NR 293 Exam 1 - All chapters test bank Questions and answers + rationales

1. A patient must be treated immediately for acute organ transplant rejection. The nurse anticipates that muromonab-CD3 (Orthoclone OKT3) will be ordered. What is the priority assessment before beginning drug therapy with muromonab-CD3?

a. Serum potassium level

b. Fluid volume status

c. Electrocardiogram

d. Blood glucose level

ANS: B

Assess fluid volume status because muromonab-CD3 is contraindicated in the presence of fluid overload. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 777

TOP: NURSING PROCESS: Assessment

2. A patient is about to undergo a kidney transplant. She will be given an immunosuppressant drug before, during, and after surgery to minimize organ rejection. During the preoperative teaching session, which information will the nurse include about the medication therapy?

a. Several days before the surgery, the medication will be administered orally.

b. The oral doses need to be taken 1 hour before meals to maximize absorption.

c. Mix the oral liquid with juice in a disposable Styrofoam cup just before administration.

d. Intramuscular injections of the medication will be needed for several days preceding surgery.

ANS: A

Several days before transplant surgery, immunosuppressant drugs need to be taken by the oral route, if possible, to avoid intramuscular injections and the risk for infection caused by the injections. Avoid Styrofoam containers because the medication may adhere to the side of the container. These medications are taken with food to minimize gastrointestinal upset.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 778

TOP: NURSING PROCESS: Implementation

3. A patient has an order for cyclosporine (Sandimmune). The nurse finds that cyclosporine-modified (Neoral) is available in the automated medication cabinet. Which action by the nurse is correct?

a. Hold the dose until the prescriber makes rounds.

b. Give the cyclosporine-modified drug.

c. Double-check the order, and then give the cyclosporine-modified drug.

d. Notify the pharmacy to obtain the Sandimmune form of the drug.

ANS: D

The nurse must double-check the formulation before giving cyclosporine. Cyclosporine-modified products (such as Neoral or Gengraf) are interchangeable with each other but are not interchangeable with Sandimmune. In this case, the nurse must obtain the Sandimmune form of the drug from the pharmacy. The other options are incorrect.

DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 778

TOP: NURSING PROCESS: Implementation

4. The nurse is preparing to administer an injection of monoclonal antibodies. Which additional drug will the nurse administer to minimize adverse reactions to the monoclonal antibodies?

a. A nonsteroidal anti-inflammatory drug

b. A benzodiazepine

c. An opioid pain reliever

d. A corticosteroid

ANS: D

The monoclonal antibodies basiliximab and daclizimab have a tendency to cause the allergy-like reaction known as cytokine release syndrome, which can be severe and even involve anaphylaxis. In an effort to avoid or alleviate this problem, it is recommended that an injection of a corticosteroid, such as methylprednisolone, be administered before the injection of monoclonal antibodies.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773

TOP: NURSING PROCESS: Implementation

5. When administering cyclosporine, the nurse notes that allopurinol is also ordered for the patient. What is a potential result of this drug interaction?

a. Reduced adverse effects of the cyclosporine

b. Increased levels of cyclosporine and toxicity

c. Reduced uric acid levels

d. Reduced nephrotoxic effects of cyclosporine

ANS: B

The allopurinol may cause increased levels of cyclosporine, and toxicity may result. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 774

TOP: NURSING PROCESS: Planning

6. The nurse is monitoring a patient who is receiving muromonab-CD3 (Orthoclone OKT3) after an organ transplant. Which effect is possible with muromonab-CD3 therapy?

a. Chest pain

b. Hypotension

c. Confusion

d. Dysuria

ANS: A

Muromonab-CD3 may cause chest pain, fever, chills, tremor, gastrointestinal disturbances (nausea, vomiting, diarrhea), and other effects as noted in Table 48-2. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773

TOP: NURSING PROCESS: Evaluation

7. When monitoring a patient who is on immunosuppressant therapy with azathioprine (Imuran), the nurse will monitor which laboratory results?

a. Serum potassium levels

b. White blood cell (leukocyte) count

c. Red blood cell count

d. Serum albumin levels

ANS: B

Leukopenia is a potential adverse effect of azathioprine therapy, so white blood cells need to be monitored. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773

TOP: NURSING PROCESS: Evaluation

8. A patient with multiple sclerosis will be starting therapy with an immunosuppressant drug. The nurse expects that which drug will be used?

a. Azathioprine (Imuran)

b. Glatiramer acetate (Copaxone)

c. Daclizumab (Zenapax)

d. Sirolimus (Rapamune)

ANS: B

Glatiramer acetate and fingolimod are the only immunosuppressants currently indicated for reduction of the frequency of relapses (exacerbations) in a type of multiple sclerosis known as relapsing-remitting multiple sclerosis.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 771

TOP: NURSING PROCESS: Planning

9. Cyclosporine is prescribed for a patient who had an organ transplant. The nurse will monitor the patient for which common adverse effect?

a. Nausea and vomiting

b. Fever and tremors

c. Agitation

d. Hypertension

ANS: D

Moderate hypertension may occur in as much as 50% of patients taking cyclosporine. The other options are potential adverse effects of other immunosuppressant drugs.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 777

TOP: NURSING PROCESS: Evaluation

1. The nurse follows which procedures when giving intravenous (IV) cyclosporine? (Select all that apply.)

a. Administering it as a single IV bolus injection to minimize adverse effects

b. Using an infusion pump to administer this medication

c. Monitoring the patient for potential delayed adverse effects, which may be severe

d. Monitoring the patient closely for the first 30 minutes for severe adverse effects

e. Checking blood levels periodically during cyclosporine therapy

f. Performing frequent oral care during therapy

ANS: B, D, E, F

Cyclosporine is infused intravenously with an infusion pump, not as an IV bolus. Monitor the patient closely for the first 30 minutes for adverse effects, especially for allergic reactions, and monitor blood levels periodically to ensure therapeutic, not toxic, levels of the medication. Perform oral hygiene frequently to prevent dry mouth and subsequent infections.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 778

TOP: NURSING PROCESS: Implementation

2. A patient has started azathioprine (Imuran) therapy as part of renal transplant surgery. The nurse will monitor for which expected adverse effect of azathioprine therapy? (Select all that apply.)

a. Tremors

b. Leukopenia

c. Diarrhea

d. Thrombocytopenia

e. Hepatotoxicity

f. Fluid retention

ANS: B, D, E

Leukopenia is an expected adverse effect of azathioprine therapy, as are thrombocytopenia and hepatotoxicity. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 773

TOP: NURSING PROCESS: Evaluation

1. A patient will be on a tacrolimus (Prograf) infusion after receiving a liver transplant. The order reads, "Give 0.03 mg/kg/day as a continuous IV infusion." The patient weighs 159 pounds, and the medication injection solution is available in a 5-mg/mL strength. Identify how many milliliters will the nurse draw up for this infusion. (record answer using two decimal places) _______

ANS:

0.43 mL

DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A

TOP: NURSING PROCESS: Implementation

1. When monitoring a patient's response to interferon therapy, the nurse notes that the major dose-limiting factor for interferon therapy is which condition?

a. Diarrhea

b. Fatigue

c. Anxiety

d. Nausea and vomiting

ANS: B

Patients who receive interferon therapy may experience flu-like symptoms: fever, chills, headache, malaise, myalgia, and fatigue. Fatigue is the major dose-limiting factor for interferon therapy. Patients taking high dosages become so exhausted that they are commonly confined to bed.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 754

TOP: NURSING PROCESS: Evaluation

2. A patient asks about his cancer treatment with monoclonal antibodies. The nurse tells him that which is the major advantage of treating certain cancers with monoclonal antibodies?

a. They will help the patient improve more quickly than will other antineoplastic drugs.

b. They are more effective against metastatic tumors.

c. Monoclonal antibodies target certain tumor cells and bypass normal cells.

d. There are fewer incidences of opportunistic infections with monoclonal antibodies.

ANS: C

Monoclonal antibodies can target cancer cells specifically and have minimal effects on healthy cells, unlike conventional cancer treatments. As a result, there are fewer adverse effects when compared to traditional antineoplastic therapy. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 755

TOP: NURSING PROCESS: Planning

3. During a patient's therapy with interleukins, the nurse monitors the patient for capillary leak syndrome. Which assessment finding, if present, would indicate this problem?

a. Bradycardia

b. A dry cough

c. Bruising on the skin

d. A sudden, 15-pound weight gain

ANS: D

With capillary leak syndrome, the capillaries lose their ability to retain vital colloids, and these substances migrate into the surrounding tissues, resulting in massive fluid retention. As a result, heart failure, myocardial infarction, and dysrhythmias may occur. The other options do not reflect capillary leak syndrome.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 760

TOP: NURSING PROCESS: Assessment

4. A patient who has received chemotherapy has a critically low platelet count. The nurse expects which drug or drug class to be used to stimulate platelet cell production?

a. Filgrastim (Neupogen)

b. Interferons

c. Oprelvekin (Neumega)

d. Epoetin alfa (Epogen)

ANS: C

Oprelvekin (Neumega) stimulates bone marrow cells, specifically megakaryocytes, which eventually form platelets. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 753

TOP: NURSING PROCESS: Planning

5. A patient who has received chemotherapy has a steadily decreasing white blood cell count. The chemotherapy will end on Tuesday afternoon. The oncologist has mentioned that a colony-stimulating factor will be started soon. The nurse knows that the appropriate time to start this medication is when?

a. While the patient is still receiving chemotherapy

b. Two hours after the chemotherapy ends

c. Wednesday afternoon, 24 hours after the chemotherapy ends

d. In 2 to 4 days, after the white blood cells have reached their nadir

ANS: C

Drugs that are given to enhance the activity of bone marrow cells interfere directly with the action of myelosuppressive cancer therapy. For this reason, therapy with colony-stimulating factors usually begins 24 hours after the chemotherapy has been completed.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 752

TOP: NURSING PROCESS: Planning

6. A patient has an order for the monoclonal antibody adalimumab (Humira). The nurse notes that the patient does not have a history of cancer. What is another possible reason for administering this drug?

a. Severe anemia

b. Rheumatoid arthritis

c. Thrombocytopenia

d. Osteoporosis

ANS: B

Monoclonal antibodies are used for the treatment of cancer, rheumatoid arthritis and other inflammatory diseases, multiple sclerosis, and organ transplantation.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 757

TOP: NURSING PROCESS: Assessment

7. During interleukin drug therapy, a patient is showing signs of severe fluid retention, with increasing dyspnea and severe peripheral edema. The next dose of the interleukin is due now. Which action will the nurse take next?

a. Hold the drug, and notify the prescriber.

b. Give the drug, and notify the prescriber.

c. Give the drug along with acetaminophen and diphenhydramine (Benadryl).

d. Monitor the patient for 2 hours, and then give the drug if the patient's condition improves.

ANS: A

The fluid retention that may occur with interleukin therapy is reversible; if therapy is stopped, the prescriber must be notified. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 760

TOP: NURSING PROCESS: Implementation

8. The nurse is administering an interferon and will implement which intervention?

a. Giving the medication with meals

b. Monitoring daily weights

c. Limiting fluids while the patient is taking this medication

d. Rotating sites if administered subcutaneously

ANS: D

Interferon is given parenterally (not orally), and injection sites need to be rotated. Fluids need to be increased during interferon therapy. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 766

TOP: NURSING PROCESS: Implementation

9. Abatacept (Orencia) is prescribed for a patient with severe rheumatoid arthritis. The nurse checks the patient's medical history, knowing that this medication would need to be used cautiously if which condition is present?

a. Coronary artery disease

b. Chronic obstructive pulmonary disease

c. Diabetes mellitus

d. Hypertension

ANS: B

Abatacept must be used cautiously in patients with recurrent infections or chronic obstructive pulmonary disease. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 762

TOP: NURSING PROCESS: Assessment

10. Aldesleukin [IL-2] (Proleukin) is prescribed for a patient. The nurse reviews the patient's medication list and would note a potential drug interaction if which drug class is also ordered?

a. Anticoagulants

b. Antiepileptic drugs

c. Oral hypoglycemic drugs

d. Antihypertensive drugs

ANS: D

Aldesleukin, when given with antihypertensives, can produce additive hypotensive effects. The other responses are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 760

TOP: NURSING PROCESS: Assessment

1. During therapy with hematopoietic drugs, the nurse will monitor the patient for which adverse effects? (Select all that apply.)

a. Hypotension

b. Edema

c. Diarrhea

d. Black, tarry stools

e. Nausea and vomiting

f. Headache

ANS: B, C, E, F

Potential adverse effects of hematopoietic drugs include edema, anorexia, nausea, vomiting, diarrhea, dyspnea, fever, and headache. See Table 47-1 for a complete list. The other options are not adverse effects of these drugs.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 752

TOP: NURSING PROCESS: Evaluation

1. A patient is to receive filgrastim (Neupogen) 5 mcg/kg/day. The patient weighs 198 pounds. Identify how many micrograms of medication will this patient receive each day. _______

ANS:

450 mcg

Convert pounds to kilograms:

Calculate mcg/day for this patient:

DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A

TOP: NURSING PROCESS: Implementation

2. A patient will be receiving aldesleukin [IL-2] (Proleukin), 600,000 IU/kg every 8 hours for 14 doses. The patient weighs 220 pounds. Identify how many IU of medication will this patient receive per dose. _______

ANS:

60 million (60,000,000) IU

Convert pounds to kilograms:

Calculate IU/kg for this patient:

DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A

TOP: NURSING PROCESS: Implementation

1. A patient is receiving doxorubicin (Adriamycin) as part of treatment for ovarian cancer. Which nursing diagnosis is related to this antineoplastic drug?

a. Decreased cardiac output related to the adverse effect of cardiotoxicity

b. Ineffective breathing pattern related to the adverse effect of pulmonary toxicity

c. Risk for injury related to the effects of neurotoxicity (ataxia, numbness of hands and feet)

d. Impaired urinary elimination pattern related to hyperuricemia

ANS: A

Decreased cardiac output related to the adverse effect of cardiotoxicity is a nursing diagnosis related to doxorubicin because adverse effects of doxorubicin include liver and cardiovascular toxicities. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 742

TOP: NURSING PROCESS: Nursing Diagnosis

2. When giving cisplatin (Platinol-AQ), the nurse is aware that the major dose-limiting effect of this drug is which condition?

a. Alopecia

b. Kidney damage

c. Cardiotoxicity

d. Stomatitis

ANS: B

Cisplatin may cause nephrotoxicity, and the patient's renal function must be monitored closely while on this drug. Ensuring hydration will help to prevent nephrotoxicity.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 735

TOP: NURSING PROCESS: Implementation

3. The nurse is teaching a class about the various chemotherapy drugs. Which of these statements explains why alkylating drugs are also called "cell cycle-nonspecific drugs"?

a. They are cytotoxic during a specific cell cycle.

b. They are cytotoxic in any phase of the cell cycle.

c. They are effective against several types of neoplasms.

d. They are more highly differentiated than cell cycle-specific drugs.

ANS: B

Cell cycle-nonspecific drugs kill cancer cells during any phase of the growth cycle, whereas cell cycle-specific drugs kill cancer cells during specific phases of the cell growth cycle. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 734

TOP: NURSING PROCESS: Evaluation

4. What is the nurse's priority action if extravasation of an antineoplastic drug occurs during intravenous (IV) administration?

a. Reduce the infusion rate.

b. Discontinue the IV, and apply warm compresses.

c. Stop the infusion immediately, but leave the IV catheter in place.

d. Change the infusion to normal saline, and inject the area with hydrocortisone.

ANS: C

If extravasation is suspected, administration of the drug must be stopped immediately but the IV catheter left in place and the appropriate antidote instilled through the existing IV tube, after which the needle may be removed. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 736

TOP: NURSING PROCESS: Implementation

5. A patient is receiving a third session of chemotherapy with daunorubicin (Cerubidine). The nurse will assess the patient for which signs of a potential severe toxic effect of this drug?

a. Tinnitus and hearing loss

b. Numbness and tingling in the fingers

c. A weight gain of 2 pounds or more in 24 hours

d. Decreased blood urea nitrogen and creatinine levels

ANS: C

Cardiac toxicity may occur, so frequent checking of heart and breath sounds is necessary and daily weights need to be recorded (with reporting of an increase of 2 pounds or more in 24 hours or 5 pounds or more in 1 week).

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 743

TOP: NURSING PROCESS: Assessment

6. When hanging a new infusion bag of a chemotherapy drug, the nurse accidentally spills a small amount of the solution onto the floor. Which action by the nurse is appropriate?

a. Let it dry, and then mop the floor.

b. Wipe the area with a disposable paper towel.

c. Use a spill kit to clean the area.

d. Ask the housekeeping department to clean the floor.

ANS: C

Special spill kits are employed to clean up even the smallest chemotherapy spills. These precautions are necessary to protect the health care provider from the cytotoxic effects of these drugs.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 741

TOP: NURSING PROCESS: Implementation

7. Just before the second course of chemotherapy, the laboratory calls to report that the patient's neutrophil count is 450 cells/mm3. The nurse expects that the oncologist will follow which course of treatment?

a. Chemotherapy will continue as scheduled.

b. Chemotherapy will resume with a lowered dosage.

c. Chemotherapy will resume after a transfusion of neutrophils.

d. Chemotherapy will be withheld until the neutrophil count returns toward normal levels.

ANS: D

The normal range for neutrophils is above 1500 cells/mm3. If neutrophils are decreased to levels of less than 500 cells/mm3 (neutropenia), there is risk for severe infection. Chemotherapy will be held until the count returns toward normal levels.

DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 744

TOP: NURSING PROCESS: Evaluation

8. A female patient is receiving palliative therapy with androgen hormones as part of treatment for inoperable breast cancer. The nurse will discuss with the patient which potential body image changes that may occur as adverse effects?

a. Hirsutism and acne

b. Weight gain

c. Flushing and hot flashes

d. Alopecia and body odor

ANS: A

Androgens used for cancer treatment, such as fluoxymesterone and testolactone, can cause menstrual irregularities, virilization of female, gynecomastia, hirsutism, acne, anxiety, headache, and nausea. The patient needs to be told of these effects before therapy begins. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 738

TOP: NURSING PROCESS: Planning

9. During chemotherapy, a patient develops severe diarrhea caused by a vasoactive intestinal peptide-secreting tumor (VIPoma). The nurse expects to administer which drug for this problem?

a. Dexrazoxane (Zinecard)

b. Allopurinol (Zyloprim)

c. Octreotide (Sandostatin)

d. Bismuth subsalicylate (Pepto-Bismol)

ANS: C

Octreotide (Sandostatin) is used for the management of a cancer-related condition called carcinoid crisis and treatment of the severe diarrhea caused by vasoactive intestinal peptide-secreting tumors (VIPomas). The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 740

TOP: NURSING PROCESS: Planning

1. The nurse is assessing a patient who is receiving chemotherapy with an alkylating drug. Which assessment findings would be considered indications of an oncologic emergency? (Select all that apply.)

a. Dry, "scratchy," or "swollen" throat

b. Loss of hair

c. Decreased red blood cell count

d. White patches in the mouth or throat

e. Temperature of 100.7° F (38.2° C)

f. Decreased urine output

ANS: A, D, E, F

Indications of an oncologic emergency include fever and/or chills with a temperature higher than 100.5° F (38.1° C); new sores or white patches in the mouth or throat; changes in bladder function or patterns; dry, burning, "scratchy," or "swollen" throat; and other signs and symptoms (see Box 46-4). The prescriber must be contacted immediately if any of the listed signs or symptoms occur. Loss of hair and decreased red blood cell count (a result of bone marrow suppression) are expected effects of chemotherapy.

DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 744

TOP: NURSING PROCESS: Assessment

2. When a patient is receiving cisplatin (Platinol-AQ) chemotherapy, the nurse will monitor for which adverse effects? (Select all that apply.)

a. Tinnitus

b. Heart failure

c. Hearing loss

d. Elevated blood urea nitrogen and creatinine levels

e. Numbness or tingling in the extremities

f. Elevated glucose and ketone levels

ANS: A, C, D, E

Cisplatin can cause nephrotoxicity, ototoxicity, and peripheral neuropathy. Nephrotoxicity is manifested by rising blood urea nitrogen and creatinine levels; ototoxicity is manifested by tinnitus, hearing loss, and dizziness; peripheral neuropathy is manifested by numbness or tingling of the extremities.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 736

TOP: NURSING PROCESS: Evaluation

1. A patient will be receiving mitoxantrone (Novantrone), 12 mg/m2 every 3 weeks, as part of treatment for prostate cancer. Each dose is mixed into a 50-mL bag of D5W and needs to infuse over 15 minutes. The infusion pump delivers the dose at milliliters per hour. Identify the nurse will set the pump to infuse at what rate. _______

ANS: 200 ml/hr

DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A

TOP: NURSING PROCESS: Implementation

1. One patient has cancer of the bone; another has cancer in the connective tissues of the thigh muscles; a third patient has cancer in the vascular tissues. Which of these is the correct term for these tumors?

a. Sarcoma

b. Leukemia

c. Carcinoma

d. Lymphoma

ANS: A

Sarcomas are malignant tumors that arise from connective tissues. These tissues can be found in bone, cartilage, muscle, blood, lymphatic, and vascular tissues. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 711

TOP: NURSING PROCESS: Assessment

2. A patient is receiving her third course of 5-fluorouracil therapy and knows that stomatitis is a potential adverse effect of antineoplastic therapy. What will the nurse teach her about managing this problem?

a. "You can take aspirin to prevent stomatitis."

b. "Be sure to watch for and report black, tarry stools immediately."

c. "You need to increase your intake of foods containing fiber and citric acid."

d. "Be sure to examine your mouth daily for bleeding, painful areas, and ulcerations."

ANS: D

The symptoms of stomatitis consist of pain or burning in the mouth, difficulty swallowing, taste changes, viscous saliva, dryness, cracking, and fissures, with or without bleeding mucosa. Teach patients to avoid consuming foods containing citric acid and foods that are hot or spicy or high in fiber. Assessing stools is important but is not related to stomatitis, and aspirin must not be used during this therapy.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 731

TOP: NURSING PROCESS: Implementation

3. The nurse is developing a plan of care for a patient who is experiencing gastrointestinal adverse effects, including anorexia and nausea, after the first course of antineoplastic therapy. What is an appropriate outcome for this patient when dealing with this problem?

a. The patient will eat three balanced meals a day within 2 days.

b. The patient will return to normal eating pattern within 4 weeks.

c. The patient will maintain normal weight by consuming healthy snacks as tolerated.

d. The patient will maintain a diet of small, frequent feedings with nutrition supplements within 2 weeks.

ANS: D

Consuming small, frequent meals with nutritional supplements, and maintaining a bland diet help to improve nutrition during antineoplastic therapy.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 729

TOP: NURSING PROCESS: Planning

4. A patient is receiving high doses of methotrexate and is experiencing severe bone marrow suppression. The nurse expects which intervention to be ordered with this drug to reduce this problem?

a. A transfusion of whole blood

b. Leucovorin rescue

c. Therapy with filgrastim (Neupogen)

d. Administration of allopurinol (Zyloprim)

ANS: B

High-dose methotrexate is associated with bone marrow suppression, and it is always given in conjunction with the rescue drug leucovorin, which is an antidote for folic acid antagonists. Basically, leucovorin rescues the healthy cells from methotrexate. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 719

TOP: NURSING PROCESS: Implementation

5. A patient who has been on methotrexate therapy is experiencing mild pain. The patient is asking for aspirin for the pain. The nurse recognizes that which of these is true in this situation?

a. The aspirin will aggravate diarrhea.

b. The aspirin will masks signs of infection.

c. Aspirin can lead to methotrexate toxicity.

d. The aspirin will cause no problems for the patient on methotrexate.

ANS: C

Methotrexate interacts with weak organic acids, such as aspirin, and can lead to toxicity by displacing the methotrexate from protein-binding sites.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 720

TOP: NURSING PROCESS: Implementation

6. The nurse is reviewing infection-prevention measures with a patient who is receiving antineoplastic drug therapy. Which statement by the patient indicates the need for further teaching?

a. "I will avoid those who have recently had a vaccination."

b. "I will eat only fresh fruits and vegetables."

c. "I will report a sore throat, cough, or low-grade temperature."

d. "It is important for both my family and me to practice good hand washing."

ANS: B

Patients who are neutropenic and susceptible to infections need to adhere to a low-microbe diet by washing fresh fruits and vegetables and making sure foods are well cooked. The other options are correct.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 729

TOP: NURSING PROCESS: Implementation

7. The nurse is administering a combination of three different antineoplastic drugs to a patient who has metastatic breast cancer. Which statement best describes the rationale for combination therapy?

a. There will be less nausea and vomiting.

b. Increased cancer-cell killing will occur.

c. The drugs will prevent metastasis.

d. Combination therapy reduces the need for radiation therapy.

ANS: B

Because drug-resistant cells commonly develop, exposure to multiple drugs with multiple mechanisms and sites of action will destroy more subpopulations of cells. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 715

TOP: NURSING PROCESS: Planning

8. A patient is receiving irinotecan (Camptosar), along with other antineoplastic drugs, as treatment for ovarian cancer. The nurse will monitor for which potentially life-threatening adverse effect that is associated with this drug?

a. Severe stomatitis

b. Bone marrow suppression

c. Delayed-onset cholinergic diarrhea

d. Immediate and severe nausea and vomiting

ANS: C

In addition to producing hematologic adverse effects, irinotecan has been associated with severe diarrhea, known as cholinergic diarrhea, which may occur during infusions. Delayed diarrhea may occur 2 to 10 days after infusion of irinotecan. It is recommended that this condition be treated with atropine unless use of that drug is strongly contraindicated. This diarrhea can be severe and even life threatening.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 723

TOP: NURSING PROCESS: Evaluation

9. The nurse is monitoring a patient who has severe bone marrow suppression following antineoplastic drug therapy. Which is considered a principal early sign of infection?

a. Fever

b. Diaphoresis

c. Tachycardia

d. Elevated white blood cell count

ANS: A

Fever and/or chills may be the first sign of an oncoming infection. Elevated white blood cell count will not occur because of the bone marrow suppression. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 729

TOP: NURSING PROCESS: Assessment

10. A patient, diagnosed with lymphoma, has an allergy to one of the proposed chemotherapy drugs. The tumor has not responded to other types of treatment. The nurse expects the oncologist to follow which course of treatment?

a. The physician will choose another drug to use.

b. The chemotherapy will be given along with supportive measures to treat a possible allergic reaction.

c. The patient will receive reduced doses of chemotherapy for a longer period of time.

d. The chemotherapy cannot be given because of the patient's allergy.

ANS: B

Even if a patient has a known allergic reaction to a given antineoplastic medication, the urgency of treating the patient's cancer may still necessitate administering the medication and then treating any allergic symptoms with supportive medications, such as antihistamines, corticosteroids, and acetaminophen.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 717

TOP: NURSING PROCESS: Planning

11. During treatment of a patient who has brain cancer, the nurse hears the oncologist mention that the patient has reached the "nadir." The nurse knows that this term means which of these?

a. The lowest level of neutrophils reached during therapy.

b. The highest level of neutrophils reached during therapy.

c. The point at which the adverse effects of chemotherapy will stop.

d. The point at which the cytotoxic action against cancer cells is the highest.

ANS: A

The lowest neutrophil count reached after a course of chemotherapy is known as the nadir. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 717

TOP: NURSING PROCESS: Implementation

1. Methotrexate is ordered for a patient with a malignant tumor, and the nurse is providing education about self-care after the chemotherapy is given. Which statements by the nurse are appropriate for the patient receiving methotrexate? (Select all that apply.)

a. Report unusual bleeding or bruising.

b. Hair loss is not expected with this drug.

c. Prepare for hair loss.

d. Avoid areas with large crowds or gatherings.

e. Avoid foods that are too hot or too cold or rough in texture.

f. Restrict fluid intake to reduce nausea and vomiting.

ANS: A, C, D, E

Counsel patients who are taking methotrexate to expect hair loss and to report any unusual bleeding or bruising. Because of the possibility of infection, avoid areas with large crowds or gatherings. Foods that are too hot or too cold or rough in texture may be irritating to the oral mucosa. Fluid intake is to be encouraged to prevent dehydration.

DIF: COGNITIVE LEVEL: Applying (Application) REF: pp. 731-732

TOP: NURSING PROCESS: Implementation

2. When giving chemotherapy as cancer treatment, the nurse recognizes that toxicity to rapidly growing normal cells also occurs. Which rapidly growing normal cells are also harmed by chemotherapy? (Select all that apply.)

a. Bone marrow cells

b. Retinal cells

c. Hair follicle cells

d. Nerve myelin cells

e. Gastrointestinal (GI) mucous membrane cells

ANS: A, C, E

Chemotherapy toxicities generally stem from the fact that chemotherapy drugs affect rapidly dividing cells—both harmful cancer cells and healthy, normal cells. Three types of rapidly dividing human cells are the cells of hair follicles, GI tract cells, and bone marrow cells. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 725

TOP: NURSING PROCESS: Implementation

1. A patient is to receive a daily dose of fludarabine (Fludara), 25 mg/m2/day for 5 consecutive days. Each dose is diluted in a 125-mL bag of normal saline and is to infuse over 30 minutes. The nurse will set the infusion pump to what rate in milliliters per hour? _______

ANS: 250 ml/hr

DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A

TOP: NURSING PROCESS: Implementation

The patient is receiving two different drugs. At current dosages and dosage forms, both drugs are absorbed into the circulation in identical amounts. Which term is used to identify this principle?

a. Bioequivalent

b. Synergistic

c. Prodrugs

d. Steady state

A

(Two drugs absorbed into the circulation in the same amount (in specific dosage forms) have the same bioavailability; thus, they are bioequivalent. A drug's steady state is the physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed from each dose. The term synergistic refers to two drugs, given together, with a resulting effect that is greater than the sum of the effects of each drug given alone. A prodrug is an inactive drug dosage form that is converted to an active metabolite by various biochemical reactions once it is inside the body.)

When given an intravenous medication, the patient says to the nurse, "I usually take pills. Why does this medication have to be given in the arm?" What is the nurse's best answer?

a. "The medication will cause fewer adverse effects when given intravenously."

b. "The intravenous medication will have delayed absorption into the body's tissues."

c. "The action of the medication will begin sooner when given intravenously."

d. "There is a lower chance of allergic reactions when drugs are given intravenously."

C

(An intravenous (IV) injection provides the fastest route of absorption. The IV route does not affect the number of adverse effects, nor does it cause delayed tissue absorption (it results in faster absorption). The IV route does not affect the number of allergic reactions.)

The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs?

a. Parenteral drugs bypass the first-pass effect.

b. Absorption of parenteral drugs is affected by reduced blood flow to the stomach.

c. Absorption of parenteral drugs is faster when the stomach is empty.

d. Parenteral drugs exert their effects while circulating in the bloodstream.

A

(Drugs given by the parenteral route bypass the first-pass effect. Reduced blood flow to the stomach and the presence of food in the stomach apply to enteral drugs (taken orally), not to parenteral drugs. Parenteral drugs must be absorbed into cells and tissues from the circulation before they can exert their effects; they do not exert their effects while circulating in the bloodstream.)

When monitoring the patient receiving an intravenous infusion to reduce blood pressure, the nurse notes that the patient's blood pressure is extremely low, and the patient is lethargic and difficult to awaken. This would be classified as which type of adverse drug reaction?

a. Adverse effect

b. Allergic reaction

c. Idiosyncratic reaction

d. Pharmacologic reaction

D

(A pharmacologic reaction is an extension of a drug's normal effects in the body. In this case, the antihypertensive drug lowered the patient's blood pressure levels too much. The other options do not describe a pharmacologic reaction. An adverse effect is a predictable, well-known adverse drug reaction that results in minor or no changes in patient management. An allergic reaction (also known as a hypersensitivity reaction) involves the patient's immune system. An idiosyncratic reaction is unexpected and is defined as a genetically determined abnormal response to normal dosages of a drug.)

The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drug's half-life?

a. The time it takes for the drug to cause half of its therapeutic response

b. The time it takes for one half of the original amount of a drug to reach the target

cells

c. The time it takes for one half of the original amount of a drug to be removed from

the body

d. The time it take

C

(drug's half-life is the time it takes for one half of the original amount of a drug to be removed from the body. It is a measure of the rate at which drugs are removed from the body. The other options are incorrect definitions of half-life.)

When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these?

a. The time it takes for a drug to elicit a therapeutic response

b. The amount of time needed to remove a drug from circulation

c. The time it takes for a drug to achieve its maximum therapeutic response

d. The time period at which a drug's concentration is sufficient to cause a therapeutic response

D

(Duration of action is the time during which drug concentration is sufficient to elicit a therapeutic response. The other options do not define duration of action. A drug's onset of action is the time it takes for the drug to elicit a therapeutic response. A drug's peak effect is the time it takes for the drug to reach its maximum therapeutic response. Elimination is the length of time it takes to remove a drug from circulation.)

When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective enzyme interaction. Which of these processes describes selective enzyme interaction?

a. The drug alters cell membrane permeability.

b. The drug's effectiveness within the cell walls of the target tissue is enhanced.

c. The drug is attracted to a receptor on the cell wall, preventing an enzyme from

binding to that receptor.

d. The drug binds to an enzyme molecule and inhibits or enhances the enzyme's

action with the normal target cell.

D

(With selective enzyme interaction, the drug attracts the enzymes to bind with the drug instead of allowing the enzymes to bind with their normal target cells. As a result, the target cells are protected from the action of the enzymes. This results in a drug effect. The actions described in the other options do not occur with selective enzyme interactions.)

When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patient's albumin levels are normal, the nurse would expect which result, as compared to a medication that is not highly protein bound?

a. Renal excretion will be faster.

b. The drug will be metabolized quickly.

c. The duration of action of the medication will be shorter.

d. The duration of action of the medication will be longer.

D

(Drugs that are bound to plasma proteins are characterized by longer duration of action. Protein binding does not make renal excretion faster, does not speed up drug metabolism, and does not cause the duration of action to be shorter.)

The patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where does the nurse instruct the patient to place the tablet?

a. Under the tongue

b. On top of the tongue

c. At the back of the throat

d. In the space between the cheek and the gum

A

(Drugs administered via the sublingual route are placed under the tongue. Drugs administered via the buccal route are placed in the space between the cheek and the gum; oral drugs are swallowed. The other options are incorrect.)

The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease. The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase?

a. Absorption

b. Distribution

c. Metabolism

d. Excretion

D

(The kidneys are the organs that are most responsible for drug excretion. Renal function does not affect the absorption and distribution of a drug. Renal function may affect metabolism of drugs to a small extent.)

patient who has advanced cancer is receiving opioid medications around the clock to keep him comfortable as he nears the end of his life. Which term best describes this type of therapy?

a. Palliative therapy

b. Maintenance therapy

c. Empiric therapy

d. Supplemental therapy

A

(The goal of palliative therapy is to make the patient as comfortable as possible. It is typically used in the end stages of illnesses when all attempts at curative therapy have failed. Maintenance therapy is used for the treatment of chronic illnesses such as hypertension. Empiric therapy is based on clinical probabilities and involves drug administration when a certain pathologic condition has an uncertain but high likelihood of occurrence based on the patient's initial presenting symptoms. Supplemental (or replacement therapy) supplies the body with a substance needed to maintain normal function.)

patient is complaining of a headache and asks the nurse which over-the-counter medication form would work the fastest to help reduce the pain. Which medication form will the nurse suggest?

a. A capsule

b. A tablet

c. An enteric-coated tablet

d. A powder

D

(Of the types of oral medications listed, the powder form would be absorbed the fastest, thus having a faster onset. The tablet, the capsule, and, finally, the enteric-coated tablet would be absorbed next, in that order.)

The nurse will be injecting a drug into the fatty tissue of the patient's abdomen. Which route does this describe?

a. Intradermal b. Subcutaneous c. Intramuscular d. Transdermal

B

(Injections into the fatty subcutaneous tissue under the dermal layer of skin are referred to as subcutaneous injections. Injections under the more superficial skin layers immediately underneath the epidermal layer of skin and into the dermal layer are known as intradermal injections. Injections into the muscle beneath the subcutaneous fatty tissue are referred to as intramuscular injections. Transdermal drugs are applied to the skin via an adhesive patch.)

Which drugs would be affected by the first-pass effect? (Select all that apply.)

a. Morphine given by IV push injection

b. Sublingual nitroglycerin tablets

c. Diphenhydramine (Benadryl) elixir

d. Levothyroxine (Synthroid) tablets

e. Transdermal nicotine patches

f. Esomeprazole (Nexium) capsules

g. Penicillin given by IV piggyback infusion

C, D, F

(Orally administered drugs (elixirs, tablets, capsules) undergo the first-pass effect because they are metabolized in the liver after being absorbed into the portal circulation from the small intestine. IV medications (IV push and IV piggyback) enter the bloodstream directly and do not go directly to the liver. Sublingual tablets and transdermal patches also enter the bloodstream without going directly to the liver, thus avoiding the first-pass effect.)

Drug transfer to the fetus is more likely during the last trimester of pregnancy for which reason?

a. Decreased fetal surface area

b. Increased placental surface area

c. Enhanced blood flow to the fetus

d. Increased amount of protein-bound drug in maternal circulation

C

(Drug transfer to the fetus is more likely during the last trimester as a result of enhanced blood flow to the fetus. The other options are incorrect. Increased fetal surface area, not decreased, is a factor that affects drug transfer to the fetus. The placenta's surface area does not increase during this time. Drug transfer is increased because of an increased amount of free drug, not protein- bound drug, in the mother's circulation.)

The nurse is monitoring a patient who is in the 26th week of pregnancy and has developed

gestational diabetes and pneumonia. She is given medications that pose a possible fetal risk, but

the potential benefits may warrant the use of the medications in her situation. The nurse

recognizes that these medications are in which U.S. Food and Drug Administration pregnancy

safety category?

a. Category X

b. Category B

c. Category C

d. Category D

D

(Pregnancy category D fits the description given. Category B indicates no risk to animal fetus; information for humans is not available. Category C indicates adverse effects reported in animal fetus; information for humans is not available. Category X consists of drugs that should not be used in pregnant women because of reports of fetal abnormalities and positive evidence of fetal risk in humans)

When discussing dosage calculation for pediatric patients with a clinical pharmacist, the nurse notes that which type of dosage calculation is used most commonly in pediatric calculations?

a. West nomogram

b. Clark rule

c. Height-to-weight ratio

d. Milligram per kilogram of body weight formula

D

(The milligram per kilogram formula, based on body weight, is the most common method of calculating doses for pediatric patients. The other options are available methods but are not the most commonly used. Height-to-weight ratio is not used.)

The nurse is assessing a newly admitted 83-year-old patient and determines that the patient is experiencing polypharmacy. Which statement most accurately illustrates polypharmacy?

a. The patient is experiencing multiple illnesses.

b. The patient uses one medication for an illness several times per day.

c. The patient uses over-the-counter drugs for an illness.

d. The patient uses multiple medications simultaneously.

D

(Polypharmacy usually occurs when a patient has several illnesses and takes medications for each of them, possibly prescribed by different specialists who may be unaware of other treatments the patient is undergoing. The other options are incorrect. Polypharmacy addresses the medications taken, not just the illnesses. Polypharmacy means the patient is taking several different medications, not just one, and can include prescription drugs, over-the-counter medications, and herbal products.)

The nurse is aware that confusion, forgetfulness, and increased risk for falls are common responses in an elderly patient who is taking which type of drug?

a. Laxatives

b. Anticoagulants

c. Sedatives

d. Antidepressants

C

(Sedatives and hypnotics often cause confusion, daytime sedation, ataxia, lethargy, forgetfulness, and increased risk for falls in the elderly. Laxatives, anticoagulants, and antidepressants may cause adverse effects in the elderly, but not the ones specified in the question.)

For accurate medication administration to pediatric patients, the nurse must take into account which criteria?

a. Organ maturity

b. Renal output

c. Body temperature

D. Height

A

(To administer medications to pediatric patients accurately, one must take into account organ maturity, body surface area, age, and weight. The other options are incorrect; renal output and body temperature are not considerations, and height alone is not sufficient.)

The nurse recognizes that it is not uncommon for an elderly patient to experience a reduction in the stomach's ability to produce hydrochloric acid. This change may result in which effect?

a. Delayed gastric emptying

b. Increased gastric acidity

c. Decreased intestinal absorption of medications

d. Altered absorption of weakly acidic drugs

D

(Reduction in the stomach's ability to produce hydrochloric acid is an aging-related change that results in a decrease in gastric acidity and may alter the absorption of weakly acidic drugs. The other options are not results of reduced hydrochloric acid production.)

The nurse is administering drugs to neonates and will consider which factor may contribute the most to drug toxicity?

a. The lungs are immature.

b. The kidneys are small.

c. The liver is not fully developed.

d. Excretion of the drug occurs quickly.

C

(A neonate's liver is not fully developed and cannot detoxify many drugs. The other options are incorrect. The lungs and kidneys do not play major roles in drug metabolism. Renal excretion is slow, not fast, because of organ immaturity, but this is not the factor that contributes the most to drug toxicity.)

An 83-year-old woman has been given a thiazide diuretic to treat mild heart failure. She and her daughter should be told to watch for which problems?

a. Constipation and anorexia

b. Fatigue, leg cramps, and dehydration

c. Daytime sedation and lethargy

d. Edema, nausea, and blurred vision

B

(Electrolyte imbalance, leg cramps, fatigue, and dehydration are common complications when thiazide diuretics are given to elderly patients. The other options do not describe complications that occur when these drugs are given to the elderly.)

An elderly patient with a new diagnosis of hypertension will be receiving a new prescription for an antihypertensive drug. The nurse expects which type of dosing to occur with this drug therapy?

a. Drug therapy will be based on the patient's weight.

b. Drug therapy will be based on the patient's age.

c. The patient will receive the maximum dose that is expected to reduce the blood

pressure.

d. The patient will receive the lowest possible dose at first, and then the dose will be

increased as needed.

D

(As a general rule, dosing for elderly patients should follow the admonition, "Start low, and go slow," which means to start with the lowest possible dose (often less than an average adult dose) and increase the dose slowly, if needed, based on patient response. The other responses are incorrect.)

The nurse is trying to give a liquid medication to a -year-old child and notes that the

medication has a strong taste. Which technique is the best way for the nurse to give the medication to this child?

a. Give the medication with a spoonful of ice cream.

b. Add the medication to the child's bottle.

c. Tell the child you have candy for him.

d. Add the medication to a cup of milk.

A

(Ice cream or another nonessential food disguises the taste of the medication. The other options are incorrect. If the child does not drink the entire contents of the bottle, medication is wasted and the full dose is not administered. Using the word candy with drugs may lead to the child thinking that drugs are actually candy. If the medication is mixed with a cup of milk, the child may not drink the entire cup of milk, and the distasteful drug may cause the child to refuse milk in the future)

The nurse is preparing to give an injection to a 4-year-old child. Which intervention is age appropriate for this child?

a. Give the injection without any advanced preparation.

b. Give the injection, and then explain the reason for the procedure afterward.

c. Offer a brief, concrete explanation of the procedure at the patient's level and with the parent or caregiver present.

d. Prepare the child in advance with details about the procedure without the parent or caregiver present.

C

(For a 4-year-old child, offering a brief, concrete explanation about a procedure just beforehand, with the parent or caregiver present, is appropriate. The other options are incorrect for any age group.)

Which statements are true regarding pediatric patients and pharmacokinetics? (Select all that apply.)

a. The levels of microsomal enzymes are decreased.

b. Perfusion to the kidneys may be decreased and may result in reduced renal

function.

c. First-pass elimination is increased because of higher portal circulation.

d. First-pass elimination is reduced because of the immaturity of the liver.

e. Total body water content is much less than in adults.

f. Gastric emptying is slowed because of slow or irregular peristalsis.

g. Gastric emptying is more rapid because of increased peristaltic activity.

A, B, D, F

(In children, first-pass elimination by the liver is reduced because of the immaturity of the liver, and microsomal enzymes are decreased. In addition, gastric emptying is reduced because of slow or irregular peristalsis. Perfusion to the kidneys may be decreased, resulting in reduced renal function. The other options are incorrect. In addition, remember that total body water content is greater in children than in adults.)

Which statements are true regarding the elderly and pharmacokinetics? (Select all that apply.)

a. The levels of microsomal enzymes are decreased.

b. Fat content is increased because of decreased lean body mass.

c. Fat content is decreased because of increased lean body mass.

d. The number of intact nephrons is increased.

e. The number of intact nephrons is decreased.

F. Gastric pH is less acidic

G. Gastric pH is more acidic

A, b, e, f

(In the elderly, levels of microsomal enzymes are decreased because the aging liver is less able to produce them; fat content is increased because of decreased lean body mass; the number of intact nephrons is decreased as the result of aging; and gastric pH is less acidic because of a gradual reduction of the production of hydrochloric acid. The other options are incorrect statements.)

25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go "natural" with her pregnancy. She shows the nurse a list of herbal remedies that she wants to buy so that she can "avoid taking any drugs." Which statement by the nurse is correct?

a. "Most herbal remedies are not harmful and are safe for use during pregnancy."

b. "Please read each label carefully before use to check for cautionary warnings."

c. "Keep in mind that products from different manufacturers are required to contain

consistent amounts of the herbal products."

d. "It's important to remember that herbal remedies do not have proven safety ratings

for pregnant women.

D

(The fact that a drug is an herbal or a dietary supplement does not mean that it can be safely administered to children, infants, or pregnant or lactating women. Many herbal products have not been tested for safety during pregnancy. Simply reading the labels may not provide enough information for use during pregnancy. Last, manufacturers of herbal products are not required to guarantee the reliability of the contents.)

The patient is asking the nurse about current U.S. laws and regulations of herbal products. According to the Dietary Supplement and Health Education Act of 1994, which statement is true?

a. Medicinal herbs are viewed as dietary supplements.

b. Herbal remedies are held to the same standards as drugs.

c. Producers of herbal products must prove therapeutic efficacy.

d. Herbal remedies are protected by patent laws.

A

(Current U.S. laws view herbal products as dietary supplements and do not hold them to the same efficacy standards as drugs. The other options do not correctly reflect current U.S. laws regarding herbal supplements.)

The patient wants to take the herb valerian to help him rest at night. The nurse would be concerned about potential interactions if he is taking a medication from which class of drugs? a. Digitalis

b. Anticoagulants

c. Sedatives

D. Immunosuppressants

C

(Valerian may cause increased central nervous system depression if used with sedatives. Digitalis, anticoagulants, and immunosuppressants do not have interactions with valerian.)

The patient has been taking an over-the-counter (OTC) acid-reducing drug because he has had "stomach problems" for several months. He tells the nurse that the medicine helps as long as he takes it, but once he stops it, the symptoms return. Which statement by the nurse is the best advice for this patient?

a. "The over-the-counter drug has helped you, so you should continue to take it."

b. "The over-the-counter dosage may not be strong enough. You should be taking

prescription-strength for best effects."

c. "For best results, you need to watch what you eat in addition to taking this drug."

d. "Using this drug may relieve your symptoms, but it does not address the cause.

You should be seen by your health care provider."

D

(use of OTC drugs may postpone effective management of chronic disease states and may delay treatment of serious or life-threatening disorders because these drugs may relieve symptoms without necessarily addressing the cause of the disorder. The other options do not address the need to investigate the cause of the symptoms and are incorrect.)

During an assessment, the patient tells the nurse that he eats large amounts of garlic for its cardiovascular benefits. Which drug or drug class, if taken, would have a potential interaction with the garlic?

a. Acetaminophen (Tylenol)

b. Insulin

c. Antilipemic drugs

d. Sedatives

B

(The use of garlic may interfere with hypoglycemic drugs. The other options are incorrect because acetaminophen, antilipemic drugs, and sedatives do not have interactions with garlic.)

patient calls the clinic to ask about taking cranberry dietary supplement capsules because a friend recommended them. The nurse will discuss which possible concern when a patient is taking cranberry supplements?

a. It may increase the risk for bleeding if the patient is taking anticoagulants.

b. It may increase the risk of toxicity of some psychotherapeutic drugs.

c. It may reduce elimination of drugs that are excreted by the kidneys.

d. Cranberry may increase the intensity and duration of effects of caffeine.

C

(use of cranberry decreases the elimination of many drugs that are renally excreted. The other concerns do not occur with cranberry supplements.)

patient wants to take the herb gingko to help his memory. The nurse reviews his current medication list and would be concerned about potential interactions if he is taking a medication from which class of drugs?

a. Digitalis

b. Anticoagulants

c. Sedatives

d. Immunosuppressants

B

(The use of gingko increases the risk of bleeding with anticoagulants (warfarin, heparin) and antiplatelets (aspirin, clopidogrel). The other concerns do not occur with gingko supplements.)

The nurse is conducting a class for senior citizens about the use of over-the-counter (OTC) drugs. Which statements are true regarding the use of OTC drugs? (Select all that apply.)

a. Use of OTC drugs may delay treatment of serious ailments.

b. Drug interactions with OTC medications are rare.

c. OTC drugs may relieve symptoms without addressing the cause of the problem.

d. OTC drugs are indicated for long-term treatment of conditions.

e. Patients may misunderstand product labels and use the drugs improperly.

A,C, E

(It is true that use of OTC drugs may delay treatment of serious ailments; OTC drugs may relieve symptoms without addressing the cause of the problem, and patients may misunderstand product labels and use the drugs improperly. These statements should be included when teaching patients about their use. In contrast, drug interactions with OTC medications are not rare and may indeed occur with prescription medications and other OTC drugs. Normally, OTC drugs are intended for short-term treatment of minor ailments.)

The nurse is reviewing the criteria for over-the-counter drugs. Which criteria for over-the- counter status in the United States are accurate? (Select all that apply.)

a. The drug must be easy to use.

b. The drug must have a low therapeutic index.

c. The consumer must be able to monitor the drug's effectiveness.

d. The drug must have a low potential for abuse.

e. The drug must not have any interactions with other drug

A,C,D

(In the United States, criteria for over-the-counter status include the drug being easy to use, the drug having a low potential for abuse, and the consumer must be able to monitor the drug's effectiveness for the condition. The drug must have a high therapeutic index (not a low one), and the drug must have limited interactions with other drugs.)

1. When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics?

a. Tetracyclines

b. Sulfonamides

c. Cephalosporins

d. Quinolones

ANS: C

Allergy to penicillin may also result in hypersensitivity to cephalosporins. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 605

TOP: NURSING PROCESS: Assessment

2. The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct?

a. "Avoid direct sunlight and tanning beds while on this medication."

b. "Milk and cheese products result in increased levels of tetracycline."

c. "Antacids taken with the medication help to reduce gastrointestinal distress."

d. "Take the medication until you are feeling better."

ANS: A

Drug-related photosensitivity occurs when patients take tetracyclines, and it may continue for several days after therapy. Milk and cheese products result in decreased levels of tetracycline when the two are taken together. Antacids also interfere with absorption and should not be taken with tetracycline. Counsel patients to take the entire course of prescribed antibiotic drugs, even if they feel that they are no longer ill.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 620

TOP: NURSING PROCESS: Implementation

3. When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs?

a. The penicillin will cause an enhanced anticoagulant effect of the warfarin.

b. The penicillin will cause the anticoagulant effect of the warfarin to decrease.

c. The warfarin will reduce the anti-infective action of the penicillin.

d. The warfarin will increase the effectiveness of the penicillin.

ANS: A

Administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 607

TOP: NURSING PROCESS: Assessment

4. A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling "anxious" and is having trouble breathing. What will the nurse do first?

a. Notify the prescriber.

b. Take the patient's vital signs.

c. Stop the antibiotic infusion.

d. Check for allergies.

ANS: C

Hypersensitivity reactions are characterized by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash. The nurse should immediately stop the antibiotic infusion, have someone notify the prescriber, and stay with the patient to monitor the patient's vital signs and condition. Checking for allergies should have been done before the infusion.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 618

TOP: NURSING PROCESS: Planning

5. A patient is admitted with a fever of 102.8° F (39.3° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain stat urine and blood cultures and to administer an antibiotic intravenously. The nurse will complete these orders in which sequence?

a. Blood culture, antibiotic dose, urine culture

b. Urine culture, antibiotic dose, blood culture

c. Antibiotic dose, blood and urine cultures

d. Blood and urine cultures, antibiotic dose

ANS: D

Culture specimens should be obtained before initiating antibiotic drug therapy; otherwise, the presence of antibiotics in the tissues may result in misleading culture and sensitivity results. The other responses are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 617

TOP: NURSING PROCESS: Implementation

6. During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse's best advice to the patient?

a. "Take it with cheese and crackers or yogurt."

b. "Take each dose with a glass of milk."

c. "Take an antacid with each dose as needed."

d. "Drink a full glass of water with each dose."

ANS: D

Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset; however, antacids and dairy products will bind with the tetracycline and make it inactive.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 619

TOP: NURSING PROCESS: Implementation

7. The nurse is monitoring a patient who has been on antibiotic therapy for 2 weeks. Today the patient tells the nurse that he has had watery diarrhea since the day before and is having abdominal cramps. His oral temperature is 101° F (38.3° C). Based on these findings, which conclusion will the nurse draw?

a. The patient's original infection has not responded to the antibiotic therapy.

b. The patient is showing typical adverse effects of antibiotic therapy.

c. The patient needs to be tested for Clostridium difficile infection.

d. The patient will need to take a different antibiotic.

ANS: C

Antibiotic-associated diarrhea is a common adverse effect of antibiotics. However, it becomes a serious superinfection when it causes antibiotic-associated colitis, also known as pseudomembranous colitis or simply C. difficile infection. This happens because antibiotics disrupt the normal gut flora and can cause an overgrowth of Clostridium difficile. The most common symptoms of C. difficile colitis are watery diarrhea, abdominal pain, and fever. Whenever a patient who was previously treated with antibiotics develops watery diarrhea, the patient needs to be tested for C. difficile infection. If the results are positive, the patient will need to be treated for this serious superinfection.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 602

TOP: NURSING PROCESS: Evaluation

8. The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy?

a. Increased red blood cell count

b. Increased hemoglobin level

c. Decreased white blood cell count

d. Decreased platelet count

ANS: C

Decreased white blood cell counts are an indication of reduction of infection and are a therapeutic effect of antibiotic therapy. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 620

TOP: NURSING PROCESS: Evaluation

9. The nurse is reviewing the sputum culture results of a patient with pneumonia and notes that the patient has a gram-positive infection. Which generation of cephalosporin is most appropriate for this type of infection?

a. First generation

b. Second generation

c. Third generation

d. Fourth generation

ANS: A

First-generation cephalosporins provide excellent coverage against gram-positive bacteria but limited coverage against gram-negative bacteria.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 610

TOP: NURSING PROCESS: Implementation

10. A patient will be having oral surgery and has received an antibiotic to take for 1 week before the surgery. The nurse knows that this is an example of which type of therapy?

a. Empiric

b. Prophylactic

c. Definitive

d. Resistance

ANS: B

Prophylactic antibiotic therapy is used to prevent infection.

Empiric therapy involves selecting the antibiotic that can best kill the microorganisms known to be the most common causes of an infection.

Definitive therapy occurs once the culture and sensitivity results are known.

Resistance is not a type of antibiotic therapy.

11. A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections?

a. Macrolides

b. Carbapenems

c. Sulfonamides

d. Tetracyclines

ANS: C

Sulfonamides achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, they are often used in the treatment of urinary tract infections.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 604

TOP: NURSING PROCESS: Implementation

12. During drug therapy for pneumonia, a female patient develops a vaginal superinfection. The nurse explains that this infection is caused by:

a. large doses of antibiotics that kill normal flora.

b. the infection spreading from her lungs to the new site of infection.

c. resistance of the pneumonia-causing bacteria to the drugs.

d. an allergic reaction to the antibiotics.

ANS: A

Normally occurring bacteria are killed during antibiotic therapy, allowing other flora to take over and resulting in superinfections. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 602

TOP: NURSING PROCESS: Implementation