Pharm Exam 3 Review Questions
During drug therapy with basiliximab, the nurse monitors for signs of cytokine release syndrome, which results in a. fever, dyspnea, and general malaise. b. neurotoxicity and peripheral neuropathy. c. hepatotoxicity with jaundice. d. thrombocytopenia with increased bleeding tendencies.
A
The current immunization for tetanus & diptheria toxoids & pertussis. Tdap, is administered to people in what age group? a. 11 years of age and older b. any age ranges c. younger than 6 years of age d. in the first 2 years of life
A
The nurse is reviewing the medication history of a patient who is taking hydroxychloroquine. However, the patient's chart does not reveal a history of malaria or travel out of the country. The patient is most likely taking this medication for what? a. systemic lupus b. roundworms c. thyroid disorders d. plasmodium
A
The nurse is teaching a pt who is taking colchicine for the treatment of gout. What will be included in the teaching? a. "Call your doctor if you have increased pain or blood in the urine" b. "Fluids should be restricted while on colchicine therapy" c. "Take colchicine with each meal of the day" d. "The drug will be discontinued when symptoms are reduced"
A
The nurse knows that antimalarial drugs are used to treat patients with infections caused by which microorganism? a. Plasmodium spp. b. Candida albicans c. Pneumocystis jirovecii d. Mycobacterium
A
What adverse effect can occur in a pt who is receiving muromonab-CD3 (Orthoclone OKT3) after an organ transplant? a. chest pain b. hypotension c. confusion d. dysuria
A
What is the priority nursing assessment to monitor when administering vaccines? a. anaphylaxis b. myalgias c. local reaction at injection site d. pain at the injection site
A
What patient finding would indicate nurse needs to hold the prescribed dose of filgrastim and notify the health care provider? a. absolute neutrophil count (ANC) count of 12,000 cells/mm3 b. Blood pressure of 142/88 mm Hg c. temperature 99.5 F d. WBC count of 4.5/mm3
A
What statement accurately described the pharmacodynamics of vaccines? a. vaccines work by stimulating the humoral immune system b. vaccines prevent the formation of antibodies against a specific antigen c. vaccines provide IgG antibodies to protect against infection d. vaccines work by suppressing the amino acid immunoglobulin sequence
A
When a patient is receiving long-term NSAID therapy, which drug may be given to prevent the serious gastrointestinal adverse effects of NSAIDs? a. misoprostol (Cytotec) b. metoprolol (Lopressor) c. metoclopramide (Reglan) d. magnesium sulfate
A
When the nurse is teaching about antigout drugs, which statement by the nurse is accurate? a. "Colchicine is best taken on an empty stomach" b. "Drink only limited amounts of fluids with the drug" c. "This drug may cause limited movements of your joints" d. "There are very few drug interactions with these medications"
A
The success of most vaccines in establishing an antigen-antibody response depends on: a. the humoral response of the immune system b. the ethnicity and ago of the patient c. sufficient levels of circulating plasma proteins d. sufficient levels of circulating polysaccharides
A A functional immune system is needed for most vaccines to be effective. The T-cell and B-cell responses are responsible for development of antibodies in response to an antigen (the vaccine)
When teaching a patient about potential adverse effects of NSAID therapy, the nurse will teach the patient to immediately notify the health care provider of what effect? a. black tarry stools b. nonnproductive cough c. diarrhea d. mild indigestion
A A major adverse effect of NSAID therapy is gastrointestinal (GI) distress with potential GI bleeding. Black tarry stools are indicative of a GI bleed
Oral poliovirus vaccine (OPV) is no longer used because of the risk for: a. vaccine-associated paralysis b. fever and chills c. encephalopathy d. meningitis
A Although rare, OPV has caused a vaccine-associate paralytic poliomyelitis (VAPP). The severity of the illness is similar to that of paralytic poliomyelitis caused by the wild-type virus. In the Western hemisphere, where wild-type poliomyelitis has been eliminated, the risk of getting polio from OPV now exceeds the risk of getting the disease from the wild-type virus
A 5-year-old receives the DTaP series. How long should the child have adequate antibody levels against the organisms that cause tetanus, diptheria, and pertussis? a. 10 years b. 2 years c. 5 years d. 20 years
A Antibody levels begin to wane 10 years after administration of the vaccine, which is why a tetanus-diphtheria (Td) booster is recommended every 10 years. Pertussis is not routinely administered after age 7, which is why a different vaccine is used
Which synthetic agent replaces a substance secreted by healthy kidneys that stimulates the production of red blood cells (RBCs)? a. epoetin alfa (Epogen) b. oprelvekin (Neumega) c. Sargramostim (Leukine) d. darbepoetin alfa (Aranesp)
A Epoetin alfa replaces erythropoietin in patients with chronic renal failure to stimulate the production of RBCs because dysfunctional kidneys secrete insufficient erythropoietin to maintain adequate supply of RBCs. Sargramostim is a granulocyte colony - stimulating factor used to increase the production of granulocytes, monocytes, and macrophages. Darbepoetin alfa is a long-acting form of erythropoietin. Oprelvekin is a synthetic interleukin-1 used to increase the production of platelets
The patient is being treated with the drug fingolimod. The nurse would expect the patient to be diagnosed with what condition a. multiple sclerosis (MS) b. Guillain-Barre syndrome c. parkinson's disease d. amyotrophic lateral sclerosis
A Fingolimod is an immunosuppressant drug indicated for MS. It is the only oral drug for relapsing forms of MS. It has significant adverse effects, including headache, hepatotoxicity, flulike symptoms, back pain, atrioventricular block, bradycardia, hypertension, and macular edema
Which potential therapeutic effect of a synthetic interleukin renders these agents well suited for antineoplastic therapy? a. increases the count of lymphokine-activated killer cells b. increases the production of immunoglobulins c. promotes the growth and differentiation of T cells d. increases the synthesis and secretion of cytokines
A Interleukins have antitumor action, binding to T cells and increasing the number of lymphokine-activated killer cells, which, destroy cancer cells. Interleukins act in many other ways, including increasing the production of antibodies, increasing the synthesis of cytokines, and promoting the growth and differentiation of all T cells
The nurse would question a prescription to administer misoprostol to a patient with what condition? a. pregnancy b. peptic ulcer c. chronic obstructive pulmonary disease d. gastroesophageal reflux disease
A Misoprostol is an abortifacient and thus is contraindicated in pregnancy
Administration of monoclonal antibodies is difficult because of which fact about these medications? a. they are likely to cause a severe hypersensitivity reaction b. they are involved with host T-lymphocyte function c. they are hepatic enzyme inducers that increase metabolism d. they are known to suppress bone marrow function
A Monoclonal antibodies are difficult to administer because they are more likely than nonantibody immunosuppressants to cause a severe hypersensitivity reaction. The allergic reaction may result in cytokine-release syndrome-which involves fever, dyspnea, tachycardia, and other clinical indicators-and in circulatory collapse
Which immunosuppressant acts at the binding sites on T-lymphocytes to reverse kidney rejection? a. Muromonab-CD3 (Orthoclone OKT3) b. Glatiramer acetate (Copaxone) c. Basiliximab (Simulect) d. Cyclosporine (Sandimmune)
A Muromonab-CD3, the only medication indicated to reverse kidney transplant rejection, acts by targeting the binding sites on T lymphocytes that recognize the foreign cells. Cyclosporine inhibits the production and release of interleukin-2. Basiliximab inhibits the binding of the cytokine mediator interleukin-2 (IL-2) to the high affinity IL-2 receptor. Glatiramir is thought to act by blocking T-cell autoimmune function.
A patient with lung cancer received paclitaxel yesterday. Before the patient can receive filgrastim, which patient assessment finding must the nurse observe? a. 24 hours elapsed since chemotherapy b. pan-cultures revealing no growth c. absolute neutrophil count of 1100/mm3 d. core temperature 97.5 F
A The patient receives paclitaxel because it is indicated in the treatment of lung cancer; however, because the drug is associated with severe neutropenia, filgrastim is also indicated for this patient. To receive filgrastim, the patient should be free of infection. The patient cannot receive this drug within 24 hours of chemotherapy, so the nurse must ensure that 24 hours has passed since the patient last received chemotherapy before administering it. A temperature of 97.5 F is a nonsensitive and nonspecific indicator that the patient is free of infection, and pan-cultures (cultures from multiple sites obtained at the same time) may need additional time before microbial growth is revealed. Generally, patients do not receive filgrastim when absolute neutrophil count exceeds 1000/mm3
What is the priority nursing assessment to monitor when administering vaccinations? a. anaphylaxis b. myalgias c. pain at the injection site d. local reaction at injection site
A anaphylaxis is a potential life-threatening adverse reaction to vaccines. pain, local reaction, and myalgias can occur but are not life threatening
What is an advantage of COX-2 inhibitors over other NSAIDs? a. maintain GI mucosa b. rapid onset of action c. less likely to cause hepatic toxicity d. longer duration of action
A by not inhibiting the COX-1 enzyme to maintain an intact gastric mucosal barrier by increasing secretion of mucus, the risks of GI adverse effects are decreased
What is the general action of immunosuppressants in organ transplant? a. they inhibit T-lymphocytes b. they increase antibody response c. they reduce hepatic metabolism of steroids d. they increase natural killer cellular activity
A immunosuppressants inhibit T-lymphocyte synthesis, thus preventing an immune response to organ transplants
The nurse recognizes that manifestations of nonsalicylate NSAID toxicity include which of these? Select the 3 that apply a. nausea and vomiting b. drowsiness c. numbness d. urinary retention e. constipation
A, B, C
The anthrax vaccine is recommended for what groups of people? (Select all that apply) a. workers who process imported animal hair b. veterinarians c. military personnel d. emergency department health care providers
A, B, C People at risk for exposure to the anthrax bacterium include military personnel, veterinarians, and workers who process imported animal hair
Before administration of an immunosuppressant drug, the nurse would perform what action? (Select all that apply) a. check blood urea nitrogen and creatinine levels b. assess level of consciousness c. assess blood pressure and heart rate d. measure abdominal girth e. check liver enzyme tests
A, B, C, E serious adverse effects to immunosuppressant drugs include neurotoxicity, nephrotoxicity, hepatotoxicity, and hypertension
Which of the following information should be included by the nurse documenting the administration of a vaccine in a patient's record? Select all that apply a. route and site of administration b. vaccine lot number c. signature and title of person administering the vaccine d. vaccine type e. date and expiration of vaccination f. dosage administration g. vaccine manufacturer h. physician's name
A, B, C, E, F, G
The nurse is reviewing the medical history of a patient who is about to receive therapy with etanercept (Enbrel). Which conditions, if present, would be a contraindication or caution for therapy with this drug? Select the 3 that apply a. latex allergy b. psoriasis c. heart failure d. glaucoma e. urinary tract infection
A, B, E
The acetic acid derivative indomethacin has what properties? (Select all that apply) a. antipyretic b. antinausea c. anticonvulsant d. antiinflammatory e. antirheumatic
A, D, E NSAIDs are known for their antiinflammatory effects. Indomethacin, in addition, is also used for its antirheumatic and antipyretic properties. NSAIDs are often known to have nausea as a common adverse effect. Indomethacin is not used as an anticonvulsant
Which effects of interferon (IFN) alfa-2b (Intron-A) are important in the treatment of hairy cell leukemia? (Select all that apply) a. increased activity of other immune cells b. increased production of antiviral enzymes c. inhibition of dysfunctional immune system d. inhibition of DNA synthesis in leukemia cells e. increased expression of leukemia antigens f. increased cytotoxic action of killer T cells
A, D, E, F In cancer therapy, IFNs are used to restore immune function and boost the immune system's capacity to defend the body. More specifically, IFNs prevent cancer cells from dividing, increase the activity of other immune system cells, inhibit DNA and protein synthesis in cancer cells, increase activity of cytotoxic T cells and phagocytosis of macrophages, and enhance antigen expression on cancer cells to increase their recognition by the immune system. IFNs are used to inhibit a dysfunctional immune system in the treatment of autoimmune diseases as a means of halting the immune system's destruction. IFNs are also used to protect the body against attack in virus-mediated diseases, including hepatitis C
During therapy with azathioprine (Imuran), the nurse must monitor for which adverse effects? (Select all that apply) a. Liver toxicity b. diarrhea c. vomiting d. bradycardia e. thrombocytopenia
A, E
When assessing a patient who is to begin therapy with an immunosuppressant drug, the nurse recognizes that such drugs should be used cautiously in patients with which condition(s)? (Select all that apply) a. pregnancy b. glaucoma c. anemia d. myalgia e. renal failure f. liver failure
A, E, F
During a teaching session about antigout drugs, the nurse tells the patient that antigout drugs work by which mechanism? a. increasing protein and rheumatoid factors b. decreasing serum uric acid levels c. increasing blood oxygen levels d. decreasing leukocytes and platelets
B
What condition needs cautious use when on abatacept (Orencia) for tx of severe rheumatoid arthritis? a. coronary artery disease b. chronic obstructive pulmonary disease c. diabetes mellitus d. hypertension
B
What is the general action of immunosuppressants? a. They reduce hepatic metabolism of steroids b. they inhibit T-lymphocytes c. they increase natural killer cellular activity d. they increase antibody response
B
What teaching would the nurse provide to a patient receiving tetanus toxoid? a. "Increase fluid and fiber in your diet to prevent constipation." b. "Soreness at the injection site is a common reaction" c. "This medication must be repeated weekly for 4 weeks" d. "You will have lifetime immunity from this injection"
B
When a patient is receiving long-term NSAID therapy, which drug may be given to prevent the serious gastrointestinal adverse effects? a. metoprolol (Lopressor) b. misoprostol (Cytotec) c. magnesium sulfate d. metoclopramide (Reglan)
B
Which antimalarial drug is also used in the treatment of lupus? a. quinine b. hydroxychloroquine (Plaquenil) c. mefloquine (Larimn) d. pyrimethamine (Daraprim)
B
Which teaching point would be appropriate to include when the nurse is informing a patient about the adverse effects of antimalarials? a. The skin may turn blotchy while these medications are taken b. These medications may cause anorexia and abdominal distress c. These medications may cause increased urinary output d. The patient may experience periods of diaphoresis and chills
B
Which teaching point would be appropriate to include when the nurse is informing a patient about the adverse effects of antimalarials? a. these medications may cause increased urinary output b. these medications may cause anorexia and abdominal distress c. the patient may experience periods of diaphoresis and chills d. the skin may turn blotchy while these medications are taken
B
While assessing a patient who is to receive muromonab-CD3, the nurse knows that which condition would be a contraindication for this drug? a. acute myalgia b. fluid overload c. polycythemia d. diabetes mellitus
B
A patient is receiving immunosuppressant therapy with muromonab-CD3 (Orthoclone OKT3) after a liver transplant. Which adverse effect of muromonab-CD3 makes it difficult for the nurse to monitor the patient for infection? a. nausea, vomiting b. fever and chills c. leukopenia d. fluid retention
B Administration of muromonab-CD3 is likely to cause fever and chills in the patient and makes early detection of infection more difficult because fever and chills are clinical indicators of infection. Instead, the nurse should review the leukocyte count because muromonab-CD3 is not associated with leukopenia, which is a potential indicator of infection. Fluid retention, nausea, and vomiting are adverse effects of muromonab-CD3, but they are not indicators of infection
Which medication is representative of the type of biologic response -- modifying drug that targets cancer cells specifically? a. denileukin diftitox (Ontak) b. Alemtuzumab (Campath) c. Interferon (IFN) alfa-2b (Intron-A) d. darbepoetin alfa (Aranesp)
B Alemtuzumab, indicated in the treatment of chronic lymphocytic leukemia, is a monoclonal antibody that targets leukemia cells specifically. Darbepoetin alfa is a long-acting human recombinant hormone analog of erythropoietin that increases stem cell production of reticulocytes but has no effect on cancer cells. Denileukin diftitox is an interleukin used in the treatment of cutaneous T-cell lymphona that stimulates the immune system to increase production and activity of T cella, cytokines, and antibodies to enhance the immune response; however, its activity is directed at immune system function and not cancer cell. IFN alfa-2b is a synthetic cytokine that also exerts general immune system actions; IFNs direct the action and communication of cell-mediated and humorally mediated immune functions and enhance the action of the immune system in general
The nurse would question a prescription to administer acetylsalicylic acid to what patient? a. 18-year-old patient with a history of sports injury b. 7-year-old patient with a history of flulike symptoms c. 42-year-old patient with a history of stroke d. 35-year-old patient with a history of heart attack
B Aspirin should never be administered to children with flulike symptoms. The use of aspirin in children with flulike symptoms has been associated with Reye's syndrome
The nurse is administering probenecid to a patient with recurrent strep throat. The nurse teaches the patient that the reason for taking this medication is for what drug effect? a. inhibit bacterial growth replication b. prolong the effectiveness of penicillin therapy c. prevent the occurrence of gout d. increase uric acid excretion
B Besides its use for the treatment of the hyperuricemia associated with gout and gouty arthritis, probenecid also has the ability to delay the renal excretion of penicillin, thus increasing serum levels of penicillin and prolonging its effect
What nursing diagnosis is appropriate for a patient prescribed colchicine? a. constipation related to adverse effect of the medication b. risk for fluid volume deficient related to nausea, vomiting, and diarrhea c. risk for injury related to adverse effect of life-threatening seizures d. risk for infection related to medication-induced leukocytosis
B Colchicine is administered on an hourly basis until pain is relieved, the patient develops severe nausea and diarrhea, or the maximum dose (6 mg) has bee administered. Bleeding into the GI or urinary tracts is a potential serious adverse effect of colchicine
The nurse is educating a patient with gout. The nurse explains the action of colchicine to the patient. What statement is accurate in discussing the therapeutic action of the medication? a. decreases production of lactic acid b. decreases mobility of leukocytes c. increases process of phagocytosis d. increases uric acid metabolism
B Colchicine works by inhibiting the metabolism and migration of leukocytes into joints affected by gout, thus resulting in decreased inflammation
An allergy to what substance is a contraindication to the administration of an immunizing drug? a. soy b. egg c. corn d. wheat
B Contraindications to the administration of immunizing drugs include allergy to the immunization itself or allergy to any of its components, such as eggs or yeast
The current immunization for tetanus and diphtheria toxoids and pertussis, Tdap, is administered to people in what age range? a. In the first 2 years of life b. 11 years of age and older c. younger than 6 years of age d. any age range
B Currently, DTap is the preferred preparation for primary and booster immunization against these diseases in children from 6 weeks to 6 years of age unless use of pertussis component is contraindicated. Tdap is the recommended vaccine for adolescents and adults, those over the age of 11 years
A patient is prescribed monoclonal antibody therapy for the treatment of rheumatoid arthritis. What patient condition would alert the nurse to question the prescription for this class of drugs? a. hypersensitive emergency b. acquired immune deficiency syndrome (AIDS) c. chronic obstructive pulmonary disease d. nephrotic syndrome
B Monoclonal antibody drugs are usually contraindicated in patients with known active infectious processes because of their immunosuppressive qualities. Use of alemtuzumab is also contraindicated in patients with active systemic infections and immunodeficiency conditions, including AIDS
The drug mycophenolate has a black box warning because for what potential adverse effect? a. abnormal heart rhythms b. congenital malformations c. hypertension d. suicidal ideations
B Mycophenolate is an antimetabolite and suppresses T cell proliferation. It is indicated for the prevention of organ rejection as well as the treatment of organ rejection. Mycophenolate has a black box warning from the U.S. Food and Drug Administration stating that it is associated with an increased risk of congenital malformations and spontaneous abortions when used during pregnancy
The varicella vaccine produces antibodies in ____ of the children under the age of 12 who receive the vaccine. a. 72% b. 97% c. 25% d. 50%
B Ninety-seven percent of children under the age of 12 develop antibodies when given the varicella vaccine. However, complete protection against chickenpox develops in only 85% to 96% of vaccines. Among the 4% to 15% who get chickenpox despite vaccination, the symptoms are always mild
The nurse anticipates a patient with low platelets will be prescribed what drug to stimulate platelet production? a. epoetin b. Oprelvekin c. Aldesleukin d. Interferon beta-1a
B Oprelvekin stimulates the production of platelets. Epoetin stimulates the production of red blood cells (RBCs) in the bone marrow. Interleukins (aldesleukin) and interferons activate the immune system but do not increase production of white blood cells (WBCs)
The nurse administers cyclosporine (Sandimmune) to a patient who has undergone a heart transplantation. What is the nurse's priority patient assessment at the beginning of the infusion? a. white blood cell count b. presence of flushing or rash c. alanine aminotransferase d. urine discoloration
B Preventing or limiting a hypersensitivity reaction can jeopardize the heart transplant by precipitating an undesirable inflammatory response. The nurse observes the patient closely during the initial 30 minutes of the cyclosporine infusion as a means of facilitating early detection of clinical indicators of hypersensitivity, including flushing, rash, wheezing, and dyspnea. Monitoring the appearance of the urine, leukocytes, and liver enzymes are reasonable nursing interventions for a patient receiving cyclosporine; however, these parameters are unlikely to change in the first 30 minutes of the infusion and do not indicate that a hypersensitivity reaction is occuring
What is the mechanism of action of nonsteroidal antiinflammatory drugs (NSAIDs)? a. increasing blood flow to painful areas b. inhibiting prostaglandin production c. enhancing pain perception d. increasing the supply of natural endorphins
B Prostaglandins are produced in response to activation of the arachidonic pathway. NSAIDs work by blocking cyclooxygenase (COX-1 and COX-2), the enzyme responsible for conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation
After the administration of denileukin diftitox (Ontak), a patient who had no contraindications to therapy experiences dyspnea and edema. Which parameter should the nurse assess to determine the cause of these adverse effects? a. urine output b. serum albumin c. blood pressure d. fluid balance
B The nurse checks the serum albumin level because denileukin diftitox is associated with hypoalbuminemia. Hypoalbuminemia is the most likely cause of the patient's dypsnea and edema; with low serum albumin level, the oncotic pressure of the intravascular fluid decreases, allowing fluid to escape into the interstitial spaces in the lungs and periphery. Urine output is related to fluid balance and renal function, but hypovolemia is not the patient's problem. Because of low oncotic pressure and the loss of intravascular volume, the patient's blood pressure may fall; however, this is a result of hypoalbuminemia and not a cause of it
The nurse assesses a patient before liver-transplant surgery. After transplantation, the patient will receive tacrolimus (Prograf). Which preoperative assessment is the nurse's priority to help prevent graft rejection? a. cardiovascular function b. mental status examination c. indicators of infection d. renal function
B The nurse's priority patient assessment in the preoperative period is the mental status examination because tacrolimus can cause agitation, anxiety, confusion, and hallucinations. Should such side effects occur, the patient is more likely to have difficulty adhering to a complex post-transplant pharmacotherapeutic regimen. Having baseline data for comparison will enable the nurse to determine the patient's ability to adhere to therapy and garner the support necessary for patient adherence to the therapeutic regimen in the post-transplant period. Renal function is a suitable set of baseline data with which to evaluate kidney transplant rejection. Indicators of infection and cardiovascular status are reasonable assessments before any tissue transplant. Liver rejection is manifested in part as altered liver enzymes
The nurse would teach a patient prescribed cyclosporine to avoid what substance? a. chocolate milk b. grapefruit juice c. acetaminophen d. sunscreen
B patients should avoid consuming grapefruit or grapefruit juice because they will increase the blood concentrations of cyclosporine. sunscreen should be used to avoid photosensitivity, and the medication should be taken with food or chocolate milk to prevent gastrointestinal upset
The nurse recognizes that manifestations of nonsalicylate NSAID toxicity include which of these? (Select all that apply) a. constipation b. nausea and vomiting c. numbness d. drowsiness e. urinary retention
B, C, D
When educating a patient about immunosuppressant therapy, what information would the nurse include in the teaching? (Select all that apply) a. "If you miss a dose of medication, take extra medicine to make up for the missed dose." b. "Never stop taking these medications without being instructed by your health care provider." c. "Medications must be taken at the correct time every time to avoid interactions." d. "You must take all medications exactly as prescribed." e. "Over-the-counter medications are alright to take as needed"
B, C, D Immunosuppressants must be taken exactly as directed and at the exact times and with the exact foods. Adherence to dosing schedules can be very difficult for patients because they are taking multiple medications that must be taken at different times throughout the day. Patients should never stop taking their immunosuppressants without being told to do so by their transplant health care provider. They should always talk to the transplant health care provider before taking any over-the-counter medications or if a scheduled dose is missed
What is the mechanism of action of biologic response-modifying drugs? (Select all that apply) a. regulation of gene expression that occurs during transcription b. enhancement or restoration of the host's immune system defenses against a tumor c. direct toxic effect on tumor cells, causing them to rupture d. adverse modification of a tumor's biology, making it harder for the tumor cells to survive and reproduce e. Interruption of the cell lifecycle at the genetic level to interfere with growth of the cancer cell
B, C, D In terms of their activity against cancer cells, biologic response-modifying drugs work by one of three mechanisms: (1) enhancement or restoration of the host's immune system defenses against the tumor; (2) direct toxic effect on the tumor cells, which causes them to lyse, or rupture; or (3) adverse modification of the tumor's biology, which makes it harder for the tumor cells to survive and reproduce. This class does not interrupt any genetic level of cell replication
A mother calls the clinic to ask what medication to give her 5-year-old child for a fever during a bout of chickenpox. The nurse's best response would be: a. "Your child is 5 years old, so it would be okay to use children's aspirin to treat his fever." b. "Start with acetaminophen or ibuprofen, but if these do not work, then you can try aspirin." c. "You can use children's dosages of acetaminophen or ibuprofen, but aspirin is not recommended." d. "It is best to wait to let the fever break on its own without medication."
C
During a teaching session for a patient receiving an immunosuppressant drug, the nurse will include which statement? a. "It is better to use oral forms of these drugs to prevent the occurrence of thrush." b. "You will remain on antibiotics to prevent infections." c. "It is important to use some form of contraception during treatment and for up to 12 weeks after the end of therapy." d. "Be sure to take your medications with grapefruit juice to increase absorption."
C
The nurse is reviewing cyclosporine and recognizes that this drug works by which mechanism of action? a. suppressing viral replication b. enhancing the action of macrophages c. inhibiting activation of T-lymphocyte cells d. increasing the number of T-lymphocyte cells
C
The nurse would teach a patient prescribed cyclosporine to avoid which substance? A. Sunscreen B. Chocolate milk C. Grapefruit juice D. Acetaminophen
C
What teaching would the nurse provide to a patient receiving tetanus toxoid? a. "this medication must be repeated weekly for 4 weeks" b. "increase fluid and fiber in your diet to prevent constipation" c. "Soreness at the injection site is a common reaction" d. "You will have lifetime immunity from this injection"
C
When monitoring a patient on immunosuppressant therapy with azathiprine (Imuran), the nurse will monitor which lab? a. red blood cell count b. serum albumin levels c. white blood cell count d. serum potassium levels
C
What condition is not an anticipated adverse effect of azathiprine? a. thrombocytopenia b. hypatotoxicity c. alopecia d. leukopenia
C Alopecia (hair loss) is not an expected adverse effect. Common adverse effects of azathioprine include leukopenia, thrombocytopenia, and hepatotoxicity
What is the relationship between aldesleukin (Proleukin) and capillary leak syndrom? a. systemic manifestation of latent cardiovascular disease b. induced by patient hypersensitivity to escherichia coli c. systemic manifestation of the inflammatory response d. induced by insufficient serum albumin and globulin
C Capillary leak syndrome is associated with aldesleukin therapy because synthetic interleukins mimic the action of endogenous lymphokines, and endogenous lymphokines are chemical mediators in inflammation. When aldesleukin is administered IV, its inflammatory effects are manifested systemically, accounting for the severe toxicity associated with its use. The toxic effects of aldesleukin may appear in a constellation of clinical indicators called capillary lead syndrome, wherein capillaries become permeable to serum proteins, leading to massive fluid overload and diffuse edema, respiratory distress, heart failure, and other life-threatening effects
Which medication should the nurse avoid administering to a patient receiving cyclosporine (Sandimmune) to prevent a reduction in the effectiveness of the cyclosporine? a. digoxin (Lanoxin) b. furosemide (Lasix) c. phenytoin (Dilantin) d. ampicillin (Principen)
C Concurrent administration of cyclosporine and phenytoin can result in decreased effectiveness of cyclosporine because phenytoin induces production of the enzymes used to metabolize cyclosporine
What vaccination is marketed and recommended in the prevention of a virus that is known to cause cervical cancer? a. Herpes zoster vaccine (Zostavax) b. Hepatitis B virus vaccine (Recombivax HB) c. Papillomavirus vaccine (Gardasil) d. Pneumococcal vaccine (Prevnar 13)
C Human papillomavirus (HPV) is a common cause of genital warts and cervical cancer. The HPV vaccine (Gardasil, Cervarix) is the first and only vaccine known to prevent cancer
The nurse would anticipate administering what medication to a patient in acute organ rejection? a. azathioprine b. sirolimus c. muromonab-CD3 d. basiliximab
C Only muromonab-CD3 (Orthroclone OKT3) is used to treat acute organ rejection. The other immunosuppressants are used to prevent organ rejection
A nurse teaching a patient receiving allopurinol would include what information? a. "Take the medication with an antacid to minimize GI distress" b. "Include salmon and organ meats in your diet on a weekly basis c. "Increase your fluid intake to 3 L per day" d. "This medication may cause your urine to turn orange"
C Patients taking allopurinol should be informed to increase fluid intake to 3 L per day, avoid hazardous activities if dizziness or drowsiness occurs with the medication, and avoid the use of alcohol and caffeine because these drugs will increase uric acid levels and decrease the levels of allopurinol
At what age should a child receive the first dose of the Haemophilus influenzae type B (HiB) vaccine? a. 4 months b. 6 months c. 2 months d. 15 months
C The HiB vaccine if first administered at the age of 2 months. The remaining doses are given at 4 months, 6 months, and at 12 to 16 months of age
A child undergoing a routine physical examination is due for the second in the series of measles, mumps, rubella (MMR) vaccinations. The nurse would plan to administer this vaccine by way of which of the following routes? a. oral b. intramuscular c. subcutaneously d. intradermal
C The MMR is given subcutaneously. DTaP, HiB, and hepatitis B vaccines are given intramuscularly
What are the functional cells of the humoral immune system that mature into immunoglobulins? a. granulocytes b. T cells c. B cells d. RBCs
C The functional cells of the humoral immune system are the B lymphocytes. When an antigen binds to receptors located on the B cells, a biochemical signal is sent to the B lymphocytes. These B cells then mature or differentiate into plasma cells, which in turn produce antibodies
Which of the following choices is a true contraindication to the administration of a childhood vaccination? a. convalescent phase of a viral illness b. mild to moderate local skin reaction following a dose of an injectable vaccine c. moderate or severe illness with or without a fever d. diarrhea
C The other three choices are often incorrectly regarded as contraindications to vaccination. Only moderate or severe illness (with or without a fever) and anaphylaxis in response to a vaccine or its ingredients are true contraindications
The patient asks the nurse about the use of herbal and dietary supplements to treat arthritis pain. What is the appropriate response by the nurse? a. "Ginko biloba has shown tremendous benefit as an antiinflammatory drug and is used to treat symptoms of pain" b. "High doses of vitamins and minerals have been used for many years to help maintain joint health." c. "There is evidence that glucosamine sulfate with chondroitin does decrease joint stiffness and pain. Discuss this with you health care provider." d. "There really are no safe herbal treatments for pain. Your best action would be to take your prescription medications."
C There is evidence that patients would benefit from glucosamine sulfate and chondroitin supplements to decrease the pain of osteoarthritis. However, they should always be used in consultation with a health care provider
What statement accurately describes the pharmacodynamics of vaccines? a. vaccines prevent the formation of antibodies against a specific antigen b. vaccines provide IgG antibodies to protect against infection c. vaccines work by stimulating the humoral immune system d. vaccines work by suppressing the amino acid immunoglobulin sequence
C Vaccines work by stimulating the humoral immune system, which synthesizes immunoglobulins. They also stimulate the formation of antibodies against their specific antigen, providing active immunity
The nurse is administering methotrexate as part of treatment for a patient with rheumatoid arthritis and will monitor for which signs of bone marrow suppression? Select the 2 that apply a. edema b. chills c. fever d. tinnitus e. increased bruising f. tingling in the extremities
C, E
A 72 yo pt is to get a pneumococcal vaccine, (pneumovax 23). The nurse recognizes that which statement is true? a. The patient will have to return for 2 additional injections b. it is given yearly to protect against current strains of pneumonia c. it is given in 2 separate doses d. it is given by IM injection
D
A patient has a new order for glatiramer acetate. The patient has not had an organ transplant. The nurse knows that the patient is receiving this drug for which condition? a. psoriasis b. rheumatoid arthritis c. irritable bowel syndrome d. relapse-remitting multiple sclerosis
D
A patient takes the monoclonal antibody adalimumab (Humira). Besides a hx of cancer, what else can this treat? a. osteoporosis b. thrombocytopenia c. severe anemia d. rheumatoid arthritis
D
Antimalarial drugs have many adverse effects. Which of the following categories is the group of primary adverse effects? a. cardiac b. hives and headaches c. respiratory d. gastrointestinal
D
During a teaching session about antigout drugs, the nurse tells the patient that antigout drugs work by which mechanism? a. increasing blood oxygen levels b. decreasing leukocytes and platelets c. increasing protein and rheumatoid factors d. decreasing serum uric acid levels
D
The nurse is reviewing the medication history of a patient who is taking hydroxychloroquine. However, the patient's chart does not reveal a history of malaria or travel out of the country. The patient is most likely taking this medication for: a. Plasmodium b. thyroid disorders c. roundworms d. rheumatoid arthritis
D
What additional drug is administered to minimize adverse reactions to monoclonal antibodies? a. a benzodiazepine b. an opioid pain reliever c. an NSAID d. a corticosteroid
D
When the nurse is teaching about antigout drugs, which statement by the nurse is accurate? a. "Drink only limited amounts of fluids with the drug." b. "This drug may cause limited movements of your joints." c. "There are very few drug interactions with these medications." d. "Colchicine is best taken on an empty stomach."
D
What cells are activated by aldesleukin, interleukin-2? a. neutrophils b. RBCs c. undifferentiated cells d. T cells
D Aldesleukin enhances the immune system by stimulating the production and activity of T cells
A patient is undergoing therapy to prevent rejection of a transplanted kidney. Use of which combination of immunosuppressant agents is most likely to permit a reduction in the dosage of one of the two medications? a. azathioprine and lisinopril b. cyclosporine and phenobarbital c. mycophenolate and calcium carbonate d. cyclosporine and sirolimus
D Concurrent administration of cyclosporine and sirolimus increases the serum level of sirolimus, so the dosage dosage may be reduced while retaining the same therapeutic effect. Lisinopril with azathioprine has an additive effect that can result in leukopenia. The combination of cyclosporine and phenobarbital increases the metabolism of cyclosporine, reducing both the serum level and the effectiveness of cyclosporine. Antacids reduce the absorption of mycophenolate, so if antacids must be administered with mycophenolate, the nurse must administer mycophenolate 1 hour before or 2 hours after an antacid
What vaccination was developed to prevent bacterial meningitis caused by Haemophilus influenzae? a. Hepatitis B vaccine b. Gardasil c. Prevnar d. Hib conjugate vaccine
D H. influenzae type b (HibTITER, ActHIB, Liquid PedvaxHBI) vaccine is a noninfectious, baceria-derived vaccine. Before this vaccine was developed, infecions caused by Hib were the leading cause of bacterial meningitis in children 3 months to 5 years of age
Before administering an intravenous (IV) injection of basiliximab, the nurse would anticipate giving what medication? a. diphenhydramine b. acetaminophen c. meperidine d. methylprednisolone
D IV methylprednisolone is administered before basiliximab injection to prevent or minimize acute allergic-type reactions associated with this medication
A patient is starting therapy with adalimumab (Humira) after a course of therapy with methotrexate (Trexall) failed to improve the patient's condition. The nurse recognizes that this patient is being treated for which condition? a. multiple sclerosis b. advanced stage cancer c. systemic lupus erythematosus d. severe rheumatoid arthritis
D The recommended therapy usually begins with methotrexate for rheumatoid arthritis (RA). Adalimumab (Humira) is indicated for the treatment of severe, progressive RA for which other RA therapies have failed
Administration of what substance provides passive immunity? a. toxoids b. antitoxins c. vaccines d. immunoglobulins
D immunoglobulins provide passive immunity by giving the patient substances to fight specific antigens. Vaccines, antitoxins, and toxoids provide active immunity by stimulating the humoral immune system
What NSAID would the nurse anticipate administering parenterally for the treatment of acute postoperative pain? a. Indomethacin b. diclofenac c. allopurinol d. ketorolac
D ketorolac can be administered by injection (intramuscularly or intravenously) and is indicated for the short-term treatment of moderate to severe acute pain
Which immunosuppressant(s) can induce a constellation of symptoms that includes tachycardia, dyspnea, diarrhea, and joint pain? (Select all that apply) a. cyclosporine (Sandimmune) b. mycophenolate mofetil (Cellcept) c. tacrolimus (Prograf) d. muromonab-CD3 (Orthoclone OKT3) e. daclizumab (Zenapax) f. Basiliximab (Simulect)
D, E, F Daclizumab, basiliximab, and muromonab-CD3 can cause cytokine-release syndrome, characterized by tachycardia, dyspnea, diarrhea, and joint pain. Tacrolimus causes adverse neurologic and renal effects; azathioprine causes adverse hematologic and hepatic effects; and cyclosporine causes adverse cardiovascular, neurologic, hepatic, and renal effects
The nurse would teach the patient about what expected adverse effect of filgrastim? a. bone pain b. constipation c. insomnia d. hypotension
Filgrastim increases the production of WBCs in the bone marrow, triggering the common adverse effect of bone pain
8. The nurse notes in a patient's medication history that the patient is taking natalizumab (Tysabri). Based on this finding, the nurse interprets that the patient has which disorder? a. multiple sclerosis b. rheumatoid arthritis c. Non-Hodgkin lymphona d. Crohn's disease
a
A 49-year-old patient has been admitted with possible chronic salicylate intoxication after self-treatment for arthritis pain. The nurse will assess for which symptoms of salicylate intoxication? (Select all that apply). a. tinnitus b. headache c. constipation d. nausea e. bradycardia
a, b, d
The nurse is reviewing the medical history of a patient who is about to receive therapy with etanaercept (Enbrel). Which conditions, if present, would be a contraindication or caution for therapy with this drug? (Select all that apply) a. urinary tract infection b. psoriasis c. heart failure d. glaucoma e. latex allergy
a, c, e
During a routine checkup, a 72-year-old patient is advised to receive an influenza vaccine injection. He questions this, saying "I had one last year. Why do I need another one?" What is the nurse's best response? a. "The effectiveness of the vaccine wears off after 6 months." b. "Each year a new vaccine is developed based on the flu strains that are likely to be in circulation." c. "When you reach 65 years of age, you need boosters on an annual basis." d. "Taking the flu vaccine each year allows you to build your immunity to a higher level each time."
b
When assessing a patient who will be receiving a measles vaccine, the nurse will assess for which contraindication(s)? (Select all that apply) a. anemia b. pregnancy c. ear infection d. neomycin allergy e. latex allergy
b, d
A 28-year-old patient is in the urgent care center after stepping on a rusty tent nail with her bare feet. The nurse evaluated the patient's immunity status and notes that the patient thinks she had her last tetanus booster about 10 years ago, just before starting college. Which immunization would be most appropriate at this time? a. Immunoglobulin intravenous (Gammar-P IV) b. DTaP (Daptacel) (diphtheria, tetanus, and acellular pertussis) c. Tdap (Adacel) (diphtheria, tetanus, and acellular pertussis) d. No immunizations are necessary at this time
c
The nurse is reviewing a patient's medication list during a preoperative visit. The patient is scheduled for diagnostic laparoscopy in 2 weeks. He asks the nurse, "I hope I can continue the Motrin, because I really ache if I don't take it. It's just minor surgery, right?" What is the nurse's best response? a. "You can continue to take it as the laparoscopy is considered minor surgery." b. "You will need to take a lower dosage during the preoperative period." c. "I'll check with you prescriber, but this drug is usually stopped a week before the surgery because it can cause increased bleeding tendencies." d. "You can switch to aspirin before the surgery; both aspirin and Motrin are over-the-counter pain relievers,"
c
When giving a vaccination to an infant, the nurse should tell the mother to expect which adverse effect? a. Fever over 101° F (38.3° C) b. Rash c. Soreness at the injection site d. Chills
c
The nurse is administering methotrexate as part of treatment for a patient with rheumatoid arthritis and will monitor for which signs of bone marrow suppression? Select all that apply a. edema b. tinnitus c. increased bruising d. tingling in the extremities e. fever f. chills
c, e, f
The nurse is providing teaching after an adult receives a booster immunization. Which adverse reactions will the nurse immediately report to the health care provider? (Select all that apply) a. swelling and redness at the injection site b. fever of 100F (37.8 C) c. joint pain d. heat over the injection site e. rash over the arms, back, and chest f. shortness of breath
c, e, f
An animal control officer was bitten by a stray dog that showed signs of rabies. Which statement by the nurse is correct regarding the treatment for rabies prophylaxis? A. "you will receive treatment if you begin to show symptoms of rabies." B. "you will receive one oral dose of medication today, and one more in 1 week." C. "you will need to receive 3 subcutaneous injections over the next week." D. "you will need to receive 5 intramuscular injections over the next 28 days."
d
The nurse is reviewing the Centers for Disease Control (CDC) recommendations for vaccines. The pneumococcal vaccine (Pneumovax 23) is recommended for which group? a. newborn infants b. patients who are immunosuppressed c. patient who are transplant candidates d. smokers between 19 and 64 years of age
d
