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

Focus on Nursing Pharmacology: Edition 6th Test Bank – Karch Focus on Nursing Pharmacology: Edition 6th Test Bank – Karch Sample Chapter 17 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? A) Avoid drinking alcohol while taking the drug B) Continue to maintain maximal physical activity C) Increase fluid intake while taking the drug D) Treat constipation with over-the-counter laxatives 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 Interferon beta 1a (Avonex) D) Ans: C Feedback: 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 (Infergen) C) Interferon alfa n3 (Alferon N) Interferon alf n3 is used for intralesional treatment of warts Interferon alfa 2a is used in the treatment of leukemia Interferon alfacon is used in the treatment of chronic hepatitis C infection in adults Interferon beta 1a is used to treat multiple sclerosis in adults 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) B) The need to use barrier contraceptives while taking the drug C) The need to avoid sexual intercourse while taking the drug 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 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 B) Escherichia coli–produced products Lactose intolerance C) Feedback: D) Penicillin Ans: B 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 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? A) Alefacept (Amevive) Azathioprine (Imuran) Feedback: B) Cyclosporine (Neoral) C) Glatiramer acetate (Copaxone) D) Ans: A 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 A patient who is receiving an immune suppressant has been admitted to the unit What would be a priority action by the nurse? Feedback: A) Monitor nutritional status B) Provide patient teaching regarding the drug C) Protect the patient from exposure to infection D) Provide support and comfort measures in relation to adverse effects of the drug Ans: C 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 A nurse is discussing interferon alfa 2b with a patient What will the nurse encourage the patient to while taking this drug? To avoid crowds A) C) Starting the infusion and inform the physician D) Treating the fever before beginning the therapy Ans: D Feedback: Monoclonal antibodies should be used cautiously with fever (treat the fever before beginning therapy) This makes Options A, B, and C incorrect 25 A 72-year-old male patient has arrived at the outpatient unit to receive an infusion of alemtuzumab (Compath) The patient tells the nurse this is the second time his chronic lymphocytic leukemia has relapsed and the second time he will receive this drug because he failed alemtuzumab therapy after being treated with an alkylating agent What is the priority nursing action? A) Calling the physician and questioning the order B) Washing your hands C) Beginning an intravenous infusion D) Canceling the infusion Ans: A Feedback: Monoclonal antibodies should be used cautiously in patients who have had previous administration of the monoclonal antibody (serious hypersensitivity reactions can occur with repeat administration) The nursing priority would be to question the order because the patient has already received alemtuzumab (Compath) previously and if the order is verified, this patient should be monitored very carefully, perhaps starting to infuse more slowly until the patient’s reaction can be determined Only after questioning the order and having it verified would the nurse perform hand hygiene and begin the infusion 26 The nurse is writing a plan of care for a patient receiving immune suppressants for leukemia What would be an appropriate nursing diagnosis for this patient? A) Anxiety related to diagnosis and drug therapy B) Acute pain related to central nervous system (CNS), gastrointestinal (GI), and flu-like effects C) Risk for infection related to immune stimulation D) Imbalanced nutrition: More than body requirements Ans: B Feedback: Nursing diagnoses related to drug therapy might include: Acute pain related to CNS, GI, and flu-like effects Anxiety related to diagnosis and drug therapy is a nursing diagnosis for a patient on an immune stimulant There is no risk for infection related to immune stimulation unless an adverse effect occurs Imbalanced nutrition would be less than body requirements due to flu-like symptoms resulting in diminished appetite 27 The nurse is preparing a patient to receive immunosuppressant drugs on an outpatient basis What is the priority for the nurse to arrange for this patient in the home environment? A) A caregiver who is skilled in cardiopulmonary resuscitation (CPR) B) A caregiver who will provide adequate nutrition C) Supportive care and comfort measures D) Arrange for a home care nurse to administer injections Ans: C Feedback: Arrange for supportive care and comfort measures for flu-like symptoms (rest, environmental control, acetaminophen) to decrease patient discomfort and increase therapeutic compliance Patients may also need support and comfort measures related to diagnosis and drug therapy Although knowledge of CPR and providing appropriate nutrition are always positive actions, they are not related to administration of immunosuppressants The patient or caregiver can be taught to administer injections unless the medication is to be given IV, in which case the patient would go to an infusion center 28 The nurse is caring for a patient who has a diagnosis of chronic hepatitis B infection and has been prescribed an immune stimulant After teaching the patient about the treatment plan, how might the nurse evaluate the effectiveness of teaching? A) The patient can state where to go to get the medication B) C) The patient can state who will administer the medication The patient can state what positive effects to watch for D) The patient can state specific measures to avoid adverse effects Ans: D Feedback: The nurse would evaluate that the teaching plan was successful if the patient can name drug, dosage, adverse effects to watch for, and specific measures to avoid adverse effects Knowing where to get the medication, who will administer it, and the positive effects to watch for would not be an adequate assessment of the teaching plan 29 The patient underwent an allograft renal transplant 48 hours earlier and is showing signs of rejection What drug would the nurse expect the physician to order? A) Muromonab B) Anakinra C) Mycophenolate D) Sirolimus Ans: A Feedback: Muromonab is indicated for the treatment of acute allograft rejection in patients undergoing renal transplantation It also is indicated for the treatment of steroid-resistant acute allograft rejection in those receiving heart or liver transplants Anakinra, mycophenolate, and sirolimus are useful for preventing renal or liver transplant rejection 30 The nurse, working with a nursing student, is caring for a patient who is to receive interleukins The student nurse asks you what happens physiologically when a patient receives interleukins What is the nurse’s best response? A) “It really helps the patient!” B) “The patient has increases in the number of natural killer cells.” C) “The patient has decreased cytokine activity.” D) “The patient gets really sick from flu-like symptoms and then they get better.” Ans: B Feedback: When interleukins are administered, there are increases in the numbers of natural killer cells and lymphocytes, in cytokine activity, and in the number of circulating platelets Options A, C, and D are incorrect 31 The nurse is caring for a child requiring cyclosporine to prevent rejection Cyclosporine is given to adults using a dosage of 15 mg/kg The nurse calculates the child’s dosage is 20 mg/kg What is the nurse’s priority action? A) Administer the drug B) Hold the dose and question the ordering provider C) Complete an incident report if this dosage has already been given before D) Notify the nursing supervisor of the medication error Ans: A Feedback: The nurse would administer the medication as ordered because doses larger than those given to adults are often needed when cyclosporine is administered to children This is not an error so the nurse would not hold the drug, question the provider, complete an incident report, or notify the nursing supervisor 32 When caring for older adults receiving immune modulators, what are the nurse’s priorities of care? (Select all that apply.) A) B) C) Assess carefully for infection Obtain baseline liver function studies and monitor follow-up studies Determine dosage based on renal and liver function D) Minimize teaching to avoid causing confusion E) Encourage the family to visit often, especially young children Ans: A, B, C Feedback: Older patients may be more susceptible to the effects of the immune modulators, partly because the aging immune system is less efficient and less responsive These patients need to be monitored closely for infection, GI, renal, hepatic, and central nervous system effects Baseline renal and liver function tests can help to determine whether a decreased dosage will be needed before beginning therapy Because these patients are more susceptible to infection, they need to receive extensive teaching, not less teaching, about ways to avoid infection and injury Contact with young children and large groups of people increase the risk of infection 33 The nurse teaches the female patient receiving immune modulating drugs about the need to use barrier contraceptives The patient says, “I hate using barrier contraceptives Why can’t I just take oral contraceptives?” What is the nurse’s best response? A) “Effects of oral contraceptives may be altered by liver changes or changes in immune response.” B) “Oral contraceptives increase the action of immune modulating drugs so dosage needs to be reduced.” C) “Immune modulators make oral contraceptives ineffective because of hormonal impact of drugs.” D) “Oral contraceptives are acceptable if barrier contraceptives are distasteful, but only high-estrogen pills can be used.” Ans: A Feedback: The use of barrier contraceptives is advised because the effects of oral contraceptives may be altered by liver changes or by changes in the body’s immune response, potentially resulting in unexpected pregnancy The other options conflict with this information and are incorrect 34 The nurse is caring for a young adult woman taking immune modulating medications who has been advised to use barrier contraceptives but she wants to start her family What information can the nurse provide about these drugs to help this patient with her decision-making? A) “Discuss the desire to start a family with the provider so risk can be minimized.” B) “Immune modulating drugs will need to be discontinued if pregnancy occurs.” C) “Immune modulating drugs have been proven to be highly teratogenic.” D) “Pregnancy is not an option when taking immune modulating drugs but adoption is an option.” Ans: A Feedback: If a patient taking immune modulators becomes pregnant or decides that she wants to become pregnant, she should discuss this with her health care provider and review the risks associated with use of the drug or drugs being taken Monoclonal antibodies should be used with caution during pregnancy and lactation Because results of longterm studies of most of these drugs are not yet available, it may be prudent to advise patients taking these drugs to avoid pregnancy if possible Immune modulating drugs not need to be discontinued, but the safest drug should be prescribed Most immune modulating drugs have not been studied and there is not enough information to know whether they are teratogenic The nurse cannot tell a patient that pregnancy is not an option 35 The nurse is caring for a patient diagnosed with rheumatoid arthritis (RA) who recently underwent a liver transplant What immunosuppressant could this patient be prescribed that would treat both diagnoses? A) Anakinra (Kineret) B) Adalimumab (Humira) C) Sirolimus (Rapamune) D) Cyclosporine (Sandimmune) Ans: A