Immunizations
Therapy for an allograft kidney transplant recipient includes prednisone (Deltasone), azathioprine (Imuran) and cyclosporine (Sandimmune). Several months post-transplant the patient becomes tuberculin positive and is started on isoniazid (Nydrazid), rifampin (Rimactane) and pyrazinamide therapy. Because of this drug therapy regimen the patient should be monitored closely for:
decreased cyclosporine blood level and signs/symptoms of kidney rejection.
. In assessing a patient who is receiving antineoplastic drugs that are potentially neurotoxic, which of the following data are most important for the nurse to obtain?
A. Heart sounds
B. Deep tendon reflexes
C. Pupillary reflex
D. Vital signs
B. Deep tendon reflexes
After receiving an allograft liver transplant, a patient is prescribed cyclosporine [Sandimmune] oral solution. What is the most critical component of patient teaching that the nurse should stress?
C. The medication will be taken every day for life.
Rationale: Allograft recipients must take immunosuppressants for life to prevent transplant rejection. The other concepts are important to teach the patient but are not as high a priority.
Which of the following statements is correct about the rate of cell growth in relation to chemotherapy?
1. Faster growing cells are less susceptible to chemotherapy.
2. Non-dividing cells are more susceptible to chemotherapy
3. Faster growing cells are more susceptible to chemotherapy
4. Slower growing cells are more susceptible to chemotherapy.
3. Faster growing cells are more susceptible to chemotherapy
The faster the cell grows, the more susceptible it is to chemotherapy and radiation therapy. Slow-growing and non-dividing cells are less susceptible to chemotherapy. Repeated cycles of chemotherapy are used to destroy nondividing cells as they begin active cell division.
The nurse is caring for of a client who is receiving a chemotherapy. Which of the following would be expected as a result of the massive cell destruction that occurred from the chemotherapy?
A. Leukopenia.
B. Anemia.
C. Thrombocytopenia.
D. Hyperuricemia.
D. Hyperuricemia.
Increase level of uric acid (Hyperuricemia) in the body is common following the treatment for leukemias and lymphomas because chemotherapy results in massive cell destruction.
A client who is severely allergic to eggs should NOT receive:
MMR vaccine
2. A common adverse effect of many antineoplastic drugs is
A. nausea C. skin rash
B. jaundice D. diplopia
A. nausea
A patient is prescribed sirolimus [Rapamune] and cyclosporine [Sandimmune] after renal transplantation. It is most important for the nurse to closely monitor which value?
A. Serum creatinine
Rationale: Sirolimus combined with cyclosporine poses a significant risk of renal injury. Renal function (serum creatinine, serum blood urea nitrogen, and urinary creatinine clearance) should be monitored.
Which of the following contributes most to the debilitation of an individual during a course of chemotherapy?
A. Diarrhea
B. Alopecia
C. Constipation
D. Pain
A. Diarrhea
Diarrhea will cause debilitation as fluid and nutrients are lost at a time when the body most needs to be nourished.
The clinic nurse provides instructions to a client receiving an antineoplastic medication. When implementing the plan, the nurse tells the client to?
A. To drink beverages containing alcohol in moderate amount during the evening.
B. To avoid hot foods and high fiber rich foods.
C. To take acetylsalicylic acid as needed for headache.
D. To consult with health care providers before receiving immunization.
D. To consult with health care providers before receiving immunization.
Because antineoplastic medications lower the resistance of the body, clients must be informed not to received immunizations without a health care provider’s approval.
The nurse who is caring for a client receiving cyclosporine (Neoral) will discontinue the medication immediately and call the prescriber if which of the following occurs?
A. Elevated RBC counts
B. Reduced basophile, lymphocyte & monocyte levels
C. Reduced neutrophils and macrophages
D. Elevated serum creatinine and BUN
D. Elevated serum creatinine and BUN
The nurse knows that the most common dose-limiting adverse effect of antineoplastic therapy is:
A. Nausea and vomiting
B. Myelosuppression
C. Alopecia
D. Anorexia
B. Myelosuppression
The client asks the nurse to explain the purpose of leucovorin rescue. Which of the following responses provided by the nurse is correct? Leucovorin rescue:
A. Decreases the amount of time normal cells are exposed to methotrexate
B. Decreases the incidence of renal failure
C. Alleviates severe nausea and vomiting
D. Enhances the client’s immune system
A. Decreases the amount of time normal cells are exposed to methotrexate
Lorraine who is on chemotherapy has a history of cardiac disease. The client is at risk for cardiac complications because:
A. White blood cells are reduced.
B. Oxygen-carrying capacity may be reduced.
C. Sodium levels may rise meaning fluid overload.
D. Hematocrit is lowered.
B. Oxygen-carrying capacity may be reduced.
If hemoglobin and red cell counts drop from myelosuppression, the oxygen-carrying capacity will fall, leaving the person at risk for angina.
The client with non-Hodgkin’s lymphoma is being managed with vincristine (Vincasar). Which of the following indicates a side effect specific to this medication?
A. Alopecia.
B. Numbness in the toes.
C. Chest heaviness.
D. Weight gain.
B. Numbness in the toes.
Azathioprine (Imuran) is prescribed to a client who had renal transplant. A nurse reviews the client’s medical record and would question the medication order for which of the following clients? The client with:
A. Benign prostatic hyperplasia
B. Cataract
C. Cirrhosis
D. Oliguria
C. Cirrhosis
The client is experiencing nausea and vomiting as a result of chemotherapy. Which response, provided by the nurse, would be most appropriate?
A. Continue taking the chemotherapy. We can help you deal with the nausea and vomiting
B. You’ll just have to get used to the nausea and vomiting because there is nothing we can do to alleviate it.
C. Be sure to drink at least a liter of fluid before your chemotherapy treatment; that will help decrease the nausea and vomiting
D. Take your chemotherapy on a full stomach.
A. Continue taking the chemotherapy. We can help you deal with the nausea and vomiting
The nurse determines that the client understands an important principle of antiestrogen antineoplastic therapy when the client makes which of the following statements? “Antiestrogen antineoplastics therapy:
A. Deprives tumor cells of the growth-promoting influence of estrogen
B. Prevents breast cancer
D. Averts the adverse effects of other antineoplastics, including hot flashes and edema
D. Protects the female from developing osteoporosis.
A. Deprives tumor cells of the growth-promoting influence of estrogen
Which of the following is the priority nursing diagnosis for a client undergoing chemotherapy?
A. Decreased cardiac output
B. Fear
C. Altered nutrition
D. Anxiety
A. Decreased cardiac output
Decreased cardiac output is more important than the other choices because it can jeopardize the client’s life.
The client is receiving Cisplatin (Platinol-AQ). Which of the following side effect is related to the medication?
A. Depressed tendon reflexes.
B. Photosensitivity.
C. Tinnitus.
D. Ptosis.
C. Tinnitus.
Cisplatin (Platinol-AQ), an alkylating medication, may cause ototoxicity, tinnitus, hypokalemia, hypomagnesemia, hypocalcemia and nephrotoxicity.
A 7-year-old girl who was bitten by a stay dog is treated in the emergency department. The dog has not been tested to rule out rabies. The nurse will anticipate that this client will receive the following immunizations: (Select all that apply)
A. Tetanus toxoid
B. DTaP vaccine
C. Rabies immunoglobulin
D. Rabies vaccine
E. Rabies toxoid
C. Rabies immunoglobulin
D. Rabies vaccine
A client with pancreatic cancer has started therapy with cisplatin [Platinol]. The nurse performs what important intervention during the course of this treatment?
A. Administers a daily laxative
B. Hydrates the client well
C. Administers an antiemetic following chemotherapy
D. Advises the female client to use barrier contraception.
B. Hydrates the client well
In a transplant client, the action of cyclosporine is to:
A. Defend the body against foreign antigens.
B. Inhibit T cells in response to antigens.
C. Inhibit B cell immunoglobulin.
D. Intensify the production of T lymphocytes
B. Inhibit T cells in response to antigens.
The primary action of cyclosporine is to inhibit T-cell generation in response to transplant antigens.
Combination chemotherapy is used in the treatment of cancer because:
A. Single-agent therapy produces cell lines that are resistant.
B. Two drugs are more likely to work.
C. Single-agent therapy requires larger doses for long remissions.
D. Two cancers may be present.
A. Single-agent therapy produces cell lines that are resistant.
Single-agent therapy tends to produce resistant tumor cells, making remission or cure impossible.
A male client with breast cancer is receiving Tamoxifen (Nolvadex). The nurse specifically monitors which laboratory value?
A. Activated partial thromboplastin time
B. Triglyceride level.
C. Fasting blood sugar.
D. Serum sodium and potassium.
B. Triglyceride level.
Tamoxifen (Nolvadex) is an antineoplastic medication that may increase cholesterol, triglyceride and calcium levels. Complete blood count, platelet count, serum calcium, cholesterol, and triglyceride level must be monitored periodically before the administration of this medication.