Pharm II- Exam 1

The healthcare provider has written in the patient's chart that the cancer is at Stage I. The nurse knows that the implications for this staging are that the: A. Cancer is advanced and the patient has a poor prognosis. B. Cancerous cells are only moderately differentiated from the parent cells. C. Cancer has been detected at an early stage. D. Tumor is large and is invading surrounding tissue.

. Cancer has been detected at an early stage

The nurse determines that the patient understands an important principle of chemotherapy when the patient makes which statement? A. "The use of multiple chemotherapy drugs affects different stages of the cancer cell's lifecycle." B. "Staging describes the process of determining how responsive the cancer is to the prescribed chemotherapy." C. "Antineoplastic drugs kill the entire tumor, including the clones, and prevent repopulation." D. "Combination chemotherapy requires higher dosages of each individual drug and increases toxicity."

A. "The use of multiple chemotherapy drugs affects different stages of the cancer cell's lifecycle"

A nurse is caring for a client who has breast cancer and asks why the treatment plan contains a combination therapy of cyclophsophamide, methotrexate, and fluouracil. The response by the nurse should include that the combination chemotherapy is used to do which of the following? (SATA) A. Decrease medication resistance B. Attack cancer cells at different stages of cell growth C. Block chemotherapy agent from entering healthy cells D. Stimulate the immune system E. Decrease injury to normal body cells

A. Medication resistance is decreases with combination therapy because the chance of developing resistance to several medications is less than to only one B. Each medication kills cancer cells at a different stage of growth. A combination of medications can kill more cancer cells than only one medication. E. Injury to normal body cells can be decrease by combination therapy because the medications used have different toxicities.

A nurse is preparing to administer cyclophosphamide IV to a client who has Hodgkins disease. Which of the following medications should the nurse expect to administer concurrently with the chemotherapy to prevent an adverse effect of cyclophosphamide? A. Protectant agent, such as mesna B. Opioid, such as morphine C. Loop diuretic, such as furosemide D. H1 receptor antagonist, such as diphenhydramine

A. Mesna is a uroprotectant agent that can help prevent hemorrhagic cystitis when administered IV with a nitrogen mustard chemotherapy medication.

A postpartum patient received Rho(D) immune globulin (RhoGAM) therapy after the delivery of an 8-lb baby boy. The nurse performs what important intervention during the course of this treatment? A. Monitors the patient for 20 minutes following the administration for hypersensitivity reaction. B. Evaluates the laboratory results for thrombocytopenia, anemia, and increased liver enzymes. C. Provides the patient with the information needed to maintain a low-saturated-fat, low-cholesterol diet. D. Instructs the patient to use nonmedicated sugar-free lozenges or hard candies to relieve a cough.

A. Monitors the patient for 20 minutes following the administration for hypersensitivity reactions ( they are likely to occur within the first 20 min of administration)

The nurse is collaborating with other members of the healthcare team regarding the care of a patient with a brain tumor. The nurse knows that the most common reason that subsequent rounds of chemotherapy may be delayed is due to what condition? A. Myelosuppression B. Alopecia C. Mucositis D. Cachexia

A. Myelosuppression ( Bone Marrow Suppression)

The patient will continue to take methotrexate (MTX, Rheumatrex, Trexall) for treatment of osteosarcoma. When teaching the patient prior to discharge, what over-the-counter drugs must not be taken concurrently with methotrexate? A. Nonsteroidal anti-inflammatory drug pain relievers B. Antihistamines C. Laxatives D. Cough suppressant

A. NSAIDs; may cause severe and fatal myelosuppression while concurrently taking methotrexate

A patient has been receiving vincristine (Oncovin) as one of the drugs in a chemotherapy regimen. What important findings will the nurse monitor to prevent or limit the main dose-related toxicity for this patient? (Select all that apply.) A. Numbness of the hands or feet B. Angina and dysrhythmias C. Constipation D. Diminished reflexes E. Dyspnea and pleuritis

A. Numbness of the hands or feet C. Constipation ( decreased peristalsis) D. Diminished reflexes

Mary is a 4-month-old infant who is brought to the clinic for her first checkup. Her mother tells the nurse that the child has never been ill. Which factor would the nurse consider most significant in assessing the baby's likelihood of receiving immunizations? A. Allergies to previously administered medications B. Mother's preconceptions and reservations relating to vaccines C. Maternal and paternal allergies or reactions to vaccine administration D. The nurse's knowledge of the recommended pediatric immunization schedule

B. Mother's preconceptions and reservations relating to vaccines

A nurse is caring for a client who s being treated with interferon alfa-2b for malignant melanoma. For which of the following adverse effects should the nurse monitor? (SATA) A. Tinnitus B. Muscle Aches C. Peripheral Neuropathy D. Bone loss E. Depression

B. Muscle aches and other flu-like manifestations are common adverse effects of interferon alfa-2b. Acetaminophen may be prescribed to relieve these manifestations. C. Peripheral neuropathy, dizziness, and fatigue are CNS effects that can occur when taking interferon alfa-2b. These should be reported to the provider, and teach the client to prevent injury from falls. E. Depression and mental status changes can occur with interferon alfa-2b treatment. Assess the client for suicidal thoughts.

A nurse is teaching a client who has breast cancer about Tamoxifen. Which of the following adverse effects of Tamoxifen should the nurse discuss with the client? A. Irregular heart beat B. Abnormal uterine bleeding C. Yellow sclera or dark-colored urine D. Difficulty swallowing

B. Vaginal discharge and bleeding are adverse effects of Tamoxifen. The client who takes Tamoxifen is also at risk for endometrial cancer, so any abnormal uterine bleeding should be carefully monitored and evaluated.

The nurse is preparing to administer cyclophosphamide (Cytoxan) and knows that the patient will experience a nadir in approximately 9 to 14 days. Which laboratory value(s) will indicate to the nurse that the patient has reached the nadir? A. Blood urea nitrogen and creatinine B. White blood cell count and absolute neutrophil count C. Ionized calcium D. Serum albumin

B. White blood cell count and absolute neutrophil count -Nadir indicates that myelosuppression has occurred and is indicated by decreased blood cell counts

The occupational health nurse will be administering hepatitis B vaccine to a new employee. Which assessment finding discovered by the nurse would necessitate withholding the injection? The patient is: A. A two-pack-per-day smoker. B. Known to have transient hypertension. C. Allergic to yeast and yeast products. D. Frightened by needles and injections.

C. Allergy to yeast and yeast products- known hypersensitivity to yeast is an absolute contraindication for Hep B vaccine.

Chemotherapy is being initiated for a patient with prostate cancer who is experiencing mucositis. Which health teaching would be most appropriate for this condition? A. Use an over-the-counter mouthwash to eliminate bacteria. B. Increase intake of citrus-containing foods and beverage C. Eat a bland diet with low roughage and use a soft toothbrush or plain water rinses for oral care. D. This adverse effect is expected and will disappear within a few days.

C. Eat a bland diet with low roughage and use a soft toothbrush or plain water rinses for oral care

A patient receiving carboplatin (Paraplatin) is also receiving filgrastim (Neupogen). The nurse will explain to the patient that the filgrastim is used for what effect? 1. It boosts the effects of the carboplatin so a decreased dosage is needed. 2. It prevents the development of secondary cancers related to the carboplatin. 3. It shortens the duration of neutropenia and associated infection risk related to the carboplatin. 4. It prevents bone loss and osteoporosis.

C. It shortens the duration of neutropenia and associated infection risk related to the carboplatin - Filgrastim increases neutrophil production and decreases the duration of neutropenia

A nurse is caring for a client who receives Rituximab to treat non-Hodgkins leukemia and who asks the nurse how Rituximab works. Which of the following should the nurse include? A. Blocks hormone receptors B. Increases immune response C. Binds with specific antigens on tumor cells D. Stops DNA replication during cell division

C. MAB binds to specific antigens on B-lymphocytes and then destroys cancer cells.

A 7-year-old girl, who was bitten by a stray dog, is treated in the emergency department. The dog has not been tested to rule out rabies. The nurse will anticipate that this patient will receive which immunizations? (Select all that apply.) A. Tetanus toxoid B. DTaP vaccine C. Rabies immunoglobulin D. Rabies vaccine E. Rabies toxoid

C. Rabies Immunoglobulin- passive immunity to potential exposure D. Rabies Vaccine -Not toxoid because Rabies is viral and the toxoid would be ineffective

The nurse is preparing to administer an MMR vaccination to a 15-month-old child. What would cause the nurse to hold the injection and recheck this order with the provider? A. The mother tells the nurse that the family will be going to the beach for the next few weeks. B. The mother states that she was told that she had a reaction to the injection when she was a child. C. The mother tells the nurse that her husband is having chemotherapy for Hodgkin's lymphoma. D. The mother tells the nurse that the child's older brother is home with a cold virus.

C. The mother tells the nurse that her husband is having chemotherapy for Hodgkin's lymphoma - risk of transmission

A patient with acute lymphoblastic leukemia has started therapy with doxorubicin (Adriamycin). The nurse will assist the patient with what important intervention during the course of this treatment? A. Perform active or assisted range-of-motion (ROM) exercises to maintain strength. B. Participate in relaxation therapy to control pain. C. Use daily mouth rinses as prescribed. D. Maintain bed rest during treatment.

C. Use daily mouth rinses as prescribed - Doxorubicin is associated with mucositis; decreases risk of opportunistic infections

Which of the following statements by a patient who is undergoing chemotherapy would be of concern to the nurse? (Select all that apply.) A. "I attended a meeting of a cancer support group this week." B. "My husband and I are planning a short trip next week." C. "I try to eat six small meals plus two protein shakes each day." D. "I am taking my 15-month-old granddaughter to the pediatrician next week for her baby shots." E. "I am going to go shopping at the mall next week.

D. "I am taking my 15 month old granddaughter to the pediatrician next week for her baby shots." E. "I am going to go shopping at the mall next week."

The nurse determines that the patient understands the teaching given for care required after receiving a tetanus toxoid injection when the patient states: A. "I will keep my arm still for the next 24 hours to give the vaccine time to absorb." B. "I will limit my fluid intake for the next 8 hours in case I have nausea." C. "I will avoid crowds and people with viruses for the next 7 days." D. "I will take some acetaminophen (Tylenol) or ibuprofen (Advil) if my arm is sore."

D. "I will take some acetaminophen ( Tylenol) or ibuprofen ( Advil) if my arm is sore. - an appropriate analgesic to treat post- administrative soreness

A nurse is caring for a patient who is receiving tamoxifen for treatment of breast cancer. The nurse will teach the patient that postchemotherapy monitoring will be necessary to detect or treat which drug-associated adverse effect? A. Paralytic ileus B. Alopecia C. Pulmonary fibrosis D. Endometrial caner

D. Endometrial Cancer

A patient with cancer is started on a drug that is a known vesicant. The nurse performs which priority activity related to this drug? Monitor the patient's: A. Response to antinausea drugs. B. Intake of calcium-rich foods. C. Respiratory status for cough. D. IV port site for redness, swelling, and pain.

D. IV port site for redness, swelling, and pain

A nurse is preparing to administer Leucovorin to a client who has cancer and is receiving chemotherapy with methotrexate. Which of the following responses should the nurse use when the client asks why Leucovorin is being given? A. "Leucovorin reduces the risk of a transfusion reaction from methotrexate" B. "Leucovorin increases platelet production and prevents bleeding" C. "Leucovorin potentiates the cytotoxic effects of methotrexate" D. "Leucovorin protects healthy cells from methotrexate's toxic effect."

D. Leucovorin protects healthy cells from methotrexate's toxic effects