Pharm oncology week 7

A nurse is assessing a child who has acute lymphocytic leukemia and is receiving vincristine sulfate . Which of the following findings is the nurse's priority ? A. Paresthesia B. Alopecia C. Stomatitis D. Constipation

Correct Answer : A. Paresthesia The nurse should apply the safety and risk - reduction priority - setting framework , which assigns priority to the factor or situation posing the greatest safety risk to the client . When there are several risks to client safety , the one posing the greatest threat is the highest priority . The nurse should use Maslow's hierarchy of needs , the ABC priority - setting framework , and / or nursing knowledge to identify which risk poses the greatest threat to the client . The greatest risk to this client is neurotoxicity . Vincristine , a cell - cycle specific chemotherapy agent , interrupts cellular reproduction at mitosis and can cause neurotoxicity . An early finding with neurotoxicity is paresthesia ( numbing ) of the peripheral extremities . As neurotoxicity progresses , the client can develop autonomic and central nervous system dysfunction . The nurse should report paresthesia immediately , as the provider might change the dosage of the therapy .

A nurse is providing teaching to a newly licensed nurse about administering morphine via IV bolus to a client . Which of the following pieces of information should the nurse include in the teaching ? A. Respiratory depression can occur 7 min after the morphine is administered . B. The morphine will peak in 10 min . C. Withhold the morphine if the client has a respiratory rate of < 16 / min . D. Administer the morphine over 2 min .

Correct Answer : A. Respiratory depression can occur 7 min after the morphine is administered Respiratory depression can occur within 7 minutes of the administration of IV bolus morphine . The nurse should monitor the client's respirations and have naloxone available to reverse the effects of the morphine .

A nurse is teaching a client who has persistent cancer pain about the adverse effects of opioids . Which of the following statements should the nurse include in the teaching ? A. " Opioids do not relieve pain without causing severe adverse effects . " B. " Physical Dependence is not the same as addiction . " C. " Tolerance typically means that the medication will no longer be effective . " D. " The most common adverse effect is respiratory depression with prolonged use . "

Correct Answer : B. " Physical dependence is not the same as addiction . " The nurse should explain that physical dependence can occur in all clients who take opioids , and the client may develop abstinence syndrome if the opioid abruptly withdrawn . Physical dependence is not the same as addiction , but it can result in addiction . Addiction results when the opioid is continued despite physical or psychological harm .

A nurse is teaching about the adverse effects of morphine with a client who has acute pain . Which of the following statements should the nurse include in the teaching ? A. " You might notice that you see better in dim areas . " B . " You Thould increase your fluid intake . " C. " You should expect to have excessive urination . " D. " You might experience difficulty sleeping . "

Correct Answer : B. " You should increase your fluid intake " The nurse should inform the client that an adverse effect of morphine is constipation . Therefore , the nurse should encourage the client to increase oral fluids to promote motility of the bowel .

A nurse is reviewing the medical record of a client who might have hearing loss . Which of the following data from the client's medical record should the nurse identify as a risk factor for hearing loss ? A. Frequent use of steroids B. Chronic use of salicylates C. Intermittent use of antacids D. Habitual use of laxatives

Correct Answer : B. Chronic use of salicylates Chronic use of salicylates such as aspirin can lead to ototoxicity , which can manifest as tinnitus or hearing loss .

A nurse is reviewing the laboratory results for a client who has a prescription for filgrastim . An increase in which of the following values indicates a therapeutic effect of this medication ? A. Erythrocyte count B. Neutrophil count C. Lymphocyte count D. Thrombocyte count

Correct Answer : B. Neutrophil count Filgrastim increases neutrophil production . It is given to treat neutropenia and reduce the risk of infection in clients who are receiving chemotherapy for cancer or who have undergone bone marrow transplant .

A nurse is caring for a client who has been receiving medication through a transdermal patch . The client is experiencing therapeutic benefits from the medication even though the medication in the patch is no longer active . The nurse should recognize that this is an example of which of the following ? A Pharmacodynamic tolerance B. Placebo effect C. Metabolic tolerance D. Tachyphylaxis

Correct Answer : B. Placebo effect The nurse should identify that the client is experiencing a placebo effect from the medication in the transdermal patch . This occurs when a medication response is caused by psychological factors and not by the biochemical or physiological properties of the medication .

A nurse is monitoring the laboratory values of a male client who has leukemia and is receiving weekly chemotherapy with methotrexate via IV infusion . Which of the following laboratory values should the nurse report to the provider ? A. BUN 18 mg / dL B. Platelets 78,000 / mm ^ 3 C. Hemoglobin 14.2 g / dL D. Aspartate aminotransferase ( AST ) 35 units / L

Correct Answer : B. Platelets 78,000 / mm ^ 3 The nurse should monitor the platelet count of a client who is taking methotrexate because the medication can cause thrombocytopenia . This client's platelet count is very low and puts the client at risk of severe bleeding . The nurse should report this finding promptly to the provider .

A nurse is caring for a client who is experiencing acute pain and is receiving morphine . Which of the following findings should indicate to the nurse the need to withhold the client's next dose of morphine ? A. The client reports an inability to void . B. The client's respiratory rate is 10 / min . C. The client has hypoactive bowel sounds . D. The client has vomited once in the last 4 hours .

Correct Answer : B. The client's respiratory rate is 10 / min . The nurse should identify that morphine can cause respiratory depression . Therefore , if the client's respiratory rate is less than 12 / min , the nurse should withhold the next dose of morphine and notify the provider .

A nurse is teaching a client who has been taking an NSAID to treat rheumatoid arthritis . During the client's first month checkup , the provider prescribed methotrexate to be added to the medication regimen . Which of the following statements should the nurse include in the teaching about the purpose of this change in the client's medication ? A. " Your current medication was not strong enough to manage this condition . " B. " Once your blood levels of methotrexate are within the therapeutic range , the NSAID will be discontinued . " C. " This medication was added to delay the disease progression . " D. " Treating this disease with 2 medications will help protect you from becoming treatment - resistant . "

Correct Answer : C. " This medication was added to delay the disease progression . " The nurse should inform the client that the provider prescribed methotrexate to be added to the medication regimen along with an NSAID to delay the progression of the disease and to delay joint damage or deformity that can result from the disease .

A nurse is caring for a client who takes scheduled morphine for cancer pain . The client reports experiencing breakthrough pain . The nurse should anticipate a prescription from the provider for which of the following medications to treat breakthrough pain ? A. Meperidine B. Buprenorphine C. Methadone D. Fentanyl

Correct Answer : D. Fentanyl The nurse should expect a prescription for fentanyl transmucosal ( nasal spray ) to treat breakthrough pain . Fentanyl is an opioid agonist with a rapid onset and a duration of 2 to 4 hours . Fentanyl should not interfere with the client's long - term opioid medication but should relieve breakthrough pain .

A charge nurse is monitoring a newly licensed nurse who is caring for a postoperative client who is receiving morphine through a PCA pump . Which of the following actions by the newly licensed nurse requires intervention ? A. Instructing the client to administer a PCA dose prior to a dressing change B. Providing increased fluids while the client is using the PCA pump C. Informing the client's partner that only the client should administer the PCA doses D. Maintaining the client on bed rest while the PCA pump is in use

Correct Answer : D. Maintaining the client on bed rest while the PCA pump is in use Use of a PCA pump does not prevent ambulation following surgery . Early ambulation should be encouraged . The nurse should instruct the client to sit at the side of the bed prior to standing to reduce the risks of orthostatic hypotension and falls .

A nurse is assessing a client who is receiving a continuous morphine IV infusion and finds the client's respiratory rate has decreased from 20 / min to 12 / min . Which of the following actions should the nurse take ? A. Flush the IV line with saline B. Administer flumazenil C . Lower the head of the bed . D. Slow the rate of the infusion

Correct Answer : D. Slow the rate of the infusion The nurse should decrease the infusion rate to reduce the amount of morphine the client receives and limit the risk of respiratory depression .

A nurse is preparing to administer cisplatin IV to a client who has lung cancer . The nurse should identify that which of the following findings is an adverse effect of this medication ? A. Hallucinations B. Pruritus C. Hand and foot syndrome D. Tinnitus

Correct Answer : D. Tinnitus An adverse effect of cisplatin is ototoxicity , which can cause tinnitus .

A nurse working in a mental health facility is admitting a client with opioid use disorder who is experiencing withdrawal The nurse should anticipate a prescription for which of the following medications from the provider ? A. Methylnaltrexone B. Methadone C. Naloxone D. Hydromorphone

Correct Answer B. Methadone The nurse should anticipate a prescription from the provider for methadone for a client who is experiencing opioid withdrawal . Methadone is an opioid medication that is used for pain management and treatment of withdrawal manifestations in clients who have opioid use disorder .

A nurse is preparing to administer codeine 30 mg PO every 4 hr PRN to a client for pain . The amount available is codeine oral solution 15 mg / 5 mL . How many mL should the nurse plan to administer per dose ? ( Fill in the blank with the numeric value only , round the answer to the nearest whole number , and use a leading zero if applicable . Do not use a trailing zero . )

Correct Answer : 10