NURS 6521N Week 9 Quiz

1 out of 1 points

  
 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?   
 Selected Answer:C. “Both classes of drugs have adverse effects, but targeted therapies tend to have less of an effect on healthy body cells.”Correct Answer:C. “Both classes of drugs have adverse effects, but targeted therapies tend to have less of an effect on healthy body cells.”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

1 out of 1 points

  
 A patient has just received her first dose of imatinib and the nurse on the oncology unit is amending the patient’s care plan accordingly. What nursing diagnosis is most appropriate in light of this addition to the patient’s drug regimen?   
 Selected Answer:A. Risk for Infection related to bone marrow suppressionCorrect Answer:A. Risk for Infection related to bone marrow suppressionResponse Feedback:Like many cancer treatments, imatinib causes bone marrow suppression that creates a consequent risk of infection. The drug does not typically result in cognitive changes, fluid overload, or skin breakdown.   

Question 3

0 out of 1 points

  
 A patient receiving high-dose cisplatin therapy exhibits symptoms of hypomagnesemia. Which of the following should the nurse suggest to help offset the magnesium losses from the cisplatin therapy?   
 Selected Answer:B. Drinking 2 to 3 liters of fluid a dayCorrect Answer:D. Consuming chocolatesResponse 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 4

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?   
 Selected Answer:D. 400 mg/hourCorrect Answer:D. 400 mg/hourResponse 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 slowed or interrupted. Reactions may be related to dose, so it is advisable not to exceed the maximum infusion rate of 400 mg/hour.   

Question 5

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   
 Selected Answer:C. continue using birth control for at least 12 months.Correct Answer:C. continue using birth control for at least 12 months.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.   

Question 6

1 out of 1 points

  
 A patient with chronic lymphocytic leukemia (CLL) will imminently begin a course of treatment with rituximab. In order to minimize the risk of adverse effects, what strategy for administration will be adopted?   
 Selected Answer:C. Administering the initial doses by slow infusion while observing for adverse reactionsCorrect Answer:C. Administering the initial doses by slow infusion while observing for adverse reactionsResponse Feedback:If no reactions are apparent after 30 minutes of rituximab infusion, the dose may be escalated every 30 minutes by 50 mg/h until a maximum infusion rate of 400 mg/h is reached. Admission to an ICU and administration of diphenhydramine do not reduce the risk of adverse effects. Rituximab is not administered through multiple IV sites simultaneously.   

Question 7

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?   
 Selected Answer:A. Risk for Infection related to suppressed bone marrow functionCorrect Answer:A. Risk for Infection related to suppressed bone marrow functionResponse 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 8

0 out of 1 points

  
 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?   
 Selected Answer:A. Cells that lack a blood supplyCorrect Answer:D. Cells that have a rapid mitotic rateResponse 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 9

1 out of 1 points

  
 A nurse is to use a single-dose 1 mL vial to administer 0.5 mL of epoetin alfa to a 39-year-old woman who is being treated for chemotherapy-induced anemia. Which of the following will the nurse do with the unused portion of the drug?   
 Selected Answer:C. Discard the unused portion of the drug.Correct Answer:C. Discard the unused portion of the drug.Response Feedback:The single-dose 1-mL vial does not have preservatives. In order to prevent contamination, the nurse will discard the unused portion of the drug. A 2-mL vial does have preservatives and would be stored at 2°C to 8°C to be used again. The 2-mL vial should be discarded 21 days after initial entry to prevent use of a possibly contaminated product.   

Question 10

1 out of 1 points

  
 A nurse is discussing oprelvekin therapy with a male patient. Which of the following will the nurse tell the patient is the most common adverse effect of the drug?   
 Selected Answer:D. Fluid retention/weight gainCorrect Answer:D. Fluid retention/weight gainResponse Feedback:Fluid retention with weight gain is the most common adverse effect of oprelvekin. Medullary bone pain (pain within the marrow) is the only consistently observed adverse effect associated with filgrastim. Papilledema is an adverse effect that is only occasionally reported in older adults who take oprelvekin. Atrial arrhythmia is not associated with this drug.   

Question 11

1 out of 1 points

  
 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   
 Selected Answer:D. marijuana.Correct Answer:D. marijuana.Response Feedback:The major ingredient of Marinol is 9-tetrahydrocannabinol (THC), the active ingredient in marijuana.   

Question 12

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   
 Selected Answer:D. specific antigens on the surface of malignant B cells.Correct Answer:D. specific antigens on the surface of malignant B cells.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 13

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   
 Selected Answer:B. through a central line.Correct Answer:B. through a central line.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 14

1 out of 1 points

  
 A 67-year-old man who is being treated for prostate cancer is taking epoetin alfa. The nurse will instruct the patient to   
 Selected Answer:D. schedule an appointment to measure hemoglobin twice a week for at least 2 to 6 weeks.Correct Answer:D. schedule an appointment to measure hemoglobin twice a week for at least 2 to 6 weeks.Response Feedback:After each dose adjustment, the nurse should ensure that the patient makes an appointment to have the hemoglobin measured twice a week for at least 2 to 6 weeks to verify that it is in the normal range. A high WBC count and hypertension have not been identified as adverse effects of epoetin alfa.   

Question 15

1 out of 1 points

  
 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 adverse effects are highest at what point during the course of treatment?   
 Selected Answer:A. Shortly after the initiation of the first infusion of rituximabCorrect Answer:A. Shortly after the initiation of the first infusion of rituximabResponse 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 16

1 out of 1 points

  
 A patient with a diagnosis of chronic myeloid leukemia has met with her oncologist, who has recommended treatment with the kinase inhibitor imatinib. What route of administration should the nurse explain to the patient?   
 Selected Answer:D. Oral administration of imatinib in a home settingCorrect Answer:D. Oral administration of imatinib in a home settingResponse Feedback:Imatinib is administered orally. Consequently, it can be administered in an outpatient environment. IV or IM administration is not performed.   

Question 17

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?   
 Selected Answer:D. The tumor responding to treatmentCorrect Answer:D. The tumor responding to treatmentResponse 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 18

0 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?   
 Selected Answer:D. FeverCorrect Answer:A. BleedingResponse 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 19

0 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?   
 Selected Answer:A. A 47-year-old male with aplastic anemiaCorrect Answer:B. A 19-year-old male receiving radiotherapyResponse 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, leading to severe adverse effects. Filgrastim is used to treat congenital, cyclic, or idiopathic neutropenia, nonmyeloid malignancies, aplastic anemia, and HIV infection. However, these conditions are not associated with the high increase of white blood cell count from filgrastim therapy.   

Question 20

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?   
 Selected Answer:D. LeukopeniaCorrect Answer:D. LeukopeniaResponse Feedback:Hydroxyurea may be contraindicated in patients with low WBCs. The drug is not contraindicated with diabetes mellitus, hypertension, or hypoglycemia.   

Question 21

1 out of 1 points

  
 A middle-aged patient has received a diagnosis of GI stromal tumor 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?   
 Selected Answer:D. “It’s important that you let us know if you develop any significant swelling or puffiness.”Correct Answer:D. “It’s important that you let us know if you develop any significant swelling or puffiness.”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 22

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?   
 Selected Answer:A. A 62-year-old male with cancerCorrect Answer:A. A 62-year-old male with cancerResponse 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 23

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.)   
 Selected Answers:A. The patient will be able to self-administer filgrastim at home.C. The patient will not experience bone pain.D. The patient will not develop febrile neutropenia.E. The patient will not develop an infection.Correct Answers:A. The patient will be able to self-administer filgrastim at home.C. The patient will not experience bone pain.D. The patient will not develop febrile neutropenia.E. The patient will not develop an infection.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 patient who is taking oprelvekin would be at risk for fluid retention. Filgrastim is not associated with this adverse effect.   

Question 24

1 out of 1 points

  
 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?   
 Selected Answer:A. “Do you feel like you’re having any pain in your bones?”Correct Answer:A. “Do you feel like you’re having any pain in your bones?”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 the drug. Shortness of breath, mucosal bleeding, and cool, clammy skin are not adverse effects typical of filgrastim.   

Question 25

1 out of 1 points

  
 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?   
 Selected Answer:C. The patient has chronic heart failure resulting in significant peripheral edema.Correct Answer:C. The patient has chronic heart failure resulting in significant peripheral edema.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 26

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?   
 Selected Answer:B. Ensure that the patient maintains a normal fluid and electrolyte balance.Correct Answer:B. Ensure that the patient maintains a normal fluid and electrolyte balance.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 27

0 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?   
 Selected Answer:B. The targeted therapy is combination of a monoclonal antibody, a kinase inhibitor, and an inorganic cytotoxin.Correct Answer:D. The targeted therapy is combined with another substance that causes cell death.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 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   
 Selected Answer:D. the increase in the neutrophil count is only transient.Correct Answer:D. the increase in the neutrophil count is only transient.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 29

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   
 Selected Answer:B. iron-rich foods such as beans and leafy green vegetables.Correct Answer:B. iron-rich foods such as beans and leafy green vegetables.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 30

0 out of 1 points

  
 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 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?   
 Selected Answer:C. Treatment with epoetin alfa will likely begin 4 to 6 days before Mr. Lepp’s first round of chemotherapy and continue indefinitely.Correct Answer:B. The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients.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 31

1 out of 1 points

  
 A 39-year-old woman is receiving doxorubicin for the treatment of cancer. After each treatment, the patient has acute nausea and vomiting accompanied by a slightly increased heart rate. The nurse will advise her to   
 Selected Answer:D. perform relaxation techniques after the treatments.Correct Answer:D. perform relaxation techniques after the treatments.Response Feedback:The nurse should explain to the patient that many patients experience acute nausea and vomiting. The nurse should also explain that nonpharmacologic measures such as relaxation techniques can sometimes help alleviate these symptoms. If the patient does not know how to perform relaxation techniques, then the nurse should teach her. It is not necessary for the patient to make an appointment for cardiac function tests, because the nausea and vomiting are not related to cardiac function. Exercise will likely exacerbate the patient’s symptoms.   

Question 32

1 out of 1 points

  
 A male patient is receiving heparin by continuous intravenous infusion. The nurse will instruct the patient and family members to report which of the following should it occur?   
 Selected Answer:A. Presence of blood in urine or stoolsCorrect Answer:A. Presence of blood in urine or stoolsResponse Feedback:The nurse should instruct the patient and family members to report the presence of blood in urine or stools and any bleeding from the gums, nose, vagina, or wounds. The anticoagulation properties of heparin can sometimes result in abnormal bleeding. Sleepiness, drowsiness, skin rash, and dizziness are not commonly identified adverse effects of the drug.   

Question 33

1 out of 1 points

  
 A patient with a recent diagnosis of chronic myelogenous leukemia (CML) is discussing treatment options with his care team. What aspect of the patient’s condition would contraindicate the use of cyclophosphamide for the treatment of leukemia?   
 Selected Answer:A. The patient’s bone marrow function is significantly depressed.Correct Answer:A. The patient’s bone marrow function is significantly depressed.Response Feedback:Patients with severely compromised bone marrow functions cannot tolerate treatment with cyclophosphamide. Diabetes, impaired renal function, and previous nonadherence to treatment must be addressed when planning the patient’s care, but these factors do not necessarily contraindicate the use of cyclophosphamide.   

Question 34

0 out of 1 points

  
 A 60-year-old patient experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The patient has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect?   
 Selected Answer:B. By inhibiting platelet aggregation on vessel walls and promoting fibrinolysisCorrect Answer:D. By inactivating clotting factors and thus stopping the coagulation cascadeResponse 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 35

0 out of 1 points

  
 A nurse has been assigned to a female patient who is to begin chemotherapy. The nurse will initiate the prescribed oprelvekin therapy   
 Selected Answer:D. 6 days after chemotherapy.Correct Answer:C. 6 to 24 hours after chemotherapy.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.