. A patient must be treated immediately for acute organ transplant rejection. The nurse anticipates that muromonab-CD3 (Orthoclone OKT3) will be ordered.
... [Show More] 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 [Show Less]