prepU ch 9,11,12 due on feb 22
Liver function
A 63-year-old male patient has just begun treatment with IV paclitaxel. About 10 minutes into the infusion, the nurse becomes conce
Protect the patient from exposure to infection
A patient who is receiving an immune modulator has been admitted to your unit. What would be a priority action by the nurse?
True
An adverse effect of tamoxifen therapy involves menopausal symptoms.
Prostate cancer
An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease?
T lymphocytes
Cellular immunity is mediated by which of the following cells?
IgE
In an allergic reaction, the immunoglobulin that binds to mast cells that release histamine is the:
The systematic enrollment of children in well-designed clinical trials
In recent years, there have been rapid advances in cancer care for children and high cure rates for many pediatric malignancies. What is the reason behind many of these advances?
Angiosarcoma
Malignancies can occur throughout the human body. Hematologic malignancies involve the bone marrow and lymphoid tissues. Which of the following is not a hematologic malignancy?
hemoglobin
Red blood cells (RBCs) are mainly composed of _________________, which enables the cells to carry oxygen to the cells in the body.
A severe bacterial infection
A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has
Take special care when shaving or brushing her teeth
A 42-year-old female with breast cancer has had a radical mastectomy. She will have radiation therapy and then begin chemotherapy. Drug therapy will consist of a combination of doxorubicin, cyclophosphamide, and paclitaxel. What will the nurse include in her teaching plan concerning the drug therapy?
promote bleeding.
A 57-year-old male patient who has been prescribed doxorubicin for small-cell lung cancer is advised by the nurse to avoid taking aspirin or drugs that contain aspirin because it may
dyspnea.
A 63-year-old male patient has just begun treatment with IV paclitaxel. About 10 minutes into the infusion, the nurse becomes concerned about a possible anaphylactic reaction to the drug because the patient is experiencing
Infections
A 78-year-old male client begins an immunosuppressant therapy for his rheumatoid arthritis. The nurse is concerned because this client is at greater risk for what complication, compared with younger adults using the same treatment modality?
Decreased numbers and responsiveness of T lymphocytes
A care aide who works in a long term care facility has observed the high incidence of infectious illnesses among the older adults who reside there. Which of the following consequences of aging is most likely the reason for diminished immune capacity older adults?
Interferons modulate the response of the immune system to viruses, bacteria, cancer, and other foreign substances.
A client comes to the clinic to learn about interferons. Which of the following would the nurse include in the lesson plan
"Drink plenty of fluids throughout the day."
A client is experiencing flu-like symptoms related to immune stimulant therapy. Which of the following instructions would be most appropriate for the client?
Chest x-ray
A client is receiving bleomycin as part of his chemotherapy regimen. Which of the following would be most important for the nurse to monitor?
Iron is contraindicated in clients with known hypersensitivity to the drug, or any component of the drug.
A client is seen in the clinic for iron deficiency anemia and the nurse provides comprehensive discharge instructions about allergic reactions. The client appears nervous, then demands to see another nurse. The nurse asks the client why she is distressed. The client replies, "because I have had a bad reaction to iron supplements before and almost died." The nurse asks for an order to change the prescription for which of the following reasons?
Results in immunodeficiency diseases
A client who has been diagnosed with a compromised immune system is eager to know about the condition. Which explanation should the nurse provide regarding the potential consequences of a compromised immune system?
Iron acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia
A client who was diagnosed with iron deficiency anemia is worried because she does not know why she was prescribed iron supplements. The nurse teaches the client about which of the following actions of oral iron administration?
Histamine
A deficiency in which of the following would result in an inhibition of the inflammatory response?
B12
A female client 50 years of age has a history of an allergy to cyanocobalamin. Based on the history, the nurse knows which of the following vitamins is contraindicated?
Abnormal immune response
A female nursing student is diagnosed with rheumatoid arthritis. What is the probable cause of her rheumatoid arthritis
Pregnancy
A female patient prescribed methotrexate for meningeal leukemia is asking the nurse about adverse effects of the drug. What would the nurse tell this patient should be avoided while taking methotrexate?
Evaluate the client for transplant rejection
A male client is prescribed cyclosporine after renal transplantation to prevent rejection. Initially, his BUN and creatinine levels were elevated; they diminished with medication adjustment and 3 weeks later are elevated again. What would the nurse expect the physician to do?
Viral hepatitis
A male client is prescribed interferon. What is his probable diagnosis?
Iron
A male client is self-administering epoetin in the home. The nurse encourages him to include what supplements as part of his daily medication regimen?
Chemotherapy should be administered by RNs who have successfully completed a course in chemotherapy administration.
A medical-surgical registered nurse (RN) is requested to go to the oncology unit, which is short staffed. When the RN arrives to the unit, the oncology nurse states, "We are so short today that you are going to have to administer chemotherapy to some of the clinic patients." According to the Oncology Nurses Society (ONS), of what should the oncology nurse be aware?
"It's important that you let us know if you develop any significant swelling or puffiness."
A middle-aged patient has received a diagnosis of GI stromal tumor following an extensive diagnostic workup. Imatinib has been recommended as a component of the patient's drug regimen. What patient education should the nurse provide to this patient?
Immune system acts with slower, muted inflammatory process
A nurse caring for elderly clients in an assisted living facility is required to educate the clients on the effects of aging on the immune system. What are effects of aging on the immune system?
Targeted therapies have the potential to damage cancerous cells while leaving normal body cells less affected.
A nurse educator who coordinates the staff education on an oncology unit is conducting an inservice on targeted therapies. What potential benefit of targeted therapies should the nurse highlight in this education session?
Non-Hodgkin's lymphoma
A nurse has completed a medication reconciliation of a patient who has been admitted following a motor vehicle accident. Among the many drugs that the patient has received in the previous year is rituximab. The nurse would be justified in suspecting the patient may have received treatment for which of the following diseases?
Inspecting site for redness or swelling
A nurse is administering an antineoplastic that can cause necrosis and cellulitis if extravasation occurs. Which intervention would be most appropriate to prevent this from occurring?
400 mg/hour
A nurse is administering rituximab to a patient via the IV route. The nurse will set the IV pump at 50 mg/hour for the first half hour of the initial infusion. If there are not apparent reactions after 30 minutes of the infusion, the nurse will increase the dosage every 30 minutes by 50 mg/hour until the maximum infusion rate reaches which of the following?
Administer prescribed specific anti-rejection medication
A nurse is caring for a client who has just had organ transplant surgery. Which nursing intervention should the nurse perform in case a rejection response is seen in the client?
Bloody urine
A nurse is caring for a patient being treated with antineoplastic drugs. The patient is at risk for thrombocytopenia due to bone marrow suppression. What should the nurse monitor for in this patient?
Increased risk of prolonged bleeding
A nurse is caring for a patient undergoing treatment with plant alkaloids for cancer. The patient is also administered warfarin for a history of atrial fibrillation. Which of the following is an interactive effect of the two drugs which the nurse should monitor the patient for?
begin with IV administration and then change to the oral route.
A nurse is caring for a patient who has just had a successful liver transplant. When facilitating the patient's treatment with cyclosporine, the nurse should anticipate that administration will
Provide mouth care with normal saline every 4 hours
A nurse is caring for a patient who has received chemotherapy treatment. The patient has developed inflammation of the oral mucous membrane, which is affecting the nutritional aspects of care. What suggestions should the nurse provide to the patient for relief?
Wear loose protective clothing.
A nurse is caring for a patient who is at risk for erythema during antineoplastic drug therapy. What should the nurse suggest to this patient?
Measure all fluid intake and output
A nurse is caring for a patient who is undergoing chemotherapy. The patient has experienced several episodes of vomiting. Which of the following activities should the nurse perform as part of ongoing assessment for signs of dehydration and electrolyte imbalances?
Epitopes on antigens are recognized by immunoglobulin receptors following presentation by accessory cells
A nurse is providing care for a client who is immunocompromised following chemotherapy. The nurse is explaining how the client's immune system normally functions and why it is presently disrupted. Which of the following characterizations of the adaptive immune system could the nurse use to underlie an explanation to the client?
nephrotoxicity.
A nurse is providing patient education to a 45-year-old man who is taking cyclosporine (Sandimmune). The nurse will provide the patient with education related to one of the most common and severe adverse effects of cyclosporine, which is
Discard the unused portion of the drug
A nurse is to use a single-dose 1 mL vial to administer 0.5 mL of epoetin alfa to a 39-year-old woman who is being treated for chemotherapy-induced anemia. Which of the following will the nurse do with the unused portion of the drug?
Cancer cells' growth is called proliferation.
A patient asks the nurse what cancer cells' growth is called. What would the nurse tell the patient?
Assess the patient for other signs of infection.
A patient has and elevated white blood cell (WBC) count. What is the nurse's primary action related to this finding?
Delays spread of cancer to other sites.
A patient has been diagnosed with cancer. The physician prescribes antineoplastic drug therapy to the patient. How should the nurse explain the use of antineoplastic drugs?
Hypertension
A patient has been prescribed epoetin alfa. In reviewing this patient's history, what would the nurse know contraindicates the use of epoetin alfa?
Changes the cell to a more alkaline environment.
A patient has been prescribed melphalan, an alkylating agent, for the treatment of an ovarian tumor. The patient wants to know the action of the drug in treating the tumor. Which of the following should the nurse inform the patient?
Complete blood count
A patient has been prescribed treatment with antineoplastic drugs, which have a depressing effect on the bone marrow. What pre-administration assessment should the nurse perform for this patient with respect to the depressing effect of the bone marrow?
"Your hair will grow back, but the new hair may be a different color or texture."
A patient having chemotherapy is losing her hair. She asks the nurse if her hair will come back as it originally was. What is the best response by the nurse?
Risk for infection
A patient is receiving anakinra for treatment of rheumatoid arthritis. The patient is scheduled to have arthroscopic evaluation of the right knee. Which of the following nursing diagnoses would be a priority after the procedure?
Suggest the use of a wig or cap.
A patient is to start with chemotherapy. The patient is worried about going bald in the course of the treatment. How can the nurse assist the patient in being comfortable with his or her body image?
Neutrophils
A patient presented to the emergency department of the hospital with a swollen, reddened, painful leg wound and has been diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) cellulitis. The patient's physician has ordered a complete blood count and white cell differential. Which of the following blood components would the physician most likely anticipate to be elevated?
"The reddish urine is harmless and an expected response to the drug."
A patient received an injection of doxorubicin and is now observing a reddish urine. The patient states, "Do you think I am bleeding?" What is the best response by the nurse?
The patient is exhibiting signs of syndrome of inappropriate antidiuretic hormone caused by the high dose of cyclophosphamide
A patient taking high doses of cyclophosphamide is exhibiting muscle cramps and confusion and reports headaches. The nurse assesses the laboratory tests and notices the sodium level is low. What does the nurse determine may be occurring with this patient?
Increased risk of nephrotoxicity
A patient undergoing antineoplastic drug therapy is administered an alkylating drug. The patient is also administered an aminoglycoside as an anti-infective agent. Which of the following interactions of the alkylating drug with the aminoglycoside should the nurse assess the patient for?
Neoadjuvant therapy
A patient will be having chemotherapy to reduce a colon tumor prior to having a colon resection. To what is this type of therapy referred?
"Both classes of drugs have adverse effects, but targeted therapies tend to have less of an effect on healthy body cell"
A patient will soon begin targeted therapy as a component of her treatment plan for chronic leukemia. The nurse is conducting health education about this new aspect of the patient's drug regimen and the patient has asked about the potential side effects of treatment. How should the nurse best respond?
Palliative therapy
A patient with a pancreatic tumor will be starting on chemotherapy to decrease the size of the tumor, give the patient a better quality of life, and reduce the discomfort. What is this form of therapy called?
An iron supplement
A patient with chronic renal failure receiving epoetin alfa will be having a total left hip arthroplasty. What supplementation should the patient receive prior to surgery?
Risk for Infection related to suppressed bone marrow function
A patient with non-Hodgkin's lymphoma (NHL) will be starting a course of doxorubicin shortly. When planning this patient's care, what nursing diagnosis should the nurse prioritize?
Tamoxifen
A postmenopausal woman with breast cancer will most likely be treated with which anti-estrogen drug?
"You have a deficiency because you are on a strict vegan diet."
After a client age 65 years diagnosed with vitamin B12 deficiency learns about the use of the vitamin, she asks the nurse what caused her B12 deficiency anemia. Which of the following statements would the nurse use when teaching the client about vitamin B12?
IgE
After reviewing the types of immunoglobulins present in the body, a student demonstrates understanding of this topic by identifying which immunoglobulin as most likely being related to allergic responses?
2 to 4 hours after the bone marrow infusion
After the client undergoes bone marrow transfusion, his physician administers sargramostim. When would the nurse expect the first dose to be administered?
administer a combination of antiemetics prior to the administration of the drug
An adult patient who has been diagnosed with a rectal tumor is scheduled to begin treatment with cisplatin. The nurse has conducted patient teaching about the possibility of nausea and vomiting. In order to reduce the patient's risk of severe nausea, the nurse should
Vitamin C and Zinc supplements
As a nurse caring for a patient with a chronic wound, which of the following would you expect to be ordered to promote wound healing?
Disruption of intact skin
Burn victims have a high potential for infection due to the destruction of several defense mechanisms, external and internal. Why would this be the case?
Reassure the patient that it is a harmless and expected response to the drug
Ms. Nicole is prescribed doxorubicin drug therapy for carcinoma of the breast. On the second day of drug therapy, she calls in to report reddish urine. What should the nurse do?
Hematocrit and hemoglobin
Prior to administration of an iron preparation, what should a nurse assess?
"Do you have any history of heart disease or irregular heart rhythms?"
Rituximab has been prescribed for a patient who has longstanding history of severe rheumatoid arthritis that has been minimally responsive to standard therapies. When assessing the patient prior to the start of the course of treatment, what assessment question is the nurse's priority?
She may develop an infectious process at the clinic.
Six months after undergoing transplantation, a female client asks her physician if it would be alright for her to volunteer at the local children's health clinic. She has limited adverse effects from her immunosuppressant drugs and is beginning to feel healthy again. The physician suggests alternate volunteer options; what is he most likely concerned about?
slows the progression of joint destruction
Student nurses are discussing rheumatoid arthritis (RA) in their pathology class. The students learn that RA is treated with leflunomide because it relieves symptoms and
True
The action of immune stimulants ultimately results in the development of flu-like symptoms as adverse effects.
Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia.
The client is a woman 65 years of age being treated for anemia secondary to chronic kidney disease. The nurse explains to the client that she will be getting a prescription for Epogen. Which of the following additional information would the nurse provide?
"Chemotherapy has caused you to have a low platelet count, which puts you at risk for bleeding. Oprelvekin is used to increase platelet production to decrease the risk."
The client is a woman age 42 years who returns to the Cancer Treatment Center diagnosed with chemotherapy-induced thrombocytopenia. The nurse knows that the interleukin drug oprelvekin is used to increase platelet production and explains to the client the need for the drug. The client will not sign the informed consent because she doesn't understand why she needs platelets. Which of the following information would the nurse include in the explanation?
"Come to the clinic as soon as possible."
The clinic nurse receives a call from a client who has been taking interferon alfa for 7 days. The client states that he has become very sad and wonders if life is worth living. What is the best response by the nurse to this client?
Blood pressure
The home care nurse is caring for a client who is self-administering epoetin. What assessment is most important for the nurse to complete during the visit?
She runs a sick child day care.
The home care nurse is caring for a female client who underwent renal transplantation 8 weeks ago and is self-administering immunosuppressant drugs. What situation in the client's life is the greatest cause for concern?
A previous organ transplant
The medication reconciliation of a newly admitted resident of a nursing home indicates that the patient takes cyclosporine. The nurse should initially suspect that this resident may have
Increased red blood cell count
The nurse administers epoetin alfa (Epogen). What is the therapeutic response the nurse expects to assess?
Change in capillary permeabilites
The nurse assesses a patient and finds an injured area that is slightly swollen. The nurse interprets this finding as being the result of which of the following?
1, 2
The nurse assists and educates clients about the structure and function of the immune system. Both B cells and T cells derive from stem cells in the bone marrow. Based on this information, what is the best information for the nurse to provide the client on the function of T lymphocytes? 1. Help protect against viral infections 2. Can detect and destroy some cancer cells 3. Develop into cells that produce antibodies 4. Provide humoral immunity
Known hypersensitivity to the drug or any component of the drug
The nurse educator is teaching an online pharmacology class. The topic of the online seminar is the contraindications for the use of colony stimulation factor. The nurse includes which of the following contraindications?
Cytokines are produced by the bone marrow and white blood cells to enhance formation of blood cells.
The nurse is administering a medication to enhance hematopoiesis. Which statement indicates the nurse understands the role of cytokines in hematopoiesis?
Prevention of rejection
The nurse is caring for a child who will be receiving a renal transplant. The physician orders cyclosporine. When teaching the parents and child about this drug, the nurse would include which of the following as the primary reason for the drug
Pneumocystis pneumonia
The nurse is caring for a client who is receiving a TNF-alpha blocking agent. The nurse understands that what condition can occur as a result of taking this medication?
graft-versus-host disease.
The nurse is caring for a client who is receiving cyclosporine following bone marrow transplantation. The nurse knows that inadequate immunosuppression in this client may cause
"Stay out of crowded places such as grocery stores."
The nurse is caring for a client with a WBC of 700 cells/mm3. Which discharge instruction is most important for the nurse to share with this client?
Techniques to reduce exposure to infection
The nurse is caring for a female client in the home. The client is prescribed filgrastim. What would be included in the nurse's education plan?
"The hematopoietic system is composed of fluid, red blood cells, white blood cells, and platelets."
The nurse is mentoring a first-year nursing student while caring for a client with a disease that affects the hematopoietic system. The student looks confused and says "I've never heard of that system. What is it?" How would the nurse repond?
"Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues."
The nurse is teaching a nursing student about anemia and knows that it is important to start by explaining the causes of anemia. Which of the following statements are true about the cause of anemia?
3 times a week
The nurse is teaching a patient receiving epoetin alfa about the drug. The nurse informs the patient that he will receive the drug at which frequency?
Wear personal protective equipment when handling the drug.
The nurse is teaching the handling of cytotoxic antineoplastic drugs to the wife of a client receiving them. What should the nurse teach her to do?
"The prescribed diet and drug are necessary to correct anemia associated with folic acid deficiency."
The nurse learns that a client in a clinic is taking folic acid to treat an associated anemia. The client decided to go on a fasting diet for the last two weeks to lose weight before her daughter's wedding. How would the nurse explain the importance of staying on the diet that the provider prescribed last month?
Allopurinol (Zyloprim)
The nurse may be asked to administer which of the following medications to a patient to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis?
Erythropoietin
The nurse notes a decreased red blood cell (RBC) count, decreased hemoglobin and hematocrit, as well as a decreased mean corpuscular volume. This could be attributable to a decrease in secretion of what hormone?
Skin cancer and lymphomas
The nursing instructor is talking with the students about immunosuppressant therapy following transplant surgery. The instructor indicates that, in addition to drug-specific adverse effects, therapy presents the risk of infection and cancer. Which of the following are the most common malignancies among transplant recipients?
Cell cycle-specific
The oncology nurse understands that he or she is administering chemotherapeutic agents that are most effective during a particular phase of the cell cycle. To what is this referred?
Stop the infusion.
The patient receiving a first infusion of paclitaxel complains of chills and dyspnea. The oncology nurse assesses the patient and observes facial flushing, wheezing, and extreme anxiety. What is the priority intervention by the nurse?
Epoetin alfa
The patient with chronic renal failure requires an agent to increase red blood cell production. What drug does the nurse anticipate administering?
All of the above
The pharmacology instructor is talking about interferon. The instructor explains that agents such as interferons have more than one biologic function. What are the functions of interferons?
White blood cells
To evaluate immune function, the nurse should look most closely at which laboratory value?
Neutrophil count
Upon reviewing the results of a complete blood count on a patient who is diagnosed with an acute infection what will the nurse expect to see elevated?
IgE
What immunoglobulin is present in small amounts and is thought to be related to allergic responses?
Some interleukins stimulate the growth of stem cell precursors of blood cells
What information is accurate when teaching about interleukins?
Humoral immunity
What is the B cell immunity called when the B cells are programmed to identify specific proteins, or antigens?
Stop the infusion.
What is the first action by the oncology nurse when observing extravasation with the patient receiving vincristine?
Wearing protective equipment such as gloves, mask, and gown
What measure protects the nurse when preparing cytotoxic drugs?
Interferon alfa-2b
Which agent would be classified as an immune stimulant?
Methotrexate
Which agent would the nurse expect to be administered orally?
Cytotoxic T cells
Which of the T cells is responsible for destroying pathogens by punching holes in their cell membrane and by secreting cytokines/lymphokines?
Cells that can either destroy a foreign cell or mark it for aggressive destruction
Which of the following accurately describes effector or cytotoxic T-cells?
• Cisplatin (Platinol-AQ) • Melphalan (Alkeran) • Carmustine (BiCNU)
Which of the following alkylating agents can cross the blood-brain barrier? Select all that apply:
It allows the body to distinguish cells as foreign or belonging to the person.
Which of the following best describes the role of the major histocompatibility complex as a barrier defense?
Neutrophils
Which of the following is rapidly produced to move to the site of the injury to attack the foreign substance?
Keeping well hydrated
Which of the following nonpharmacological interventions may prevent cystitis caused by cyclophosphamide (Cytoxan)
A 62-year-old male with cancer
Which of the following patients will be at the greatest risk for anemia and would be the most likely candidate for epoetin alfa therapy?
I know that I will need to stay on this medication for the rest of my life.
Which of the following statements indicates that your client understands immunosuppressant therapy following a solid organ transplant?
Ineffective red blood cells
Which of the following would a nurse identify as the primary issue associated with anemias?
Cautioning the client that stool may be dark or green
Which of the following would be appropriate for a client who is receiving iron therapy?
Leucovorin
Which of the following would the nurse expect the health care provider to prescribe for a client receiving methotrexate?
Cyclosporine
Which of the following would the nurse expect to administer orally?
Iron supplement
You are caring for a client who is receiving epoetin alfa. What adjunct treatment will you expect the physician to order for this client?
The body responds to specific self-antigens to produce antibodies or cell-mediated immune responses against its own cells
You are caring for a patient newly diagnosed with multiple sclerosis. Your patient asks you why MS is called an autoimmune disease. What would be your best response
Prostate
You are caring for a patient who is taking bicalutamide (Casodex), an anti-androgen. You would know that this type of drug may be administered to men with which type of cancer?
interferon alfa-2b
Your client has been diagnosed with genital warts. Which of the following medications would you anticipate being ordered?
Serious complications can occur if you are not monitored carefully.
Your client has completed immunosuppressive therapy in preparation for transplantation. When explaining the risks of immunosuppression, you would include which of the following?
Cancer.
Your client previously underwent a solid organ transplant. You are aware that she is taking immunosuppressants and has an increased risk for:
Inflammatory process
Your newest admit to ICU is a gunshot victim with wounds in his chest and thigh. Extensive edema is present. Anticipating a generalized reaction to tissue damage, you conclude the patient's edema is due to
