Drugs Exam 4

A student states, "It seems like helper T cells do a lot more than just 'help' the cellular immunity process". Which response about CD4+ helper T cells best conveys an aspect of their role in immunity?

"They do play a major role in stimulating and regulating the whole process."

A patient having chemotherapy is losing her hair. She asks the nurse if her hair will come back as it originally was. What is the best response by the nurse?

"Your hair will grow back, but the new hair may be a different color or texture."

Leuprolide (Lupron)

-Advanced prostate cancer -Inhibits gonadotropin (GnRH) release which suppresses ovarian and testicular steroidogenesis

Natural/Innate Immunity

-Always present -Attacks non-self microbes -Does not distinguish between different microbes -Mechanisms include: epithelial barriers, phagocytic cells, plasma proteins, cell messenger molecules

A nurse is caring for a client who has undergone organ transplant surgery. The client asks the nurse what antibodies are. What is the best response by the nurse?

A protein substance that the body produces in response to an antigen

An adult client has recently begun cancer treatment with methotrexate (MTX). When reviewing this client's laboratory work, the nurse should consequently prioritize assessment of which of the following?

BUN and creatinine

A client with previously good health has become severely ill with a viral infection. Diagnostic testing suggests that the client has had an inadequate immune response. What phenomenon could best account for this inadequate immune response?

Body cells that are infected by the virus are being ignored by the immune system

A 49-year-old client is diagnosed with ovarian cancer. What is a characteristic of malignant cells that differentiates them from normal body cells?

Cancerous cells grow in an uncontrollable fashion.

Which microorganism is known to cause retinitis in people with HIV/AIDS?

Cytomegalovirus

No cancer cells have been identified that can remain dormant for more than 2 years.

False

Methotrexate

Folate antimetabolite used in treating various malignancies and rheumatoid arthritis

A nurse is addressing a group of nursing students about gamma globulins. What is the best response to the nursing students about the function of IgA?

Helpful in defense against invasion of microbes via nose, eyes, lungs, and intestines

Which hepatic viruses can be prevented by vaccination? Select all that apply.

Hep A Hep B

Antiviral drugs have limited use because they are effective against only a small number of specific viral infections, including which of the following? (Select all that apply.)

Human immunodeficiency virus (HIV) Herpes simplex virus (HSV) Cytomegalovirus (CMV)

What allows the body to recognize cells as being self-cells?

Human leukocyte antigens (HLAs)

In an allergic reaction, the immunoglobulin that binds to mast cells that release histamine is the:

IgE

A client's chemotherapy regimen has been deemed successful, but the client is experiencing debilitating nausea and vomiting. These adverse effects should signal the nurse to the possibility of what nursing diagnosis?

Imbalanced nutrition: less than body requirements

A school nurse is talking with a health class of freshman high school students about human immunodeficiency virus (HIV). What patient would the nurse tell the students is at the greatest risk of contracting HIV?

Injection drug user

A nurse is administering an antineoplastic extravasation occurs. How can the nurse best prevent tissue damage caused by extravasation?

Inspect the site frequently for redness or swelling

What is responsible for storing a concentrated amount of white blood cells?

Lymph nodes

A client's immune response include phagocytosis of the bacteria that have infected the client. What cells are capable of performing this role in the immune response?

Monocytes

A patient being treated for HIV with saquinavir informs the nurse they he has been "suffering from depression" and taking St. John's wort to help. What is important for the nurse to discuss with this patient?

Refraining from use of St. John's wort, which can cause decreased effectiveness of saquinavir

A client develops leukopenia after receiving chemotherapy. Which nursing diagnosis would be most appropriate?

Risk for infection

Which cells are responsible for cell-mediated immunity?

T cells

A nurse educator who coordinates the staff education on an oncology unit is conducting an inservice on targeted therapies. What potential benefit of targeted therapies should the nurse highlight in this education session?

Targeted therapies have the potential to damage cancerous cells while leaving normal body cells less affected.

The nurse assesses the client and recognizes leukotrienes have been released in the client's body as the result of what sign or symptom?

The client reports calf, thigh and knee pain

A client is undergoing a cytotoxic chemotherapy regimen for the treatment of stage III lung cancer. What effect will this regimen likely have on the client's hemostatic function?

The client's platelet count will decline.

What should the oncology nurse understand when administering a cell cycle-nonspecific chemotherapeutic agent about its effect?

The drug will be effective through all phases of the cell cycle.

An HIV-positive patient is taking efavirenz and tells the nurse that she now has fat on the upper back and neck but is losing fat in the extremities and face. What does the nurse determine is causing this patient's symptoms?

The patient has lipodystrophy from the efavirenz.

The nurse is caring for a patient who has HIV and is taking saquinavir therapy. What should the nurse include in the dietary education for this patient?

The patient should not take this medication with grapefruit or pomegranate juice.

A patient with HIV is taking zidovudine and becomes pregnant. What does the nurse anticipate that the instructions will be for this patient?

The patient will be advised to continue taking the zidovudine.

When describing the process of cancer cell growth to a client, the nurse addresses angiogenesis. Which description would the nurse include?

The process of creating new blood vessels to supply oxygen and nutrients to the cells

A nurse is explaining the rationale for the use of combination therapy in the treatment of HIV infections. Which would the nurse include as the primary reason?

The use of multiple drugs allows attack on the virus at different points in its life cycle.

A client with a diagnosis of bladder cancer is started on a chemotherapeutic regimen that includes three agents. What is the rationale for using multiple antineoplastic agents?

The use of three agents decreases the development of cell resistance.

What potential benefit is unique to biologic agent therapies?

They may affect cancer cells while leaving normal body cells unaffected.

Which autoacids facilitate platelet aggregation?

Thromboxanes

An adverse effect of tamoxifen therapy involves menopausal symptoms.

True

Etanercept

Used in managing rheumatoid arthritis, psoriatic arthritis, Ankylosing spondylitis

Which agents would be considered cancer non-cell cycle specific agents?

alkylating agents

A 79-year-old woman has recently moved to a long-term care facility, and the nurse at the facility is conducting a medication reconciliation. The nurse notes that the woman has recently been taking tamoxifen. The nurse is justified in concluding that the woman has a history of what malignancy?

breast cancer

The oncology nurse understands that chemotherapeutic agents are most effective during a particular phase of the cell cycle. This means the agents are:

cell cycle-specific.

A client has been diagnosed with a brain tumor and is dealing with this diagnosis by seeking detailed information about cancer. The nurse would explain to the client that cancer is essentially a result of the disruption of the:

cell cycle.

Some leukotrienes have the ability to attract neutrophils and to stimulate them. This property is known as:

chemotaxis

IgG

circulates in body fluids, attacking antigens

IgM

circulates in body fluids; has five units to pull antigens together into clumps

A client who has undergone an organ transplant is at a greatly heightened risk of health problems because of what impaired ability?

differentiate between its own cells and antigens on foreign cells

IgE

found on mast cells in tissues; starts and inflammation

The client who has been receiving a cytotoxic drug has asked the nurse to explain the usual goal of a cell. What function should the nurse prioritize during an explanation?

maintenance of homeostasis

Once a person has been exposed to a particular antigen and a repeat exposure occurs, what stimulates a quicker immune response?

memory T cells

A client has developed a wound infection and leukocytes are leaving the bloodstream to perform phagocytosis on pathogens. What white cells are most likely performing this function?

neutrophils

A male patient has been prescribed efavirenz as monotherapy for HIV. On follow-up visits to the clinic, it will be most important for the nurse to assess for which of the following?

signs of microbial resistance

When describing the various effects of antineoplastic agents, the nurse explains that antineoplastic drugs primarily affect human cells that are rapidly multiplying, going through the cell cycle quickly. The nurse would identify which cells as an example?

skin

Tamoxifen achieves a therapeutic effect by which means?

slowing the growth of cancer cells

A client became ill with an influenza virus several days ago. Today, the client describes being free of symptoms. What component of the immune system will be predominant today?

suppressor T cells

While providing care to a client with HIV infection, the nurse knows that reverse transcriptase is an enzyme that retroviruses use to affect RNA and DNA to turn:

viral RNA into viral DNA

The dosages of the chemotherapy agents that will be administered are based primarily on what client variable?

weight

The nurse is assessing a new client admitted to a nursing home. The client asks the nurse to explain interleukins. The nurse would include which information?

"Interleukins help the immune system with inflammation."

Adaptive/Acquired Immunity

-Attacks specific microbes (antigens) -Develops after exposure to the specific antigen -Mechanisms include: humoral immunity (antibody proteins in the blood that attack the specific antigen), cell-mediated immunity (phagocytic cells that attack the specific antigen)

Secondary Immune Response

-B memory cells respond to the antigen immediately -Plasma antibody levels rise within days -Booster shots cause a secondary immune response so antibody levels will be high before the disease is encountered

Type II

-Cytotoxic -IgG or IgM attack antigens on cell surfaces -usually involves antigens on RBC's or WBC's -transfusion reactions, Rh disease, drug reactions

5 FU

-Effective against a wide spectrum of solid tumors -Acts as a "false" metabolite, causing a thymine deficiency

Primary Immune Response

-Macrophage must eat antigen and present it to TH cells -TH cells activate B cells, which produce antibodies -Plasma antibody levels rise -Vaccination produces a primary immune response

Enfuvirtide

-Managing HIV infection in patients who have experienced treatment failure -SC administration -Binds to the gp41 protein on the surface of HIV

Raltegravir

-Post exposure prophylaxis, HAART (highly active antiretroviral therapy) resistance -Inhibits HIV integrase to prevent viral insertion into the host DNA

What would the nurse recognize as the primary goal(s)of highly active antiretroviral therapy (HAART)? Select all that apply.

-Preserve CD4 counts. -Suppress virema. -Delay drug-resistant mutations.

Efavirenz

-Used in treatment of HIV-1 infection -Oral administration -Inhibits reverse transcriptase

A client has sought care from her primary care provider after "feeling under the weather" for several days. What signs and symptoms would support the presence of a viral infection? Select all that apply.

-malaise -fever -headache

What is the normal range for CD4+ cells in the human body?

800 to 1200 CD4+ cells/mm3

An instructor is describing the role and functioning of the sodium-potassium pump. The nurse should describe what type of transport mechanism?

Active transport

A male patient has been prescribed methotrexate. The nurse should caution the patient against using which over-the-counter medication?

Aspirin Salicylates decrease the renal clearance of MTX, resulting in an increased risk of MTX toxicity.

The nurse is caring for a client who is HIV positive. What laboratory test is used to determine this client's ability to fight against viral infections?

CD4

A patient diagnosed with acute primary HIV infection is in the clinic. What treatment should be initiated for this patient?

Combination antiretroviral therapy

A 25-year-old woman with rheumatoid arthritis is being treated with acetaminophen and salicylates. The health care provider has switched her medication regimen to include DMARDs. What is the advantage of DMARDs over salicylates?

DMARDs can arrest the progression of rheumatoid arthritis.

The nurse is caring for a client who has acquired immunodeficiency syndrome (AIDS) and whose CD4 (helper) T cell count is steadily decreasing. The nurse's assessment findings will reflect what pathophysiological process?

Decreased stimulation of B cells

A client with leukemia is being treated with a combination of antineoplastics, including methotrexate. The client's most recent laboratory results indicate the client is experiencing bone marrow suppression. What is the nurse's priority action?

Ensure that all staff and visitors adhere to infection control precautions.

Temperature regulation occurs in the hypothalamus. Normally, when the body temperature increases the body will respond by causing vasodilation in the periphery. What physiologic change is occurring with fever that allows the body's temperature to increase?

Fever occurs as a result of increased synthesis of prostaglandin in the hypothalamus.

A 26-year-old man with testicular cancer is prescribed combination chemotherapy that involves using two drugs that are effective against testicular tumors. Combination drug therapy is superior to single-drug therapy because of:

Higher tumor response rates

A client comes to the clinic to learn about interferons. What would the nurse include in the lesson plan?

Interferons modulate the response of the immune system to viruses, bacteria, cancer, and other foreign substances.

What best describes the role of the major histocompatibility complex as a barrier defense?

It allows the body to distinguish cells as foreign or belonging to the person.

A client is exposed to a viral infection. What role will interferon most likely play during this exposure?

It will interfere with virus replication.

A female client is diagnosed with HIV and hepatitis C, and the health care provider orders antiviral therapy. The nurse would expect the provider to order monitoring of which laboratory value?

LFT's

What laboratory studies would be important for the nurse to especially monitor to check for lactic acidosis in the pregnant client on zidovudine therapy, especially during the last trimester?

Serum electrolytes and liver function tests

A male patient has been prescribed efavirenz as monotherapy for HIV. On follow-up visits to the clinic, it will be most important for the nurse to assess for which of the following?

Signs of microbial resistance

A client's health care provider is considering the addition of efavirenz to the client's drug regimen for the treatment of recently diagnosed HIV. Which aspects of the client's medical history should prompt the nurse to question the use of this drug?

The client has hepatitis C and a history of heavy alcohol use.

A client is experiencing an immune response and the only immunoglobulin that is currently in circulation is IgM. How should the nurse best interpret this fact?

The client has very recently been exposed to the antigen

What rationale should the nurse provide to the client when describing the necessity of recovery periods between treatment cycles of chemotherapy?

Time is needed to replace many of the healthy body cells killed by chemotherapy.

A patient is being tested for HIV using the EIA (enzyme immunoassay). The EIA shows antibodies. The nurse expects the physician to order what test to confirm the EIA test results?

Western blot test

An adult client who has been diagnosed with a rectal tumor is scheduled to begin treatment with cisplatin.The nurse has conducted client teaching about the possibility of nausea and vomiting. In order to reduce the client's risk of severe nausea, the nurse should:

administer a combination of antiemetics prior to the administration of the drug.

The nurse is caring for a diverse group of clients. Which client is most likely to require education about the role of histocompatibility antigens?

client with chronic renal failure who will soon receive a kidney transplant

A nurse educator is discussing the role of protooncogenes in the pathophysiology of cancer. What typically triggers protooncogenes to differentiate into oncogenes?

exposure to carcinogens

IgA

found in secretions on mucous membranes; prevents antigens from entering the body

IgD

found on the surface of B cells; acts as an antigen receptor

When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean

his body has not produced antibodies to the AIDS virus

In the earlier stages of an inflammatory process leukocytosis occurs due to a(n):

increase in circulating neutrophils

The health caregiver is explaining the rationale for administering a hypotonic intravenous solution to a client. Which mechanism of membrane transport most likely underlies this action?

osmosis

When explaining the structure and function of the cell membrane to a client, the nurse should describe it as being:

primarily responsible for maintaining cellular integrity.

A 66-year-old woman has experienced a significant decline in her quality of life as a result of worsening rheumatoid arthritis. Her physician has prescribed etanercept and the nurse is responsible for facilitating this new aspect of the patient's drug regimen. This will involve the administration of:

weekly subcutaneous injections.

A female client will soon begin targeted therapy as a component of her treatment plan for chronic leukemia. The nurse is conducting health education about this new aspect of the client's drug regimen and the client has asked about the potential side effects of treatment. How should the nurse best respond?

"Both classes of drugs have adverse effects, but targeted therapies tend to have less of an effect on healthy body cells."

The nurse is caring for a client with leukemia who is undergoing chemotherapy. What should the nurse teach the client about the relationship between cell physiology and adverse effects of chemotherapy?

"Chemotherapy has a magnified effect on cells that reproduce quickly, like those of your gastrointestinal tract."

Type III Hypersensitivity

-Free floating antigen + antibody --> circulating immune complex: autoimmune vasculitis, glomerulonephritis, serum sickness, arthus reaction -immune complexes deposit on walls of blood vessels and activate complement -blood vessels are damaged

Which would the nurse expect to administer to counteract the effects of methotrexate?

Leucovorin

A client has a congenital disorder that disrupts of the function of the Golgi apparatus within cells. This disorder would affect what aspect of cellular metabolism?

Processing and packaging of hormones for excretion

A pregnant client's prenatal blood work has returned positive for HIV. What antiretroviral medication would be safest to give this client?

Zidovudine

Which client would be most likely to benefit from the administration of interferon therapy?

a client with leukemia

The nurse is describing the function of receptor sites in the cell membrane. The nurse explains that in order to effect change within the cell:

the receptor site must recognize the specific chemical.

A client who is a young adult was immunized against pertussis as a child and has now been exposed to the causative bacteria, Bordetella pertussis. The client's exposure to this bacteria will cause:

the release of IgG by memory B cells.

Zidovudine

-Epstein-Barr virus, hepatitis B virus, and HIV infection -Inhibits the synthesis of DNA by reverse transcriptase

The nurse is caring for a client receiving antiviral medications to treat HIV. What laboratory study should the nurse monitor most closely to determine the effectiveness of the medications?

CD4 count HIV attacks the helper T cells (CD4 cells) within the immune system. Monitoring T cell count would indicate how effective the drug is at controlling the virus.

Antiviral drugs have limited use because they are effective against only a small number of specific viral infections, including which of the following? (Select all that apply.)

-Human immunodeficiency virus (HIV) -Herpes simplex virus (HSV) -Cytomegalovirus (CMV)

Your patient is HIV positive and is involved in ART to decrease symptoms and increase lifespan and quality. The regimen currently involves a combination of antiretrovirals. The rationale to support this treatment regimen is: (Select all that apply.)

-To decrease viral mutations. -To increase drug efficacy.

Tamoxifen (Nolvadex)

-Treating advanced breast cancer -Potent nonsteroidal antiestrogenic drug; competes with estrogen for binding sites in tissues high in estrogen receptors, such as breast tissue

Saquinavir

-Treatment of HIV infection in adults -Oral administration -Competitive inhibitor of HIV protease, an enzyme required for HIV

Vincristine

-Treatment of small cell lung cancer, breast cancer -Mitotic inhibition, which arrests cell division in the metaphase stage of mitosis

Type IV Hypersensitivity

-cell-mediated: sensitized T cells attack antigen -direct cell-mediated cytotoxicity: viral reactions -delayed-type hypersensitivity: tuberculin test, allergic contact dermatitis, hypersensitivity pneumonitis

What should the nurse's assessment of the client prior to administration of antiviral drugs include? (Select all that apply.)

-client's general state of health -resistance to infection -vital signs

Type I Hypersensitivity

-commonly called "allergic reactions" -systemic or anaphylactic reactions -Local or atopic reactions: rhinitis, food allergies, bronchial asthma, hives, atopic dermatitis