Immune Meds ATI and NCLEX questions

ATI: A nurse is teaching a client about immunizations. Which of the following information should the nurse include in the teaching? a. "You should receive a tetanus booster every 10 years." b. "You should not receive the influenza immunization if you have a common cold." c. "You do not have to receive the shingles vaccine if you have received two doses of the varicella virus vaccine." d. "As long as you don't have risk factors, you will start receiving the pneumococcal vaccine when you are 50 years old."

"You should receive a tetanus booster every 10 years." Rationale: The nurse should inform the client that the tetanus-diphtheria (Td) vaccine is recommended every 10 years.

NCLEX: A client with a diagnosis of breast cancer is taking cyclophosphamide. The client calls the health care clinic and tells the nurse that the medication is upsetting the stomach. Which instruction would the nurse provide to the client? 1. Take the medication with food 2. Avoid drinking fluids while taking the medication 3. Try to take the medication with a small amount of orange juice 4. Continue to take the medication on an empty stomach, and lie down after taking the medication

1. Take the medication with food The medication would be taken on an empty stomach, but if the client complains of gastrointestinal (GI) upset, it can be taken with food. The client who is taking cyclophosphamide needs to be instructed to drink copious amounts of fluids during the administration of this medication. Orange juice probably would cause and increase the GI upset. Option 4 will not assist in relieving the discomfort experienced by the client.

NCLEX: A client with testicular cancer is receiving cisplatin. The nurse assesses for which finding as a toxic effect of this medication? 1. Tinnitus 2. Diarrhea 3. Nausea and Vomiting 4. Elevated WBC count

1. Tinnitus It can cause nephrotoxicity, bone marrow depression, and ototoxicity, which manifests as tinnitus and high-frequency hearing loss. Nausea and vomiting are expected side effects, which can be severe and begin 1 hour after administration, persisting for 1 to 2 days. Diarrhea is not an associated side effect or toxic effect.

NCLEX: A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? 1. Glucose level 2. Calcium level 3. Potassium level 4. Prothrombin time

2. Calcium level Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium level should be assessed. These blood levels, along with cholesterol and triglyceride levels, need to be monitored periodically during therapy. The nurse would assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.

NCLEX: The client with breast cancer has been given a prescription for cyclophosphamide. The nurse determines that the client understands the proper use of the medication if the client states to take which measure? 1. Increase dietary intake of potassium. 2. Increase fluid intake to 2 to 3 L/day. 3. Take the medication with large meals. 4. Decrease dietary intake of magnesium.

2. Increase fluid intake to 2 to 3 L/day An adverse effect of cyclophosphamide is hemorrhagic cystitis. The client would drink large amounts of fluid during the administration of this medication. Clients also would observe for hematuria. The medication needs to be taken on an empty stomach unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be encouraged to increase potassium intake. The client would not be instructed to alter magnesium intake.

NCLEX: Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The client asks the nurse if a family member with bladder cancer can also take this medication. The nurse most appropriately responds by making which statement? 1. "This medication can be used only to treat breast cancer." 2. "Yes, your family member can take this medication for bladder cancer as well." 3. "This medication can be taken to prevent and treat clients with breast cancer." 4. "This medication can be taken by anyone with cancer as long as their health care provider approves it."

3. "This medication can be taken to prevent and treat clients with breast cancer." Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy and for preventing breast cancer in those who are at high risk.

NCLEX: The nurse is monitoring a client with leukemia who is receiving doxorubicin by intravenous infusion. The nurse would monitor for which finding that would indicate doxorubicin toxicity? 1. Elevated creatinine 2. Red coloration in the urine 3. Electrocardiogram (ECG) changes 4. Elevated blood urea nitrogen (BUN)

3. Electrocardiogram (ECG) changes Cardiotoxicity can occur with the use of doxorubicin. The medication can produce irreversible toxicity to the heart, including ECG changes and heart failure. Elevated values on renal function tests are not associated with the use of this medication. A red coloration of the urine may occur with the use of this medication, but this effect is harmless.

NCLEX: The nurse is assigned to care for a client with metastatic breast cancer who is taking tamoxifen citrate. The nurse plans to monitor for which changes in laboratory values for this client? Select all that apply. 1. Increase in lipase level 2. Increase in blood glucose level 3. Increase in serum calcium level 4. Increase in serum potassium level 5. Decrease in low-density lipoprotein levels

3. Increase in serum calcium level 5. Decrease in low-density lipoprotein levels Tamoxifen citrate is an antiestrogen and antineoplastic medication. It may increase the calcium level and lower the low-density lipoprotein levels. Before the initiation of therapy, the complete blood count (CBC), platelet count, and serum calcium levels would be determined. These blood levels would continue to be monitored periodically during therapy. The nurse would monitor for signs of hypercalcemia while the client is taking this medication. These signs include increased urine volume, excessive thirst, nausea, vomiting, constipation, decreased muscle tone, and deep bone or flank pain. Options 1, 2, and 4 are not associated with this medication.

NCLEX: A primary health care provider prescribes cisplatin and vincristine to a client with bladder cancer. The nurse would explain to the client that two medications are administered together for which reason? 1. To prevent alopecia 2. To decrease the destruction of cells 3. To increase the therapeutic response 4. To prevent gastrointestinal side effects

3. To increase the therapeutic response Combinations of medications are used to enhance tumoricidal effects and increase the therapeutic response. Alopecia and gastrointestinal disturbances are side and adverse effects of chemotherapy.

NCLEX: A client with carcinoma of the breast is admitted to the hospital for treatment with intravenously administered doxorubicin. The client relates that friends have warned about hair loss. What is the most appropriate nursing response? 1. "Your friends are correct." 2. "You will not lose your hair." 3. "Hair loss may occur, but it will grow back just as it is now." 4. "Hair loss may occur, and it will grow back, but it may have a different color or texture."

4. "Hair loss may occur, and it will grow back, but it may have a different color or texture." Alopecia (hair loss) can occur after the administration of many antineoplastic medications. Alopecia is reversible, but the new hair growth may have a different color and texture. Therefore, options 1, 2, and 3 are incorrect.

A client with non-Hodgkin's lymphoma is receiving daunorubicin (similar to doxorubicin). Which finding would indicate to the nurse that the client is experiencing an adverse effect related to the medication? 1. Fever 2. Sores in the mouth and throat 3. Complaints of nausea and vomiting 4. Crackles on auscultation of the lungs

4. Crackles on auscultation of the lungs

NCLEX: A client with ovarian cancer is being treated with vincristine. The nurse monitors the client, knowing that which manifestation indicates an adverse effect specific to this medication? 1. Diarrhea 2. Hair loss 3. Chest pain 4. Peripheral neuropathy

4. Peripheral neuropathy An adverse effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all antineoplastic medications. Chest pain is unrelated to this medication.

NCLEX: The nurse caring for a client receiving vincristine is monitoring the client for toxicity. The nurse interprets that the client is experiencing a toxic effect of this medication on the basis of which assessment finding? 1. Nausea and vomiting 2. Decreased platelet count 3. Decreased WBC count 4. Weakness and sensory loss in the legs

4. Weakness and sensory loss in the legs Peripheral neuropathy is the major dose-limiting toxicity associated with vincristine. Nearly all clients exhibit signs and symptoms of sensory or motor nerve injury such as decreased reflexes, weakness, paresthesia, and sensory loss. Nausea and vomiting are rare with the use of this medication. In contrast with most anticancer medications, vincristine causes little toxicity to bone marrow.

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

A Protectant agent, such as mesna Mesna is a uroprotectant agent that can help prevent hemorrhagic cystitis when administered IV with a nitrogen mustard chemotherapy medication

ATI 3.0 A healthcare professional is caring for a patient who is about to begin taking tamoxifen (Soltamox) to treat breast cancer. The healthcare professional should recognize the need for cautious use off the drug if the patient also has which of the following? A. Cataracts B. COPD C. Diabetes D. Alcohol use disorder

A. Cataracts Tamoxifen, an estrogen-receptor blocker, can cause retinopathy, cataracts, and decreased visual acuity. Its use requires caution with patients who already have cataracts.

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

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

ATI 3.0: When talking to a patient who is about to begin vincristine therapy to treat lymphoma, the healthcare professional should include which of the following instructions? A. Increase fiber intake B. Report tinnitus or vertigo C. Take the drug with 8 ox of water D. Allow 4 hr before taking an antacid

A. Increase fiber intake Vincristine, a vinca alkaloid, can cause severe constipation and upper colon fecal impaction. The health care professional should monitor the patient's bowel function and palpate the abdomen for distention. The patient should increase fluid and fiber intake, and take stool softeners.

ATI 3.0: Healthcare professional should question the use of cyclophosphamide for a patient who has which of the following? A. Reynaud's syndrome B. Dehydration C. Jaundice D. Charcot-Marie- Tooth syndrome

B. Dehydration Cyclophosphamide, a nitrogen mustard, is contraindicated for patients who have a fluid-volume deficit because dehydration increases the risk for renal toxicity.

ATI Book: A nurse is caring for a client who is being treated with interferon alfa-2b for malignant melanoma. For which of the following adverse effects should the nurse monitor? (Select all that apply.) A. Tinnitus B. Muscle aches C. Peripheral neuropathy D. Bone loss E. Depression

B. Muscle aches C. Peripheral neuropathy E. Depression Muscle aches and flu-like symptoms are common s/e of interferon alfa-2b. Acetaminophen may be ordered to relieve these manifestations Peripheral neuropathy, dizziness, and fatigue are CNS effects that can occur when taking. Report symptoms to HCP and teach to prevent falls. Depression and mental status changes can occur with interferon alfa-2b treatment. Assess for suicidal thoughts

ATI 3.0 When talking with the patient who is about to begin methotrexate (Trexall) therapy to treat non-Hodgkin lymphoma, the healthcare professional should include which of the following instructions? A. Take echinacea B. Use a soft-bristled toothbrush C. Take aspirin for muscle pain D. Urinate every 4 hrs

B. Use a soft-bristled toothbrush Methotrexate, a folic acid antagonist, can cause severe bone marrow suppression with decreased thrombocyte counts and also oral and GI ulceration. Patients should use a soft-bristled toothbrush to prevent gum bleeding and mouth trauma.

ATI: While assessing a patient who is receiving interferon Alfa 2a (roferon A) to treat Kaposi's sarcoma, the healthcare professional should check for which of the following possible indications of an adverse reaction? A. Bradycardia B. Dilated Pupils C. Fever D. Constipation

C. Fever Interferon alfa-2a, a biologic-response modifier, can cause a flu-like reaction, manifesting as fever, myalgia, and fatigue. For this effect, the health care professional should give the patient acetaminophen (Tylenol).

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

D. "Leucovorin protects healthy cells from methotrexate's toxic effect." Leucovorin, a folic acid derivative and an antagonist to methotrexate, is given within 12 hr of high doses of methotrexate to protect healthy cells from the toxic effects of methotrexate.

ATI: A nurse is teaching a client who has a new diagnosis of breast cancer about the drug tamoxifen. The nurse should tell the client that which of the following conditions is a contraindication for taking tamoxifen? a. Deep-vein thrombosis b. COPD c. Diabetes mellitus d. Alcohol term-26use disorder

Deep-vein thrombosis Rationale: Tamoxifen, an estrogen receptor blocker, can cause thromboembolism. Its use requires cautious use with clients who have deep-vein thrombosis.

A nurse is providing teaching to a client about using leuprolide to treat endometriosis. Which of the following instructions should the nurse include? A. Perform weight-bearing activities B. Wear sunscreen or protective clothing C. Take the drug with food to increase absorption D. Avoid drinking grapefruitclient

Preform weight-bearing activities Leuprolide suppresses estrogen and can cause bone loss. The nurse should instruct the client to perform weight-bearing activities and increase their intake of calcium and vitamin D.

A nurse is teaching a client about receiving leuprolide to treat endometriosis. The nurse should instruct the client to expect which of the following side effects?

Vaginal dryness Leuprolide can cause vaginal dryness. The nurse should suggest that the client use water-based vaginal lubricants to help minimize this effect.

ATI: A nurse is caring for a client who is receiving vincristine to treat lung cancer. The nurse should monitor the client and recognize which of the following manifestations as an indication that the client is experiencing an adverse effect of the drug. a. Weak hand grasps b. Constricted pupils c. Bradycardia d. Crackles

Weak hand grasps Rationale: Vincristine, a vinca alkaloid, can cause peripheral neuropathy. The nurse should monitor deep-tendon reflexes and the strength and movement of the hands and feet. The nurse should instruct the client to report paresthesia or reduced sensation in the hands or feet.

ATI: A nurse is teaching a guardian of a child about the recommended age range to receive the human papillomavirus (HPV) vaccine. Which of the following age ranges should the nurse include? a. 11 to 12 years old b. 7 to 9 years old c. 13 to 15 years old d. 15 to 17 years old

a. 11 to 12 years old Rationale: Three doses of the vaccine for HPV are recommended for adolescents ages 11 to 12 years old.

Activities: You should instruct a client who is tasking tamoxifen to treat breast cancer to watch for and report which of the following adverse effects of this drug? a. Abnormal menstrual bleeding b. Muscle pain and weakness c. Yellowing of skin and eyes d. Peripheral edema

a. Abnormal menstrual bleeding Can cause uterine cancer. Client should report abnormal uterine bleeding, pelvic pain, or pressure, and make sure she has regular gynecologic examinations.

ATI: A nurse is preparing to administer the measles, mumps, and rubella (MMR) vaccine to a child. The nurse should recognize that the MMR vaccine provides which of the following types of immunity? a. Artificial active immunity b. Active c. Passive d. Artificial passive immunity

a. Artificial active immunity Rationale: The nurse should recognize that the MMR vaccine provides artificial active immunity to the child. A vaccine contains a form of the disease that is live, attenuated, or killed, which will allow the body to build up an active immunity against the disease.

ATI: A nurse is teaching the guardian of a 4-month-old infant about recommended immunizations for the infant. Which of the following immunizations should the nurse include? a. Haemophilus influenzae type B vaccine (Hib) b. Varicella vaccine c. Meningococcal conjugate vaccine (MCV4) d. Tetanus-diphtheria-acelluar pertussis vaccine (Tdap)

a. Haemophilus influenzae type B vaccine (Hib) Rationale: The nurse should inform the guardian that the Haemophilus influenzae type B vaccine (Hib) is recommended for infants and children to prevent a serious type of meningitis commonly seen in young children.

ATI: A nurse is teaching a client about recommended immunizations. Which of the following immunizations should the nurse recommend the client receive starting at 50 years of age? a. Herpes zoster vaccine b. Human papillomavirus vaccine (HPV) c. Pneumococcal vaccine d. Haemophilus influenza type B vaccine (Hib)

a. Herpes zoster vaccine Rationale: The herpes zoster, or shingles vaccine, is recommended for adults older than 50 years of age.

Activities: You are about to administer cisplatin to a client who has ovarian cancer. Before beginning the infusion, you should take which of the following actions? (SATA) a. Infusion 1 to 2 L of IV fluid b. Check the client's peripheral pulses c. Administer an antiemetic d. Evaluate the client's hearing e. Determine the client's weight

a. Infusion 1 to 2 L of IV fluid c. Administer an antiemetic d. Evaluate the client's hearing e. Determine the client's weight

ATI: A nurse is caring for a client who has a new prescription for cisplatin to treat testicular cancer. The nurse should instruct the client to report which of the following adverse effects? (Select all that apply.) a. Paresthesia b. Sore throat c. Flank pain d. Tinnitus e. Conjunctivitis

a. Paresthesia b. Sore throat c. Flank pain d. Tinnitus Rationale:*Paresthesia is correct. Cisplatin, a platinum compound, can cause peripheral neuropathy. The nurse should tell the client to report numbness, tingling, or decreased sensation in the hands or feet.*Sore throat is correct. Cisplatin can cause bone marrow depression. The nurse should tell the client to report fever, sore throat, bruising, or fatigue.*Flank pain is correct. Cisplatin can cause kidney toxicity. Prior to therapy, the nurse should hydrate the client with 1 to 2 L of IV fluid and continue for 24 hr following therapy to flush the kidneys and help prevent kidney toxicity.*Tinnitus is correct. Cisplatin can cause ototoxicity. The nurse should monitor the client's hearing and instruct the client to report hearing loss, vertigo, or tinnitus.

Case Study: You should give the client the following instructions about chemotherapy with doxorubicin? (SATA) a. Report vaginal itching b. Expect red-tinged tears c. Use effective contraception d. Expect regrowth after hair loss e. Increased intake of calcium and vitamin D

a. Report vaginal itching b. Expect red-tinged tears c. Use effective contraception d. Expect regrowth after hair loss

NCLEX: A client with lung cancer is receiving a high dose of methotrexate. A PCP also prescribes leucovorin to the client. The nurse would explain to the client that leucovorin is prescribed for which reason? a. "It promotes DNA synthesis" b. "It helps to preserve normal cells" c. "It promotes excretion of the medication" d. "It facilitates the synthesis of nucleic acids"

b. "It helps to preserve normal cells" High concentrations of methotrexate harm and damage normal cells. To save normal cells, leucovorin is given; this is known as leucovorin rescue. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting normal cells to synthesize. Note that leucovorin rescue is potentially hazardous. Failure to administer leucovorin in the right dose at the right time can be fatal.

Case Study: You're administering cyclophosphamide and mesna to a client. Mesna, a chemoprotective agent, helps prevent which adverse reactions to cyclophosphamide? a. Retinopathy b. Seizure activity c. Hemorrhagic cystitis d. Cardiotoxicity

c. Hemorrhagic cystitis Can cause renal toxicity, often manifesting as hemorrhagic cystitis. The HCP will admin mesna, while also increasing IV fluids and monitoring the client's urine for hematuria. Unlikely to cause retinopathy, seizure active or cardiotoxicity.

Case Study: During IV administration of doxorubicin, the infusion site becomes swollen, red, and painful. Which of the following actions should you take? a. Slow the infusion rate b. Apply pressure to the site c. Stop the IV infusion d. Apply ice and continue the infusion

c. Stop the IV infusion Can cause tissue damage from extravasation. Stop the IV infusion and contact the PCP. The HCP should monitor the skin for ulceration, which can occur 1-4 weeks after extravasation.

Case Study: When talking with a client about chemotherapy with doxorubicin, you explain the need for periodic diagnostic tests. The result of which of the following diagnostic tests or procedures requires monitoring? a. Lumbar puncture b. IV pyelogram c, Bone density scan d. ECG

d. ECG Can cause cardiotoxicity. Cardiac symptoms can develop years after treatment, so it is essential for cardiac function before, during, and after therapy. Instruct client to report palpitations, SOB, or chest pain. Doxorubicin does not require cerebrospinal fluid analysis, and unlikely to need an IV pyelogram or bone loss.

Case Study: You should monitor a client taking cyclophosphamide for which adverse reactions? a. Gynecomastia b. Dilated pupils c. Bradycardia d. Fever

d. Fever Can cause bone marrow suppression. The HCO should monitor for indications of leukopenia, such as a fever, and instruct client to report sore throat, fever, or easy or unexplained bruising. They should wash their hands and avoid crowds. Unlikely to cause dilated pupils, bradycardia or gynecomastia.