CHEMOTHERAPY
The nurse is monitoring a patient receiving Doxorubicin. Which assessment finding is the most important to report to the healthcare provider immediately?
A) Hair loss 8 days after starting the treatment regimen
B) Dark red tinge to urine
C) Palpitations and a skipped heartbeat
D) Dark red bruising of the lower right leg
C) Palpitations and a skipped heart beat
Doxorubicin is known to be very cardiotoxic and can lead to life threatening, and lead to arrhythmias, palpitations and the feeling of a missed heartbeat can indicate cardiotoxicity.
The nurse is preparing to administer IV lorazepam to a patient having a seizure. Which assessment finding would cause the nurse to hold the medication and notify the provider?
A) HR 92/min
B) RR 10/min
C) BP 138/82 mmHg
D) T 99.2°F (37.3°C)
B) RR 10/min
An adverse effect of benzodiazepines is respiratory depression. A RR of 10/min is already lower than expected; administering the lorazepam to this patient would cause their RR to further decrease.
A nurse is caring for four postoperative patients. Which patient requires immediate intervention?
A) Patient receiving propofol who reports a warm sensation in their IV
B) Patient receiving ketamine who reports new hallucinations
C) Patient receiving succinylcholine who develops muscle rigidity and a temperature of 104 F
D) Patient who received spinal anesthesia and reports numbness in both legs
C) Patient receiving succinylcholine who develops muscle rigidity and a temperature of 104 F
Muscle rigidity with hyperthermia after succinylcholine indicates malignant hyperthermia, a medical emergency requiring immediate dantrolene administration. The other findings are expected effects.
A client using pitocin (oxytocin) for labor induction develops six contractions in 10 minutes for two consecutive intervals. What is the nurse's priority action?
A) Notify the provider because the client is experiencing uterine tachysystole
B) Continue the infusion because frequent contractions are expected
C) Administer terbutaline immediately without a provider's order
D) Encourage the client to ambulate.
A) Notify the provider because the client is experiencing uterine tachysystole
More than five contractions in 10 minutes for two consecutive intervals indicates uterine tachysystole. The provider should be notified so the medication dose can be reduced. Continuous fetal monitoring is essential.
A nurse is educating a client about tadalafil to treat erectile dysfunction. Which nursing instruction is appropriate?
A) Avoid consumption of dairy products while taking tadalafil
B) It is safe to take tadalafil concurrently with nitroglycerin
C) Avoid consumption of grapefruit juice while taking tadalafil
D) Tadalafil should not be taken concurrently with cephalosporins, such as ceftriaxone
C) Avoid consumption of grapefruit juice while taking tadalafil
Grapefruit juice is a CYP inhibitor that can increase plasma levels of phosphodiesterase type 5 inhibitors.
A nurse is assessing a patient who has been taking leuprolide for 2 weeks. Which assessment finding should the nurse follow up on immediately?
A) Recurrent hot flashes
B) Gynecomastia and decreased libido
C) Prolonged QT interval on an EKG
D) Decreased testosterone levels
C) Prolonged QT interval on an EKG
A prolonged QT interval is an adverse effect of leuprolide. This can cause life-threatening arrythmias or cardiac arrest, so this would be the nurse's priority assessment finding.
A nurse is explaining to a group of students the way in which antiepileptic medications reduce seizures. Which statement best describes the MoA of antiepileptic medications?
A) Increases production of serotonin and dopamine neurotransmitters in the brain
B) Lowers the neuronal threshold to enhance neuron firing
C) Slows Na+ and Ca+ entry back into neurons and enhances GABA effects
D) Blocks acetylcholine receptors to stimulate the sympathetic nervous system
C. Slows Na+ and Ca+ entry back into neurons and enhances GABA effects
Antiepileptic medications have 3 primary methods of suppressing seizure activity: slowing Na+ and Ca+ entry back into neurons, enhancing the inhibitory effects of GABA, and suppressing neuronal firing.
A nurse is preparing to assist a provider with a minor procedure on an 18-month-old toddler. The provider requests a topical local anesthetic. The nurse knows that which of the following medications is strictly contraindicated for this patient?
A) Lidocaine
B) Bupivacaine
C) Ropivacaine
D) Benzocaine
D) Benzocaine
You must not give benzocaine to children under the age of 2 due to the risk of methemoglobinemia. Methemoglobinemia is a blood disorder where hemoglobin is converted to a form that cannot effectively transport oxygen to the body's tissues.
A client is scheduled for cervical ripening prior to labor induction and has a Dinoprostone (Cervidil) insert placed vaginally. Which nursing action is most essential while this medication is in place?
A) Check maternal blood glucose levels every 2 hours
B) Perform continuous monitoring of fetal heart rate and uterine activity
C) Instruct the client to ambulate continuously to encourage cervical dilation
D) Prepare the client for immediate emergency spinal anesthesia
B) Perform continuous monitoring of fetal heart rate and uterine activity.
Oxytocics/cervical ripening agents carry a risk of uterine tachysystole or hypertonicity. Continuous monitoring of fetal heart rate (FHR) and contraction frequency/intensity is mandatory.
A nurse is providing discharge instructions to a 68-year-old male client who has been newly prescribed tamsulosin for benign prostatic hyperplasia (BPH). Which of the following instructions is most important for the nurse to include to prevent client injury?
A) "Take this medication on an empty stomach first thing in the morning to maximize absorption."
B) "Change positions slowly from lying to sitting or standing, especially when first starting the medication."
C) "Expect your blood pressure to increase significantly during the first week of therapy."
D) "Discontinue the medication immediately if you experience a decrease in prostate size within 48 hours."
B) "Change positions slowly from lying to sitting or standing, especially when first starting the medication."
Tamsulosin is an alpha-1 adrenergic blocker that relaxes smooth muscle in the prostate and bladder neck, but it also causes peripheral vasodilation. This can lead to orthostatic hypotension, dizziness, and fainting, particularly after the initial dose.
A nurse is preparing to provide their patient with their first dose of Cisplatin. What finding would prompt the nurse to withhold the dose?
A) Sudden decline in hearing and ringing in the left ear
B) Potassium level of 3.5
C) Elevated serum uric acid levels
D) Blood glucose level of 125 mg/dL with reports of thirst
A) Sudden decline in hearing and ringing in the left ear.
Cisplatin puts the patient at risk of developing ototoxicity and nephrotoxicity. Ringing in the ear may indicate nerve damage to the ear, so the dose should be held and the nurse should notify the provider.
A client taking phenytoin reports swollen, bleeding gums during a follow-up visit. Which nursing instruction is most appropriate for the client?
A) Stop taking the medication immediately and contact your HCP.
B) Brush with a soft-bristle toothbrush and floss twice daily.
C) Avoid foods high in calcium and vitamin D.
D) Restrict fluid intake to 1L/day.
B) Brush with a soft-bristle toothbrush and floss twice daily.
Based on the assessment findings, the client is experiencing gingival hyperplasia. To manage thse symptoms, it is important to brush teeth with a soft-bristle toothbrush and floss twice a day.
A patient who received an epidural anesthetic during labor had their Foley catheter discontinued at 0800. It is now 1400. The patient reports a mild urge to urinate but has not yet voided. The bladder scanner reveals 300 mL of urine. What is the MOST appropriate nursing action?
A) Immediately notify the physician of urinary retention
B) Assist the patient to the commode and continue to monitor
C) Perform a straight catheterization to prevent bladder injury
D) Prepare to administer neostigmine intravenously to reverse the epidural effects
B) Assist the patient to the commode and continue to monitor
When a patient receives a local anesthetic via an epidural, they will receive a Foley catheter to avoid urinary retention. Once the Foley catheter is discontinued, it is very important to monitor urine output. The physician only needs to be notified if the patient does not void within 8 hours of discontinuing the Foley catheter. Because only 6 hours have passed (0800 to 1400), continuing to monitor and assisting the patient to the commode is the most appropriate action, as the patient has until 1600 to void.
The nurse is caring for four clients receiving reproductive medications. Which client requires immediate follow-up?
A) A client taking Plan B who reports fatigue and a mild headache.
B) A client taking combined oral contraceptives who has breast tenderness.
C) A client taking combined oral contraceptives who reports a new diagnosis of breast cancer.
D) A client taking a progestin-only pill who reports breakthrough bleeding.
C) A client taking combined oral contraceptives who reports a new diagnosis of breast cancer.
Combined oral contraceptives should be discontinued immediately if the client is diagnosed with breast cancer because some breast cancers are estrogen-sensitive.
A 52-year-old male client is prescribed methyltestosterone therapy for primary hypogonadism. During a follow-up visit, which of the following assessment findings should the nurse prioritize reporting immediately to the primary healthcare provider?
A) Weight gain of 1.5 kg (3.3 lbs) over the past two weeks with bilateral 2+ pitting edema in the lower extremities.
B) Mild acne and increased oiliness of the facial skin.
C) A slight increase in libido and improved overall energy levels.
D) Mild, transient nausea occurring when the medication is taken without food.
A) Weight gain of 1.5 kg (3.3 lbs) over the past two weeks with bilateral 2+ pitting edema in the lower extremities.
Methyltestosterone may cause sodium and fluid retention. Rapid weight gain and dependent edema are hallmark signs of fluid overload and require immediate clinical evaluation.
A patient being treated with Vincristine reports difficulty performing fine motor movements, and new tendency to stumble while walking. What is the nurse's priority action?
A) Perform a full neurological assessment
B) Notify the provider of the patient’s symptoms
C) Guide the patient back to the bed and implement fall precautions
D) Administer a PRN dose of acetaminophen for nerve pain
C) Guide the patient back to the bed and implement fall precautions
An adverse effect of vincristine is neurotoxicity. While it is important to perform a neurological assessment and notify the provider of the symptoms, the nurse should first guide the patient back to the bed and implement fall precautions to protect the patient’s immediate safety.
A nurse is reviewing laboratory results for four clients during shift report. Which client should the see first?
A) Client taking pregabalin reporting swelling of the tongue and throat
B) Client taking ethosuximide complaining of nausea, vomiting, and dizziness
C) Client taking valproic acid complaining of epigastric pain radiating to the back
D) Client taking oxcarbazepine reporting weight gain and constipation
A) Client taking pregabalin reporting swelling of the tongue and throat
The client reporting swelling of the tongue and throat is experiencing manifestations of angioedema. Based on the airway-breathing-circulation framework, the patient is at high risk of airway obstruction and needs to be assessed immediately.
A patient in the ICU requires emergent intubation. The HCP orders intravenous propofol and rocuronium. To ensure patient safety and ethical care, which of the following actions by the nurse demonstrates the best clinical judgment regarding the administration of these medications?
A) Administer rocuronium first to ensure the airway is rapidly secured, followed immediately by propofol to induce sleep.
B) Mix the propofol and rocuronium in the same syringe to minimize the time to intubation.
C) Administer propofol first to ensure the patient is fully asleep before administering rocuronium.
D) Hold the propofol and administer only rocuronium, as propofol causes severe prolonged apnea.
C) Administer propofol first to ensure the patient is fully asleep before administering rocuronium.
Rocuronium is a neuromuscular blocking drug (paralytic). Paralytic drugs do not sedate the patient. Propofol must be administered prior to administering paralytics to ensure the patient is fully asleep before paralyzing them. Administering the paralytic first would trap the patient in a paralyzed but fully awake state.
A 34-year-old female client requests a prescription for combined oral contraceptives. While reviewing her medical history, which finding should lead the nurse to contact the provider to question this prescription?
A) History of dysmenorrhea and heavy menstrual flow
B) Active cigarette smoking and history of migraine headaches with aura
C) Body mass index (BMI) of 22 kg/m² and wait circumference of 30 in
D) History of seasonal allergic rhinitis
B. Active cigarette smoking and history of migraine headaches with aura
Combined oral contraceptives are contraindicated in women who smoke or experience migraine headaches with aura due to a significantly heightened risk of thromboembolic events.
The nurse is providing discharge instructions to a young adult male client newly prescribed testosterone transdermal gel for delayed puberty. Which statement by the client indicates an understanding of the safety precautions associated with this formulation?
A) "I should apply the gel to my chest and abdomen every morning right after taking a shower."
B) "Once the gel dries, I must wash the application site thoroughly with soap and water before physical contact with others."
C) "I can apply the gel to any area of my body as long as the skin is clean, dry, and free of open wounds."
D) "If the gel gets on my hands during application, I can simply wipe them clean with a dry tissue."
B) "Once the gel dries, I must wash the application site thoroughly with soap and water before physical contact with others."
To prevent accidental secondary exposure (virilization) to women and children, clients must wash the application site thoroughly with soap and water if skin-to-skin contact is anticipated, or cover the area with clothing after the gel has dried.
A nurse is educating a patient on the medication Anastrazole. Which piece of information is vital to include in the patient teaching?
A) The patient should participate in vigorous activity 75 minutes a week to improve bone health
B) Limit the consumption of calcium-rich food to prevent toxicity
C) Take a second pill shortly after the first if results aren't seen in 2 hours
D) Increase consumption of dietary calcium and vitamin D
D) Increase consumption of dietary calcium and vitamin D
Anastrozole inhibits the conversion of androgens to estrogen, leading to decreased overall estrogen levels. This puts the patient at risk for osteoporosis and bone fractures, therefore, the patient should increase calcium and vitamin D in their diet to assist with bone density.
A nurse is caring for a 7-year-old child who suddenly stops talking during class, stares blankly for about 10 seconds, has eyelid fluttering, and then immediately resumes the conversation without confusion afterward. Which medication would the nurse anticipate administering to the child?
A) Phenytoin (Dilantin)
B) Ethosuximide (Zarontin)
C) Carbamazepine (Tegretol)
D) Diazepam (Valium)
B) Ethosuximide (Zarontin)
The assessment findings indicate that the child experiences absence seizures. Ethosuximide is a traditional antiepileptic used exclusively for absence seizures.
A patient is receiving a local infiltration of lidocaine. During the procedure, the patient becomes visibly restless, reports a strange metallic taste in their mouth, and complains of ringing in their ears. The nurse recognizes this complication and should take which of the following actions? Select ALL that apply.
A) Prepare to administer lipid emulsion therapy
B) Reassure the patient that these are expected, transient side effects of lidocaine
C) Immediately administer intravenous flumazenil
D) Anticipate the potential for seizures if the condition is not promptly treated
E) Assess the patient's vital signs for hypotension and bradycardia
A) Prepare to administer lipid emulsion therapy.
D) Anticipate the potential for seizures if the condition is not promptly treated
E) Assess the patient's vital signs for hypotension and bradycardia
Restlessness (CNS excitation), metallic taste, and tinnitus (ringing in the ears) are signs of local anesthetic toxicity. This toxicity can progress into seizures if not promptly treated. Hypotension and cardiac suppression (bradycardia) are also signs of local anesthetic toxicity that the nurse must assess for. The correct treatment for local anesthetic toxicity is lipid emulsion therapy. These are medical emergencies, not expected side effects.
A client asks why she must use a backup contraceptive method during the first week after starting oral contraceptive pills for the first time. Which response by the nurse is most appropriate?
A) "The therapeutic effects will not occur until the medication has been taken daily for 7 consecutive days."
B) "The pills do not prevent ovulation during the first month."
C) "The backup contraceptives provide the intended contraceptive effect."
D) "The medication becomes effective only after the first menstrual cycle."
A) "The therapeutic effects will not occur until the medication has been taken daily for 7 consecutive days."
When starting combined oral contraceptives for the first time (or restarting after a month without use), pregnancy protection begins after 7 consecutive days of daily pills.
A home health nurse is reviewing the medication profile of a 72-year-old male client newly prescribed dutasteride for symptomatic BPH. Which of the following clinical findings or laboratory values is most critical for the nurse to monitor during ongoing therapy?
A) Serum creatinine and blood urea nitrogen (BUN) levels
B) Serum prostate-specific antigen (PSA) levels
C) Fasting blood glucose and hemoglobin A1c levels
D) Serum potassium and sodium electrolyte panels
B) Serum prostate-specific antigen (PSA) levels
Dutasteride causes serum PSA levels to decrease by approximately 50% during the first 6 months of therapy. It is important to establish a new PSA baseline due to the medication potentially masking prostate cancer development.