Pharmacology

The nurse is teaching a nursing student about anemia and knows that it is important to start by explaining the causes of anemia. Which statement is true about the cause of anemia?

"Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues."

A female client will soon begin targeted therapy as a component of her treatment plan for chronic leukemia. The nurse is conducting health education about this new aspect of the client's drug regimen and the client has asked about the potential side effects of treatment. How should the nurse best respond?

"Both classes of drugs have adverse effects, but targeted therapies tend to have less of an effect on healthy body cells."

Mr. Singh is a 66-year-old man who is receiving chemotherapy for the treatment of lung cancer that has metastasized to his liver. In an effort to prevent infection, Mr. Singh has been prescribed filgrastim (Neupogen). Which of the nurse's following assessment questions most directly addresses a common adverse effect of filgrastim?

"Do you feel like you're having any pain in your bones?"

A client diagnosed with iron deficiency has been taking oral ferrous sulfate for the past several days. When the nurse is assessing for therapeutic effects, what question is most warranted?

"How is your energy level compared with a few days ago?"

A nurse is preparing to discharge a client who has been prescribed warfarin. While assessing the client's knowledge of the drug, what statement should the nurse address?

"I take aspirin to help with the pain of my arthritis."

The nurse determines that teaching about warfarin is successful when the client makes what statement?

"I will check with my health care provider before taking any herbal supplements."

The nurse educates a client diagnosed with atrial fibrillation about the prescribed warfarin. Which client statements establish the need for further clarification?

"I will stop eating green leafy vegetables, broccoli, yogurt, or cheese."

The nurse is assessing a new client admitted to a nursing home. The client asks the nurse to explain interleukins. The nurse would include which information?

"Interleukins help the immune system with inflammation."

A client who is being treated with an antineoplastic medication for cancer is prescribed Kepivance. The client is refusing this medication, stating that "all these drugs are making everything worse," including the inside of her mouth. What would be an appropriate response from the nurse?

"Kepivance is used to protect the normal cells in your body from the chemotherapy."

A female client is receiving L-asparaginase. She is at the end of her chemotherapeutic course and is concerned because her liver function tests are abnormal. What is an appropriate response by the nurse?

"Liver impairment usually subsides when chemotherapy is complete."

A client diagnosed with diabetes and currently prescribed prednisone reports blood sugar levels that are higher than normal. What is the nurse's best statement related to this change in glucose levels?

"Prednisone can cause increased blood sugar levels."

When explaining the risks of pretransplant immunosuppression, the nurse demonstrates understanding of the process when making which statement?

"Serious complications can occur if you are not monitored carefully while you are immunosuppressed."

A client who has recently been diagnosed with HIV is waiting for the results of lab work to determine their T-cell count. How should the nurse best explain a T cell to the client?

"T cells are lymphocytes, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body."

The nurse is caring for a patient newly diagnosed with multiple sclerosis. The patient asks why MS is called an autoimmune disease. What would be the nurse's best response?

"The body attacks its own cells because it responds to specific self-antigens to produce antibodies."

A nurse administers filgrastim to a client who is also prescribed chemotherapy. The nurse monitors the client's absolute neutrophil count (ANC) and anticipates stopping the drug when the ANC reaches which level?

10,000/mm3

The nurse would contact the prescriber immediately if interferon was prescribed for which client?

11-month-old female with HIV acquired from her mother

A nurse will use extreme caution when administering heparin to which patient?

A 38-year-old male with peptic ulcer disease

Heparin therapy is prescribed to a client with deep vein thrombosis. Which client would be at greatest risk of bleeding from this therapy?

A 45-year-old corporate executive with peptic ulcer disease

Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy? A 40-year-old male with a high white blood cell count A 62-year-old male with cancer A 20-year-old female A 30-year-old pregnant woman

A 62-year-old male with cancer

The nurse is caring for diverse group of clients. Which client is most likely to benefit from the administration of cyclosporine?

A client with chronic renal failure who is recovering from a kidney transplant

A nurse is caring for a client who has undergone organ transplant surgery. The client asks the nurse what antibodies are. What is the best response by the nurse?

A protein substance that the body produces in response to an antigen

Which of the following patients has the greatest potential to benefit from treatment with rituximab?

A woman who has chronic lymphocytic leukemia

Which of the following patients has the greatest potential to benefit from treatment with rituximab? Awoman who has been diagnosed with ductal carcinoma in situ A man with AIDS who is currently being treated for Kaposi's sarcoma A lifelong smoker who has been diagnosed with non-small cell lung cancer A woman who has chronic lymphocytic leukemia

A woman who has chronic lymphocytic leukemia Rituximab has historically been used to treat CD20-positive B-cell malignancies such as B-cell leukemias, chronic lymphocytic leukemia, non-Hodgkin's lymphoma, and some multiple myeloma.

What drugs would the nurse administer for their antiplatelet effects? Select all that apply. Alteplase Fondaparinux Desirudin Abciximab Ticlopidine

Abciximab Ticlopidine

The nurse is caring for a client with a fever and severe diarrhea in addition to thrombophlebitis. How will this client's condition impact the clotting process?

Activation of plasminogen

The nurse may be asked to administer which medications to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis?

Allopurinol

A patient with chronic renal failure receiving epoetin alfa will be having a total left hip arthroplasty. What supplementation should the patient receive prior to surgery?

An iron supplement

The nurse is caring for a client who had a postpartum hemorrhage 2 weeks ago that resulted in anemia. The client has called the clinic after passing dark stools, stating, "I looked this up online, and I'm worried I might have stomach or intestinal bleeding." What is the nurse's best initial action?

Ask the client whether she is taking iron supplements

How do immune suppressants work when ordered for a client who has had an organ transplant?

Blocking normal effects of the immune system

A nurse is caring for a client prescribed gemcitabine. On the morning laboratory results, the nurse discovers the following: white blood cell count 4500/mm3 and platelets 135,000/mm3. The nurse anticipates discovering which sign on the ongoing assessment?

Bloody urine

A 60-year-old client experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The client has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect?

By inactivating clotting factors and thus stopping the coagulation cascade

The nurse is caring for a client who has been diagnosed with bacterial pneumonia. The client has been ill for several days, and the nurse recognizes that the client's body is suppressing the immune response in order to conserve energy. The nurse should recognize which cells have a role in the immune response?

CD8 cells

A patient has been prescribed melphalan, an alkylating agent, for the treatment of an ovarian tumor. The patient wants to know the action of the drug in treating the tumor. Which of the following should the nurse inform the patient?

Changes the cell to a more alkaline environment.

While reviewing a client's the record, the nurse sees that the client received a dose of interferon alpha-2b? For what disorder does the nurse suspect the client was being treated?

Chronic Hepatitis C

The client is a woman 65 years of age being treated for anemia secondary to chronic kidney disease. The nurse explains to the client that she will be getting a prescription for Epogen. Which of the following additional information would the nurse provide?

Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia.

The client is a woman, 69 years of age, seen in the clinic for anemia and administration of epoetin alfa. Before giving the drug, the nurse takes a complete history and reviews the client's EMR, because the nurse knows that epoetin alfa is contraindicated for which conditions? (Select all that apply.) Clients with uncontrolled hypertension Clients needing an emergency transfusion Clients with a hypersensitivity to human albumin Clients with a recent infection Clients with exposure to anthrax

Clients with uncontrolled hypertension Clients needing an emergency transfusion Clients with a hypersensitivity to human albumin

A nurse determines a nursing diagnosis of constipation is appropriate for a client receiving iron supplements. Which suggestion would be appropriate for the nurse to recommend to the client to promote resolution of this problem?

Consume a diet high in fiber

Which would the nurse expect to administer orally?

Cyclosporine Explanation: Cyclosporine is administered orally. Alefacept is administered as an intravenous bolus or intramuscularly; glatiramer acetate is administered subcutaneously; and abatacept is given intravenously.

The nurse is administering a medication to enhance hematopoiesis. Which statement indicates the nurse understands the role of cytokines in hematopoiesis?

Cytokines are produced by the bone marrow and white blood cells to enhance formation of blood cells.

When the nurse administers warfarin, it is expected that the drug will have what effect on the body?

Decrease in production of vitamin K-dependent clotting factors

A client is prescribed warfarin. The client also takes a diuretic for the treatment of cardiac problems. The nurse will monitor the client for which potential interaction?

Decreased effectiveness of the anticoagulant

A nurse is to use a single-dose 1 mL vial to administer 0.5 mL of epoetin alfa to a 39-year-old woman who is being treated for chemotherapy-induced anemia. Which of the following will the nurse do with the unused portion of the drug?

Discard the unused portion of the drug.

The client is prescribed warfarin. His INR is 5.2. At what level is this dose?

Elevated

An 18-year-old woman who takes birth control pills and is a heavy smoker is scheduled for abdominal surgery. Which of the following post-surgical nursing interventions would be most important to prevent thrombus formation?

Encourage active range-of-motion exercises every 4 hours.

A client with leukemia is being treated with a combination of antineoplastics, including methotrexate. The client's most recent laboratory results indicate the client is experiencing bone marrow suppression. What is the nurse's priority action?

Ensure that all staff and visitors adhere to infection control precautions.

The nurse is caring for a client with an acute infection that resulted in a prompt immune reaction. What signs or symptoms experienced by the client would the nurse recognize as being mediated by interleukins? Select all that apply. Fever Joint pain Muscle pain Hyperactivity Insomnia

Fever Joint pain Muscle pain

Which would a nurse identify as inhibiting factor Xa?

Fondaparinux

Ms. Carter is discharged from the hospital after a myocardial infarction. The health care provider prescribes continuance of the drug clopidogrel at home to help prevent future myocardial infarction (MI). Five days after discharge, she contacts the provider's office with low-grade fever and painful GI distress. What important adverse effect(s) should the nurse instruct the client to monitor for?

GI ulcers and bleeding

The pharmacology instructor is talking with his class about cytokines. Cytokines act as chemical messengers among cells. What are some of these diverse cytokines?

Growth factors

What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa?

Impaired tissue oxygenation related to anemia

The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome?

Increased RBC count

Which would a nurse identify as the primary issue associated with anemias?

Ineffective red blood cells

A 39-year-old client has begun taking tamoxifen to reduce the risk of contralateral breast cancer. The client is now reporting hot flashes and dysmenorrhea. What is the nurse's best action?

Inform the client that these are likely adverse effects of drug therapy

A nurse is presenting information at a health fair concerning cancer. When questioned about the use of green tea, the nurse would point out which potential effect of green tea?

Insomnia

How can a nurse best prevent tissue damage caused by an antineoplastic extravasation?

Inspect the site frequently for redness or swelling

A 46-year-old woman is undergoing treatment for breast cancer, and her current course of chemotherapy will be supplemented with trastuzumab (Herceptin). The nurse should anticipate which of the following routes of administration?

Intravenous administration with a dosage based on the patient's body weight Trastuzumab is administered as an initial IV loading dose followed by weekly IV doses for the duration of treatment.

A patient has just been told that her cancer has metastasized to the right kidney. An interferon has been prescribed to treat this metastasis. The patient asks why the interferon is ordered. What is the nurse's best response?

It has been shown to inhibit tumor growth.

A female client is ending an extensive chemotherapeutic regimen that included cytotoxic antineoplastic drugs. What does the nurse understand about bone marrow toxicity in this client?

It is a common adverse effect of her treatment.

A male client is prescribed cytotoxic antineoplastic drugs as part of his cancer treatment regimen. His wife is 2 months pregnant. The nurse teaches both the client and his wife that she should avoid contact with the drug, for which reasons? (Select all that apply.) It is mutagenic. It is nephrogenic. It is hepatogenic. It is teratogenic. It is carcinogenic.

It is mutagenic. It is carcinogenic. It is teratogenic.

The primary health care provider orders a 300-mg dose of clopidogrel for a client. The client then is to receive 75 mg/day. The nurse interprets the 300-mg dose to be which type of dose?

Loading dose

During which phase of the cell cycle would a nurse expect a mitotic inhibitor to act?

M Explanation: Mitotic inhibitors act during the M phase of the cell cycle.

The black box warning associated with warfarin concerns its risk of causing what condition?

Major or fatal bleeding

A male client is informed that the latest tests indicate that his cancer has spread to his liver. The client receives capecitabine as part of his treatment regimen. What would the nurse expect the health care provider to do?

Monitor the client closely and repeat LFTs routinely.

A 75-year-old client presents to the health care provider's office with bleeding gums and multiple bruises. When the nurse reviews the client's drug history, the nurse finds that the client is prescribed aspirin 81 mg/d. What drug may cause increased bleeding when used in conjunction with the aspirin?

NSAIDS

A patient will be having chemotherapy to reduce a colon tumor prior to having a colon resection. To what is this type of therapy referred?

Neoadjuvant therapy

A client has developed a wound infection and leukocytes are leaving the bloodstream to perform phagocytosis on pathogens. What white cells are most likely performing this function?

Neutrophils Explanation: When an injury or invasion occurs, neutrophils are rapidly produced and move to the site of insult to attack the foreign substance. Basophils are not capable of phagocytosis but contain chemicals that can initiate or maintain an immune response and may be fixed or circulate in the blood. Eosinophils are not well understood but are often found at the site of an allergic reaction. Monocytes are capable of phagocytosis and show up in greater numbers after the neutrophils to remove debris.

The nurse determines a nursing diagnosis of imbalanced nutrition: less than body requirements is the priority for a client receiving chemotherapeutic therapy. Which suggestion would be least appropriate for the nurse to include in the client's plan of care?

Offer fatty foods to stimulate the taste buds.

The nurse is teaching a client about the heparin which has been prescribed for a thrombus formation. Which information should the nurse prioritize in this teaching? Select all that apply Onset of action is almost immediate. Maximum effect occurs within 10 minutes. It is preferably given intramuscularly. Clotting time returns to normal within 4 hours. It causes fewer adverse reactions than the oral form.

Onset of action is almost immediate. Maximum effect occurs within 10 minutes. Clotting time returns to normal within 4 hours.

The effects of warfarin (Coumadin) are monitored by what laboratory test(s)?

PT and INR

What are situations in which the nurse would hold the drug and notify the health care provider? (Select all that apply.) PT exceeds 1.5 times the control PT is less than 1.5 times the control value There is evidence of bleeding INR is less than 3.0 INR is greater than 3.0

PT exceeds 1.5 times the control There is evidence of bleeding INR is greater than 3.0

A client, who is prescribed vinblastine, is also currently administered warfarin. The nurse will carefully monitor the client for which reaction?

Prolonged bleeding

The nursing instructor is talking about anticoagulant therapy. The instructor explains that when administering warfarin (Coumadin) to a client with deep vein thrombophlebitis, the nurse monitors the PTT, PT, INR, and hematocrit. Which laboratory value would the instructor say indicates warfarin is at therapeutic levels?

Prothrombin time (PT) 1.2 to 1.5 times the control

The nurse is caring for a client who is going home on warfarin. What lab test(s) will the client require to evaluate therapeutic effects of the drug?

Prothrombin time (PT) and international normalized ratio (INR)

Mike, a lymphoma client, is administered bleomycin drug therapy according to the health care provider's instructions. Following the drug administration, he reports fever, chills, nausea, and general weakness. What preventive measure would be helpful in his case?

Providing premedication with acetaminophen and diphenhydramine

A 30-year-old woman has been diagnosed with leukemia and will be using an immune modulator for treatment. What should the nurse teach the client about her drug therapy?

She should use barrier contraceptives while taking the drug.

The nurse is conducting an ongoing assessment on a client who has received a chemotherapeutic agent. Which sign(s) should the nurse prioritize and alert the health care provider concerning? Select all that apply. Sore throat White blood cell count of less than 3500/mm3 Cough Frequent urination Temperature of 100°F

Sore throat White blood cell count of less than 3500/mm3 Cough Frequent urination

A nurse is teaching a client about the chemotherapeutic agent that has been prescribed. When asked about potential hair loss, which answer should the nurse prioritize?

Suggest the use of a wig or cap

A female client is prescribed cyclosporine after her bone marrow transplant. What is the mechanism of action of cyclosporine that makes this an ideal drug for this patient?

Suppression of the normal effects of the immune system in the body

A 42-year-old female with breast cancer has had a radical mastectomy. She will have radiation therapy and then begin chemotherapy. Drug therapy will consist of a combination of doxorubicin, cyclophosphamide, and paclitaxel. What will the nurse include in the teaching plan concerning the drug therapy?

Take special care when shaving or brushing her teeth.

After assessing the client receiving erythropoietin drug therapy, the nurse suspects what finding is an adverse effect of erythropoietin drug therapy?

The client has peripheral edema to the feet and lower legs.

A client has been diagnosed with an autoimmune disease that causes numerous distressing symptoms. What pathophysiologic process is causing this client's symptoms?

The client's body is producing antibodies against the client's own self-antigens.

The nurse explains to a client that angina can be caused by a thrombus forming in which anatomical location?

The heart

Which symptom, if assessed after the administration of epoetin alfa (Epogen), would be cause for alarm?

The patient displays weakness on one side of the body.

A patient has completed 4 weeks of treatment with epoetin alfa. Which of the following assessment findings would most strongly indicate that treatment has been effective?

The patient's hemoglobin level is 11 gdL

When describing the process of cancer cell growth to a client, the nurse addresses angiogenesis. Which description would the nurse include?

The process of creating new blood vessels to supply oxygen and nutrients to the cells Angiogenesis refers to the process in which abnormal cells release enzymes that generate blood vessels in the area to supply both oxygen and nutrients to the cells. Metastasis refers to process of traveling from the place of origin to develop new tumors in other areas of the body. Autonomy refers to the process of growing without the usual homeostatic restrictions that regulate cell growth and control. Anaplasia refers to the process in which the cells lose their ability to differentiate and organize, which leads to a loss in their ability to function normally.

A female client develops hepatotoxicity from the antineoplastic drugs that she is receiving. She has abnormal levels of AST, ALT, and bilirubin. The health care provider may not decrease the drugs for what reason?

These findings do not indicate decreased ability to metabolize drugs.

Prior to administering a dose of 5-FU to a patient with pancreatic cancer, the nurse is conducting the necessary drug research. The nurse is aware that 5-FU is a cell cycle-specific chemotherapeutic agent. Which statement best describes cell cycle-specific drugs?

They affect cancerous cells during a particular phase of cellular reproduction.

The nurse is describing the necessity of recovery periods between treatment cycles to a client receiving chemotherapy. How should the nurse best explain the need?

Time is needed to replace many of the healthy body cells killed by chemotherapy.

A client is receiving immunizations before traveling to a storm-stricken region of the tropics where cholera, typhoid, and malaria are in epidemic. While specific immunizations to combat specific diseases would be administered, why would an injection of IgA also be administered?

To increase local antibody response

The nurse is teaching a young female about the prescribed anticoagulant. The nurse determines the session is successful when the client correctly indicates they will apply which recommendation?

Use a reliable contraceptive.

The nurse is caring for a client who is receiving a combination of antineoplastic agents. The client has been told that alopecia is likely to occur, and the client is tearful and distraught about this. What is the nurse's best response?

Validate the client's sense of impending loss and offer guidance for getting a wig.

A 73-year-old client receiving warfarin (Coumadin) has blood in the urinary drainage bag this morning. After reporting these observations to the health care provider, the nurse will expect to administer what substance?

Vitamin K

The nurse is preparing to administer doxorubicin for a client who has a diagnosis of neuroblastoma. What action should the nurse perform?

Wear personal protective equipment

A nurse is performing discharge teaching with a client who will soon return home. The client will continue taking imatinib for the foreseeable future, and the nurse is teaching the client about the safe administration of this drug. How should the nurse instruct the client to take imatinib?

With food and a large glass of water

A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the client's:

aPTT

A female nursing student is diagnosed with rheumatoid arthritis. What is the probable cause of her rheumatoid arthritis?

abnormal immune response

An adult client who has been diagnosed with a rectal tumor is scheduled to begin treatment with cisplatin. The nurse has conducted client teaching about the possibility of nausea and vomiting. In order to reduce the client's risk of severe nausea, the nurse should:

administer a combination of antiemetics prior to the administration of the drug.

To compensate for clopidogrel's slow onset of action, the nurse should anticipate implementing which intervention?

administering a one-time loading dose that is higher than the maintenance dose

The pharmacology instructor is talking about interferon. The instructor explains that agents such as interferons have more than one biologic function. What function is NOT associated with interferons?

antibacterial

A client with acute coronary syndrome is prescribed clopidogrel. Which additional medication will the nurse expect to be prescribed for this client?

aspirin

A nurse is caring for a patient who has just had a successful liver transplant. When facilitating the patient's treatment with cyclosporine, the nurse should anticipate that administration will

begin with IV administration and then change to the oral route.

A client has been receiving regular doses of epoetin alfa for several weeks, and the home care nurse has been monitoring the client's condition closely. When taking the client's vital signs, the nurse should pay particular attention to what assessment datum?

blood pressure

The home care nurse is caring for a client who is self-administering epoetin. What assessment is most important for the nurse to complete during the visit?

blood pressure

A nurse is caring for a patient being treated with antineoplastic drugs. The patient is at risk for thrombocytopenia due to bone marrow suppression. What should the nurse monitor for in this patient?

bloody urine

The nurse is caring for a client who has leukemia. What aspect of this client's health status should the nurse prioritize when confirming the appropriateness and dosing of antimetabolites?

bone marrow suppression

A 70-year-old resident of a long-term care facility has experienced increasing pain, swelling, and redness to her lower leg over the past 12 hours, prompting the care providers at the facility to have the woman brought to the local emergency department. Diagnostic testing has confirmed deep vein thrombosis (DVT) and an IV infusion of alteplase (Activase) has been initiated. Unlike anticoagulants, a thrombolytic such as alteplase can

break down existing clots

A nurse is preparing an antineoplastic agent for a 9-year-old cancer patient. Before administering an antineoplastic agent, the nurse's most important action should be to:

check indexes of bone marrow functioning.

If a client who is prescribed tacrolimus has impaired liver function, what would the nurse expect the health care provider to do?

decrease the dose

A client who has undergone an organ transplant is at a greatly heightened risk of health problems because of what impaired ability?

differentiate between its own cells and antigens on foreign cells

A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to:

drink a lot of water

A 63-year-old male patient has just begun treatment with IV paclitaxel. About 10 minutes into the infusion, the nurse becomes concerned about a possible anaphylactic reaction to the drug because the patient is experiencing:

dyspnea

A client has chronic renal failure. As the disease progresses, the client is experiencing increasing shortness of breath, due to anemia. The nurse would anticipate which medication order?

epoetin alfa

A client with chronic renal failure has a low hemoglobin level. Which medication(s) will the nurse anticipate being prescribed for this client? Select all that apply. interferon alpha-n3 interferon beta-1a epoetin beta darbepoetin alfa epoetin alfa

epoetin beta darbepoetin alfa epoetin alfa

A client taking an anticoagulant drug tells the nurse she is having bleeding in the gums and teeth. When reviewing client history, the client states she has decided to try an herbal remedy. Which of the following is most likely the cause of increased bleeding?

ginger

The nurse is teaching a client about dietary concerns related to the administration of warfarin. The nurse determines the teaching session is successful when the client correctly points out that a consistent intake of which foods is necessary when using warfarin?

green leafy vegetables

A male client is diagnosed with prostate cancer. The treatment modality of choice includes both surgery and chemotherapy. What does the chemotherapeutic option include?

hormonal therapies

A 78-year-old male client begins an immunosuppressant therapy for his rheumatoid arthritis. The nurse is concerned because this client is at greater risk for what complication, compared with younger adults using the same treatment modality?

infections

A 59-year-old client is on warfarin therapy. On follow-up visits to the clinic, the nurse will assess the client's:

intake of vitamin K.

A patient is receiving carboplatin. The nurse would expect to administer this drug by which route?

intravenous

The client is taking ifosfamide as a component of cancer treatment, and the client's oncologist has just added mesna to the client's medication regimen. How should the nurse best assess for the therapeutic effect of mesna?

monitoring the client's urine output for signs of hematuria

A nurse has completed a medication reconciliation of a patient who has been admitted following a motor vehicle accident. Among the many drugs that the patient has received in the previous year is rituximab. The nurse would be justified in suspecting the patient may have received treatment for which of the following diseases?

non-Hodgkin's lymphoma

A client is to receive clopidogrel. The nurse would expect to administer this agent by which route?

oral

All hematopoietic and immune blood cells are derived from which cells in the bone marrow?

stem cells

The nurse is caring for a client who has been prescribed mycophenolate mofetil following kidney transplant. What instruction should the nurse provide during client teaching to minimize the risk of undesired effects?

taking the pills on an empty stomach

A client, currently prescribed epoetin alfa, has recent blood work that reveals a hemoglobin level of 12.8 g/dL. What action does this assessment finding necessitate regarding the epoetin alfa?

temporarily withholding administration

A nurse is caring for a client being treated with antineoplastic drugs. The client reports recently experiencing bloody urine. What complication might this client be experiencing?

thrombocytopenia

A male client is prescribed interferon. What is his probable diagnosis?

viral hepatitis

The dosages of the chemotherapy agents that will be administered are based primarily on what client variable?

weight

A client is undergoing chemotherapy for vulvar cancer. The client had a friend who died after treatment, which has caused severe anxiety and fear; the client is constantly tired and sees this as an indication she won't survive. The nurse knows that the client is scheduled for immunostimulant drug therapy to support the hematopoietic system. The nurse would include which statement to explain the action of drug?

"Taking immunostimulants to stimulate the production of blood cells will help you feel better."

An adult client has been diagnosed with ischemic heart disease, and a family member has asked for information about the action of granulocyte colony-stimulating factor (G-CSF) drugs. Which response by the nurse best answers the request for information?

"The drug promotes blood vessel growth around blocked areas in coronary arteries."

The nurse is caring for a client in the immediate postoperative period following cardiac transplantation. The client is receiving mycophenolate IV. What should the nurse teach the client regarding drug therapy? Select all that apply. "The drug will be given orally as soon as possible." "You'll be given this medication four times a day." "It's important to avoid people with contagious diseases." "Ask a pharmacist about drug-drug interactions before taking any over-the-counter (OTC) drug once you're discharged." "Never miss a dose of medication."

"The drug will be given orally as soon as possible." "It's important to avoid people with contagious diseases." "Ask a pharmacist about drug-drug interactions before taking any over-the-counter (OTC) drug once you're discharged." "Never miss a dose of medication."

You are precepting a nursing student and together you are caring for a patient who is to receive interleukins. The student nurse asks you what happens physiologically when a patient receives interleukins. What would be your best response?

"The patient has increases in the number of natural killer cells."

A client received an injection of doxorubicin and is now observing a reddish urine. The client reports blood in the urine to the nurse. How should the nurse respond?

"The reddish urine is an expected response to the drug."

Which client statement demonstrates an accurate understanding of the action of a prescribed anticoagulant?

"This medication will keep unnecessary clots from forming in my blood."

The nurse is caring for a client who had a postpartum hemorrhage 2 weeks ago that resulted in anemia. The client has called the clinic after passing dark stools, stating, "I looked this up online, and I'm worried I might have stomach or intestinal bleeding." What is the nurse's best initial action?

Ask the client whether she is taking iron supplements.

The nurse is caring for an older adult receiving immune modulators. What are appropriate actions by the nurse? Select all that apply. Assess carefully for infection. Obtain baseline liver function studies and monitor follow-up studies. Determine dosage based on renal and liver function. Minimize teaching to avoid causing confusion. Encourage the family to visit often, especially young children.

Assess carefully for infection. Obtain baseline liver function studies and monitor follow-up studies. Determine dosage based on renal and liver function.

A 44-year-old man has come to the clinic with an asthma exacerbation. He tells the nurse that his father and brother also suffer from asthma, as does his 15-year-old son. The nurse explains that this is an allergic response based on a genetic predisposition. The specific allergen initiated by immunological mechanisms is usually mediated by immunoglobulin:

E. Explanation: Allergic reactions characterized by the action of IgE antibodies and a genetic predisposition to allergic reactions are found in diseases like asthma. IgG is the most common immunoglobulin and is found in intravascular and intercellular compartments. IgA and IgM are found in mucous secretions.

A client is admitted to the hospital with deep vein thrombosis. An infusion of heparin is established. What action best protects the client's safety?

Ensure that protamine sulfate is readily available

A client has been receiving a chemotherapeutic agent for a diagnosis of leukemia. The nurse will prioritize which factor(s) on the ongoing assessment of this client? Select all that apply. General condition Individual response to the drug Any adverse reactions Guidelines established by evidence-based practice Laboratory and radiographic reports

General condition Individual response to the drug Any adverse reactions Laboratory and radiographic reports

A client comes to the clinic for epoetin alfa therapy. The nurse monitoring the client knows that blood will be drawn before the treatment begins, in order to evaluate which level?

HCT

A client with human immunodeficiency virus has an impaired ability to stimulate lymphocytes to be aggressive and responsive during the immune response. This is primarily due to a deficiency in what cells?

Helper T cells

A client comes to the clinic asking what hematopoiesis means. How should the nurse explain this to the client?

Hematopoiesis means undifferentiated stem cells are stimulated to become specific blood cells.

A nurse is preparing to administer iron dextran to a client. The nurse will obtain which information on the preadministration assessment to calculate the drug dosage?

Hemoglobin level

Tumor necrosis factors (TNF) participate in the inflammatory response of the human body. What do they cause in the inflammatory response?

Hemorrhagic necrosis in several types of tumor cells

A postsurgical client possesses numerous risk factors for venous thromboembolism, including a previous deep vein thrombosis. What drug would the nurse anticipate administering while this client recovers in the hospital?

Heparin

What client assessment finding will have the greatest effect on the half-life of methotrexate therapy?

History of chronic renal impairment

A client's chemotherapeutic regimen includes procarbazine. What is the client's most likely diagnosis?

Hodgkin lymphoma Procarbazine (Matulane) is used in combination therapy for treatment of stages III and IV of Hodgkin disease.

A male client is diagnosed with prostate cancer. The treatment modality of choice includes both surgery and chemotherapy. What does the chemotherapeutic option include?

Hormonal therapies Explanation: Hormonal therapies that block the effects of estrogen (in an estrogen-responsive tumor) and androgen (in an androgen-responsive tumor), respectively, are essential in the treatment of breast and prostate cancers.

By what route will the nurse administer the antihemophilic agent to the client with hemophilia following a car accident?

IV

A client is experiencing an allergy to a penicillin antibiotic. What immunoglobulin (Ig) will most directly relate to this immune response?

IgE

A school-aged client was vaccinated against varicella several years ago according to the recommended immunization schedule. The client has now been exposed to the virus by a classmate with chickenpox. What immune response will prevent the client's infection?

IgG will be released by B memory cells Explanation: Exposure to an antigen eventually causes memory B cells to produce IgG specific to that antigen, which can be released upon secondary exposure to the antigen. Hageman factor is involved with inflammation, not humoral immunity. CD4 T cells do not directly produce or release antibodies. IgA is a specific type of immunoglobulin that does not exist in general circulation.

The nurse has just admitted a client to the unit who is newly diagnosed with Kaposi's sarcoma. The health care provider has order an IV infusion of an interferon. What drug has the provider ordered?

Interferon alfa-2b

A client presents to the emergency department with a swollen, reddened, painful leg wound and has been diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) cellulitis. The health care provider has ordered a complete blood count and white cell differential. Which blood components would the provider most likely anticipate to be elevated?

Neutrophils Explanation: Increased neutrophils are associated with inflammation in general and bacterial infections in particular. Platelets play a role in inflammation but their levels would not rise to the same extent as would neutrophils. Eosinophils are not strongly associated with bacterial infection and basophils would not increase to the same degree as neutrophils

What does the nurse understand about why patients are more compliant with pegfilgrastim therapy versus filgrastim therapy?

Pegfilgrastim only has to be administered once per chemotherapy cycle instead of daily.

A client has just received a kidney transplant. In order to prevent rejection, the nurse should perform what action?

Perform interventions that minimize response to the major histocompatibility complex.

A client who is receiving an immune suppressant has been admitted to the hospital unit. What action should the nurse prioritize?

Place client in protective isolation

The nurse is providing care for a client whose current medications include tacrolimus. The nurse should anticipate that this client is likely to be taking what medication concurrently?

Prednisone

A male client is receiving heparin by continuous intravenous infusion. The nurse will instruct the client and family members to report what should it occur?

Presence of blood in urine or stools

The health care provider discovers a clot in the client's left lower leg. Anticoagulant drugs are prescribed to prevent formation of new clots and to achieve which other effect?

Prevent extension of clots already present

The anemia that occurs with chronic renal failure is caused by the kidneys themselves. What inability of the kidneys causes anemia in chronic renal failure?

Produce erythropoietin

The pharmacology instructor is discussing heparin with the students. How would the instructor explain the action of heparin?

Promotes the inactivation of clotting factors

A client exhibits signs and symptoms of heparin overdose. The nurse would anticipate administering:

Protamine sulfate

A nurse is caring for a 64-year-old female client who is receiving IV heparin and reports bleeding from her gums. The nurse checks the client's laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which drug may be ordered?

Protamine sulfate

A patient who is receiving an immune modulator has been admitted to the unit. What would be a priority action by the nurse?

Protect the patient from exposure to infection.

A client is prescribed cyanocobalamin following gastric bypass surgery. The nurse will prioritize which finding on the ongoing assessment?

Pulmonary edema

A client is prescribed doxorubicin drug therapy for carcinoma of the breast. On the second day of drug therapy, she calls in to report reddish urine. What should the nurse do?

Reassure the client that it is a harmless and expected response to the drug.

The nurse is caring for a patient with chronic kidney disease who is receiving epoetin alfa. Which assessment finding would be of greatest concern for the nurse?

Reports of calf pain on dorsiflexion of the foot

A client who has been diagnosed with a compromised immune system is eager to know about the condition. Which explanation should the nurse provide regarding the potential consequences of a compromised immune system?

Results in immunodeficiency diseases

A patient with non-Hodgkin's lymphoma (NHL) will be starting a course of doxorubicin shortly. When planning this patient's care, what nursing diagnosis should the nurse prioritize?

Risk for Infection related to suppressed bone marrow function

A client is receiving anakinra for treatment of rheumatoid arthritis. The client is scheduled to have arthroscopic evaluation of the right knee. What is the priority nursing diagnosis for this client after the procedure?

Risk for infection

What is an adverse effect of excessive immunosuppression?

Serious infection Explanation: Excessive immunosuppression significantly increases the risk of serious infection. Graft rejection and graft-versus-host disease result from inadequate immunosuppression.

Six months after undergoing transplantation, a female client asks her health care provider if it would be all right for her to volunteer at the local children's health clinic. She has limited adverse effects from her immunosuppressant drugs and is beginning to feel healthy again. The provider suggests alternate volunteer options because:

She may develop an infectious process at the clinic.

The client receiving a first infusion of paclitaxel reports chills and dyspnea. The oncology nurse assesses the client and observes facial flushing, wheezing, and extreme anxiety. What is the priority intervention by the nurse?

Stop the infusion

The nurse is administering a client's chemotherapeutic drug through a peripheral IV site, and the nurse observes that extravasation has occurred. What is the nurse's best action?

Stop the infusion and inform the health care provider immediately

A postmenopausal woman with breast cancer will most likely be treated with which anti-estrogen drug?

Tamoxifen

A client is being sent home with subcutaneous heparin after a total hip replacement. The nurse understands what symptom would indicate a serious drug reaction?

Tarry stools

The nurse is caring for a female client in the home. The client is prescribed filgrastim. What would be included in the nurse's education plan?

Techniques to reduce exposure to infection

A stable daily dose of warfarin is reached when which parameter is achieved?

The PT and INR are within their therapeutic ranges, and the dose does not cause bleeding.

A client is experiencing an immune response and the only immunoglobulin that is currently in circulation is IgM. How should the nurse best interpret this fact?

The client has very recently been exposed to the antigen

A client has been prescribed epoetin alfa. What assessment finding may suggest that the drug is contraindicated?

The client's blood pressure is 161/107 mm Hg.

To monitor possible intermittent claudication, the nurse will assess for a thrombus lodging in what specific location?

The legs

A client prescribed epoetin alfa requests changing the medication from the subcutaneous to the oral route. Which statement should the nurse use to formulate a response to this request?

This drug is destroyed by acids found in the stomach.

A client taking epoetin alfa requests changing the medication from the subcutaneous route to the PO route. How should the nurse respond?

This medication is destroyed in the stomach and can only be given by injection.

Mr. Reiss is prescribed cyclophosphamide high-dose drug therapy. His health history indicates prior radiation to the pelvis. To minimize the adverse effect of the drug, the nurse encourages him to drink 2 to 3 L of fluid a day. Keeping his prior history in mind, what could be the reason for this suggestion?

To minimize his increased risk for hemorrhagic cystitis

A nurse educator is discussing the role of protooncogenes in the pathophysiology of cancer. What typically triggers protooncogenes to differentiate into oncogenes?

exposure to carcinogens

The nurse is caring for a 76-year-old client who is receiving IV heparin 5000 units q4h. At the initiation of therapy, the client's control activated thromboplastin time (aPTT) was found to be 35 seconds. One hour prior to the next scheduled dose, aPTT is determined to be 92 seconds. Based on this result, the nurse will:

hold the dose and contact the provider.

The nurse is caring for a client who is receiving epoetin alfa. What adjunct treatment will the nurse expect the health care provider to order for this client?

iron supplement

The nurse is planning to visit the home of a client who will begin receiving interferon alpha-2b as treatment for hairy cell leukemia. Which laboratory values should the nurse confirm have prescribed before administering the medication? Select all that apply. platelet count liver function tests serum sodium level renal function tests complete blood count

platelet count liver function tests renal function tests complete blood count

Mycophenolate mofetil is being considered in the treatment of a 39-year-old female transplant recipient. Before the initiation of therapy, the nurse must assess the client for what information to ensure safety?

pregnancy status

A nurse is conducting an assessment on a client who has recently undergone exploratory laparotomy. The nurse notes the continued order for enoxaparin. The nurse predicts this is to accomplish which goal?

prevent formation of blood clot

By what means does warfarin achieve the desired anticoagulant effects?

preventing synthesis of clotting factors in the liver

An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease?

prostate cancer

The nurse is caring for a client whose current antineoplastic regimen includes bicalutamide. The nurse should anticipate what additional aspect of this client's cancer treatment?

prostatectomy

A client accidentally ingested extra doses of warfarin at home and now presents with an elevated INR and bleeding. Which medication will the nurse prepare as prescribed to administer along with vitamin K?

prothrombin complex concentrate

A client's exposure to an infectious microorganism has stimulated the client's immune response, including activation of effector (cytotoxic) T cells. These cells will help to eliminate pathogens by:

releasing cytokines that will destroy the foreign cells.

A client is to receive enoxaparin. The nurse would administer this drug by which route?

subcutaneous injection