Pharm Exam 2
A client who has been diagnosed with acute lymphocytic leukemia will be receiving doxorubicin infusions as part of a chemotherapy regimen. The nurse monitors the client for signs and symptoms of doxorubicin toxicity. What clinical finding indicates that toxicity has occurred? 1 Alopecia 2 Dyspnea 3 Metallic taste to food 4 Cardiac rhythm abnormalities
4 Cardiac rhythm abnormalities Doxorubicin is cardiotoxic, which is manifested by transient ECG abnormalities. Alopecia is an expected side effect of doxorubicin, not a toxic effect. Dyspnea and a metallic taste to food are not effects of doxorubicin.
A client is admitted to the hospital with slight jaundice and reports of pain on the left side and back. A diagnosis of acute pancreatitis is made. Which common response to acute pancreatitis should the nurse monitor in the client? 1 Crackles 2 Hypovolemia 3 Gastric reflux 4 Jugular vein distention
2. Hypovolemia Hypovolemia that results from a fluid shift from the intravascular compartment to the peritoneal cavity can cause circulatory collapse; this is a life-threatening event that requires immediate intervention. Crackles indicate an accumulation of fluid in the alveoli associated with hypervolemia, not hypovolemia. Gastric reflux occurs with gastroesophageal reflux disease (GERD), not with pancreatitis. Jugular vein distention indicates hypervolemia, not hypovolemia.
After surgery for cancer, a client is to receive chemotherapy. When teaching the client about the side effects of chemotherapy, what advice should the nurse share about alopecia characteristics? 1 Usually rare 2 Not permanent 3 Frequently prolonged 4 Sometimes preventable
2. Not permanent Once the drugs that interfere with cell division are stopped, the hair will grow back; sometimes the hair will be a different color or texture. Alopecia is a common side effect of chemotherapy. Hair loss persists while the drugs are being received; once the drugs are withdrawn, the hair grows back. Although ice caps on the head and rubber bands around the scalp have been used to try to limit alopecia, they have not been particularly effective.
A client is receiving combination chemotherapy for treatment of metastatic carcinoma. For which systemic side effect should the nurse monitor the client? 1 Ascites 2 Nystagmus 3 Leukopenia 4 Polycythemia
3. Leukopenia Leukopenia, a reduction in white blood cells, is a systemic effect of chemotherapy as a result of myelosuppression. Ascites is not a side effect of chemotherapy. Chemotherapy does not affect the eyes; nystagmus is an involuntary, rapid rhythmic movement of the eyeballs. Also, nystagmus is a local, not a systemic, response. The red blood cells will be decreased, not increased.
A nurse is providing discharge instructions to a client diagnosed with cirrhosis and varices. Which information should the nurse include in the teaching session? Select all that apply. 1 Adhering to a low-carbohydrate diet 2 Avoiding aspirin and aspirin-containing products 3 Limiting alcohol consumption to two drinks weekly 4 Avoiding acetaminophen and products containing acetaminophen 5 Avoiding coughing, sneezing, and straining to have a bowel movement
2, 4, 5 Aspirin can damage the gastric mucosa and precipitate hemorrhage when esophageal or gastric varices are present. Acetaminophen is hepatotoxic and should not be used by the client with cirrhosis. The client with cirrhosis should avoid coughing, sneezing, and straining to have a bowel movement. These activities increase pressure in the portal venous system and increase the client's risk of variceal hemorrhage. A high-carbohydrate diet is encouraged as the diseased liver's ability to synthesize and store glucose is diminished. To decrease the risk of complications, the client must abstain from alcohol.
A nurse identifies that a client receiving chemotherapy has lost weight. What are appropriate nursing interventions for this client? Select all that apply. 1 Providing low-carbohydrate meals 2 Explaining the effect of chemotherapy 3 Encouraging the intake of preferred foods 4 Promoting the intake of small, frequent meals 5 Administering prescribed antiemetics before meals
3,4,5 Selecting preferred foods increases the likelihood of the client eating the food. Small, frequent feedings are better tolerated than large meals. Antiemetics should be administered prophylactically to decrease nausea and enhance appetite. The diet should provide maximum protein and carbohydrates to meet demands related to restoration of body cells and energy. Explaining the effect of chemotherapy will not alter the client's nutrition.
The serum ammonia level of a client with hepatic cirrhosis and ascites is elevated. What nursing intervention is the priority? 1 Weigh the client daily. 2 Restrict the client's oral fluid intake. 3 Measure the client's urine specific gravity. 4 Observe the client for increasing confusion.
4. Observe the client for increasing confusion An increased serum ammonia level impairs the central nervous system, causing an altered level of consciousness. Increasing ammonia levels are not related to weight. An alteration in fluid intake will not affect the serum ammonia level. Measuring the client's urine specific gravity is not the priority; the priority is to monitor the client's neurological status.
A 6-year-old child who just completed a cycle of chemotherapy is to be discharged home. What is the priority teaching point at discharge? 1 Purchasing a wig 2 Ensuring adequate rest 3 Offering sufficient fluids 4 Performing thorough hand washing
4. Performing thorough hand washing Effective hand washing helps prevent infection, and this is the most important intervention in the care of a child with a suppressed immune system. Although purchasing a wig may be important for the child's self-image, it is not the priority. Although providing rest and offering sufficient fluids are also important, neither is the priority.
An adolescent who is undergoing chemotherapy for the treatment of bone cancer has stomatitis as a result of chemotherapy. What should the nurse include when teaching the child about self-care? Select all that apply. 1 Clean the teeth with a swab. 2 Drink fluids through a straw. 3 Brush the teeth three times a day. 4 Rinse frequently with a mouthwash. 5 Avoid foods served at extremes of temperature.
1,2,5 A soft-tipped applicator should be used to help prevent trauma to the oral mucosa. Drinking fluids through a straw allows the fluid to bypass the sores in the mouth and may be less irritating to the mucosa; it provides comfort. Extremes in temperature may injure the oral mucosa and cause discomfort. Brushing the teeth three times a day will injure the oral mucosa and should be avoided. Rinsing frequently with a mouthwash may irritate the oral mucosa and should be avoided; if mouthwash is prescribed, it should be diluted.
A client who is obese and has a history of alcohol abuse is admitted to the hospital with the diagnosis of acute pancreatitis. Which is the initial priority expected client outcome in response to therapy at this time? 1. Report decreased pain 2. Insert nasogastric (NG) tube quickly 3. Join Alcoholics Anonymous 4. Lose four pounds (1.8 kilograms) a week
1. Report decreased pain Pain relief is the priority. Severe pain is associated with acute pancreatitis caused by inflammation of the pancreas, peritoneal irritation, and biliary tract obstruction. Although inserting the NG tube quickly is appropriate, it is not priority, and some clients do not need an NG tube; the NG tube is inserted to allow the pancreas to rest, decreasing pain. Losing weight and joining Alcoholics Anonymous are later goals.
A 5-year-old child who is HIV positive is taken to the health department for immunizations before the start of school. The CD4 count shows severe immunosuppression. What immunizations can the child be given safely at this time? Select all that apply. 1 Varicella 2 Hepatitis A 3 Polio vaccine (IPV) 4 Measles, mumps, rubella (MMR) 5 Diphtheria, tetanus, pertussis (DTaP)
2, 3, 5 The varicella and MMR vaccines should not be administered in the presence of severe immunosuppression because they are live vaccines. Hepatitis A, IPV, and DTaP are not live vaccines; therefore they are appropriate for any child, regardless of immune status. View Topics
A client with cirrhosis of the liver and ascites has been taking chlorothiazide, a thiazide diuretic. Why did the provider add spironolactone to the client's medication regimen? 1 To stimulate sodium excretion 2 To help prevent potassium loss 3 To increase urine specific gravity 4 To reduce arterial blood pressure
2. To help prevent potassium loss Spironolactone is a potassium-sparing diuretic often used in conjunction with thiazide diuretics. The provider was prompted to add spironolactone to the chlorothiazide to prevent potassium loss. Both medications stimulate sodium excretion. Both medications increase urine specific gravity and reduce arterial blood pressure.
A client receiving chemotherapy asks the nurse why an antibiotic was prescribed. Which tissue affected by chemotherapy should the nurse consider when formulating a response? 1 Liver 2 Blood 3 Bone marrow 4 Lymph nodes
3. Bone marrow Prolonged chemotherapy may slow production of leukocytes in bone marrow, thus suppressing the immune system. Antibiotics may be required to help counter infections that the body can no longer handle easily. The liver does not produce leukocytes. Although leukocytes are in both blood and lymph nodes, these cells are more mature than those found in the bone marrow and thus are more resistant to the effects of chemotherapy.
A nurse administers lactulose to a client with cirrhosis of the liver. Which laboratory test change leads the nurse to determine that the lactulose is effective? 1 Decreased amylase 2 Decreased ammonia 3 Increased potassium 4 Increased hemoglobin
2. Decreased ammonia Lactulose destroys intestinal flora that break down protein and in the process give off ammonia. In clients with cirrhosis, ammonia is inadequately detoxified by the liver and can build to toxic levels. Amylase levels are associated with pancreatic problems. Increased potassium levels are associated with kidney failure. Hemoglobin is increased when the body needs more oxygen-carrying capacity, such as in smokers, or in high altitudes.
A client who underwent chemotherapy has leukopenia. Which instruction from the nurse will be beneficial for the client? 1 "You should avoid exposure to the sun." 2 "You should eat high-fiber foods and increase fluid intake." 3 "You should avoid large crowds and people with infections." 4 "You should consume iron supplements and erythropoietin."
3. You should avoid large crowds and people with infections Low levels of white blood cells are called leukopenia. A leukopenic client should avoid large crowds and people with infection as the client may contract infection due to compromised immunity. The suggestion of avoiding exposure to the sun would be beneficial for a client with chemotherapy-induced skin changes. The suggestion of eating high-fiber foods and increasing fluid intake would be beneficial for a client with constipation after chemotherapy. Consuming iron supplements and erythropoietin would be required for a client who developed anemia after chemotherapy.
An older adult client who is receiving chemotherapy for cancer has severe nausea and vomiting and becomes dehydrated. The client is admitted to the hospital for rehydration therapy. Which nursing actions have specific gerontologic implications the nurse must consider? Select all that apply. 1 Assessment of skin turgor 2 Documentation of vital signs 3 Assessment of intake and output 4 Administration of antiemetic drugs 5 Replacement of fluid and electrolytes
1, 4, 5 When skin turgor is assessed, the presence of tenting may be related to loss of subcutaneous tissue associated with aging rather than to dehydration; skin over the sternum should be used instead of skin on the arm for checking turgor. Older adults are susceptible to central nervous system side effects, such as confusion, associated with antiemetic drugs; dosages must be reduced, and responses must be evaluated closely. Because many older adults have delicate fluid balance and may have cardiac and renal disease, replacement of fluid and electrolytes may result in adverse consequences, such as hypervolemia, pulmonary edema, and electrolyte imbalance. Vital signs can be obtained as with any other adult. Intake and output can be measured accurately in older adults.
A nurse is caring for a client who is human immunodeficiency virus (HIV) positive. Which complication associated with this diagnosis is most important for the nurse to teach prevention strategies? 1 Infection 2 Depression 3 Social isolation 4 Kaposi sarcoma
1. Infection The client has a weakened immune response. Instructions regarding rest, nutrition, and avoidance of unnecessary exposure to people with infections help reduce the risk for infection. Clients can be taught cognitive strategies to cope with depression, but the strategies will not prevent depression. The client may experience social isolation as a result of society's fears and misconceptions; these are beyond the client's control. Although Kaposi sarcoma is related to HIV infection, there are no specific measures to prevent its occurrence.
A client with human immunodeficiency virus (HIV) infection is diagnosed with tuberculosis. Before starting antitubercular pharmacotherapy, what essential test results should the nurse review? 1 Liver function studies 2 Pulmonary function studies 3 Electrocardiogram and echocardiogram 4 White blood cell counts and sedimentation rate
1. Liver function studies Antitubercular drugs, such as isoniazid (INH) and rifampin (RIF), are hepatotoxic; liver function should be assessed before initiation of pharmacologic therapy. Pulmonary function studies, electrocardiogram, and echocardiogram might be done; the results of these tests are not crucial for the nurse to review before administering antitubercular drugs. White blood cell counts and sedimentation will not provide information relative to starting antitubercular therapy or to its side effects.
A client is receiving doxorubicin as part of a chemotherapy protocol. The nurse should assess the client for which major life-threatening side effect of doxorubicin? 1 Anemia 2 Cardiotoxicity 3 Pulmonary fibrosis 4 Ulcerative stomatitis
2. Cardiotoxicity Heart failure and dysrhythmias are the primary life-threatening toxic effects unique to doxorubicin. When bone marrow is depressed to precarious levels, the dose is altered or blood components administered. Pulmonary fibrosis is not an adverse effect of doxorubicin or of any of the other antineoplastic agents. Ulcerative stomatitis is an uncomfortable side effect of doxorubicin, but it is not life threatening as are the primary life-threatening toxic effects unique to doxorubicin.
A nurse is caring for a child who is receiving vincristine as part of a chemotherapy protocol. What body systems are most important for the nurse to assess after drug administration? Select all that apply. 1 Respiratory 2 Neurological 3 Reproductive 4 Hematologic 5 Gastrointestinal
2, 4, 5 Vincristine is neurotoxic; therefore the child should be monitored for paresthesias, seizures, footdrop, bowel and bladder problems, and alterations in the function of cranial nerves. Hematologic problems such as anemia, thrombocytopenia, and leukopenia occur, although they are not as severe as with other chemotherapeutic agents, such as cyclophosphamide. Gastrointestinal adverse effects include severe constipation, intestinal necrosis, intestinal perforation, and paralytic ileus, in addition to nausea and vomiting. Respiratory problems are not associated with vincristine therapy. The reproductive system is not affected by vincristine therapy.
What determines if a client will develop AIDS from an HIV infection? 1 Level of IgM in the blood 2 The number of CD4+ T-cells available 3 Presence of antigen-antibody complexes 4 Speed with which the virus invades the RNA
2. The number of CD4+ T-cells available Whether HIV becomes AIDS depends upon the number of CD4+ T-cells. IgM and the presence of antigen-antibody complexes have no effect on HIV. The speed with which HIV invades the RNA has no impact on the future development of AIDS.
A client receiving chemotherapy for cancer develops sores in the mouth and asks the nurse why this happened. What is the nurse's best response? 1 "The sores occur because of the direct irritating effects of the drug." 2 "These tissues are poorly nourished because you have a decreased appetite." 3 "The frequently dividing cells of the gastrointestinal tract are damaged by the drug." 4 "This side effect occurs because it targets the cells of the gastrointestinal system."
3. "The frequently dividing cells of the gastrointestinal tract are damaged by the drug." Many chemotherapeutic agents function by interfering with DNA replication associated with cellular reproduction (mitosis). Frequent cellular mitosis of the stratified squamous epithelium of the mouth and anus results in these areas being powerfully affected by the drugs. The response "The sores occur because of the direct irritating effects of the drug" is not accurate; most agents are administered parenterally. A decreased appetite (anorexia) does not cause stomatitis. Chemotherapeutic agents affect most rapidly proliferating cells, which include not only the cells of the gastrointestinal epithelium but also those of the bone marrow and hair follicles.
A 1-year-old infant is receiving zidovudine for management of human immunodeficiency (HIV) infection. The nurse determines that the infant is exhibiting signs of life-threatening zidovudine toxicity. What clinical finding supports this conclusion? 1 Weight loss 2 Extreme lethargy 3 Bruises over the body 4 Increased urine output
3. Bruises over the body Zidovudine can cause life-threatening blood dyscrasias, including thrombocytopenia. Weight loss is a response to the disease rather than the therapy. With zidovudine toxicity the infant will demonstrate agitation, restlessness, and insomnia, not lethargy. Urine output is unrelated to zidovudine toxicity.
A client with Hodgkin disease is placed on an ABVD combination chemotherapy regimen. Because doxorubicin is part of this therapy, what education will the nurse provide about this drug? 1 Cease taking any medication that contains vitamin D. 2 Keep the doxorubicin in a dark place protected from light. 3 Expect urine to turn red for a few days after taking this drug. 4 Take the doxorubicin on an empty stomach with large amounts of fluids.
3. Expect urine to turn red for a few days after taking this drug. Doxorubicin causes the urine to turn red for a few days; the client should be informed of this expectation so as not to become alarmed when it occurs. Discontinuing the intake of vitamin D is true for plicamycin, not the drugs in this protocol. It is unnecessary to keep doxorubicin in a dark area, protected from light. Doxorubicin is not given orally, only via the intravenous route.`
A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone. What should the nurse monitor the client for? 1 Bruising 2 Tachycardia 3 Hyperkalemia 4 Hypoglycemia
3. Hyperkalemia Spironolactone is a potassium-sparing diuretic that is used to treat clients with ascites; therefore the nurse should monitor the client for signs and symptoms of hyperkalemia. Bruising and purpura are associated with cirrhosis, not with the administration of spironolactone. Spironolactone does not cause tachycardia. Spironolactone does not cause hypoglycemia.
A client with cancer develops pancytopenia during the course of chemotherapy. The client asks the nurse why this has occurred. What explanation will the nurse provide? 1 Steroid hormones have a depressant effect on the spleen and bone marrow. 2 Lymph node activity is depressed by radiation therapy used before chemotherapy. 3 Noncancerous cells also are susceptible to the effects of chemotherapeutic drugs. 4 Dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration.
3. Noncancerous cells also are susceptible to the effects of chemotherapeutic drugs. Chemotherapy destroys erythrocytes, white blood cells, and platelets indiscriminately along with the neoplastic cells because these are all rapidly dividing cells that are vulnerable to the effects of chemotherapy. Stating that steroid hormones have a depressant effect on the spleen and bone marrow is not a true description of the side effects of steroids. Depressed lymph node activity as a result of radiation therapy used before chemotherapy is not the cause for fewer erythrocytes, white blood cells, and platelets. Although it is true that dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration, this does not explain pancytopenia.
A child with Wilms tumor is undergoing chemotherapy in a protocol that includes vincristine and doxorubicin hydrochloride. Which common side effect unique to doxorubicin will the nurse expect to observe in the child? 1 Hair loss 2 Vomiting 3 Red urine 4 Stomatitis
3. Red urine Red urine is a common side effect of doxorubicin administration. The drug is not metabolized and is excreted in the urine. The genitourinary responses to vincristine are nocturia, oliguria, urine retention, and gonadal suppression. Hair loss, vomiting, and stomatitis occur with both medications.
Which intervention would reduce the risk of perinatal transmission via vaginal birth in an adolescent who is diagnosed with HIV infection? 1 Using forceps during delivery 2 Using a fetal scalp electrode during delivery 3 Using antiretroviral during the intrapartum period 4 Administering zidovudine an hour before labor
3. Using antiretroviral during the intrapartum period. In the intrapartum period, antiretroviral therapy is recommended to prevent transmission of HIV. Therefore the risk of perinatal transmission may be reduced in an adolescent who receives antiretroviral therapy in the intrapartum period. Use of forceps or fetal scalp electrode during delivery may result in inoculation of the virus into the fetus; therefore, this should be avoided. Intravenous zidovudine should be given during labor, not an hour before it, if the adolescent is having a vaginal birth.
Allopurinol is prescribed for a 6-year-old child undergoing chemotherapy for cancer of the bone. When given the medication, the child asks, "Why do I have to take this pill?" What is the best response by the nurse? 1 "It protects your body from getting new problems after your treatment is over." 2 "It stops your sick white cells from going to other parts of your body." 3 "You know the healthcare provider wouldn't prescribe anything for you unless it was very important." 4 "With the other medicines, it helps you get rid of the things that are making you sick."
4. "With the other medicines, it helps you get rid of the things that are making you sick." Telling the child it helps get rid of the things making the child sick is the most accurate and age-appropriate response to the child's question. Telling the child that the medicine protects the body from new problems is inaccurate, and not being truthful will interfere with the development of the child's trust in the nurse. Telling the child that it stops sick white cells from spreading is inaccurate and may instill more fear. Telling the child that it is needed because the healthcare provider says so is insensitive to the question and does not provide an explanation.
A client with small-cell lung cancer is receiving chemotherapy. A complete blood count is prescribed before each round of chemotherapy. Which component of the complete blood count is of greatest concern to the nurse? 1 Platelets 2 Hematocrit 3 Red blood cells (RBCs) 4 White blood cells (WBCs)
4. WBCs Antineoplastic drugs depress bone marrow, which causes leukopenia; the client must be protected from infection, which can be life threatening. RBCs diminish slowly and can be replaced with a transfusion of packed red blood cells. Platelets decrease as rapidly as WBCs, but complications can be limited with infusions of platelets.
The nurse is caring for a client undergoing chemotherapy for cancer treatment. The client's laboratory results indicate bone marrow suppression. What will the nurse encourage the client to do? 1 Use an electric razor when shaving 2 Drink citrus juices frequently for nourishment 3 Increase activity level by ambulating frequently 4 Sleep with the head of the bed slightly elevated
`1. use an electric razor when shaving. Suppression of bone marrow increases bleeding susceptibility associated with decreased platelets. Drinking citrus juices frequently for nourishment does not offer an advantage. The client receiving chemotherapy because of the side effects of stomatitis should avoid citrus juices. With bone marrow suppression there is a decrease in red blood cells to meet cellular oxygen needs; rest should be encouraged, if needed. Sleeping with the head of the bed slightly elevated does not offer any specific advantage; the client should sleep in the position of comfort.
A client receiving combination chemotherapy for treatment of metastatic carcinoma asks the nurse in the clinic why more than one type of drug is necessary. Which concept is most important to teach the client in relation to why drug cocktails are more effective than a single drug in cancer therapy? 1 Drug resistance 2 Tumor doubling time 3 Cellular growth cycle 4 Retained radioactive particles
`3. Cellular growth cycle Different drugs destroy cells at different stages of their replication; rapidly dividing cells not destroyed by one drug may be destroyed by another drug during a different stage of cell replication. Although certain tumors are drug resistant, it is not the reason for multiple chemotherapeutic drugs; drug-resistant tumors may be treated with surgery, radiation therapy, or other methods. Doubling time of the tumor is a factor that influences the length of time chemotherapy will be given, but it is not the reason multiple drugs are given. Retained radioactive particles can occur with internal radiation therapy, not chemotherapy.