Test bank for focus on nursing pharmacology 6th edition by amy morrison karch download

The patient is to begin taking interferon alfa 2b.. Ans: Feedback: Interferon alfa 2b is metabolized in the kidney so adequate fluid intake is needed to promote metabolism and excretion

Focus on Nursing Pharmacology: Edition 6th Test Bank – Karch

Focus on Nursing Pharmacology: Edition 6th Test Bank – Karch

Sample

Chapter 17

1 A patient has been diagnosed with hairy cell

leukemia The patient is to begin taking interferon

alfa 2b What will the nurse include in her

instructions to the patient concerning this drug?

Avoid drinking alcohol while taking the drug

A)

B) Continue to maintain maximal physical

activity

C) Increase fluid intake while taking the drug

Treat constipation with over-the-counter laxatives

D)

C

Ans:

Feedback:

Interferon alfa 2b is metabolized in the kidney so adequate fluid intake is needed to promote metabolism and excretion of the drug as well as to minimize

common adverse effects including dry skin and

dizziness Maintaining maximal physical activity is a good idea but has no relationship to the use of the drug Fluids should be increased not decreased while taking the drug Constipation is not an associated adverse effect of this medication

2 The health care provider plans to inject an interferon

directly into the patient’s wart What interferon will the

nurse prepare?

Interferon alfa 2a (Roferon-A) A)

B) Interferon alfacon 1 (Infergen)

Interferon alfa n3 (Alferon N) C)

Interferon beta 1a (Avonex) D)

Ans: C

Feedback:

Interferon alf n3 is used for intralesional treatment of warts Interferon alfa 2a is used in the treatment of leukemia Interferon alfacon 1 is used in the

treatment of chronic hepatitis C infection in adults Interferon beta 1a is used to treat multiple sclerosis in adults

3 A 30-year-old woman has been diagnosed with

leukemia and will be using an immune modulator for treatment What will be important to discuss with the patient when the nurse provides patient teaching about her treatment?

The need to continue oral contraceptives A)

The need to use barrier contraceptives while taking the drug

B)

The need to avoid sexual intercourse while taking the drug

C)

D) The importance of taking an aspirin daily to

decrease the adverse effects of the drug

B Ans:

Feedback:

A patient taking an immune modulator would be

advised to use barrier contraceptives to prevent

pregnancy The interaction of the immune modulator and the oral contraceptive may interfere with the oral contraceptive’s ability to work properly Asking

patients to avoid sexual intercourse is not necessary if barrier methods are properly used Daily aspirin would not decrease adverse effects of this drug

4 The nurse has an order to administer oprelvekin

(Neumega) to a patient for the first time Before

administering the drug, what allergy would the nurse want to specifically question the patient about?

A) Egg products

Escherichia coli–produced products

B)

Lactose intolerance C)

Feedback:

D) Penicillin

B Ans:

The interleukins are produced using

deoxyribonucleic acid technology and E coli

bacteria Patients with known allergy to E coli

products should not receive oprelvekin The

allergies to penicillin, egg products, or lactose

intolerance would not be of concern with this drug

5 The physician has decided to prescribe T- and B-cell

suppressors for a patient diagnosed with psoriasis What drug will be ordered for this patient?

Alefacept (Amevive)

A)

Azathioprine (Imuran)

Alefacept is prescribed for patients with severe

chronic plaque psoriasis Cyclosporine is used to suppress rejection in a variety of transplant situations Azathioprine is used to treat patients with rheumatoid arthritis and in prevention of rejection in renal

homotransplants Tacrolimus is used for prevention

of rejection after renal or liver transplantation

6 A patient who is receiving an immune suppressant

has been admitted to the unit What would be a priority action by the nurse?

D) Provide support and comfort measures in

relation to adverse effects of the drug

C Ans:

Feedback:

Patients taking immune suppressant drugs are more susceptible to infection because the patient’s normal body defenses will be diminished As a result, the priority action by the nurse would to protect the

patient from exposure to infection through room

selection, good hand hygiene, and taking care to avoid exposure to sick staff members Teaching will need to include avoiding crowded places and people with known infection and those working in soil Nutritional status is important as are comfort and support

measures and other instructions concerning the drug However, protecting the patient from infection should

be the priority action

7 A nurse is discussing interferon alfa 2b with a patient

What will the nurse encourage the patient to do while taking this drug?

To avoid crowds A)

B) To increase salt intake

To decrease milk intake C)

To eat three meals a day D)

flulike syndrome Salt, diet, and milk do not interfere

with this drug

8 A 70-year-old patient with acute myelocytic

leukemia is receiving sargramostim (Leukine) What

is a priority nursing action for this patient?

A) Providing a quiet environment

Increasing fluids B)

Providing comfort measures related to nausea

A common adverse effect of this drug is vomiting and diarrhea Due to the patient’s age it would be important to keep him hydrated Vomiting and diarrhea can cause dehydration quickly in the elderly Providing a quiet environment and comfort measures for the nausea would be important but not as critical

as increasing fluids Diet is very important to this patient; however, usually this drug causes a loss of appetite Therefore, increasing fluids would be extremely important to the patient’s nutritional status

9 The nurse is caring for a patient in the immediate

postoperative period following cardiac transplantation who is receiving mycophenolate (CellCept) twice a day IV What will the nurse teach the patient regarding drug therapy? (Select all that apply.)

“The drug will be given orally as soon as possible

“Ask a pharmacist about drug–drug interactions before taking any over-thecounter (OTC) drug.”

D)

“Never miss a dose of medication.”

E)

A, C, D, E Ans:

Feedback:

The nurse will explain that the IV medication will be changed to oral therapy when the patient is able to tolerate oral medications The patient will take the medication twice a day, not three times a day Care should be taken to never miss a dose The patient should avoid other medications that are hepatotoxic

or nephrotoxic due to a risk of increased toxicity so the patient should be taught to always consult a doctor or pharmacist before beginning an OTC drug Patients who have immune suppression must be taught how to reduce risk of infection, including avoiding people with contagious diseases, such as

10

The nurse administers aldesleukin to a patient

diagnosed with renal cell carcinoma When

assessing the patient a few days later, what

abnormal findings would the nurse attribute to the medication? (Select all that apply.)

A) Increased lymphocyte count

B) Increased red blood cell count

C) Increased platelet count

D) Irregular pulse rate

E) Increased blood pressure

Ans: A, C, D

Feedback:

colds or viruses

Aldesleukin activates human cellular immunity and inhibits tumor growth through increases in

lymphocytes, platelets, and cytokines Common

adverse effects include hypotension, sinus

tachycardia, arrhythmias, as well as pruritus, nausea, vomiting, diarrhea, anorexia, GI bleeding, bone

marrow suppression, respiratory difficulties, fever, chills, pain, mental status changes, and dizziness There is no impact on red blood cell count It does not raise blood pressure

A) They stimulate B-lymphocyte activity

B) They interfere with multiplication of stem

cells

C) They stimulate growth and

differentiation of lymphoid cells into lymphocytes

D) They interfere with the ability of viruses in

infected cells to replicate

Ans: D

Feedback:

Interferons are substances naturally produced and released by human cells that have been invaded by viruses They may also be released from cells in response to other stimuli, such as cytotoxic T-cell activity Interferons do not stimulate B-lymphocyte activity, interfere with multiplication of stem cells, nor do they stimulate growth and differentiation of lymphoid cells into lymphocytes

12

How do immune suppressants work when ordered for

a patient who has had an organ transplant?

A) Blocking normal effects of the immune

system

B) Stimulating immune system to fight off

infection

C) Working with corticosteroids to enhance

transplantation (in which non–self-cells are

transplanted into the body and destroyed by the immune reaction) and in autoimmune disorders (in which the body’s defenses recognize self-cells as foreign and work to destroy them) in some cancers Options B, C, and D are distracters for this question

13 A patient has just been told that her cancer has

metastasized to her right kidney An interferon

(Aldesleukin) has been prescribed to treat this

metastasis The patient asks why this interferon is ordered What is the nurse’s best response?

A) “Aldesleukin has been shown to protect

autologous tumor cells.”

B) “Aldesleukin has been shown to inhibit

tumor growth.”

C) “Aldesleukin has been shown to enhance

allogeneic stem-cell transplantation.”

D) “Aldesleukin has been shown to have a

direct proliferative effect on renal tumors.”

Ans: B

Feedback:

Aldesleukin is prescribed for metastatic renal cell carcinoma in adults and treatment of metastatic melanomas (orphan drug use) working by activating human cellular immunity and inhibiting tumor growth through increases in lymphocytes, platelets, and cytokines Aldesleukin does not protect

autologous tumor cells, enhance allogeneic stemcell transplantation, or have a direct proliferative effect

on renal tumors

14

The nurse admits a patient who was newly

diagnosed with Kaposi’s sarcoma to the unit The physician has ordered an IV infusion of an

interferon What drug would be appropriate?

A) Interferon beta1a

B) Interferon gamma 1b

C) Interferon alfa 2b

Interferons act to prevent virus particles from

replicating inside the cells They also stimulate interferon receptor sites on noninvaded cells to produce antiviral proteins, which prevent viruses from entering the cell In addition, interferons have been found to inhibit tumor growth and replication,

to stimulate cytotoxic T-cell activity, and to enhance the inflammatory response Options A and E are incorrect

16

The nursing class is studying monoclonal antibodies What monoclonal antibody reacts to human T cells, disabling them and acting as an immune suppressor?

is available as an IV agent It reacts as an antibody

to human T cells, disabling the T cells, acting as an immune suppressor Adalimumab is an antibody specific for human tumor necrosis factor

Cetuximab is an antibody specific to epidermal growth factor receptor sites Rituximab is an

antibody specific to sites on activated B lymphocytes

17

What monoclonal antibody is used to prevent

respiratory syncytial virus (RSV) in high risk

Palivizumab is specific to the antigenic site on

respiratory syncytial virus (RSV); it inactivates that virus It is used to prevent RSV disease in high-risk children Natalizumab is an antibody specific to surface receptors on all leukocytes except

neutrophils Belimumab is a specific inhibitor of Blymphocyte stimulator that inhibits the survival of B-lymphocytes and their differentiation into immune-globulin producing cells Eculizumab binds to

complement proteins and prevents the formation of the complement complex

A) Alemtuzumab

B) Daclizumab

C) Erlotinib

D) Omalizumab

Ans: B

Feedback:

Daclizumab is specific to interleukin-2 receptor sites

on activated T lymphocytes; it reacts with those

sites and blocks cellular response to allograft

transplants Alemtuzumab is an antibody specific for lymphocyte receptor sites used to treat chronic lymphocytic leukemia patients who have been

treated with alkylating agents and have been failed

by fludarabine therapy Erlotinib is effective against specific malignant receptor sites Omalizumab is an antibody to immunoglobulin E, an important factor

in allergic reactions

19 The pharmacology instructor is explaining

interleukins to the class What would be the best definition of interleukins?

A) They are substances naturally produced

and released by human cells that have been invaded by viruses

B) They block the inflammatory reaction and

decrease initial damage to cells

C)

They are chemicals used to communicate between leukocytes and stimulate

immunity

D) They attach to specific receptor sites and

respond to very specific situations

Ans: C

Feedback:

Interleukins are chemicals produced by T cells to communicate between leukocytes and stimulate

cellular immunity and inhibit tumor growth

Immune suppressants block the inflammatory

reaction and decrease initial damage to cells

Interferons are naturally produced and released by human cells that have been invaded by viruses

Monoclonal antibodies attach to specific receptor sites and respond to very specific situations

20 The nurse is caring for a female patient, aged 62,

who has been admitted for treatment of metastatic melanoma What agent would the nurse anticipate the physician is likely to order?

Ipilimumab is a human cytotoxic T-cell antigen-4 blocking antibody By blocking this site, T cells are activated and proliferate at a faster rate It is used to treat patients with unresectable or metastatic

melanoma Aldesleukin is an interleukin, used for metastatic renal cell carcinoma in adults; a

treatment of metastatic melanomas Interferon alfa 2b is indicated for hairy cell leukemia, melanoma, AIDS-related Kaposi’s sarcoma, chronic hepatitis B and C infections, intralesional treatment of

condyloma acuminatum in patients 18 years of age

or older Cyclosporine is a T and B cell suppressor and is indicated for prophylaxis for organ rejection

in kidney, liver, and heart transplants (used with corticosteroids); treatment of chronic rejection in patients previously treated with other

immunosuppressants; treatment of rheumatoid arthritis; and recalcitrant psoriasis

21 While studying the T- and B-cell immune

suppressors, the nursing students learn that the most commonly used immune suppressant is what?

A) Cyclosporine (Sandimmune)

B) Azathioprine (Imuran)

C) Pimecrolimus (Elidel)

D) Glatiramer (Copaxone)

Ans: A

Feedback:

Several T- and B-cell immune suppressors are

available for use Of the numerous agents available, cyclosporine is the most commonly used immune suppressant Options B, C, and D are all T- and Bcell immune suppressors, they are simply not the most commonly prescribed

22 What interleukin receptor antagonist would the nurse

anticipate is most likely to be ordered for a patient,

25 years old, who has not responded to traditional antirheumatic drugs?

A) Natalizumab (Tysabri)

B) Anakinra (Kineret)

C) Eculizumab (Soliris)