PPharmacology Exam 2 Ch. 13, 14, 53, 54
Administer antiemetics several hours before chemotherapy and for 12 to 48 hours after as prescribed, because antineoplastic medications stimulate the vomiting center in the brain.
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Beta blockers, cimetidine, and erythromycin increase the effects of theophylline. [bronchodilators]
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473. A client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? 1. Echocardiography2. Electrocardiography3. Cervical radiography4. Pulmonary function studies
473. Answer: 4 Rationale: Bleomycin is an antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication. Test-Taking Strategy: Eliminate options 1 and 2 first because they are cardiac related and are therefore comparable or alike. From the remaining options, use the ABCs—airway, breathing, and circulation—to direct you to the correct option.
The physician has prescribed Vermox (mebendazole) for a child with pinworms. Which statement is true regarding the medication? a. Intravenous antibiotic therapy will be ordered. b. Medication is administered intramuscularly. c. The entire family will need to take the medication. d. Medication will be repeated in two months.
Answer c is correct. The entire family will need to take the medication.
Intestinal Parasites
Common infections in children are giardiasis and pinworm infestation. 1. Giardiasis is caused by protozoa and is prevalent among children in crowded environments, such as classrooms or day care centers.2. Pinworms (enterobiasis) are universally present in temperate climate zones and are easily transmitted in crowded environments.
Assessment: Giardiasis
a. Diarrhea and vomitingb. Anorexiac. Failure to thrived. Abdominal cramps with intermittent loose stools and constipation e. Steatorrheaf. Stool specimens from 3 or more collections are used for diagnosis.
Assessment: Pinworms
a. Intense perianal itching b. Irritability, restlessness c. Poor sleepingd. Bed wetting
The five-year-old is being tested for enterobiasis (pinworms). Which symptom is associated with enterobiasis? a Rectal itching b Nausea cOral ulcerations d Scalp itching
Answer A is correct. Pinworms cause rectal itching. Answers B, C, and D are incorrect because they are not symptoms of pinworms.
Interventions: Gardiasis
a. Medications that kill the parasites may be prescribed; medications are not usually prescribed for children younger than 2 years. b. Caregivers should wash hands meticulously. c. Provide education to family and caregivers regarding sanitary practices.
61. The nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which result validates the nurse's findings? 1. pH 7.25, Paco2 50 mm Hg (50 mm Hg) 2. pH 7.35, Paco2 40 mm Hg (40 mm Hg) 3. pH 7.50, Paco2 52 mm Hg (52 mm Hg) 4. pH 7.52, Paco2 28 mm Hg (28 mm Hg)
Answer: 1 Rationale: Atelectasis is a condition characterized by the collapse of alveoli, preventing the respiratory exchange of oxygen and carbon dioxide in a part of the lungs. The normal pH is 7.35 to 7.45. The normal Paco2 is 35 to 45 mm Hg (35 to45 mm Hg). In respiratory acidosis, the pH is decreased and the Paco2 is elevated. Option 2 identifies normal values. Option 3 identifies an alkalotic condition, and option 4 identifies respiratory alkalosis. Test-Taking Strategy: Focus on the subject, the arterial blood gas results in a client with atelectasis. Remember that in a respiratory imbalance you will find an opposite response between the pH and the Paco2. Also, remember that the pH is decreased in an acidotic condition. First eliminate option 2 because it reflects a normal blood gas result. Options 3 and 4 identify an elevated pH, indicating an alkalotic condition. The correct option is the only one that reflects an acidotic condition.
The nurse is teaching a client about coughing and deep-breathing techniques to prevent postoperative complications. Which statement is most appropriate for the nurse to make to the client at this time as it relates to these techniques? 1. "Use of an incentive spirometer will help prevent pneumonia." 2. "Close monitoring of your oxygen saturation will detect hypoxemia."3. "Administration of intravenous fluids will prevent or treat fluid imbalance."4. "Early ambulation and administration of blood thinners will prevent pulmonary embolism."
127. Answer: 1 Rationale: Postoperative respiratory problems are atelectasis, pneumonia, and pulmonary emboli. Pneumonia is the inflammation of lung tissue that causes productive cough, dyspnea, and lung crackles and can be caused by retained pulmonary secretions. Use of an incentive spirometer helps prevent pneumonia and atelectasis. Hypoxemia is an inadequate concentration of oxygen in arterial blood. While close monitoring of the oxygen saturation will help detect hypoxemia, monitoring is not directly related to coughing and deep-breathing techniques. Fluid imbalance can be a deficit or excess related to fluid loss or overload, and surgical clients are often given intravenous fluids to prevent a deficit; however, this is not related to coughing and deep breathing. Pulmonary embolus occurs as a result of a blockage of the pulmonary artery that disrupts blood flow to 1 or more lobes of the lung; this is usually due to clot formation. Early ambulation and administration of blood thinners helps prevent this complication; however, it is not related to coughing and deep-breathing techniques. Test-Taking Strategy: Note the strategic words, most appropriate. Focus on the subject, client instructions related to coughing and deep-breathing techniques. Also, focus on the data in the question and note the relationship between the words coughing and deep-breathing in the question and pneumonia in the correct option.
A mother asks the nurse, "How did my children get pinworms?" The nurse explains that pinworms are most commonly spread by which of the following when contaminated?■ 1. Food.■ 2. Hands.■ 3. Animals.■ 4. Toilet seats.
2. The adult pinworm emerges from the rec- tum and colon at night onto the perianal area to lay its eggs. Itching and scratching introduces the eggs to the hands, from where they can easily reinfect the child or infect others. Nightclothes and bed linens can be sources of infection. The eggs can also be transmitted by dust in the home. Although transmis- sion through contaminated food and water supplies is possible, it is rare. Contaminated animals can spread histoplasmosis and salmonella. The spread of infections by toilet seats has not been supported by research.
289. The nurse is preparing to administer exogenous surfactant to a premature infant who has respiratory distress syndrome. The nurse prepares to administer the medication by which route? 1. Intradermal2. Intratracheal 3. Subcutaneous 4. Intramuscular
289. Answer: 2 Rationale: Respiratory distress syndrome is a serious lung disorder caused by immaturity and the inability to produce surfactant, resulting in hypoxia and acidosis. It is common in premature infants and may be due to lung immaturity as a result of surfactant deficiency. The mainstay of treatment is the administration of exogenous surfactant, which is administered by the intratracheal route. Options 1, 3, and 4 are not routes of administration for this medication. Test-Taking Strategy: Focus on the subject, route of administration for exogenous surfactant. Note the relationship between the diagnosis, respiratory distress syndrome, and the correct option, intratracheal.
The nurse should advise the mother of a toddler suspected of having pinworms to do the cellophane tape test at which of the following times?■ 1. Before bathing. ■ 2. After a bowel movement. ■ 3. While the child is asleep. ■ 4. After a meal.
3. Pinworms come out of the rectum during the nighttime and early morning hours. Therefore, the best time to apply the tape to get results is while the child is asleep.
The clinic nurse is providing instructions to a parent of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement should the nurse make to the parent? 1. "The immunization schedule will need to be altered."2. "The child should not receive any hepatitis vaccines."3. "The child will receive all of the immunizations except for the polio series."4. "The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination."
355. Answer: 4 Rationale: Cystic fibrosis is a chronic multisystem disorder (autosomal recessive trait disorder) characterized by exocrine gland dysfunction. The mucus produced by the exocrine glands is abnormally thick, tenacious, and copious, causing obstruction of the small passageways of the affected organs, particularly in the respiratory, gastrointestinal, and reproductive systems. Adequately protecting children with cystic fibrosis from communicable diseases by immunization is essential. In addition to the basic series of immunizations, a yearly influenza immunization is recommended for children with cystic fibrosis. Options 1, 2, and 3 are incorrect. Test-Taking Strategy: Eliminate options 1, 2, and 3 because they are comparable or alike, indicating that the immunization schedule will be adjusted in some way. Recalling the importance of protection from communicable diseases, particularly in children with a disorder such as cystic fibrosis, will assist in directing you to the correct option.
Mebendazole (Vermox) is prescribed for an 8-year-old child with pinworms. The child has an 18-month-old brother and a 4-year-old sister. The nurse should be sure that the parents are also treat- ing which of the following family members with this drug? 1. Both of the child's siblings. 2. The child's parents and brother. 3. Everyone who lives in the household. 4. The parents and sister.
4. Mebendazole is prescribed for household members older than 2 years. Although the child's 18-month-old brother would not receive the drug, his 4-year-old sister and parents would.
The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action? 1. Take the medication with food.2. Increase fluid intake to 2000 to 3000 mL daily.3. Decrease sodium intake while taking the medication. 4. Increase potassium intake while taking the medication.
484. Answer: 2 Rationale: Hemorrhagic cystitis is an adverse effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake. Test-Taking Strategy: Focus on the subject, client teaching about cyclophosphamide. Recalling that cyclophosphamide can cause hemorrhagic cystitis will direct you to the correct option. Content Area: Pharmacology: Oncology Medications: Alkylating
The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which findings would the nurse expect to note on assessment of this client? Select all that apply. 1. A low arterial PCo2 level 2. A hyperinflated chest noted on the chest x-ray 3. Decreased oxygen saturation with mild exercise 4. A widened diaphragm noted on the chest x-ray 5. Pulmonary function tests that demonstrate increased vital capacity
567. Answer: 2, 3 Rationale: Clinical manifestations of chronic obstructive pulmonary disease (COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x- rays reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced. Pulmonary function tests will demonstrate decreased vital capacity. 1609 Test-Taking Strategy: Focus on the subject, manifestations of COPD. Think about the pathophysiology associated with this disorder. Remember that hypercapnia, a hyperinflated chest, a flat diaphragm, oxygen desaturation on exercise, and decreased vital capacity are manifestations.
478. The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase, an antineoplastic agent. The nurse contacts the primary health care provider before administering the medication if which disorder is documented in the client's history? 1. Pancreatitis 2. Diabetes mellitus3. Myocardial infarction4. Chronic obstructive pulmonary disease
Answer: 1 Rationale: Asparaginase is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function, and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between dose administrations. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicated with this medication. Test-Taking Strategy: Focus on the subject, a contraindication of asparaginase. It is necessary to know the contraindications associated with this medication. Recalling that this medication affects pancreatic function will direct you to the correct option. Level of Cognitive Ability: Analyzing
The nurse determines the client needs further instruction on cimetidine if which statements were made? Select all that apply. 1. "I will take the cimetidine with my meals." 2. "I'll know the medication is working if my diarrhea stops." 3. "My episodes of heartburn will decrease if the medication is effective."4. "Taking the cimetidine with an antacid will increase its effectiveness."5. "I will notify my primary health care provider if I become depressed or anxious."6. "Some of my blood levels will need to be monitored closely
Answer: 1, 2, 4 Rationale: Cimetidine, a histamine (H2)-receptor antagonist, helps alleviate the symptom of heartburn, not diarrhea. Because cimetidine crosses the blood-brain barrier, central nervous system side and adverse effects, such as mental confusion, agitation, depression, and anxiety, can occur. Food reduces the rate of absorption, so if cimetidine is taken with meals, absorption will be slowed. Antacids decrease the absorption of cimetidine and should be taken at least 1 hour apart. If cimetidine is concomitantly administered with warfarin therapy, warfarin doses may need to be reduced, so prothrombin and international normalized ratio results must be followed. Test-Taking Strategy: Note the strategic words, needs further instruction. These words indicate a negative event query and ask you to select the options that are incorrect statements. Think about the therapeutic effect, adverse effects, and potential medication interactions to direct you to the correct options.
482. The nurse is monitoring the intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. On inspection of the site, the nurse notes redness and swelling and that the infusion of the medication has slowed in rate. The nurse suspects extravasation and should take which actions? Select all that apply. 1. Stop the infusion.2. Prepare to apply ice or heat to the site.3. Restart the IV at a distal part of the same vein.4. Notify the primary health care provider (PHCP).5. Prepare to administer a prescribed antidote into the site. 6. Increase the flow rate of the solution to flush the skin and subcutaneous tissue.
Answer: 1, 2, 4, 5 Rationale: Redness and swelling and a slowed infusion indicate signs of extravasation. If the nurse suspects extravasation during the IV administration of an antineoplastic medication, the infusion is stopped and the PHCP is notified. Ice or heat may be prescribed for application to the site, and an antidote may be prescribed to be administered into the site. Increasing the flow rate can increase damage to the tissues. Restarting an IV in the same vein can increase damage to the site and vein. Test-Taking Strategy: Focus on the assessment signs in the question and the words suspects extravasation. Visualize the situation to identify the nursing actions. 1367 Think about the actions that will cause further damage. Note that options 3 and 6 are comparable or alike and can cause further damage.
287. A client in preterm labor (31 weeks) who is dilated to 4 cm has been started on magnesium sulfate and contractions have stopped. If the client's labor can be inhibited for the next 48 hours, the nurse anticipates a prescription for which medication? 1. Nalbuphine2. Betamethasone3. Rho(D) immune globulin4. Dinoprostone vaginal insert
Answer: 2 Rationale: Betamethasone, a glucocorticoid, is given to increase the production of surfactant to stimulate fetal lung maturation. It is administered to clients in preterm labor at 28 to 32 weeks of gestation if the labor can be inhibited for 48 hours. Nalbuphine is an opioid analgesic. Rho(D) immune globulin is given to Rh-negative clients to prevent sensitization. Dinoprostone vaginal insert is a prostaglandin given to ripen and soften the cervix and to stimulate uterine contractions. Test-Taking Strategy: Focus on the subject, a client at 31 weeks' gestation. Recall that the preterm infant is at risk for respiratory distress syndrome because of immaturity and the inability to produce surfactant. Next, recalling the actions of the 882 medications in the options and that betamethasone is used to increase the production of surfactant will direct you to the correct option.
476. A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication. When implementing the plan, the nurse should make which statement to the client? 1. "You can take aspirin as needed for headache."2. "You can drink beverages containing alcohol in moderate amounts each evening."3. "You need to consult with the primary health care provider (PHCP) before receiving immunizations."4. "It is fine to receive a flu vaccine at the local health fair without PHCP approval because the flu is so contagious."
Answer: 3 Rationale: Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without the PHCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side/adverse effects. Test-Taking Strategy: Focus on the subject, client teaching about an antineoplastic medication, and think about the side/adverse effects of antineoplastic medications. Recalling that antineoplastic medications lower the resistance of the body will direct you to the correct option.
486. The nurse is monitoring the laboratory results of a client receiving an antineoplastic medication by the intravenous route. The nurse plans to initiate bleeding precautions if which laboratory result is noted? A clotting time of 10 minutes An ammonia level of 10 mcg/dL (6 mcmol/L). A platelet count of 50,000 mm3 (50 × 109/L) A white blood cell count of 5000 mm3 (5.0 × 109/L)
Answer: 3 Rationale: Bleeding precautions need to be initiated when the platelet count decreases. The normal platelet count is 150,000 to 450,000 mm3 (150 to 400 × 109/L). When the platelet count decreases, the client is at risk for bleeding. The normal white blood cell count is 5000 to 10,000 mm3 (5.0 to 10.0 × 109/L). When the white blood cell count drops, neutropenic precautions need to be implemented. The normal clotting time is 8 to 15 minutes. The normal ammonia value is 10 to 80 mcg/dL (6 to 47 mcmol/L). Test-Taking Strategy: Use knowledge regarding normal laboratory values. Options 1, 2, and 4 are comparable or alike and identify normal laboratory values. Remember to correlate a low platelet count with the need for bleeding precautions and a low white blood cell count with the need for neutropenic precautions. Level of Cognitive Ability: Synthesizing
An older client recently has been taking cimetidine. The nurse monitors the client for which most frequent central nervous system side effect of this medication? 1. Tremors2. Dizziness3. Confusion4. Hallucinations
Answer: 3 Rationale: Cimetidine is a histamine (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations. Test-Taking Strategy: Note the strategic word, most. Use knowledge of the older client and medication effects to direct you to the correct option
479. Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The client asks the nurse if her family member with bladder cancer can also take this medication. The nurse most appropriately responds by making which statement? 1. "This medication can be used only to treat breast cancer."2. "Yes, your family member can take this medication for bladder cancer as well."3. "This medication can be taken to prevent and treat clients with breast cancer."4. "This medication can be taken by anyone with cancer as long as their health care provider approves it."
Answer: 3 Rationale: Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy and for preventing breast cancer in those that are at high risk. Test-Taking Strategy: Note the strategic words, most appropriately. Recalling that this medication is used for breast cancer will assist you in eliminating options 2 and 4. Note the closed-ended word "only" in option 1 to assist you in eliminating this option. Also, recall that this medication is used for both prevention and treatment of breast cancer.
477. A client with ovarian cancer is being treated with vincristine. The nurse monitors the client, knowing that which manifestation indicates an adverse effect specific to this medication? 1. Diarrhea2. Hair loss3. Chest pain4. Peripheral neuropathy
Answer: 4 Rationale: An adverse effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all antineoplastic medications. Chest pain is unrelated to this medication. Test-Taking Strategy: Eliminate options 1 and 2 first because they are comparable or alike and are side/adverse effects associated with many of the antineoplastic agents. Note that the question asks for the adverse effect specific to this medication. Correlate peripheral neuropathy with vincristine.
481. Megestrol acetate, an antineoplastic medication, is prescribed for a client with metastatic endometrial carcinoma. The nurse reviews the client's history and should contact the primary health care provider if which diagnosis is documented in the client's history? 1. Gout2. Asthma3. Myocardial infarction4. Venous thromboembolism
Answer: 4 Rationale: Megestrol acetate suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of venous thromboembolism. Options 1, 2, and 3 are not contraindications for this medication. Test-Taking Strategy: Focus on the subject, a contraindication to megestrol acetate. It is necessary to know the adverse effects associated with this medication. Recalling that megestrol acetate is a hormonal antagonist enzyme and that an adverse effect is thrombotic disorders will direct you to the correct option. Level of Cognitive Ability: Analyzing
474. A client with acute myelocytic leukemia is being treated with busulfan. Which laboratory value would the nurse specifically monitor during treatment with this medication? 1. Clotting time2. Uric acid level3. Potassium level4. Blood glucose level
Rationale: Busulfan can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute kidney injury. Options 1, 3, and 4 are not specifically related to this medication. Test-Taking Strategy: Focus on the subject, a specific laboratory value. It is necessary to know the adverse effects associated with this medication. Recalling that busulfan increases the uric acid level will direct you to the correct option. Level of Cognitive Ability: Analyzing
Interventions: Pinworms
a. Perform a visual inspection of the anus with a flashlight 2 to 3 hours after sleep. b. The tape test is the most common diagnostic test. c. Educate the family and caregivers regarding the tape test. A loop of transparent tape is placed firmly against the child's perianal area; it is removed in the morning and placed in a glass jar or plastic bag and transported to the laboratory for analysis. d. Medications that kill the parasites may be prescribed; medications are not usually prescribed for children younger than 2 years. e. The medication regimen may be repeated in 2 weeks to prevent reinfection. f. All members of the family are treated for the infection. g. Teach the family and caregivers about the importance of meticulous hand washing and about washing all clothes and bed linens in hot water.