Math & Pharm Exam 4

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? A. "Administering more than one drug prevents drug resistance." B."More than one drug is administered in case you don't respond to one of them." C. "This makes your treatment more cost-effective." D. "We are not sure what drug will be the most effective, so this combination ensures success."

A. "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.

In an effort to prevent cytokine release syndrome associated with antirejection drugs, the nurse would anticipate the premedication with which agents? Select all that apply. A. Acetaminophen B. Corticosteroids C. Antihistamines D. Phenothiazines E. H2 antagonists

A. Acetaminophen B. Corticosteroids C. Antihistamines Premedication with corticosteroids or acetaminophen plus an antihistamine has been reported to be effective in reducing the severity of symptoms caused by cytokine release.

The nurse is monitoring a patient receiving doxorubicin. What intervention is a priority for this patient? A. Administering dexrazoxane B. Encouraging fluids to 3 L/day C. Keeping patient away from crowds D. Administering antiemetic 60 min before infusion

A. Administering dexrazoxane Patients receiving doxorubicin need to be monitored for cardiac toxicity. Dexrazoxane is a cytoprotective (chemoprotective) agent that may be given to help prevent cardiac toxicities associated with doxorubicin administration.

A 34-year old female post heart transplant is to receive immunosuppressive drugs to ptrevent rejection. Which of the following nursing interventions is a priority in this patient? A. Advise the patient to avoid anyone with an active infection B. Instruct the patient to take blood pressure and temperature measurements each day C. Instruct the patient that exercising places undue stress on the body, further suppressing the immune system D. Promote proper nutrition by cooking all foods, including fruits and vegetables.

A. Advise the patient to avoid anyone with an active infection

The nurse would identify which of the following as examples of passive immunity? Select all that apply. A. Antibodies from an outside source, such as the mother's placenta and breast milk B. Immune-globulin to provide antibodies against a specific disease C. Antigen response to a pathogen D. Immunizations E. Exposure to a disease

A. Antibodies from an outside source, such as the mother's placenta and breast milk B. Immune-globulin to provide antibodies against a specific disease One example of natural immunity passively acquired is in infants, who are unable to protect against disease because of immature immune systems but instead require antibodies from an outside source, such as the mother's placenta and breast milk. Another example is receiving an immune-globulin to provide antibodies against a specific disease. Passive acquired immunity is essential when (1) time does not permit active vaccination alone, (2) the exposed individual is at high risk for complications of the disease, or (3) the individual suffers from an immune system deficiency that renders that person unable to produce an effective immune response.

A patient is receiving aldesleukin. It is most important for the nurse to assess for concurrent use of which group of medications? A. Antihypertensives B. Opioid analgesics C. Positive inotropes D. Antiviral drugs

A. Antihypertensives Drug interactions with aldesleukin include drugs known to cause renal and liver toxicity including vancomycin, cyclosporine, NSAIDs, methotrexate, INH, and ethanol. Antihypertensives, such as beta blockers and calcium channel blockers, can worsen hypotension.

When teaching a patient receiving paclitaxel, the nurse plans to instruct the patient to monitor for which side effect? A. Arthralgias B. Hypertension C. Vertigo D. Weight gain

A. Arthralgias Myalgias (muscle pains) and arthralgias (joint pains) are a common side effect of paclitaxel that the patient should be prepared to expect.

The nurse is providing medication instructions to a patient prescribed acyclovir for genital herpes simplex. Which instruction will the nurse include in the patient's medication teaching plan? A. Avoid contact with lesions when they are present. B. Acyclovir will eliminate future outbreaks of genital herpes simplex. C. Acyclovir prevents the transmission of infection to other partners. D. Sexual relations can be resumed after 24 h on acyclovir.

A. Avoid contact with lesions when they are present. Patients taking acyclovir should avoid contact with lesions and sexual relations with others when lesions are present to avoid infecting partners. There is no cure for genital herpes simplex, and there are no data to support that the use of acyclovir prevents the transmission of infection to other partners.

The nurse is caring for a patient who has been ordered a treatment regimen for colorectal cancer. The nurse brings the consent form to the patient to sign prior to initiating the treatment, and the patient tells the nurse, "I really don't understand why I can't be treated with vitamins and nutritional therapy." What is the nurse's priority action? A. Contact the health care provider. B. Schedule an instructional session with the dietician. C. Encourage the patient to sign the consent form. D. Discuss the treatment regimen with the pharmacist.

A. Contact the health care provider. The health care provider should be contacted since the patient cannot sign the informed consent form for treatment. It is the health care provider's responsibility, not the pharmacist's nor the dietician's, to make certain that the patient understands the reason for treatment. The nurse should not encourage the patient to sign the consent form when the patient does not understand the reason for treatment.

Which point should the nurse include in providing teaching regarding corticosteroid therapy? Select all that apply. A. Delayed wound healing may occur. B. Do not stop medication abruptly. C. Do not receive live vaccines. D. Monitor pulse daily. E. Risk for infection decreases.

A. Delayed wound healing may occur. B. Do not stop medication abruptly. C. Do not receive live vaccines. Long-term use may lead to impaired wound healing, skin atrophy, and decreased response to infections. Live vaccines could lead to significant infections and should be avoided. Sudden cessation of corticosteroids may lead to withdrawal symptoms with high doses or long-term use and the onset of Addison's crisis. Pulse rates should not be affected, and risk for infection increases.Long-term use may lead to impaired wound healing, skin atrophy, Cushing syndrome, glaucoma and cataracts, Kaposi sarcoma, and growth suppression in children. Cessation of corticosteroids may lead to withdrawal symptoms with high doses or long-term use. Pulse rates should not be affected, and risk for infection increases.

The patient has been administered a toxoid. The patient is most likely being vaccinated against which disease? A. Diphtheria B. Human papillomavirus C. Hepatitis B D. Mumps

A. Diphtheria Vaccination against diphtheria is performed with administration of a toxoid. Human papillomavirus and hepatitis B both require a recombinant viral antigen vaccine; mumps requires a live attenuated virus.

When providing teaching for the patient being discharged home on antiretroviral therapy for HIV, which statement will the nurse include? A. Do not eat raw fish. B. Limit food intake to proteins only. C. Avoid ingesting bananas. D. Applesauce may cause you to experience side effects of the medication.

A. Do not eat raw fish. Dietary teaching for the patient taking ART should include advising the patient to eat a variety of foods and to avoid ingesting raw eggs and raw fish and cooking of meats to advised temperature. Advise patient how to minimize side effects (e.g., take specific drug with food) and discuss diet of banana, rice, applesauce, and toast for management of diarrhea.

A patient is receiving IV cyclophosphamide. Which intervention is a priority for this patient? A. Ensuring that the patient is well hydrated B. Monitoring the white blood cell count C. Administering an antianxiety agent D. Running IV dextrose with the chemotherapy

A. 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.

The nurse is caring for a patient with a hemoglobin of 15 g/dL, platelet count of 450,000/mm3, and thrombocyte count of 8,000/mm3 who is to receive cyclophosphamide therapy. What is the nurse's priority intervention? A. Hold the cyclophosphamide therapy. B. Isolate the patient. C. Start platelet transfusion. D. Teach the patient effects of chemotherapy.

A. Hold the cyclophosphamide therapy. Cyclophosphamide 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.

A patient is receiving the alkylating drug cyclophosphamide. It is most important for the nurse to provide A. IV hydration and assessment of fluid status. B. vigilant skin care and cleaning with mild soap. C. mouth care using half-strength hydrogen peroxide and a soft toothbrush. D. patient-controlled analgesia with meperidine.

A. IV hydration and assessment of fluid status. The patient should be well hydrated while taking this drug to prevent hemorrhagic cystitis (bleeding as a result of severe bladder inflammation). MESNA (2-mercaptoethane sulfonate sodium [MESNEX]) is a cytoprotectant (chemoprotectant) drug that is often given with high-dose cyclophosphamide to inactivate urotoxic metabolites in the bladder and minimize damage to this organ.

The patient has been started on stavudine (d4T). After taking the drug for 3 days, the patient contacts the nurse to report that the patient has started experiencing muscle pain and weakness. What is the nurse's highest priority action? A. Instruct the patient to hold doses of the medication until further notice. B. Reassure the patient that this is an expected side effect of the medication. C. Instruct the patient to self-medicate with an NSAID medication. D. Reassure the patient that the symptom is time-limited and will resolve.

A. Instruct the patient to hold doses of the medication until further notice. The patient should not take any more doses of the medication until the health care provider can evaluate the patient. Muscle pain and weakness may be related to lactic acidosis, a serious side effect of the medication. The nurse's scope of practice does not allow for adjusting the patient's medication regimen.

The nurse receives an order for a patient to be treated with interferon alpha-2a. The nurse should prepare to administer the medication by which route? Select all that apply. A. Intramuscularly B. Intravenously C. Orally D. Subcutaneously E. Topically

A. Intramuscularly D. Subcutaneously Interferon alpha-2a can be administered by either intramuscular or subcutaneous injection.

Once a child has received a vaccination, what action is the nurse's priority? A. Monitor for possible anaphylaxis. B. Assess for muscle pain. C. Treat pain at the injection site. D. Assess for infection.

A. Monitor for possible anaphylaxis. Anaphylaxis is a potentially life-threatening adverse reaction to vaccines. Muscle pain and pain at the injection site can occur, but assessment and treatment of these is not the primary action. Infection is not likely from this course.

The nurse admits a patient diagnosed with metastatic colorectal cancer. The nurse anticipates that the health care provider will order which medication? A. Panitumumab B. Bortezomib C. Dasatinib D. Rituximab

A. Panitumumab Panitumumab (Vectibix) is indicated for the treatment of metastatic colorectal cancer.

Which of the following can help increase HIV drug adherence? Select all that apply. A. Pill organizers B. Drug charts C. Scheduled pill holidays D. Alarms on cell phone or watch E. Taking drugs at the same time each day, such as after brushing teeth.

A. Pill organizers B. Drug charts D. Alarms on cell phone or watch E. Taking drugs at the same time each day, such as after brushing teeth.

The nurse is providing education about the stages of syphilis. The nurse describes a stage in which there is the presence of a sore called a chancre. The student would be correct in identifying the description as which stage of syphilis? A. Primary B. Latent C. Secondary D. Tertiary

A. Primary Primary syphilis infections present with a sore, or chancre, at the site where the infection entered the body—typically, the penis in men and outer genitals or inner vagina in women. It is usually painless. The chancre develops about 3 weeks after exposure and resolves in 3-6 weeks without treatment. During this stage, the person is very contagious, even after the chancre has resolved.Secondary syphilis is characterized by a skin rash that appears 2-8 weeks after the chancre. After the rash has resolved, a period that lasts anywhere from 1 to 20 years goes by without any symptoms. This is called the latent stage, and it occurs in persons who have gone untreated. Tertiary syphilis may occur as early as 1 year after infection or at any time during an untreated person's lifetime.

The patient has been taking ritonavir for a week and informs the nurse that the patient is experiencing occasional episodes of abdominal discomfort. What patient teaching will the nurse provide to the patient? Select all that apply. A. Reassure the patient that this is an expected side effect of the medication. B. Instruct the patient to report episodes that increase in intensity or frequency. C. Instruct the patient to stop taking the medication. D. Instruct the patient to maintain a symptom diary. E. Take an over-the-counter h2 antagonist.

A. Reassure the patient that this is an expected side effect of the medication. B. Instruct the patient to report episodes that increase in intensity or frequency. D. Instruct the patient to maintain a symptom diary. Abdominal discomfort is an expected side effect of the medication and is not indicative of any significant problem with the medication. However, the patient should certainly report episodes of discomfort that increase in intensity and/or frequency. Use of a symptom diary can assist with the reporting process. The patient should not add any over-the-counter medications.

The nurse is teaching a pharmacology class about the ways in which biologic response modifiers assist the immune system. Which of the following should the nurse include in the presentation? Select all that apply. A. They enhance the immune system's ability to kill abnormal cells. B. They modify cancer cells to render them unable to replicate. C. They inhibit normal cells from changing into cancer cells. D. They enhance the body's ability to repair or replace damaged cells caused by other cancer treatments. E. They prevent cancer cells from metastasizing.

A. They enhance the immune system's ability to kill abnormal cells. C. They inhibit normal cells from changing into cancer cells. D. They enhance the body's ability to repair or replace damaged cells caused by other cancer treatments. E. They prevent cancer cells from metastasizing. Biologic response modifiers assist the immune system by enhancing the immune system's ability to kill abnormal cells. They change cancer cells to make them behave more like healthy cells. They inhibit normal cells from changing into cancer cells. They enhance the body's ability to repair or replace damaged cells caused by other cancer treatments. They prevent cancer cells from metastasizing.

Which of the following is the term for a yeast infection of the vulva or vaginal area? A. Vulvovaginal candidiasis B. Gonorrhea C. Bacterial vaginosis D. Trichomoniasis

A. Vulvovaginal candidiasis Vulvovaginal candidiasis (VVC) is a yeast infection of the vulva or vaginal area.

Newborns receive immunities via the transfer of maternal antibodies across the placenta. This is known as A. natural, passive immunity. B. acquired, passive immunity. C. natural, active immunity. D. acquired, active immunity.

A. natural, passive immunity. Passive immunity occurs when an individual receives antibodies against a particular pathogen from another source. Newborn infants naturally receive passive immunity via the transfer of maternal antibodies across the placenta. Passive immunity may also be acquired through the administration of antibodies pooled from several human or animal sources that have been exposed to disease-causing pathogens.

A patient being treated for cancer is receiving medication for palliation. The nurse understands that palliative therapy is used to A. relieve symptoms. B. kill tumor cells. C. decrease viral load. D. increase body defenses.

A. relieve symptoms. If cancer can no longer be controlled, chemotherapy may be used to relieve disease-related symptoms or improve quality of life. This is called palliative treatment.

A patient is receiving filgrastim. Which assessment finding indicates that the medication has been effective? A. Absence of bone pain B. Absence of infection C. Decreased bleeding D. Absence of headaches

B. Absence of infection Filgrastim increases the production of white blood cells in the bone marrow. The desired patient outcome is that the patient will not contract an infection.

The nurse is assessing a patient who may have a sexually transmitted infection. What is the first step in the nurse's assessment? A. Culture vaginal secretions. B. Ask the patient about sexual partners. C. Determine if the patient has a fever. D. Ask about medication allergies.

B. Ask the patient about sexual partners. Before physical data are gathered, a history is elicited. The term partner is used when discussing sexual activity, rather than value-laden terms such as wife or boyfriend. Include the following questions for all patients, regardless of sex or sexual orientation: Do you have sex with women? and Do you have sex with men?

Which point should be included in the teaching plan for a patient who is prescribed metronidazole for bacterial vaginosis? A. Take on an empty stomach. B. Avoid consuming alcoholic beverages. C. Take with an antacid. D. Remain upright after taking the drug.

B. Avoid consuming alcoholic beverages. Because metronidazole can cause stomach upset, it should be taken with food or a full glass of water or milk. Alcohol causes severe nausea and vomiting when ingested with metronidazole, so patients should be instructed not to drink alcoholic beverages or use products that contain alcohol, such as mouthwash, for the duration of drug therapy and for 48 h after treatment.

A patient is receiving antiretroviral therapy (ART). Which outcome indicates a therapeutic response to the medication therapy? A. Elevation of HIV RNA levels B. CD4 T-cell increase C. Decreased T-cell reactivity D. Increased immune system functioning

B. CD4 T-cell increase The expected outcome of ART is a suppression of HIV RNA levels and CD4 T-cell increases in patients. Elevated HIV RNA levels, decreased T-cell reactivity, and increased immune system functioning are not indicative of a therapeutic response to medication therapy.

The nurse is completing an admission assessment for a patient diagnosed with pancreatic cancer who is prescribed erlotinib. The patient is currently being treated for an infection with clarithromycin. What is the nurse's initial intervention? A. Administer diphenhydramine (Benadryl). B. Contact the health care provider. C. Administer acetaminophen (Tylenol). D. Hold the Iressa until the patient's course of clarithromycin is completed.

B. Contact the health care provider. Clarithromycin inhibits the liver microsomal CYP3A4 enzyme, which increases the blood levels of erlotinib. The health care provider will need to make a decision about starting the medication. Diphenhydramine (Benadryl) is frequently used as a premedication for intravenous chemotherapy; however, this intervention will not be implemented until the health care provider has had an opportunity to decide about starting the erlotinib. Acetaminophen (Tylenol) will likely be avoided with this patient because the patient should be monitored for fever.

Which of the following laboratory tests is used to monitor the efficacy of HIV drug therapy? A. White blood cell count B. DC41 T-cell count C. Plasma B-cells D. Complete blood count

B. DC41 T-cell count

The nurse is caring for a patient receiving cyclophosphamide. What is a priority intervention for this patient? A. Assessing blood pressure hourly B. Encouraging fluids before, during, and after drug administration C. Drawing peak and trough levels D. Keeping patient isolated until drug is excreted

B. Encouraging fluids before, during, and after drug administration Patients receiving cyclophosphamide should drink at least 2-3 L of fluid before, during, and after administration to prevent hemorrhagic cystitis.

Patients receiving targeted therapy, imatinib mesylate, to treat cancer need to avoid which food? A. Chocolate B. Grapefruit C. Green tea D. Aged cheese

B. Grapefruit Drinking grapefruit juice can increase the blood levels of most targeted therapies and make side effects or adverse effects worse.

A patient asks the nurse what part of the body is most affected by the HIV virus. The nurse informs the patient that HIV primarily affects which system? A. Cardiovascular B. Immune C. Renal D. Hepatic

B. Immune HIV damages the immune system by destroying CD4 T-cells.

The patient has been ordered treatment with bortezomib (Velcade). The nurse recognizes that this medication is most often used to treat which cancers? A. Hepatocellular cancer and advanced renal cell carcinoma B. Mantle cell lymphoma and multiple myeloma C. Chronic lymphocytic leukemia D. Colorectal cancer and head and neck cancers

B. Mantle cell lymphoma and multiple myeloma Bortezomib (Velcade) is most frequently used to treat mantle cell lymphoma and multiple myeloma.

The health care provider is considering placing the patient on ritonavir. The patient tells the nurse that the patient has recently been diagnosed with type 2 diabetes mellitus. What is the nurse's highest priority action? A. Notify the pharmacist that a larger dose will be needed. B. Notify the health care provider of the new information. C. Instruct the patient to monitor blood sugars more often. D. Instruct the patient to keep an accurate glucose log.

B. Notify the health care provider of the new information. The health care provider should be notified of this new information. Patients with diabetes mellitus or hyperglycemia may experience an exacerbation of their condition during ritonavir treatment.

The nurse would identify which drug as the antibiotic of choice for fungal infections manifested as thrush in the mouth or esophagus? A. Amoxicillin B. Nystatin C. Amphotericin B D. Vancomycin

B. Nystatin 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/day.

The nurse is caring for a patient who is being treated with interferon beta-1b. The nurse recognizes that the medication is most frequently used to treat which condition? A. Hairy-cell leukemia B. Relapsing multiple sclerosis C. Chronic myelogenous leukemia D. Malignant melanoma

B. Relapsing multiple sclerosis Interferon beta-1b is most often ordered to treat relapsing multiple sclerosis.

Which information will the nurse provide to a patient receiving tetanus toxoid? A. Increase the fluid and fiber in your diet to prevent constipation. B. Soreness at the injection site is a common reaction. C. Lifetime immunity is achieved from this injection. D. Tetanus toxoid must be repeated weekly for 4 weeks.

B. Soreness at the injection site is a common reaction. Myalgia at the injection site is a common side effect of tetanus toxoid. There is no need to repeat the toxoid weekly for 4 weeks, and the vaccine should not produce constipation. The toxoid usually is given approximately every 10 years.

Which intervention is a priority for a patient who is taking ART? A. Increase fluids to 2400 mL/day. B. Teach adherence to the medication regimen. C. Refer the patient for preventive care measures. D. Teach hand washing to the patient.

B. Teach adherence to the medication regimen. Although all of these interventions should be carried out, teaching adherence to the regimen is the highest priority.

The nurse would identify which drug as the antibiotic of choice for Pneumocystis jirovecii pneumonia (PJP)? A. Augmentin B. Trimethoprim-sulfamethoxazole C. Gentamycin D. Vancomycin

B. Trimethoprim-sulfamethoxazole Pneumocystis jirovecii pneumonia (PJP) is a life-threatening illness in immunocompromised patients. Routine prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMZ) has significantly reduced the morbidity and mortality of PJP following transplantation.

In order to protect against exposure to chemotherapy drugs when caring for patients receiving intravenous (IV) therapy, what will the nurse do? A. Wear gowns, gloves, masks, and headgear when administering all chemotherapy drugs. B. Wear a disposable gown when administering IV chemotherapy. C. Wear a mask when receiving the drug from the pharmacist. D. Administer IV chemotherapy only under the direct observation of the health care provider.

B. Wear a disposable gown when administering IV chemotherapy. A disposable gown should be worn when administering IV chemotherapy. The combination of gowns, gloves, masks, and headgear is not necessary for all chemotherapy drugs. A mask is not necessary when the pharmacist is preparing the drug. Nurses can administer chemotherapy without the observation of the health care provider.

An adult patient says, my children are being vaccinated. Are there any that I should have? What is the nurse's best reply? A. No, there are no vaccines that an adult needs. B. Yes, you need to remain current on several vaccines; check with your provider. C. Yes, you will need the same ones your children need. D. No, you have probably had all of the childhood diseases by now.

B. Yes, you need to remain current on several vaccines; check with your provider. While much emphasis is placed on regularly immunizing infants and children, adult immunizations are frequently overlooked. However, they are equally important to the health and well-being of this population.

The nurse is preparing to administer the tetanus vaccine to the patient. The nurse recognizes that the patient will be receiving A. inactivated bacteria. B. a toxoid. C. inactivated viral antigen. D. recombinant viral antigen.

B. a toxoid. The vaccine against tetanus is a toxoid.

When working with a patient receiving epoetin alpha, it is most important for the nurse to assess the patient for the development of A. bone pain and headaches. B. hypertension and edema. C. nausea and vomiting. D. fluid retention and allergic reactions.

B. hypertension and edema. Hypertension and edema are the most common side effects/adverse reactions of epoetin alpha (Procrit) therapy.

The patient is prescribed gefitinib (Iressa). The nurse recognizes that this medication will be given A. once daily by IV. B. once daily by mouth. C. twice daily by injection. D. twice daily by IV.

B. once daily by mouth. Gefitinib (Iressa) is designed to be administered once daily by mouth.

The nurse is caring for a patient with colorectal cancer who is to receive fluorouracil. Which symptom will be most important for the nurse to report to the health care provider?

Bleeding gums

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

C. "Do not take this medication with grapefruit juice." Temsirolimus (Torisel) should not be taken with grapefruit juice. Grapefruit juice may alter the exposure of temsirolimus.

Which value represents a normal absolute neutrophil count (ANC)? A. 5,000 B. 3,500 C. 1,500 D. 500

C. 1,500 A normal ANC is over 1,500. An ANC of 500 to 1,500 is considered neutropenic, and an ANC less than 500 indicates severe neutropenia and significantly increases a person's risk for infection.

The nurse prepares to administer aldesleukin to a patient diagnosed with renal carcinoma. Which assessment indicates a therapeutic effect of this medication? A. An increase in renal tumor size B. An increase in red blood cells C. A decrease in renal tumor size D. A decrease in hemoglobin and hematocrit

C. A decrease in renal tumor size Aldesleukin enhances the immune system by stimulating the production and activity of T-cells and decreases the size of renal cell tumors.

The patient is being treated with interferon alpha-2b. The patient is currently receiving theophylline as part of the regimen. Which adjustment would the nurse anticipate as a result of the interaction of these two medications? A. A decrease in the dose of interferon alfa-2b B. A significant increase in theophylline requiring dose adjustment C. A significant decrease in theophylline requiring dose adjustment D. Addition of an interferon alfa-2a

C. A significant decrease in theophylline requiring dose adjustment It is unknown whether IFN-α-2b is metabolized by the liver; therefore, caution is advised when IFN-α-2b is taken with other drugs metabolized through the hepatic cytochrome P450 enzyme system. The effect of IFN on the CYP450 system might increase enzyme degradation or inhibit CYP450 system. IFN-α-2b with concomitant use of theophylline may result in a 100% increase in theophylline concentrations, requiring a decrease in theophylline dosage.

A patient receiving filgrastim therapy complains of bone pain. What will the nurse do first? A. Hold the medication. B. Call the health care provider. C. Administer the ordered nonopioid analgesic. D. Increase the dose of filgrastim.

C. Administer the ordered nonopioid analgesic. Skeletal bone pain is a very consistently observed reaction to the therapy as the bone marrow expands. Nonopioid analgesics generally control the pain.

The nurse is preparing to administer vaccines to a young child. What will the nurse do initially? A. Rub the site of the vaccination with alcohol. B. Explain active and passive immunity to the child and caregivers. C. Ask the caregivers about food allergies and over-the-counter medications. D. Tell the child to lie on the stomach to receive the vaccines.

C. Ask the caregivers about food allergies and over-the-counter medications. Before immunizations are administered, children and their caregivers should be questioned regarding their use of prescription and over-the-counter medications, including herbal preparations and any food or drug allergies. Depending on the patient's allergies, the other interventions may not occur if it is determined that it is too dangerous for the patient to receive the vaccine.

The patient has been ordered treatment with alemtuzumab (Campath). The nurse recognizes that this medication is most often used to treat which cancers? A. Hepatocellular cancer and advanced renal cell carcinoma B. Mantle cell lymphoma and multiple myeloma C. Chronic lymphocytic leukemia D. Colorectal cancer and head and neck cancers

C. Chronic lymphocytic leukemia Alemtuzumab (Campath) is most frequently used to treat chronic lymphocytic leukemia.

Which medication is indicated in the treatment of vulvovaginal candidiasis? A. Ceftriaxone B. Azithromycin C. Fluconazole D. Ivermectin

C. Fluconazole Vulvovaginal candidiasis is a yeast infection of the vulva or vaginal area treated with the azoles: clotrimazole, miconazole, triconazole, butoconazole, terconazole, fluconazole.

A patient receiving an organ transplant was given basiliximab 2 h before surgical transplantation. When will the second dose be given? A. Immediately after transplantation surgery B. Two hours after transplantation surgery C. Four days after transplantation surgery D. Six weeks after transplantation surgery

C. Four days after transplantation surgery The second dose of basiliximab is administered 4 days after transplantation.

The nurse has instructed a patient diagnosed with human immunodeficiency virus (HIV) on the use of zidovudine. Which patient statement demonstrates a need for additional teaching? A. I may get a headache from this medication. B. I might have difficulty sleeping with this medication. C. I do not need to use condoms as long as I take my medication as prescribed. D. I do not have to worry about taking the medication on an empty stomach or not.

C. I do not need to use condoms as long as I take my medication as prescribed. Antiretroviral agents do not stop the transmission of HIV, and patients need to continue standard precautions. Zidovudine (Retrovir, AZT) is not known for causing headaches or producing insomnia and does not require being taken with food.

What is the goal of combination antiretroviral therapy? A. Decrease the viral load and decrease the CD41 count B. Decrease the CD41 count and increase the viral load C. Increase the CD41 count and decrease the viral load D. Replace the memory cells within the immune system

C. Increase the CD41 count and decrease the viral load

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

C. 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.

A patient diagnosed with human immunodeficiency virus (HIV) is in her first trimester of pregnancy. The nurse will teach this patient about which medication? A. Delavirdine B. Efavirenz C. Nevirapine D. Zidovudine

C. Nevirapine Nevirapine may be used as an alternative therapy for women who are pregnant, especially in the first trimester of pregnancy. The other drug choices are not recommended for pregnant patients.

The drugs of choice for the treatment of trichomoniasis include which classifications of drugs? A. Penicilins B. Tetracyclines C. Nitroimidazoles D. Aminoglycosides

C. Nitroimidazoles The nitroimidazoles are the only class of antimicrobials effective against T. vaginalis. Metronidazole and tinidazole are approved for oral or parenteral treatment of trichomoniasis.

Which process by which antibiodies are received by an individual, used for protection against a particular pathogen, and acquired from another source? A. Active immunity B. Childhood immunity C. Passive immunity D. Toxiods

C. Passive immunity

Patients receiving sargramostim are most likely to develop which adverse reaction? A. Tumor lysis syndrome B. Hemorrhagic cystitis C. Pleural/pericardial effusion D. Hypertensive crisis

C. Pleural/pericardial effusion Pleural/pericardial effusions are the most common adverse reactions.

Which order would the nurse question if added to the patient receiving belatacept as a portion of the patient's drug regimen? A. An antihistamine B. Acetaminophen C. Shingles vaccine D. Amphotericin B

C. Shingles vaccine Transplant recipients receiving belatacept should not receive live vaccines because their immune response may be inadequate, and they are at risk for disseminated infection resulting from the live virus.

The patient has been administered a live virus as a vaccine. The patient is most likely being vaccinated against which disease? A. Tetanus B. Diphtheria C. Smallpox D. Anthrax

C. Smallpox A live virus is included in the smallpox vaccine. Toxoids are used to immunize against both tetanus and diphtheria. Anthrax requires a vaccine of inactivated bacteria.

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? A. Goldenrod leaves B. Grapefruit juice C. St. John's wort D. Vitamin D

C. St. John's wort St. John's wort may decrease the concentration of doxorubicin (Adriamycin). Use of St. John's wort should be reported to the health care provider.

Which factor is identified as the major barrier to the transplantation as a routine medical treatment option? A. Availability or organs B. State laws C. The body's immune system D. Lack of effective drugs

C. The body's immune system The immune system remains the biggest barrier to transplantation as a routine medical treatment because it has effective mechanisms to fight off foreign organisms. These same mechanisms are involved in the rejection of transplanted organs, which are recognized as foreign by the recipient's immune system.

The patient has been ordered gefitinib (Iressa) in the treatment of non-small cell lung cancer. After receiving three doses of the medication, the patient complains to the nurse of experiencing a skin rash. The nurse recognizes that this symptom is indicative of A. an overdosage of the medication. B. an allergic reaction to the medication. C. an expected side effect of the medication. D. a progression of the cancer.

C. an expected side effect of the medication. A skin rash is known to be a side effect that is typically experienced with this medication.

The nurse is preparing to administer the hepatitis A vaccine to the patient. The nurse recognizes that the patient will be receiving A. inactivated bacteria. B. a toxoid. C. inactivated viral antigen. D. recombinant viral antigen.

C. inactivated viral antigen. The vaccine against hepatitis A is an inactivated viral antigen.

The patient is scheduled to receive a measles vaccine. The nurse recognizes that the patient will be receiving A. inactivated viral components. B. inactivated virus. C. live virus. D. live attenuated virus.

C. live virus. The measles vaccine is a live virus.

When administering an intravenous infusion of monoclonal antibody, panitumumab, it is most important for the nurse to A. restrict the patient's intake of fluids. B. premedicate the patient with morphine. C. stay with the patient during the first 15 min of the infusion. D. assess the patient for the development of ototoxicity.

C. stay with the patient during the first 15 min of the infusion. Infusion reactions are common with infusion of monoclonal antibodies. Resuscitation equipment should be nearby. The nurse should stay with the patient for the first 15 min of the infusion and monitor vital signs every 15 to 30 min during the infusion and for 1 h after the infusion is complete. The patient should be well hydrated before, during, and after therapy; an antihistamine is usually ordered as a premedication, and the more common toxicity is hepatic.

A patient is to receive a chemotherapy protocol that includes an alkylating agent, an antimetabolite, and an antitumor antibiotic. The patient asks the nurse why so much chemotherapy is needed. What is the nurse's best response?

Combination chemotherapy increases the extent of tumor cell killing.

A health care provider has been exposed to HIV while caring for a patient. Following the postexposure prophylaxis regimen (PEP), the health care provider will most likely receive treatment for how long? A. 1 week B. 2 weeks C. 3 weeks D. 4 weeks

D. 4 weeks Many PEP regimens are available, with varying degrees of tolerability and probability of patients completing 4 weeks of treatment.

The nurse recognizes that compliance with ART regimens is often problematic for patients. What level of compliance is needed to help ensure ongoing success with this therapy? A. 50% B. 65% C. 80% D. 95%

D. 95% Adherence challenges are common with any drug therapy, but ART presents a greater challenge because patients are asked to achieve an adherence of 95% or greater. Nonadherence can result in HIV viral replication and can potentiate drug resistance.

The nurse is caring for a patient receiving high-dose methotrexate (MTX) therapy. What intervention is a priority for this patient? A. Administering bleomycin immediately after treatment with MTX B. Infusing IV dextrose at 100 mL/h throughout the drug therapy C. Encouraging oral fluids to 4 L/day while being treated with MTX D. Administering leucovorin within 2 days of treatment with MTX

D. Administering leucovorin within 2 days of treatment with MTX Leucovorin calcium is given within the first 24-42 h of starting methotrexate to block the systemic toxic effect of high-dose MTX. It is a form of folic acid that does not require dihydrofolate reductase to produce folic acid. Therefore, it is used to prevent or treat toxicity induced by methotrexate, a folic acid antagonist. Bleomycin is not administered with MTX; IV dextrose is not necessary with MTX therapy, and increased fluids to this degree are not necessary with MTX.

The patient is being treated with interferon gamma. The nurse recognizes that the medication is most frequently used to treat which condition? A. Leukemia B. Multiple sclerosis C. Malignant melanoma D. Chronic granulomatous disease

D. Chronic granulomatous disease Interferon gamma is most often ordered to treat chronic granulomatous disease.

The nurse is caring for a patient who has been diagnosed with metastatic breast cancer. The nurse receives an order to administer dasatinib (Sprycel). What is the nurse's priority action? A. Contact the pharmacist regarding administering the medication. B. Start an IV as part of preparing to administer the medication. C. Administer ordered premedications prior to giving the drug. D. Contact the health care provider regarding the medication.

D. Contact the health care provider regarding the medication. The nurse should contact the health care provider regarding use of this medication, since it is most frequently ordered to treat leukemia rather than metastatic breast cancer.

Cyclosporine oral solution should not be mixed in which of the following types of fluids? A. Apple juice B. Orange juice C. Grape juice D. Grapefruit juice

D. Grapefruit juice

A patient is receiving cyclosporine after transplantation surgery. Which of the following items should be avoided? A. Apple juice B. Grape juice C. Orange juice D. Grapefruit juice

D. Grapefruit juice Grapefruit juice should be avoided as grapefruit juice affects drug metabolism increasing blood concentrations of cyclosporine.

The nurse is caring for a patient who is being treated with interferon alpha-2b. The nurse recognizes that this medication is most frequently used to treat which condition? A. Genital venereal warts B. Chronic hepatitis B C. Multiple sclerosis D. Hairy-cell leukemia

D. Hairy-cell leukemia Interferon alpha-2b is usually ordered for treatment of hairy-cell leukemia.

Which is the first vaccine developed to prevent cancer? A. Rotavirus B. Pneumococcal disease C. Meningococcal disease D. Human papillomavirus

D. Human papillomavirus Gardasil, the human papillomavirus (HPV) vaccine, has been called the first vaccine designed to prevent cancer. Prevnar is the first pneumococcal conjugate vaccine, which provides protection against seven serotypes of pneumococci. Menhibrix, a combination vaccine for infants and children age 6 weeks through 18 months, is used for prevention of invasive disease caused by Neisseria meningitides and Haemophilus influenza type b. Rotavirus is a leading cause of severe acute gastroenteritis in infants and young children. RotaTeq, a live oral vaccine containing five strains of rotavirus, is effective in protecting against severe gastroenteritis and significantly reduces the need for hospitalization among infected children.

Before administering epoetin alpha, it is most important for the nurse to assess the patient for a history of which condition? A. Anemia B. Chronic renal failure C. Pancreatitis D. Hypertension

D. Hypertension Erythropoietin-stimulating agent administration is contraindicated in patients with (1) uncontrolled hypertension, (2) known hypersensitivity to mammalian cell-derived products, and (3) known hypersensitivity to human albumin or polysorbate.

A patient comes to the clinic complaining of itching in the vaginal area and is diagnosed as having candidiasis. Which intervention is a priority for this patient? A. Have the patient soak in a warm bath. B. Assist the patient with vaginal irrigations. C. Administer IV erythromycin. D. Insert a vaginal suppository of miconazole 100 mg.

D. Insert a vaginal suppository of miconazole 100 mg Candidiasis is a fungal infection that is treated with the antifungal agent miconazole, among others.

The patient is prescribed erlotinib (Tarceva). The nurse recognizes that this medication is most frequently used to treat which cancer? A. Metastatic breast cancer B. Hepatocellular cancer C. Colorectal cancer D. Non-small cell lung cancer

D. Non-small cell lung cancer Erlotinib (Tarceva) is used to treat non-small cell lung cancer as well as pancreatic cancer.

Which nursing intervention is designed to treat the most common side effects of filgrastim? A. Provide antihypertensives to lower blood pressure. B. Provide bronchodilators to treat wheezing. C. Provide antibiotics to treat secondary infections. D. Provide antiemetic to relieve vomiting.

D. Provide antiemetic to relieve vomiting. Patients receiving filgrastim (Neupogen) therapy frequently experience nausea and vomiting requiring antiemetics.

The community health nurse is assessing a child who has a rash. The child is found to have measles. What is the nurse's best action? A. Take no action; let the disease process run its course. B. Take the child to the nearest emergency department for treatment. C. Tell the parent to stay away from the child to avoid infection. D. Report the measles to public health officials.

D. Report the measles to public health officials. Health care providers are responsible for reporting cases of vaccine-preventable diseases to public health officials, who then make weekly reports to the Centers for Disease Control and Prevention. These data identify whether an outbreak is occurring and the impact of immunization policies and procedures.

The nurse is caring for several patients receiving chemotherapy. What patient will the nurse assess first? A. The patient receiving doxorubicin with a history of angina B. The patient receiving fluorouracil (with an elevated platelet count) C. The patient taking cyclophosphamide who is urinating 100 mL/h D. The patient receiving mechlorethamine with pain at the IV insertion site

D. The patient receiving mechlorethamine with pain at the IV insertion site Mechlorethamine (nitrogen mustard) is a severe 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.

The nurse identifies which condition as a common bacterial opportunistic infection seen in patients with HIV? A. Cytomegalovirus B. Candidiasis C. Toxoplasmosis D. Tuberculosis

D. Tuberculosis Tuberculosis is a bacterial infection. Cytomegalovirus is a virus. Candidiasis is a fungal infection. Toxoplasmosis is a protozoal infection.

The nurse is caring for several patients who are scheduled to receive epoetin alfa (Procrit). The nurse would question the administration of this medication to a patient with which condition? A. Anemia B. Chronic renal failure C. Human immunodeficiency virus D. Uncontrolled hypertension

D. Uncontrolled hypertension Hypertension is a side effect of epoetin alfa (Procrit); hence, the drug should not be given to patients with uncontrolled hypertension. Anemia, chronic renal failure, and human immunodeficiency virus or acquired immunodeficiency syndrome are indications for the therapeutic use of epoetin.

The nurse assesses a patient who is receiving doxorubicin intravenously. The nurse determines extravasation has occurred. The first action by the nurse is to A. attempt to aspirate residual doxorubicin from the patient's vein. B. remove the intravenous catheter. C. pack the intravenous site with ice. D. stop the intravenous infusion of doxorubicin.

D. stop the intravenous infusion of doxorubicin. If extravasation occurs, stop infusion immediately. Do not remove IV device from the patient. Attempt to aspirate residual vesicant from the IV device using a small syringe and then remove the IV device. Assess the site. Notify health care provider. Apply warm packs for 15 to 20 min at least 4 times per day for first 24 h. For peripheral extravasations elevate extremity. Tissue necrosis may occur 3 to 4 weeks after infiltration into tissue.

Which instruction is the important for the nurse to include when teaching a patient about imatinib therapy?

Do not drink grapefruit juice while taking this drug

When a patient does not appear for a routine clinic visit, the nurse calls to ask about the missed visit. The patient says "I don't need to come any longer. I'm so glad I no longer have human immunodeficiency virus." The nurse learns that recent laboratory results indicated an "undetectable" human immunodeficiency virus viral load and that the patient stopped his medication several weeks earlier. What is the nurse's best response?

Educate the patient about the continued need for his medications and ongoing laboratory monitoring.

All transplant drugs have the same advisory, to use caution when administering them with another immunosuppressant drug because of the increased risk for:

Infection

A patient is scheduled to receiver chemotherapy drugs that will cause myelosuppression. Which action by the nurse will be most important?

Monitor for a change in temperature

The nurse is teaching a group of junior high school students about preventing sexually transmitted infections if they are sexually active. Which of the following are the best methods of prevention?

Monogamy

A patient taking sunitinib reports that the skin on her hands and feet is red, painful and has some blisters. What is the nurse's best action?

Notify the oncologist to determine if a dosage reduction is needed.

During routine prenatal testing, a patient is diagnosed with human immunodeficiency virus infection. To help prevent perinatal transmission of human immunodeficiency virus to the fetus, what is the nurse's best action?

Provide written and oral education about the use of antiretroviral therapy during pregnancy.

Which is the priority nursing diagnosis for patients receiving epidermal growth factor receptor inhibitors?

Risk for impaired skin integrity related to skin side effects.

A patient undergoing chemotherapy for breast cancer asks why she is not receiving trastuzumab like her sister. What is the nurse's best response?

Your breast cancer cells are estrogen-receptor positive, and targeted therapy is not needed.