonin sleep medication." 3. "I should no longer drink grapefruit juice." Rationale: Concurrent use with melatonin may increase blood pressure and heart rate. Grapefruit juice may enhance absorption of nifedipine (Adalat CC).

The patient has been prescribed interferon as treatment against cancer. What information should the nurse provide? Select all that apply. 1. "You can increase your intake of interferon by eating grapes and drinking a glass of red wine daily." 2. "Interferons act to suppress cancer cell division." 3. "Interferons enhance your body's ability to remove cancer cells." 4. "Interferons are a type of hormone therapy, so side effects are limited." 5. "The danger with using interferons is that they may cause cancer to develop in sites distant from your original tumor."

2. "Interferons act to suppress cancer cell division." 3. "Interferons enhance your body's ability to remove cancer cells." Rationale: Interferons suppress cancer cell division and increase the activity of macrophages.

A client is diagnosed with a small lipoma on his arm and is being discharged from the clinic. The client says, "I have a tumor, but I am not being treated with anything. I don't understand." How should the nurse respond? Select all that apply. 1. "I am supposed to make an appointment for you to see the oncologist who will recommend treatment." 2. "Lipomas are benign and usually do not require treatment." 3. "Lipomas grow slowly and are not cancerous." 4. "Lipomas do not metastasize and are not cancer." 5. "The physician will consult with a surgeon and will contact you later."

2. "Lipomas are benign and usually do not require treatment." 3. "Lipomas grow slowly and are not cancerous." 4. "Lipomas do not metastasize and are not cancer." Rationale: A lipoma is a fatty tumor and is benign. They do not require treatment unless they are positioned where they are easily irritated or injured. If so, simple removal generally suffices. Lipomas grow slowly. Lipomas do not metastasize.

A client with pancreatic cancer is receiving chemotherapy even though prognosis is grim. How does the nurse explain the rationale for this treatment? Select all that apply. 1. "It is a long shot, but maybe the chemotherapy will cure him." 2. "Sometimes the chemotherapy can reduce the size of the tumor." 3. "We just hate to give up on him. He is such a nice man." 4. "Chemotherapy can sometimes reduce the pain." 5. "Hopefully, the chemotherapy will improve his quality of life."

2. "Sometimes the chemotherapy can reduce the size of the tumor." 4. "Chemotherapy can sometimes reduce the pain." 5. "Hopefully, the chemotherapy will improve his quality of life." Rationale: Chemotherapy is sometimes given to reduce tumor size and help to reduce problems associated with the pressure the tumor is exerting on adjacent structures. : Pain reduction is a common reason for administering chemotherapy to a client with a poor prognosis. Palliative chemotherapy is administered to improve the client's quality of life.

A client's dosage schedule includes chemotherapy for each of 5 days and then no chemotherapy for 5 days. The client says, "Why don't they just keep giving me the chemo? I want to kill this cancer and get on with my life." How should the nurse respond? Select all that apply. 1. "This chemotherapy is so strong that you cannot physically stand to take it for more than 5 days." 2. "We need to give your normal cells time to recover from the medication before you get more chemotherapy." 3. "You should let the doctors worry about that." 4. "We need to let some of the cancer cells develop into the stage where the chemotherapy can kill them." 5. "The chemotherapy is not always immediately available, so pauses are taken to allow for more stock to arrive."

2. "We need to give your normal cells time to recover from the medication before you get more chemotherapy." 4. "We need to let some of the cancer cells develop into the stage where the chemotherapy can kill them." Rationale: The goal of chemotherapy is to destroy malignant cells with as little damage to normal cells as possible. In some cases, a pause in chemotherapy treatment is necessary to allow this recovery. Some chemotherapies are cell-cycle specific and kill cells only in a specific window of development. Pauses in chemotherapy are necessary to allow cells to mature into this window.

For the last 3 months, the nurse has been working with a group of patients who have been using nonpharmacological methods to try to manage their hypertension. The nurse anticipates that which patients will require the addition of a pharmacological intervention? Select all that apply. 1. A 30-year-old female whose blood pressure is 138/88 mmHg who is otherwise healthy. 2. A 61-year-old man whose blood pressure is 144/90 mmHg who also has type 2 diabetes. 3. A 56-year-old woman whose blood pressure is 135/84 who also has Cushing's disease. 4. A 65-year-old man whose blood pressure is 148/88 mmHg who is otherwise healthy. 5. A 61-year-old woman whose blood pressure is 153/92 mmHg who is otherwise healthy.

2. A 61-year-old man whose blood pressure is 144/90 mmHg who also has type 2 diabetes. 5. A 61-year-old woman whose blood pressure is 153/92 mmHg who is otherwise healthy. Rationale: Since this 61-year-old has both hypertension and diabetes, pharmacotherapy is indicated. Blood pressure over 150/90 mmHg requires treatment in those over age 60.

A patient who is in hypertensive crisis will be given the calcium channel blocker clevidipine (Cleviprex). The nurse should prepare for which interventions? Select all that apply. 1. Monitoring bowel sounds 2. Administering the drug intravenously 3. Continuous blood pressure monitoring 4. Crushing caplets for administration 5. Infusing normal saline at 125 mL/hr

2. Administering the drug intravenously 3. Continuous blood pressure monitoring Rationale: Clevidipine (Cleviprex) is administered IV and has an ultrasound half-life so BP will be monitored continuously.

Changes in which level would be sensed by baroreceptors and relayed to the vasomotor center? 1. Oxygenation 2. Blood pressure 3. Carbon dioxide 4. Blood pH

2. Blood pressure Rationale: Baroreceptors sense and relay changes in blood pressure.

Which are the three factors that make up blood pressure? 1. Blood volume, heart rate, and stroke volume 2. Cardiac output, blood volume, and peripheral vascular resistance 3. Age, weight, and race 4. Body mass index, diet, and genetics

2. Cardiac output, blood volume, and peripheral vascular resistance Rationale: Although many factors can contribute to blood pressure, such as diet and weight, it is a person's cardiac output, blood volume, and peripheral vascular resistance that create the pressure.

The patient with hypertension is receiving nifedipine (Procardia XL). The nurse determines that the patient needs additional medication education when the patient selects which menu for breakfast? 1. Whole-wheat pancakes with syrup, and bacon, oatmeal, and orange juice 2. Eggs, whole-wheat toast with butter, cereal, milk, and grapefruit juice 3. Eggs and sausage, a biscuit with margarine, coffee with cream, and cranberry juice 4. Egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice

2. Eggs, whole-wheat toast with butter, cereal, milk, and grapefruit juice Rationale: Grapefruit juice in combination with a sustained-release calcium channel blocker could result in rapid toxic overdose, which is a medical emergency.

A nurse suspects that the IV line infusing vincristine (Oncovin) has infiltrated. The nurse discontinued the line. Which other actions are indicated? Select all that apply. 1. Apply local ice packs. 2. Inject hyaluronidase per protocol. 3. Place a tourniquet on the client's arm above the IV site. 4. Place warm compresses on the site. 5. Administer prednisone per protocol.

2. Inject hyaluronidase per protocol. 4. Place warm compresses on the site. Rationale: Cold compresses will significantly increase the toxicity of vinca alkaloids. Warm compresses are recommended as treatment.

Which statement is accurate in regard to secondary hypertension? 1. There is no known cause. 2. It can result from chronic renal impairment. 3. It is also known as idiopathic. 4. It accounts for 90% of all hypertensive cases.

2. It can result from chronic renal impairment. Rationale: Secondary hypertension has an identifiable cause.

The nurse is educating a patient whose blood pressure is 140/90 mmHg on ways to lower blood pressure and avoid hypertension. Which lifestyle choices may eliminate the need for pharmacotherapy in this patient?Select all that apply. 1. Increasing intake of wine 2. Restricting salt intake 3. Increasing intake of red meat 4. Increasing activity 5. Stopping smoking

2. Restricting salt intake 4. Increasing activity 5. Stopping smoking Rationale: Restricting sodium, increasing activity, and eliminating tobacco products are positive lifestyle changes associated with the nonpharmacologic treatment of hypertension.

What is a priority nursing intervention for a patient who has just begun antihypertensive treatment with enalapril (Vasotec)? 1. Monitor the patient for headaches. 2. Take the patient's blood pressure. 3. Order a sodium-restricted diet for the patient. 4. Review the patient's lab results for hypokalemia.

2. Take the patient's blood pressure. Rationale: Enalapril (Vasotec) may produce a first-dose phenomenon resulting in profound hypotension, which may result in syncope.

The nurse is conducting the initial group education session for patients who have hypertension. What is the most important information to include? Select all that apply. 1. Blood pressures tend to decrease as people age, due to decreased blood volume. 2. The aorta has sensors that help regulate blood pressure. 3. Anger can result in hypertension. 4. The vasomotor center, located in the limbic system of the brain, helps regulate blood pressure. 5. Hypertension is diagnosed when the blood pressure is greater than 145/95 mmHg.

2. The aorta has sensors that help regulate blood pressure. 3. Anger can result in hypertension. Rationale: The aorta and internal carotid artery have baroreceptors that sense changes in pressure in blood vessels and chemoreceptors that detect oxygen, carbon dioxide, and pH levels. Anger and stress can cause blood pressure to rise.

The nurse is teaching the patient about lifestyle modifications to help manage the patient's hypertension. The nurse determines that teaching has been effective when the patient makes which statement? 1. "I need to get started on my medications right away." 2. "My father had hypertension, did nothing, and lived to be 90-years-old." 3. "I know I need to give up my cigarettes and alcohol." 4. "I won't be able to run in the marathon race anymore."

3. "I know I need to give up my cigarettes and alcohol." Rationale: Limiting intake of alcohol and discontinuing tobacco products are important nonpharmacological methods for controlling hypertension.

The nurse completed medication education with the patient who receives hydrochlorothiazide (Microzide). The nurse determines that teaching has been effective when the patient makes which statement? 1. "I really need to avoid grapefruit juice when I take this medication." 2. "I need to avoid salt substitutes and potassium-rich foods." 3. "I take my medication early in the morning." 4. "If I develop a cough, I should call my doctor."

3. "I take my medication early in the morning." Rationale: Taking hydrochlorothiazide (Microzide) early in the day will help prevent nocturia.

The patient is receiving doxazosin (Cardura) for hypertension. He asks the nurse how the medication works. What is the nurse's best response? 1. "It works by causing your kidneys to excrete more urine." 2. "It works by making your heart work more efficiently." 3. "It works by making your blood vessels expand." 4. "It works by decreasing the release of your stress hormones."

3. "It works by making your blood vessels expand." Rationale: : Doxazosin (Cardura) is selective for blocking alpha1-receptors in vascular smooth muscle, which results in dilation of arteries and veins.

The nursing instructor teaches student nurses about chemotherapy for cancer. Which statement best explains why lung cancers are less sensitive to antineoplastic agents than other types of cancers? 1. "Lung cancer cells have a very erratic cell cycle, and this is why there isn't much difference between the number of replicating and resting cells." 2. "Lung cancer cells have been growing for a long time before detection, so they are less sensitive to antineoplastic agents." 3. "Lung cancer cells have a low-growth fraction, which means there isn't much difference between the number of replicating and resting cells." 4. "Lung cancer cells grow in a high-oxygen environment, so they are not very sensitive to antineoplastic agents."

3. "Lung cancer cells have a low-growth fraction, which means there isn't much difference between the number of replicating and resting cells." Rationale: Growth fraction is a ratio of the number of replicating cells to the number of resting cells. Antineoplastic drugs are much more toxic to tissues and tumors with high growth fractions. Breast and lung cancers have low growth fractions.

A client states, "I get so sick to my stomach after chemotherapy. Why can't they just put it directly into my tumor?" Which nursing response is indicated? 1. "There is no technology available to directly place chemotherapy in a tumor." 2. "These are such strong medications that they would eat up your tissues." 3. "That type of therapy does exist, but it does not work for your particular type of cancer." 4. "I know you get sick, but the nausea and vomiting is not severe and passes quickly."

3. "That type of therapy does exist, but it does not work for your particular type of cancer." Rationale: This is a straightforward and accurate statement of fact.

The client receives several chemotherapeutic agents as treatments for cancer. The client asks the nurse why he needs so many drugs. What is the best response by the nurse? 1. "Using multiple drugs means a shorter treatment time." 2. "Using multiple drugs decreases the incidence of side effects." 3. "Using multiple drugs will help kill more of the cancer." 4. "Using multiple drugs is more cost-effective in treating cancer."

3. "Using multiple drugs will help kill more of the cancer." Rationale: Using multiple drugs is the goal of combination treatment because more of the cancer cells will be killed with this approach.

The client experiences nausea and vomiting soon after chemotherapy treatments. What is the best action by the nurse? 1. Administer a sleeping medication during chemotherapy. 2. Increase fluid intake to flush the kidneys prior to chemotherapy. 3. Administer an antiemetic 1-2 hours before chemotherapy. 4. Restrict food on the day the client receives chemotherapy.

3. Administer an antiemetic 1-2 hours before chemotherapy. Rationale: Pharmacologic intervention, such as administering an antiemetic, is usually necessary to control nausea and vomiting.

The patient comes to the emergency department with a blood pressure of 200/120 mmHg. The physician orders hydralazine (Apresoline) IV. What will the nurse's priority assessment include? 1. Hypotension and bradycardia 2. Hypotension and hyperthermia 3. Hypotension and tachycardia 4. Hypotension and tachypnea

3. Hypotension and tachycardia Rationale: Direct vasodilators produce reflex tachycardia, a compensatory response to the sudden decrease in blood pressure caused by the drug.

What is the nurse's priority when preparing to administer intravenous vesicant chemotherapy? 1. Notify the physician that a central line is necessary. 2. Wear gloves when drawing up the medication. 3. Know the protocol for extravasation. 4. Wear a mask when injecting the medication.

3. Know the protocol for extravasation. Rationale: Before giving this medication, the nurse must be prepared for the eventuality of extravasation by knowing the protocol and having protocol supplies available.

The nurse educator is reviewing the body's control of blood pressure. In which order will the nurse explain the steps of this process? 1. Angiotension II is produced 2. Renin acts 3. Liver produces angiotensinogen 4. Angiotension I is produced 5. Vasoconstriction occurs

3. Liver produces angiotensinogen 2. Renin acts 4. Angiotension I is produced 1. Angiotension II is produced 5. Vasocontriction occurs Rationale: The angiotensinogen produced by the liver is acted upon by renin to form angiotension I. Angiotension I is acted upon in the lung to form angiotension II. This powerfully potent vasoconstrictor results in vasoconstriction of arterioles which raises blood pressure.

The patient is receiving hydrochlorothiazide (Microzide) as well as digoxin (Lanoxin). Which lab result would the nurse recognize as most significant? 1. ALT level of 35 units/L 2. Sodium level of 140 mEq/L 3. Potassium level of 2.9 mEq/L 4. BUN level of 20 mg/dl

3. Potassium level of 2.9 mEq/L Rationale: Hypokalemia caused by hydrochlorothiazide (Microzide) may increase digoxin (Lanoxin) toxicity. The normal range for potassium is 3.5 to 5.2 mEq/L.

A hospitalized patient has been started on enalapril (Vasotec). The nurse would hold this drug and discuss which findings with the prescriber? Select all that apply. 1. Cough 2. Light-headedness on ambulation 3. Swelling around the eyes 4. Sneezing 5. Difficulty swallowing

3. Swelling around the eyes 5. Difficulty swallowing Rationale: Swelling around the eyes and difficulty swallowing may indicate angioedema, which is a serious adverse effect. Holding the drug is indicated.

The client is prescribed tamoxifen for the treatment of breast cancer. The nurse should advise the client to monitor for which adverse effect? 1. Fatigue 2. Cough 3. Vaginal discharge 4. Signs of dehydration

3. Vaginal discharge Rationale: Vaginal discharge is an expected adverse effect of tamoxifen and should be reported to the health care team.

In understanding the difference between normal cells and cancer cells, the nurse knows that cancer is the result of 1. cell division occurring extensively in normal cells. 2. cell division occurring via controlled cell division. 3. damage to genes controlling cell growth. 4. suppressor genes continuing cell growth for cell division.

3. damage to genes controlling cell growth. Rationale: Cancer is thought to result from damage to the suppressor genes controlling cell growth.

In understanding the growth fraction as it pertains to the success of chemotherapy, the nurse knows that the growth fraction is a ratio of 1. the number of replicating cells to the number of active cells. 2. the number of non-replicating cells to the active cells. 3. the number of replicating cells to the number of resting cells. 4. the number of non-replicating cells to the number of resting cells.

3. the number of replicating cells to the number of resting cells. Rationale: The growth fraction is a measure of the number of cells undergoing mitosis in a tissue. It is a ratio of the number of replicating cells to the number of resting cells.

The main mechanism of action of alkylating agents is... 1. they stimulate the body's immune system. 2. unknown. 3. they change the shape of the DNA double helix and prevent nucleic acid from completing normal cell division. 4. they disrupt metabolic pathways.

3. they change the shape of the DNA double helix and prevent nucleic acid from completing normal cell division. Rationale: Alkylation changes the shape of the DNA double helix and prevents the nucleic acid from completing normal cell division.

The nurse is taking the initial history of a patient admitted to the hospital for hypertension. The physician has ordered a beta-adrenergic blocker. Which statement by the patient does the nurse recognize as most significant? 1. "I don't handle stress well; I have a lot of diarrhea." 2. "When I have a migraine headache, I need to have the room darkened." 3. "My father died of a heart attack when he was 48-years-old." 4. "I have always had problems with my asthma."

4. "I have always had problems with my asthma." Rationale: With increased doses, beta-adrenergic blockers can slow the heart rate and cause bronchoconstriction. They should be used with caution in patients with asthma.

A nurse suspects that the IV line through which doxorubicin (Adriamycin) is infusing has infiltrated. The nurse has discontinued the IV site. What additional action should be taken? 1. No special action is necessary. 2. A warm, wet compress should be placed on the site. 3. Wash the area thoroughly with soap and water. 4. Apply ice packs to the area immediately.

4. Apply ice packs to the area immediately. Rationale: Ice packs will help to reduce the absorption of the drug.

The patient with hypertension has experienced heart failure. The nurse notes that the patient is receiving nifedipine (Procardia). What is a priority assessment for the nurse? 1. Review recent lab results for hypokalemia. 2. Assess urinary output. 3. Assess level of orientation. 4. Auscultate breath sounds for crackles.

4. Auscultate breath sounds for crackles. Rationale: Some calcium channel blockers can reduce myocardial contractility and can worsen heart failure. Crackles in the lungs can indicate pulmonary edema, which could indicate heart failure.

The patient has been recently diagnosed with hypertension. Assessment data include: Wt: 200 pounds Ht: 5' 4" Diet: Mostly starches Alcohol intake: 3 beers/week Stressors: Works 60 hours/week In planning care with this patient, what is the priority outcome? 1. Patient will eliminate alcohol from the diet. 2. Patient will decrease stress by limiting work to 40 hours/week. 3. Patient will balance diet according to the food pyramid. 4. Patient will achieve and maintain optimum weight.

4. Patient will achieve and maintain optimum weight. Rationale: Achieving and maintaining optimum weight is of greatest importance when a patient has hypertension. For obese patients, a 10 to 20 pound weight loss can produce a measurable change in blood pressure.

The client receives cyclophosphamide (Cytoxan). The nurse evaluates the client's laboratory work. Which laboratory finding would support canceling the client's next treatment with this drug? 1. Hemoglobin of 14 g/dl 2. Blood urea nitrogen of 12 mg/dl 3. WBC count of 8000 cells/mcl 4. Platelet count of 8000/mm3

4. Platelet count of 8000/mm3 Rationale: A normal platelet count is at least 150,000. The client's count is at a dangerous level, and the client is at risk for hemorrhage, so this client should not receive another treatment of cyclophosphamide until numbers have increased.

Which laboratory test would be the priority for a patient with hypertension who takes a thiazide diuretic? 1. Magnesium 2. Calcium 3. Chloride 4. Potassium

4. Potassium Rationale: Sodium and potassium are the electrolytes of most concern. A patient on thiazide diuretics should be monitored for hypokalemia.

The client receives methotrexate (Rheumatrex). The nurse assesses for side effects of this drug. Which side effects are a primary concern for the nurse? 1. Hyperglycemia and fatigue 2. Nausea and vomiting 3. Hypertension and seizures 4. Ulcerative stomatitis and diarrhea

4. Ulcerative stomatitis and diarrhea Rationale: Ulcerative stomatitis and diarrhea require suspension of therapy because they may lead to hemorrhagic enteritis and death from intestinal perforation.

The most important nursing consideration for clients receiving alkylating agents is... 1. monitoring nausea and vomiting. 2. monitoring nutritional intake. 3. monitoring skin integrity. 4. monitoring CBC with differential.

4. monitoring CBC with differential. Rationale: Blood cells are particularly sensitive to alkylating agents. Bone marrow suppression is the primary dose-limiting toxicity of the drugs in this class. If the absolute neutrophil count (ANC) obtained by reading CBC with differential falls below 500/mm3, the risk for infection increases.