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Question 1 A client’s serum protein and albumin levels are below normal values. For a drug that is highly protein- bound, there would be: Answers: 1. more drug bound to protein
- more drug excreted in the urine
- More free drug in circulation
- less free drug in circulation Response Feedback: With less protein available, less drug is attached to protein. Drugs that are not protein-bound are active or free.
• Question 2
A client is taking a drug that is highly protein-bound. Several days later, the client takes a second drug that is 50% protein-bound. What happens to the first drug that is moderately highly protein-bound? Answers:
- The first drug remains protein-bound.
- The first drug is released from the protein and becomes more pharmacologically active.
- The first drug becomes increasingly active.
- The second drug becomes more active. Response Feedback: 90% protein binding is considered very highly bound. When taken by the client, it would displace the moderately highly protein-bound medication and make the first drug free in the circulation and active.
• Question 3
A client is suffering from end-stage renal disease. Because of this condition, the nurse monitors drug levels to assess for: Answers: 1. drug ineffectiveness
- subtherapeutic levels
- poor compliance
- accumulation Response Feedback: Although some medications are excreted via the skin and feces, the primary route for drug elimination is the renal system. If kidney function is impaired, drugs may reach toxic levels.
• Question 4
A nurse working in an obstetrics clinic is reviewing the pregnancy classification of drugs. The FDA developed a pregnancy classification regarding drug effects on an unborn child (fetus). The two drug categories that are considered safe to use during pregnancy are: Answers: 1. categories B and C
- categories A and D
- categories C and D
- categories A and B Response Feedback: This is the definition of these categories; the others are not considered safe.
• Question 5
A nurse is soliciting a history from a woman of childbearing years and the client believes she may be pregnant. She is taking a medication that the nurse discovers is category X. The description for pregnancy category X is: Answers: 1. no risk to fetus
- animal studies indicate a risk to the fetus
- a risk to the human fetus has been proven
- no risk in animal studies Response Feedback: This is the definition of category X. This medication would be contraindicated.
• Question 6
Which of the following statements by a client who is undergoing anti neoplastic therapy would be of concern to he nurse? (MARK ALL THAT APPLY) Answers: "I have attended a meeting of a cancer support group" "I am eating six small meals plus two protein shakes a day." "My husband and I are planning a short trip next week" "I am going to go shopping at the at the mall next week." "I am taking my 15-month old granddaughter to the pediatrician next week for her baby shots." Response Feedback: The nurse should be concerned for the following: Clients and family members should avoid receiving live virus vaccinations or exposure to chickenpox. The client could have an exacerbation or a more pronounced episode of the disease. The client should not care for the granddaughter if vaccination with live viruses is planned. The client should also avoid crowds, especially in enclosed spaces when possible, to minimize exposure risk. The nurse should discuss measures to minimize the risk of infections if the client
should expect thrombocytes to increase in 1 week should expect erythroctyes (reticulocytes) to increase after 1 week should drink Feresol with a straw report feeling dizzy during IV administration related to possible decease in B/P should avoid food intake regardless of GI upset
• Question 10
Patient's receiving cyanocobalamin: Mark all that apply. Answers: (^) should take K+ supplements should have a diet high in protein should drink oral medications with a straw should be aware folic acid supplements may mask cyanocobalamin deficiency should understand they have a lack of vitamin 12 should understand they have a lack of folic acid should understand they have a lack of iron
• Question 11
A patient receiving Zidoduvine should avoid: Mark all that apply. Answers: MMR vaccine furosemide (Lasix) erythropoietin methotrexate (Rheumtrex)
• Question 12
A client who is being treated with iron supplements is not exhibiting the increased amount in his blood that was anticipated. The nurse suspects that his diet or lifestyle may be inhibiting absorption of the iron. The nurse recognizes that the client’s absorption of iron intake may be hampered by consumption of: Answers: oral ascorbic acid and citrus fruits. antacids taken with meals other multivitamins, ingested concurrently. a full meal 2 hours after iron intake. Response Feedback: Antacids and food decrease the ability for iron to be absorbed by the gastric lining. Ascorbic acid enhances absorption.
• Question 13
A patient who is particular about her skin appearance is worried about the injection. She is about to receive an intramuscular injection of iron (Dextran), which site would be the best choice for the injection? Answers: dorsogluteal ventral gluteal deltoid vastus lateralis Response Feedback: Z-track method injection should be utilized to prevent leakage into the SQ skin. Iron (Dextran) given IM may stain the skin. Dorsogluteal injections are not recommended due to possibly injecting the sciatic nerve. Vastus lateralus should be utilized for children since this is the largest muscle. Deltoid injections are typical injections, but to assure staining is not visible the vental gluteal would be the best choice.
• Question 14
Mark all that apply with intrinsic factor: Answers: Folic Acid has decreased absorption with intrinsic factor. Cyanocobalamin cannot be absorbed without intrinsic factor. Cyanocobalamin has increased absorption with intrinsic factor. Ferrous sulfate has increased absorption with intrinsic factor. Cyanocobalamin has decreased absorption with intinsic factor.
• Question 15
A lack of which of the following may lead to a beefy, red tongue? Answers: Ferrous Sulfate Cyanocobalamin Folic Acid Intrinsic Factor
• Question 16
Which following medication is utilized for treatment of Herpes Simplex? Answers: Doxycycline Nitrofurantoin
A client is demonstrating signs and symptoms of anemia. Select the signs and symptoms of this condition: Mark all that apply. Answers: 1. decreased clotting
- fatigue
- shortness of breath
- bruising
- increased susceptibility to infection 6.pallor Response Feedback: These are the signs of low red blood cell production. Options 1 and 5 are related to low platelet levels, and option 4 is related to low white blood cell counts.
• Question 21
A client is discharged on anticancer medications. An advantage for home use of these medications is: Answers: 1. it can be closely monitored for potency of the drug
- the client and family can readily monitor side effects and adverse reactions
- it is cost-effective for providing cancer care
- adequate hydration can be provided in the home more so than in clinics and other institutions Response Feedback: Receiving chemotherapy at home is less expensive because of decreased hospital costs.
• Question 22
A client is ordered to receive chemotherapy. The nurse is aware that the tumors that respond best to anticancer drugs are those with: Answers:
- high growth fraction
- very large mass
- low growth fraction
- long doubling times Response Feedback: These cells are rapidly dividing and are most affected by chemotherapy.
• Question 23
A client is receiving chemotherapy and is experiencing nausea and vomiting. Select the following actions that would be effective in managing these side effects: Select all that apply
Answers:
- implementing relaxation therapy
- giving the antiemetics at the same time as the chemotherapies
- providing flat sodas and crackers
- encouraging milk products
- providing antiemetics ½ hour before chemotherapy
- forcing fluids Response Feedback: Antiemetics should be given before, not simultaneously with, chemotherapy. Milk and forcing fluids would exacerbate nausea.
• Question 24
A client is taking G-CSF, or filgrastim (Neupogen). Which of the following nursing interventions is indicated for the most common side effect of this medication? Answers: 1. stool softeners and a high-fiber diet for constipation
- acetaminophen (Tylenol) and assessment for fever
- high fluid intake and vitamin C for alkaline urine
- nonnarcotic analgesia and comfort measures for pain Response Feedback: Bone pain is the most common side effect.
• Question 25
A client with cancer is on chemotherapy and neutropenic precautions. This is because clients taking anticancer drugs are susceptible to infections resulting from: Answers: 1. decreased platelet count
- increased white blood cell count
- decreased white blood cell count
- decreased red blood cell count Response Feedback: The decrease in white blood cell count reduces the body’s defenses to infection.
• Question 26
A client with cancer is being treated with medication via intravenous therapy. The client is noted to have swelling at the IV site, pain at the IV site, and cool and pale skin. This is of special concern if the drug is: Answers: 1. an antimetabolite
- an antibiotic
- allowing the T 4 lymphocytes to increase Response Feedback: The treatment goals for medications related to HIV allow the T 4 cells to increase and the viral load to decrease.
• Question 30
A client receiving interferon is experiencing rigors. Which of the following nursing interventions may be implemented to prevent and treat this condition? Answers: (^) 1. Pretreat the patient with acetaminophen and meperidine (Demerol).
- Provide antiemetics before treatment and around the clock.
- Infuse IV fluids as quickly as possible and assess urine output.
- Provide analgesia every 4 hours and assess for pain. Response Feedback: Rigors are treated with these medications.
• Question 31
A client receiving chemotherapy and biologic response modifiers is experiencing signs of bone marrow suppression, including neutropenia, anemia, and thrombocytopenia. Which of the following signs and symptoms indicate thrombocytopenia? Answers: 1. shortness of breath, pallor, and fatigue
- elevated temperature, congestion, and cough
- ecchymosis, bleeding gums, and petechiae
- abdominal distention, constipation, and decreased breath sounds Response Feedback: These are signs of low platelet levels.
• Question 32
A client questions a nurse about taking antiretrovirals with other medications, which may cause drug interactions. The nurse should make which of the following statements with regard to taking these medications? Answers: 1. “Next time you go to your doctor, let the doctor know all the medications you are taking.”
- “If you have any questions about your medications, ask the local pharmacist.”
- “Make sure you do not take your antiviral medications with any other medications.”
- “Bring all your medications into the office as soon as possible and we can ensure that they are safe to take together.”
Response Feedback: The nurse needs to ensure that there are no drug-drug interactions before beginning aggressive therapy.
• Question 33
A client is to receive oprelvekin (Neumega). One of the chief side effects of this medication is fluid retention. Which of the following assessments would confirm this condition? Answers: 1. bradycardia and hypotension
- peripheral edema and exertional dyspnea
- restlessness and hypoxia
hypothermia and ventricular dysrhythmias Response Feedback: These are signs of overhydration.
• Question 34
A client is to receive filgrastim (Neupogen) as a granulocyte-stimulating factor. This medication should not be given: Answers: 1. to clients with ANCs of less than 500
to a patient with a history of hypertension
to patients with severe myelosuppression
- within 24 hours of cytotoxic agents Response Feedback: The medication should not be given within 24 hours of chemotherapy agents.
• Question 35
A patient with testicular cancer is ordered to receive etoposide (VePesid). It is noted that the patient’s BUN level is slightly elevated and his creatinine clearance time is slightly prolonged. The nurse would anticipate the dose of the medication would be: Answers: (^) 1. reduced
- increased
- discontinued
- left unchanged
A client with leukemia is receiving colony-stimulating factors (CSFs). The nurse is aware that these medications: Answers: 1. treat bacterial infections
- increase fungus-destroying ability
- are tumoricidal
- decrease length of posttreatment neutropenia Response Feedback: CSFs stimulate white blood cell production.
• Question 40
A client with lung cancer is being treated with chemotherapy. The nurse monitors the client’s CBC (complete blood count). The purpose of monitoring this value is to: Answers: 1. assess for circulatory function
- assess the effectiveness of treatment
- assess for side effects of the treatment
- assess for tumor cell death Response Feedback: The impact on bone marrow function is the greatest indicator of strength of the chemotherapy, which will peak at the nadir of treatment.
• Question 41
Biologic response modifiers (BRMs) are a class of drugs used to: Answers: 1. decrease severity of infection
- enhance the body’s immune system
- decrease side effects of chemotherapy
- increase red blood cell production Response Feedback: This is the function of BRMs.
• Question 42
Enfuvirtide (Fuzeon) is a new antifusion inhibitor used in treating HIV. In teaching the client about this medication, the most common adverse reaction must be addressed. The nurse would instruct the patient to watch for: Answers:
- injection site irritation
- arthralgia
- heart block
- diarrhea Response Feedback: 98% of the patients taking this medication sustain this reaction.
• Question 43
Estrogen therapy is treatment for progressive prostatic cancer and breast cancer (postmenopausal women). The nurse administers the estrogen with the awareness that the proposed action of estrogen is to: Answers: 1. increase tumor growth
- suppress tumor growth
- kill malignant tumor cells
- stimulate normal cell growth Response Feedback: This is the function of estrogen—it decreases the growth of the tumor.
• Question 44
Use of antiretroviral therapy has been found effective in decreasing the vertical transmission of HIV. Initiation of zidovudine therapy to HIV-infected pregnant women is recommended at which of the following weeks of gestation? Answers:
- 14 to 34
- 20 to 40
- 6 to 10
- 11 to 20 Response Feedback: This is considered the appropriate time to treat the woman. In addition, the woman will receive medication during labor and the newborn will receive treatment.
• Question 45
Which of the following are side effects noted to occur with the administration of erythropoietin? Answers: 1. orthostatic hypotension and dizziness
- shortness of breath and tachypnea
- headaches and hypertension
- bradycardia and agonal respirations
(WBC) was 1,000 mm3. Based on this laboratory report, nursing care plan must include nursing interventions to Answers: 1. Prevent dehydration
- Protect from stressful situation
- Prevent stasis of circulation
- Protect from infection
• Question 50
Mrs. Balboa, a client with congestive heart failure, has a slightly elevated BUN. What is the most likely explanation for the abnormal BUN? Answers: 1. Plasma dilution caused by aldosterone increase
- Impaired liver function
- Increased protein breakdown cause by stress
- Poor renal perfusion
• Question 51
The nurse suspects that the client may be experiencing peripheral neuropathy as a result of receiving paclitaxel (Taxol). What is the highest priority nursing intervention to use in monitoring the client for this adverse reaction? Answers: a. Numbness and/or tingling of the fingers and toes b. Decrease in levels of white blood cells and platelets c. Increase in overactive deep tendon reflexes d. Paralysis of the muscles in the lower extremities Response Feedback: Symptoms of neuropathy include feelings of numbness and/or tingling in the fingers and toes.
• Question 52
A client is ordered to receive cyclophosphamide (Cytoxan). The client is advised to drink increased water and fluids to: Answers: a. increase the red blood cell count. b. prevent liver dysfunction. c. prevent renal failure.
d. prevent hemorrhagic cystitis. Response Feedback: Cytoxan can cause hemorrhagic cystitis and irritation of the bladder wall.
• Question 53
A male client is receiving chemotherapy and is concerned about endangering his female sexual partner while he is receiving the drugs. The nurse’s highest priority instruction to this client is to __________ receiving the drugs. Answers: a. continue to use his preferred method of birth control while b. abstain from sexual activity for 7 days after c. use condoms for up to seven days after d. use a second form of birth control while Response Feedback: Condoms should be used for up to 7 days after receiving the drugs to prevent endangering the client’s sexual partner.
• Question 54
A patient is ordered to receive an angiogenesis inhibitor called bevacizumab (Avastin). During a client teaching session, the nurse instructs the patient that the primary function of this medication is to: Answers: a. prevent blood vessel growth in cancer tumors. b. suppress inflammatory tumor growth. c. treat opportunistic infections. d. inhibit DNA replication in cancer cells. Response Feedback: The primary action of the medication is to prevent blood vessel growth in cancer tumors.
