Pharm II Test 5 ONCOLOGY

Which should the nurse anticipate to be included in the client's treatment plan during the intravenous sargramostim (Leukine)? 1. ECG monitoring 2. Insertion of indwelling urinary catheter 3. Administration of oxygen 4. Administration of an antiemetic

1

A client asks the nurse when she should start having Pap tests to help detect cervical cancer? 1. "You should start the testing by age 21." 2. "You should start testing by age 21 or if you begin using alcohol." 3. "By age 21, but earlier if you have a family history of cancer." 4. "By age 21 or earlier if you are smoking."

1

A client asks why tamoxifen is so effective for the treatment of breast cancer. Which response should the nurse provide the client? 1. "Tamoxifen works by blocking estrogen receptors on breast tissue." 2. "Tamoxifen works by inhibiting the cellular mitosis of breast cancer." 3. "Tamoxifen works by inhibiting the metabolism of breast cancer cells." 4. "Tamoxifen works by binding to the DNA of breast cancer cells."

1

A client receiving cyanocobalamin (Nascobal) with a history of a gastrectomy tells the nurse that they have stopped taking the prescription months ago. Which assessment findings should the nurse anticipate? 1. Memory loss, numbness in the limbs, and depression 2. A gradual decrease in red blood cell counts 3. Jaundice and tarry stools 4. Low hemoglobin and hematocrit counts

1

A mother asks the nurse if her breastfed infant is at risk for a B12 deficiency due to her vegetarian dietary preference. Which statement should the nurse provide the mother? 1. "Vitamin B12 is not secreted in the breast milk." 2. "The baby is unable to store adequate amounts of vitamin B12." 3. "The baby's digestive system is unable to absorb sufficient amounts of vitamin B12." 4. "The baby is at risk if exclusively breastfed for 12 months."

1

The nursing plan of care for a patient receiving oprelvekin (Neumega) should include careful monitoring for symptoms of which adverse effect? 1. Fluid retention 2. Severe hypotension 3. Impaired liver function 4. Severe diarrhea

1

Which adverse effects should the nurse monitor the client receiving vincristine (Oncovin) for? 1. Neurotoxicity 2. Cardiotoxicity 3. Nephrotoxicity 4. Hepatotoxicity

1

Which client should the nurse recognize has the highest risk for developing cancer? 1. The client who consumes excessive alcohol 2. The client who is 25 pounds overweight but exercises regularly 3. The client who usually applies sunscreen when going outdoors 4. The client who frequently forgets self-breast exams but has routine mammograms

1

Which clinical finding indicates the nurse should hold the dose of methotrexate (MTX)? 1. Ulcerative stomatitis 2. Elevated serum uric acid level 3. Deep vein thrombosis 4. Elevated white blood cell count

1

Which describes the primary actions of Filgrastim (Granix)? 1. Increases neutrophil production 2. Increases the production of basophils 3. Enhances cytotoxic function of the neutrophil 4. Enhances phagocytic activity of the neutrophil 5. Enhances the action of the basophils

1

Which finding should the nurse instruct the client receiving tamoxifen to immediately report to the healthcare provider? 1. A temperature of 101.1°F 2. Weight gain of 3 pounds in 1 week 3. Size increase of the tumor 4. Nausea and vomiting

1

Which intervention should the nurse integrate into the plan of care for a client receiving cyclophosphamide (Cytoxan) experiencing oral irritation? 1. Instruct the client to avoid extreme temperatures of food selections. 2. Instruct the client to use an antiseptic mouthwash. 3. Instruct the client to rinse her mouth with normal saline. 4. Instruct the client to drink cold beverages.

1

Which is most important for the nurse to monitor a client receiving erythropoiesis-stimulating agents? 1. Thromboembolism 2. Transient ischemic attack 3. Myocardial infarction 4. Cerebral vascular accident

1

Which is the priority nursing assessment for a client prescribed epoetin alfa (Epogen)? 1. Blood pressure 2. Temperature 3. Oxygen saturation 4. Apical pulse

1

Which time frame in conjunction with chemotherapy should the nurse administer prescribed Filgrastim (Neupogen)? 1. Twenty-four hours prior to the chemotherapy 2. At the time of the chemotherapy infusion 3. Immediately following the chemotherapy 4. Immediately before the chemotherapy

1

An older adult patient diagnosed with iron-deficiency anemia will be taking ferrous sulfate (Feosol). The nurse will teach which of the required administration guidelines to the patient? (Select all that apply.) 1. Take the tablets on an empty stomach if possible. 2. Increase fluid intake and increase dietary fiber while taking this medication. 3. If liquid preparations are used, dilute with water or juice and sip through a straw placed in the back of the mouth. 4. Crush or dissolve sustained-release tablets in water if they are too big to swallow. 5. Take the drug at bedtime for best results.

1, 2, 3

After reviewing a client's blood work, the nurse suspects the client is experiencing iron-deficiency anemia. Which questions should the nurse ask the client? Select all that apply. 1. "Have you had a significant dietary change in the last 6 months?" 2. "Do you handle chemicals in your new job?" 3. "Have your stools changed in appearance?" 4. "Have you been eating more carbohydrates than usual?" 5. "Are your menstrual periods heavier than normal for you?"

1, 2, 3, 5

1) Which assessment findings indicate the treatment for a client prescribed an erythropoiesis-stimulating factor is successful? Select all that apply. 1. The client's hemoglobin is increased. 2. The client reports less shortness of breath on exertion. 3. The client has not had an episode of epistaxis in over 3 weeks. 4. The client reports enjoying a light exercise. 5. The client has not had a fever since treatment began.

1, 2, 4

The nurse has provided education about cancer prevention to a community group. Which statements made by the participants indicate an understanding of the information? 1. "I've been thinking about trying a vegetarian diet. Now may be a good time." 2. "I am going to call my doctor and schedule a pap smear." 3. "I think I will start taking vitamin A and selenium." 4. "I've never been a drinker, but I am going to start drinking a glass of wine with dinner." 5. "I am going to read the label on that new bottle of sunscreen I bought."

1, 2, 5

Which therapeutic interventions should the nurse include when teaching a client about the primary treatments for cancer? SATA 1. Surgery 2. Chemotherapy 3. Nutrition therapy 4. Alternative medicine 5. Radiation therapy

1, 2, 5

Which topics should the nurse include in the education of the client prescribed testosterone treatment for cancer? Select all that apply. 1. Weight gain 2. Sweating 3. Hair loss 4. Constipation 5. Nervousness

1, 2, 5

A 2-year-old patient is receiving vincristine (Oncovin) for Wilms' tumor. Which of the following findings will the nurse monitor to prevent or limit the main adverse effect for this patient? (Select all that apply.) 1. Numbness of the hands or feet 2. Angina or dysrhythmias 3. Constipation 4. Diminished reflexes 5. Dyspnea and pleuritis

1, 3, 4

Which should the nurse identify as pharmacotherapy with natural products that have antineoplastic activity? 1. Taxanes 2. Antimetabolites 3. Vinca alkaloids 4. Topoisomerase inhibitors 5. Alkylating agents

1, 3, 4

For which should the nurse monitor the older adult receiving chemotherapy? Select all that apply. 1. Hypotension 2. Incontinence 3. Peripheral neuropathy 4. Urinary retention 5. Reduced deep tendon reflexes

1, 3, 5

Which should the nurse include as the causes of cancer when providing client education? SATA 1. "Some cancers have a strong genetic component." 2. "Cancer can result from tissue trauma." 3. "Cancers have a very strong environmental component." 4. "Cancer can result from increased levels of stress." 5. "Cancer can result from damaged tumor suppressor genes."

1, 3, 5

A client with a benign tumor on his arm asks the nurse why he is not being treated with anything. Which response should the nurse provide? SATA 1. "Benign tumors do not metastasize." 2. "Many of the tumors are resistant to treatment." 3. "Treatment will only be required if the tumor continues to grow." 4. "Your tumor is slow growing." 5. "Benign tumors rarely require treatment."

1, 4, 5

A client with leukemia asks the nurse where the cancer in her body is located. Which response should the nurse provide the client? 1. Epithelial tissue 2. Bone marrow 3. Connective tissue 4. Lymphoid tissue

2

-A client asks the nurse how epoetin alfa (Epogen) will help their anemia. Which response should the nurse provide the client? 1. "This prescription prevents the destruction of the red blood cells." 2. "The prescription stimulates your body to make red blood cells." 3. "This prescription contains red blood cells." 4. "This prescription increases the iron binding capacity of the red blood cells."

2

A client receiving ferrous sulfate (Feosol) tells the nurse they are experiencing constipation. Which intervention should the nurse recommend? 1. Laxatives 2. Increase fluids and high fiber foods in the diet 3. Self-administer Fleet® enemas 4. Increase exercise

2

A client with Hodgkin's disease asks the nurse why he is receiving corticosteroids for chemotherapy. Which response should the nurse include in the discussion? 1. "The red blood cells are destroyed." 2. "They suppress cell division in lymphocytes." 3. "The prescription causes bone marrow suppression." 4. "The prescription blocks substances for tumor growth."

2

A client with cancer asks the nurse how cancer occurs. Which response should the nurse provide the client? 1. "Cancer is genetic; you inherited the predisposition for cancer." 2. "Cancer cells are the body's cells that have lost the ability to control their growth." 3. "Cancer is caused primarily by viruses in the environment." 4. "Cigarette smoking and second-hand smoke are the primary causes of cancer."

2

A patient who is undergoing cancer chemotherapy asks the nurse why she is taking three different chemotherapy drugs. What is the nurse's best response? 1. "Your cancer was very advanced and therefore requires more medications." 2. "Each drug attacks the cancer cells in a different way, increasing the effectiveness of the therapy." 3. "Several drugs are prescribed to find the right drug for your cancer." 4. "One drug will cancel out the side effects of the other."

2

A pregnant client prescribed cyanocobalamin (Nascobal) asks if the prescription will hurt her baby. Which response should the nurse provide the client? 1. "This prescription is safe if taken in the form of a pill during pregnancy." 2. "This prescription is safe during pregnancy." 3. "The prescription is safe in the third trimester of pregnancy." 4. "The prescription is safe when administered as an injection."

2

The nurse has provided education for a client prescribed oprelvekin (Neumega). Which statement made by the client indicates an understanding of the information? 1. "This prescription will help my chemotherapy work better." 2. "This prescription will help increase my platelet count." 3. "This prescription will help me regain the weight I have lost." 4. "This prescription will help increase my red blood cell count."

2

The nurse notes that the patient has reached his nadir. What does this finding signify? 1. The patient is receiving the highest dose possible of the chemotherapy. 2. The patient is experiencing bone marrow suppression and his blood counts are at their lowest point. 3. The patient has peaked on his chemotherapy level and should be going home in a few days. 4. The patient is experiencing extreme depression and will be having a psychiatric consult.

2

The nurse reviewing a client's record notes the morphology of the client's erythrocytes is reported to be microcytic-hypochromic. Which anemia should the nurse associate with the morphology? 1. Pernicious anemia 2. Iron-deficiency anemia 3. Sickle-cell anemia 4. Hemolytic anemia

2

To best monitor for therapeutic effects from filgrastim (Granix, Neupogen), the nurse will assess which laboratory finding? 1. Hemoglobin and hematocrit 2. White blood cell or absolute neutrophil counts 3. Serum electrolytes 4. Red blood cell count

2

When planning to teach the patient about the use of epoetin alfa (Epogen, Procrit), which instructions would the nurse give? 1. Eating raw fruits and vegetables must be avoided. 2. Frequent rest periods should be taken to avoid excessive fatigue. 3. Skin and mucous membranes should be protected from traumatic injury. 4. Exposure to direct sunlight must be minimized and sunscreen used when outdoors.

2

Which adverse effect should the nurse monitor the client receiving doxorubicin (Adriamycin) for? 1. Neurotoxicity 2. Cardiotoxicity 3. Nephrotoxicity 4. Hepatotoxicity

2

Which affect does colony-stimulating factors have on the body? 1. Stimulate platelet production 2. Stimulate white blood cell production 3. Stimulate red blood cell production 4. Stimulate stem cells production

2

Which describes the action of aromatase inhibitors? 1. Block the estrogen receptors that stimulate the growth of ER-positive tumors 2. Block an enzyme that catalyzes the final step in the synthesis of estrogen 3. Suppress the ovary and adrenal gland from producing estrogen 4. Weaken the effect of estrogen on ER-positive tumors

2

Which describes the classification system for anemias? 1. Based on the shape of erythrocytes 2. Based on the size and color of the erythrocytes 3. Based on the number of erythrocytes present 4. Based on the amount of oxygen carried by the erythrocytes

2

Which describes the nurse's understanding of the purpose for choosing the names for the colony-stimulating factors? 1. Named according to the interleukins they stimulate 2. Named according to the type of blood cells they stimulate 3. Named according to the type of neurotransmitters that are stimulated 4. Named according to the type of hormones they stimulate

2

Which is the initial origin for the development of erythrocytes? 1. Megakaryocyte 2. Myeloid stem cell 3. Lymphoid stem cell 4. Colony-stimulating factors

2

Which prescription should the nurse anticipate to administer to a client with acute iron intoxication? 1. Folic acid 2. Deferoxamine (Desferal) 3. Blood transfusion 4. Cyanocobalamin (Nascobal)

2

The nurse is preparing to teach a client how to self-administer an erythropoiesis-stimulating drug. Which instruction should the nurse include? Select all that apply. 1. "Shake the vial to mix the contents before use." 2. "Draw up what is needed and discard the rest of the vial." 3. "Place your stock of medication in your refrigerator." 4. "Warm the vial in your hand a few minutes before drawing up the medication." 5. "Give the medication deeply into a muscle."

2, 3, 4

A client with chronic alcoholism asks the nurse why they should take folic acid. Which response should the nurse provide the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The alcohol decreases your folic acid level." 2. "The alcohol interferes with folate metabolism in the liver." 3. "The folic acid will improve your vitamin B12 deficiency." 4. "Your dietary intake of folic acid is decreased when you drink alcohol." 5. "The folic acid can help reverse some of the liver damage that has occurred from the alcohol abuse."

2, 4

Which action should the nurse take after discontinuing an intravenous infusion of vincristine (Oncovin) that has extravasated? 1. Apply local ice packs. 2. Inject hyaluronidase per protocol. 3. Place a tourniquet on the client's arm above the IV site. 4. Place warm compresses on the site. 5. Administer prednisone per protocol.

2, 4

A client with cancer that has not responded to treatment asks the nurse why he is being offered palliative chemotherapy. Which information should the nurse include in the discussion? SATA 1. "Palliative chemotherapy can continue to help slow the growth of the cancer." 2. "Sometimes the chemotherapy can reduce the size of the tumor." 3. "The cancer may still respond to treatment." 4. "Chemotherapy can sometimes reduce the pain." 5. "Chemotherapy may well improve your quality of life."

2, 4, 5

Which should the nurse understand can be used to minimize bone marrow toxicity? Select all that apply. 1. Alkylating agents 2. Bone marrow transplantation 3. Hormone antagonists 4. Platelet administration 5. Growth factor therapy

2, 4, 5

A patient diagnosed with pernicious anemia is to start cyanocobalamin (Nascobal) injections. Which patient statements demonstrates an understanding of the nurse's teaching? (Select all that apply.) 1. "I need to be careful to avoid infections." 2. "I will need to take this drug for the rest of my life." 3. "I should increase my intake of foods that contain vitamin B12." 4. "I need to take the liquid preparation through a straw." 5. "I may be able to switch over to nasal sprays once my vitamin B12levels are normal."

2, 5

How are monoclonal antibodies such as bevacizumab (Avastin) different from other antineoplastic drugs? 1. They treat many different types of cancer, both blood and solid tumors. 2. They only need to be administered for a short period of time. 3. They are highly specific to certain cell types and target specific cancers. 4. They have fewer adverse effects than traditional antineoplastic drugs.

3

1A client asks the nurse why lung cancers are less sensitive to antineoplastic agents. Which response should the nurse provide the client? 1. "Lung cancer cells have a very erratic cell cycle, and this is why there isn't much difference between the number of replicating and resting cells." 2. "Lung cancer cells have been growing for a long time before detection, so they are less sensitive to antineoplastic agents." 3. "Lung cancer cells have a low growth fraction, which means there isn't much difference between the number of replicating and resting cells." 4. "Lung cancer cells grow in a high-oxygen environment, so they are not very sensitive to antineoplastic agents."

3

A client asks the nurse why he is receiving several chemotherapeutic agents as treatment for cancer. Which response should the nurse provide the client? 1. "Using multiple drugs means a shorter treatment time." 2. "Using multiple drugs decreases the incidence of side effects." 3. "Using multiple drugs will help kill more of the cancer." 4. "Using multiple drugs is more cost effective in treating cancer."

3

A client asks the nurse why the healthcare provider has prescribed darbepoetin alfa (Aranesp) instead of epoetin alpha (Epogen). Which response should the nurse provide the client? 1. "Darbepoetin alfa has less side effects." 2. "Darbepoetin alfa is more effective." 3. "Darbepoetin alfa has a longer duration of action." 4. "Darbepoetin alfa is less expensive."

3

Darbepoetin (Aranesp) is ordered for each of the following patients. The nurse would question the order for which condition? 1. A patient with chronic renal failure 2. A patient with AIDS who is receiving anti-AIDS drug therapy 3. A patient with hypertension 4. A patient on chemotherapy for cancer

3

For which adverse effect should the nurse monitor the client prescribed tamoxifen? 1. Fatigue 2. Cough 3. Vaginal discharge 4. Signs of dehydration

3

The nurse has provided education for a client with iron-deficiency anemia. Which statement made by the client indicates further teaching is required? 1. "Most iron in our bodies is stored on hemoglobin in the red blood cell." 2. "Transferrin is a protein that transports iron to places in our bodies where it is needed." 3. "We need extra iron because when the red blood cells die, all their iron is excreted from the body." 4. "The most common cause of nutritional anemia is iron deficiency."

3

What is the most effective treatment method for the nausea and vomiting that accompany many forms of chemotherapy? 1. Administer an oral antiemetic when the patient complains of nausea and vomiting. 2. Administer an antiemetic by intramuscular injection when the patient complains of nausea and vomiting. 3. Administer an antiemetic prior to the antineoplastic medication. 4. Encourage additional fluids prior to administering the antineoplastic medication.

3

Which contributes to the regulation of hematopoiesis? 1. White bone marrow 2. Hematopoietic stem cells 3. Hormones 4. Essential vitamins and nutrients

3

Which describes the growth fraction ratio? 1. The number of replicating cells to the number of active cells. 2. The number of nonreplicating cells to the number of active cells. 3. The number of replicating cells to the number of resting cells. 4. The number of nonreplicating cells to the number of resting cells.

3

Which describes the main mechanism of action of alkylating agents? 1. The agents can become incorporated into the structures of DNA and RNA, resulting in a disruption of nucleic acid function. 2. When cancer cells attempt to synthesize proteins, RNA, or DNA metabolic pathways are disrupted and the cancer cells die or their growth is slowed. 3. They change the shape of the DNA double helix and prevent nucleic acid from completing normal cell division. 4. They either directly or indirectly bind to cancer cells causing an activation of the immune response which results in the destruction of the cancer cells.

3

Which information should the nurse include in the teaching for a client prescribed ferrous sulfate (Feosol) tablets? 1. Take this prescription with milk. 2. Take this prescription before bedtime. 3. Take this prescription with orange juice. 4. Take this prescription with meals.

3

Which is the nurse's priority when preparing to administer intravenous vesicant chemotherapy? 1. Notify the healthcare provider for a central line placement. 2. Wear gloves when drawing up the medication. 3. Understand the protocol for extravasation. 4. Place the client in reverse isolation prior to administering the vesicant.

3

Which route of administration should the nurse anticipate the prescribed vitamin B12 to be administered for the client with pernicious anemia? 1. Intravenous 2. Oral 3. Intramuscular 4. Nasal inhalation

3

Which should the nurse consider when administering an injection of ferrous sulfate intramuscularly to a client? Select all that apply. 1. Give the injection in the deltoid muscle. 2. Iron is best absorbed if given subcutaneously. 3. Iron is irritating to the tissues. 4. The z-track method should be used. 5. Iron preparations should be administered through a needle gauge 16 or larger.

3, 4

A client asks the nurse how epoetin alfa (Procrit) is related to their chemotherapy. Which response should the nurse provide? 1. "This prescription is administered to enhance the effectiveness of the chemotherapy." 2. "This prescription helps to counteract the nausea and vomiting caused by chemotherapy." 3. "This prescription will stimulate the immune system to help kill the cancer cells." 4. "This prescription will help prevent anemia that can be caused by your chemotherapy."

4

The educator is reviewing red blood cell formation with a nurse. Which statement made by the nurse indicates an understanding? 1. "Red blood cell formation is regulated through chemicals called colony-stimulating factors." 2. "Red blood cell formation is regulated through messages from the hormone secretin, which is located in the kidney." 3. "Red blood cell formation is regulated through specific liver enzymes and a process called hemochromatosis." 4. "Red blood cell formation is regulated through messages from the hormone erythropoietin."

4

The nurse is reviewing the medical history for a client prescribed oprelvekin (Neumega). Which condition should the nurse be concerned about? 1. Liver disease 2. Asthma 3. Diabetes mellitus 4. Renal disease

4

Which action should the nurse take after discontinuing an intravenous infusion of doxorubicin (Adriamycin) that has extravasated? 1. Inspect the area for irritation. 2. A warm, wet compress should be placed on the site. 3. Wash the area thoroughly with soap and water. 4. Apply ice packs to the area immediately.

4

Which is the most important nursing consideration for clients receiving alkylating agents? 1. Nausea and vomiting 2. Nutritional intake 3. Skin integrity 4. CBC with differential

4

Which of the following statements by a patient who is undergoing antineoplastic therapy would be of concern to the nurse? (Select all that apply.) 1. "I have attended a meeting of a cancer support group." 2. "My husband and I are planning a short trip next week." 3. "I am eating six small meals plus two protein shakes a day." 4. "I am taking my 15-month-old granddaughter to the pediatrician next week for her baby shots." 5. "I am going to go shopping at the mall next week."

4, 5