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from Pharm text book chapters: 22 41 coag 25, 26 -seizure & AD 75 bone/joint 27 neuro, muscle 59, 60 chemo 77 eye/ear

A nurse should advise a client who is receiving lorazepam (Ativan) about the adverse effects of this medication which include:
1. tachypnea
2. astigmatism
3. ataxia
4. euphoria

Ataxia.

Rationale: Ataxia, weakness, restlessness, dizziness, or other motor problems can occur with lorazepam. Options 1, 2, and 4 are incorrect. These are not adverse effects associated with lorazepam.

The client with insomnia is being treated with temazepam (Restoril). The nurse monitors for therapeutic effectiveness by noting which of the following?
1. sleeping in 3-hour intervals, awaking for a short time, and then returning to sleep
2.feeling less anxiety during activities of daily living
3. having fewer episodes of panic attacks when stressed
4. sleeping 7 hours without awakening

Sleeping 7 hours without awakening

Rationale: Sleeping for 7 hours is the desired effect of temazepam. Options 1, 2, and 3 are incorrect. The client should experience periods of sleep lasting longer than 3 hours and should obtain a full night's sleep. The client will be taking temazepam to assist with insomnia, not to treat anxiety related to everyday stress or to help control panic attacks.

The nurse is teaching a client about a new eyedrop prescription for timolol (Timoptic) for treatment of open-angle glaucoma. The client has a history of seasonal allergies and hypertension. What is an important administration technique to stress for this client?
a. Take any eyedrops for allergies 5 minutes before administering the timolol drops
b. Do not use the timolol drops while concurrently taking allergy medication.
c. The timolol drops may temporarily worsen seasonal allergies.
d. Gently put pressure on the inner canthus (tear duct) for 1 minute after instilling the timolol drop.

Gently put pressure on the inner canthus (tear duct) for 1 minute after instilling the timolol drop.

Rationale: Timolol is a beta-adrenergic blocker. To prevent swallowing and systemic absorption, pressure should be applied to the inner canthus of the eye for 1 minute after instilling the drop. Options 1, 2, and 3 are incorrect. No other eyedrops or ointments should be used when taking timolol or other drops for glaucoma without the approval of the provider. Eye solutions for allergies may contain adrenergic drugs that may worsen glaucoma. Timolol is not contraindicated during seasonal allergies. It is not known to worsen seasonal allergies, although it may cause bronchoconstriction in the sensitive individual or if swallowed and systemic effects occur.

Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Planning

The nurse is providing health teaching to a client who has been prescribed latanoprost (Xalatan) for open-angle glaucoma. While harmless, the nurse would caution the patient about which potential nonocular effects of the drug? Select all that apply.
a. Darkening and thickening of the upper eyelid
b. Darkening and thickening of eyelashes
c. A lightening of iris color and a slight darkening of the sclera
d. A slight darkening of the iris color
e. A permanent bluish tint to the conjunctiva

Darkening and thickening of the upper eyelid
Darkening and thickening of eyelashes
A slight darkening of the iris color
Rationale: Latanoprost (Xalatan) may cause thickening and darkening of the eyelashes and upper eyelid and may cause darkening of the iris, especially noticeable in clients with light eye colors. Options 3 and 5 are incorrect. Latanoprost will not cause lightening of the iris, darkening of the sclera, or a permanent bluish tint to the conjunctiva.

Cognitive Level: Applying; Client Need: Health Promotion and Maintenance; Nursing Process: Implementation

The nurse is teaching a client with otitis about a prescription for polymyxin B, neomycin, with hydrocortisone (Cortisporin). The client should be instructed to report which symptom immediately?
a. Mild itching in the outer ear canal
b. Gradually decreasing pain
c. Slight dizziness after instilling the eardrop
d. Increasing pain, particularly in the area around the ear

Increasing pain, particularly in the area around the ear
Rationale: Increasing ear pain, particularly around the ear area, may indicate worsening infection or mastoiditis and should be immediately reported. Options 1, 2, and 3 are incorrect. Mild itching and irritation may occur, but severe itching or swelling should be reported. Gradually decreasing pain is a therapeutic effect as the infection clears. Dizziness may occur if the eardrop is instilled directly onto the tympanic membrane.

The nurse is instilling drops of phenylephrine (Neo-Synephrine) into the client's eye before cataract surgery. Phenylephrine is used prior to cataract surgery because it causes _________ , allowing visualization of the operative area.

Mydriasis
Phenylephrine causes mydriasis, allowing better visualization of the area of the lens during cataract surgery.

Which instruction should the nurse include in the teaching plan for the client who is receiving timolol (Betimol, Timoptic, others) for the treatment of glaucoma?
a. Monitor your weight daily and report gain of over 2 lb per week.
b. Monitor your body temperature for late afternoon onset of fever.
c. Assess your blood pressure once weekly and report any reading less than 90/60.
d. Monitor your breathing for any periods of shortness of breath.

Assess your blood pressure once weekly and report any reading less than 90/60.

Rationale: Systemic side effects of beta-adrenergic agents may include bronchoconstriction, dysrhythmias, and hypotension. Because of the potential for systemic side effects, these drugs should be used with caution in clients with asthma, bradycardia, or heart failure. Clients and their families should be taught to monitor their pulse and blood pressure. Option 1, 2, and 4 are incorrect. Daily weight, temperature, and potential for shortness of breath would not need to be stressed in the teaching plan.

A client has developed glaucoma. The nurse reviewing this client's medication history would identify long-term use of which drug as a potential contributor to glaucoma?
a. Corticosteroids
b. Beta blockers
c. Calcium channel blockers
d. Insulin

Corticosteroids

Rationale: The long-term use of corticosteroids may contribute to the development of glaucoma. Options 2, 3, and 4 are incorrect. Beta blockers are used for the treatment of glaucoma; they do not cause it. Calcium channel blockers and insulin play no role in the development of glaucoma.

The nurse plans care for a client who is receiving an ophthalmic anesthetic agent based on which priority for nursing care?
a. Measures to increase tear secretion
b. Measures to protect the eye
c. Monitoring for conjunctivitis
d. Assessing for level of consciousness

Measures to protect the eye

Rationale. Protecting the client's eye from injury is a priority of care when a topical eye anesthetic agent is administered, as the corneal reflex is lost when it is given. Options 1, 3, and 4 are incorrect. Measures to increase tear secretion are unnecessary. The nurse will monitor for the local effect of conjunctivitis, but this is not the priority of care. Since the medication is local and not general, there should be no need to monitor the client's level of consciousness.

Which of the following agents would the nurse anticipate administering to the client for a recurrent episode of impacted earwax?
a. Cerumenex
b. Ciprofloxacin (Cipro otic)
c. Cortisporin
d. Chloramphenicol (Chloromycetin)

...

The nursing is providing health teaching to a client with open-angle glaucoma. Which of the following types of ocular medications is contraindicated for this client?
a. antibiotic drops
b. fluorescein sodium
c. proparacaine (Alcaine)
d. Mydriatic drops

...

The nurse who is reviewing the medical history of a client prescribed timolol (Timoptic) recognizes that of the following conditions, which may have been risk factors contributing to the client's glaucoma? Select all that apply.
a. hypertension
b. migraine headaches
c. epilepsy
d. cataracts
e. Cushing's syndrome

...

The nurse teaches the client with glaucoma that latanoprost (Xalatan) will work to decrease the intraocular pressure by:
a. decreasing the production of aqueous humor
b. causing permanent constriction of the pupil
c. increasing the outflow of aqueous humor
d. decreasing the plasma volume

ch77 q4

A 67-year-old client experienced a severe back strain while lifting groceries from his car. He is given a prescription for cyclobenzaprine (Flexeril). The nurse will include what precautions in the teaching plan for this patient? Select all that apply.
a. Report any palpitations or rapid pulse rate immediately.
b. Take frequent walks throughout the day to relieve soreness.
c. Rinse the mouth frequently with an alcohol-based mouthwash to relieve excess secretions.
d. Be cautious with driving or other activities requiring alertness.
e. Immediately report any facial or tongue swelling.

Report any palpitations or rapid pulse rate immediately.
Be cautious with driving or other activities requiring alertness.
Immediately report any facial or tongue swelling.

Rationale: Cyclobenzaprine may cause tachycardia, and any palpitations or rapid heart rate should be reported. Drowsiness also may occur, and driving or other hazardous activities should be avoided until the effects of the drug are known. Swelling of the face or tongue may occur and must be reported immediately to the provider. Options 2 and 3 are incorrect. Clients with severe muscle spasms are encouraged to rest affected muscle groups until acute spasms subside.

A client with spastic cerebral palsy is being treated with oral baclofen (Lioresal). Which client statement indicates the need for more teaching?
a. "I will be cautious about activities because I may feel weak."
b. "It may take several months before I experience full effects of the drug."
c. "If I experience unpleasant side effects, I can stop taking the drug."
d. "I will be sure to get enough fluid and fiber in my diet."

"If I experience unpleasant side effects, I can stop taking the drug."

Rationale: Abruptly discontinuing baclofen may result in fever, seizures, rebound spasticity, and hallucinations. Options 1, 2, and 4 are incorrect. Baclofen may cause weakness and, like other muscle relaxants and antispasmodics, may cause constipation. Being cautious with activities and increasing fluid and fiber intake will help to limit the adverse effects caused by baclofen. It may take several months before the full effects of baclofen are reached.

A client has been taught to apply capsaicin to increase mobility and relieve pain. Which educational intervention is most important for the client to learn?
a. Apply the medication liberally above and below the site of pain.
b. Apply with a gloved hand only to the site of pain.
c. Apply to areas of redness and irritation.
d. Apply liberally with a bare hand.

Apply with a gloved hand only to the site of pain.

Rationale: Capsaicin should be applied to the site of pain with a gloved hand to avoid introducing the capsaicin to the eyes or other parts of the body not under treatment. Options 1, 3, and 4 are incorrect. Capsaicin should only be applied to the site of pain, not proximal or distal to the pain. If capsaicin begins to irritate and cause redness, it should be discontinued. Capsaicin should not be applied with a bare hand.

A client has been treated for cervical dystonia with an injection of botulinum toxin type A (Botox). Which of the following will the nurse teach the client to report immediately?
a. Fever, aches, or chills
b. Difficulty swallowing, blurred vision, or ptosis
c. Moderate levels of muscle weakness on the affected side
d. Continuous spasms and pain on the affected side

Difficulty swallowing, blurred vision, or ptosis

Rationale: Dysphagia (difficulty swallowing), blurred vision, and ptosis are all symptoms of possible botulism toxicity and should be reported immediately. Options 1, 3, and 4 are incorrect. Fever, aches, and chills are not anticipated adverse effects of this drug. Moderate levels of muscle weakness may occur after the drug is administered, and strengthening exercises may be needed on the affected side. Continuous muscle spasms and pain should not occur, because the drug blocks muscle contraction.

A client has been taking cyclobenzaprine (Amrix, Flexeril) for muscle spasms. The client is admitted to the emergency department with severe central nervous system depression. Which medication will the nurse expect to be ordered and administered?
a. Naloxone (Narcan)
b. Meperidine (Demerol)
c. Diazepam (Valium)
d. Physostigmine (Antilirium)

Physostigmine (Antilirium)

Rationale: Physostigmine may be administered to reverse serious anticholinergic adverse effects. Options 1, 2, and 3 are incorrect. Naloxone is often used to decrease the effects of opioids on the CNS but is not the drug of choice in the treatment of CNS depression with cyclobenzaprine. Meperidine is a CNS depressant and should not be administered with cyclobenzaprine. Diazepam is also a skeletal muscle relaxant and should not be administered with cyclobenzaprine

A female client, age 45, is receiving dantrolene sodium (Dantrium) for treatment of painful muscle spasms associated with multiple sclerosis. What will the nurse teach the client? Select all that apply.
a. Increase fluid and fiber intake to prevent constipation.
b. Inform the health care provider if she is taking estrogen products.
c. Sip water or suck on ice or hard candy to relieve xerostomia.
d. Be sure to obtain 20 minutes of sun exposure per day to boost vitamin D levels.
e. Return periodically to the provider to monitor the client's liver function.

Inform the health care provider if she is taking estrogen products.
Sip water or suck on ice or hard candy to relieve xerostomia.
Return periodically to the provider to monitor the client's liver function.

Rationale: Dantrolene may cause hepatotoxicity, with the greatest risk occurring for women over age 35. Estrogen taken concurrently with dantrolene may increase this risk. The drug may cause xerostomia (dry mouth), and sucking on hard candy or sipping water or ice chips may relieve the dryness. Options 1 and 4 are incorrect. Fluids and fiber also may help diarrhea, but dantrolene may cause diarrhea, not constipation. Dantrolene may cause photosensitivity, so clients taking the drug should avoid direct exposure to the sun.

A client is very conscious of heavy perspiration. Because of this, the client limits activities with friends and stays isolated during the warm months of the year. The nurse's best intervention is to:
a. Inform of support groups that could assist in decreasing isolation.
b. Instruct on the benefits of botulinum toxin type A therapy.
c. Visit a plastic surgeon to discuss surgical intervention for the perspiring.
d. Instruct on limiting certain foods in her diet.

Instruct on the benefits of botulinum toxin type A therapy.

Rationale: Botulinum toxin type A is a treatment of choice for excessive perspiration. Options 1, 3, and 4 are incorrect. Although support groups can be helpful, pharmacological intervention is primary in the treatment of excessive perspiration. Surgical intervention is not a treatment of choice for perspiration. The consumption of foods affects metabolism but is not primary to the treatment of excessive perspiration.

Which interventions will assist in reducing the client's pain related to muscle spasms? Select all that apply.
a. Unsupervised exercise
b. Protein drinks
c. Ice packs to the affected area
d. Massage
e. Application of heat

Ice packs to the affected area
Massage
Application of heat

Rationale: Many individuals who suffer from painful muscle spasms find relief with the use of ice packs applied to the affected area. A nonpharmacological intervention that may be ordered by the health care provider or physical therapist is massage. Another nonpharmacological intervention that may be ordered by the health care provider or physical therapist is the application of heat. Options 1 and 2 are incorrect. The client should exercise only under the supervision of a physical therapist. Protein drinks may be acceptable for some clients who have debilitation, but will have no effect on the muscle spasms.

A client taking kava orally to provide anxiety relief is started on cyclobenzaprine (Amrix, Flexeril) to reduce low-back muscle spasms. Which safety factor is most important to instruct the client ingesting kava with cyclobenzaprine (Amrix, Flexeril)?
a. Change positions cautiously.
b. Chew gum to prevent thirst.
c. Increase dose if pain persists.
d. Kava will not affect cyclobenzaprine

Change positions cautiously.

Rationale: The client should use caution when changing positions, due to the depression of the CNS. Options 2, 3, and 4 are incorrect. When combining kava with cyclobenzaprine, the client may experience dry mouth, for which chewing gum will assist in the provision of comfort, but it will have no effect on client safety. The patient should never increase the dosage without the health care provider's approval. The client who takes kava and cyclobenzaprine together will experience increased CNS depression.

Which of these statements by a client would indicate that further instruction is needed about alprazolam (Xanax)?
a. "I will stop smoking by undergoing hypnosis."
b. "I will not drive immediately after I take this medication."
c. "I will stop the medicine when I feel less anxious."
d. "I will take my medication with food if my stomach feels upset."

"I will stop the medicine when I feel less anxious."

Rationale: This medication must be gradually reduced, not abruptly terminated. Abrupt termination may cause withdrawal symptoms (nausea, vomiting, abdominal cramps, diaphoresis, confusion, tremors, seizures). Options 1, 2, and 4 are incorrect. These are appropriate statements and indicate that the client understands the teaching.

The nurse should question a health care provider's order of phenobarbital for the client with which conditions?
a. Seizure disorder
b. Panic disorder
c. Prior to a bronchoscopy
d. Prior to receiving a general anesthetic

Panic disorder

Rationale: Panic disorder is not an appropriate use for phenobarbital. Options 1, 3, and 4 are incorrect. Treatment of status epilepticus, use prior to diagnostic testing, and use prior to receiving general anesthesia are all appropriate for phenobarbital.

The nurse is caring for a client receiving a sedative-hypnotic. Which adverse effect associated with this drug therapy is the highest priority for the nurse?
a. Urinary incontinence
b. Activity intolerance
c. Risk for falls
d. Poor nutritional intake

Risk for falls

Rationale: Client safety is the major concern with sedative-hypnotics, so prevention of falls is the highest priority. Options 1, 2, and 4 are incorrect. The client may experience urinary incontinence, activity intolerance, or poor nutritional intake related to drug therapy or other reasons

The client, who is receiving benzodiazepines, smokes two packs of cigarettes per day. The nurse expects to administer a(n) ______________ dose of this medication.
a. Larger
b. Smaller
c. Extra
d. Half

Larger

Rationale: Smoking enhances the metabolism of benzodiazepines, so the medication is broken down and removed from the body more quickly if the client were not a smoker. Therefore, a smoker may require a larger dose of a benzodiazepine to get the same effect as that in a nonsmoker. Options 2, 3, and 4 are incorrect. A smaller or half-dose, or a single extra dose, may not help relieve the client's symptoms.

Which statement by the client who has been taking diazepam (Valium) for 3 months indicates that the outcome of medication therapy has been successfully achieved?
a. "I will need to take this medication for the rest of my life."
b. "I feel like I am able to cope with routine stress at my job and home responsibilities."
c. "Because I am now feeling better, I am planning to stay on it for a long while."
d. "I thought this medication would make me think better."

I feel like I am able to cope with routine stress at my job and home responsibilities."

Rationale. Short-term relief in stressful situations is appropriate. Options 1, 3, and 4 are incorrect. It is not appropriate to continue diazepam (Valium) for the rest of the client's life or for an extended period of time. Diazepam (Valium) will not help one to think more clearly, only to decrease anxiety (option 4).

A client who has been taking benzodiazepines for several years suddenly decides to stop taking the medication. For what symptoms of acute withdrawal will the nurse monitor?
a. Weakness, delirium, seizures
b. Blurred vision, orthostatic hypotension
c. Sore throat, fever, jaundice
d. Sleep disturbances

Weakness, delirium, seizures

Rationale: The client may experience symptoms similar to alcohol withdrawal, such as weakness, delirium, or seizures, if benzodiazepines are abruptly discontinued. Options 2, 3, and 4 are incorrect because they do not occur with abrupt withdrawal of benzodiazepines.

The nurse is teaching a client about the use of a hypnotic drug at home. What client teaching is needed related to this medication?
a. "Take the medication with a caffeinated drink such as coffee."
b. "Be sure to go to bed with a full stomach."
c. "Train yourself to sleep with the lights and TV on."
d. "Avoid the use of alcohol while taking this drug."

"Avoid the use of alcohol while taking this drug."

Rationale: Alcohol is a CNS depressant, so taking two CNS depressants concurrently may cause over-sedation, or even coma. Options 1, 2, and 3 are incorrect, and are not recommended to improve sleep; they may only worsen the sleep problems.

A client asks a nurse the major difference between a sedative and a hypnotic. The nurse's response would be based on an understanding that the determining factor is the medication's:
a. Dose.
b. Action.
c. Route of administration.
d. Adverse effects.

Dose.

Rationale: The same medication at low doses may produce a sedative or calming effect but at higher doses may produce a hypnotic sleep-inducing effect. Options 2, 3, and 4 are incorrect. The action, route, and adverse effects are basically the same, regardless of the dose of the medication.

The client is receiving levodopa/carbidopa for parkinsonism. Which drug would the nurse expect to be added to the client's drug regimen to help control tremors?
a. Amantadine (Symmetrel)
b. Benztropine (Cogentin)
c. Haloperidol (Haldol)
d. Donepezil (Aricept)

Benztropine (cogentin)

Rationale: benztropine, a cholinergic antagonist, is frequently used as combination therapy with other antiparkinson drugs to decrease tremors. Options 1, 3, and 4 are incorrect. Amantadine acts to increase dopamine's release, but only as long as dopamine is available. Haloperidol is a phenothiazine antipsychotic that may lead to pseudo-parkinson's disease in many persons. Donepezil prolongs the time between diagnosis and the institutionalization of the client with alzheimer's disease and is not used for parkinson's disease.

Which statement, if made by the client, would alert the nurse that the antiparkinson medication is effective?
a. "I'm sleeping a lot more, especially during the day."
b. "My appetite has improved."
c. "I'm able to shower by myself."
d. "My skin doesn't itch anymore."

"i'm able to shower by myself."

Rationale: being independent with adls shows an improvement in physical abilities. Options 1, 2, and 4 are incorrect. Drowsiness is a common adverse effect of anti-parkinson's medications. Anorexia or loss of appetite is a common adverse effect, not an expected therapeutic effect. Itchy skin is not directly related to pd symptoms or to the medications used.

The nurse is counseling the caregivers of a client with Alzheimer's disease. Which statement, if made by a caregiver, would indicate that the session had been effective?
a. "I should give this medication as symptoms of AD become noticeable."
b. "If constipation occurs, I will notify the health care provider immediately."
c. "The medication may improve symptoms but will not cure the disease."
d. "I will take the client's vital signs before every dose of the medication."

"the medication may improve symptoms but will not cure the disease."

Rationale: it is imperative that the caregivers understand that there is no cure for ad; the best that can happen is that the medication may delay the worsening of symptoms. Options 1, 2, and 4 are incorrect. The medication should be given continuously and not only when the symptoms are present. The client may become constipated but it does not require emergency treatment. The drug may cause bradycardia or atrial fibrillation and the pulse rate should be checked weekly, but it is not necessary to take the client's vital signs before each dose of medication.

The nurse knows that which of the following is a major disadvantage for the use of tacrine (Cognex) to treat the symptoms of early Alzheimer's disease? Select all that apply.
a. Must be administered four times per day.
b. Causes weight gain.
c. May cause vision difficulties.
d. May cause serious hepatic damage.
e. Can be purchased over-the-counter

Must be administered four times per day.
May cause serious hepatic damage.

Rationale: it is difficult to remember to take a medication four times a day, and as the client's cognitive functioning declines, it may be increasingly difficult to administer it. Serious liver damage is a possibility with tacrine, which decreases its usefulness. Options 2, 3, and 5 are incorrect. Tacrine may cause weight loss, rather than gain, and does not cause vision difficulties. Tacrine is available by prescription only and cannot be purchased over the counter.

The nurse knows an advantage to rivastigmine (Exelon) over other cholinesterase inhibitors is that it:
a. Has no significant drug interactions.
b. Does not cause cholinergic adverse effects.
c. Is absorbed best on an empty stomach.
d. Does not alter glucose control in clients with diabetes.

Has no significant drug interactions.

Rationale: rivastigmine has no significant drug interactions. This is thought to be true because there is no interaction with enzymes in the liver that metabolize drugs. Options 2, 3, and 4 are incorrect because they do not apply to rivastigmine

The family of a client diagnosed with early stage Alzheimer's disease confides in the nurse about the client's depression. Which response by the nurse would be appropriate?
a. "Don't worry; the depression will go away by itself."
b. "Soon the client won't be able to remember anything, so won't be depressed."
c. "The health care provider can order a trial with an antidepressant medication."
d. "You can get some OTC estrogen cream; it will help delay the symptoms."

"the health care provider can order a trial with an antidepressant medication."

Rationale: depression should never be ignored. Many times a client diagnosed with ad will have enough cognitive functioning to be aware of the ramifications of the diagnosis, and will become depressed. This depression can be decreased with the correct antidepressant. Options1, 2, and 4 are incorrect. Depression will not just go away and should be reported to the health care provider for further treatment. It may take several years for the disease to progress and it is not helpful to the therapeutic nurse-client relationship to include personal remarks or inappropriate comments regarding the client or the disease process. Estrogen does not reduce the risk of dementia; studies show that it may increase the risk slightly.

The nurse is caring for a client with moderate stage Alzheimer's disease. The nurse expects which drug to be most beneficial at this stage?
a. Donepezil (Aricept)
b. Tacrine (Cognex)
c. Memantine (Namenda)
d. Haloperidol (Haldol)

Memantine (namenda)

Rationale: memantine is the only medication recommended for the moderate stage of alzheimer's disease. Options 1, 2, and 4 are incorrect. Donepezil and tacrine are used for earlier stages. Haloperidol may be used if the client is exhibiting psychotic symptoms, especially in early stage ad.

Levodopa (Larodopa) is prescribed for a client with Parkinson's disease. At discharge, which teaching point should be stressed by the nurse?
a. Monitor blood pressure every 2 hours for the first 2 weeks.
b. Expect the urine color to be orange.
c. Report decreased sex drive.
d. Keep scheduled laboratory appointments for liver and renal function tests.

Keep scheduled laboratory appointments for liver and renal function tests.

Rationale: levodopa may cause decreased liver function, so it is imperative that the client have regular liver function tests performed. Options 1, 2, and 3 are incorrect. It is not necessary to monitor blood pressure that often. Urine may turn dark in color, not orange. Sex drive may be increased, not decreased.

The nurse is monitoring a client with Parkinson's disease for a reduction in symptoms 3 weeks after starting pharmacotherapy with levodopa/carbidopa (Sinemet). Which symptom indicates the medication is achieving therapeutic effectiveness?
a. A reduction in muscle rigidity, bradykinesia, and postural instability.
b. An increase in mental capacity, memory, and logical thinking.
c. A normal pupil response to direct light and improvement in vision.
d. An absence of visual, auditory, and tactile hallucinations.

A reduction in muscle rigidity, bradykinesia, and postural instability.

Rationale: the nurse should monitor the client for a decline in the symptoms associated with pd, which include muscle rigidity, bradykinesia, and postural instability. Options 2, 3, and 4 are incorrect. Levodopa/carbidopa does not affect mental status or memory. Pupillary response and visual impairment are not symptoms of pd and would not be good indicators of the therapeutic response of levodopa/carbidopa. Parkinson's disease does not cause hallucinations.

A client with Alzheimer's disease has been rushed to the emergency department with a suspected overdose of donepezil (Aricept). The nurse should monitor for which symptoms associated with toxicity of this drug?
a. Tinnitus, photosensitivity, and hypertension
b. Bradycardia, respiratory depression, and hypotension
c. Tachycardia, hyperventilation, wheezing, and chills
d. Alopecia, anxiety, and dry mucous membranes

Bradycardia, respiratory depression, and hypotension

Rationale: overdosage of donepezil will result in signs of cholinergic crisis: nausea, vomiting, bradycardia, respiratory depression, hypotension and seizures. Option 1 is incorrect because these are not symptoms of overdose associated with donepezil. Option 3 is incorrect because individuals who have overdosed on donepezil will not demonstrate hypertension, hyperventilation, or chills. Option 4 is incorrect because this does not describe toxic level of donepezil.

A 10-year-old child has been evaluated for a learning disability and has been diagnosed with absence seizures. Ethosuximide (Zarontin) has been ordered and the nurse is teaching the client and family about the drug. Because of the client's age, it is important to include instructions to:
a. Curtail afterschool sports activities, because the drug's metabolism may be increased with physical activity.
b. Increase intake of calcium-rich foods and vitamin D to prevent bone loss.
c. Monitor height and weight weekly to be sure GI side effects are not hindering nutrition and normal growth.
d. Increase fluid intake to avoid dehydration caused by the drug.

Monitor height and weight weekly to be sure GI side effects are not hindering nutrition and normal growth.

Rationale: GI effects such as nausea, anorexia, and abdominal pain are common with ethosuximide. Because the client is still growing, improper nutrition may affect normal growth. Monitoring height and weight weekly will assist in tracking normal growth. Options 1, 2, and 4 are incorrect. Physical activity will not affect the drug's metabolism, and activity is normal and needed for healthy growth and development. Ethosuximide is not known to cause bone loss or dehydration.

The nurse is caring for a 42-year-old client who was recently diagnosed with partial seizures and has been prescribed oxcarbazepine (Trileptal). Which laboratory study would the nurse expect to be ordered?
a. CBC with differential
b. Serum albumin and glucose levels
c. Sedimentation rate and platelet count
d. Serum sodium and renal function studies

Serum sodium and renal function studies

Rationale: Oxcarbazepine is excreted by the kidneys, and renal function laboratory studies will be monitored to detect adverse renal effects. Because hyponatremia may develop during treatment, serum sodium levels should also be monitored. Options 1, 2, and 3 are incorrect. Oxcarbazepine does not affect CBC, platelets, sedimentation rate, or albumin or serum glucose levels.

An 80-year-old client is prescribed carbamazepine (Tegretol) for a newly diagnosed seizure disorder. The nurse will implement safety measures because this client is at an increased risk for which adverse effects with the administration of this drug?
a. Dementia and confusion
b. Insomnia and forgetfulness related to sleep deprivation
c. Stroke and decreased motor function
d. Sedation and falls

Sedation and falls

Rationale: Sedation and an increased risk of falls are associated with carbamazepine. Options 1, 2, and 3 are incorrect. Carbamazepine is used off-label to treat dementia with aggressiveness and agitation. The drug is not associated with insomnia and has not been demonstrated to increase the risk of stroke.

A 23-year-old client has been taking gabapentin (Neurontin) for control of partial seizures. He is admitted to the emergency department with slurred speech, dyspnea, reports of double vision, and sedation. The admitting nurse suspects the client has:
a. Not taken his drug for several days.
b. Taken an overdose of the drug, either accidentally or deliberately.
c. Taken the drug with grapefruit or grapefruit juice.
d. Continued to smoke despite prior client education that smoking interacts with the drug.

Not taken his drug for several days.

The nurse, who is monitoring a client taking phenytoin (Dilantin), has noted symptoms of nystagmus, confusion, and ataxia. Considering these findings, the nurse would suspect that the dose of the drug should be:
a. Reduced.
b. Increased.
c. Maintained.
d. Discontinued

Reduced.

Rationale: High doses of phenytoin can cause nystagmus, confusion, ataxia, coma, and seizures, and should be reduced. Options 2, 3, and 4 are incorrect. Increasing or maintaining the same dose will continue the symptoms of toxicity or exacerbate them. The drug should not be discontinued abruptly, because seizure activity may occur.

Carbamazepine (Tegretol) has been prescribed for a 24-year-old client for the control of partial seizures. The nurse will teach the client to immediately report:
a. Blurred vision.
b. Leg cramps.
c. Blister-like rash.
d. Lethargy.

Blister-like rash.

Carbamazepine is associated with an increased risk of Stevens-Johnson syndrome (SJS) and toxic epidermal necrosis in genetically susceptible individuals. Sunburning and a reddish-purple rash, especially associated with blisters, are possible symptoms of severe dermatologic reactions and should be evaluated immediately. Options 1, 2, and 4 are incorrect. Blurred vision, leg cramping, and lethargy are all possible side effects of carbamazepine but tolerance to these effects usually develops over time.

A 16-year-old client is admitted to the Emergency Department following a tonic-clonic seizure. He has been taking phenytoin (Dilantin) for the last 10 years for seizure activity. Which factor is the most likely cause of the recurrence of seizure activity?
a. Administration of ibuprofen
b. Intake of 2,000 mL of fluid per day
c. Growth in adolescence
d. Overdose of antiepileptic medications

Growth in adolescence

Rationale: The child and parent should be instructed that with growth, the dosage of antiepileptic medications must be increased. Options 1, 2, and 4 are incorrect. The administration of ibuprofen, ingestion of 2,000 mL of fluid per day, or overdose of antiepileptic medications will not contribute to the onset of seizure activity.

A 22-year-old client who has been treated for 10 years for a seizure disorder has discussed pregnancy with her health care provider. Which drug therapy would the nurse expect to be added to the client's drug regimen prior to conception?
a. Clomiphene (Clomid)
b. Vitamin K
c. Calcium (Caltrate)
d. Folic acid (Folgard)

Folic acid (Folgard)

Rationale: Prior to conception, folic acid should be recommended to women who are required to continue with AED therapy. This will decrease the incidence of birth defects associated with the drugs. Options 1, 2 and 3 are incorrect. It would be inappropriate for the client to take Clomid, a drug used for infertility, unless it is determined that the client is suffering from infertility. The administration of vitamin K will increase the risk of blood clotting. The administration of calcium is important due to the development of osteomalacia, but it will not have the effect of folic acid in the prevention of neurological deficits in pregnancy.

A 13-year-old child who is developmentally delayed has a seizure disorder and has been taking phenytoin (Dilantin) since birth. When caring for this client, the nurse would provide which nursing intervention?
a. Hold the phenytoin (Dilantin) until after the electroencephalogram (EEG).
b. Provide good mouth care due to gingival hyperplasia.
c. Administer saturated solution of potassium iodide (SSKI) through a straw due to iodine deficiency.
d. Insert a tongue blade into the mouth during a seizure.

Provide good mouth care due to gingival hyperplasia.

Rationale: Long-term administration of phenytoin (Dilantin) will cause gingival hyperplasia; thus good mouth care is imperative. Options 1, 3, and 4 are incorrect. The nurse should not hold Dilantin unless there is a specific order by the health care provider. The child with a seizure disorder would not be administered SSKI. The nurse should never insert a tongue blade during a seizure, as it is usually unsuccessful and can result in injury to the client.

A client with a seizure disorder has been placed on a ketogenic diet. What would the nurse teach is this diet's benefit to prevent seizures?
a. It has no effect on the prevention of seizures.
b. It reduces stress, which increases seizure threshold.
c. It lowers the potassium and decreases neuron firing.
d. It decreases the excitability of the neurons.

It decreases the excitability of the neurons.

Rationale: The ketogenic diet consists of a high-fat and low-carbohydrate diet. The diet produces ketone metabolism in the brain, which decreases the excitability of the neurons. Options 1, 2, and 3 are incorrect. The ketogenic diet does have an effect on the prevention of seizures. It does not reduce stress or alter the potassium level.

The client with deep vein thrombosis is being treated with a heparin infusion. The nurse would monitor for therapeutic effectiveness by noting which of the following?
a. Activated partial thromboplastin time (aPTT)
b. Prothrombin time (PT)
c. Platelet counts
d. International normalized ratio (INR)

Activated partial thromboplastin time (aPTT)

Rationale: An activated partial thromboplastin time (aPTT) is the appropriate laboratory value that should be monitored with heparin infusions. When the client is receiving this drug, the results should be 1.5 to 2.0 times that client's baseline, or 60 to 80 seconds. Options 2, 3, and 4 are incorrect. A prothrombin time or INR is used to monitor the effectiveness of warfarin. Platelets are not affected by anticoagulants and are therefore not used in the monitoring of these drugs.

Which of the following should the nurse include in the teaching plan for a client receiving subcutaneous heparin? Select all that apply.
a. Inject medication in the deep fatty layer of the abdomen.
b. When brushing your teeth, use a soft toothbrush.
c. Hold direct pressure on any puncture sites for 15 minutes.
d. Use dental floss daily after brushing.
e. Take a daily aspirin tablet, 325 mg, to prevent inflammation at the injection site

Inject medication in the deep fatty layer of the abdomen.
When brushing your teeth, use a soft toothbrush.
Hold direct pressure on any puncture sites for 15 minutes.

Rationale: The client should be taught proper injection technique, including the need to inject the heparin into the deep subcutaneous fat layer. A soft toothbrush should be used for oral hygiene. Puncture wounds or cuts will require longer-than-normal pressure held at the site to stop bleeding—15 minutes or longer. Options 4 and 5 are incorrect. Dental flossing should be avoided while the client is receiving anticoagulants. The flossing can cause gum irritation and excessive bleeding. Aspirin has antiplatelet effects, and concurrent use may increase the risk of bleeding or hemorrhage.

A client who is taking warfarin (Coumadin) states, "I wake up every morning with arthritis pain and I always take aspirin or ibuprofen." The nurse's response would be based on which physiologic concept?
a. Aspirin and ibuprofen (Motrin) will counteract the therapeutic effects of many anticoagulants.
b. Anticoagulants will reduce the half-life of drugs such as aspirin and ibuprofen.
c. Many substances such as aspirin and ibuprofen will increase the risk of bleeding.
d. The combination of aspirin products with anticoagulants will worsen arthritis pain.

Many substances such as aspirin and ibuprofen will increase the risk of bleeding.

Rationale: Many drugs such as aspirin and ibuprofen have strong anticoagulant effects. When the client on warfarin takes these drugs, the increased risk of bleeding can be hazardous. Options 1, 2, and 4 are incorrect. Drugs such as aspirin and ibuprofen do not neutralize the effect of an anticoagulant. Anticoagulants do not influence the half-life of any drugs. The pain associated with arthritis is not worsened by the combination of these drugs.

What should the nurse teach the client who is to receive alteplase (Activase) as part of the treatment for myocardial infarction?
a. The drug will be given IV, and the client should be able to go home later today.
b. The client should remain quiet and lying down during drug administration and for up to 8 hours after infusion.
c. The risk of bleeding returns to normal limits within 24 hours after the drug has been infused.
d. An increase in vitamin K-rich foods or a supplement will be needed for the week following the treatment.

The client should remain quiet and lying down during drug administration and for up to 8 hours after infusion.

Rationale: Because of the risk of hemorrhage, dysrhythmias, and hypotension, the client should remain supine during and for up to 8 hours post-drug infusion. Options 1, 3, and 4 are incorrect. The client will remain in the hospital for a minimum of 24 hours or longer postprocedure for monitoring per agency protocol. The risk of bleeding remains elevated for 2 to 4 days postinfusion. Oral anticoagulants such as warfarin or antiplatelet drugs will be ordered after the infusion; increasing vitamin K in the diet or by supplement may increase the risk of clotting.

A client who is taking clopidogrel (Plavix) to prevent another stroke asks the nurse how the medication works. The nurse's response should be based upon an understanding that Plavix:
a. Inhibits platelet aggregation to prevent clot formation.
b. Activates antithrombin III and subsequently inhibits thrombin.
c. Inhibits enzymes involved in the formation of vitamin K.
d. Converts plasminogen to plasmin to dissolve fibrin clots.

Inhibits platelet aggregation to prevent clot formation.

Rationale: Clopidogrel is an antiplatelet drug used to prevent blood clots from forming inside arteries by inhibiting platelet aggregation. Options 2, 3, and 4 are incorrect. Heparin is an anticoagulant that blocks the formation of blood clots by activating antithrombin III. Warfarin is a vitamin K antagonist used to prevent the blood from clotting. The drug alteplase is a tissue plasminogen activator that dissolves fibrin clots.

A client will be receiving lepirudin (Refludan). Which statements are true concerning this drug therapy? Select all that apply.
a. Ginger, garlic, and green tea may increase the risk of bleeding.
b. Vitamin B12 is used to augment this drug's response.
c. Refludan is used for heparin-induced thrombocytopenia.
d. Activated partial thromboplastin time is monitored to determine effectiveness.
e. This drug is contraindicated for clients with severe hypertension

Ginger, garlic, and green tea may increase the risk of bleeding.

Refludan is used for heparin-induced thrombocytopenia.

Activated partial thromboplastin time is monitored to determine effectiveness.

This drug is contraindicated for clients with severe hypertension.

The nurse is teaching the client about the heparin infusion. Which of the following statements made by the client indicates that further teaching is necessary?
a. "When this drug dissolves my blood clot, can I go home?"
b. "While receiving the medication, I avoid drinking alcohol."
c. "Eating soft foods will be best while receiving this drug."
d. "I should report any sudden onset of pain, such as headache or abdominal pain."

"When this drug dissolves my blood clot, can I go home?"

Rationale: Heparin does not dissolve blood clots. This drug prohibits the formation of new clots and the expansion of existing clots. Options 2, 3, and 4 are incorrect. The client should avoid smoking and drinking alcohol while on heparin therapy. Foods that are rough—such as nuts, peanut brittle, corn chips, and raw carrots—that can potentially cause injury to the mouth and soft palate should be avoided. Clients should be instructed to report any strange and unexplained onset of pain such as severe headaches and abdominal pain, which may reflect internal bleeding

A client has been on heparin infusion therapy for 3 days. Today, the health care provider has ordered warfarin (Coumadin) 5 mg orally every night. Which nursing action is appropriate?
a. Continue the heparin and administer the Coumadin as directed.
b. Discontinue the heparin and dispense half of the Coumadin dose prescribed.
c. Continue the heparin and obtain clarification from the health care provider.
d. Discontinue the heparin 12 hours before administering the first dose of Coumadin.

Continue the heparin and administer the Coumadin as directed.

Rationale: Remember that heparin and Coumadin have two different mechanisms of action. Frequently, when a client is receiving heparin infusion, the health care provider may prescribe Coumadin before the heparin is discontinued. Coumadin requires 3 to 4 days for the plasma to reach a therapeutic level. During the transition period, the nurse should monitor the client for bleeding. Options 2, 3, and 4 are incorrect. There is no indication to discontinue the heparin. Clarification of an order is always good. However, the protocol presented is not unusual and is frequently used prior to the discontinuation of the heparin infusion. There is no reason to wait 12 hours after the discontinuation of the heparin to administer the Coumadin. The two drugs act differently on the physiologic mechanisms for coagulation.

Thrombolytics are prescribed for each of the following clients. A nurse should question the order for the client with which condition?
a. Myocardial infarction
b. Pulmonary embolism
c. Acute ischemic strokes
d. Closed head injury

Closed head injury

Rationale: A closed head injury is one contraindication for the use of thrombolytic drugs. If a blood clot is in the brain, disturbing it may have a deleterious effect on the neurological system. Options 1, 2, and 3 are incorrect. Thrombolytics are drugs that dissolve blood clots. They are frequently used in the care of clients with heart attacks. Pulmonary embolism is another use for these drugs, as thrombolytics will dissolve any clots in the lungs. Only strokes (CVAs) that are known to be caused by thrombus or emboli will be treated with these drugs.

The health care provider has written in the client's chart that the cancer is at Stage I. The nurse knows that the implications for this staging are that the:
a. Cancer is advanced and the client has a poor prognosis.
b. Cancerous cells are only moderately differentiated from the parent cells.
c. Cancer has been detected at an early stage.
Tumor is large and is invading surrounding tissue

Cancer has been detected at an early stage.

Rationale: Stage 1 suggests that the tumor is relatively small in size, has not invaded the surrounding tissue, and has not been detected in surrounding lymph nodes; thus it has been detected at an early stage. Options 1, 2, and 4 are incorrect. Stage 1 is the earliest staging and has the best prognosis. Cell differentiation refers to grading of cancer cells, not staging of cancer cells. Stage 1 suggests that the tumor is small and has not begun to invade surrounding tissue.

The nurse is evaluating the client who is receiving chemotherapy to determine the risk for infection. Which laboratory values would prompt the nurse to implement protective isolation measures for this client?
a. High uric acid level
b. Low neutrophil count
c. High red blood cell count
d. Low platelet count

Low neutrophil count

Rationale: A low neutrophil count means that the client has a decreased immune system, placing the client at risk for an infection. Protective isolation measures would be initiated to shelter the client from microorganisms. Options 1, 3, and 4 are incorrect. A high uric acid level places the client at risk for renal problems. A high red blood cell count does not impair the client's immune system. A low platelet count places the client at risk for bleeding complications but does not affect the immune system.

The nurse determines that the client understands an important principle of chemotherapy when the client makes which statement?
a. "The use of multiple chemotherapy drugs affects different stages of the cancer cell's life cycle."
b. "Staging describes the process of determining how responsive the cancer is to the prescribed chemotherapy."
c. "Antineoplastic drugs kill the entire tumor, including the clones, and prevent repopulation."
d. "Combination chemotherapy requires higher dosages of each individual agent and increases toxicity."

"The use of multiple chemotherapy drugs affects different stages of the cancer cell's life cycle."

Rationale: The use of multiple drugs affects different stages of the cancer cell's life cycle, and attacks the various clones within the tumor via several mechanisms of action, thus increasing the percentage of cell kill. Combination chemotherapy also allows lower dosages of each individual agent, reducing toxicity and slowing the development of resistance. Options 2, 3, and 4 are incorrect. Staging describes the process of determining the extent of cancer in the body and where the cancer is located. Antineoplastic drugs may kill only a small portion of the tumor, leaving some clones unaffected and able to repopulate the tumor with resistant cells. Combination chemotherapy also allows lower dosages of each individual agent, reducing toxicity and slowing the development of resistance.

Chemotherapy is being initiated for a client with prostate cancer who is experiencing mucositis. Which health teaching would be most appropriate for this condition?
a. Use an over-the-counter mouthwash to eliminate bacteria.
b. Increase intake of citrus-containing foods and beverages.
c. Eat a bland diet with low roughage and use a soft toothbrush or plain water rinses for oral care.
d. This adverse effect is expected and will disappear within a few days.

Eat a bland diet with low roughage and use a soft toothbrush or plain water rinses for oral care.

Rationale: Mucositis is the painful inflammation and ulceration of the mucous membranes lining the digestive tract, an adverse effect of chemotherapy and radiation treatment for cancer. Clients experiencing this adverse effect should be instructed to eat a bland diet with low roughage and to use a soft toothbrush or plain water rinses for oral care if the mucositis is severe. Options 1, 2, and 4 are incorrect. Most OTC mouthwashes contain a significant amount of alcohol, which will further inflame the oral issue and should be avoided. Citrus foods and beverages should be avoided because the acidic nature of these foods would cause the client pain. Mucositis can last the duration of the chemotherapy treatment and should be treated rather than ignored. This condition will prevent intake of adequate nutrition to build new cells.

The nurse is collaborating with the interdisciplinary team regarding the care of a client with a brain tumor. The nurse knows that the most common reason that subsequent rounds of chemotherapy may be delayed is what condition?
a. Myelosuppression
b. Alopecia
c. Mucositis
d. Cachexia

Myelosuppression

Rationale: Myelosuppression is the most common dose-limiting adverse effect of chemotherapy, and the one that most often causes discontinuation or delays of chemotherapy. Options 2, 3, and 4 are incorrect. Although alopecia may be distressing for the client, its presence does not determine when the next round of chemotherapy can be administered. Mucositis is not a reason that subsequent rounds of chemotherapy should be delayed. Cachexia is the physical wasting with loss of weight and muscle mass caused by disease. Although it is considered, it is not the most common reason for delaying chemotherapy.

A client with cancer is started on a chemotherapeutic agent that is a known vesicant. The nurse performs which priority activity related to this drug? Monitor the client's:
a. Response to antinausea drugs.
b. Intake of calcium-rich foods.
c. Respiratory status for cough.
d. IV port site for redness, swelling, and pain.

IV port site for redness, swelling, and pain.

Rationale: Many antineoplastics are classified as vesicant agents that can cause serious tissue injury if they escape from an artery or vein during an infusion or injection. The nurse should closely monitor the infusion site for swelling and pain. Options 1, 2, and 3 are incorrect. Vesicants do not necessarily cause nausea. It would be inappropriate for the nurse to monitor the client's intake of calcium-rich foods, because this is not related to receiving a chemotherapy classified as a vesicant. Respiratory status is not related to the administration of a vesicant-type chemotherapy agent

The client who is receiving a chemotherapeutic agent asks the nurse why these drugs may cause alopecia. The nurse's response is based on which of the following physiological principles? Chemotherapy:
a. Usually leads to poor caloric intake and nutrition.
b. Causes damage to cells that have low growth fractions.
c. May lead to neutropenia, thrombocytopenia, and anemia.
d. Affects cells that rapidly divide through the mitotic process.

Affects cells that rapidly divide through the mitotic process.

Rationale: Chemotherapy affects all cells in the body that are dividing rapidly through the mitotic process, which includes cells in the hair follicles. Option 1 is incorrect. Although chemotherapy may lead to nausea, vomiting, and other GI issues, this is not what causes alopecia in the client with cancer. Option 2 is incorrect. Chemotherapy affects cells that have a high growth fraction. Option 3 is incorrect. While chemotherapy may lead to neutropenia, this does not have an impact on the development of alopecia.

The client receiving chemotherapy informs the nurse that he experiences severe nausea when thinking about the chemotherapy treatments. The nurse would document this objective finding as:
a. Delayed vomiting.
b. Avoidance behavior.
c. Anticipatory nausea.
d. Breakthrough vomiting.

Anticipatory nausea.

Rationale: Anticipatory nausea is learned from previous experiences with vomiting. Anticipatory nausea and vomiting occur as a result of a previous unpleasant experience with chemotherapy. It occurs as the person is preparing for the next dose of chemotherapy. Delayed vomiting develops more than 24 hours after chemotherapy is given. It may occur with certain types of chemotherapy, such as cisplatin, carboplatin, cyclophosphamide, and doxorubicin (option 1). Avoidance behavior is not indicative of the client trying to avoid treatment. It is a very real phenomenon (option 2). Breakthrough vomiting occurs despite treatment to prevent it. It requires more or different antinausea and vomiting treatment (option 4).

The client who is receiving chemotherapy asks the nurse why some chemotherapy cannot be taken orally. Which response by the nurse is correct?
a. Chemotherapy destroys the lining of the gastrointestinal tract, causing bleeding.
b. Some chemotherapies, if administered orally, are not absorbed consistently.
c. The gastric hydrochloric acid will deactivate or destroy all chemotherapies.
Gastric content, such as food, prevents chemotherapy agents from being digested.

Some chemotherapies, if administered orally, are not absorbed consistently.

Rationale: One problem associated with oral administration is the inconsistency of absorption. Option 1 is incorrect. There are some drugs that can be given orally. These chemotherapy agents do not destroy the lining of the GI tract, causing bleeding. Option 3 is incorrect. When a chemotherapeutic agent comes in a form that can be given orally, it is not destroyed by gastric hydrochloric acid. Option 4 is incorrect. Oral agents typically are not affected by food or other gastric content.

The nurse is preparing to administer cyclophosphamide (Cytoxan) and knows that the client will experience a nadir in approximately 9 to 14 days. Which laboratory value(s) will indicate to the nurse that the client has reached the nadir?
a. Blood urea nitrogen and creatinine
b. White blood cell count and absolute neutrophil count
c. Ionized calcium
d. Serum albumin

White blood cell count and absolute neutrophil count

Rationale: The nadir indicates that myelosuppression has occurred and is indicated by decreased blood cell counts. WBC and ANC are sensitive indicators of the nadir. Options 1, 3, and 4 are incorrect. BUN, creatinine, ionized calcium, and serum albumin are not indicators of the nadir and myelosuppression.

A client has been receiving vincristine (Oncovin) as one of the drugs in a chemotherapy regimen. What important findings will the nurse monitor to prevent or limit the main dose-related toxicity for this client? Select all that apply.
a. Numbness of the hands or feet
b. Angina and dysrhythmias
c. Constipation
d. Diminished reflexes
e. Dyspnea and pleuritis

Numbness of the hands or feet
Constipation
Diminished reflexes

Rationale: The main dose-limiting toxicity to occur with vincristine is neurotoxicity. Numbness of the hands and feet, constipation related to decreased peristalsis, and diminished reflexes are all signs of neurotoxicity. Options 2 and 5 are incorrect. Cardiac and pulmonary toxicities are not associated with vincristine

A nurse is caring for a client who is receiving tamoxifen for treatment of breast cancer. The nurse will teach the client that postchemotherapy monitoring will be necessary to detect or treat which drug-associated adverse effect?
a. Paralytic ileus
b. Alopecia
c. Pulmonary fibrosis
d. Endometrial cancer

Endometrial cancer

Rationale: Tamoxifen is associated with an increased risk of endometrial cancer and monitoring will be necessary to detect early changes that may indicate this adverse effect has occurred. Options 1, 2, and 3 are incorrect. Paralytic ileus and pulmonary fibrosis are not associated with tamoxifen. Alopecia is a common adverse effect of many chemotherapy drugs but will not require long-term monitoring.

A client with acute lymphoblastic leukemia has started therapy with doxorubicin (Adriamycin). The nurse will assist the client with what important intervention during the course of this treatment?
a. Perform active or assisted range-of-motion (ROM) exercises to maintain strength.
b. Participate in relaxation therapy to control pain.
c. Use daily mouth rinses as prescribed.
d. Maintain bed rest during treatment.

Use daily mouth rinses as prescribed.

Rationale: As with many chemotherapy drugs, doxorubicin is associated with mucositis. Daily mouth rinses will be prescribed to decrease the risk of opportunistic infections from yeast and mouth bacteria. Options 1, 2, and 4 are incorrect. Performing active or assisted ROM is an important intervention associated with drugs that cause neurotoxicities. Controlling pain is associated with chemotherapy that may cause pain as an adverse effect. Maintaining bed rest is not related to the use of chemotherapy, but may be required for other reasons.

The client will continue to take methotrexate (MTX, Rheumatrex, Trexall) for treatment of osteosarcoma. When teaching the client prior to discharge, what over-the-counter (OTC) drugs must not be taken concurrently with methotrexate?
a. Nonsteroidal anti-inflammatory drug pain relievers
b. Antihistamines
c. Laxatives
d. Cough suppressants

Nonsteroidal anti-inflammatory drug pain relievers

Rationale: NSAIDs may cause severe and fatal myelosuppression when taken concurrently with methotrexate. Options 2, 3, and 4 are incorrect. Antihistamines, laxatives, and cough suppressants may be used with methotrexate. However, the provider should be consulted if they are needed because symptoms associated with these drugs may indicate a more serious condition that requires additional treatment.

A client receiving carboplatin (Paraplatin) is also receiving filgrastim (Neupogen). The nurse will explain to the client that the filgrastim is used for what effect?
a. It boosts the effects of the carboplatin so a decreased dosage is needed.
b. It prevents the development of secondary cancers related to the carboplatin.
c. It shortens the duration of neutropenia and associated infection risk related to the carboplatin.
d. It prevents bone loss and osteoporosis.

It shortens the duration of neutropenia and associated infection risk related to the carboplatin.

Rationale: Filgrastim increases neutrophil production and decreases the duration of neutropenia with associated infection risk. Options 1, 2, and 4 are incorrect. Filgrastim does not boost the action of carboplatin, prevent the formation of additional cancers, or prevent bone loss.

The nurse is explaining to the client the measures to take to decrease the pain of stomatitis. What should be included in client teaching?
a. "Drink a hot liquid once every hour."
b. "Rinse the mouth out with commercial mouthwash every hour."
c. "Suck on ice chips or ice pops."
d. "See the dentist regularly."

"Suck on ice chips or ice pops."

Rationale: Keeping the mouth cold will decrease the pain by providing a type of anesthesia. Option 1, drinking a hot liquid every half hour, and option 2, rinsing the mouth with every hour are incorrect. These actions will increase the mouth pain. Option 4, seeing the dentist regularly is good advice, but will not ease the pain.

The client who is receiving chemotherapy expresses distress over the loss of hair. Which response would be most appropriate for the nurse?
a. "You will be bald for the rest of your life."
b. "There are some very attractive wigs available."
c. "Your hair will regrow after the chemotherapy is completed."
d. "Saving your life is far more important than losing your hair."

"Saving your life is far more important than losing your hair."

Rationale: Once chemotherapy is completed, the hair follicles will no longer be attacked by the chemotherapy medication and the hair will regrow, although it may be of a different texture and/or color than the client previously had. Option 1 is not a true statement. The hair will regrow. While option 2 is true, the fact that there are attractive wigs available is not the most important thing the client needs to hear. Option 3 is incorrect because it is an insensitive response.

A client has been diagnosed with metastatic prostate cancer. The nurse knows that the most likely classification of antineoplastic drug therapy that will be prescribed will be:
a. Antimetabolite.
b. Antibiotic.
c. Hormone or hormone antagonist.
d. Alkylating agent.

Hormone or hormone antagonist.

Rationale: The hormone or hormone antagonists will either lower the testosterone level or block the testosterone receptors, thereby slowing progression of the cancer and increasing client comfort. Options 1, 2 and 4 are incorrect, because they are not as effective against this type of cancer.

Chemotherapy is being initiated for a client with lung cancer. What health teaching would be most appropriate for the nurse to provide? Select all that apply.
a. Eat only high-calorie foods and fluids throughout treatment.
b. All antineoplastics are equally effective against any type of cancer.
c. The client will be hospitalized for each chemotherapy treatment.
d. Nausea, vomiting, and other adverse effects are common, but medications can be ordered to counteract them.
e. The type of chemotherapy ordered depends on the type of cancer present.

Nausea, vomiting, and other adverse effects are common, but medications can be ordered to counteract them.
The type of chemotherapy ordered depends on the type of cancer present.

Rationale: Because antineoplastics affect all fast-growing cells in the body, nausea, vomiting, diarrhea or constipation are common, but can be controlled if not alleviated with medications (option 4). Not all cancers respond to the same antineoplastic. Protocols have been established based on experience, so the client will be treated with what has proven to be the most effective medication(s) (option 5). Option 1 may be partially true, but not all clients will tolerate high calorie foods, and the nurse wants to encourage the client to eat a well-balanced diet, as much as possible. Options 2 and 3 are incorrect statements.

The client who has been prescribed alendronate (Fosamax) demonstrates an understanding of how to correctly take the medication when stating:
a. "I will take my medication prior to eating my lunch or dinner."
b. "I will take my medication immediately before bedtime or at 9 P.M."
c. "I will take my medication with a full glass of water 30 minutes before breakfast."
d. "I should lie flat for at least 30 minutes after I take this medication."

"I will take my medication with a full glass of water 30 minutes before breakfast."

Rationale: Alendronate may cause severe GI adverse effects. To decrease this risk, particularly for esophageal irritation, and to promote the absorption of the medication, alendronate should be taken with a full glass of water after rising in the morning. The client should not eat or drink anything or lie down for 30 minutes after administration. Options 1, 2, and 4 are incorrect. The medication should be taken before breakfast, not before lunch or at bedtime. The client should not lie down after taking alendronate for at least 30 minutes, preferably longer.

Which of the following symptoms would alert the nurse to the possibility of the development of toxicity to methotrexate (Rheumatrex, Trexall)?
a. Headache, dizziness, and blurred vision
b. Hematuria, hiccoughs, and jaundice
c. Stomatitis, constipation, and dyspepsia
Jaundice, ascites, and edema formation

Headache, dizziness, and blurred vision

Rationale: Headache, dizziness, and blurred vision are all early symptoms of toxicity to methotrexate. Options 2, 3, and 4 are incorrect. Hematuria, jaundice, and ascites are not associated with the use of methotrexate. While stomatitis may occur, constipation would be unrelated to methotrexate.

The client asks the nurse to explain how colchicine (Colcrys) works. The nurse would base the response on which physiological principle?
a. It increases the deposits of uric acid in the synovial spaces of the joints.
b. It relieves the pain associated with joint inflammation from gouty arthritis.
c. It prevents the accumulation of uric acid crystals in the joints.
d. It increases renal secretion of uric acid crystals.

It prevents the accumulation of uric acid crystals in the joints.

Rationale: Colchicine prevents the migration of neutrophils (WBCs) into the area of inflammation caused by uric acid crystals, reducing further inflammation and relieving the symptoms of gout and gouty arthritis. Options 1, 2, and 4 are incorrect. Colchicine does not increase uric acid deposits in the synovial spaces of the joints, prevent accumulation of uric acid crystals in the joints, or increase renal excretion of uric acid crystals. Clients feel better from decreased inflammation secondary to fewer uric acid crystal deposits. Renal secretion of uric acid is not a mechanism of action of colchicine.

Which laboratory findings would the nurse monitor to determine whether pharmacotherapy is helping a client taking calcium supplementation for osteomalacia?
a. Increasing serum calcium and increasing phosphate levels
b. Increasing serum calcium and decreasing phosphate levels
c. Decreasing serum calcium and increasing phosphate levels
d. Decreasing serum calcium and decreasing phosphate levels

Increasing serum calcium and increasing phosphate levels

Rationale: The client with osteomalacia has low serum calcium and low phosphate levels. An indicator that replacement therapy is achieving therapeutic benefits would be increasing serum calcium and phosphate levels. Options 2, 3, and 4 are incorrect. Increasing or decreasing actions of the serum calcium and phosphate levels are incorrectly stated.

Which assessment findings in a client who is receiving calcitriol (Rocaltrol) should the nurse immediately report to the prescriber?
a. Muscle weakness, nausea, and vomiting
b. Diarrhea, abdominal pain, and stomatitis
c. Bone pain, joint stiffness, and fever
d. Photosensitivity, tinnitus, and bone pain

Muscle weakness, nausea, and vomiting

Rationale: Vitamin D toxicity may occur in the client receiving calcitriol. Symptoms to assess include muscle weakness, fatigue, nausea, vomiting, and changes in the color or amount of urine. Options 2, 3, and 4 are incorrect. Diarrhea, stomatitis, and photosensitivity are not symptoms that would be associated with the effects of vitamin D therapy. Bone pain and fever are symptoms of vitamin D deficiency.

Disease-modifying antirheumatic drugs (DMARDs) are prescribed for clients with rheumatoid arthritis. Which statements related to this therapy are correct? DMARDs: (Select all that apply.)
a. Include gold salts, antimalarial agents, and drugs that modify the immune response.
b. Enhance the quality of life in clients with rheumatoid arthritis.
c. Often take several months to achieve maximum therapeutic effects.
d. Are very safe and require very little monitoring during therapy.
e. Are not accepted in modern pharmacotherapy as a viable treatment option.

Include gold salts, antimalarial agents, and drugs that modify the immune response.
Enhance the quality of life in clients with rheumatoid arthritis.
Often take several months to achieve maximum therapeutic effects.

Rationale: DMARDs include gold salts, antimalarial agents, D-penicillamine, and drugs that modify immune and inflammatory responses and have been found to reduce mortality rate, improve symptoms, and enhance the quality of life in clients with RA. Maximum therapeutic effects from DMARDs often take several months to achieve. Options 4 and 5 are incorrect. These drugs can be toxic, and close monitoring of clients is required during the course of therapy. DMARDs are well accepted in medical practice because they have been found to reduce mortality rate and improve symptoms of RA.

The client who is receiving allopurinol (Lopurin) for treatment of gout asks whether it is necessary to avoid drinking alcohol while taking this medication. The nurse teaches the client that when a person with gout consumes alcohol, it:
a. Causes significant kidney and liver damage.
b. Interferes with the absorption of allopurinol.
c. Inhibits the renal excretion of uric acid.
d. Causes the urine to become more alkaline.

Inhibits the renal excretion of uric acid.

Rationale: Gout is a metabolic disorder characterized by the accumulation of uric acid in the bloodstream or joint cavities. Alcohol increases uric acid levels by decreasing renal excretion. Options 1, 2, and 4 are incorrect. The risk of liver and kidney damage is not altered by alcohol consumption. Alcohol does not interfere with the absorption of allopurinol. Alcohol does not cause the urine to become more alkaline in a client with gout.

The nurse is planning care for a client who is prescribed hydroxychloroquine (Plaquenil) for rheumatoid arthritis. The nurse should encourage the client to make an appointment with which health care provider?
a. Ophthalmologist
b. Cardiologist
c. Respiratory therapist
d. Psychologist

Ophthalmologist

Rationale: The risk of visual disturbances is a prominent adverse effect of hydroxychloroquine. Clients need to be taught to schedule and keep ophthalmology appointments to screen for the development of any visual problems. Options 2, 3, and 4 are incorrect. Heart, respiratory, and psychological disturbances are not prominent adverse effects of hydroxychloroquine.

The nurse is teaching a client about a new eyedrop prescription for timolol (Timoptic) for treatment of open-angle glaucoma. The client has a history of seasonal allergies and hypertension. What is an important administration technique to stress for this client?
a. Take any eyedrops for allergies 5 minutes before administering the timolol drops
b. Do not use the timolol drops while concurrently taking allergy medication.
c. The timolol drops may temporarily worsen seasonal allergies.
d. Gently put pressure on the inner canthus (tear duct) for 1 minute after instilling the timolol drop.

Gently put pressure on the inner canthus (tear duct) for 1 minute after instilling the timolol drop.

Rationale: Timolol is a beta-adrenergic blocker. To prevent swallowing and systemic absorption, pressure should be applied to the inner canthus of the eye for 1 minute after instilling the drop. Options 1, 2, and 3 are incorrect. No other eyedrops or ointments should be used when taking timolol or other drops for glaucoma without the approval of the provider. Eye solutions for allergies may contain adrenergic drugs that may worsen glaucoma. Timolol is not contraindicated during seasonal allergies. It is not known to worsen seasonal allergies, although it may cause bronchoconstriction in the sensitive individual or if swallowed and systemic effects occur.

The nurse is providing health teaching to a client who has been prescribed latanoprost (Xalatan) for open-angle glaucoma. While harmless, the nurse would caution the patient about which potential nonocular effects of the drug? Select all that apply.
a. Darkening and thickening of the upper eyelid
b. Darkening and thickening of eyelashes
c. A lightening of iris color and a slight darkening of the sclera
d. A slight darkening of the iris color
e. A permanent bluish tint to the conjunctiva

Darkening and thickening of the upper eyelid
Darkening and thickening of eyelashes
A slight darkening of the iris color

Rationale: Latanoprost (Xalatan) may cause thickening and darkening of the eyelashes and upper eyelid and may cause darkening of the iris, especially noticeable in clients with light eye colors. Options 3 and 5 are incorrect. Latanoprost will not cause lightening of the iris, darkening of the sclera, or a permanent bluish tint to the conjunctiva.

Pilocarpine (Isopto Carpine) has been ordered for a client with closed-angle glaucoma who has not responded well to other drugs. Pilocarpine causes _________, which stretches the trabecular meshwork, allowing a greater outflow of aqueous humor and lowering the intraocular pressure.

Miosis

Pilocarpine causes miosis, which stretches the trabecular meshwork, allowing greater outflow of aqueous humor and decreasing the IOP.

The nurse is teaching a client with otitis about a prescription for polymyxin B, neomycin, with hydrocortisone (Cortisporin). The client should be instructed to report which symptom immediately?
a. Mild itching in the outer ear canal
b. Gradually decreasing pain
c. Slight dizziness after instilling the eardrop
d. Increasing pain, particularly in the area around the ear

Increasing pain, particularly in the area around the ear

Rationale: Increasing ear pain, particularly around the ear area, may indicate worsening infection or mastoiditis and should be immediately reported. Options 1, 2, and 3 are incorrect. Mild itching and irritation may occur, but severe itching or swelling should be reported. Gradually decreasing pain is a therapeutic effect as the infection clears. Dizziness may occur if the eardrop is instilled directly onto the tympanic membrane

. The nurse is instilling drops of phenylephrine (Neo-Synephrine) into the client's eye before cataract surgery. Phenylephrine is used prior to cataract surgery because it causes __________, allowing visualization of the operative area.

Mydriasis

Phenylephrine causes mydriasis, allowing better visualization of the area of the lens during cataract surgery.

Which instruction should the nurse include in the teaching plan for the client who is receiving timolol (Betimol, Timoptic, others) for the treatment of glaucoma?
a. Monitor your weight daily and report gain of over 2 lb per week.
b. Monitor your body temperature for late afternoon onset of fever.
c. Assess your blood pressure once weekly and report any reading less than 90/60.
d. Monitor your breathing for any periods of shortness of breath.

Assess your blood pressure once weekly and report any reading less than 90/60.

Rationale: Systemic side effects of beta-adrenergic agents may include bronchoconstriction, dysrhythmias, and hypotension. Because of the potential for systemic side effects, these drugs should be used with caution in clients with asthma, bradycardia, or heart failure. Clients and their families should be taught to monitor their pulse and blood pressure. Option 1, 2, and 4 are incorrect. Daily weight, temperature, and potential for shortness of breath would not need to be stressed in the teaching plan.

A client has developed glaucoma. The nurse reviewing this client's medication history would identify long-term use of which drug as a potential contributor to glaucoma?
a. Corticosteroids
b. Beta blockers
c. Calcium channel blockers
d. Insulin

Corticosteroids

Rationale: The long-term use of corticosteroids may contribute to the development of glaucoma. Options 2, 3, and 4 are incorrect. Beta blockers are used for the treatment of glaucoma; they do not cause it. Calcium channel blockers and insulin play no role in the development of glaucoma.

The nurse plans care for a client who is receiving an ophthalmic anesthetic agent based on which priority for nursing care?
a. Measures to increase tear secretion
b. Measures to protect the eye
c. Monitoring for conjunctivitis
d. Assessing for level of consciousness

Measures to protect the eye

Rationale. Protecting the client's eye from injury is a priority of care when a topical eye anesthetic agent is administered, as the corneal reflex is lost when it is given. Options 1, 3, and 4 are incorrect. Measures to increase tear secretion are unnecessary. The nurse will monitor for the local effect of conjunctivitis, but this is not the priority of care. Since the medication is local and not general, there should be no need to monitor the client's level of consciousness.

What is Adjuvant chemotherapy and what is the purpose?

is the admin of antineoplastic drugs after surgery or radiation therapy.
The purpose is to rid the body of any cancerous cells that were not removed during the surgery or to treat any micrometastases that may be developing.

What is neoadjuvant chemotherapy and what is the purpose?

is the admin of antineoplastic drugs before surgery or radiation therapy with the goal of shrinking a large tumor to a more manageable size. Shrinking the tumor preoperatively results in less surgical invasion when removing the tumor.

Understand dosing of cell cycle specific drugs.

...

Understand the principle of "cure" in cancer drug therapy

...

Understand dose specific scheduling of antineoplastic drugs is based on physical parameters of the patient's condition

...

Be familiar with primary and secondary cancer prevention methods.

...

Know reasons chemotherapy will be delayed or discontinued.

...

Know the side effects of administering vessicant chemotherapy.

...

Know mucositis as a side effect of cancer treatment.

...

Staging and Grading of Cancer...

cancers are described by their stage and grade. Must be done to determine the extent to which a cancer has invaded the body.

Staging of cancer

is the process of determining where the cancer is located and the extent of its invasion. Once a cancer is staged the level does not change even if the cancer progresses.

T Category of cancer staging...

Describes the primary tumor

Staging of Cancer: TX

primary tumor cannot be assessed

Staging of Cancer: T0

no evidence of primary tumor

Staging of Cancer: T1

tumor is confined to the primary area

Staging of Cancer: T3-T4

Tumor has invaded areas surrounding the primary tumor.

Staging of Cancer: N category...

describes whether or not the cancer has spread to lymph nodes

Staging of Cancer: NX

Nearby lymph nodes cannot be assessed

Staging of Cancer: N0

no regional lymph nodes metastasis

Staging of Cancer: N1-N3

primary tumor has spread to reginal lymph nodes

Staging of Cancer: M Category

describes whether or not distant metastases are present

Staging of Cancer: MX

distant metastases cannot be assessed

Staging of Cancer: M0

no distant metastases were found

Staging of Cancer: M1

distant metastases are present

Stage G_0, sometimes called the testing stage.

Is the phase during which cells conduct their everyday activities such as metabolism, impulse conduction, contraction, or secretion.

Stage G_0

a cell may enter this phase at any point in the cycle and remain there for extended periods.

Stage G1 (Gap 1)

if a cell receives a signal to divide, it leaves G0 phase and enter this phase, during which it synthesizes the RNA, proteins, and other components needed to duplicate its RNA

Stage S (Synthesis)

during the S phase the cell dupl

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