Pharmacology - Chapters 30, 32, 33, 34

A patient who is about to start tositumomab (Bexxar) therapy for non-Hodgkin lymphoma tests positive on a pregnancy test. What information does the nurse provide to the patient? 1. "This therapy is harmful to the fetus during pregnancy." 2. "You will be prescribed rituxan (Rituximab) for treatment." 3. "You initially need to take standard cytotoxic chemotherapy." 4. "You need to take lower doses of the drug during your first trimester."

"This therapy is harmful to the fetus during pregnancy." The use of tositumomab (Bexxar) during pregnancy causes fetal damage. Therefore the nurse should inform the patient about the effects of the drug on the fetus. The use of standard cytotoxic chemotherapy will not prevent adverse fetal effects, because the drugs cross the placenta. Rituxan (Rituximab) is another monoclonal antibody and is also contraindicated during pregnancy. A lower dose of tositumomab (Bexxar) will not prevent fetal damage.

The student nurse recognizes which suffixes as used in targeted cancer therapies? Select all that apply. 1. -mab 2. -nib 3. -mib 4. -pril 5. -lol

-mab -nib -mib Targeted cancer therapies are identified by suffixes such as -mab indicating monoclonal antibody; -nib indicating tyrosine kinase inhibitor; and -mib indicating a proteasome inhibitor. Suffixes ending in -pril indicate an angiotensin-converting enzyme inhibitor, and those ending in -lol indicate beta blockers.

Which drug is an alkylating-like agent? 1. Cyclophosphamide 2. Carmustine 3. Cisplatin 4. Cladribine

Cisplatin Cisplatin is an alkylating-like agent. Cyclophosphamide is an alkylating agent, specifically a nitrogen mustard gas derivative. Carmustine is a nitrosurea. Cladribine is a purine analogue.

The patient is prescribed gefitinib (Iressa). The nurse recognizes that this medication will be given: 1. once daily by IV. 2. twice daily by IV. 3. once daily by mouth. 4. twice daily by injection.

once daily by mouth. Gefitinib (Iressa) should be given once a day, at the same time. The half life is 48 hours. The drug should not be given twice daily and is not given IV.

Nurses should educate patients that organ transplant recipients taking immunosuppressant drugs should avoid what? Select all that apply. 1. Flu shots 2. Live vaccines 3. Daily showers or baths 4. Raw fruits and vegetables 5. Undercooked meat and eggs 6. Anyone with an active infection

Live vaccines Undercooked meat and eggs Anyone with an active infection Organ transplant recipients taking immunosuppressant drugs should avoid live vaccines, undercooked meat and eggs, and anyone with an active infection. Flu shots and daily showers or baths are recommended to help prevent infection. Raw fruits and vegetables should not be avoided but should be carefully washed.

Which are general adverse effects of chemotherapy? Select all that apply. 1. Alopecia 2. Leukocytosis 3. Hypertension 4. Urinary retention 5. Thrombocytopenia

Alopecia Thrombocytopenia Bone marrow suppression (leukopenia, thrombocytopenia, and anemia) and alopecia are common adverse reactions to antineoplastic drugs. Urinary retention, hypertension, and leukocytosis are not expected side effects.

The nurse is assessing a patient who had cervical cancer due to a viral infection. Which viral infection did the patient have? 1. Enterococcus infection 2. Varicella-zoster infection 3. Human papillomavirus infection 4. Human parainfluenza virus infection

Human papillomavirus infection Human papillomavirus infection can cause cervical and anal cancer. Enterococcus infection causes urinary tract infection. Varicella-zoster is a virus that causes chicken pox. Human parainfluenza virus causes human parainfluenza.

A patient is receiving IV cyclophosphamide (Cytoxan). Which intervention is correct? 1. Administering an antianxiety agent 2. Monitoring the white blood cell count 3. Ensuring that the patient is well hydrated 4. Running IV dextrose with the chemotherapy

Ensuring that the patient is well hydrated The patient should be well hydrated while taking this drug to prevent hemorrhagic cystitis (bleeding as a result of severe bladder inflammation). Normal saline is used as the maintenance IV when administering chemotherapy. Although it is important to monitor the patient's white blood cell count while receiving chemotherapy, avoiding hemorrhagic cystitis is the priority because it can be life-threatening. Antianxiety agents can be used if needed for the patient but on an individual basis, not routinely.

For what does chronic use of azathioprine put organ transplant recipients at an increased risk? 1. Malignancy 2. Weight gain 3. Organ failure 4. Organ rejection

Malignancy Chronic use of azathioprine puts organ transplant recipients at an increased risk for malignancy. It does not increase the risk for weight gain, organ failure, or organ rejection.

What drug combination should be avoided due to the increased risk of gastrointestinal (GI) bleeding? 1. Tacrolimus and anticonvulsant drugs 2. Azathioprine and antihypertensive drugs 3. Cyclosporine and 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors 4. Mycophenolate mofetil and nonsteroidal antiinflammatory drugs (NSAIDs)

Mycophenolate mofetil and nonsteroidal antiinflammatory drugs (NSAIDs) GI bleeding is a common side effect of mycophenolate mofetil. Combining mycophenolate mofetil with NSAIDs increases the risk of GI bleeding. Anticonvulsants can decrease serum drug levels of tacrolimus. Combining azathioprine with antihypertensive drugs increases the risk of leukopenia. Concomitant administration of cyclosporine with HMG-CoA reductase inhibitors may increase the risk for rhabdomyolysis.

How would the nurse define the term nadir to a patient? 1. The patient's tolerance to the chemotherapy's bone marrow suppressant effect 2. The maximum dose for a chemotherapy drug in reference to bone marrow suppression 3. The average number of days it takes the bone marrow to recover from a dose of chemotherapy 4. The average number of days it takes for chemotherapy to have its peak effect on the bone marrow

The average number of days it takes for chemotherapy to have its peak effect on the bone marrow Nadir refers to the average number of days it takes for a chemotherapeutic drug to have its peak effect on the bone marrow, which would coincide with the patient's lowest blood count and highest risk for infection and/or bleeding.

The primary health care provider prescribed irinotecan (Camptosar) to a patient for the treatment of cancer. What instruction does the primary health care provider give to the nurse? 1. "Administer diuretics to the patient for 1 week." 2. "Administer laxatives to the patient for 5 days alternately." 3. "Administer fluorouracil (Carac) during the entire course of chemotherapy." 4. "Administer antidiarrheal agent (Imodium) during the entire course of chemotherapy."

"Administer antidiarrheal agent (Imodium) during the entire course of chemotherapy." Irinotecan (Camptosar) can cause cholinergic diarrhea. This diarrhea can be severe and life threatening. So, the patient can be treated aggressively with loperamide (Imodium). Laxatives and diuretics are not given with irinotecan (Camptosar). These agents have the potential to worsen the dehydration resulting from the severe diarrhea. So, the nurse should avoid administration of diuretics and laxatives to the patient. Administration of irinotecan (Camptosar) with fluorouracil (Carac) causes severe side effects such as pulmonary embolism, stroke, and acute fatal myocardial infarction. Therefore the primary health care provider does not advise the nurse to administer irinotecan (Camptosar) with fluorouracil (Carac).

The nurse is caring for a patient with cancer who has been prescribed dacarbazine (DTIC-Dome) 100 mg, which is highly emetic. Which is the most appropriate instruction given by the primary health care provider to the nurse? 1. "Administer electrolytes to the patient to prevent dehydration due to vomiting." 2. "Administer antiemetic medications when the patient has nausea and vomiting." 3. "Administer 50 mg dacarbazine (DTIC-Dome) when the patient has nausea and vomiting." 4. "Administer antiemetic medications 30 minutes before administering dacarbazine (DTIC-Dome)."

"Administer antiemetic medications 30 minutes before administering dacarbazine (DTIC-Dome)." Most of the antineoplastic medications have emetic potential and cause nausea and vomiting in patients. The patient must be pretreated with antiemetic drugs. Antiemetic medications must be administered 30 to 60 minutes before administering dacarbazine. The patient may not be adherent to the anticancer medication due to side effects like vomiting and nausea. It is preferable to give antiemetics as a prophylactic treatment rather than administer them once the patient has nausea and vomiting. Electrolytes are administered to the patient after starting the treatment to prevent fluid imbalance. Administering dacarbazine in low doses (50 mg) may not be effective and desired therapeutic action will not be achieved.

A patient asks, "Why am I getting three drugs for my cancer if they all do the same thing?" What is the nurse's best response? 1. "This makes your treatment more cost-effective." 2. "Administering more than one drug prevents drug resistance." 3. "More than one drug is administered in case you don't respond to one of them." 4. "We are not sure what drug will be the most effective, so this combination ensures success."

"Administering more than one drug prevents drug resistance." Administering a combination of antineoplastic agents allows for smaller doses of each, which can minimize the severity of side effects and help prevent drug resistance. It does not make the treatment more cost effective. It is not administered in case the patient does not respond or one drug is not effective.

What recommendation should the nurse provide to patients receiving immunosuppressant therapy in the event they need to go to the emergency department? 1. "Avoid going to the emergency department as it will increase your risk of infection." 2. "Wear gloves and wash your hands frequently if you go to the emergency department." 3. "Do not request special treatment at the emergency department, as it may only increase your wait time." 4. "Disclose at check-in that you are receiving immunosuppressant drugs to avoid sitting in the waiting room for a long time."

"Disclose at check-in that you are receiving immunosuppressant drugs to avoid sitting in the waiting room for a long time." The recommendation the nurse should provide to patients receiving immunosuppressant therapy in the event they need to go to the emergency department is "Disclose at check-in that you are receiving immunosuppressant drugs to avoid sitting in the waiting room for a long time." This will reduce the risk of infection. Immunocompromised patients should not be counseled to avoid the emergency department if they require care. Wearing gloves and washing hands frequently will not protect the patient from airborne particles that may be in the waiting room. Patients should not expect to be penalized for disclosing they are receiving immunosuppressant drugs.

A patient is prescribed temsirolimus (Torisel) for treatment of breast cancer. Which teaching is a priority for this patient? 1. "Take this medication only in the morning." 2. "Take this medication with a full glass of water." 3. "Do not take this medication with grapefruit juice." 4. "Take metoclopramide (Reglan) with each dose of this medication."

"Do not take this medication with grapefruit juice." All targeted therapy drugs for cancer should not be taken with grapefruit juice, because this may increase blood levels of the drugs and increase the risk of side effects. The medication should be taken with water. The medication does not need to be taken with metoclopramide; however, premedication with an antihistamine is required.

The nurse is counseling a patient with a gastrointestinal stromal tumor who is taking imatinib mesylate (Gleevac). What does the nurse instruct this patient regarding the use of herbal preparations? 1. "The use of herbs in hot water is beneficial." 2. "Do not use St. John's wort during therapy." 3. "You can take herbal preparations in lower doses." 4. "The use of ginkgo biloba is considered safe during therapy."

"Do not use St. John's wort during therapy." The nurse instructs the patient to avoid the use of St. John's wort during therapy because the herb decreases drug serum levels and reduces the drug's effectiveness. The use of herbs in hot water may not be beneficial, because some herbs can have harmful effects on the patient. It is risky to instruct the patient to take a lower dose of herbal preparations, because the herbs may still have the potential to cause significant interactions. The use of ginkgo biloba is not safe, because it increases the patient's risk for bleeding.

The nurse is assessing a patient with cancer who has been prescribed methotrexate (Rheumatrex). On reviewing the patient's case history, the nurse finds that the patient has joint pain and is taking aspirin (Ecotrin) for pain relief. Which response given by the nurse is appropriate? 1. "Stop taking aspirin (Ecotrin) immediately." 2. "Take aspirin (Ecotrin) after meals to prevent gastric ulcers." 3. "For prolonged relief take sustained-release tablets of aspirin (Ecotrin)." 4. "Indomethacin (Indocin) is safer and more effective than aspirin (Ecotrin)."

"Stop taking aspirin (Ecotrin) immediately." Nonsteroidal antiinflammatory drugs (NSAIDs) like aspirin (Ecotrin) reduce the renal excretion of methotrexate, thereby leading to accumulation of the drug in the body. Aspirin (Ecotrin) also potentiates the toxic effects of methotrexate. The nurse advises the patient to stop taking aspirin (Ecotrin) to prevent gastrointestinal toxicity. Indomethacin also belongs to the category of NSAIDs, so it is not safe to administer it to patients who have been prescribed methotrexate. Due to additive effect, NSAIDs increase the potential of methotrexate to cause gastrointestinal toxicity. Suggesting that the patient take aspirin after meals will not help to prevent gastric ulcers as aspirin causes damage to the gastrointestinal mucosa. Usually sustained release dosage forms are prescribed for prolonged relief, but aspirin is contraindicated in patients taking methotrexate, so the nurse cannot suggest taking sustained release tablets.

A patient asks the nurse about monoclonal antibody therapy, which is prescribed for a brain tumor. What does the nurse inform the patient? 1. "There is no risk of adverse reactions with this drug." 2. "The infusion reactions are likely to increase subsequently." 3. "The primary health care provider will prescribe oral medications." 4. "There is a possibility of blood pressure changes during this therapy."

"There is a possibility of blood pressure changes during this therapy." The monoclonal antibody is administered intravenously, which is likely to cause infusion reactions, such as changes in blood pressure. Therefore the nurse should inform the patient about these possible effects. Monoclonal antibodies are given intravenously, not orally, because they are inactivated in the gastrointestinal tract. The infusion reactions do not increase, but decrease with subsequent infusions. Fatigue and bone marrow suppression are some of the adverse reactions of monoclonal antibody therapy.

Basiliximab is designated pregnancy category B. What education regarding contraceptive use should the nurse give to the patient on this drug? 1. "Contraceptive measures are not necessary while on this drug because it interferes with fertility." 2. "Due to alterations in DNA, plan to use an effective contraceptive measure long-term after taking this drug." 3. "If you are taking oral contraceptives, you must use a back-up method while on this drug as it interferes with their effectiveness." 4. "Use effective contraceptive measures before beginning treatment, during treatment, and for 4 months after completion of therapy."

"Use effective contraceptive measures before beginning treatment, during treatment, and for 4 months after completion of therapy." Basiliximab is designated pregnancy category B. This means no adequate and well-controlled studies have been done on the drug's use in pregnant women; therefore, women of childbearing potential should use effective contraceptive measures before beginning treatment, during treatment, and for 4 months after completion of therapy. Contraceptive measures are necessary for this period of time but not long-term thereafter. Oral contraceptives are effective during basiliximab therapy.

What initial dosage of basiliximab should children who weigh over 35 kg receive? 1. 5 mg 2. 10 mg 3. 20 mg 4. 40 mg

20 mg In adults and children over 35 kg, basiliximab is administered intravenously (IV), 20 mg within 2 hours before transplant surgery, followed by a second 20-mg dose 4 days after transplantation. Children under 35 kg should receive 10 mg IV within 2 hours before transplant surgery, followed by a second 10-mg dose 4 days after transplantation. Dosages of 5 mg and 40 mg are not indicated.

In organ transplant recipients taking nystatin liquid for prevention of oral thrush, prophylactic use should be discontinued when concomitant steroid administration is reduced below what dosage? 1. 5 mg per day 2. 10 mg per day 3. 20 mg per day 4. 25 mg per day

20 mg per day Transplant recipients use nystatin to prevent or treat thrush in the mouth and esophagus. This is usually given when the patient is on a high-dose immunosuppression regimen and is stopped when the steroid dose is reduced below 20 mg per day, not 5 mg, 10 mg, or 25 mg per day.

Which assessment finding indicates a need to obtain a change of drug prescription? 1. A cancer patient is prescribed gefitinib (Iressa) along with warfarin (Coumadin). 2. A cancer patient is prescribed temsirolimus (Torisel) and diphenhydramine (Benadryl). 3. A patient is prescribed panitumumab (Vectibex) for advanced metastatic colorectal carcinoma. 4. A patient is prescribed intravenous alemtuzumab (Campath) for chronic lymphocytic leukemia (CLL).

A cancer patient is prescribed gefitinib (Iressa) along with warfarin (Coumadin). The use of warfarin (Coumadin) with gefitinib (Iressa) increases the risk for bleeding in cancer patients. Therefore the nurse needs to report this finding to the primary health care provider immediately. Panitumumab (Vectibex) is used in the management of tumors that express or overexpress epidermal growth factor receptor, such as advanced metastatic colorectal carcinoma. Diphenhydramine (Benadryl) does not interact with temsirolimus (Torisel). Instead, diphenhydramine (Benadryl) helps to prevent temsirolimus (Torisel) infusion reactions in cancer patients. Alemtuzumab (Campath) is effective in the destruction of malignant cells. Therefore it is used in the management of CLL.

Neutropenia is considered a lower than normal amount of which white blood cell count? 1. Absolute basophils 2. Absolute eosinophils 3. Absolute monocytes 4. Absolute neutrophils

Absolute neutrophils A normal absolute neutrophil count (ANC) is over 1500. An ANC of 500-1500 is considered neutropenic, and an ANC less than 500 indicates severe neutropenia and significantly increases a person's risk for infection. Absolute basophils, eosinophils, and monocytes are not measures of neutropenia.

Alopecia is a side effect of most antineoplastic medications, often causing patients to feel depressed and not adhere to the medication regimen. What will the nurse tell patients with depression due to hair loss? Select all that apply. 1. Advise the patient to wear scarves throughout the treatment 2. Advise the patient to purchase a wig for use during treatment 3. Advise the patient that the drug will cause permanent hair loss 4. Advise the patient that hair loss will begin soon after treatment

Advise the patient to wear scarves throughout the treatment Advise the patient to purchase a wig for use during treatment Advise the patient that hair loss will begin soon after treatment Antineoplastic medication inhibits the cell division of rapidly multiplying cells. Along with the cancer cells, it destroys some healthy cells like hair cells, as they rapidly divide. This causes alopecia. Patients are advised to use wigs and wear scarves before the actual hair loss begins. It helps to prevent embarrassment and depression. Hair loss due to antineoplastic medications cannot be prevented by applying hibiscus oil, so the nurse should not give the patient false hope. The nurse gives appropriate information to patients. Usually hair falls out 7 to 10 days after starting chemotherapy. Hair loss due to antineoplastics is not a permanent condition. The nurse informs the patient that new hair growth may not be of similar color and texture as that of the lost hair.

Which statement about cancer and ethnicity is accurate? 1. Of all women, 50% will develop some form of cancer. 2. African American women are less likely to get breast cancer, but they die of it more often. 3. Caucasians in northern climates have a higher incidence of melanoma. 4. Hispanics are more likely to develop lung cancer than other demographics.

African American women are less likely to get breast cancer, but they die of it more often. African American women are less likely to develop breast cancer, but they are more likely to die from it if they have it. Approximately one in three women will develop some form of cancer in their lifetimes, but one in two men will have a cancer diagnosis. People living in northern climates would have less sun exposure. Hispanics are less likely than other groups to develop lung cancer.

What instructions are included in the basic assessment of a cancer patient who is on antineoplastic drugs? Select all that apply. 1. Rely on past laboratory reports. 2. Analyze baseline neurologic functions. 3. Assess the patient's medication history. 4. Prescribe medication as per the nurse's choice. 5. Order laboratory reports before starting the treatment.

Analyze baseline neurologic functions. Assess the patient's medication history. Order laboratory reports before starting the treatment. The nurse should assess patients who are on antineoplastic agents for baseline neurologic activities such as alertness, consciousness, and change in sensations. The nurse should order laboratory reports to check the patient's systemic activity when required. A complete medication history of the patient should be obtained in order to avoid unintended reactions or drug interactions. The nurse should order the laboratory reports of the patients before staring the treatment. It helps in planning effective treatment for the patient without any toxic effects. The nurse should check laboratory reports to avoid missing any important information necessary for the treatment. The nurse should not rely on past laboratory reports as the parameters could have changed. The nurse cannot prescribe medications to the patient. However, the nurse can inform the primary health care provider about the patient's condition. The nurse should administer the medications according to the prescription.

Which monoclonal antibody drug has been approved for induction therapy in kidney transplants? 1. Tacrolimus 2. Belatacept 3. Basiliximab 4. Cyclosporine

Basiliximab Basiliximab is a monoclonal antibody drug that has been approved for induction therapy in kidney transplants. Tacrolimus is a calcineurin inhibitor. Belatacept is a first-in-class selective T-cell costimulation blocking agent indicated for use in combination with basiliximab induction, mycophenolate mofetil, and corticosteroids to prevent kidney transplant rejection. Cyclosporine is a calcineurin inhibitor.

Which term describes when a healthy organ donated at the time of a person's death is transplanted into the body of a patient with end-stage organ failure? 1. Induction transplantation 2. Cadaveric transplantation 3. Living-donor transplantation 4. Immunosuppressant transplantation

Cadaveric transplantation In cadaveric transplantation, a healthy organ donated at the time of a person's death is transplanted into the body of a patient with end-stage organ failure. Induction therapy provides intense immunosuppression with drugs designed to diminish antigen presentation and T-cell response, thus reducing the risk for acute rejection during the initial transplant period. In living-donor transplantation, a kidney or a portion of liver donated by a living person is transplanted into the body of a patient with end-stage kidney or liver disease. Immunosuppressant drugs alter different aspects of the immune system, thereby reducing the chances of transplant rejection.

Which dietary supplement can be freely used during treatment with cyclophosphamide? 1. Garlic 2. Echinacea 3. Vitamin A 4. Calcium

Calcium Calcium does not interfere with cyclophosphamide, so it is safe to use during treatment. When combined with cyclophosphamide, garlic, and Echinacea must be used cautiously due to antiplatelet properties. Cyclophosphamide and vitamin A can have dangerous synergistic effects.

What does the nurse assess in a patient who is being administered doxorubicin (Adriamycin)? Select all that apply. 1. Cardiac activity 2. Thyroid function 3. Pancreas function 4. Medication history 5. Infusion spot for infiltration

Cardiac activity Medication history Infusion spot for infiltration Doxorubicin may worsen the patient's cardiac activity, so the nurse should assess the patient regularly. The nurse must check the patient's medication history to avoid undesired interactions. Extravasation may occur with doxorubicin, so the nurse must monitor the intravenous infusion site. Doxorubicin has no effect on pancreas activity. The drug has no effect on thyroid activity, so it is not necessary to examine thyroid function.

Which is the most serious side effect of doxorubicon? 1. Cardiotoxicity 2. Pancreatitis 3. Neutropenia 4. Hematuria

Cardiotoxicity Cardiotoxicity is a serious adverse effect of doxorubicin usage. Pancreatitis is not a known adverse reaction. Neutropenia and hematuria are possible but are not as severe as cardiac toxicity.

The nurse observes that a patient who is taking erlotinib (Tarceva) for pancreatic cancer has increased serum levels of the drug. The patient has been taking the drug as prescribed and does not smoke, drink alcohol, or use any herbal preparations. What else should the nurse assess for? 1. Consumption of a high-fat diet 2. The use of phenytoin (Dilantin) 3. Consumption of grapefruit juice 4. The presence of peptic ulcer disease

Consumption of grapefruit juice The consumption of grapefruit juice during erlotinib (Tarceva) therapy increases drug serum levels through inhibition of CYP3A4, which increases the risk of adverse effects. The presence of peptic ulcer disease indicates a gastrointestinal (GI) problem, which will not increase drug levels in the blood. Instead, the drug will increase the risk for GI perforation. The use of phenytoin (Dilantin) decreases erlotinib (Tarceva) levels in blood. Therefore the nurse would not assess for the use of this drug. An increase in fats interferes with drug absorption. Therefore the consumption of a high-fat diet is likely to reduce drug levels in the blood.

Which drug can be administered both orally and intravenously? 1. Imatinib (Gleevec) 2. Cisplatin (Platinol) 3. Hydroxyurea (Hydrea) 4. Cyclophosphamide (Cytoxan)

Cyclophosphamide (Cytoxan) Cyclophosphamide (Cytoxan) is an alkylating antineoplastic agent that is administered both orally and intravenously. Imatinib (Gleevec) and hydroxyurea (Hydrea) are available only in oral dosage form. Cisplatin (Platinol) is an alkylating agent available only as intravenous (IV) dosage.

What do purine antimetabolites block? Select all that apply. 1. DNA synthesis 2. T-cell costimulation 3. Purine metabolism 4. Lymphocyte cell death 5. Interleukin 2 (IL-2)-mediated signal transduction

DNA synthesis Purine metabolism Purine antimetabolites block DNA synthesis and purine metabolism. Costimulation blockers block T-cell costimulation. Mammalian target of rapamycin (mTOR) inhibitors block IL-2-mediated signal transduction. Purine antimetabolites inhibit lymphocyte proliferation, not cell death.

The nurse is assessing a patient who has bone marrow suppression due to cancer treatment. What laboratory finding in the patient report is suggestive of myelosuppression? 1. Increase in platelet count 2. Decrease in uric acid level 3. Decrease in red blood cell (RBC) count 4. Increase in white blood cell (WBC) count

Decrease in red blood cell (RBC) count Bone marrow suppression is an unwanted adverse effect of certain antineoplastics. It occurs due to drug- or radiation-induced destruction of the active cells in the bone marrow. It leads to a decrease in RBC count and causes drug-induced anemia. Due to bone marrow suppression, WBC count and platelet count decreases. A decrease in WBC count is called leukopenia. Due to the decrease in WBCs, the patient is at greater risk for infection. A decrease in platelet count is called thrombocytopenia. Thrombocytopenia increases the risk of bleeding in the patient. Antineoplastics cause cell lysis, so they increase the level of uric acid in the patient.

The accumulation of which drug can lead to cardiomyopathy? 1. Bleomycin (Blenoxane) 2. Mitomycin (Mutamycin) 3. Doxorubicin (Adriamycin) 4. Cyclophosphamide (Cytoxan)

Doxorubicin (Adriamycin) Doxorubicin (Adriamycin) is a cytotoxic antineoplastic agent, the accumulation of which can cause cardiomyopathy. Bleomycin (Blenoxane) is the cytotoxic antibiotic that causes pulmonary fibrosis and pneumonia. Mitomycin (Mutamycin) causes liver, kidney, and lung toxicity. Cyclophosphamide (Cytoxan) causes hemorrhagic cystitis.

Organ transplant recipients may only use belatacept if they are seropositive for which virus? 1. HIV 2. Measles 3. Varicella 4. Epstein-Barr

Epstein-Barr Belatacept carries a boxed warning for increased risk of developing posttransplant lymphoproliferative disorder, predominantly involving the central nervous system. Additionally, recipients without immunity to Epstein-Barr virus (EBV) are at a particularly increased risk; therefore, belatacept is for use in EBV-seropositive patients only. This is not the case for HIV, measles, or varicella.

The nurse is completing an admission assessment for a patient admitted for treatment with doxorubicin (Adriamycin). The nurse plans to contact the health care provider if the patient is taking which supplement? 1. Green tea 2. Vitamin D 3. Grapefruit juice 4. Goldenrod leaves

Green tea Green tea (Camellia sinensis) may enhance antitumor effects of doxorubicin (Adriamycin). Use of green tea or any herbal therapy that has an interaction or potential interaction with chemotherapy should be reported to the health care provider. Goldenrod leaves, grapefruit juice, and vitamin D should not have an interaction with this drug.

When a patient is receiving cyclophosphamide (Cytoxan), he or she should be advised to drink plenty of water/fluids to prevent which condition? 1. Renal failure 2. Liver dysfunction 3. Hemorrhagic cystitis 4. Red blood cell count

Hemorrhagic cystitis Patients receiving cyclophosphamide should drink at least 2 to 3 L of fluid before, during, and after administration to prevent hemorrhagic cystitis.

The primary health care provider reduced the dosage of imatinib (Gleevec) in a patient who developed elevated levels of bilirubin. What might be the reason for the reduction in dose? 1. Renal dysfunction 2. Hepatic dysfunction 3. Cardiac dysfunction 4. Pulmonary dysfunction

Hepatic dysfunction Imatinib (Gleevec) causes elevation of hepatic enzyme levels, so the primary health care provider will adjust the dosage of the drug accordingly. The elevated levels of bilirubin indicate that the patient has developed hepatic dysfunction. Renal dysfunction is the condition in which kidney function is impaired; bilirubin levels are not affected in this condition. It is characterized by changes in the creatinine levels and uric acid levels. Cardiac dysfunction, or improper cardiac activity, is not related to bilirubin levels. It is characterized by changes in the heart rate and dysrhythmia. Pulmonary dysfunction is the inadequate exchange of gas in the respiratory system and is not related to bilirubin.

Which are limitations of immunosuppressant drugs? Select all that apply. 1. High cost 2. Toxic effects 3. Must be taken daily 4. Limited effectiveness 5. Only available intravenously

High cost Toxic effects Must be taken daily Limited effectiveness Immunosuppressant drugs are expensive, are associated with toxic effects, must be taken daily, and have limited effectiveness. They are available in forms other than intravenous.

The nurse is caring for a patient with a hemoglobin of 15 g/dL, platelet count of 450,000/mm3, and thrombocyte count of 8000/mm3 who is to receive cyclophosphamide (Cytoxan) therapy. What is the nurse's priority intervention? 1. Hold the Cytoxan therapy. 2. Isolate the patient. 3 Start platelet transfusion. 4. Teach patient effects of chemotherapy.

Hold the Cytoxan therapy. Cyclophosphamide (Cytoxan) causes bone marrow suppression, which is evidenced by a decrease in red blood cells, white blood cells, and platelets. A thrombocyte count of 8000/mm3 is significantly lower than normal. The chemotherapy should be held. The patient does not have to be isolated. Teaching the patient is not as high a priority as holding the medication

Current research has led to discovery of cancer-causing viruses. Which virus that is linked to cancer can be prevented by vaccination in humans? 1. Leukemia viruses 2. Rous sarcoma virus 3. Shope papillomavirus 4. Human papillomavirus

Human papillomavirus Extensive research has indicated that there are cancer-causing viruses that can affect most mammalian species. Examples include human papillomavirus (HPV in humans), the various cat leukemia viruses, the Rous sarcoma virus in chickens, and the Shope papillomavirus in rabbits. The HPV now has a vaccination on the market, which is likely to decrease the chance of getting the virus that can lead to several different types of cancers.

A patient is receiving temsirolimus (Torisel) for renal cell carcinoma. After the initial infusion, the patient is prescribed oral antidiabetic agents. Which assessment finding could be a reason for this prescription? 1. Arthralgia 2. Neutropenia 3. Hyperglycemia 4. Hyperthyroidism

Hyperglycemia Hyperglycemia, or high blood sugar, is a side effect of temsirolimus (Torisel) that can be managed with the use of oral antidiabetic agents. Arthralgia refers to joint pain, which cannot be treated with antidiabetic drugs. Neutropenia is a granulocyte disorder that cannot be prevented with antidiabetic drugs. Hyperthyroidism indicates a need for thionamides, not antidiabetic drugs.

Which therapy is aimed at reducing the chances of organ transplant rejection? 1. Cytokine therapy 2. Immunosuppression 3. Cadaveric transplantation 4. Living-donor transplantation

Immunosuppression The underlying premise of immunosuppression is to use multiple drugs that alter different aspects of the immune system, thereby reducing the chances of transplant rejection and enabling the use of lower doses of individual drugs, which reduces the likelihood of drug toxicity. Cytokines may be affected by this therapy, but cytokine therapy does not describe immunosuppression. In cadaveric transplantation, a healthy organ donated at the time of a person's death is transplanted into the body of a patient with end-stage organ failure. In living-donor transplantation, a kidney or a portion of liver donated by a living person is transplanted into the body of a patient with end-stage kidney or liver disease. Immunosuppression is used with both types of transplantation.

For what do immunosuppressant drugs put organ transplant recipients at an increased risk? 1. Infection 2. Weight gain 3. Organ failure 4. Organ rejection

Infection Immunosuppressant drugs put organ transplant recipients at an increased risk for infection. They do not increase the risk of weight gain, organ failure, or organ rejection.

The nurse is caring for a patient who is administered an epidermal growth factor for the treatment of cancer. Why does the nurse teach the patient to report the presence of foaming urine? 1. It indicates the presence of blood. 2. It indicates the presence of glucose. 3. It indicates the presence of ketones. 4. It indicates the presence of proteins.

It indicates the presence of proteins. The nurse teaches the patient to report the presence of foaming urine, which is an indication of proteins in the urine. The presence of proteins is concerning, because it is essential for proteins to be processed by the body in order for the body to achieve the therapeutic effects of epidermal growth factor. Blood may be found in the urine as a result of strenuous exercise, medication, or injury to the urinary system. Glucose may be found in the urine of people with uncontrolled diabetes or kidney injury. Ketones may be found in the urine of people with poorly controlled diabetes, or those who are suffering from starvation, alcoholism, or metabolic disorders. Blood, ketones, glucose, and proteins are not normally found in the urine and would require further investigation.

What are the clinical uses of methotrexate (Rheumatrex)? Select all that apply. 1. It is prescribed for psoriasis. 2. It is prescribed for diabetes mellitus. 3. It is prescribed for rheumatoid arthritis. 4.It is prescribed for megaloblastic anemia. 5. It is prescribed for non-Hodgkin lymphomas.

It is prescribed for psoriasis. It is prescribed for rheumatoid arthritis. It is prescribed for non-Hodgkin lymphomas. Methotrexate is a folate antagonist. It has immunosuppressant and antiinflammatory properties, so it can be prescribed for the treatment of psoriasis and rheumatoid arthritis. Due to the immunosuppressant activity it inhibits lymphocyte multiplication, so it can be prescribed for the treatment of non-Hodgkin lymphomas. It cannot be prescribed for the treatment of diabetes mellitus as it does not enhance insulin synthesis. It cannot be prescribed for the treatment of megaloblastic anemia, as it reduces active folic acid in the body by reducing the enzyme dihydrofolate reductase.

The nurse finds that a patient who is taking sunitinib (Sutent) for a gastrointestinal stromal tumor has developed jaundice of the skin and sclera. Which patient assessment is a priority in this case? 1. Thyroid test 2. Blood pressure 3. Liver enzyme test 4. The patient's weight

Liver enzyme test The development of jaundice indicates liver impairment. Therefore the nurse should assess the patient's liver enzyme test results to confirm liver disease. Jaundice of the skin and sclera are not symptoms of thyroid disease or of hypertension. Therefore the nurse is not likely to evaluate thyroid test results or check the patient's blood pressure. The patient does not have any fluid imbalances, so it is not necessary to assess the patient's weight.

Which term describes when a kidney or a portion of liver donated by a living person is transplanted into the body of a patient with end-stage kidney or liver disease? 1. Induction transplantation 2. Cadaveric transplantation 3. Living-donor transplantation 4. Immunosuppressant transplantation

Living-donor transplantation In living-donor transplantation, a kidney or a portion of liver donated by a living person is transplanted into the body of a patient with end-stage kidney or liver disease. Induction therapy provides intense immunosuppression with drugs designed to diminish antigen presentation and T-cell response, thus reducing the risk for acute rejection during the initial transplant period. In cadaveric transplantation, a healthy organ donated at the time of a person's death is transplanted into the body of a patient with end-stage organ failure. Immunosuppressant drugs alter different aspects of the immune system, thereby reducing the chances of transplant rejection.

A patient is nauseated and vomiting after receiving chemotherapy. How will the nurse best intervene? 1. Inform the patient that the nausea will pass with time 2. Maintain hydration and nutrition and administer antinausea medications 3. Tell the patient to avoid eating any food during chemotherapy treatments 4. Use antacids to relieve the irritation to the stomach, which should stop the nausea

Maintain hydration and nutrition and administer antinausea medications It is very important for patients undergoing chemotherapy to maintain adequate nutrition and hydration. Several antiemetic drugs are available that are very successful in controlling this side effect. The patient will most likely remain nauseated even without food intake.

Which drug, referred to as nitrogen mustard, was the first antineoplastic drug invented? 1. Ifosfamide (Ifex) 2. Chlorambucil (Leukeran) 3. Mechlorethamine (Mustargen) 4. Cyclophosphamide (Cytoxan)

Mechlorethamine (Mustargen) Mechlorethamine (Mustargen) was the first drug introduced to treat cancer. It is still in use today and is in the drug class of the nitrogen mustards. Ifosfamide (Ifex), chlorambucil (Leukeran), and cyclophosphamide (Cytoxan) are classic alkylators invented in later years.

Which drugs may potentiate kidney dysfunction when administered with cyclosporine? Select all that apply. 1. Rifampin 2. Lovastatin 3. Melphalan 4. Cimetidine 5. Amiodarone

Melphalan Cimetidine Melphalan and cimetidine may potentiate kidney dysfunction when administered with cyclosporine. Rifampin can decrease cyclosporine concentrations. Lovastatin may increase the risk for rhabdomyolysis. Amiodarone can increase cyclosporine concentrations.

What drug is administered in high doses for acute transplant rejection? 1. Sirolimus 2. Cyclosporine 3. Mycophenolate mofetil 4. Methylprednisolone sodium succinate

Methylprednisolone sodium succinate In addition to their use in maintenance therapy, corticosteroids are used in high doses for the treatment of acute transplant rejection. The drug, methylprednisolone sodium succinate, is administered intravenously (IV) in doses that range from 250 mg to 500 mg daily for 3 to 5 days. Sirolimus, cyclosporine, and mycophenolate mofetil are not appropriate in high doses for acute rejection.

CD3-positive T lymphocytes are abruptly removed from circulation immediately after administration of which drug for transplant rejection? 1. ATG rabbit 2. Prednisone 3. Muromonab-CD3 4. Mycophenolate mofetil

Muromonab-CD3 CD3-positive T lymphocytes are abruptly removed from circulation immediately after administration of muromonab-CD3 for transplant rejection. This does not describe the mechanism of action of ATG rabbit, prednisone, or mycophenolate mofetil.

A patient has just begun chemotherapy. About a week after the first treatment, the patient's complete blood count shows markedly lower levels of white and red blood cells and platelets. What does the nurse document in the patient's chart? 1. Myelosuppression 2. Nadir 3. Pernicious anemia 4. Thrombocytopenia

Myelosuppression Myelosuppression is the term used to indicate a decrease in bone marrow, which decreases blood cell production. Nadir is the time at which blood counts are apt to be at their lowest points during chemotherapy, typically 7 to 10 days after therapy has begun. Pernicious anemia is not directly related to chemotherapy. Thrombocytopenia only pertains to platelets.

What drug is used for oral thrush in transplant recipients? 1. Nystatin 2. Ganciclovir 3. Valganciclovir 4. Trimethoprim-sulfamethoxazole (TMP-SMZ)

Nystatin Nystatin is used for oral thrush in transplant recipients. Transplant recipients receive antiviral prophylaxis with oral ganciclovir or valganciclovir for 3 to 6 months following surgery to prevent cytomegalovirus. Routine prophylaxis with TMP-SMZ is used to reduce the morbidity and mortality of Pneumocystis jiroveci pneumonia following transplantation.

Under what condition should sirolimus be used during pregnancy? 1. During the first trimester only 2. In pregnant mothers under the age of 35 years 3. Only if the potential benefit outweighs the potential risk 4. In the absence of other risk factors, such as obesity and smoking

Only if the potential benefit outweighs the potential risk Sirolimus should be used during pregnancy only if the potential benefit outweighs the potential risk. This condition should be met regardless of trimester, maternal age, and other risk factors.

What drugs can decrease cyclosporine concentrations in the organ transplant recipient? Select all that apply. 1. Orlistat 2. Rifampin 3. Melphalan 4. Cimetidine 5. Amiodarone

Orlistat Rifampin Orlistat and rifampin can decrease cyclosporine concentrations. Melphalan and cimetidine may potentiate kidney dysfunction when administered with cyclosporine. Amiodarone can increase cyclosporine concentrations.

Which are known adverse effects of alkylating agents? Select all that apply. 1. Ototoxicity 2. Neurotoxicity 3. Cardiotoxicity 4. Nephrotoxicity 5. Bone marrow suppression

Ototoxicity Neurotoxicity Nephrotoxicity Bone marrow suppression Alkylating drugs are capable of causing pulmonary fibrosis, nephrotoxicity, neurotoxicity, bone marrow suppression, peripheral neuropathy, ototoxicity, and hemorrhagic cystitis. The adverse effects of these drugs are important because of their severity, but they can often be prevented or minimized by prophylactic measures. Cardiotoxicity is not listed as an adverse effect for this class of drugs.

Which food is most likely to slow absorption and reduce bioavailability of tacrolimus in the organ transplant recipient? 1. Asparagus 2. Peanut butter 3. Chicken breast 4. Whole wheat bread

Peanut butter Food, especially food high in fat like peanut butter, slows absorption and reduces bioavailability of tacrolimus. Asparagus, chicken breast, and whole wheat bread are not high-fat foods and would have less impact on the absorption and bioavailability of tacrolimus.

What interventions does the nurse focus on for patients who are administered alkylating agents? Select all that apply. 1. Prevent infection 2. Monitor urinary patterns 3. Prevent injuries or blood loss 4. Avoid monitoring patient sensation 5. Avoid monitoring the patient's breath sounds 6. Check the intravenous (IV) infusion site only while administering the drug

Prevent infection Monitor urinary patterns Prevent injuries or blood loss The patient should avoid potential sources of infection as his or her immunity is compromised. Blood loss must be prevented as the patient has impaired clotting due to thrombocytopenia. Nephrotoxicity and hemorrhagic cystitis are adverse effects caused by alkylators such as cisplatin and cyclophosphamide. Therefore the nurse must monitor the patient's urinary patterns to rule out toxic effect of drugs. The patient's senses must be monitored as peripheral neuropathy is a potential adverse effect of alkylators. The IV infusion site must be monitored every hour in order to check for extravasation. Abnormal breath sounds and cough are associated with alkylators as busulfan may cause pulmonary fibrosis.

Which side effect(s) can be seen in a patient who is taking gefitinib (Iressa)? Select all that apply. 1. Rash 2. Diarrhea 3. Anorexia 4. Weight gain 5. Cardiotoxicity

Rash Diarrhea Anorexia Gefitinib (Iressa) may cause rash due to toxicity. Diarrhea is also a common side effect that occurs due to the drug action. Anorexia may occur if the patient has severe electrolyte imbalances. The patient is at a higher risk for weight loss due to electrolyte imbalances. Cardiotoxicity is not a side effect of gefitinib (Iressa). Cardiotoxicity may occur if the patient is taking anthracyclines and cyclophosphamide along with gefitinib (Iressa).

A patient is taking an antineoplastic agent for the treatment of cancer. During assessment the nurse finds that the patient has thrombocytopenia. Which symptom associated with thrombocytopenia does the nurse find in the patient? 1. Abnormal breath sounds 2. Elevated body temperature 3. Red or purple spots on body 4. Productive cough with purulent sputum

Red or purple spots on body Antineoplastic agents cause bone marrow depression, which results in thrombocytopenia. This increases the risk of bleeding in patients on chemotherapy. Red or purple spots are observed on the patient's body due to bleeding. In this condition, there is prolonged bleeding from IV administration sites. Antineoplastic agents cause the destruction of certain rapidly dividing cells in the bone marrow. This affects cellular precursors of white blood cells (WBCs), red blood cells (RBCs), and platelets. Abnormal breath sounds, elevated body temperature, and a productive cough with purulent sputum indicate severe neutropenia in the patient, but not thrombocytopenia.

What term describes the immune system of the transplant recipient attacking the transplanted organ? 1. Infection 2. Rejection 3. Transplantation 4. Immunosuppression

Rejection Transplant rejection occurs when the immune system of the transplant recipient attacks the transplanted organ. Infection describes invasion of a pathogenic microorganism. Transplantation describes removal of the organ from the donor and placement into the recipient. Immunosuppression is the therapy used to decrease the risk for transplant rejection.

A patient is prescribed doxorubicin (Adriamycin). The nurse finds that the patient has developed signs and symptoms of cardiotoxicity. What intervention will the nurse expect to perform to ensure patient safety? 1. Reduce the drug dosage 2. Replace the drug with a liposomal form 3. Replace the drug with idarubicin (Idamycin) 4. Replace the drug with daunorubicin (Daunomycin)

Replace the drug with a liposomal form Doxorubicin (Adriamycin) is a drug, which acts through intercalation and is available in a liposomal form. The liposomal form reduces the cardiotoxic side effects of the drug and increases its therapeutic activity. Abrupt changes in the administration of the drug will not be helpful in reducing the drug's toxicity. Idarubicin (Idamycin) causes cardiovascular toxicity, thus it should not be administered to the patient with symptoms of cardiotoxicity. Reducing the dosage may decrease the drug's activity and may hamper its therapeutic effect. Danuorubicin (Daunomycin) has severe cardiotoxic side effects and is not available in liposomal form.

Proper administration of nystatin liquid for oral thrush in transplant recipients should include which instructions? Select all that apply. 1. Shake the preparation well before measuring the dose. 2. Allow the nystatin to coat the mouth for as long as possible. 3. Do not eat or drink anything for 30 minutes after taking the medication. 4. Swish the dose around in the mouth for at least 2 minutes before swallowing. 5. Discontinue prophylactic use when concomitant steroid dose is reduced below 5 mg daily.

Shake the preparation well before measuring the dose. Allow the nystatin to coat the mouth for as long as possible. Do not eat or drink anything for 30 minutes after taking the medication. Swish the dose around in the mouth for at least 2 minutes before swallowing. Proper administration of nystatin liquid for oral thrush in transplant recipients should include instructions to shake the preparation well before measuring the dose; allow the nystatin to coat the mouth for as long as possible; not eat or drink anything for 30 minutes after taking the medication; swish the dose around in the mouth for at least 2 minutes before swallowing; and discontinue prophylactic use when concomitant steroid dose is reduced below 20 mg (not 5 mg) daily.

Which immunosuppressant drugs are classified as mammalian target of rapamycin (mTOR) inhibitors? Select all that apply. 1. Sirolimus 2. Belatacept 3. Tacrolimus 4. Basiliximab 5. Everolimus 6. Cyclosporine

Sirolimus Everolimus Sirolimus and everolimus are mammalian target of rapamycin (mTOR) inhibitors. Belatacept is a costimulation blocker. Tacrolimus is a calcineurin inhibitor (CNI). Basiliximab is a monoclonal antibody that inhibits interleukin 2 (IL-2)-mediated activation of lymphocytes, a critical component of the cellular immune response involved in transplant rejection. Cyclosporine is a CNI.

Which drugs are classified as mammalian target of rapamycin (mTOR) inhibitors? Select all that apply. 1. Sirolimus 2. Tacrolimus 3. Everolimus 4. Basiliximab 5. Belatacept

Sirolimus and Everolimus There are two mTOR inhibitors approved for the prevention of organ rejection in kidney transplant recipients aged 13 years and older: sirolimus and everolimus. Tacrolimus is a calcineurin inhibitor. Basiliximab is a monoclonal antibody. Belatacept is a costimulation blocker.

Which signs and symptoms of infection should patients taking immunosuppressant therapy know? Select all that apply. 1. Sore throat 2. Constipation 3. Shortness of breath 4. Changes in mental status 5. Fever of 101 ˚F for more than 1 hour

Sore throat Shortness of breath Changes in mental status Signs and symptoms of infection include sore throat, shortness of breath, and changes in mental status, as well as diarrhea (not constipation), and fever that is 100.4 °F (38 °C) or higher for more than 1 hour, or a one-time temperature of 101 °F or higher.

Organ transplant recipients taking trimethoprim-sulfamethoxazole (TMP-SMZ) for prophylaxis of Pneumocystis jiroveci pneumonia (PJP) should be educated about what side effect? 1. TMP-SMZ can make the skin more sensitive to sunlight. 2. TMP-SMZ can make patients more susceptible to infection. 3. TMP-SMZ can make patients more prone to allergic reactions. 4. TMP-SMZ can make patients more likely to experience transplant rejection.

TMP-SMZ can make the skin more sensitive to sunlight. TMP-SMZ can make the skin more sensitive to sunlight; therefore, patients should be instructed to use a lotion with a minimum sun protection factor (SPF) of 25 when in the sun. TMP-SMZ does not make patients more susceptible to infection, more prone to allergic reactions, or more likely to experience transplant rejection.

What immunosuppressant drugs are classified as calcineurin inhibitors (CNIs)? Select all that apply. 1. Sirolimus 2. Belatacept 3. Tacrolimus 4. Basiliximab 5. Everolimus 6. Cyclosporine

Tacrolimus Cyclosporine CNIs suppress the immune system by binding to cytoplasmic proteins that inhibit calcineurin phosphatase, resulting in a reduction in cytokine synthesis and inhibition of T-lymphocyte proliferation. There are two CNIs, tacrolimus and cyclosporine. Sirolimus is a mammalian target of rapamycin (mTOR) inhibitor. Belatacept is a costimulation blocker. Basiliximab is a monoclonal antibody that inhibits interleukin 2 (IL-2)-mediated activation of lymphocytes, a critical component of the cellular immune response involved in transplant rejection. Everolimus is an mTOR inhibitor.

Which drug acts as an estrogen receptor modulator? 1. Testolactone (Teslac) 2. Tamoxifen (Nolvadex) 3. Anastrozole (Arimidex) 4. Fluoxymesterone (Halotestin)

Tamoxifen (Nolvadex) Tamoxifen (Nolvadex) is a hormonal antineoplastic agent that is classified as an estrogen receptor modulator. It modulates estrogen receptors, suppressing sex hormones. Anastrozole (Arimidex) is classified as an aromatase inhibitor. Testolactone (Teslac) and fluoxymesterone (Halotestin) are classified as androgens, which oppose the effect of male sex hormones.

The nurse is preparing a patient for an alemtuzumab (Campath) infusion. The patient has a history of infusion reactions, such as blood pressure changes and hypoxia. What does the nurse expect the primary health care provider to instruct? 1. That the infusion dose be reduced 2. That cytotoxic chemotherapy be started 3. That the patient premedicated with rituxan (Rituximab) 4. That an antihistamine be administered before infusion

That an antihistamine be administered before infusion The patient is premedicated with an antihistamine half an hour before infusion to prevent alemtuzumab (Campath) infusion reactions. A reduction in the infusion dose is not likely to have therapeutic effects on the patient. Cytotoxic therapy is used, along with alemtuzumab (Campath), in the management of cancer. However, it does not prevent infusion reactions. Instead, it causes other adverse reactions, such as bone marrow suppression. Rituxan (Rituximab) is a monoclonal antibody that is prescribed for the management of non-Hodgkin lymphoma, not to prevent infusion reactions.

What does the suffix "umab" signify? 1. The drug is composed of only human proteins. 2. The drug is composed of only murine proteins. 3. The drug contains less than 5% murine proteins. 4. The drug contains more than 60% human proteins.

The drug is composed of only human proteins. drug with the suffix "umab" indicates that it is composed only of human proteins. Murine, or mouse antibodies, have a very short half-life in the human body. The suffix "momab" indicates that the drug is made of only murine proteins. Drugs that contain less than 5% murine proteins bear the suffix "zumab." They are humanized monoclonal antibodies containing both human and gene mouse sequences. These drugs contain 95% or more human proteins. Drugs with the suffix "imab" contain more than 60% human proteins and approximately 30% murine proteins.

A patient who is receiving chemotherapy has developed severe stomatitis. The nurse explains to the patient about care that can be taken to relieve pain and discomfort related to stomatitis. The nurse observes the patient to evaluate the teaching provided. Which action performed by the patient needs to be corrected? 1. The patient avoids spicy and hot food. 2. The patient uses a soft-bristled toothbrush. 3. The patient consumes alcohol in moderation. 4. The patient performs oral hygiene frequently.

The patient consumes alcohol in moderation. Stomatitis refers to inflammation of the oral mucosa in response to chemotherapy. Alcohol is an irritant and can worsen stomatitis; therefore the patient should avoid alcohol. The patient should use a soft-bristled toothbrush to prevent injury to the oral mucosa. The inflamed oral mucosa becomes painful when exposed to hot food and spicy food. Therefore the patient should avoid these. The patient should perform oral hygiene before and after eating to prevent worsening of the inflammation.

The nurse is assessing a patient who is taking bortezomib (Velcade) for mantle-cell lymphoma. The nurse finds from the patient's medical history that the patient had a high tumor burden at the start of therapy. What can the nurse conclude from this finding? 1. There will be a decrease in cancer cell apoptosis. 2. The patient will experience asthenia and low-grade fever. 3. There is little possibility of inhibition of cancer cell growth. 4. The patient is at risk for developing tumor lysis syndrome (TLS).

The patient is at risk for developing tumor lysis syndrome (TLS). A high tumor burden at the beginning of therapy increases the patient's risk for TLS because bortezomib (Velcade) causes rapid killing of cancer cells. Bortezomib (Velcade) inhibits cancer cell growth, regardless of the tumor burden. There will be an increase in cancer cell apoptosis because bortezomib (Velcade) inhibits the activity of the 26S proteasome, which causes a decrease in cell proliferation. Asthenia and low-grade fever are common side effects of bortezomib (Velcade) and are not related to the tumor burden.

The nurse is assessing a patient with Kaposi sarcoma who has been prescribed vincristine (Vincasar PFS) and mitomycin (Mitosol). What does the nurse expect after reviewing the patient's prescription? 1. The patient may have an increased risk of seizures. 2. The patient may have an increased risk of cardiotoxicity. 3. The patient may have an increased risk of pulmonary toxicity. 4. The patient may have a decreased pace of recovery from the illness.

The patient may have an increased risk of pulmonary toxicity. The patient who has been prescribed vincristine (Vincasar PFS) and mitomycin (Mitosol) may have an increased risk of pulmonary toxicity due to drug interaction. The adverse effect of mitomycin (Mitosol) and vinctristine ( Vincasar PFS) is dyspnea. Mitomycin and vincristine do not interact to cause cardiotoxicity. Patients who are administered paclitaxel (Taxol) and doxorubicin (Adriamycin) have a risk of cardiotoxicity due to drug interaction. Patients with cancer who are administered multiple drugs have faster recovery. Interaction between vincristine (Vincasar PFS) and mitomycin (Mitosol) does not cause seizures. Interaction between vincristine and phenytoin increases the risk of seizures.

The nurse is caring for several patients receiving chemotherapy. What patient will the nurse assess first? 1. The patient receiving doxorubicin (Adriamycin) with a history of angina 2. The patient taking cyclophosphamide (Cytoxan) who is urinating 100 mL/hr 3. The patient receiving fluorouracil (5-FU, Adrucil) with an elevated platelet count 4. The patient receiving mechlorethamine (Mustargen) with pain at the IV insertion site

The patient receiving mechlorethamine (Mustargen) with pain at the IV insertion site Mechlorethamine (nitrogen mustard [Mustargen]) is a vesicant and can cause tissue necrosis if it infiltrates into the tissues. Pain at the IV site is an indication of possible infiltration and needs to be addressed. History of angina is a concern because Adriamycin is cardiotoxic; however, this patient is not the priority. An elevated platelet count is not a cause for concern. A patient urinating 100 mL an hour while receiving Cytoxan is also not a concern.

A patient who takes sorafenib (Nexavar) for pancreatic cancer shows little improvement. The nurse finds that the patient is eating low-fat meals and also has bronchial asthma. The nurse also finds that the patient has rheumatoid arthritis and has recently started on dexamethasone (Decadron) tablets. What can the nurse conclude from this data? 1. The patient is not taking both drugs at the same time. 2. The presence of multiple diseases is affecting drug absorption. 3. The consumption of low-fat meals inhibited the absorption of sorafenib (Nexavar). 4. The use of dexamethasone (Decadron) decreased the effectiveness of sorafenib (Nexavar).

The use of dexamethasone (Decadron) decreased the effectiveness of sorafenib (Nexavar). The use of dexamethasone (Decadron) induces metabolizing enzyme activity and reduces blood levels of sorafenib (Nexavar). This decreases its effectiveness. The consumption of high-fat meals hinders the absorption of sorafenib (Nexavar). The use of dexamethasone (Decadron), not multiple diseases, is affecting drug absorption in this case. The use of dexamethasone (Decadron) is likely to reduce the effectiveness of the drug, whether the patient takes both drugs together or at different times.

Adjustments to drug therapy for organ transplant recipients are typically based on which factor? 1. Patient adherence 2. Patient preference 3. Therapeutic drug monitoring 4. Therapeutic reaction assessment

Therapeutic drug monitoring Adjustments to drug therapy for organ transplant recipients are typically based on therapeutic drug monitoring to ensure drugs are at safe and effective levels in individual patients. Adjustments to drug therapy are not based on patient adherence, patient preference, or therapeutic reaction assessment.

The nurse is discussing the use of alkylating drugs with the patient. What is the best way to describe the mechanism of action of alkylating drugs on cancer cells? 1. They stop the meiosis of the cell. 2. They change the structure of the RNA. 3. They alter the chemical structure of the DNA. 4. They interact with the cell through intercalation.

They alter the chemical structure of the DNA. The alkylating drugs work by preventing cancer cells from reproducing. Specifically, they alter the chemical structure of the cells' DNA, which is essential to the reproduction of any cell. This stops the cancer from reproducing or spreading. Cytotoxic antibiotics interact with DNA through a process called intercalation, in which the drug molecule is inserted between the two strands of a DNA molecule, ultimately blocking DNA synthesis.

Cyclosporine became available in 1983 and was modified in 1994 for what purpose? 1. To increase half-life 2. To reduce side effects 3. To improve bioavailability 4. To decrease the percentage of drug that is protein-bound

To improve bioavailability Cyclosporine became available in 1983 and was modified to improve bioavailability in 1994. This modification was not intended to increase half-life, reduce side effects, or decrease the percentage of drug that is protein-bound.

What drug is used to reduce the morbidity and mortality of Pneumocystis jiroveci pneumonia following organ transplantation? 1. Nystatin 2. Ganciclovir 3. Valganciclovir 4. Trimethoprim-sulfamethoxazole (TMP-SMZ)

Trimethoprim-sulfamethoxazole (TMP-SMZ) Routine prophylaxis with TMP-SMZ is used to reduce the morbidity and mortality of Pneumocystis jiroveci pneumonia following transplantation. Nystatin is used for oral thrush in transplant recipients. Transplant recipients receive antiviral prophylaxis with oral ganciclovir or valganciclovir for 3 to 6 months following surgery to prevent cytomegalovirus.

A patient arrives at the emergency department with angioedema of the face. The nurse finds that the patient has renal cell carcinoma and has been prescribed temsirolimus (Torisel). Which is the most important thing the nurse should assess for in this case? 1. Use of a live vaccine 2. Use of sunitinib (Sutent) 3. Use of oral antidiabetic agents 4. Use of antihypertensive drugs

Use of antihypertensive drugs The use of antihypertensive drugs during temsirolimus (Torisel) therapy may cause angioedema of the face. Therefore the nurse needs to obtain the patient's history regarding the use of antihypertensive drugs. Oral antidiabetic drugs do not interfere with temsirolimus (Torisel). Sunitinib (Sutent) is a multikinase inhibitor and is not prescribed for renal cell carcinoma. Therefore the nurse is not likely to assess for the use of that drug. Temsirolimus (Torisel) reduces the effects of live vaccines. However, it is not a priority in this case, because vaccines do not cause angioedema.

During the first month of taking azathioprine, how often should patients have a complete blood count (CBC) taken? 1. Weekly 2. Twice monthly 3. Monthly 4. Twice weekly

Weekly Patients who receive azathioprine should have a CBC, including a platelet count, taken weekly during the first month, twice monthly for the second and third months of treatment, then monthly. Twice weekly is not required.

When is the first dose of basiliximab administered to the patient receiving a kidney transplant? 1. During transplant surgery 2. Within 2 hours after transplant surgery 3. Within 2 days prior to transplant surgery 4. Within 2 hours prior to transplant surgery

Within 2 hours prior to transplant surgery Basiliximab is administered intravenously, 20 mg within 2 hours before transplant surgery, followed by a second 20-mg dose 4 days after transplantation. This first dose is not administered during surgery, after surgery, or within 2 days prior to surgery.