NURS-6521N-32, Advanced Pharmacology: Week 9 Quiz Questions and Answers, Exams of Nursing

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Course NURS-6521N-32,Advanced Pharmacology.2016 Winter Qtr 11/28-02/19-PT27 Test Week 9 - Quiz

Started 1/28/17 8:19 PM Submitted 1/28/17 9:15 PM Status Completed

Attempt Score

35 out of 35 points

Time Elapsed 55 minutes out of 1 hour and 30 minutes Instructions (^) Please answer each question below and click Submit when youhave completed the Quiz. Results Displayed

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- Question 1

A patient will soon begin targeted therapy as a component of her treatment plan for chronic leukemia. The nurse is conducting health education about this new aspect of the patient's drug regimen and the patient has asked about the potential side effects of treatment. How should the nurse best respond?

1 out of 1 points

Response Feedback:

Targeted therapies are generally considered to be less toxic than traditional chemotherapy drugs. However, adverse reactions to targeted therapies can occur such as severe skin reactions, GI toxicities, skin reactions, and thrombosis.

- Question 2

Mr. Singh is a 66-year-old man who is receiving chemotherapy for the

1 out of 1 points

treatment of lung cancer that has metastasized to his liver. In an effort to prevent infection, Mr. Singh has been prescribed filgrastim (Neupogen).

Which of the nurse's following assessment questions most directly addresses a common adverse effect of filgrastim? Response Feedback :

Medullary bone pain is a consistently observed adverse effect that can be attributed to drug therapy with filgrastim; it is mild to moderate in severity and is reported in 56% of patients taking

t h e d r u g

. Shortness of breath, mucosal bleeding, and cool, clammy skin are not adverse effects typical of filgrastim. - Question 3

An older adult woman has been diagnosed with acute lymphoblastic leukemia (ALL) and her care team has identified potential benefits of imatinib. Which of the following characteristics of this patient's current health status may preclude the use of imatinib?

1 out of 1 points

Response Feedback :

Imatinib may be associated with edema. Patients should be weighed regularly and assessed for signs of fluid retention that could be severe. The risk of edema increases with higher doses of imatinib and age greater than 65 years. Previous strokes, orthopedic surgery, or well-controlled diabetes may not contraindicate the use of imatinib.

- Question 4

An oncology nurse is reviewing the pathophysiology of cancer and is discussing with a colleague the factors that contribute to the success or

1 out of 1 points

failure of a patient's chemotherapy. Which of the following cancerous cells is most susceptible to the effects of chemotherapeutic drugs? Response Feedback :

Cells that have a short generation time or rapid mitotic rate are most sensitive to antineoplastic agents. All cells (both cancerous and noncancerous) have a blood supply. A lack of contact inhibition is characteristic of cancer, but this is not associated with susceptibility to chemotherapeutic drugs.

- Question 5

A nurse is caring for a patient with cancer who has been prescribed dronabinol (Marinol) to help reduce nausea and vomiting from

1 out of 1 points

chemotherapy. The nurse will inform the patient that he or she is taking an oral form of Response Feedback:

The major ingredient of Marinol is 9-tetrahydrocannabinol (THC), the active ingredient in marijuana.

- Question 6

1 out of 1 points When planning care for a patient who is receiving filgrastim (Neupogen) for a nonmyeloid malignancy, the nurse should formulate which of the following patient outcomes? (Select all that apply.) Response Feedback :

Desired outcomes for a patient receiving filgrastim include that febrile neutropenia will be avoided and infection and bone pain will not develop, or at least bone pain will not be unmanageable if it develops. Also, because this drug is administered subcutaneously every day during therapy, management of their own administration would be a positive outcome for patients. A

p a t i e n t who is taking oprelvekin would be at risk for fluid retention. Filgrastim is not associated with this adverse effect.

- Question 7

1 out of 1 points A nurse has been assigned to a 55-year-old woman who has a malignant brain tumor. The patient is receiving her first dose of carmustine. It will be critical for the nurse to observe for which of the following?

Response Feedback :

Respiratory difficulty can indicate a hypersensitivity reaction or anaphylaxis. The nurse would report any breathing difficulties immediately to the physician. If the patient does not eat or drink for more than 24 hours, the physician should be notified. Nausea and vomiting are adverse effects of the drug therapy, and an antiemetic regimen would be appropriate. Reddish urine is an adverse effect of doxorubicin, not carmustine.

- Question 8

1 out of 1 points

A patient has been scheduled to begin treatment with rituximab for non- Hodgkin's lymphoma. The nurse who will administer this drug should understand that it targets Response Feedback:

Rituximab is a type of monoclonal antibody that binds specifically to the CD20 antigen found on the surface of normal and malignant B lymphocytes and causes cell lysis. The drug does not target the complement system, plasma cell DNA, or the cell membrane of malignant cells.

- Question 9

1 out of 1 points A patient with chronic heart failure has begun treatment with epoetin alfa, which she will receive in her own home from a home health nurse. The nurse should teach the patient to supplement this treatment with a diet that is high in Response Feedback:

Patients receiving epoetin alfa should maintain adequate iron intake, which may aid in the effectiveness of epoetin alfa. Foods high in iron include green leafy vegetables, beans, and organ meats.

- Question 10

1 out of 1 points A nurse is administering rituximab to a patient via the IV route. The nurse will set the IV pump at 50 mg/hour for the first half hour of the initial infusion. If there are not apparent reactions after 30 minutes of the infusion, the nurse will increase the dosage every 30 minutes by 50 mg/hour until the maximum infusion rate reaches which of the following? Response Feedback :

Infusion-related effects occur in 80% of patients within 30 minutes to 2 hours after the first rituximab infusion, but the severity of most reactions dissipates when the infusion rate is

s l o w e d o r interrupted. Reactions may be related to dose, so it isadvisable not to exceed the maximum infusion rate of 400 mg/hour.

- Question 11

1 out of 1 points Which of the following patients will be at the greatest risk for anemia and

would be the most likely candidate for epoetin alfa therapy? Response Feedback :

Older adults who have cancer and are receiving chemotherapy are especially vulnerable to the adverse effects of anemia as a result of chemotherapy and would therefore be the most likely candidates for epoetin alfa therapy. Young adults over age 18, pregnant women, and patients with a high white blood cell count are not as vulnerable to anemia and would not require epoetin alfa therapy.

- Question 12

A patient receiving high-dose cisplatin therapy exhibits symptoms of

1 out of 1 points

hypomagnesemia. Which of the following should the nurse suggest to help offset the magnesium losses from the cisplatin therapy? Response Feedback :

Patients with hypomagnesemia, or low magnesium levels, should increase their dietary intake of magnesium. Dark chocolate is high in magnesium and will help offset losses from the cisplatin therapy. Calcium and magnesium compete to gain entrance into the intestines, so calcium-rich foods should be limited.

Consumption of potassium-rich foods would have no effect on the patient's magnesium levels. The incidence of hemorrhagic cystitis can be reduced by a vigorous hydration regimen of at least 2 to 3 liters of fluid a day, but this would not help control symptoms of hypomagnesemia.

- Question 13

A nurse has completed a medication reconciliation of a patient who has

1 out of 1 points

been admitted following a motor vehicle accident. Among the many drugs that the patient has received in the previous year is rituximab. The nurse would be justified in suspecting the patient may have received treatment for which of the following diseases? Response Feedback:

Rituximab has historically been used to treat CD20-positive B-cell malignancies such as B-cell leukemias, chronic lymphocytic leukemia, non-Hodgkin's lymphoma, and some multiple myeloma. It is not normally used to treat malignant melanoma, lung cancer, or kidney cancer.

- Question 14

1 out of 1 points

A nurse is assessing a patient who has chronic lymphoblastic myelogenous leukemia. The treatment plan includes hydroxyurea (Hydrea). The nurse will assess the patient for which of the following?

Response Feedback:

Hydroxyurea may be contraindicated in patients with low WBCs. The drug is not contraindicated with diabetes mellitus, hypertension, or hypoglycemia.

- Question 15

1 out of 1 points

Intravenous carmustine has been prescribed for a patient with cancer. The nurse should help relieve the discomfort of pain and burning during the infusion by Response Feedback:

The nurse can relieve the discomfort of infusion by slowing the infusion, increasing the volume used for dilution, and increasing the total volume of the primary IV infusion. Giving 2 units of bleomycin before administering carmustine would not help relieve discomfort.

- Question 16

1 out of 1 points

A female patient has follicular non-Hodgkin's lymphoma and is receiving thalidomide (Thalomid). It will be most important for the nurse to monitor this patient for which of the following? Response Feedback:

Common adverse effects of thalidomide include thrombotic problems, drowsiness, photosensitivity, and peripheral neuropathies. Chills, rigors, fever, and angina are not associated with the use of this drug.

- Question 17

Mr. Lepp is a 63-year-old man who was diagnosed with colon cancer several weeks ago and who is scheduled to begin chemotherapy. He

1 out of 1 points

reports to the nurse that he read about the need for erythropoietin in an online forum for cancer patients and wants to explore the use of epoetin alfa with his oncologist. Which of the following facts should underlie the nurse's response to Mr. Lepp? Response Feedback :

In patients with cancer, epoetin alfa should only be used when anemia is due to concomitant myelosuppressive chemotherapy and should be discontinued when the chemotherapy course is completed. The use of epoetin alfa during cancer may shorten survival and/or increase the risk of tumor progression or recurrence. Patients with cancer are also at risk for serious cardiovascular and thrombovascular events. Consequently, the benefits of treatment must be considered in light of these potentially adverse effects.

- Question 18

1 out of 1 points

A nurse educator who coordinates the staff education on an oncology unit is conducting an inservice on targeted therapies. What potential benefit of targeted therapies should the nurse highlight in this education session? Response Feedback

By focusing on molecular and cellular changes that are specific to cancer, targeted cancer therapies may be more effective than

: (^) current treatments and less harmful to normal cells so that they may produce fewer adverse effects. However, adverse effects are not wholly absent. These drugs are not normally used as cancer prophylaxis and many are prohibitively expensive.

- Question 19

1 out of 1 points

A female patient is taking filgrastim (Neupogen) to decrease the incidence of infection. The nurse notices a small increase in the neutrophil count 2 days after starting therapy. The nurse's evaluation of the increase is that Response Feedback:

A small increase in the neutrophil count 1 or 2 days after starting therapy indicates only a transient increase and does not indicate the full therapeutic effects of the drug. It indicates neither slow action nor ineffectiveness of the drug.

- Question 20

1 out of 1 points A male patient is receiving rituximab therapy for non-Hodgkin's lymphoma. Which of the following would be a priority nursing intervention to reduce the risk for cytotoxicity and tumor lysis syndrome? Response Feedback :

Ensuring that the patient maintains a normal fluid and electrolyte balance is critical to maintaining a consistent drug dilution in the body and therefore limiting the risk of cytotoxicity and tumor lysis syndrome. Ensuring that the patient maintains a normal breathing pattern, is protected from exposure to infections, and does not develop renal impairment are also important nursing responsibilities; however, they do not help to significantly reduce the risk for cytotoxicity and tumor lysis syndrome.

- Question 21

1 out of 1 points

A nurse has administered filgrastim to a diverse group of patients in recent months. Which of the following patients should the nurse observe for extremely elevated white blood cell counts following administration of the drug? Response Feedback :

Patients who receive cytotoxic chemotherapy or radiotherapy or suffer from myeloid malignancies need cautious administration of filgrastim. When the drug is administered from 24 hours prior to 24 hours after cytotoxic chemotherapy, extremely elevated white blood cell counts have been known to occur. In myeloid malignancies, myeloid cells may be sensitive to filgrastim,

l e a d i n g t o s e v e r e a d v e r s e e f f e c t s. F i l g r a s t i m is used to treat congenital, cyclic, or idiopathic neutropenia, nonmyeloid malignancies, aplastic anemia, and HIV infection. However, theseconditions are not associated with the high increase of white blood cell count from filgrastim therapy.

- Question 22

A 60-year-old patient experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary

1 out of 1 points

embolism in the emergency department. The patient has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect? Response Feedback:

Heparin, along with antithrombin, rapidly promotes the inactivation of factor X, which, in turn, prevents the conversion of prothrombin to thrombin. Heparin does not achieve its therapeutic effect through the excretion or inhibition of vitamin K or by inhibiting platelet aggregation.

- Question 23

1 out of 1 points

A male patient has been on long-term bicalutamide (Casodex) therapy. In order to assess adverse effects of the drug therapy, the nurse will closely monitor which of the following? Response Feedback :

It is important for the nurse to monitor the patient's liver function closely if the patient is on prolonged therapy with an antiandrogenic agent. Adverse effects of the therapy include gynecomastia, diarrhea, hot flashes, breast pain, impotence, loss of libido, and abnormal liver functions. Monitoring of blood counts, an annual pap smear, and regular visual function tests are advised for patients undergoing tamoxifen therapy.

- Question 24

A female patient is prescribed oprelvekin therapy to treat

1 out of 1 points

thrombocytopenia. Which of the following should the nurse continuously monitor to determine the efficacy and duration of the oprelvekin therapy? Response Feedback :

Oprelvekin stimulates the formation of platelets, so the nurse should regularly monitor the platelet count to determine the duration of the therapy. The therapy should be continued until the p o s tna d i r pl a te l e t co unt i s a t l e as t 50 ,0 00 ce ll s / mm^3. T he oprelvekin therapy is effective if the platelet count rises to a normal range without severe bleeding. Fluid retention, weight gain, and arrhythmias are major adverse effects of oprelvekin

t h e r a p y and would not be a measure of the efficacy and durationof the therapy.

- Question 25

1 out of 1 points

A patient with non-Hodgkin's lymphoma (NHL) will be starting a course of doxorubicin shortly. When planning this patient's care, what nursing diagnosis should the nurse prioritize?

Response Feedback:

Because doxorubicin suppresses bone marrow function, the patient is at risk of leukopenia and subsequent infection.

Impaired skin integrity is less likely and airway clearance will not normally be affected. Nutritional deficit, not excess, is common.

- Question 26

1 out of 1 points A patient has completed 4 weeks of treatment with epoetin alfa. Which of the following assessment findings would most strongly indicate that treatment has been effective? Response Feedback :

The most clinically significant indicator of the effectiveness of treatment with EPO is the patient's hemoglobin level. Respiratory status, peripheral circulation, and leukocyte levels are relevant to the patient's overall health status, but these do not directly suggest the success of failure of EPO treatment.

- Question 27

1 out of 1 points A patient's current course of cancer treatment involves the administration of a conjugated monoclonal antibody. What characteristic of the drug is specified by the fact that it is classified as a conjugated drug? Response Feedback :

Monoclonal antibodies can be conjugated, meaning that they are combined with another substance such as radiation or a toxic drug that then produces indirect cell destruction as the conjugate infiltrates the cell. A conjugated drug is not necessarily derived from nonhuman sources, and it does not possess the ability to modify pharmacokinetics.

- Question 28

1 out of 1 points A 45-year-old woman with acute leukemia is going to begin chemotherapy with vincristine. The nurse is aware that vincristine must always be administered Response Feedback :

If vincristine is administered as a continuous infusion, a central line should always be used. It is important to prime IV lines for chemotherapy administration with 5% dextrose in water or normal saline, not with vincristine, before administering the drug. The infusion rate, although important, is not as important a factor for vincristine administration as is the need for a central line.

- Question 29

1 out of 1 points

A 62-year-old patient taking tamoxifen exhibits increased bone and tumor pain along with a local disease flare. The nurse interprets this as an indication of which of the following? Response Feedback:

Increased bone and tumor pain along with a local disease flare

indicates that the tumor is responding to the tamoxifen treatment. It does not indicate hypersensitivity, nephrotoxic effects, or cardiomyopathy.

- Question 30

A nurse has been assigned to a female patient who is to begin chemotherapy. The nurse will initiate the prescribed oprelvekin therapy 1 out of 1 points Response Feedback:

Administration of oprelvekin should begin 6 to 24 hours after the end of chemotherapy. Oprelvekin should be discontinued at least 2 days before the next chemotherapy session begins.

- Question 31

A nurse on an oncology unit is aware of the need to assess for adverse effects in patients who are being treated with rituximab. The risks of

1 out of 1 points

adverse effects are highest at what point during the course of treatment? Response Feedback:

Infusion-related effects reportedly occur in 80% of patients within 30 minutes to 2 hours after beginning the first rituximab infusion. These exceed the incidence of adverse effects at other points in the course of treatment.

- Question 32

A middle-aged patient has received a diagnosis of GI stromal tumor

1 out of 1 points

following an extensive diagnostic workup. Imatinib has been recommended as a component of the patient's drug regimen. What patient education should the nurse provide to this patient? Response Feedback:

Patients must understand the importance of reporting edema of weight gain while taking imatinib. The patient will not likely have a PICC line. Nausea and dry mouth are not common adverse effects and the patient should not unilaterally stop taking the drug.

- Question 33

A nurse is caring for a 64-year-old female patient who is receiving IV heparin and reports bleeding from her gums. The nurse checks the patient's laboratory test results and finds that she has a very high aPTT.

1 out of 1 points

The nurse anticipates that which of the following drugs may be ordered?

Response Feedback :

If a patient who receives IV heparin is found to be highly anticoagulated, protamine sulfate may be prescribed. Protamine sulfate, which is a strong base, reacts with heparin, which is a strong acid, to form a stable salt, thereby neutralizing the anticoagulant effects of heparin. Protamine sulfate does not produce the same effects for coumadin, alteplase, or ticlopidine.

Test Information

- Question 34

An oncology nurse is aware of the risks for injury that exist around the preparation, transportation, and administration of chemotherapeutic agents. In order to reduce these risks of injury, the nurse should take which of the following actions?

1 out of 1 points

Response Feedback:

IV lines should be primed with a compatible nonhazardous solution before the actual

drug administration. Intravenous lines should be disposed of in an approved biohazard container, not normal trash cans.

Needleless systems should be used and a toilet is preferable to a commode because it can be flushed of contents without prior handling of waste by care providers.

- Question 35

1 out of 1 points A 28-year-old woman has completed rituximab therapy for an autoimmune disease. She tells the nurse that she and her husband would like to start a family. The nurse will advise her to Response Feedback:

Rituximab is not recommended for use in pregnancy or when women are lactating. The patient should consequently be advised to continue using birth control for the duration of treatment. Saturday, January 28, 2017 9:15:24 PM EST

Take Test: Week 9 - Quiz

Description Instructions (^) Please answer each question below and click Submit when youhave completed the Quiz. Timed Test This test has a time limit of 1 hour and 30 minutes.You will be notified when timeexpires, and you may continue or submit.

Warnings appear when half the time , 5 minutes , 1 minute , and 30seconds remain. Multiple Attempts Force Completion

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Question Completion Status:

QUESTION 1

1. A patient will soon begin targeted therapy as a component of her treatment plan for chronic leukemia. The nurse is conducting health education about this new aspect of the patient's drug regimen and the patient has asked about the potential side effects of treatment. How should the nurse best respond? A (^) “Targeted therapies are often more effective than traditional . (^) chemotherapy, but the downside of this effectiveness is that adverse effects are more common and severe.” B (^) “The adverse effects to targeted therapies are most often a result of the . (^) patient's cancer, not the drugs themselves.”

C (^) “Chemotherapy causes a lot of unpleasant side effects, and the

. (^) advantage of targeted therapies is that these are all avoided.”

D (^) “Both classes of drugs have adverse effects, but targeted therapies

. (^) tend to have less of an effect on healthy body cells.”

QUESTION 2

1. Mr. Singh is a 66-year-old man who is receiving chemotherapy for the treatment of lung cancer that has metastasized to his liver. In an effort to prevent infection, Mr. Singh has been prescribed filgrastim (Neupogen). Which of the nurse's following assessment questions most directly addresses a common adverse effect of filgrastim? A (^) “Do you feel like you're having any pain in . (^) your bones?”

B (^) “Are you experiencing any waves of cool,

. (^) clammy skin?”

C (^) “Have you noticed any bleeding in your gums

. (^) or cheeks?”

D (^) “Have you had any shortness of breath

1 points

. (^) lately?”

QUESTION 3

1. An older adult woman has been diagnosed with acute lymphoblastic leukemia (ALL) and her care team has identified potential benefits of imatinib. Which of the following characteristics of this patient's current health status may preclude the use of imatinib? A (^) The patient had a total knee arthroplasty several months earlier. . B (^) The patient has chronic heart failure resulting in significant peripheral .

1 points

1 points

edema. C (^) The patient has type 2 diabetes mellitus that is controlled using diet and

. (^) oral antihyperglycemics.

D (^) The patient experienced a mild ischemic stroke several years ago and

. (^) had transient ischemic attacks last year.

QUESTION 4

1. An oncology nurse is reviewing the pathophysiology of cancer and is discussing with a colleague the factors that contribute to the success or failure of a patient's chemotherapy. Which of the following cancerous cells is most susceptible to the effects of chemotherapeutic drugs? A (^) Cells with a long . (^) generation time

B (^) Cells that lack a blood

. (^) supply

C (^) Cells that lack contact

. (^) inhibition

D (^) Cells that have a rapid

. (^) mitotic rate

QUESTION 5

1. A nurse is caring for a patient with cancer who has been prescribed dronabinol (Marinol) to help reduce nausea and vomiting from chemotherapy. The nurse will inform the patient that he or she is taking an oral form of A (^) cocaine. . B (^) marijuana. . C (^) nicotine. . D (^) methampheta . (^) mine.

1 points

QUESTION 6

1. When planning care for a patient who is receiving filgrastim (Neupogen) for a nonmyeloid malignancy, the nurse should formulate which of the following patient outcomes? (Select all that apply.) A (^) The patient will not develop febrile neutropenia. . B (^) The patient will not develop an infection. . C (^) The patient will not retain fluid. . D (^) The patient will be able to self-administer .

1 points

1 points

1 points

filgrastim at home. E. (^) The patient will not experience bone pain.

QUESTION 7

1. A nurse has been assigned to a 55-year-old woman who has a malignant brain tumor. The patient is receiving her first dose of carmustine. It will be critical for the nurse to observe for which of the following? A (^) Respiratory difficulty . B (^) Inability to drink fluids for 6 . (^) hours

C (^) Nausea and vomiting . D (^) Reddish urine .

QUESTION 8

1. A patient has been scheduled to begin treatment with rituximab for non-Hodgkin's lymphoma. The nurse who will administer this drug should understand that it targets A (^) the DNA of mature plasma cells. . B (^) the molecular structure of the cells making up the semipermeable . (^) membrane of cancerous cells.

C (^) specific antigens on the surface of malignant B cells. . D (^) the function of the complement system. .

QUESTION 9

1. A patient with chronic heart failure has begun treatment with epoetin alfa, which she will receive in her own home from a home health nurse. The