NURS 329 Quiz #2
You are caring for an esophageal cancer patient. Which of the following would alert you to hold the chemotherapy and contact the patient's oncologist? (Select all that apply). A. Chest pain B. Fatigue C. Fever of 100.5 F D. Mild nausea E. Shortness of breath
A, C, and E
What is the most common adverse effect experienced by patients receiving chemotherapy? A. Alopecia B. Bone marrow suppression C. Nausea & vomiting D. Peripheral neuropathy
C. Nausea & vomiting
A patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what? A. Increase intake of dietary sodium. B. Take antibiotics to prevent infection. C. Never abruptly withdraw therapy. D. Have an eye examination every year
C. Never abruptly withdraw therapy.
The nurse should review which baseline data before starting epoetin alfa [Epogen] therapy in a patient with chronic renal failure (CRF)? (Select all that apply.) a. Ferritin level b. Temperature trends c. Blood glucose level d. Blood pressure trends e. Hemoglobin and hematocrit
a, d, and e
When assessing a patient for adverse effects of cyclosporine [Sandimmune], it is most important for the nurse to review which laboratory findings? (Select all that apply.) a. Creatinine level b. Hemoglobin level c. Platelet count d. Bilirubin level e. White blood cell (WBC) count
a, d, and e Rationale: Remember that adverse effects of Cyclosporine include significant neurotoxicity, renal toxicity, hepatotoxicity, and infection risk.
After administering acetylcysteine [Mucomyst] to a patient who overdosed on acetaminophen [Tylenol], a nurse should recognize which outcome as an indicator of the therapeutic effects of acetylcysteine? a. Absence of jaundice b. Clear breath sounds c. Increased bowel sounds d. Palpable pedal pulses
a. Absence of jaundice
The nurse is administering epoetin alfa [Procrit] to a patient receiving chemotherapy. Which adverse effect is a potential risk with this drug? a. Accelerated tumor progression b. Hypotension c. Easy bruising d. Bone pain
a. Accelerated tumor progression
A nurse is admitting a client to the hospital following acetaminophen toxicity. Which of the following medications can the nurse expect to administer? a. Acetylcysteine b. Misoprostol c. Naltrexone d. Acetylcholine
a. Acetylcysteine
A nurse provides discharge instructions for a patient who is taking acetaminophen [Tylenol] after surgery. The nurse should instruct the patient to avoid which product while taking acetaminophen? a. Alcoholic drinks b. Leafy green foods c. Bananas d. Dairy products
a. Alcoholic drinks
A nurse administers metronidazole [Flagyl] to a patient who has which infection? a. Amebiasis b. Toxoplasmosis c. Leishmaniasis d. Chagas' disease
a. Amebiasis
Which statement explains why cancer treatment is more effective when multiagent chemotherapy is used? a. Drug resistance occurs less frequently. b. The intervals between dosages are shorter. c. Normal cell repopulation is not necessary. d. The effect occurs during the mitotic phase of the cell cycle.
a. Drug resistance occurs less frequently.
A nurse teaches a patient who takes daily low-dose aspirin for protection against myocardial infarction and stroke to avoid also taking which medication? a. Ibuprofen [Motrin] b. Zolpidem [Ambien] c. Loratadine [Claritin] d. Diphenhydramine [Benadryl]
a. Ibuprofen [Motrin]
The nurse is preparing to administer a medication for acute organ rejection. Which medication will the nurse prepare to administer? a. Methylprednisolone sodium [Solu-Medrol] b. Diphenhydramine [Benadryl] c. Acetaminophen [Tylenol] d. Meperidine [Demerol]
a. Methylprednisolone sodium [Solu-Medrol] Rationale: Methylprednisolone sodium, a glucocorticoid, is administered intravenously to treat episodes of acute organ rejection.
The nurse is evaluating the effectiveness of the drug oprelvekin [Neumega] in a patient undergoing cancer chemotherapy. Which finding is most indicative that this drug is having its intended effect? a. Platelet count of 150 × 103/mm3 b. Hemoglobin level of 13.2 g/dL c. White blood cell count of 5500/mm3 d. Total lymphocyte count of 1000/mm3
a. Platelet count of 150 × 103/mm3
The nurse should question an order for glucocorticoids in the treatment of a patient with what? a. Systemic fungal infection b. Diabetes mellitus c. Myasthenia gravis d. Glaucoma
a. Systemic fungal infection
A patient with cancer who is neutropenic is hospitalized. Which action by the nursing assistant requires the supervising nurse to intervene? a. The nursing assistant delivers a fresh fruit basket to the patient's room. b. The nursing assistant obtains the patient's temperature at frequent intervals. c. The nursing assistant maintains isolation protocol for the patient. d. The nursing assistant assists the patient in basic hygiene as needed.
a. The nursing assistant delivers a fresh fruit basket to the patient's room.
Which statements should the nurse include when teaching a patient about treatment with metronidazole [Flagyl]? (Select all that apply.) a. "If your urine turns dark when taking this drug, immediately stop treatment." b. "Avoid consuming alcohol with this drug." c. "You may experience a metallic taste in your mouth when taking this drug." d. "Constipation is a frequent side effect of this medication." e. "This drug must be administered intravenously."
b and c Rationale: Dark urine is a normal side effect. Diarrhea often occurs, not constipation. Flagyl can be given PO or IV
A nurse is preparing to administer doxorubicin [Adriamycin] intravenously (IV) to a patient who has breast cancer. Which actions should the nurse take? (Select all that apply.) a. Infuse normal saline for the preceding 24 hours. b. Place the patient on a cardiac monitor. c. Tell the patient the urine turns red. d. Give a diuretic after the infusion. e. Ensure the patency of the IV site.
b, c, and e Rationale: Cardiac activity may be assessed with a monitor, because acute dysrhythmias and electrocardiographic (ECG) changes can occur within minutes of administration. The medication imparts a harmless red color to urine. IV patency is critical, because doxorubicin is a vesicant and can cause significant local tissue injury if extravasation occurs.
When planning for a cancer patient's return home after chemotherapy, which direction will you include regarding the avoidance of infection? a. "You will not have to stay away from people who are sick because you are finished with chemotherapy." b. "Wash your hands frequently to prevent the spread of germs." c. "You do not need to wear gloves when changing your intravenous catheter dressing." d. "Remove the carpet from your room because it can harbor germs.
b. "Wash your hands frequently to prevent the spread of germs."
The healthcare provider prescribes hematopoietic growth factor for a patient. The nurse should notify the healthcare provider to question the prescription for which patient condition? a. A patient with chronic renal failure (CRF) b. A patient with uncontrolled hypertension c. A patient taking zidovudine for human immunodeficiency virus (HIV) d. A patient with nonmyeloid malignancy chemotherapy-induced anemia
b. A patient with uncontrolled hypertension
A patient is receiving glucocorticoids for the treatment of rheumatoid arthritis. The patient complains of having a headache. Which ordered medication should the nurse administer? a. Aspirin [Bayer] b. Acetaminophen [Tylenol] c. Ibuprofen [Advil] d. Naproxen sodium [Aleve]
b. Acetaminophen [Tylenol]
A nurse teaches a patient who is receiving metronidazole [Flagyl] that consuming which substance may cause a drug interaction? a. Lactose b. Alcohol c. Eggs d. Nuts
b. Alcohol
The nurse is caring for a patient undergoing cancer chemotherapy who presents with rash, bone pain, hypertension, and pedal edema. Which symptom is most likely an adverse reaction to the filgrastim [Neupogen] the patient is receiving? a. Rash b. Bone pain c. Headache d. Swelling in feet
b. Bone pain
Before a patient starts therapy with tinidazole [Tindamax], it is most important for the nurse to assess the patient for a history of what? a. Allergy to penicillin b. Central nervous system (CNS) disease c. Diabetes mellitus d. Congestive heart failure
b. Central nervous system (CNS) disease
The nurse identifies which class of anticancer drugs as used most often in the treatment of patients? a. Targeted drugs b. Cytotoxic drugs c. Immunomodulating agents d. Biologic response modifiers
b. Cytotoxic drugs
Which chemotherapy drug has a dose limiting cardiac toxicity and a high risk of extravasation? a. Cisplatin b. Doxorubicin c. Paclitaxel d. Vincristine
b. Doxorubicin
A nurse provides teaching about which antibiotic to a patient requiring prophylaxis for chloroquine-resistant malaria? a. Penicillin b. Doxycycline c. Clindamycin d. Tetracycline
b. Doxycycline
Cell cycle specific drugs act at a specific phase within the cell cycle while cell cycle nonspecific drugs only work in the resting phase of the cell cycle. a. True b. False
b. False
The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding does the nurse know is an adverse effect of ibuprofen [Advil] therapy? a. Hives b. Hematemesis c. Dysmenorrhea d. Jaundice
b. Hematemesis
A patient who takes cyclosporine [Sandimmune] is also receiving ketoconazole [Nizoral]. The nurse should expect which therapeutic outcome from the combined medications? a. Improved glomerular filtration rate b. Inhibition of cyclosporine metabolism c. Decreased risk of lymphoma occurrence d. Decreased risk of bacterial and viral infections
b. Inhibition of cyclosporine metabolism
You are explaining how filgrastim (Neupogen) works to a patient. You understand that which characteristic explains how this medication works? a. It increases the number of red blood cells produced by the bone marrow. b. It increases the number of neutrophils produced by the bone marrow. c. It increases the number of platelets produced by the bone marrow. d. It increases the number of mature white blood cells in circulation
b. It increases the number of neutrophils produced by the bone marrow.
"Unresponsiveness to feedback mechanisms that control cellular growth in healthy tissue" describes which of these characteristic of cancer cells? a. Invasive growth b. Persistent proliferation c. Telomerase activity d. Formation of metastases
b. Persistent proliferation
Which finding indicates a positive outcome from treatment with filgrastim [Neupogen]? a. Bone pain is eliminated. b. The neutrophil count increases. c. Cancer goes into remission. d. The red blood cell count increases.
b. The neutrophil count increases.
A nurse should recognize that a patient who takes quinine [Qualaquin] is at risk for a complication if what develops? a. Hemoptysis b. Tinnitus c. Dyspnea d. Constipation
b. Tinnitus
The nurse will include which statements when teaching a patient about the use of acetaminophen [Tylenol]? (Select all that apply.) a. "Acetaminophen is a useful drug for the treatment of inflammation, such as a rheumatoid arthritis." b. "The most common side effect of treatment with the drug is kidney failure." c. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." d. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." e. "Use of this drug can prevent heart attack and stroke."
c and d Rationale: Acetaminophen does not treat inflammation. The most serious side effects is liver failure. It does not have anti platelet activity, like that of aspirin, so it does not prevent heart attack or stroke. Routine use of Tylenol after vaccines may blunt the immune response.
A nurse instructs a patient to discontinue the scheduled use of high-dose aspirin before undergoing which procedures? (Select all that apply.) a. Routine dental cleaning b. Removal of a skin mole c. Cataract surgery d. Cholecystectomy e. Hysterectomy
d and e Rationale: High-dose aspirin should be discontinued 1 week before elective surgery. There is no need to stop aspirin before procedures with a low risk of bleeding such as the other procedures listed.
A nurse instructs the parent of a child with influenza that which medication or medications may be used safely to reduce fever? a. Ibuprofen [Advil] b. Naproxen [Aleve] c. Aspirin [Bayer] d. Acetaminophen [Tylenol] e. Indomethacin [Indocin]
d. Acetaminophen [Tylenol] Rationale: The use of NSAIDs by children with influenza or chickenpox may precipitate Reye's syndrome.
Which factor in a patient's history is most likely related to the development of giardiasis? a. Recent travel to a subtropical region b. Unprotected sex with several partners c. Exposure to a bite from a tsetse fly d. Drinking contaminated creek water
d. Drinking contaminated creek water Rationale: Recent travel to a subtropical region can lead to the risk of leishmaniasis, which is acquired through a sandfly bite in tropical areas. Unprotected sex with multiple partners is a risk factor for trichomoniasis.
The nurse is caring for a patient with anemia related to chronic renal failure. Which agent might be used to treat the anemia? a. Filgrastim [Neupogen] b. Sargramostim [Leukine] c. Oprelvekin [Neumega] d. Epoetin alfa [Procrit]
d. Epoetin alfa [Procrit]
When planning care for a patient who is receiving cyclophosphamide [Cytoxan], it is most important for the nurse to include which intervention to prevent complications of cyclophosphamide [Cytoxan] therapy? a. Palpate for pedal pulses every 2 hours. b. Monitor for laryngeal stridor and tetany. c. Give an antidiarrheal medication. d. Increase the IV and oral fluid intake.
d. Increase the IV and oral fluid intake. Rationale: Bladder injury can be minimized by maintaining adequate hydration through increased fluid intake.
The nurse is developing a plan to minimize the risk of adrenal insufficiency for a patient who is receiving long-term glucocorticoid therapy. Which outcome should be included? a. Increases daily intake of sodium for vascular expansion b. Tapers blood pressure medications to avoid hypotension c. Obtains periodic ultrasound scans of adrenal glands d. Increases or supplements dosage of glucocorticoid at times of stress
d. Increases or supplements dosage of glucocorticoid at times of stress
Which laboratory value places a cancer patient at risk for an infection? a. White blood count of 6000/mm3 b. Red blood cell count of 4 million/mm3 c. Platelet count of 140,000/mm3 d. Neutrophil count of 500/mm3
d. Neutrophil count of 500/mm3 Rationale: Remember ANC under 1000 indicates neutropenia!
A patient takes glucocorticoids and digoxin [Lanoxin]. It is most important for the nurse to monitor which electrolyte? a. Calcium b. Magnesium c. Sodium d. Potassium
d. Potassium
A patient with a chronic illness is on daily glucocorticoids. He is brought to the hospital following a severe motor vehicle accident. He is wearing a medical alert bracelet stating his home medications. Noting that the patient takes glucocorticoids daily, the nurse knows which of the following to be true? a. The patient will need lower doses of glucocorticoids following the trauma. b. The patient will have to stop all glucocorticoids immediately. c. The patient will need the same dose of glucocorticoids he used at home. d. The patient will need higher doses of glucocorticoids following a trauma.
d. The patient will need higher doses of glucocorticoids following a trauma.
A nurse is caring for a patient who has thrombocytopenia after chemotherapy. Which action should the nurse take? a. Take the pulse before and after activity. b. Administer a colony-stimulating factor. c. Obtain blood cultures and then begin antibiotic therapy. d. Use minimal cuff inflation when taking the blood pressure.
d. Use minimal cuff inflation when taking the blood pressure. Rationale: Thrombocytopenia, a reduction in circulating platelets, increases the risk for bleeding. Routine procedures such as blood pressure readings should be performed with care and only as needed, because overinflation of the cuff may cause bruising.
A nurse in the ED is performing an admission history for a client who has severe aspirin toxicity.Which of the following findings should the nurse expect? a. body temperature 95 degrees b. lung crackles c. cool, dry skin d. respiratory depression
d. respiratory depression
A nurse is assessing a client who has salicylism. Which of the following findings should the nurse expect? Select all that apply. a. Dizziness b. Diarrhea c. Jaundice d. Tinnitus e. Headache
a, d, and e
Which of the following drugs has no anti-inflammatory properties and blocks transmission of pain impulses peripherally? A. Acetaminophen (Tylenol) B. Aspirin (ASA) C. Tramadol (Ultram) D. All of the above
A. Acetaminophen (Tylenol)
Which of the following is needed to calculate a patient's body surface area (BSA)?( Select all that apply) A. Oxygen level B. Height C. Renal function D. Weight
B and D
What does the nurse identify as possible complications of glucocorticoid therapy? (Select all that apply.) a. Impaired carbohydrate and glucose tolerance b. Increased production of glucocorticoids from the adrenals c. Predisposition to gastrointestinal ulceration d. Decrease in serum sodium and glucose levels e. Increase in plaque development in coronary arteries
a and c Rationale: The adrenals will have decreased production of glucocorticoids. Serum sodium & glucose levels will increase. Plaque is not affected.
The nurse assesses a patient who takes quinine for signs of cinchonism, a syndrome characterized by what? (Select all that apply.) a. Tinnitus b. Headache c. Visual disturbances d. Constipation e. Prolonged QT interval
a, b, and c
Which statements regarding treatment modalities for treating cancer does the nurse identify as true? (Select all that apply.) a. Surgery is the most common treatment for solid cancers. b. Drug therapy is the treatment of choice for disseminated cancers. c. Drug therapy is not effective in treating a patient with cancer who has had surgery. d. Drug therapy is effective as an adjunct therapy in treating a patient who has had irradiation. e. Irradiation is the treatment of choice for leukemias.
a, b, and d
Why would combination therapy be used to treat cancer? Select all that apply. Combination therapy... a. Aims to increase the length of remission b. Decreases the risk of tumor resistance c. Decreases tumor death & cell kill d. Decreases damage to normal healthy cells e. Increases the patient's adverse effects
a, b, and d
What does the nurse identify as a possible adverse effect of long-term glucocorticoid therapy? (Select all that apply.) a. Adrenal insufficiency b. Osteoporosis c. Hypoglycemia d. Hyperkalemia e. Cataracts
a, b, and e Rationale: Hyperglycemia & hypokalemia are adverse effects
Common adverse effects of calcineurin inhibitors include (Select all that apply) a. Nephrotoxicity b. Infection c. Gingival hyperplasia d. Hirsutism e. Hypokalemia f. pulmonary fibrosis
a, b, c, and d
What long-term adverse effects of steroids will you include in a caner patient's health teaching? Select all that apply. a. Osteoporosis b. Adrenal insufficiency c. Decreased immune response d. Gastric ulceration e. Fluid and electrolyte imbalances f. Thinning of skin
a, b, c, d, e, and f
What are the primary benefits to a patient who is receiving glucocorticoids as part of a chemotherapy regimen? (Select all that apply.) a. They promote appetite and weight gain. b. They increase long-bone rebuilding. c. They reduce cerebral edema after radiation. d. They are cytotoxic to selective cancers. e. They reduce the risk of pathogen invasion.
a, c, and d
Jason's parents are concerned with him getting dexamethasone in addition to Vincristine. How do you explain the purpose of this medication to them? Select all that apply. a. "Steroids, when given in high doses, work directly on certain cancer tissues causing their death." b. "Dexamethasone is a steroid that will be used in small amounts to treat inflammation in Jason's body." c. "Dexamethasone will help Jason better tolerate some of the chemotherapy side effects." d. "Dexamethasone is useful in fighting any potential infections that Jason might get while on chemotherapy." e. "Dexamethasone is typically used with other chemotherapy drugs as part of the treatment." f. "Dexamethasone will prevent muscle wasting while he is receiving chemotherapy."
a, c, and e
Which statements about the care of a patient with aspirin poisoning does the nurse identify as true? (Select all that apply.) a. Warming blankets are routinely used to raise the patient's temperature. b. Diuretics and fluid restrictions are needed to correct the fluid overload commonly seen with aspirin poisoning. c. Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylates. d. Activated charcoal is contraindicated in the treatment of aspirin poisoning. e. Hemodialysis or peritoneal dialysis can accelerate salicylate removal.
c and e Rationale: Treatment is largely supportive and consists of external cooling, infusion of fluids, infusion of bicarbonate, and mechanical ventilation (if necessary). Absorption of aspirin can be reduced by gastric lavage and by giving activated charcoal. If necessary, hemodialysis or peritoneal dialysis can accelerate salicylate removal.
A patient with nonmyeloid cancer is receiving oprelvekin [Neumega]. Which adverse effects are most likely associated with this drug? (Select all that apply.) a. Hypertension b. Accelerated tumor progression c. Fluid retention d. Atrial fibrillation e. Anaphylactic reactions
c, d, and e
A nurse determines that a patient who takes primaquine is at risk for developing an adverse effect if the patient reports which finding? a. Frequent, loose stools b. Violent dreams c. Darkening of the urine d. Ecchymosis
c. Darkening of the urine Rationale: Hemolysis is common adverse effect of Primaquine so a patient may have hemoglobin in their urine.
When administering prednisone to a patient, the nurse will do what? a. Administer the prednisone in the evening to coincide with the natural secretion pattern of the adrenal cortex. b. Instruct the patient to stop taking the prednisone immediately if diarrhea develops. c. Ensure that meals are at bedside so that administration with food reduces gastric irritation. d. Avoid intravenous delivery to prevent adverse effects.
c. Ensure that meals are at bedside so that administration with food reduces gastric irritation. Rationale: Glucocorticoids given in larger pharmacologic doses for nonendocrine causes produce many adverse effects, including gastric irritation and ulcers. They should be given with food
Which chemotherapy drug has a risk for hemorrhagic cystitis? a. Doxorubicin b. Vincristine c. Ifosfamide d. Cispatin
c. Ifosfamide Rationale: MESNA given to protect bladder
The nurse is screening a patient before administering a live virus vaccine. The patient is currently taking a glucocorticoid medication. Which action should the nurse take? a. Continue screening and give the vaccine if appropriate. b. Note the contraindication but give the vaccine anyway. c. Note the contraindication and clarify the order with the healthcare provider. d. Hold the vaccine and notify the department of health.
c. Note the contraindication and clarify the order with the healthcare provider.
A nurse develops a plan of care for a patient receiving chemotherapy whose neutrophil count has reached the nadir. Which nursing action is the priority? a. Provide daily oral hygiene. b. Limit contact with visitors. c. Obtain temperature frequently. d. Restrict all fresh fruits and vegetables.
c. Obtain temperature frequently.
A patient is scheduled to start taking aspirin for the treatment of rheumatoid arthritis. The nurse anticipates that which medication most likely will be prescribed? a. Docusate sodium [Colace] b. Ascorbic acid (vitamin C) c. Pantoprazole [Protonix] d. Furosemide [Lasix]
c. Pantoprazole [Protonix]
A nurse should recognize that a patient who takes an angiotensin-converting enzyme (ACE) inhibitor while also taking high-dose aspirin is at risk of developing what complication? a. Congestive heart failure b. Liver toxicity c. Renal failure d. Hemorrhage
c. Renal failure
A transplant recipient is receiving cyclosporine [Sandimmune]. Which response should a nurse expect if the medication is having the desired effect? a. Increased antibody response b. Increased natural killer (NK) cellular activity c. Suppression of T lymphocytes d. Suppression of hepatic metabolism of steroids
c. Suppression of T lymphocytes
A nurse is taking a history for a client that takes aspirin every day for a sprained wrist. Which of the following prescribed medications of the client is contraindicated with aspirin use? a. Digoxin b. Metformin c. Warfarin d. Nitroglycerine
c. Warfarin
