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Silvestri: Saunders Comprehensive Review for the NCLEX-RN® Examination, 5 th
Edition
Pharmacology Test Bank MULTIPLE CHOICE
- The nurse is caring for a client in labor. The nurse reviews the physician’s prescriptions and notes that the client has a prescription for butorphanol tartrate (Stadol). The nurse understands that this medication is prescribed for:
- Pain relief
- Increasing uterine contractions
- Decreasing uterine contractions
- Promoting fetal lung maturity ANS: 1 Rationale: The client in labor may be given parenteral analgesia during the first stage of labor, up to 2 to 3 hours before the anticipated delivery. Butorphanol tartrate is a medication that may be prescribed for pain relief. “Increasing uterine contractions,” “decreasing uterine contractions,” and “promoting fetal lung maturity” are not actions of this medication. Test-Taking Strategy: Knowledge of the action of butorphanol tartrate is required to answer this question. Remember that this medication is used for pain relief. Review the action of this medication if you had difficulty with this question and are unfamiliar with this medication. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Planning
- The postpartum nurse is caring for a client with an epidural catheter in place for opioid analgesic administration following cesarean birth. If the client develops respiratory depression and requires naloxone (Narcan) as an antidote, the client may complain of which of the following?
- Increase in her pain level
- Decrease in her pain level
- Increase in the amount of itching from the opioid used in the epidural
- Decrease in the amount of itching from the opioid used in the epidural
ANS: 1
Rationale: Remember that opioids are used for epidural analgesia. Naloxone is an opioid antagonist, which reverses the effects of opioids. If it is given, the client may complain of an increase in her pain level. Therefore “decrease in her pain level,” “increase in the amount of itching from the opioid used in the epidural,” and “decrease in the amount of itching from the opioid used in the epidural” are incorrect. Test-Taking Strategy: To answer this question accurately, you must know that opioid analgesics are the medications used with epidural analgesia to relieve pain. Therefore if naloxone is administered as an antidote for an opioid analgesic, the client’s pain will increase. Review the effects of naloxone if this question was difficult. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Assessment
- A client experiencing preterm labor at the twenty-ninth week of gestation has been admitted to the hospital. The client has a prescription to receive betamethasone (Celestone). The nurse understands that the medication will do which of the following?
- Prevent spontaneous delivery.
- Stop the uterine contractions.
- Promote maturation of the fetal lungs.
- Accelerate the growth rate of the fetus. ANS: 3 Rationale: Betamethasone (Celestone) is classified as an anti-inflammatory and corticosteroid. It increases the surfactant level and lung maturity in the fetus, which reduces the incidence of respiratory distress syndrome. Delivery must be delayed for at least 48 hours after administration of betamethasone to allow time for the lungs of the fetus to mature. Test-Taking Strategy: Options that are comparable or alike are not likely to be correct. With this in mind, eliminate “prevent spontaneous delivery” and “stop the uterine contractions.” Note the strategic words “twenty-ninth week of gestation.” Specific knowledge about the medication and knowledge of the problems encountered by premature infants will assist in answering this question. Review the action of this medication if this question was difficult. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal-child nursing (3rd ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity
addition, a bolus of AZT is given intravenously during labor, and the neonate is treated for six weeks after birth. Test-Taking Strategy: To answer this question accurately, you must be familiar with pharmacological therapy for clients who are HIV-positive. Knowing that the fetus is most vulnerable to the effects of medications and chemicals during the period of organogenesis will assist you in selecting the correct answer. Review treatment measures for the pregnant client with HIV infection if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Planning
- The nurse has a routine prescription to instill erythromycin ointment (Ilotycin) into the eyes of a newborn. The nurse plans to explain to the parents that the purpose of the medication is to:
- Help the newborn to see more clearly.
- Guard against infection acquired during intrauterine life.
- Ensure the sterility of the conjunctiva in the newborn.
- Protect the newborn from contracting an eye infection during birth. ANS: 4 Rationale: The use of eye prophylaxis with an agent such as erythromycin protects the newborn from contracting a conjunctival infection during birth. This infection, called ophthalmia neonatorum, results from maternal vaginal infection with chlamydia or gonorrhea. This prophylaxis is mandatory in the United States. “Help the newborn to see more clearly,” “guard against infection acquired during intrauterine life,” and “ensure the sterility of the conjunctiva in the newborn” do not describe the purposes of this medication. Test-Taking Strategy: Familiarity with the purpose of this medication is needed to answer this question. Remember erythromycin protects the newborn from contracting a conjunctival infection during birth. Review the purpose of this medication if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Health Promotion and Maintenance TOP: Content Area: Pharmacology MSC: Integrated Process: Teaching and Learning
- The nurse has a routine prescription to administer an injection of phytonadione (vitamin K) to the newborn. Before giving the medication, the nurse explains to the client that this medication will:
- Prevent clotting abnormalities in the newborn.
- Stimulate the liver to produce vitamin K.
- Prevent vitamin deficiency of fat-soluble vitamins.
- Supplement the infant, because breast milk and formula are low in vitamin K. ANS: 1 Rationale: Vitamin K is given to the newborn to prevent clotting abnormalities. Vitamin K is usually produced by bacteria in the gastrointestinal tract, which is sterile in the newborn. The other options are incorrect reasons for administering this medication to a newborn. Test-Taking Strategy: Use the process of elimination. Thinking about the action and purpose of vitamin K will assist in answering correctly. Review the rationale for this newborn prophylaxis if this question was difficult. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2010). Maternal child nursing care (4th ed.). St. Louis: Mosby. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Implementation
- The client who has developed atrial fibrillation is not responding to medication therapy and has been placed on warfarin (Coumadin). The nurse is doing discharge dietary teaching with the client. The nurse would tell the client to avoid which of the following foods while taking this medication?
- Cherries
- Potatoes
- Broccoli
- Spaghetti ANS: 3 Rationale: Anticoagulant medications work by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K are often omitted from the diet. Vitamin K is found in large amounts in green leafy vegetables, such as broccoli, cabbage, turnip greens, and lettuce. The other options listed are foods that are lower in vitamin K. Test-Taking Strategy: Knowledge about the relationship between warfarin and vitamin K is needed to answer this question. Note the strategic word “avoid” in the question. This tells you that the correct option is a food that is high in vitamin K. If you had difficulty with this question, review foods high in vitamin K. PTS: 1
Blood pressure may increase, but this is not the intended therapeutic effect. “Decreased pulse rate” and “increased urine output” are unrelated to the effects of this medication. Test-Taking Strategy: To answer this question accurately, recall the action of the medication and its use in the immediate postpartum period. Remember that this medication improves uterine tone. Review the action of methylergonovine if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Evaluating REF: Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2010). Maternal child nursing care (4th ed.). St. Louis: Mosby. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Evaluation
- The nurse is told that the result of a serum carbamazepine (Tegretol) level for a child who is receiving the medication for the control of seizures is 10 mcg/mL. Based on this laboratory result, the nurse anticipates that the physician will prescribe:
- Discontinuation of the medication
- A decrease of the dosage of the medication
- An increase of the dosage of the medication
- Continuation of the presently prescribed dosage ANS: 4 Rationale: When carbamazepine is administered, blood levels need to be monitored periodically to check for the child’s absorption of the medication. The amount of the medication prescribed is based on the blood level achieved. The therapeutic serum range of carbamazepine is 4 to 12 mcg/mL. The nurse would anticipate that the physician will continue the presently prescribed dosage. Test-Taking Strategy: Knowing the therapeutic serum drug level of carbamazepine will direct you to the correct option. Remember that the therapeutic serum range is 4 to 12 mcg/mL. If you had difficulty with this question, learn the therapeutic serum drug level of carbamazepine. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal-child nursing (3rd ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Planning
- The nurse is providing instructions to a mother of a child with atopic dermatitis (eczema) regarding the application of topical cortisone cream to the affected skin sites. Which of the following statements, if made by the mother, indicates an understanding of the use of this medication?
- “I shouldn’t rub the medication into the skin.”
- “The medication is applied everywhere except the face.”
- “I need to wash the sites gently before I apply the medication.”
- “I need to apply the medication generously and allow it to absorb.” ANS: 3 Rationale: Topical corticosteroids should be applied sparingly and rubbed into the area thoroughly. The affected area should be cleansed gently prior to application. It should not be applied everywhere or over extensive areas. Systemic absorption is more likely to occur with extensive application. It is applied to the affected sites. Test-Taking Strategy: Note the strategic words “indicates an understanding.” Look for the option that indicates that the mother understands how to apply the cream. Eliminate “The medication is applied everywhere except the face.” because cream should be applied only to areas that are affected. Eliminate “I need to apply the medication generously and allow it to absorb.” because of the strategic word “generously.” Eliminate “I shouldn’t rub the medication into the skin.” because of the strategic words “shouldn’t rub.” Review the procedure for application of this cream if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Evaluating REF: Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2010). Maternal child nursing care (4th ed.). St. Louis: Mosby. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Evaluation
- The nurse working in the ambulatory care center is providing medication instructions about methylphenidate (Ritalin) to the mother of a child with attention-deficit/hyperactivity disorder (ADHD). The nurse recommends that the mother give the medication to the child:
- At bedtime
- With the evening meal
- Just before the noontime meal
- In the morning, 2 hours before breakfast ANS: 3 Rationale: Methylphenidate is best taken shortly before a meal. It should not be taken after 12 noon or 1 PM for children or after 6 PM for adults, because the stimulating effect may keep the client awake. The other options are incorrect. Test-Taking Strategy: Knowledge about the correct administration procedure for this medication is required to answer this question. Remember that it is best to administer it shortly before the noontime meal. If you had difficulty with this question, review the client teaching points for methylphenidate.
ANS: 4
Rationale: Oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth because it will stain the teeth. The parents should be instructed to brush or wipe the teeth after administration. Iron is administered between meals because absorption is decreased if there is food in the stomach. Iron requires an acidic environment to facilitate its absorption in the duodenum. Test-Taking Strategy: Eliminate “I should give the iron with food.” “I can mix the iron with cereal to give it.” and “I should add the iron to the formula in the baby’s bottle.” first because they are comparable or alike and because medication should not be added to formula and food. Also, note the strategic word “liquid” in the question. This should assist in recalling that liquid iron stains teeth. Review the teaching points related to this medication if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Evaluating REF: McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal-child nursing (3rd ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Evaluation
- The client with psoriasis is being treated with calcipotriene (Dovonex) cream. Administration of high doses of this medication can cause which side effect?
- Alopecia
- Hyperkalemia
- Hypercalcemia
- Thinning of the skin ANS: 3 Rationale: Calcipotriene (Dovonex), an analogue of vitamin D 3 , is indicated for mild to moderate psoriasis. Responses are equal to those achieved with medium-potency topical glucocorticoids. The most common adverse effect is local irritation. Unlike glucocorticoids, calcipotriene does not cause thinning of the skin. At high doses, calcipotriene has caused hypercalcemia. Hyperkalemia is not a side effect. Test-Taking Strategy: Note the strategic words “high doses.” Remember that hypercalcemia is a concern. Note that the relationship between the name of the medication and “hypercalcemia.” The medication name begins with calci-, which is similar to calcium. Review this medication if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Analyzing REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity
TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Assessment
- Collagenase (Santyl) is prescribed for a client with a severe burn to the hand. The nurse is providing instructions to the client and spouse regarding wound treatment. Which of the following should the nurse include in the instructions?
- Apply twice a day, and leave it open to the air.
- Apply once a day, and leave it open to the air.
- Apply twice a day, and cover it with a sterile dressing.
- Apply once a day, and cover it with a sterile dressing. ANS: 4 Rationale: Collagenase is used in the treatment of dermal lesions and severe burns. Its action is to débride the affected area. It is applied once daily and covered with a sterile dressing. “Apply twice a day, and leave it open to the air,” “apply once a day, and leave it open to the air,” and “apply twice a day, and cover it with a sterile dressing” are incorrect application procedures. Test-Taking Strategy: Knowledge regarding the use of this medication is required to answer this question. Remember that this medication is applied daily and covered with a sterile dressing. Review the procedure for applying collagenase if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient- centered collaborative care (6th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Teaching and Learning
- A nurse is caring for a female client at home with a diagnosis of actinic keratosis. The client tells the nurse that her skin is very dry and irritated. The treatment includes diclofenac sodium (Solaraze). The nurse teaches the client that this medication is from which class of medications?
- Anti-infectives
- Vitamin A lotions
- Coal tar preparations
- Nonsteroidal anti-inflammatory drugs (NSAIDs) ANS: 4 Rationale: Diclofenac sodium (Solaraze) is a nonsteroidal anti-inflammatory drug (NSAID) for topical use. It is indicated for use for actinic keratosis. The mechanism underlying its benefits is unknown. The most common side effects are dry skin, itching, redness, and rash at the site of application. Diclofenac
- The client with a burn injury is applying mafenide (Sulfamylon) to the wound. The client calls the physician’s office and tells the nurse that the medication is uncomfortable and is causing a burning sensation. The nurse instructs the client to:
- Discontinue the medication.
- Apply a thinner film than prescribed to the burn site.
- Continue with the treatment, as this is expected.
- Come to the office to see the physician immediately. ANS: 3 Rationale: Mafenide is used to treat partial- and full-thickness burns. It is bacteriostatic for both gram- negative and gram-positive organisms present in avascular tissues. The client should be warned that the medication will cause local discomfort and burning. The nurse does not instruct a client to alter a medication prescription (“discontinue the medication” and “apply a thinner film than prescribed to the burn site”). It is not necessary that the client see the physician immediately at this time. Test-Taking Strategy: Eliminate “discontinue the medication” and “apply a thinner film than prescribed to the burn site” because they represent, in effect, a change in medication prescription, which is outside the realm of legal nursing practice. To choose correctly between the last two options, you must be familiar with this medication and its expected effects. Remember that this medication will cause local discomfort and burning. If you had difficulty with this question, review this medication now. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Teaching and Learning
- The client with an infected leg wound that is draining purulent material has a prescription for sodium hypochlorite (Dakin solution) to be used in the care of the wound. The nurse would do which of the following while using this solution?
- Rinse off immediately following irrigation.
- Pour onto sterile sponges, and pack in wound.
- Let the solution run freely over normal skin tissue.
- Use each bottle of solution for 2 weeks before replacing. ANS: 1 Rationale: Dakin solution is a hypochlorite solution that is used for irrigating and cleaning necrotic or purulent wounds. It cannot be used to pack purulent wounds, because the solution is inactivated by copious pus. (It can be used to pack necrotic wounds, however.) It should not come into contact with
healing or normal tissue, and it should be rinsed off immediately if used for irrigation. The solution is unstable, and it is best to prepare a fresh solution for use during each dressing change. Test-Taking Strategy: Note the strategic words “draining purulent material.” This will direct you to “rinse off immediately following irrigation.” If you are unfamiliar with the use of this solution, review this content. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Implementation
- An adolescent client with severe cystic acne has been prescribed isotretinoin (Accutane). Which statement by the client would suggest the need for further teaching?
- “I will return to the clinic for blood tests.”
- “If my lips begin to burn, it is probably because of the medication.”
- “My eyes may become dry and burn as a result of the medication.”
- “I need to take my vitamin A supplement so that the treatment will work.” ANS: 4 Rationale: Isotretinoin (Accutane) is used to inhibit inflammation in the client with severe cystic acne. Adverse effects include elevated triglyceride levels, skin dryness, and eye discomfort, such as dryness and burning. Lip inflammation, called cheilitis, can also occur. Vitamin A supplements are stopped during this treatment because of their additive effects. Test-Taking Strategy: Use the process of elimination and note the strategic words “need for further teaching.” These words indicate a negative event query and the need to select the incorrect option. Remember that vitamin A supplements are stopped during treatment. This will also assist in answering questions similar to this one. If you are unfamiliar with this medication and the client teaching points involved, review this content. PTS: 1 DIF: Level of Cognitive Ability: Evaluating REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Teaching and Learning
- An ambulatory care client with allergic dermatitis has been given a prescription for a tube of diphenhydramine (Benadryl) 1% to use as a topical agent. The nurse determines that the medication was effective if which of the following was assessed?
PTS: 1
DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Implementation
- The nurse reviewing a medical record notes that high concentrations of methotrexate followed by leucovorin (citrovorum factor, folic acid) are being given to the client with cancer. The nurse correctly interprets that the reason for therapy with leucovorin is to:
- Preserve normal cells.
- Promote protein synthesis.
- Promote medication excretion.
- Hasten the effect of the methotrexate. ANS: 1 Rationale: The administration of leucovorin with methotrexate is known as leucovorin rescue. High concentrations of methotrexate cause harm and damage to normal cells. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting normal cells to synthesize. Leucovorin rescue is potentially hazardous, because failure to administer leucovorin in the right dose at the right time can be fatal. Test-Taking Strategy: To answer this question accurately, it is necessary to understand the action of leucovorin and the reason for administering it with methotrexate. Eliminate “hasten the effect of the methotrexate” first, because increased fluids and diuretics normally are prescribed and administered to hasten the effect of methotrexate. To select from the remaining options, you must be familiar with this medication. If you had difficulty with this question, review leucovorin rescue. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Analysis
- The nurse understands that an indication for the use of asparaginase (Elspar) is:
- Lung cancer
- Breast cancer
- Metastatic prostate cancer
- Acute lymphocytic leukemia ANS: 4
Rationale: Asparaginase is indicated for the treatment of acute lymphocytic leukemia. “Lung cancer,” “breast cancer,” and “metastatic prostate cancer” are treated with other antineoplastic agents. Test-Taking Strategy: Knowledge regarding the indications for use of specific antineoplastic agents is required to answer this question. Remember that acute lymphocytic leukemia may be treated with asparaginase. Review the specific uses of this medication if you had difficulty answering this question. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Planning
- The nurse is caring for a client on the oncology unit who has developed stomatitis during chemotherapy. The nurse would plan which of the following measures to treat this complication?
- Rinse the mouth with diluted baking soda or saline.
- Use lemon and glycerin swabs liberally on painful oral lesions.
- Place the client on NPO status for 12 hours, then resume liquids.
- Brush the teeth and use nonwaxed dental floss at least twice a day. ANS: 1 Rationale: Stomatitis, or mouth ulcerations, occurs with the administration of many antineoplastic medications. The client’s mouth should be examined daily for signs of ulceration. If stomatitis occurs, the client should be instructed to rinse the mouth with baking soda or saline. Food and fluids are important and should not be restricted. If chewing and swallowing are painful, the client may switch to a liquid diet. Instruct the client to avoid spicy foods and foods with hard crusts or edges. The client should avoid tooth brushing and flossing when stomatitis is severe. Lemon and glycerin swabs may cause pain and further irritation. Test-Taking Strategy: Begin to answer this question by recalling the characteristics of stomatitis. Eliminate “use lemon and glycerin swabs liberally on painful oral lesions,” because lemon can be irritating to ulcerated lesions. Eliminate “place the client on NPO status for 12 hours, then resume liquids,” because foods and fluids would not be restricted for a client who received antineoplastic medication. Eliminate “brush the teeth and use nonwaxed dental floss at least twice a day,” because a toothbrush and floss will irritate ulcerations and also may cause bleeding. If you had difficulty with this question, review the procedures for caring for stomatitis. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Black, J., & Hawks, J. (2009). Medical-surgical nursing: clinical management for positive outcomes (8th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity
complication of therapy. It also may be used in mouthwash following fluorouracil (Adrucil) therapy to prevent stomatitis. Allopurinol is not used to treat nausea, diarrhea, or muscle spasms. Test-Taking Strategy: Focus on the subject, the purpose of allopurinol in the client receiving chemotherapy. Remember that allopurinol is also used to remove uric acid from the body in clients with gout. This will assist in directing you to “hyperuricemia.” Review the purpose of allopurinol in the client receiving chemotherapy if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Implementation
- The client with breast cancer has been given a prescription for cyclophosphamide (Cytoxan). The nurse determines that the client understands the proper use of the medication if the client states that he or she will:
- Increase dietary intake of potassium.
- Take the medication with large meals.
- Decrease dietary intake of magnesium.
- Increase fluid intake to 2 to 3 L/day. ANS: 4 Rationale: A toxic effect of cyclophosphamide (Cytoxan) is hemorrhagic cystitis. The client should drink large amounts of fluid during the administration of this medication. Clients also should observe for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be encouraged to increase potassium intake. The client would not be instructed to alter magnesium intake. Test-Taking Strategy: Knowledge of the toxic effects of cyclophosphamide will assist you to answer this question correctly. If you correlated cyclophosphamide with hemorrhagic cystitis, by the process of elimination, “increase fluid intake to 2 to 3 L/day” would then be selected. If you had difficulty with this question, review the toxic effects associated with this medication. PTS: 1 DIF: Level of Cognitive Ability: Evaluating REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Evaluation
- The nurse should be prepared to institute bleeding precautions in the client receiving antineoplastic medication if which of the following results were reported from the lab?
- Clotting time, 12 seconds
- Ammonia level, 28 mcg/dL
- Platelet count, 50,000 cells/mm^3
- White blood cell count (WBC), 4500/mm^3 ANS: 2 Rationale: Platelets are the building blocks of blood clots. The normal platelet count is 150,000 to 450,000 cells/mm^3. Bleeding precautions should be instituted when the platelet count drops to a critically low level, as defined by agency policy. Bleeding precautions include avoiding all trauma, such as rectal temperatures or injections. The normal clotting time is 8 to 15 seconds. The normal ammonia value is 10 to 80 mcg/dL. The normal WBC is 5000 to 10,000 cells/mm^3. When the WBC count drops, neutropenic precautions should be implemented. Test-Taking Strategy: Knowledge of normal laboratory values and the significance of the specific laboratory tests is required to answer the question. Eliminate “clotting time, 12 seconds” and “ammonia level, 28 mcg/dL,” because they identify normal laboratory values. To select between the last two options, correlate a low platelet count with the need for bleeding precautions and a low WBC count with the need for neutropenic precautions. Review bleeding precautions if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient- centered collaborative care (6th ed.). St. Louis: Saunders. OBJ: Client Needs: Safe and Effective Care Environment TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Planning
- The client with cancer is about to be started on mitomycin (Mutamycin). The nurse should suggest contacting the physician after noting that the client is also taking which of the following medications?
- Furosemide (Lasix)
- Ondansetron (Zofran)
- Warfarin (Coumadin)
- Allopurinol (Zyloprim) ANS: 3 Rationale: Mitomycin is an antitumor antibiotic. The use of aspirin, anticoagulants, and thrombolytic agents should be avoided concurrent with this medication, because mitomycin causes thrombocytopenia. Warfarin (Coumadin) is an anticoagulant, and the risk of bleeding is increased if administered during mitomycin therapy. Furosemide is a diuretic and is not related to the question. Ondansetron (Zofran) is an antiemetic used to prevent or treat nausea and vomiting during chemotherapy. Allopurinol is an
