Pharm final- cancer and modifiers
Which type of interferon is considered in the treatment of multiple sclerosis? 1 Interferon alpha-2b (Intron A) 2 Interferon beta-1b (Betaseron) 3 Interferon alpha-2a (Roferon-A) 4 Interferon gamma-1b (Actimmune)
2 Interferon beta-1b (Betaseron) is considered for the treatment of multiple sclerosis. Interferon alpha-2b (Intron A) and interferon alpha-2a (Roferon-A) are considered for the treatment of hairy cell leukemia. Interferon gamma-1b (Actimmune) is considered for the treatment of chronic granulomatous disease.
What is the laboratory maintenance goal for the neutropenic patient with HIV receiving treatment with filgrastim? 1 ALC 1000 μl 2 WBC 5000 μl 3 AEC 350 4 ANC 2,000-10,000/mm3
4 An ANC of 2,000-10,000/mm3 is the laboratory maintenance treatment goal for the neutropenic patient with HIV receiving treatment with filgrastim. The ALC 1000 μl, WBC 5000 μl, and AEC 350 values are insignificant.
The patient has been ordered treatment with alemtuzumab (Campath). The nurse recognizes that this medication is most often used to treat which cancers? 1 Chronic lymphocytic leukemia 2 Mantle cell lymphoma and multiple myeloma 3 Colorectal cancer and head and neck cancers 4 Hepatocellular cancer and advanced renal cell carcinoma
1 Alemtuzumab (Campath) is approved to treat chronic lymphocytic leukemia. It is not approved to treat the other conditions listed.
What does the suffix "umab" signify? 1 The drug is composed of only human proteins. 2 The drug is composed of only murine proteins. 3 The drug contains less than 5% murine proteins. 4 The drug contains more than 60% human proteins
1 A drug with the suffix "umab" indicates that it is composed only of human proteins. Murine, or mouse antibodies, have a very short half-life in the human body. The suffix "momab" indicates that the drug is made of only murine proteins. Drugs that contain less than 5% murine proteins bear the suffix "zumab." They are humanized monoclonal antibodies containing both human and gene mouse sequences. These drugs contain 95% or more human proteins. Drugs with the suffix "imab" contain more than 60% human proteins and approximately 30% murine proteins.
A patient is administered aldesleukin (Proleukin) therapy for metastatic renal cell carcinoma. After administering this drug, the nurse finds that the patient's blood pressure is dropping rapidly. What could be the most likely cause for this? 1 The patient is on antihypertensive drugs. 2 The patient has capillary leak syndrome. 3 The patient has an anaphylactic reaction. 4 The patient is on another immunomodulator drug.
1 Aldesleukin (Proleukin), when administered with other antihypertensive drugs, is most likely to produce additive hypotensive effects. In this situation, the nurse should check if the patient is on any antihypertensive drugs. Unlike tocilizumab (Actemra), aldesleukin does not interact with other immunomodulator drugs. Capillary leak syndrome is an adverse effect of aldesleukin (Proleukin) in which the capillaries become leaky. This does not cause hypotension. Anaphylactic reaction is not associated with aldesleukin (Proleukin). It is an adverse effect of tocilizumab (Actemra).
Which prescription is effective for a patient with advanced metastatic non-small cell lung cancer? 1 Gefitinib (Iressa) 2 Cetuximab (Erbitux) 3 Bortezomib (Velcade) 4 Panitumumab (Vectibix
1 Gefitinib (Iressa) selectively inhibits the activation of the epidermal growth factor receptor tyrosine kinase. Therefore it is used in the management of advanced metastatic non-small cell lung cancer. Cetuximab (Erbitux) is used for the management of colorectal and head and neck cancers. Panitumumab (Vectibix) is a fully-humanized monoclonal antibody that is used in the management of advanced metastatic colorectal carcinoma. Bortezomib (Velcade) is a proteasome inhibitor used to manage mantle-cell lymphoma and multiple myeloma.
The nurse is caring for a patient who has been ordered a treatment regimen for colorectal cancer. The nurse brings the consent form to the patient to sign prior to initiating the treatment, and the patient tells the nurse, "I really don't understand why I can't be treated with vitamins and nutritional therapy." What is the nurse's correct intervention? 1 Contact the health care provider 2 Encourage the patient to sign the consent form 3 Schedule an instructional session with the dietician 4 Discuss the treatment regimen with the pharmacist
1 The health care provider should be contacted because the patient cannot sign the informed consent form for treatment. It is the health care provider's responsibility, not the pharmacist's or the dietician's, to make certain that the patient understands the reason for treatment. The nurse should not encourage the patient to sign the consent form when the patient does not understand the reason for treatment.
What medication does the nurse anticipate will be prescribed for the patient with osteoporosis to protect the patient's immune response? 1 Interferon gamma (IFNγ) 2 Interleukin (IL-2) 3 Interferon beta (IFN-β) 4 Colony-stimulating factors (CSFs)
1 The nurse can expect IFNγ to be prescribed for the patient with osteoporosis. IFNγ helps protect the patient's immune response. IL-2 increases the growth and activity of other T-cells and B-cells. IFN-β is used in the treatment of patients with relapsing-remitting forms of multiple sclerosis. CSFs are used to stimulate or regulate the growth maturation and differentiation of bone marrow stem cells.
The nurse is assessing a patient who has colon cancer and is prescribed bevacizumab (Avastin). A month after the therapy, the nurse finds swelling in the patient's lower extremities, and the patient also experiences dyspnea. What can the nurse conclude from this data? 1 The patient has developed deep vein thrombosis. 2 The patient has consumed alcohol during therapy. 3 The patient is experiencing symptoms of cardiotoxicity. 4 The side effects are likely to disappear after subsequent infusions
1 The presence of swelling in the lower extremities and dyspnea indicate deep vein thrombosis, which is a side effect of Bevacizumab (Avastin). Chest pain and dyspnea are signs of cardiotoxicity. The use of alcohol does not cause swelling in the lower extremities. Instead, it interferes with absorption of the drug and alters its therapeutic effects. Deep vein thrombosis is not an infusion reaction; it is a side effect of the drug.
Which assessment finding indicates a need to obtain a change of drug prescription? 1 A cancer patient is prescribed gefitinib (Iressa) along with warfarin (Coumadin). 2 A cancer patient is prescribed temsirolimus (Torisel) and diphenhydramine (Benadryl). 3 A patient is prescribed panitumumab (Vectibex) for advanced metastatic colorectal carcinoma. 4 A patient is prescribed intravenous alemtuzumab (Campath) for chronic lymphocytic leukemia (CLL)
1 The use of warfarin (Coumadin) with gefitinib (Iressa) increases the risk for bleeding in cancer patients. Therefore the nurse needs to report this finding to the primary health care provider immediately. Panitumumab (Vectibex) is used in the management of tumors that express or overexpress epidermal growth factor receptor, such as advanced metastatic colorectal carcinoma. Diphenhydramine (Benadryl) does not interact with temsirolimus (Torisel). Instead, diphenhydramine (Benadryl) helps to prevent temsirolimus (Torisel) infusion reactions in cancer patients. Alemtuzumab (Campath) is effective in the destruction of malignant cells. Therefore it is used in the management of CLL.
A patient is admitted with early-stage breast cancer. Following the instruction of the oncologist, the nurse administers trastuzumab (Herceptin) to the patient. The patient experiences severe adverse effects after the administration of the drug. What is a possible reason for such symptoms? 1 The patient had ventricular dysfunction. 2 The patient had signs of latent tuberculosis. 3 The patient had undergone organ transplantation. 4 The patient had signs of herpes zoster reactivation.
1 Trastuzumab (Herceptin) is used in the treatment of breast cancer. It carries a Food and Drug Administration (FDA) black box warning that it should not be used in patients with abnormal ventricular dysfunction or severe heart failure. It can lead to serious complications in these patients. Infliximab (Remicade), which is indicated for ankylosing spondylitis and Crohn disease, carries an FDA black box warning to test for latent tuberculosis before administration. Aldesleukin (Proleukin) is used in the treatment of metastatic renal cell carcinoma. It is contraindicated in organ transplants because it may cause organ rejection. Herpes zoster reactivation is the adverse effect of tocilizumab (Actemra), used in the treatment of severe rheumatoid arthritis.
Which side effect(s) can be seen in a patient who is taking gefitinib (Iressa)? Select all that apply. 1 Rash 2 Diarrhea 3 Anorexia 4 Weight gain 5 Cardiotoxicity
1,2,3 Gefitinib (Iressa) may cause rash due to toxicity. Diarrhea is also a common side effect that occurs due to the drug action. Anorexia may occur if the patient has severe electrolyte imbalances. The patient is at a higher risk for weight loss due to electrolyte imbalances. Cardiotoxicity is not a side effect of gefitinib (Iressa). Cardiotoxicity may occur if the patient is taking anthracyclines and cyclophosphamide along with gefitinib (Iressa).
The nurse is caring for a patient who is prescribed imatinib mesylate (Gleevec) for leukemia. What should the nurse teach the patient? Select all that apply. 1 "You can take the drug with water and a meal." 2 "You must avoid breastfeeding while on therapy." 3 "You can dissolve the drug in water or apple juice." 4 "You should take the medication with grapefruit juice." 5 "You should begin taking St. John's wort during therapy.
123 The nurse should inform relevant patients that imatinib mesylate (Gleevec) can pass through breast milk. Therefore the patient should stop breastfeeding during therapy, and for a period of 60 days after therapy. The patient can dissolve the drug in water or apple juice to reduce gastric irritation. It can also be taken with meals and a large glass of water because its absorption is fast and is not affected by mealtimes. The nurse should instruct the patient not to take St. John's wort during therapy because it decreases the drug's blood levels and reduces its effectiveness. Additionally, the patient is also instructed not to drink grapefruit juice during therapy because it increases drug concentration in the plasma and increases side effects.
Which intervention(s) does the nurse implement for a patient who starts sorafenib (Nexavar) therapy for the treatment of pancreatic cancer? Select all that apply. 1 Monitors for electrolyte imbalances 2 Monitors the patient's blood pressure 3 Administers the prescribed dose with food 4 Monitors the hands and feet for redness or swelling 5 Instructs the patient to decreases fats in the diet to prevent weight gain
124 The use of sorafenib (Nexavar) causes side effects, such as nausea and vomiting, which may result in weight loss. Therefore the nurse should monitor for electrolyte imbalances. Redness or swelling in the hands and feet indicate palmar-plantar erythrodysesthesia, which requires prompt treatment. Sorafenib (Nexavar) is likely to cause hypertension during the first six weeks of therapy, so the nurse should monitor the patient's blood pressure. Weight gain is not a side effect of sorafenib (Nexavar), so it is not necessary for the patient to decrease dietary fats. The nurse administers sorafenib (Nexavar) 1 or 2 hours before meals to prevent gastric problems.
Which side effect(s) of sunitinib (Sutent) may be seen in a patient with gastrointestinal stromal tumor? Select all that apply. 1 Dyspepsia 2 Constipation 3 Hypertension 4 Hyperthyroidism 5 Liver impairment
135 The use of sunitinib (Sutent) causes cardiovascular side effects such as hypertension due to the inhibition of kinases. Dyspepsia is a gastrointestinal side effect of sunitinib (Sutent). Liver impairment may occur due to elevated liver enzyme levels. The use of sunitinib (Sutent) will cause diarrhea, not constipation. Sunitinib (Sutent) also causes endocrinal changes, such as hypothyroidism, due to the inhibition of kinases.
The nurse is required to start cetuximab (Erbitux) therapy for a patient with colorectal cancer. What care should the nurse take while administering the drug for the first time? Select all that apply. 1 Administer with a low-protein binding 0.22-micron filter 2 Shake the vial thoroughly before administering the drug 3 Administer the drug as an IV infusion every alternate week 4 Administer the drug via IV infusion with an infusion controller 5 Premedicate the patient with intravenous (IV) diphenhydramine
145 The nurse should premedicate the patient with an H1 antagonist, such as diphenhydramine 50 mg IV, 30 to 60 minutes before the first dose to reduce the risk of transfusion reactions. The drug should be administered as an IV infusion with an infusion controller, and never as a bolus or IV push. The nurse must monitor the rate of infusion to prevent transfusion reactions and to reduce the risk of toxicity. The drug should be administered with a low-protein binding 0.22-micron filter. This helps to minimize the loss of protein-bound molecules in the tubing and the filter. The vial should not be shaken, and its contents should not be diluted. The medication is protein bound, and shaking vigorously could disrupt the molecules and the chemical configuration of the infusion, decreasing its potential effectiveness. There is no need for dilution, because the medication is ready for administration and the rate of infusion is controlled by the infusion controller. The patient continues to receive an IV infusion of the drug every week, not every alternate week, after the initial dose.
A patient who is receiving chemotherapy reports severe fatigue. The patient's hemoglobin levels are found to be 7.4 g/dL. The primary health care provider prescribes epoetin alfa (Epogen) along with ferrous fumarate (Femiron). After 5 weeks of therapy, the patient's hemoglobin levels are found to be 11.5 g/dL. What will the nurse expect the provider to order? 1 Continuing both drugs 2 Discontinuing both the drugs 3 Discontinuing epoetin alfa (Epogen) 4 Discontinuing ferrous fumarate (Femiron)
2 Administering both the drugs to a patient who has a hemoglobin level of 11.5 g/dL may result in serious adverse effects. Patients who have anemia caused by nuclear maturation defects should not be administered epoetin alfa (Epogen). Continuing the administration of both the drugs may lead to increased blood viscosity. This can cause further complications such as myocardial infarction and stroke. Administration of ferrous fumarate (Femiron) should be stopped if the patient is suffering from anemia other than iron deficiency.
A patient is prescribed aldesleukin (Proleukin) for the treatment of metastatic melanoma. The nurse observes that the albumin and protein levels in the patient's serum increased in a week. What is a possible reason for such an event? 1 Hypertension 2 Capillary leak syndrome 3 Bone marrow suppression 4 Reactions at the site of injection
2 Aldesleukin (Proleukin) administration causes capillary leak syndrome. The capillaries lose integrity and therefore lose water but not albumin or proteins. Due to volume loss, albumin and protein will be more concentrated. These substances migrate to surrounding tissues, resulting in massive fluid retention. This is called capillary leak syndrome. Hypertension is the main adverse effect of certolizumab (Cimzia). It is used in the treatment of Crohn disease. Bone marrow suppression is the main adverse effect of methotrexate (Trexall). It is an anticancer drug used in the treatment of rheumatoid arthritis. Injection site reactions are the main adverse effect of anakinra (Kineret). It is used to control the symptoms of rheumatoid arthritis.
Which oral immunosuppressant drug is classified as an mTOR kinase inhibitor? 1 Tacrolimus (Prograf) 2 Sirolimus (Rapamune) 3 Azathioprine (Imuran) 4 Mycophenolate mofetil (CellCept)
2 Sirolimus (Rapamune) is an oral immunosuppressant whose mechanism of action works by inhibiting the enzyme mammalian target of mTOR kinase in humans. Tacrolimus (Prograf) is classified as a calcineurin inhibitor. Both azathioprine (Imuran) and mycophenolate mofetil (CellCept) block T cell proliferation.
The registered nurse is teaching a nursing student about the use of colony-stimulating factors (CSFs) in the treatment of cancer. Which properties of CSFs does the nursing student infer to be the reason behind their use in cancer treatment? Select all that apply. 1 "They increase the length of posttreatment neutropenia." 2 "They enhance the delivery of higher dosages of any kind of drug." 3 "They enhance macrophage or granulocyte tumor-destroying ability." 4 "They enhance thrombocytopenia after myelosuppressive chemotherapy." 5 "They reduce bone marrow recovery time after bone marrow transplantation.
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What are the adverse reactions of erythropoietin (Epogen)? Select all that apply. 1 Rigors 2 Seizures 3 Neutropenia 4 Hemorrhage 5 Myocardial infarction
25 Seizures and myocardial infarction are the adverse reactions of erythropoietin (Epogen). Rigors and hemorrhage are the adverse reactions of sargramostim (Leukine). Neutropenia is an adverse reaction of filgrastim (Neupogen).
A patient is prescribed temsirolimus (Torisel) for treatment of breast cancer. Which teaching is a priority for this patient? 1 "Take this medication only in the morning." 2 "Take this medication with a full glass of water." 3 "Do not take this medication with grapefruit juice." 4 "Take metoclopramide (Reglan) with each dose of this medication."
3 All targeted therapy drugs for cancer should not be taken with grapefruit juice, because this may increase blood levels of the drugs and increase the risk of side effects. The medication should be taken with water. The medication does not need to be taken with metoclopramide; however, premedication with an antihistamine is required.
The formation of erythrocytes and maturation of the red blood cell (RBC) is driven by what hormone? 1 Progesterone 2 Testosterone 3 Erythropoietin 4 Free thyroxine
3 Erythropoiesis is the process of erythrocyte formation, and this involves the maturation of a nucleated RBC precursor into a hemoglobin-filled, nucleus-free erythrocyte. This process is driven by the hormone erythropoietin, which is produced by the kidneys. Erythropoietin is also produced commercially and is used to treat anemia in certain specific circumstances.
Which condition in a cancer patient would require a need to cancel an ibritumomab tiuxetan (Zevalin) prescription? 1 Weight gain 2 Abdominal pain 3 Active bacterial infection 4 Severe rheumatoid arthritis
3 Ibritumomab tiuxetan (Zevalin) causes bone marrow suppression, which will worsen the patient's bacterial infection. Therefore the primary health care provider is likely to start the ibritumomab tiuxetan (Zevalin) therapy after treating the bacterial infection. Severe rheumatoid arthritis is not a contraindication for the use of this drug. In fact, ibritumomab tiuxetan (Zevalin) can also be used in the treatment of rheumatoid arthritis. Weight gain is not a contraindication for the use of this drug. Abdominal pain is a side effect of ibritumomab tiuxetan (Zevalin) and can be treated with medications.
A patient had a history of pericardial effusions and had autologous bone marrow transplantation. Which drug should be used with caution for this patient? 1 Palifermin (Kepivance) 2 Filgrastim (Neupogen) 3 Sargramostim (Leukine) 4 Pegfilgrastim (Neulasta)
3 Sargramostim (Leukine) should be used with caution for patients who had a history of pericardial effusion, because this drug increases fluid retention. Palifermin (Kepivance) decreases the incidence of infections in patients that are receiving myelotoxic therapy. Filgrastim (Neupogen) and pegfilgrastim (Neulasta) decrease the incidence of infections caused by myelosuppressive chemotherapeutic agents used during chemotherapy.
The nurse finds that a patient who is taking sunitinib (Sutent) for a gastrointestinal stromal tumor has developed jaundice of the skin and sclera. Which patient assessment is a priority in this case? 1 Thyroid test 2 Blood pressure 3 Liver enzyme test 4 The patient's weight
3 The development of jaundice indicates liver impairment. Therefore the nurse should assess the patient's liver enzyme test results to confirm liver disease. Jaundice of the skin and sclera are not symptoms of thyroid disease or of hypertension. Therefore the nurse is not likely to evaluate thyroid test results or check the patient's blood pressure. The patient does not have any fluid imbalances, so it is not necessary to assess the patient's weight.
A patient diagnosed with multiple sclerosis is admitted to the unit for relapsing-remitting symptoms. Which initial medication order does the nurse anticipate to administer? 1 Interferon alfa-2b IV induction 20 million units/m2 2 Interferon gamma subcut: 50 mcg/m2 three times/week 3 Interferon beta-1b subcut: 250 mcg every other day 4 Interferon alfa-2b subcut: 30 million units/m2 three times/week
3 The initial medication order the nurse will administer would be a 250-mcg subcutaneous dose of interferon beta-1b every other day. Intravenous interferon alfa-2b induction is used to treat hairy cell leukemia, adjuvant to surgical resection of malignant melanoma as well as other viral conditions. Interferon gamma is used to treat chronic granulomatous disease. The 30 million units of subcutaneous interferon alfa-2b is the dosage used to treat Kaposi sarcoma.
What is the major advantage of administering colony-stimulating factors (CSFs) to a patient who requires higher doses of chemotherapy? 1 Prevention of thrombocytopenia 2 Enhanced macrophage-destroying abilities 3 Minimized myelosuppressive toxicity 4 Decreased length of posttreatment neutropenia
3 The major advantage of administering CSFs to a patient who requires higher doses of chemotherapy is that it minimizes myelosuppressive toxicity, thus allowing the delivery of higher doses of chemotherapy. CSFs are administered to prevent thrombocytopenia, enhance macrophage-destroying abilities, and decrease the length of post treatment neutropenia, but these benefits are not as relevant to the chemotherapy dosage.
What is the most important nutritional information to provide for the patient receiving epoetin alfa? 1 Decrease intake of sodium 2 Increase intake of calcium 3 Increase intake of foods high in iron 4 Increase intake of foods high in potassium
3 The most important nutritional information to provide for the patient taking epoetin alfa is to increase the intake of foods high in iron. Inadequate iron stores interfere with the therapeutic response to epoetin alfa. Although the patient's iron stores will be monitored and most patients will need supplemental iron, providing nutritional counseling regarding increased dietary intake of iron is a preventative measure. Changes in sodium, calcium, and potassium intake are less relevant to epoetin alfa treatment.
Which drugs can cause cardiotoxicity in a patient when administered in conjunction with trastuzumab (Herceptin) for cancer treatment? Select all that apply. 1 Antacids 2 Antibacterial 3 Anthracyclines 4 Antihistamines 5 Cyclophosphamide
3,5 Anthracyclines and cyclophosphamide can increase the severity of cardiac dysfunction if administered with rastuzumab (Herceptin). The use of antihistamines does not cause cardiotoxicity when given with trastuzumab (Herceptin). In fact, antihistamines will help to prevent trastuzumab (Herceptin) infusion reactions. Antacids and antibacterial drugs do not interact with rastuzumab (Herceptin).
A patient with cancer has been prescribed a prototype drug, epoetin alpha (Erythropoietin), to prevent anemia after chemotherapy. What life-threatening reaction does the nurse anticipate after reviewing the prescription? Select all that apply. 1 The patient may have seizures. 2 The patient may have thrombocytopenia. 3 The patient may have myocardial infarction. 4 The patient may have thromboembolic disease. 5 The patient may suffer from gastrointestinal (GI) hemorrhage
34 The most life-threatening adverse reactions for a patient who has been prescribed epoetin alpha (Erythropoietin) are myocardial infarction and thromboembolic disease in extreme cases for a patient with hypertension. Seizures are a common adverse reaction during the administration of epoetin alpha (Erythropoietin), but these seizures are not fatal. Thrombocytopenia is a life-threatening reaction of filgrastim (Neupogen) and pegfilgrastim (Neulasta). A common adverse reaction of the prototype drug sargramostim (Leukine) comprises GI hemorrhage.
A nurse observes hypotension in a patient who is receiving treatment for renal carcinoma. Which medication does the nurse suspect to have caused hypotension? 1 Filgrastim (Neupogen) 2 Palifermin (Kepivance) 3 Oprelvekin (Neumega) 4 Aldesleukin (Proleukin)
4 Aldesleukin (Proleukin) is used to treat renal carcinoma, and hypotension is a side effect of this drug. Filgrastim (Neupogen) is used to decrease the incidence of infection in patients receiving myelosuppressive cancer chemotherapy; anorexia is one of the side effects of this drug. Palifermin (Kepivance) is used in the treatment of hematologic malignancy; oral toxicities are one of the side effects of this drug. Oprelvekin (Neumega) is used to prevent recurrent severe chemotherapy-induced thrombocytopenia; exertional dyspnea is one of the side effects of this drug.
The nurse is caring for a patient who is prescribed epoetin alfa (Epogen). What does the nurse expect as the reason for use of this medication in this patient? 1 To replace blood loss from surgery 2 To replace blood loss from a trauma 3 Treatment of pregnancy-associated anemia 4 Used for an anemic patient with renal failure
4 Epoetin alfa (Epogen) is the synthetic form of erythropoietin and is a hormone produced by the kidneys. The patient in renal failure does not have typical kidney function and therefore may have this medication prescribed to treat anemia associated with the lack of natural production of the hormone.
The patient is prescribed erlotinib (Tarceva). The nurse recognizes that this medication is most frequently used to treat which cancer? 1 Colorectal cancer 2 Hepatocellular cancer 3 Metastatic breast cancer 4 Non-small cell lung cancer
4 Erlotinib (Tarceva) is used to treat non-small cell lung cancer as well as pancreatic cancer. It is not used to treat breast cancer, hepatocellular cancer, or colorectal cancer.
A patient with renal failure is prescribed darbepoetin (Aranesp) to increase the red blood cell count. What other drug will the nurse expect to be prescribed along with the darbepoetin (Aranesp)? 1 Folic acid (Folvite) 2 Ascorbic acid (Ascot) 3 Calcium-based antacids 4 Ferrous fumarate (Feostat)
4 Ferrous fumarate (Feostat) is an iron salt involved in the maturation of erythrocytes. Darbepoetin (Aranesp) acts by stimulating the progenitor cells that produce the immature erythrocytes. Folic acid (Folvite) is a vitamin B complex used in the treatment of anemia caused by folic acid deficiency. Ascorbic acid (Ascot) is used to increase the absorption of iron in patients with iron deficiency. Calcium-based antacids increase the risks in patients with renal failure and are avoided.
The nurse would question the order for epoetin in a patient with which condition? 1 Anemia 2 HIV/AIDS 3 Chronic renal failure 4 Uncontrolled hypertension
4 Hypertension is a side effect of epoetin; hence the drug should not be given to patients with uncontrolled hypertension. Anemia, chronic renal failure, and zidovudine (Retrovir) (AZT) treatment for HIV/AIDS are indications for the therapeutic use of epoetin.
The nurse is caring for a patient who is administered an epidermal growth factor for the treatment of cancer. Why does the nurse teach the patient to report the presence of foaming urine? 1 It indicates the presence of blood. 2 It indicates the presence of glucose. 3 It indicates the presence of ketones. 4 It indicates the presence of proteins.
4 The nurse teaches the patient to report the presence of foaming urine, which is an indication of proteins in the urine. The presence of proteins is concerning, because it is essential for proteins to be processed by the body in order for the body to achieve the therapeutic effects of epidermal growth factor. Blood may be found in the urine as a result of strenuous exercise, medication, or injury to the urinary system. Glucose may be found in the urine of people with uncontrolled diabetes or kidney injury. Ketones may be found in the urine of people with poorly controlled diabetes, or those who are suffering from starvation, alcoholism, or metabolic disorders. Blood, ketones, glucose, and proteins are not normally found in the urine and would require further investigation.
The nurse is caring for a patient receiving bevacizumab (Avastin) for breast cancer. Which assessment finding would be a cause for concern? 1 History of anxiety 2 History of depression 3 History of constipation 4 History of esophageal varices
4 The nurse would be concerned if the patient has a history of esophageal varices. Bevacizumab (Avastin) is associated with gastrointestinal perforation, bleeding, and hemorrhage. The patient with esophageal varices will have weakened esophagus walls, which increases the risk for perforation and/or hemorrhage. The patient must be monitored for signs of bleeding. A history of depression or anxiety is not a contraindication to this medication. Depression and anxiety are not noted as side effects. Although constipation is a side effect for narcotics, it is not a known side effect of this medication.
A patient receiving intravenous (IV) aldesleukin begins to complain of chest pain and appears dyspneic. Included in the nurse's further assessment findings are a blood pressure of 85/30, heart rate of 144 bpm, muffled heart sounds, and distended neck veins. The electrocardiogram (ECG) shows a low-voltage QRS complex. What complication does the nurse suspect? 1 Narrowed pulse pressure 2 Pulmonary emboli 3 Myocardial Infarction 4 Cardiac tamponade
4 The patient receiving aldesleukin who is hypotensive, tachycardic, has muffled heart sounds, distended neck veins, and an ECG change in the QRS complex is displaying signs and symptoms of cardiac tamponade, a medical emergency. The aldesleukin must be discontinued immediately and will be permanently contraindicated for the patient. A narrowed pulse pressure is a symptom of different medical conditions. The symptoms for a pulmonary emboli are dyspnea, tachycardia, and sudden sharp chest pain that worsens with deep breathing or coughing. Symptoms of a myocardial infarction include pressure or tightness in the chest; pain in the chest, back, or jaw; diaphoresis; nausea; and vomiting. ECG changes may include ST elevation, T-wave inversion, and a pathological Q wave.
Why is it important that the patient receiving treatment with epoetin (EPO) have adequate iron stores? 1 Inadequate iron stores interfere with white blood cell (WBC) production. 2 Inadequate iron stores potentiate adverse effects of EPO. 3 EPO use is contraindicated for a patient with inadequate iron stores. 4 Inadequate iron stores interfere with EPO's therapeutic response.
4 The patient receiving treatment with epoetin (EPO) must have adequate iron stores because inadequate iron stores interfere with EPO's therapeutic response. EPO agents stimulate RBC production; they do not interfere with WBC production. Inadequate iron stores do not potentiate adverse effects of EPO. EPO is not contraindicated for a patient with inadequate iron stores. The patient's iron will be monitored, and supplemental iron will be administered as needed.
A patient arrives at the emergency department with angioedema of the face. The nurse finds that the patient has renal cell carcinoma and has been prescribed temsirolimus (Torisel). Which is the most important thing the nurse should assess for in this case? 1 Use of a live vaccine 2 Use of sunitinib (Sutent) 3 Use of oral antidiabetic agents 4 Use of antihypertensive drugs
4 The use of antihypertensive drugs during temsirolimus (Torisel) therapy may cause angioedema of the face. Therefore the nurse needs to obtain the patient's history regarding the use of antihypertensive drugs. Oral antidiabetic drugs do not interfere with temsirolimus (Torisel). Sunitinib (Sutent) is a multikinase inhibitor and is not prescribed for renal cell carcinoma. Therefore the nurse is not likely to assess for the use of that drug. Temsirolimus (Torisel) reduces the effects of live vaccines. However, it is not a priority in this case, because vaccines do not cause angioedema.
Which nursing action is a priority when a patient is taking dasatinib (Sprycel) for chronic myelogenous leukemia (CML)? 1 Monitor drug serum levels 2 Instruct the patient to decrease dietary iron 3 Ask the patient to take antacids with the medication 4 Instruct the patient to increase dietary phosphorous and calcium
4 The use of dasatinib (Sprycel) decreases phosphorous and calcium serum levels. Therefore the nurse should instruct the patient to increase calcium and phosphorous in the diet. Monitoring drug serum levels would be a priority if the patient was taking multiple drugs during therapy. The nurse is likely to instruct the patient to increase iron in the diet because dasatinib (Sprycel) may cause anemia. The nurse administers dasatinib (Sprycel) 2 hours before and 2 hours after each dose of antacid, not at the same time.
A patient who takes sorafenib (Nexavar) for pancreatic cancer shows little improvement. The nurse finds that the patient is eating low-fat meals and also has bronchial asthma. The nurse also finds that the patient has rheumatoid arthritis and has recently started on dexamethasone (Decadron) tablets. What can the nurse conclude from this data? 1 The patient is not taking both drugs at the same time. 2 The presence of multiple diseases is affecting drug absorption. 3 The consumption of low-fat meals inhibited the absorption of sorafenib (Nexavar). 4 The use of dexamethasone (Decadron) decreased the effectiveness of sorafenib (Nexavar).
4 The use of dexamethasone (Decadron) induces metabolizing enzyme activity and reduces blood levels of sorafenib (Nexavar). This decreases its effectiveness. The consumption of high-fat meals hinders the absorption of sorafenib (Nexavar). The use of dexamethasone (Decadron), not multiple diseases, is affecting drug absorption in this case. The use of dexamethasone (Decadron) is likely to reduce the effectiveness of the drug, whether the patient takes both drugs together or at different times.
Which enzyme is activated producing several interferon-stimulated enzymes when interferon binds to a cell surface receptor? 1 Cysteine 2 Cytokine 3 Interleukin 4 Tyrosine kinase
4 When interferon binds to a cell surface receptor, the tyrosine kinases are activated which produce several interferon-stimulated enzymes. Cysteine is the base of nucleic acids. Cytokines are a group of proteins secreted by specific cells that act as chemical messengers in an immune response. Interleukin is a group of cell-signaling molecule proteins produced by the leukocytes to help regulate immune responses.
Which laboratory values will be monitored for the patient receiving interferon alfa-2b? Select all that apply. 1 Alkaline phosphatase (ALP) 2 Lactate dehydrogenase (LDH) 3 Asparate aminotransferase (AST) 4 Creatinine 5 Uric acid
1,2,3 ALP, LDH, and AST will be monitored in a patient receiving interferon alfa-2b because alfa-2b has the potential to cause hepatotoxicity. Creatinine and uric acid are not directly reflective of liver function.
Which are filgrastim's modes of action? Select all that apply. 1 Enhances neutrophil migration 2 Enhances neutrophil cytotoxicity 3 Enhances granulocyte function 4 Increases maturation of neutrophils 5 Stimulates proliferation of myeloid cells
1,2,4 Enhancement of neutrophil migration, neutrophil cytotoxicity, and maturation of neutrophils are filgrastim's modes of action. Sargramostim enhances the function of granulocytes and stimulates the proliferation of myeloid cells.
What does interferon gamma (IFNγ) directly affect on a virus? Select all that apply. 1 Maturation 2 Inflammation 3 Transcription 4 Attachment 5 Penetration
1,3,4,5 IFNγ directly affects the virus's maturation, transcription, attachment, and penetration. IFNγ enhances recruitment of leukocytes to the sites of inflammation caused by the virus.
Which may be used as premedication to reduce the risk of infusion reactions with tositumomab? Select all that apply. 1 Antihistamines 2 Acetaminophen 3 Normal saline bolus 4 Albumin 5 Corticosteroids
12 To reduce the risk of infusion reactions with fever, nausea, chills, blood pressure changes, hyperglycemia, and hypoxia associated with tositumomab, the patient may be premedicated with antihistamines and acetaminophen. There are no indications for providing normal saline boluses, albumin, or corticosteroids to reduce the risk of an infusion reaction to tositumomab.
Which medications is the patient instructed to avoid while receiving aldesleukin therapy? Select all that apply. 1 Celecoxib 2 Cyclosporine 3 Atenolol 4 Nifedipine 5 Metoclopramide
1234 The patient receiving aldesleukin therapy is instructed to avoid atenolol, celecoxib, nifedipine, and cyclosporine. Aldesleukin is associated with kidney and liver toxicity, and other drugs known to cause such toxicity, like celecoxib and cyclosporine, can exacerbate the impairment caused by aldesleukin. Aldesleukin administered with antihypertensive medications like atenolol and nifedipine can worsen hypotension. Metoclopramide is an antiemetic that can be safely given to a patient on aldesleukin.
A registered nurse is teaching a student nurse about the conditions that require the dose of aldesleukin to be held. Which statement made by the student nurse indicates the need for further teaching? 1 "Hold the dose if the stool guaiac is greater than 3 to 4+." 2 "Hold the dose if the urine output is greater than 10 mL/h." 3 "Hold the dose if the serum creatinine is greater than 4.5 mg/dL." 4 "Hold the dose if the systolic blood pressure is lower than 90 mm Hg."
2 The dose of aldesleukin should be held when the urine output is 10 mL/h with rising serum creatinine. If the urine output is >10mL/h, a subsequent dose should be given. The dose should be held if the stool guaiac is repeatedly >3 to 4+. The dose should be held if the serum creatinine is >4.5 mg/dL.
The nurse is counseling a patient with a gastrointestinal stromal tumor who is taking imatinib mesylate (Gleevac). What does the nurse instruct this patient regarding the use of herbal preparations? 1 "The use of herbs in hot water is beneficial." 2 "Do not use St. John's wort during therapy." 3 "You can take herbal preparations in lower doses." 4 "The use of ginkgo biloba is considered safe during therapy."
2 The nurse instructs the patient to avoid the use of St. John's wort during therapy because the herb decreases drug serum levels and reduces the drug's effectiveness. The use of herbs in hot water may not be beneficial, because some herbs can have harmful effects on the patient. It is risky to instruct the patient to take a lower dose of herbal preparations, because the herbs may still have the potential to cause significant interactions. The use of ginkgo biloba is not safe, because it increases the patient's risk for bleeding.
Which side effects are likely to be found in a patient who is receiving filgrastim (Neupogen) for the treatment of chronic neutropenia? Select all that apply. 1 Pruritus 2 Alopecia 3 Anorexia 4 Arthralgia 5 Hypertension
2,3 Alopecia and anorexia are side effects found in patients receiving filgrastim (Neupogen) for the treatment of severe neutropenia. Pruritus is a side effect of palifermin (Kepivance). Arthralgia and hypertension are side effects of erythropoietin (Epogen).
What types of progenitor cellular proliferation do granulocytic-macrophage colony-stimulating factors (CSFs) promote? Select all that apply. 1 Monocyte 2 Erythroid 3 Megakaryocytic 4 Myelomonocytic 5 Hematopoietic stem cell
2,3,4 Granulocytic-macrophage CSFs promote erythroid, megakaryocytic, and myelomonocytic progenitor cellular proliferation. A monocyte is a white blood cell. A hematopoietic stem cell is a progenitor cell, but granulocytic-macrophage CSFs do not promote their proliferation.
A patient is receiving treatment for anemia, secondary to cancer therapy. Which situation should the nurse evaluate if the patient shows improper response to erythropoietin (Epogen) therapy? 1 Edema 2 Hyperkalemia 3 Iron deficiency 4 Shortness of breath
3 Erythropoietin (Epogen) is used in the treatment of anemia secondary to cancer therapy. Iron deficiency should be evaluated if a patient does not respond or maintain response to erythropoietin (Epogen). Edema, hyperkalemia, and shortness of breath are the adverse reactions of erythropoietin (Epogen). These situations are not related to improper response to erythropoietin (Epogen).
A patient is receiving filgrastim (Neupogen). Which assessment finding indicates that the medication has been effective? 1 Increase in red blood cells 2 Decrease in red blood cells 3 Increase in white blood cells 4 Decrease in white blood cells
3 Filgrastim (Neupogen) increases the production of white blood cells in the bone marrow. The desired patient outcome is that the patient will not contract an infection. The other assessments are not therapeutic effects of Neupogen.
A patient is receiving temsirolimus (Torisel) for renal cell carcinoma. After the initial infusion, the patient is prescribed oral antidiabetic agents. Which assessment finding could be a reason for this prescription? 1 Arthralgia 2 Neutropenia 3 Hyperglycemia 4 Hyperthyroidism
3 Hyperglycemia, or high blood sugar, is a side effect of temsirolimus (Torisel) that can be managed with the use of oral antidiabetic agents. Arthralgia refers to joint pain, which cannot be treated with antidiabetic drugs. Neutropenia is a granulocyte disorder that cannot be prevented with antidiabetic drugs. Hyperthyroidism indicates a need for thionamides, not antidiabetic drugs.
Which cells in the body produce type II interferon? Select all that apply. 1 Hepatocytes 2 Fibroblasts 3 Macrophages 4 Natural killer cells (NKCs) 5 Lymphokine-activated killer cells (LAKs
4 5 NKCs and LAKs produce type II interferon. Hepatocytes are the parenchymal cells in the liver that are involved with protein synthesis. Fibroblasts and macrophages produce type I interferons.
The nurse is assessing a patient who is taking bortezomib (Velcade) for mantle-cell lymphoma. The nurse finds from the patient's medical history that the patient had a high tumor burden at the start of therapy. What can the nurse conclude from this finding? 1 There will be a decrease in cancer cell apoptosis. 2 The patient will experience asthenia and low-grade fever. 3 There is little possibility of inhibition of cancer cell growth. 4 The patient is at risk for developing tumor lysis syndrome (TLS).
4 A high tumor burden at the beginning of therapy increases the patient's risk for TLS because bortezomib (Velcade) causes rapid killing of cancer cells. Bortezomib (Velcade) inhibits cancer cell growth, regardless of the tumor burden. There will be an increase in cancer cell apoptosis because bortezomib (Velcade) inhibits the activity of the 26S proteasome, which causes a decrease in cell proliferation. Asthenia and low-grade fever are common side effects of bortezomib (Velcade) and are not related to the tumor burden.
Which adverse effect is related to the conventional high-dose intravenous (IV) bolus of aldesleukin? 1 Hypoglycemia 2 Hypertension 3 Respiratory alkalosis 4 Capillary leak syndrome
4 Many of the adverse effects of conventional high-dose IV bolus aldesleukin are related to capillary leak syndrome. Capillary leak syndrome results from extravasation of plasma proteins and fluid into the extravascular space, which leads to vascular atony, decreasing blood flow to the organs, and eventually death from multiorgan dysfunction. Hyperglycemia, hypotension, and respiratory acidosis are side effects and adverse reactions that occur with the administration of aldesleukin.
A patient is taking trastuzumab (Herceptin) in conjunction with anthracyclines for breast cancer. The patient experiences side effects during the initial infusion. Which effects would the nurse need to report to the primary health care provider? Select all that apply. 1 Fever 2 Chills 3 Nausea 4 Chest pain 5 Shortness of breath
4,5 The use of trastuzumab (Herceptin) with anthracyclines is likely to cause cardiotoxicity. Therefore the nurse needs to report chest pain and shortness of breath because they may indicate cardiotoxicity. Nausea, fever, and chills may be seen during the initial infusion. These symptoms are common side effects, which typically do not recur after the initial infusion.
