Pharmacology
A patient is receiving tamoxifen, a hormonal therapy for cancer. Select all side effects that we would review with the patient on this medication.
A. hot flashes
B risk for DVT
C. Increased risk for uterine cancer
D. Diarrhea
E. Peripheral neuropathy
A, B, C
A client who has cancer and is receiving chemo has a sodium level of 119. What management would we expect (you may be asked to highlight on the next gen)?
Fluid restriction
Normal saline 500ml/hr
Monitor lab work
Increased sodium intake
Radiation or chemotherapy
Fluid restriction
Increased sodium intake
Radiation or chemotherapy
Monitor lab work
What diet advice would you provide for someone wanting to reduce their risk for cancer?
Increase fiber, reduce animal fat, decrease red meats, reduce processed meats, avoid charring foods, Fresh fruits and veggies
Which part of the HIV infection process is disrupted by the antiretroviral drug class protease inhibitor?
A. Activating the viral enzyme integrase within the infected host cell
B. Binding the virus to the CD4 receptor and either of the two co-receptors
C. Clipping the newly generated viral proteins into smaller functional pieces
D. Fusing of the newly created viral particle with the infected cell's membrane.
C
A. Uric Acid 20
B. Na 145
C. Ca 10
A patient who has a tumor in the left breast, begins to experience numbness in the lower extremity and urinary retention. What management would we expect?
High dose radiation with corticosteroids, Back brace
What foods would you instruct patients with cancer and receiving chemotherapy to avoid?
Fresh fruits and veggies, raw foods, deli meats (unless cooked), unpasteurized cheeses.
The client on combination anti-retrovial therapy calls the nurse and left his medications at home, however his family overnighted the meds to him. The patient missed the day before dose. What action does the nurse recommend.
A. Take today's dosage as prescribed and continue to follow therapy program.
B. Do not worry, unless you miss your drugs for 4 days in a row there is no problem.
C. Take double doses of drugs for the next 2 days.
Go to the nearest ED and have immediate blood drawn for viral load determination.
A
How many days or hours do you need to follow up on a PPD? What is considered positive low risk individuals and what is considered positive for high risk individuals?
48-72 hours 15 for low risk and 5 for high risk.
What education would you include before giving the first dose of Fuzeon, a fusion inhibitor.?
May cause peripheral neuropathy and increased risk for pneumonia.
What are common complications of leukemia and why?
Reduction in normal blood cells because the bone marrow is overcrowded with the abnormal cells
What is important to understand about the differences of radiation? What education do we provide our patients for site care?
External beam vs brachytherapy (internal radiation)
Hygiene: do not scrub the site, avoid sunlight to the area exposed to radiation, mild soaps
Explain each stage of HIV/ AIds
Stage O- 1st HIV positive, does not change for 6 months
Stage 1 T cell over 500 no aids defining characteristics
Stage 2 200-499 No aids defining characteristics
Stage 3 less than 200 and may have aids defining characteristics
Stage unknown confirmed but no information on how much the cell count is
What kind of isolation does a TB positive patient need to be on?
Airborne
The primary health care provider has prescribed 1 L of D5NS to infuse at a rate of 125ml/h. The nurse begins the infusion at 0700A. When will the nurse anticipate completion of the infusion?
1500 or 3 pm.
What is important to understand about chemo handling for nurses and patients?
Nurses and patients cannot handle medications without proper PPE, medications cannot be crushed or split. Some IV chemos are considered vesicants and must be monitored for extravasation during administration.
What should you educate a a patient with neutropenia?
Infection risk, wearing mask out in public, avoid large crowds, handwashing, avoid fresh fruits and plants
You are teaching a family about caring for the patient in the home. What statement by the family would require further education?
A. We will need to wash any soiled laundry with hot water, detergent and 1 cup of bleach.
B. We can use a plastic bottle to keep needles and dispose in the trash.
C. We will need to wash dishes and eating utensils with hot water and dishwashing soap.
D. We need to label toothbrushes and razors
B
Which adults are at a higher risk for development of active tuberculosis?
A. 38 y/o with HIV III AIDS who stopped taking their meds
B. 42 IV drug user
C. 50 year old guatemalan migrant farm worker
D. 62 year old incarcerated in prison for 20 years
E. 70 year old with moderate to severe chronic obstructive pulmonary disease
. A, B, C, D
When caring for a client with a central venous line, which of the following nursing actions should be implemented in the plan of care for chemotherapy administration? What choices would be appropriate and what choices would be labeled as contraindicated?
A. Administer a cytotoxic agent to keep the regimen on schedule even if blood return is not present.
B. If unable to aspirate blood, reposition the client and encourage the client to cough
C. Contact the health care provider about verifying placement if the status is questionable.
D. Inspect the insertion site for swelling, erythema, or drainage.
A. Contraindicated
B,C, D Appropriate
A patient was scheduled to receive chemo 3 days ago, but was rescheduled due to their abnormal labs and other abnormal findings. Please list whether the labs or other findings below have improved, no change, or declined.
September 4: WBC 1300, Hgb 7, K 5.3, Ca 9, Uric acid 10, BP 112/72 HR 60, Temp 100, Urinary output 25, Specific gravity 1.020
September 7: WBC 3.5, Hgb 10, K 4.2, Ca 9.2, uric acid 6, BP 115/76 HR 62, Temp 99.2, Urinary output 70, Specific gravity 1.030
WBC Improved, Hgb Improved, K Improved, Ca no change, uric acid improved, BP no change, Hr, no change, temp improved, urinary output improved, specific gravity declined.
A patient with wasting syndrome due to candidal esophagitis affecting their ability to swallow, what interventions would be appropriate and what interventions would be inappropriate?
A. Soft, hot liquid foods
B. Fluconazole treatment
C. Provide mouth care and ice chips to the patient
D. Monitor I &Os
E. High calorie, high protein diet
F. Commercial mouthwash before and after eating or taking meds
Appropriate
I&Os, Mouth care and ice chips, high calorie high protein diet, fluconazole treatment
Inappropriate
Commercial mouthwash, Soft HOT foods
DOUBLE Jeopardy
anergy
A patient who has HIV presents to the office with shortness of breath, hemoptysis, and weight loss 3 days ago respirations 25. The lungs were dull to auscultation. The nurse performed a PPD in office during that time and the results were negative. The patient's respirations are 30 today. The patient reported he is still experiencing the symptoms with no relief with current treatment of bactrim. The patient is admitted to the hospital standard precautions. What findings below would require follow up or questioning (on a next gen you may be asked to highlight those findings.
SOB, hemoptysis, weight loss, dull lung fields, PPD negative, Respirations 30, standard precautions, question bactrim