Test bank for focus on nursing pharmacology 6th edition by amy morrison karch download

Focus on Nursing Pharmacology: Edition 6th Test Bank – Karch
Focus on Nursing Pharmacology: Edition 6th Test Bank – Karch
Sample
Chapter 17
1.

A patient has been diagnosed with hairy cell
leukemia. The patient is to begin taking interferon
alfa 2b. What will the nurse include in her
instructions to the patient concerning this drug?

A)

Avoid drinking alcohol while taking the
drug.

B)

Continue to maintain maximal physical
activity.

C)

Increase fluid intake while taking the drug.

D)

Treat constipation with over-the-counter
laxatives.

C

Ans:

Feedback:

Interferon alfa 2b is metabolized in the kidney so
adequate fluid intake is needed to promote metabolism
and excretion of the drug as well as to minimize
common adverse effects including dry skin and
dizziness. Maintaining maximal physical activity is a
good idea but has no relationship to the use of the
drug. Fluids should be increased not decreased while
taking the drug. Constipation is not an associated
adverse effect of this medication.


Interferon beta 1a (Avonex)
D)

Ans:

C

Feedback:

2.

The health care provider plans to inject an interferon
directly into the patient’s wart. What interferon will the

nurse prepare?

Interferon alfa 2a (Roferon-A)
A)

B)

Interferon alfacon 1 (Infergen)

C)

Interferon alfa n3 (Alferon N)


Interferon alf n3 is used for intralesional treatment of
warts. Interferon alfa 2a is used in the treatment of
leukemia. Interferon alfacon 1 is used in the
treatment of chronic hepatitis C infection in adults.
Interferon beta 1a is used to treat multiple sclerosis in
adults.

3.

A 30-year-old woman has been diagnosed with
leukemia and will be using an immune modulator for
treatment. What will be important to discuss with the
patient when the nurse provides patient teaching about
her treatment?
The need to continue oral contraceptives
A)

B)

The need to use barrier contraceptives while
taking the drug

C)

The need to avoid sexual intercourse while
taking the drug


D)

The importance of taking an aspirin daily to
decrease the adverse effects of the drug

B
Ans:


Feedback:

A patient taking an immune modulator would be
advised to use barrier contraceptives to prevent
pregnancy. The interaction of the immune modulator
and the oral contraceptive may interfere with the oral
contraceptive’s ability to work properly. Asking
patients to avoid sexual intercourse is not necessary if
barrier methods are properly used. Daily aspirin would

not decrease adverse effects of this drug.

4.

The nurse has an order to administer oprelvekin
(Neumega) to a patient for the first time. Before
administering the drug, what allergy would the nurse
want to specifically question the patient about?

A)

Egg products

B)

Escherichia coli–produced products

Lactose intolerance
C)


Feedback:

D)

Penicillin

Ans:

B

The interleukins are produced using
deoxyribonucleic acid technology and E. coli
bacteria. Patients with known allergy to E. coli
products should not receive oprelvekin. The
allergies to penicillin, egg products, or lactose
intolerance would not be of concern with this drug.

5.

The physician has decided to prescribe T- and B-cell
suppressors for a patient diagnosed with psoriasis.
What drug will be ordered for this patient?

A)

Alefacept (Amevive)

Azathioprine (Imuran)


Feedback:

B)

Cyclosporine (Neoral)
C)

Glatiramer acetate (Copaxone)
D)

Ans:

A

Alefacept is prescribed for patients with severe
chronic plaque psoriasis. Cyclosporine is used to
suppress rejection in a variety of transplant situations.
Azathioprine is used to treat patients with rheumatoid
arthritis and in prevention of rejection in renal
homotransplants. Tacrolimus is used for prevention
of rejection after renal or liver transplantation.

6.

A patient who is receiving an immune suppressant
has been admitted to the unit. What would be a
priority action by the nurse?


Feedback:

A)

Monitor nutritional status.

B)

Provide patient teaching regarding the
drug.

C)

Protect the patient from exposure to
infection.

D)

Provide support and comfort measures in
relation to adverse effects of the drug.


Ans:

C

Feedback:

Patients taking immune suppressant drugs are more
susceptible to infection because the patient’s normal
body defenses will be diminished. As a result, the
priority action by the nurse would to protect the
patient from exposure to infection through room
selection, good hand hygiene, and taking care to avoid
exposure to sick staff members. Teaching will need to
include avoiding crowded places and people with
known infection and those working in soil. Nutritional
status is important as are comfort and support
measures and other instructions concerning the drug.
However, protecting the patient from infection should

be the priority action.

7.

A nurse is discussing interferon alfa 2b with a patient.
What will the nurse encourage the patient to do while
taking this drug?

To avoid crowds
A)


B)

To increase salt intake

C)

To decrease milk intake

To eat three meals a day
D)

Ans:

A

Feedback:

Potential adverse effects in addition to the types of

conditions interferon alfa 2b is prescribed to
contribute to the need for the patient to take care to
avoid people with infections so the patient should be
taught to avoid crowds whenever possible. Adverse
effects include dizziness, confusion, rash, dry skin,
anorexia, nausea, bone marrow suppression, and
flulike syndrome. Salt, diet, and milk do not interfere
with this drug.


8.

A 70-year-old patient with acute myelocytic
leukemia is receiving sargramostim (Leukine). What
is a priority nursing action for this patient?

A)

Providing a quiet environment

B)

Increasing fluids

C)

Providing comfort measures related to
nausea

Encouraging appropriate dietary intake

D)

Ans:

B

Feedback:


A common adverse effect of this drug is vomiting
and diarrhea. Due to the patient’s age it would be
important to keep him hydrated. Vomiting and
diarrhea can cause dehydration quickly in the elderly.
Providing a quiet environment and comfort measures
for the nausea would be important but not as critical
as increasing fluids. Diet is very important to this
patient; however, usually this drug causes a loss of
appetite. Therefore, increasing fluids would be
extremely important to the patient’s nutritional status.

9.

The nurse is caring for a patient in the immediate
postoperative period following cardiac
transplantation who is receiving mycophenolate
(CellCept) twice a day IV. What will the nurse teach
the patient regarding drug therapy? (Select all that
apply.)

A)

“The drug will be given orally as soon as
possible.

“Take the medication three times a day.”
B)

C)

“Avoid people with contagious diseases.”


D)

E)

“Ask a pharmacist about drug–drug
interactions before taking any overthecounter (OTC) drug.”

“Never miss a dose of medication.”

A, C, D, E
Ans:

Feedback:

The nurse will explain that the IV medication will be
changed to oral therapy when the patient is able to
tolerate oral medications. The patient will take the
medication twice a day, not three times a day. Care

should be taken to never miss a dose. The patient
should avoid other medications that are hepatotoxic
or nephrotoxic due to a risk of increased toxicity so
the patient should be taught to always consult a
doctor or pharmacist before beginning an OTC drug.
Patients who have immune suppression must be
taught how to reduce risk of infection, including
avoiding people with contagious diseases, such as


colds or viruses.

10.

The nurse administers aldesleukin to a patient
diagnosed with renal cell carcinoma. When
assessing the patient a few days later, what
abnormal findings would the nurse attribute to the
medication? (Select all that apply.)

A)

Increased lymphocyte count

B)

Increased red blood cell count

C)

Increased platelet count

D)

Irregular pulse rate

E)

Increased blood pressure

Ans:

A, C, D

Feedback:


Aldesleukin activates human cellular immunity and
inhibits tumor growth through increases in
lymphocytes, platelets, and cytokines. Common
adverse effects include hypotension, sinus
tachycardia, arrhythmias, as well as pruritus, nausea,
vomiting, diarrhea, anorexia, GI bleeding, bone
marrow suppression, respiratory difficulties, fever,
chills, pain, mental status changes, and dizziness.
There is no impact on red blood cell count. It does
not raise blood pressure.

11.

While studying for a pharmacology test, a student
asks his peers about interferons. What statement about
interferons is accurate?

A)

They stimulate B-lymphocyte activity.

B)

They interfere with multiplication of stem
cells.

C)

They
stimulate
growth
and
differentiation of lymphoid cells into
lymphocytes.


D)

They interfere with the ability of viruses in
infected cells to replicate.

Ans:

D

Feedback:

Interferons are substances naturally produced and
released by human cells that have been invaded by
viruses. They may also be released from cells in
response to other stimuli, such as cytotoxic T-cell
activity. Interferons do not stimulate B-lymphocyte
activity, interfere with multiplication of stem cells,
nor do they stimulate growth and differentiation of
lymphoid cells into lymphocytes.

12.

How do immune suppressants work when ordered for
a patient who has had an organ transplant?

A)

Blocking normal effects of the immune
system

B)

Stimulating immune system to fight off
infection


C)

Working with corticosteroids to enhance
healing

D)

Working with corticosteroids to promote
suppressor cells

Ans:

A

Feedback:
Immune suppressants are used to block the normal
effects of the immune system in cases of organ
transplantation (in which non–self-cells are
transplanted into the body and destroyed by the
immune reaction) and in autoimmune disorders (in
which the body’s defenses recognize self-cells as
foreign and work to destroy them) in some cancers.
Options B, C, and D are distracters for this question.

13.

A patient has just been told that her cancer has
metastasized to her right kidney. An interferon
(Aldesleukin) has been prescribed to treat this
metastasis. The patient asks why this interferon is
ordered. What is the nurse’s best response?

A)

“Aldesleukin has been shown to protect
autologous tumor cells.”

B)

“Aldesleukin has been shown to inhibit

tumor growth.”

C)

“Aldesleukin has been shown to enhance
allogeneic stem-cell transplantation.”

D)

“Aldesleukin has been shown to have a
direct proliferative effect on renal tumors.”

Ans:

B

Feedback:

Aldesleukin is prescribed for metastatic renal cell
carcinoma in adults and treatment of metastatic
melanomas (orphan drug use) working by activating
human cellular immunity and inhibiting tumor
growth through increases in lymphocytes, platelets,
and cytokines. Aldesleukin does not protect
autologous tumor cells, enhance allogeneic stemcell
transplantation, or have a direct proliferative effect
on renal tumors.

14.

The nurse admits a patient who was newly
diagnosed with Kaposi’s sarcoma to the unit. The
physician has ordered an IV infusion of an
interferon. What drug would be appropriate?

A)

Interferon beta1a

B)

Interferon gamma 1b

C)

Interferon alfa 2b

D)

Peginterferon alfa 2b

Ans:

C

Feedback:

Interferon alfa 2b indications include hairy cell
leukemia, melanoma, AIDS-related Kaposi’s
sarcoma, chronic hepatitis B and C infection,
intralesional treatment of condyloma acuminatum in
patients 18 years of age or older. No other interferons
are indicated for treatment of Kaposi’s sarcoma.

15.

The pharmacology instructor is talking about
interferon. The instructor explains that agents, such
as interferons, have more than one biologic function.
What are the functions of interferons?
(Select all that apply.)


A)

Antibacterial

B)

Antiviral

C)

Immunomodulatory

D)

Antiproliferative

E)

Anticancer

Ans:

B, C, D

Feedback:

Interferons act to prevent virus particles from
replicating inside the cells. They also stimulate
interferon receptor sites on noninvaded cells to
produce antiviral proteins, which prevent viruses
from entering the cell. In addition, interferons have
been found to inhibit tumor growth and replication,
to stimulate cytotoxic T-cell activity, and to enhance
the inflammatory response. Options A and E are

incorrect.


16.
The nursing class is studying monoclonal antibodies.
What monoclonal antibody reacts to human T cells,
disabling them and acting as an immune suppressor?

A)

Adalimumab

B)

Cetuximab

C)

Rituximab

D)

Muromonab-CD3

Ans:

D

Feedback:

Muromonab-CD3, the first monoclonal antibody
approved for use, is a T-cell–specific antibody, that
is available as an IV agent. It reacts as an antibody
to human T cells, disabling the T cells, acting as an
immune suppressor. Adalimumab is an antibody
specific for human tumor necrosis factor.
Cetuximab is an antibody specific to epidermal
growth factor receptor sites. Rituximab is an


antibody specific to sites on activated B lymphocytes.

17.

What monoclonal antibody is used to prevent
respiratory syncytial virus (RSV) in high risk
children?

A)

Palivizumab

B)

Natalizumab

C)

Belimumab

D)

Eculizumab

Ans:

A

Feedback:


Palivizumab is specific to the antigenic site on
respiratory syncytial virus (RSV); it inactivates that
virus. It is used to prevent RSV disease in high-risk
children. Natalizumab is an antibody specific to
surface receptors on all leukocytes except
neutrophils. Belimumab is a specific inhibitor of
Blymphocyte stimulator that inhibits the survival of
B-lymphocytes and their differentiation into immuneglobulin producing cells. Eculizumab binds to
complement proteins and prevents the formation of
the complement complex.

18.

The nurse is caring for a patient with an allograft
transplant. The physician orders a monoclonal
antibody to prevent rejection of the transplant. What
monoclonal antibody would the nurse expect to be
ordered?

A)

Alemtuzumab

B)

Daclizumab

C)

Erlotinib