Pharmacology exam 2 Paulino
When administering a medication known to be metabolized by the liver, the nurse should closely monitor for adverse drug reactions in which patient? 1 A 3-month-old infant 2 A 12-month-old infant 3 An 18-month-old toddler 4 A 13-year-old adolescent
1
Why are infants especially sensitive to drugs that affect central nervous system (CNS) function? 1 The blood-brain barrier is especially strong in infants. 2 The blood-brain barrier is not fully developed at birth. 3 The blood-brain barrier does not exist until 1 year of age. 4 The blood-brain barrier is weakened by the birth process.
2
Characteristics unique to each patient can influence pharmacokinetic and pharmacodynamic processes. What characteristics may determine the patient's response to a drug? Select all that apply. 1 Age 2 Mood 3 Weight 4 Gender 5 Genetics
1 3 4 5
How can the nurse enhance effective medication use in an older adult? Select all that apply. 1 Provide oral rather than written instruction. 2 Explain the purpose and importance of each drug. 3 Educate the patient about the side effects of each drug. 4 Develop a chart that includes the time to take each drug. 5 Encourage family members to monitor the patient's drug regimen
2 3 4 5
The nurse understands that which type of anticancer drugs can act during any phase of the cell cycle? 1 G 1 phase-specific 2 S phase-specific 3 Phase-nonspecific 4 M phase-nonspecific
3
The nurse considers whether to notify the provider about a drug that is ordered. Which property of the drug is the most compelling indication to hold the drug? 1 The drug's effects are reversible. 2 The drug is difficult to administer. 3 The drug produces an undesirable side effect. 4 The drug is not effective for its intended purpose.
4
Which factors alter drug distribution in older adults? Select all that apply. 1 Decreased bone density 2 Increased total body water 3 Decreased percentage of body fat 4 Decreased percentage of lean body mass 5 Reduced concentration of serum albumin
4 5
A patient with breast cancer is receiving trastuzumab in combination with doxorubicin. The nurse would monitor the patient for which complication? A Heart failure B Hyperglycemia C Renal dysfunction D Herpes zoster (shingles)
A
Before beginning treatment with trastuzumab, the nurse should check which screening? A HER2-positive breast cancer B Philadelphia chromosome-positive leukemia C Anaplastic lymphoma kinase-positive lung cancer D Epidermal growth factor receptor-positive colorectal cancer
A
For which adverse effects will the nurse monitor in a patient receiving chemotherapy? Select all that apply. A Alopecia B Stomatitis C Neutropenia D Hypertension E Urinary retention
A B C
A nurse is caring for a patient who is receiving chemotherapy for breast cancer. The provider prescribes zoledronate. When administering this drug, the nurse provides which information to the patient? Select all that apply. A This may help prolong life. B This will help prevent fractures. C This may help kill the cancer cells. D This may help prevent metastases. E This will increase calcium in the blood.
A B D
A nurse is describing the characteristics of neoplastic cells to a patient. Which information will the nurse include in the teaching session? Select all that apply. A Immortality B Noninvasive growth C Persistent proliferation D Formation of metastases E Progressively shorter telomeres
A C D
A patient receives a rituximab infusion. The nurse monitors which laboratory tests for signs of tumor lysis syndrome (TLS)? Select all that apply. A Calcium B Platelets C Uric acid D Potassium E Hemoglobin
A C D
A patient is receiving vincristine for cancer. Which assessment is the highest priority? A Presence of alopecia B Presence of peripheral neuropathy C Presence of bone marrow suppression D Presence of severe nausea and/or vomiting
B
The nurse is assessing a patient who is taking rituximab for non-Hodgkin's lymphoma. In the patient's medical history, the nurse finds that the patient had a high tumor burden at the start of therapy. Based on this finding, which assessment is priority? A Presence of flu-like syndrome B Presence of tumor lysis syndrome C Presence of pulmonary hemorrhage D Presence of capillary leak syndrome
B
The nurse on the oncology floor is planning care for four patients. The patient taking which cytotoxic anticancer drug will require ondansetron least frequently? A Cisplatin B Bleomycin C Carboplatin D Methotrexate
B
The nurse is preparing to administer doxorubicin intravenously (IV) to a patient with breast cancer. Which actions does the nurse take? Select all that apply. A Give a diuretic after the infusion. B Ensure the patency of the IV site. C Tell the patient the urine will turn red. D Place the patient on a cardiac monitor. E Infuse normal saline for the preceding 24 hours.
B C D
What are the primary benefits to a patient who is receiving glucocorticoids as part of a chemotherapy regimen? Select all that apply. A They increase long-bone rebuilding. B They promote appetite and weight gain. C They are cytotoxic to selective cancers. D They reduce the risk of pathogen invasion. E They reduce cerebral edema after radiation.
B C E
In which gestational period is drug therapy associated with a greater incidence of drug-induced developmental defects in the newborn? 1 First trimester 2 Second trimester 3 Third trimester 4 Perinatal period
1
The nurse is concerned that an older patient's adverse drug reactions are due to reduced renal excretion. Which laboratory result should the nurse closely monitor? 1 Creatinine clearance 2 Serum albumin levels 3 Serum creatinine levels 4 Blood urea nitrogen (BUN)
1
Before an infusion of paclitaxel, the nurse administers which medication to prevent a complication? A Furosemide B Omeprazole C Acetaminophen D Diphenhydramine
D
Before administering etoposide, the nurse mixes the drug in a sufficient amount of intravenous (IV) fluid. Which adverse effect is the nurse trying to prevent with the IV fluid? A Thrombosis B Dehydration C Hypotension D Kidney damage
C
Following periodic lab work, the nurse instructs the patient who is receiving cancer chemotherapy to use a soft-bristled toothbrush and to avoid activities that may increase risk of injury. What is the rationale for the nurse's instructions? A The patient has developed anemia. B The patient has developed neutropenia. C The patient has developed thrombocytopenia. D The patient has developed sores in the oral cavity
C
Knowing that neonates and infants have a lower binding capacity for medications, the nurse anticipates that the healthcare provider will order which adjustment when prescribing drugs that are highly protein bound? 1 A decrease in the dosage of drug 2 An increase in the dosage of drug 3 A shorter time interval between doses 4 Intravenous (IV) administration of the drug
1
What should the nurse do when administering medications to a pregnant patient who has asthma? 1 Give the asthma medications because they improve fetal outcomes. 2 Hold the medications because drugs for asthma are not safe during pregnancy. 3 Give the medications as ordered because most drugs do not cross the placenta. 4 Assess the creatinine level because renal blood flow decreases during pregnancy.
1
When assessing for drug effects in the older adult, which phase of pharmacokinetics is the greatest concern? 1 Excretion 2 Absorption 3 Distribution 4 Metabolism
1
When teaching a pregnant patient about the effects of medication on the fetus, the nurse should recognize that the greatest harm from maternally ingested medications occurs during which time period? 1 First trimester 2 Third trimester 3 Second trimester 4 Birthing process
1
Which is not a reason for the decline in hepatic drug metabolism with age? 1 Poor diet 2 Reduced liver mass 3 Reduced hepatic blood flow 4 Decreased activity of some hepatic enzymes
1
Which of these is not an example of age-related adverse drug effects? 1 Toxicity 2 Kernicterus 3 Growth suppression 4 Discoloration of developing teeth
1
The nurse is explaining the changes in the distribution process of drugs occurring in elderly patients. Which pharmacokinetic changes occur in patients older than 60 years? Select all that apply. 1 Decreased serum albumin 2 Increase in lean body mass 3 Relative increase in body fat 4 Reduction in body fat content 5 Increase in protein-binding sites
1 3
When caring for an older adult, which physiologic cardiac changes should the nurse assess to evaluate for impact of the drug action? Select all that apply. 1 Blood flow 2 Blood group 3 Cardiac output 4 Blood viscosity 5 Blood cell count
1 3
The nurse is responsible for dispensing medications to a child younger than 1 year old. What characteristics of children this age have a significant impact on dosage of drugs? Select all that apply. 1 Decreased acid in stomach 2 Risk of excessive hydration 3 Limited protein-binding capacity 4 Immature liver and kidney function 5 Thin skin with reduced permeability
1 3 4
How can healthcare providers promote medication adherence for children? Select all that apply. 1 Providing a calibrated medicine spoon for measuring liquid medications 2 Recommending that medication be stopped once the child begins to feel better 3 Taking extra time with parents to help ensure conscientious and skilled participation 4 Mixing oral drugs with small amounts of food or juice (when allowed) to improve palatability 5 Selecting the most convenient dosage form and dosing schedule when using over-the-counter drugs
1 3 4 5
Which factors alter the metabolism of drugs among older adults? Select all that apply. 1 Decreased hepatic mass 2 Decreased renal blood flow 3 Decreased hepatic blood flow 4 Decreased glomerular filtration rate 5 Decreased activity of hepatic enzymes
1 3 5
Which factors may contribute to unintentional nonadherence? Select all that apply. 1 Forgetfulness 2 Unpleasant side effects 3 Inability to pay for medications 4 Belief that the drug is not needed 5 Failure to comprehend instructions
1 3 5
Which statements should the nurse include when educating a breast-feeding patient about her medications? Select all that apply. 1 "Drugs taken by lactating women can be excreted in breast milk." 2 "There is a lot of research regarding drugs taken by lactating women." 3 "Nearly all drugs can enter breast milk, and the extent of entry is the same for all drugs." 4 "Most drugs can be detected in milk, but concentrations are usually too low to cause harm." 5 "If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant."
1 4 5
When monitoring the impact of chemotherapy on patients, the nurse must consider potential toxicity to normal cells primarily in which tissues? Select all that apply. 1 Brain 2 hair follicles 3 Bone marrow 4 Gastrointestinal epithelium 5 Germinal epithelium of the testes
2 3 4 5
Which actions should the nurse perform to ensure that the medication dose for a pediatric patient is correct? Select all that apply. 1 Use the patient's weight in pounds. 2 Compare the drug dosage prescribed with the calculated safe range. 3 Use a current drug reference to determine usual dosage per 24 hours. 4 Determine the total amount of the drug to administer per dose and per day. 5 If the drug dosage prescribed varies from recommended reference range, notify the provider. 6 Determine the dose parameters by multiplying the weight by the minimum and maximum daily doses of the drug to determine the safe range.
2 4 5 6
Which statement about drug use among older adults is true? 1 Older adults require higher doses of most drugs. 2 Older adults experience fewer adverse drug reactions. 3 Drug use among older adults is disproportionately high. 4 Older patients are less sensitive to drugs than younger adults.
3
When assessing a patient receiving cisplatin, the nurse will monitor for which adverse effects? Select all that apply. A Ototoxicity B Nephrotoxicity C Pulmonary fibrosis D Peripheral neuropathy E Severe nausea and/or vomiting
A B D E
When administering anticancer drugs, the nurse identifies which interventions as effective in minimizing renal injury from hyperuricemia? Select all that apply. A Administration of fluids B Administration of rasburicase C Premedication with ondansetron D Premedication with dexamethasone E Prophylactic administration of allopurinol
A B E
The patient reports that her mother, grandmother, and sister have all had breast cancer and that she is concerned that she, too, will get breast cancer in the future. The nurse anticipates the provider to discuss which medications with this patient? Select all that apply. A Raloxifene B Tormifene C Tamoxifen D Fulvestrant E Anastrozole
A C
Which assessments are most important for a patient receiving doxorubicin? Select all that apply. A Infusion site B Thyroid function C Cardiac function D Pancreas function E Macroscopic urine
A C
Which statements should the nurse include when teaching a patient about use of abiraterone in the treatment of prostate cancer? Select all that apply. A "You may develop hot flashes." B "Do not take prednisone with abiraterone." C "You may develop enlargement of your breast tissue." D "Restrict foods that are high in potassium content because hyperkalemia frequently results from taking this drug." E "Blood work will be obtained at regular intervals to assess the function of your liver."
A C E
A cancer patient who is on chemotherapy reports severe nausea and vomiting. Which action would be most beneficial to the patient? A Wash hands often. B Administer allopurinol. C Administer ondansetron. D Wash lettuce before serving.
C
A nurse is administering subQ an immunostimulant that is approved for only melanoma. Which immunostimulant is the nurse administering to the patient? A Aldesleukin B Interferon alfa-2b C Peginterferon alfa-2b D Bacille Calmette-Guérin (BCG) vaccine
C
A patient with cancer who is neutropenic is hospitalized. Which action by the nursing assistant requires the supervising nurse to intervene? A Maintaining isolation protocol for the patient B Assisting the patient in basic hygiene as needed C Delivering a fresh fruit basket to the patient's room D Obtaining the patient's temperature at frequent intervals
C
The nurse hydrates a patient with intravenous (IV) fluids before administering cyclophosphamide IV. Which adverse effect is the nurse trying to prevent in the patient? A Cardiotoxicity B Pulmonary fibrosis C Hemorrhagic cystitis D Peripheral neuropathy
C
The nurse is planning care for a patient who is scheduled to receive bevacizumab. The patient had colon surgery 3 weeks ago. Which outcome does the nurse establish on the care plan? A Absence of hemorrhagic cystitis B Absence of tumor lysis syndrome C No evidence of wound dehiscence D No increased intracranial pressure
C
The nurse will anticipate administering which medication to patients receiving high-dose methotrexate? A Cisplatin B Bleomycin C Leucovorin D Dactinomycin
C
The nurse would identify which immunostimulant as most effective in the treatment of in situ bladder cancer? A Interferon alfa-2b B Peginterferon alfa-2b C Bacille Calmette-Guérin (BCG) vaccine D Aldesleukin (interleukin-2)
C
When administering phase-specific anticancer medications, which schedule does the nurse use to achieve maximum therapeutic effectiveness? A At the end of treatment B One day every 12 weeks C Short intervals over time D The first day of the month
C
Which interventions does the nurse implement when caring for a patient receiving pemetrexed? Select all that apply. A Administer lidocaine to prevent cardiac toxicity. B Administer the drug by mouth on an empty stomach. C Administer prophylactic glucocorticoids to reduce skin rash. D Administer prophylactic doses of folic acid 1 week before dosing. E Administer prophylactic doses of vitamin B 12 1 week before dosing.
C D E
A patient is receiving cisplatin. Which finding, if noted in the patient receiving cisplatin, would prompt the nurse to notify the provider immediately? A Difficulty sleeping B Heartburn and dyspepsia C Breast fullness and tenderness D Numbness in the fingers and toes
D
A patient with cancer asks the nurse what the provider means when she uses the word, "nadir." What is the nurse's best response? A "It is the patient's tolerance to the chemotherapy's bone marrow suppressant effect." B "It is the time it takes the bone marrow to completely recover from a dose of chemotherapy." C "It is the maximum dose for a chemotherapy drug in reference to bone marrow suppression effects." D "It is the lowest neutrophil count caused by the chemotherapy and the time at which you are most at risk for an infection."
D
A patient with cancer asks the nurse why he must take multiple chemotherapy drugs. The nurse bases the response on which understanding of the rationale behind multidrug chemotherapy regimens? A The patient is terminal. B The patient has an infection. C This activates P-glycoprotein. D This prevents drug resistance.
D
After reviewing the chart, the nurse will find which information is a cause to notify the health care provider about a patient receiving bevacizumab? A Carboplatin prescribed B Blood pressure 120/70 C No recent or scheduled surgeries D Previous gastrointestinal (GI) bleed
D
The nurse is caring for several patients receiving chemotherapy on the cancer unit. Which patient will the nurse assess first? A The patient receiving doxorubicin who has reddish color sweat B The patient receiving fluorouracil with an elevated platelet count C The patient receiving cyclophosphamide who is urinating 100 mL/hr D The patient receiving mechlorethamine with pain at the intravenous (IV) insertion site
D
The nurse planning care for a patient taking filgrastim would list which outcome as a goal for treatment? A Decrease in platelets B A decrease in stomatitis C An increase in red blood cells D An increase in white blood cells
D
When planning care for a patient who is receiving cyclophosphamide, the nurse finds which intervention most important to include to prevent complications of cyclophosphamide therapy? A Give an antidiarrheal medication. B Palpate for pedal pulses every 2 hours. C Monitor for laryngeal stridor and tetany. D Increase the intravenous and oral fluid intake.
D
Which symptom does the nurse investigate first when monitoring a patient taking tamoxifen? A Hot flashes B Pedal edema C Sleep disruption D Vaginal bleeding
D
Which type of cancer will the nurse expect to find documented in the chart for a patient receiving tamoxifen? A Lung cancer B Renal cancer C Colon cancer D Breast cancer
D
Which benefits of combination chemotherapy would be discussed with a patient making a decision about options to treat recently diagnosed breast cancer? Select all that apply. 1 Increased cancer cell kill 2 Suppression of drug resistance 3 Reduced injury to normal cells 4 Increased sensitivity of tumor to chemotherapy 5 Overall reduction in unpleasant side effects of the chemotherapy
1 2 3
Which factors are involved in the physiological changes that affect drug absorption among older adults? Select all that apply. 1 The rate of absorption of medication will be reduced. 2 Reduced gastric acidity alters the absorption of certain drugs. 3 A lower percentage of an oral dose of medication will be absorbed. 4 Delayed gastric emptying and reduced splanchnic blood flow reduce absorption. 5 Altered gastrointestinal (GI) absorption is a major factor in drug sensitivity in older adults.
1 2 4
Which statements about transdermal absorption in infants are correct? Select all that apply. 1 The stratum corneum of the infant's skin is very thin. 2 Blood flow to the skin is greater in infants than in older patients. 3 Transdermal administration is the safest route of administration. 4 Infants are at increased risk of toxicity compared with older children. 5 Absorption through the skin is more rapid and complete with infants
1 2 4 5
A drug that is not classified according to a Pregnancy Risk Category is prescribed for a pregnant patient. What should the nurse do? 1 Hold the medication. 2 Administer the medication. 3 Notify the healthcare provider. 4 Ask the pharmacy to assign a Pregnancy Risk Category.
2
The nurse prepares to administer a newly prescribed medication to a 22-year-old woman. The insert in the medication package states, "Pregnancy Category X." Select the nurse's best action. 1 Assume that the patient is pregnant. 2 Ask the patient, "When was your last menstrual period?" 3 Assess the patient for a history of sexually transmitted disease. 4 Ask the patient, "Have you been sexually active during the past year?
2
Which statement is true regarding drug absorption in infants versus adults? 1 When a drug is administered orally in the infant, drug absorption is delayed, unlike in the adult. 2 When a drug is administered intravenously, levels decline more slowly in the infant than in the adult. 3 When a drug is administered subcutaneously in the infant, the drug levels remain below the minimum effective concentration longer than in an adult. 4 When a drug is administered intravenously, drug absorption in the infant remains below the minimum effective concentration longer than in the adult.
2
Which statement is true regarding pharmacokinetics in children 1 year and older? 1 Children older than 1 year metabolize drugs much slower than adults. 2 By age 1 year, most pharmacokinetic parameters in children are similar to those in adults. 3 Drug sensitivity in children older than 1 year is more like that of infants than that of adults. 4 Drug-metabolizing capacity is markedly decreased until age 2 years and then gradually increases.
2
A patient with diabetes has a positive urine pregnancy test. What is the appropriate intervention for this patient? 1 Withhold antidiabetic medication for the perinatal period. 2 Instruct the patient to take a low dose of antidiabetic drugs. 3 Instruct the patient to continue taking all antidiabetic medications. 4 Educate the patient about risks to the fetus associated with antidiabetic medications
3
The nurse is administering medication to an older adult with altered renal function. This patient's renal system will likely have which effect on the medication? 1 The medication will be excreted quicker. 2 The medication will be metabolized quicker. 3 The medication will be excreted more slowly. 4 The medication will be metabolized more slowly.
3
The nurse is caring for an adolescent who weighs 72 pounds. Which does the nurse recognize as the most precise method for adjusting dosage of this patient's medications? 1 Body weight 2 Body mass index 3 Body surface area 4 Body fat percentage
3
Which statement about intramuscular (IM) administration is incorrect? 1 Drug absorption after IM injection in the neonate is slow and erratic. 2 Absorption of IM drugs becomes more rapid in infancy than in neonates. 3 Absorption of IM drugs becomes slower and more erratic in infancy than in neonates. 4 Neonates experience low blood flow through muscle during the first days of postnatal life.
3
For a drug to be a proven teratogen, which criteria must be met? Select all that apply. 1 The drug should be tested in pregnant women. 2 The drug causes malformation in animal testing. 3 The drug must cause a characteristic set of malformations. 4 The drug must act only during a specific window of vulnerability. 5 The incidence of malformations should increase with increasing dosage and duration of drug exposure.
3 4 5
If five daily doses of a 2-g medication with a one-day half-life are given, what will be the total amount of the medication in the system after the fifth dose?_____ g
3.9
A mother of a 1-month-old infant calls the clinic and asks the nurse if the medication she is taking can be passed to her infant during breast-feeding. What is the appropriate response for this patient? 1 "I will leave the doctor a message to return your call." 2 "You should not take any medication while breast-feeding." 3 "Only certain medications pass to infants while breast-feeding." 4 "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking."
4
According to the U.S. Food and Drug Administration (FDA) Pregnancy Risk categories, which category represents the greatest risk for fetal harm? 1 A 2 B 3 C 4 D
4
For medications that do not have established pediatric doses, the most common method of extrapolating the appropriate dose is based on which measurement? 1 Age 2 Weight 3 Height/length 4 Body surface area
4
The dosage of a certain drug is reduced when administered to a pregnant woman with liver impairment. Which other clinical situation requires reduction in the dosage of most drugs administered during pregnancy? 1 Epilepsy 2 Diabetes 3 Hypertension 4 Renal impairment
4
The drug prescribed for an older adult patient is renally excreted. How should the nurse assess the patient's renal function to administer this drug safely? 1 Urine urea 2 Serum troponin 3 Urine creatinine 4 Creatinine clearance
4
Which statements by a student nurse about the effect of pregnancy on medication action indicate effective learning? Select all that apply. 1 "There is increased gastrointestinal motility during pregnancy." 2 "The liver decreases metabolism of medications during pregnancy." 3 "The maternal circulating blood volume concentrates the medications." 4 "There is a more rapid renal excretion of medications during pregnancy." 5 "The serum and tissue concentrations of the medications decrease during pregnancy."
4 5
The nurse is caring for a patient who is prescribed imatinib for chronic myeloid leukemia. Which instructions does the nurse include in discharge teaching? Select all that apply. A "You can take the drug with water and a meal." B. "You must avoid breastfeeding while on therapy." C "You should begin taking St. John's wort during therapy." D "You should start to gain weight within a short amount of time." E "You will have blood tests weekly during the first month of treatment."
A B E
Which statements regarding treatment modalities for cancer does the nurse identify as true? Select all that apply. A Irradiation is the treatment of choice for leukemias. B Surgery is the most common treatment for solid cancers. C Drug therapy is the treatment of choice for disseminated cancers. D Drug therapy is not effective in treating a patient with cancer who has had surgery. E Drug therapy is effective as an adjunct therapy in treating a patient who has had irradiation.
B C E
The nurse develops a plan of care for a patient receiving chemotherapy whose neutrophil count has reached its nadir. Which nursing action is the priority? A Limit contact with visitors. B Provide daily oral hygiene. C Obtain temperature frequently. D Restrict all fresh fruits and vegetables.
C
Chemotherapy is dose-limiting primarily because of its toxicity to the cells in which tissues ? Select all that apply. A Liver B Brain C Bone marrow D Sperm-forming cells E Gastrointestinal lining
C D E
