Chemotherapy
The nurse is caring for a patient who is receiving a hazardous medication and daily dialysis. The nurse should teach the dialysis nurse to:
A. wear appropriate personal protective equipment.
B. follow standard precautions.
C. add an additional treatment cycle to the patient's treatment.
D. refuse to dialyze the patient until the treatment is completed.
A. Wear appropriate personal protective equipment
A patient receiving an aromatase inhibitor has an increased risk of developing which late effect?
A. Metabolic syndrome
B. Peripheral neuropathy
C. Osteoporosis
D. Pericarditis
C. Osteoporosis
Answer/Rationale: Aromatase inhibitors increase the risk for developing osteoporosis.
A patient with an increased risk of hypercalcemia should be taught to:
A. minimize weight-bearing activities while receiving chemotherapy.
B. limit the intake of dietary sodium.
C. avoid the use of thiazide diuretics.
D. decrease fluid intake to less than three liters per day.
D. avoid the use of thiazide diuretic
A patient with cancer receiving end-of-life care asks why transmucosal fentanyl has been prescribed. The nurse explains that transmucosal fentanyl:
A. has been shown to achieve the fastest relief of breakthrough pain.
B. has been reported to provide the best long-acting pain control.
C. is less aggressive than morphine, but able to provide the same effect.
D. is best used during the evening hours to provide relief throughout the night.
A. has been shown to achieve the fastest relief of breakthrough pain
Answer/Rationale: Transmucosal fentanyl has demonstrated the fastest time to achieve relief with breakthrough pain.
A patient experiencing spinal cord compression to the lumbar-sacral area is most likely to exhibit which of the following signs and symptoms?
A. Paralysis, incontinence, and lower back pain
B. Flaccidity, chest pain, and a positive Babinski reflex
C. A headache, shoulder and arm pain
D. Dyspnea and increased pain above the level of the tumor
A. Paralysis, incontinence, and lower back pain
Answer/Rationale: A patient with a lumbar-sacral spinal cord compression is likely to experience paralysis, incontinence, and lower back pain.
Which medication is administered to prevent hemorrhagic cystitis?
A. Mesna
B. Fosaprepitant
C. Dexrazoxane
D. Leucovorin
A. Mesna
Answer/Rationale: Mesna is used to prevent hemorrhagic cystitis.
A patient with diffuse large B-cell lymphoma who received chemotherapy five days ago is experiencing muscle cramps, diarrhea and lethargy. Which of the following conditions is the patient most likely experiencing?
A. Tumor lysis syndrome
B. Syndrome of inappropriate antidiuretic hormone
C. Superior vena cava syndrome
D. Malignant hypertension
A. Tumor lysis syndrome
Answer/Rationale: Symptoms of tumor lysis syndrome include muscle cramps, diarrhea and lethargy; usually developing within the first few days of a cycle of chemotherapy.
A bone marrow biopsy is performed to determine which of the following?
A. Vitamin deficiency
B. Bone density
C. Hormone status
D. Cytogenetic analysis
D. Cytogenetic analysis
Answer/Rationale: Bone marrow biopsy helps to identify the cytopathology, and chromosomal abnormalities of a malignant condition.
A patient with cancer receiving palliative services reports poor sleep, fatigue, and frequently feeling worried. Which medication should the nurse expect to be prescribed for the patient?
A. Methylphenidate
B. Diphenhydramine
C. Citalopram
D. Mirtazapine
C. Citalopram
Answer/Rationale: The symptoms described are consistent with generalized anxiety. Selective serotonin reuptake inhibitors, such as citalopram, are considered first-line for the management of generalized anxiety disorder.
The nurse should instruct a patient to use barrier contraception to protect the sexual partner with which of the following medications?
A. Rasburicase
B. Filgrastim
C. Fulvestrant
D. Paclitaxel
D. Paclitaxel
Answer/Rationale: A patient receiving chemotherapy should be instructed to use a barrier contraceptive during sexual activity.
Which of the following tasks should the nurse ask a patient to perform prior to the administration of each dose of high-dose cytarabine?
A. Answering a series of complex questions
B. Rinsing with a steroid-containing mouthwash
C. Writing the first and last name
D. Providing a urine sample to check for ketones
A. Answering a series of complex questions
Answer/Rationale: Neurotoxicity can occur with high doses of cytarabine. Neurologic and cerebellar functioning should be assessed before each dose.
A patient who received chemotherapy two weeks ago presents with temperature, 102.4ºF (39.1ºC); heart rate,145 beats per minute; respiration rate, 30 breaths per minute; and blood pressure 80/38 mm Hg. The patient's white blood cell count is 18,000/mm3. Which oncologic emergency should the nurse suspect?
A. Malignant bowel obstruction
B. Tumor lysis syndrome
C. Cardiac tamponade
D. Septic shock
D. Septic shock
Answer/Rationale: Patients with sepsis present with signs of infection, including leukocytosis, hypotension, fever, and tachycardia.
What is the absolute neutrophil count for a patient who has a white blood cell count of 500/mm3 with 32% polysegmented neutrophils and 7% bands?
A. 125/mm3
B. 100/mm3
C. 223/mm3
D. 195/mm3
D. 195/mm3
Answer/Rationale: The absolute neutrophil count can be calculated by adding polysegmented neutrophils and bands, converting to a percentage, and multiplying by the white blood cell count (0.32 +0.07 = 0.39) x 500 = 195/mm3.
A patient with chemotherapy-induced mucositis should be taught to:
A. delay needed dental work until the completion of therapy.
B. use mouthwashes with an alcohol-containing base.
C. use a firm-bristled toothbrush at least four times a day.
D. avoid foods that are spicy, acidic, or rough in texture.
D. avoid foods that are spicy, acidic, or rough in texture.
Answer/Rationale: Any spicy, acidic and hard foods tend to irritate the mucosal lining.
Which of these factors is most likely to result in a higher incidence of acute graft-versus- host disease?
A. T-cell depleted grafts
B. HLA-identical related donors
C. Reduced-intensity conditioning regimen
D. Female-to-male donation
D. Female-to-male donation
Answer/Rationale: A male recipient receiving the stem cells of a female increases the risk for the development of acute graft-versus-host disease.
A premenopausal patient with metastatic breast cancer is receiving letrozole. Which other medication is also expected to be prescribed for ovarian ablation?
A. Goserelin
B. Tamoxifen
C. Exemestane
D. Degarelix
A. Goserelin
Answer/Rationale: Concomitant ovarian ablation with a luteinizing hormone-releasing hormone agonist therapy, such as goserelin, is recommended in the adjuvant, recurrent, or metastatic settings for women with breast cancer who are premenopausal.
A patient has had an allogeneic hematopoietic stem cell transplant. How many days after this transplant should the patient expect to experience neutrophil engraftment?
A. 15 - 20 days
B. 35 - 40 days
C. 1 - 5 days
D. 25 - 30 days
A. 15 - 20 days
Answer/Rationale: A patient is most likely to experience neutrophil engraftment between days 15 - 20 following an allogeneic stem cell transplant, and sometimes as early as day +10.
Which of the following laboratory values should the nurse check prior to administering a dose of zoledronic acid to a patient with hypercalcemia of malignancy?
A. Potassium
B. Uric acid
C. Creatinine
D. Sodium
C. Creatinine
Answer/Rationale: Renal toxicity is a side effect of zoledronic acid. A serum creatinine must be monitored prior to each infusion of zoledronic acid.
Which of the following is the most common side effect of a 5-HT3 antagonist?
A. Anemia
B. Neutropenia
C. Constipation
D. Muscle pain
C. Constipation
Answer/Rationale: Constipation is a common side effect of 5-HT3 antagonists.
A patient who received a Whipple procedure should expect to receive a prescription for which of the following medications prior to discharge?
A. Octreotide
B. Docusate sodium
C. Cholestyramine
D. Pancrelipase
D. Pancrelipase
Answer/Rationale: Pancreatic enzymes are administered before meals to assist in fat absorption.
The nurse should teach a patient who is scheduled to begin treatment with neratinib about the risk of which of the following side effects?
A. Significant diarrhea requiring loperamide
B. Sudden death secondary to QTc prolongation
C. Weight gain secondary to fluid retention
D. Pulmonary fibrosis requiring regular chest x-rays
A. Significant diarrhea requiring loperamide
Answer/Rationale: Neratinib can cause serious diarrhea which requires regular loperamide for the first 2 cycles.
A patient with small cell lung cancer reports a weight gain of 4 kg over the past four days with a decrease in appetite and muscle cramps. The patient's serum sodium level is 128 mEq/L and potassium is 3.6 mEq/L. The nurse suspects the patient is exhibiting signs of:
A. cardiac tamponade.
B. tumor lysis syndrome.
C. syndrome of inappropriate antidiuretic hormone.
D. superior vena cava syndrome
C. syndrome of inappropriate antidiuretic hormone.
Answer/Rationale: Patients with small cell lung cancer may display symptoms of syndrome of inappropriate antidiuretic hormone including weight gain, nausea, anorexia, and muscle cramps.
A patient with an insulinoma would be most likely to experience which of the following signs and symptoms?
A. Hypoglycemia, confusion, and vision changes
B. Hypokalemia, achlorhydria, and vasoconstriction
C. Glucose intolerance, diarrhea, and anemia
D. Abdominal pain, reflux, and vitamin B6 deficiency
A. Hypoglycemia, confusion, and vision changes
Answer/Rationale: Signs and symptoms of an insulinoma are consistent with signs and symptoms of hypoglycemia to include confusion and vision changes.
A patient states, "I have been afraid to show my body to my spouse since the mastectomy." To promote open communication, the nurse responds:
A. "Do not worry, things will look better in a few weeks."
B. "There are many options for prostheses and reconstruction."
C. "Let's practice discussing your concerns with your spouse."
D. "I am sure your spouse loves you just the way you are."
C. "Let's practice discussing your concerns with your spouse."
Answer/Rationale: The nurse is able to provide a safe space to explore concerns and actively problem solve.
Which type of risk measures the occurrence of cancer, either through new cases or deaths, in a general population?
A. Comparative
B. Absolute
C. Attributable
D. Relative
B. Absolute
Answer/Rationale: Absolute risk measures of the occurrence of cancer, through incidence or mortality in a population.