immune

6. A glucocorticoid is prescribed for a patient. The nurse checks the patient's medical history knowing that glucocorticoid therapy is contraindicated in which disorder? a. Cerebral edema b. Peptic ulcer disease c. Tuberculous meningitis d. Chronic obstructive pulmonary disease

ANS: B Contraindications to the administration of glucocorticoids include drug allergy and may include cataracts, glaucoma, peptic ulcer disease, mental health problems, and diabetes mellitus. The other options are indications for glucocorticoids. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 526 TOP: NURSING PROCESS: Assessment

3. A patient is concerned about the body changes that have resulted from long-term prednisone therapy for the treatment of asthma. Which effect of this drug therapy would be present to support the nursing diagnosis of disturbed body image? a. Weight loss b. Weight gain c. Pale skin color d. Hair loss

ANS: B Facial erythema, weight gain, hirsutism, and "moon face" (characteristic of Cushing's syndrome) are possible body changes that may occur with long-term prednisone therapy. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 527 TOP: NURSING PROCESS: Nursing Diagnosis

8. A patient with multiple sclerosis will be starting therapy with an immunosuppressant drug. The nurse expects that which drug will be used? a. Azathioprine (Imuran) b. Glatiramer acetate (Copaxone) c. Daclizumab (Zenapax) d. Sirolimus (Rapamune)

ANS: B Glatiramer acetate and fingolimod are the only immunosuppressants currently indicated for reduction of the frequency of relapses (exacerbations) in a type of multiple sclerosis known as relapsing-remitting multiple sclerosis. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 771 TOP: NURSING PROCESS: Planning

7. When monitoring a patient who is on immunosuppressant therapy with azathioprine (Imuran), the nurse will monitor which laboratory results? a. Serum potassium levels b. White blood cell (leukocyte) count c. Red blood cell count d. Serum albumin levels

ANS: B Leukopenia is a potential adverse effect of azathioprine therapy, so white blood cells need to be monitored. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773 TOP: NURSING PROCESS: Evaluation

A patient has an order for the monoclonal antibody adalimumab (Humira). The nurse notes that the patient does not have a history of cancer. What is another possible reason for administering this drug? a. Severe anemia b. Rheumatoid arthritis c. Thrombocytopenia d. Osteoporosis

ANS: B Monoclonal antibodies are used for the treatment of cancer, rheumatoid arthritis and other inflammatory diseases, multiple sclerosis, and organ transplantation.

7. A patient who has been on long-term corticosteroid therapy has had surgery to correct an abdominal hernia. The nurse keeps in mind that which potential effect of this medication may have the most impact on the patient's recovery? a. Hypotension b. Delayed wound healing c. Muscle weakness d. Osteoporosis

ANS: B Muscle weakness and osteoporosis may also result from long-term therapy, but delayed wound healing would have the most impact on the patient's recovery from abdominal surgery at this time. Hypertension, not hypotension, may result from long-term corticosteroid therapy. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 526 TOP: NURSING PROCESS: Planning

A patient is to receive a daily dose of fludarabine (Fludara), 25 mg/m2/day for 5 consecutive days. Each dose is diluted in a 125-mL bag of normal saline and is to infuse over 30 minutes. The nurse will set the infusion pump to what rate in mL/hr?

250 mL/hr 30 minutes = 0.5 hours 125 mL : 0.5 hr :: x mL : 1 hr (125 ´ 1) = (0.5 ´ x); 125 = 0.5x; x = 250; set the pump to infuse at 250 mL/hr

One patient has cancer of the bone; another has cancer in the connective tissues of the thigh muscles; a third patient has cancer in the vascular tissues. These patients have a type of tumor referred to as a a. sarcoma. b. leukemia. c. carcinoma. d. lymphoma.

a. sarcoma. Sarcomas are malignant tumors that arise from connective tissues. These tissues can be found in bone, cartilage, muscle, blood, lymphatic, and vascular tissues. The other options are incorrect.

1. A health care worker will be receiving hepatitis B immunoglobulin (BayHep B), 0.06 mg/kg IM now and repeated in 30 days as part of hepatitis B prophylaxis after a needle stick accident. The patient weighs 264 pounds. How many milligrams will the patient receive for each dose? (Record answer using one decimal place.)

ANS: 7.2 mg Convert pounds to kilograms: 264 ¸ 2.2 = 120 kg Calculate mg/kg: 0.06 mg/kg/dose ´ 120 kg = 7.2 mg/dose

1. A patient will be on a tacrolimus (Prograf) infusion after receiving a liver transplant. The order reads, "Give 0.03 mg/kg/day as a continuous IV infusion." The patient weighs 159 pounds, and the medication injection solution is available in a 5-mg/mL strength. Identify how many milliliters will the nurse draw up for this infusion. (record answer using two decimal places) _______

ANS: 0.43 mL DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

A patient is to receive filgrastim (Neupogen) 5 mcg/kg/day. The patient weighs 198 pounds. Identify how many micrograms of medication will this patient receive each day. _______

ANS: 450 mcg Convert pounds to kilograms: Calculate mcg/day for this patient:

A patient will be receiving aldesleukin [IL-2] (Proleukin), 600,000 IU/kg every 8 hours for 14 doses. The patient weighs 220 pounds. Identify how many IU of medication will this patient receive per dose. _______

ANS: 60 million (60,000,000) IU Convert pounds to kilograms: Calculate IU/kg for this patient:

1. A patient has been admitted for an exacerbation of chronic obstructive pulmonary disease and will be receiving methylprednisolone (Solu-Medrol) 30 mg intravenously every 6 hours. The medication is available in 40-mg/mL vials. Identify how many milliliters will the nurse draw up for this dose. _______

ANS: 0.75 mL DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

When giving cisplatin (Platinol-AQ), the nurse is aware that the major dose-limiting effect of this drug is which condition? a. Alopecia b. Kidney damage c. Cardiotoxicity d. Stomatitis

ANS: B Cisplatin may cause nephrotoxicity, and the patient's renal function must be monitored closely while on this drug. Ensuring hydration will help to prevent nephrotoxicity. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 735 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is conducting a class on potential bioterrorism agents, and a participant asks, "Which one has three routes of exposure to humans?" Which response by the nurse is correct? a. Anthrax b. Smallpox c. Botulism d. Tularemia

ANS: A Infection with Bacillus anthracis, the cause of anthrax, can occur via three routes of exposure: cutaneous, gastrointestinal, and inhalation. The other options are incorrect.

10. A 30-year-old woman is in the clinic for her yearly gynecologic exam and asks the nurse about the "new vaccine that prevents HPV." She wants to receive the papillomavirus vaccine (Gardasil). Which response by the nurse is most appropriate? a. "This vaccine is recommended for women 13 to 26 years of age." b. "We will need to make sure you are not pregnant first." c. "There will be a total of three injections." d. "I will check with your health care provider and then get the first dose of the vaccine ready."

ANS: A It is important to make sure that a patient receiving Gardasil is not pregnant and that the patient knows that there are a total of three injections, but this particular patient is too old to receive the vaccine. The guidelines recommend the vaccine for women 13 to 26 years of age and for girls 11 to 12 years of age.

9. A 72-year-old patient is to receive a pneumococcal vaccine, polyvalent (Pneumovax 23). The nurse recognizes that which statement about this vaccine is true? a. It is given by subcutaneous injection. b. It is given by deep intramuscular injection. c. The patient will have to return for a total of three injections. d. It is given yearly to provide immunization against current strains of pneumococcal bacteria.

ANS: A Pneumococcal vaccines are given by subcutaneous injection, and only once. The other options are incorrect.

3. A 45-year-old man has received a series of immunizing drugs in preparation for a trip to a developing country. Within hours, his wife brings him to the emergency department because he has developed edema of the face, tongue, and throat and is having trouble breathing. The nurse suspects that, based on the patient's history and symptoms, he is experiencing which condition? a. Serum sickness b. Cross-sensitivity c. Thrombocytopenic purpura d. Adenopathy

ANS: A Serum sickness sometimes occurs after repeated injections of equine (horse)-made immunizing drugs and is characterized by edema of the face, tongue, and throat; rash; urticaria; fever; flushing; dyspnea; and other symptoms.

A female patient is receiving palliative therapy with androgen hormones as part of treatment for inoperable breast cancer. The nurse will discuss with the patient which potential body image changes that may occur as adverse effects? a. Hirsutism and acne b. Weight gain c. Flushing and hot flashes d. Alopecia and body odor

ANS: A Androgens used for cancer treatment, such as fluoxymesterone and testolactone, can cause menstrual irregularities, virilization of female, gynecomastia, hirsutism, acne, anxiety, headache, and nausea. The patient needs to be told of these effects before therapy begins. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 738 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient is receiving doxorubicin (Adriamycin) as part of treatment for ovarian cancer. Which nursing diagnosis is related to this antineoplastic drug? a. Decreased cardiac output related to the adverse effect of cardiotoxicity b. Ineffective breathing pattern related to the adverse effect of pulmonary toxicity c. Risk for injury related to the effects of neurotoxicity (ataxia, numbness of hands and feet) d. Impaired urinary elimination pattern related to hyperuricemia

ANS: A Decreased cardiac output related to the adverse effect of cardiotoxicity is a nursing diagnosis related to doxorubicin because adverse effects of doxorubicin include liver and cardiovascular toxicities. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 742 TOP: NURSING PROCESS: Nursing Diagnosis MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. The nurse is monitoring a patient who is receiving muromonab-CD3 (Orthoclone OKT3) after an organ transplant. Which effect is possible with muromonab-CD3 therapy? a. Chest pain b. Hypotension c. Confusion d. Dysuria

ANS: A Muromonab-CD3 may cause chest pain, fever, chills, tremor, gastrointestinal disturbances (nausea, vomiting, diarrhea), and other effects as noted in Table 48-2. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773 TOP: NURSING PROCESS: Evaluation

2. A patient is about to undergo a kidney transplant. She will be given an immunosuppressant drug before, during, and after surgery to minimize organ rejection. During the preoperative teaching session, which information will the nurse include about the medication therapy? a. Several days before the surgery, the medication will be administered orally. b. The oral doses need to be taken 1 hour before meals to maximize absorption. c. Mix the oral liquid with juice in a disposable Styrofoam cup just before administration. d. Intramuscular injections of the medication will be needed for several days preceding surgery.

ANS: A Several days before transplant surgery, immunosuppressant drugs need to be taken by the oral route, if possible, to avoid intramuscular injections and the risk for infection caused by the injections. Avoid Styrofoam containers because the medication may adhere to the side of the container. These medications are taken with food to minimize gastrointestinal upset. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 778 TOP: NURSING PROCESS: Implementation

During interleukin drug therapy, a patient is showing signs of severe fluid retention, with increasing dyspnea and severe peripheral edema. The next dose of the interleukin is due now. Which action will the nurse take next? a. Hold the drug, and notify the prescriber. b. Give the drug, and notify the prescriber. c. Give the drug along with acetaminophen and diphenhydramine (Benadryl). d. Monitor the patient for 2 hours, and then give the drug if the patient's condition improves.

ANS: A The fluid retention that may occur with interleukin therapy is reversible; if therapy is stopped, the prescriber must be notified. The other options are incorrect.

2. A patient will be starting therapy with a corticosteroid. The nurse reviews the patient's orders and notes that an interaction may occur if the corticosteroid is taken with which of these drug classes? a. Nonsteroidal anti-inflammatory drugs b. Antibiotics c. Opioid analgesics d. Antidepressants

ANS: A The use of corticosteroids with aspirin, other NSAIDs, and other ulcerogenic drugs produces additive gastrointestinal effects and an increased chance for the development of gastric ulcers. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 526 TOP: NURSING PROCESS: Assessment

2. The nurse expects that a patient is experiencing undersecretion of adrenocortical hormones when which conditions are found upon assessment? (Select all that apply.) a. Dehydration b. Weight loss c. Steroid psychosis d. Increased potassium levels e. Increased blood glucose levels f. Decreased serum sodium levels

ANS: A, B, D, F The undersecretion (hyposecretion) of adrenocortical hormones causes a condition known as Addison's disease, which is associated with decreased blood sodium and glucose levels, increased potassium levels, dehydration, and weight loss. Steroid psychosis is an effect of glucocorticoid excess. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 524 TOP: NURSING PROCESS: Assessment

2. The nurse is reviewing the information about the herpes zoster vaccine (Zostavax) before administering the dose. Which statements about the vaccine are true? (Select all that apply.) a. It is a one-time vaccine. b. The vaccine is recommended for patients 50 years of age and older. c. The vaccine is given to children to prevent chickenpox. d. It is used to prevent postherpetic neuralgia. e. It is contraindicated in patients who have already had shingles. f. The vaccine is used to prevent reactivation of the zoster virus that causes shingles.

ANS: A, B, F Zoster vaccine (Zostavax) is used to prevent shingles; it also prevents reactivation of the zoster virus that causes shingles. It is given to patients age 50 years of age and older, and it is a one-time vaccine. It is not given to prevent chickenpox or given to children. It does not prevent postherpetic neuralgia, and it can be given to patients who have already had shingles.

When a patient is receiving cisplatin (Platinol-AQ) chemotherapy, the nurse will monitor for which adverse effects? (Select all that apply.) a. Tinnitus b. Heart failure c. Hearing loss d. Elevated blood urea nitrogen and creatinine levels e. Numbness or tingling in the extremities f. Elevated glucose and ketone levels

ANS: A, C, D, E Cisplatin can cause nephrotoxicity, ototoxicity, and peripheral neuropathy. Nephrotoxicity is manifested by rising blood urea nitrogen and creatinine levels; ototoxicity is manifested by tinnitus, hearing loss, and dizziness; peripheral neuropathy is manifested by numbness or tingling of the extremities. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 736 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

1. The nurse is reviewing the health history of a new patient who may need immunizations. Active immunizations are usually contraindicated in which patients? (Select all that apply.) a. Patients with a febrile illness b. Children younger than 1 year of age c. Elderly patients d. Patients who are immunosuppressed e. Those receiving cancer chemotherapy

ANS: A, D, E Contraindications to the administration of immunizing drugs include a history of reactions to or serious adverse effects resulting from the drugs, and patients who are already immunosuppressed (patients with AIDS and patients receiving chemotherapy). Immunizations are best deferred until after a febrile illness. Children younger than 1 year of age and the elderly may receive immunizing drugs.

The nurse is assessing a patient who is receiving chemotherapy with an alkylating drug. Which assessment findings would be considered indications of an oncologic emergency? (Select all that apply.) a. Dry, "scratchy," or "swollen" throat b. Loss of hair c. Decreased red blood cell count d. White patches in the mouth or throat e. Temperature of 100.7° F (38.2° C) f. Decreased urine output

ANS: A, D, E, F Indications of an oncologic emergency include fever and/or chills with a temperature higher than 100.5° F (38.1° C); new sores or white patches in the mouth or throat; changes in bladder function or patterns; dry, burning, "scratchy," or "swollen" throat; and other signs and symptoms (see Box 46-4). The prescriber must be contacted immediately if any of the listed signs or symptoms occur. Loss of hair and decreased red blood cell count (a result of bone marrow suppression) are expected effects of chemotherapy. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 744 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. A patient is in the urgent care center after experiencing a black widow spider bite. The nurse prepares to give which product to treat this injury? a. Live vaccine b. Antivenins or antisera c. Tetanus immune globulin d. Active immunizing drug

ANS: B Antivenins, also known as antisera, are used to prevent or minimize the effects of poisoning by poisonous snakes and spiders. They provide the person who has been bitten with the substance needed to overcome the effects of the venom.

4. A 12-month-old infant has received an MMR II (measles, mumps, and rubella virus vaccine), and her mother calls the clinic that afternoon to ask about helping her fussy infant to "feel better." What will the nurse suggest? a. Apply an ice pack to the injection site. b. Apply warm compresses to the injection site. c. Observe the site for further swelling and redness. d. Bring the infant in to the emergency department for an immediate examination.

ANS: B Applying warm compresses to the injection site and using acetaminophen (not aspirin, which carries the risk for Reye's syndrome) should help to relieve the discomfort. The other options are incorrect.

6. A nurse is working in an immunization clinic. A new colleague asks, "When is the first dose of the diphtheria, tetanus, and acellular pertussis (DtaP, Daptacel) given?" The nurse knows that this series is started at what age? a. At birth b. 6 weeks c. 3 months d. 1 year

ANS: B The first dose of the series of three injections is given at 6 weeks of age. The other options are incorrect.

11. A patient has been diagnosed with a severe case of inhalational anthrax. The nurse is preparing to implement the medication orders. Which medication is appropriate for inhalational anthrax? a. doxycycline b. ciprofloxacin c. immunoglobulin (BayGam) d. anthrax vaccine

ANS: B The fluorquinolone ciprofloxacin is used to treat more severe (i.e., the inhalational form) cases of anthrax. Doxycycline is used for more mild cases (gastrointestinal and cutaneous forms). The anthrax vaccine is used to prevent anthrax. Immunoglobulin is not an appropriate treatment.

Abatacept (Orencia) is prescribed for a patient with severe rheumatoid arthritis. The nurse checks the patient's medical history, knowing that this medication would need to be used cautiously if which condition is present? a. Coronary artery disease b. Chronic obstructive pulmonary disease c. Diabetes mellitus d. Hypertension

ANS: B Abatacept must be used cautiously in patients with recurrent infections or chronic obstructive pulmonary disease. The other options are incorrect.

1. The nurse is administering adrenal drugs to a patient. Which action by the nurse is appropriate for this patient? a. Administering oral drugs on an empty stomach to maximize absorption b. Rinsing the oral cavity after using corticosteroid inhalers c. Administering the corticosteroids before bedtime to minimize adrenal suppression d. Discontinuing the medication immediately if weight gain of 5 pounds or more in 1 week occurs

ANS: B After the patient has used the corticosteroid inhalers, cleaning the oral cavity helps to prevent possible oral fungal infections from developing. Adrenal drugs need be taken with meals to minimize gastrointestinal upset and in the mornings to minimize adrenal suppression, and they need to be discontinued by weaning, not abruptly. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 530 TOP: NURSING PROCESS: Implementation

1. A patient must be treated immediately for acute organ transplant rejection. The nurse anticipates that muromonab-CD3 (Orthoclone OKT3) will be ordered. What is the priority assessment before beginning drug therapy with muromonab-CD3? a. Serum potassium level b. Fluid volume status c. Electrocardiogram d. Blood glucose level

ANS: B Assess fluid volume status because muromonab-CD3 is contraindicated in the presence of fluid overload. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 777 TOP: NURSING PROCESS: Assessment

The nurse is teaching a class about the various chemotherapy drugs. Which of these statements explains why alkylating drugs are also called "cell cycle-nonspecific drugs"? a. They are cytotoxic during a specific cell cycle. b. They are cytotoxic in any phase of the cell cycle. c. They are effective against several types of neoplasms. d. They are more highly differentiated than cell cycle-specific drugs.

ANS: B Cell cycle-nonspecific drugs kill cancer cells during any phase of the growth cycle, whereas cell cycle-specific drugs kill cancer cells during specific phases of the cell growth cycle. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 734 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

4. A patient is taking fludrocortisone (Florinef) for Addison's disease, and his wife is concerned about all of the problems that may occur with this therapy. When teaching them about therapy with this drug, the nurse will include which information? a. It may cause severe postural hypotension. b. It needs to be taken with food or milk to minimize gastrointestinal upset. c. The medication needs to be stopped immediately if nausea or vomiting occurs. d. Weight gain of 5 pounds or more in 1 week is an expected adverse effect.

ANS: B Patients receiving fludrocortisone need to take it with food or milk to minimize gastrointestinal upset; weight gain of 5 pounds or more in 1 week needs to be reported to the physician; abrupt withdrawal is not recommended because it may precipitate an adrenal crisis. Adverse effects are related to the fluid retention and may include heart failure and hypertension. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 531 TOP: NURSING PROCESS: Implementation

When monitoring a patient's response to interferon therapy, the nurse notes that the major dose-limiting factor for interferon therapy is which condition? a. Diarrhea b. Fatigue c. Anxiety d. Nausea and vomiting

ANS: B Patients who receive interferon therapy may experience flu-like symptoms: fever, chills, headache, malaise, myalgia, and fatigue. Fatigue is the major dose-limiting factor for interferon therapy. Patients taking high dosages become so exhausted that they are commonly confined to bed.

5. When monitoring a patient who is taking a systemically administered glucocorticoid, the nurse will monitor for signs of which condition? a. Dehydration b. Hypokalemia c. Hyponatremia d. Hypoglycemia

ANS: B Systemic glucocorticoid drugs may cause potassium depletion, hyperglycemia, and hypernatremia. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 526 TOP: NURSING PROCESS: Evaluation

5. When administering cyclosporine, the nurse notes that allopurinol is also ordered for the patient. What is a potential result of this drug interaction? a. Reduced adverse effects of the cyclosporine b. Increased levels of cyclosporine and toxicity c. Reduced uric acid levels d. Reduced nephrotoxic effects of cyclosporine

ANS: B The allopurinol may cause increased levels of cyclosporine, and toxicity may result. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 774 TOP: NURSING PROCESS: Planning

1. The nurse is reviewing therapy with glucocorticoid drugs. Which conditions are indications for glucocorticoid drugs? (Select all that apply.) a. Glaucoma b. Cerebral edema c. Chronic obstructive pulmonary disease and asthma d. Organ transplantation e. Varicella f. Septicemia

ANS: B, C, D Cerebral edema, chronic obstructive pulmonary disease, asthma, and organ transplantation are indications for glucocorticoid therapy. Glaucoma, varicella, and septicemia are all contraindications to glucocorticoid therapy. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 525 TOP: NURSING PROCESS: Planning

During therapy with hematopoietic drugs, the nurse will monitor the patient for which adverse effects? (Select all that apply.) a. Hypotension b. Edema c. Diarrhea d. Black, tarry stools e. Nausea and vomiting f. Headache

ANS: B, C, E, F Potential adverse effects of hematopoietic drugs include edema, anorexia, nausea, vomiting, diarrhea, dyspnea, fever, and headache. See Table 47-1 for a complete list. The other options are not adverse effects of these drugs.

2. A patient has started azathioprine (Imuran) therapy as part of renal transplant surgery. The nurse will monitor for which expected adverse effect of azathioprine therapy? (Select all that apply.) a. Tremors b. Leukopenia c. Diarrhea d. Thrombocytopenia e. Hepatotoxicity f. Fluid retention

ANS: B, D, E Leukopenia is an expected adverse effect of azathioprine therapy, as are thrombocytopenia and hepatotoxicity. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773 TOP: NURSING PROCESS: Evaluation

1. The nurse follows which procedures when giving intravenous (IV) cyclosporine? (Select all that apply.) a. Administering it as a single IV bolus injection to minimize adverse effects b. Using an infusion pump to administer this medication c. Monitoring the patient for potential delayed adverse effects, which may be severe d. Monitoring the patient closely for the first 30 minutes for severe adverse effects e. Checking blood levels periodically during cyclosporine therapy f. Performing frequent oral care during therapy

ANS: B, D, E, F Cyclosporine is infused intravenously with an infusion pump, not as an IV bolus. Monitor the patient closely for the first 30 minutes for adverse effects, especially for allergic reactions, and monitor blood levels periodically to ensure therapeutic, not toxic, levels of the medication. Perform oral hygiene frequently to prevent dry mouth and subsequent infections. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 778 TOP: NURSING PROCESS: Implementation

2. The nurse is reviewing principles of immunization. What type of immunization occurs when antibodies pass from mother to infant during breastfeeding or through the placenta during pregnancy? a. Artificial active immunization b. Attenuating immunization c. Natural passive immunization d. Artificial passive immunization

ANS: C Natural passive immunization occurs when antibodies are transferred from the mother to her infant in breast milk or through the bloodstream via the placenta during pregnancy. Artificial active immunization causes an antigen-antibody response and stimulates the body's defenses to resist any subsequent exposures. Passive immunization is conferred by bypassing the host's immune system and injecting the person with antiserum or concentrated antibodies obtained from other humans or animals; this gives the host direct means of fighting off an invading microorganism. The host's immune system therefore does not have to manufacture these antibodies.

5. A sanitation worker has experienced a needle stick by a contaminated needle that was placed in a trash can. The employee health nurse expects that which drug will be used to provide passive immunity to hepatitis B infection? a. Haemophilus influenzae type b (Hib) b. Varicella virus vaccine (Varivax) c. Hepatitis B immunoglobulin (BayHep B) d. Hepatitis B virus vaccine (inactivated) (Recombivax HB)

ANS: C Recombivax HB promotes active immunity to hepatitis B infection in people who are considered to be at high risk for potential exposure to the virus, whereas hepatitis B immunoglobulin provides passive immunity for the prophylaxis and postexposure treatment of people exposed to hepatitis B virus or HBs-Ag-positive materials, such as blood, plasma, or serum. Hib and Varivax vaccines are not appropriate for this situation.

A patient is receiving a third session of chemotherapy with daunorubicin (Cerubidine). The nurse will assess the patient for which signs of a potential severe toxic effect of this drug? a. Tinnitus and hearing loss b. Numbness and tingling in the fingers c. A weight gain of 2 pounds or more in 24 hours d. Decreased blood urea nitrogen and creatinine levels

ANS: C Cardiac toxicity may occur, so frequent checking of heart and breath sounds is necessary and daily weights need to be recorded (with reporting of an increase of 2 pounds or more in 24 hours or 5 pounds or more in 1 week). DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 743 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient who has received chemotherapy has a steadily decreasing white blood cell count. The chemotherapy will end on Tuesday afternoon. The oncologist has mentioned that a colony-stimulating factor will be started soon. The nurse knows that the appropriate time to start this medication is when? a. While the patient is still receiving chemotherapy b. Two hours after the chemotherapy ends c. Wednesday afternoon, 24 hours after the chemotherapy ends d. In 2 to 4 days, after the white blood cells have reached their nadir

ANS: C Drugs that are given to enhance the activity of bone marrow cells interfere directly with the action of myelosuppressive cancer therapy. For this reason, therapy with colony-stimulating factors usually begins 24 hours after the chemotherapy has been completed.

What is the nurse's priority action if extravasation of an antineoplastic drug occurs during intravenous (IV) administration? a. Reduce the infusion rate. b. Discontinue the IV, and apply warm compresses. c. Stop the infusion immediately, but leave the IV catheter in place. d. Change the infusion to normal saline, and inject the area with hydrocortisone.

ANS: C If extravasation is suspected, administration of the drug must be stopped immediately but the IV catheter left in place and the appropriate antidote instilled through the existing IV tube, after which the needle may be removed. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 736 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

A patient asks about his cancer treatment with monoclonal antibodies. The nurse tells him that which is the major advantage of treating certain cancers with monoclonal antibodies? a. They will help the patient improve more quickly than will other antineoplastic drugs. b. They are more effective against metastatic tumors. c. Monoclonal antibodies target certain tumor cells and bypass normal cells. d. There are fewer incidences of opportunistic infections with monoclonal antibodies.

ANS: C Monoclonal antibodies can target cancer cells specifically and have minimal effects on healthy cells, unlike conventional cancer treatments. As a result, there are fewer adverse effects when compared to traditional antineoplastic therapy. The other options are incorrect.

During chemotherapy, a patient develops severe diarrhea caused by a vasoactive intestinal peptide-secreting tumor (VIPoma). The nurse expects to administer which drug for this problem? a. Dexrazoxane (Zinecard) b. Allopurinol (Zyloprim) c. Octreotide (Sandostatin) d. Bismuth subsalicylate (Pepto-Bismol)

ANS: C Octreotide (Sandostatin) is used for the management of a cancer-related condition called carcinoid crisis and treatment of the severe diarrhea caused by vasoactive intestinal peptide-secreting tumors (VIPomas). The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 740 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient who has received chemotherapy has a critically low platelet count. The nurse expects which drug or drug class to be used to stimulate platelet cell production? a. Filgrastim (Neupogen) b. Interferons c. Oprelvekin (Neumega) d. Epoetin alfa (Epogen)

ANS: C Oprelvekin (Neumega) stimulates bone marrow cells, specifically megakaryocytes, which eventually form platelets. The other options are incorrect.

When hanging a new infusion bag of a chemotherapy drug, the nurse accidentally spills a small amount of the solution onto the floor. Which action by the nurse is appropriate? a. Let it dry, and then mop the floor. b. Wipe the area with a disposable paper towel. c. Use a spill kit to clean the area. d. Ask the housekeeping department to clean the floor.

ANS: C Special spill kits are employed to clean up even the smallest chemotherapy spills. These precautions are necessary to protect the health care provider from the cytotoxic effects of these drugs. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 741 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

1. Two patients arrive at the clinic; one is a young boy with sickle cell anemia, and another is a 57-year-old woman with early stages of Hodgkin's disease. The nurse notices that both patients need the same vaccine. What vaccine would that be? a. Varicella virus vaccine (Varivax) b. Herpes zoster vaccine (Zostavax) c. Hepatitis B virus vaccine, inactivated (Recombivax HB) d. Haemophilus influenzae type b (Hib) vaccine

ANS: D H. influenzae type b conjugate vaccine is usually given to patients with one of the following disorders: sickle cell anemia, an immunodeficiency syndrome, Hodgkin's disease, and others. The other options are incorrect.

Aldesleukin [IL-2] (Proleukin) is prescribed for a patient. The nurse reviews the patient's medication list and would note a potential drug interaction if which drug class is also ordered? a. Anticoagulants b. Antiepileptic drugs c. Oral hypoglycemic drugs d. Antihypertensive drugs

ANS: D Aldesleukin, when given with antihypertensives, can produce additive hypotensive effects. The other responses are incorrect.

The nurse is administering an interferon and will implement which intervention? a. Giving the medication with meals b. Monitoring daily weights c. Limiting fluids while the patient is taking this medication d. Rotating sites if administered subcutaneously

ANS: D Interferon is given parenterally (not orally), and injection sites need to be rotated. Fluids need to be increased during interferon therapy. The other options are incorrect.

9. Cyclosporine is prescribed for a patient who had an organ transplant. The nurse will monitor the patient for which common adverse effect? a. Nausea and vomiting b. Fever and tremors c. Agitation d. Hypertension

ANS: D Moderate hypertension may occur in as much as 50% of patients taking cyclosporine. The other options are potential adverse effects of other immunosuppressant drugs. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 777 TOP: NURSING PROCESS: Evaluation

4. The nurse is preparing to administer an injection of monoclonal antibodies. Which additional drug will the nurse administer to minimize adverse reactions to the monoclonal antibodies? a. A nonsteroidal anti-inflammatory drug b. A benzodiazepine c. An opioid pain reliever d. A corticosteroid

ANS: D The monoclonal antibodies basiliximab and daclizimab have a tendency to cause the allergy-like reaction known as cytokine release syndrome, which can be severe and even involve anaphylaxis. In an effort to avoid or alleviate this problem, it is recommended that an injection of a corticosteroid, such as methylprednisolone, be administered before the injection of monoclonal antibodies. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773 TOP: NURSING PROCESS: Implementation

Just before the second course of chemotherapy, the laboratory calls to report that the patient's neutrophil count is 450 cells/mm3. The nurse expects that the oncologist will follow which course of treatment? a. Chemotherapy will continue as scheduled. b. Chemotherapy will resume with a lowered dosage. c. Chemotherapy will resume after a transfusion of neutrophils. d. Chemotherapy will be withheld until the neutrophil count returns toward normal levels.

ANS: D The normal range for neutrophils is above 1500 cells/mm3. If neutrophils are decreased to levels of less than 500 cells/mm3 (neutropenia), there is risk for severe infection. Chemotherapy will be held until the count returns toward normal levels. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 744 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A patient has an order for cyclosporine (Sandimmune). The nurse finds that cyclosporine-modified (Neoral) is available in the automated medication cabinet. Which action by the nurse is correct? a. Hold the dose until the prescriber makes rounds. b. Give the cyclosporine-modified drug. c. Double-check the order, and then give the cyclosporine-modified drug. d. Notify the pharmacy to obtain the Sandimmune form of the drug.

ANS: D The nurse must double-check the formulation before giving cyclosporine. Cyclosporine-modified products (such as Neoral or Gengraf) are interchangeable with each other but are not interchangeable with Sandimmune. In this case, the nurse must obtain the Sandimmune form of the drug from the pharmacy. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 778 TOP: NURSING PROCESS: Implementation

During a patient's therapy with interleukins, the nurse monitors the patient for capillary leak syndrome. Which assessment finding, if present, would indicate this problem? a. Bradycardia b. A dry cough c. Bruising on the skin d. A sudden, 15-pound weight gain

ANS: D With capillary leak syndrome, the capillaries lose their ability to retain vital colloids, and these substances migrate into the surrounding tissues, resulting in massive fluid retention. As a result, heart failure, myocardial infarction, and dysrhythmias may occur. The other options do not reflect capillary leak syndrome.

During treatment of a patient who has brain cancer, the nurse hears the oncologist mention that the patient has reached the "nadir." The nurse knows that this term means the a. lowest level of neutrophils reached during therapy. b. highest level of neutrophils reached during therapy. c. point at which the adverse effects of chemotherapy will stop. d. point at which the cytotoxic action against cancer cells is the highest.

a. lowest level of neutrophils reached during therapy. The lowest neutrophil count reached after a course of chemotherapy is known as the nadir. The other options are incorrect.

The nurse is providing education regarding chemotherapy to a patient who is about to receive the first course of treatment. Which statement by the nurse is appropriate? a. "Report black, tarry stools if they occur." b. "Perform daily oral care with mouthwash." c. "Limit your fluid intake to reduce nausea and vomiting." d. "Contraceptive measures can be discontinued as soon as chemotherapy is completed."

a. "Report black, tarry stools if they occur." Teach patients to report signs of bleeding, which would include black, tarry stools. Commercial mouthwashes must not be used because of their alcohol content. Fluids are needed to prevent dehydration. Contraceptive measures may have to be continued for months to years after antineoplastic therapy.

When giving chemotherapy as cancer treatment, the nurse recognizes that toxicity to rapidly growing normal cells also occurs. Which rapidly growing normal cells are also harmed by chemotherapy? (Select all that apply.) a. Bone marrow cells b. Retinal cells c. Hair follicle cells d. Nerve myelin cells e. Gastrointestinal (GI) mucous membrane cells

a. Bone marrow cells c. Hair follicle cells e. Gastrointestinal (GI) mucous membrane cells Chemotherapy toxicities generally stem from the fact that chemotherapy drugs affect rapidly dividing cells—both harmful cancer cells and healthy, normal cells. Three types of rapidly dividing human cells are the cells of hair follicles, GI tract cells, and bone marrow cells. The other options are incorrect.

The nurse is monitoring a patient who has severe bone marrow suppression following antineoplastic drug therapy. Which is considered the principal early sign of infection? a. Fever b. Diaphoresis c. Tachycardia d. Elevated white blood cell count

a. Fever Fever and/or chills may be the first sign of an oncoming infection. Elevated white blood cell count will not occur because of the bone marrow suppression. The other options are incorrect.

Methotrexate is ordered for a patient with a malignant tumor, and the nurse is providing education about self-care after the chemotherapy is given. Which statements by the nurse are appropriate for the patient receiving methotrexate? (Select all that apply.) a. Report unusual bleeding or bruising. b. Hair loss is not expected with this drug. c. Prepare for hair loss. d. Avoid straight-edged razors. e. Avoid foods that are too hot or too cold or rough in texture. f. Restrict fluid intake to reduce nausea and vomiting.

a. Report unusual bleeding or bruising. c. Prepare for hair loss. d. Avoid straight-edged razors. e. Avoid foods that are too hot or too cold or rough in texture. Counsel patients who are taking methotrexate to expect hair loss and to report any unusual bleeding or bruising. Because of the possibility of thrombocytopenia, straight-edged razors should not be used. Foods that are too hot or too cold or rough in texture may be irritating to the oral mucosa. Fluid intake is to be encouraged to prevent dehydration.

The nurse is reviewing infection-prevention measures with a patient who is receiving antineoplastic drug therapy. Which statement by the patient indicates the need for further teaching? a. "I will avoid those who have recently had a vaccination." b. "I will eat only fresh fruits and vegetables." c. "I will report a sore throat, cough, or low-grade temperature." d. "It is important for both my family and me to practice good hand washing."

b. "I will eat only fresh fruits and vegetables." Patients who are neutropenic and susceptible to infections need to adhere to a low-microbe diet by washing fresh fruits and vegetables and making sure foods are well cooked. The other options are correct.

The nurse is administering a combination of three different antineoplastic drugs to a patient who has metastatic breast cancer. Which statement best describes the rationale for combination therapy? a. There will be less nausea and vomiting. b. Increased cancer-cell killing will occur. c. The drugs will prevent metastasis. d. Combination therapy reduces the need for radiation therapy.

b. Increased cancer-cell killing will occur. Because drug-resistant cells commonly develop, exposure to multiple drugs with multiple mechanisms and sites of action will destroy more subpopulations of cells. The other options are incorrect.

A patient is receiving high doses of methotrexate and is experiencing severe bone marrow suppression. The nurse expects which intervention to be ordered with this drug to reduce this problem? a. A transfusion of whole blood b. Leucovorin rescue c. Therapy with filgrastim (Neupogen) d. Administration of allopurinol (Zyloprim)

b. Leucovorin rescue High-dose methotrexate is associated with bone marrow suppression, and it is always given in conjunction with the rescue drug leucovorin, which is an antidote for folic acid antagonists. Basically, leucovorin rescues the healthy cells from methotrexate. The other options are incorrect.

A patient, diagnosed with lymphoma, has an allergy to one of the proposed chemotherapy drugs. The tumor has not responded to other types of treatment. The nurse expects the oncologist to follow which course of treatment? a. The physician will choose another drug to use. b. The chemotherapy will be given along with supportive measures to treat a possible allergic reaction. c. The patient will receive reduced doses of chemotherapy for a longer period of time. d. The chemotherapy cannot be given because of the patient's allergy.

b. The chemotherapy will be given along with supportive measures to treat a possible allergic reaction. Even if a patient has a known allergic reaction to a given antineoplastic medication, the urgency of treating the patient's cancer may still necessitate administering the medication and then treating any allergic symptoms with supportive medications, such as antihistamines, corticosteroids, and acetaminophen.

A patient is receiving irinotecan (Camptosar), along with other antineoplastic drugs, as treatment for ovarian cancer. The nurse will monitor for which potentially life-threatening adverse effect that is associated with this drug? a. Severe stomatitis b. Bone marrow suppression c. Delayed-onset cholinergic diarrhea d. Immediate and severe nausea and vomiting

c. Delayed-onset cholinergic diarrhea In addition to producing hematologic adverse effects, irinotecan has been associated with severe diarrhea, known as cholinergic diarrhea, which may occur during infusions. Delayed diarrhea may occur 2 to 10 days after infusion of irinotecan. It is recommended that this condition be treated with atropine unless use of that drug is strongly contraindicated. This diarrhea can be severe and even life threatening.

When administering chemotherapy for treatment of cancer, the nurse implements which intervention that treats or even prevents chemotherapy-induced nausea and vomiting? a. Instructing the patient to avoid caffeine while on chemotherapy b. Giving an antiemetic when the chemotherapy is started c. Giving an antiemetic 30 to 60 minutes before the chemotherapy is started. d. Increasing mobility before and during chemotherapy

c. Giving an antiemetic 30 to 60 minutes before the chemotherapy is started. Premedication with antiemetics 30 to 60 minutes before administration of the antineoplastics is the preferred treatment protocol to help reduce nausea and vomiting, prevent dehydration and malnutrition, and promote comfort. The other options are incorrect.

A patient who has been on methotrexate therapy is experiencing mild pain. Her husband calls to see if he can give her aspirin for the pain. The nurse's response is based on the fact that aspirin a. aggravates diarrhea. b. masks signs of infection. c. can lead to methotrexate toxicity. d. will cause no problems for the patient on methotrexate.

c. can lead to methotrexate toxicity. Methotrexate interacts with weak organic acids, such as aspirin, and can lead to toxicity by displacing the methotrexate from protein-binding sites.

A patient is receiving her third course of 5-fluorouracil therapy and knows that stomatitis is a potential adverse effect of antineoplastic therapy. What will the nurse teach her about managing this problem? a. "You can take aspirin to prevent stomatitis." b. "Be sure to watch for and report black, tarry stools immediately." c. "You need to increase your intake of foods containing fiber and citric acid." d. "Be sure to examine your mouth daily for bleeding, painful areas, and ulcerations."

d. "Be sure to examine your mouth daily for bleeding, painful areas, and ulcerations." The symptoms of stomatitis consist of pain or burning in the mouth, difficulty swallowing, taste changes, viscous saliva, dryness, cracking, and fissures, with or without bleeding mucosa. Teach patients to avoid consuming foods containing citric acid and foods that are hot or spicy or high in fiber. Assessing stools is important but is not related to stomatitis, and aspirin must not be used during this therapy.

The nurse is developing a plan of care for a patient who is experiencing gastrointestinal adverse effects, including anorexia and nausea, after the first course of antineoplastic therapy. What is an appropriate goal for this patient when dealing with this problem? The patient will a. eat three balanced meals a day within 2 days. b. return to normal eating pattern within 4 weeks. c. maintain normal weight by consuming healthy snacks as tolerated. d. maintain a diet of small, frequent feedings with nutrition supplements within 2 weeks.

d. maintain a diet of small, frequent feedings with nutrition supplements within 2 weeks. Consuming small, frequent meals with nutritional supplements, and maintaining a bland diet help to improve nutrition during antineoplastic therapy.