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bIOLOGIC cRISIS FINAL QUIZ pHARMACOCHENETICS
bIOLOGIC cRISIS FINAL QUIZ pHARMACOCHENETICS
Multiple Choice :Select the correct answer and shade in the answer sheet.
3. Nurse Victoria is teaching a group of middle-aged men about peptic ulcers. When discussing risk
factors for peptic ulcers, the nurse should mention:
A. A history of hemorrhoids and smoking
B. A sedentary lifestyle and smoking
C. Alcohol abuse and smoking
D. Alcohol abuse and a history of acute renal failure
4. 4. Which of the following tests can be used to diagnose ulcers?
A. Barium swallow
B. Abdominal x-ray
C. Esophagogastroduodenoscopy (EGD)
D. Computed tomography (CT) scan
A. Neutralize acid
B. Reduce acid secretions
C. Stimulate gastrin release
D. Protect the mucosal barrier
A. Before meals
B. With meals
C. At bedtime
D. When pain occurs
9. When a client has peptic ulcer disease, the nurse would expect a
priority intervention to be:
10. A 40-year-old male client has been hospitalized with peptic ulcer
disease. He is being treated with a histamine receptor antagonist
(cimetidine), antacids, and diet. The nurse doing discharge planning will
teach him that the action of cimetidine is to:
14. 14. Prolonged use of Proton Pump Inhibitors will likely result with
the following except:
A. Hypermagnesemia
B. Pneumonia
C. Fractures
D. Hypochlorhydria
A. Insomnia
B. Constipation
C. Wheezing
D. Hypotension
A. Removes the cap and shakes the inhaler well before use.
B. Presses the canister down with finger as he breathes in.
C. Inhales the mist and quickly exhales.
D. Waits 1 to 2 minutes between puffs if more than one puff has been
prescribed.
19. The nurse is teaching the client how to use a metered dose inhaler
(MDI) to administer a Corticosteroid drug. Which of the following client
actions indicates that he is using the MDI correctly? Select all that
apply.
A. Intrinsic asthma
B. Extrinsic asthma
C. Status asthmaticus
D. Reactive airway disease
A. Prilosec
B. Nizatidine
C. Ranitidine
D. Cimetidine
A. 9:00 AM
B. 11:00 AM
C. 12:00 NN
D. 1:00 PM
33. This antidiabetic drug is also used in women with polycystic ovarian
syndrome.
A. Acarbose
B. Metformin
C. Rosiglitazone
D. Nateglinide
A. salmeterol
B. albuterol
C. phenylephrine
D. terbutaline
A. midodrine
B. clonidine
C. albuterol
D. isoproterenol
36. Nurse Kate is taking care of patients taking ibuprofen. Which of the
following should be included in her assessment and monitoring?
37. 37. Upon checking the medication chart, Nurse Mike found out that
his patient is taking both acetaminophen and furosemide. Which of the
following interventions is an appropriate nursing action for these two
drugs?
A. Invasive growth
C. Presence of metastasis
B. lymphoma
C. hepatocellular cancer
D. gastric cancer
B. S (synthesis) phase
D. P (Proein) Phase
A. Mitomycin
B. Vinblastine
C. Melphalan
D. Cisplatin
43. Which of the following chemotherapeutic agent has least known mylosuppression?
A. Actinomycin D
B. Cyclophosphamide
C. Bleomycin
D. Docetaxel
A. 6-Mercaptopurine
B. Methotrexate
C. 5-Fluorouracil
D. Vindesine
8. ____________ is not an antineoplastic agent, which binds to reactive metabolite of IFEX or Cytoxan without affecting
antitumor activity.
A. Fluorouracil
B. Tamoxifen
C. L-Asparaginase
D. Mesna
9. Filgrastim (Neupogen) is a:
D. nitrogen mustard.
10. ___________ is a therapeutic agent used to promote recovery of neutrophils after chemotherapy.
A. Filgrastim
B. L-Asparaginase
C. Levamisole
D. Hydroxyurea
A. Breast cancer
B. Colorectal cancer
C. Hodgkin’s disease
D. Leukemia
12. Which of the following drugs is most specific in the management of breast cancer?
A. L-Asparaginase
B. Chlorambucil
C. Tamoxifen
D. Fludarabine
13. The nitrogen mustard with the broadest spectrum of antitumor activity in its class is:
A. Ifosfamide
B. Cyclophosphamide
C. Mechlorethamine
D. Chlorambucil
A. Thioguanine
B. Fluorouracil
C. Mercaptopurine
D. Methotrexate
15. Which of the following is a hormonal agent used as a chemotherapy of breast cancer?
A. Tamoxifen citrate
B. Ifosfamide
C. Carmustine
D. Methotrexate
A. “Radiation does not cause the problems with sexual functioning that occur
with chemotherapy or surgical procedures used to treat cancer.”
B. “It is possible you may have some changes in your sexual function, and
you may want to consider pretreatment harvesting of sperm if you want
children.”
C. “The radiation will make you sterile, but your ability to have sexual
intercourse will not be changed by the treatment.”
D. “You may have some temporary impotence during the course of the
radiation, but normal sexual function will return.”
A. “Why don’t we talk about the options you have for the care of your
children?”
B. “Many patients with cancer live for a long time, so there is time to plan for
your children.”
C. “For now you need to concentrate on getting well, not worry about your
children.”
D. “Perhaps your ex-husband will take the children when you can’t care for
them.”
3. A patient who has terminal cancer of the liver and is cared for by
family members at home tells the nurse, “I have intense pain most of
the time now.” The nurse recognizes that teaching regarding pain
management has been effective when the patient
5. The home health nurse is caring for a patient who has been
receiving interferon therapy for treatment of cancer. Which statement
by the patient may indicate a need for a change in treatment?
A. Hemoglobin of 10 g/L
B. WBC count of 1700/µl
C. Platelets of 65,000/µl
D. Serum creatinine level of 1.2 mg/dl
8. The nurse teaches a patient with cancer of the liver about high-
protein, high-calorie diet choices. Which snack choice by the patient
indicates that the teaching has been effective?
A. provide foods that are highly spiced to stimulate the taste buds.
B. avoid presenting foods for which the patient has a strong dislike.
C. add strained baby meats to foods such as soups and casseroles.
D. teach the patient to eat whatever is nutritious since food is tasteless.
10. After the nurse has explained the purpose of and schedule for
chemotherapy to a 23-year-old patient who recently received a
diagnosis of acute leukemia, the patient asks the nurse to repeat the
information. Based on this assessment, which nursing diagnosis is most
likely for the patient?
12. Which action by a nursing assistant (NA) when caring for a patient
who is pancytopenic indicates a need for the nurse to intervene?
14. When assessing a patient’s needs for psychologic support after the
patient has been diagnosed with stage I cancer of the colon, which
question by the nurse will provide the most information?
A. “Can you tell me what has been helpful to you in the past when coping
with stressful events?”
B. “How long ago were you diagnosed with this cancer?”
C. “Are you familiar with the stages of emotional adjustment to a diagnosis
like cancer of the colon?”
D. “How do you feel about having a possibly terminal illness?”
A client diagnosed with widespread lung cancer asks the nurse why he must be careful
to avoid crowds and people who are ill. What is the nurse's best response?
A. "With lung cancer, you are more likely to develop pneumonia and could pass this on
to other people who are already ill."
B. "When lung cancer is in the bones, it becomes a bone marrow malignancy, which
stops producing immune system cells."
C. "The large amount of mucus produced by the cancer cells is a good breeding ground
for bacteria and other microorganisms."
D. "When lung cancer is in the bones, it can prevent production of immune system cells,
making you less resistant to infection."
D. Tumor cells that enter the bone marrow reduce the production of healthy white blood
cells (WBCs), which are needed for normal immune function. Therefore clients who
have cancer, especially leukemia, are at an increased risk for infection. Other people
are not at risk for becoming infected as a result of contact with a person who has lung
cancer. Lung cancer that has spread to the bone is still lung cancer; it is not a bone
marrow malignancy. It is true that the person with lung cancer may produce more
mucus, which can harbor microorganisms, but this is not the main reason why the client
should avoid crowds and people who are ill.
Which precaution is most important for the nurse to teach a client receiving radiation
therapy for head and neck cancer?
A. Avoid eating red meat during treatment.
B. Pace your leisure activities to prevent fatigue.
C. See your dentist twice yearly for the rest of your life.
D. Avoid using headphones or headsets until your hair grows back.
C. Radiation therapy that is directed in or around the oral cavity has a variety of actions
that increase the risk for dental caries (cavities) and tooth decay. The salivary glands
are affected, which changes the composition of the person's saliva and often causes
"dry mouth." This result allows rapid bacterial overgrowth, which leads to cavity
formation. In addition, the radiation damages the integrity of the enamel and also
damages some of the living cells in the tooth. All contribute to an increased risk for
dental infections and cavities.
A client receiving high-dose chemotherapy who has bone marrow suppression has
been receiving daily injections of epoetin alfa (Procrit). Which assessment finding
indicates to the nurse that today's dose should be held and the health care provider
notified?
A. Hematocrit of 28%
B. Total white blood cell count of 6200 cells/mm3
C. Blood pressure change from 130/90 mm Hg to 148/98 mm Hg
D. Temperature change from 99° F (37.2 C) to 100 F (37.8 C)
C. Epoetin alfa and other erythropoiesis-stimulating agents (ESAs) such as darbepoetin
alfa (Aranesp) and epoetin alfa (Epogen, Procrit) increase the production of many blood
cell types, not just erythrocytes, which increases the client's risk for hypertension, blood
clots, strokes, and heart attacks, especially among older adults. Dosing is based on
individual client hemoglobin and hematocrit levels to ensure that just enough red blood
cells are produced to avoid the need for transfusion but not to bring hemoglobin or
hematocrit levels up to normal. The increased blood pressure is an indication to stop
this therapy immediately.
Which action is most important for the nurse to implement to prevent nausea and
vomiting in a client who is prescribed to receive the first round of IV chemotherapy?
A. Keep the client NPO during the time chemotherapy is infusing.
B. Administer antiemetic drugs before administering chemotherapy.
C. Ensure that the chemotherapy is infused over a 4- to 6-hour period.
D. Assess the client for manifestations of dehydration hourly during the infusion period.
B. When emetogenic chemotherapy drugs are prescribed, the client should receive
antiemetic drugs before the chemotherapy drugs are administered. This allows time for
prevention of chemotherapy-associated nausea and vomiting; however, the antiemetic
therapy cannot stop until all risks for nausea and vomiting have passed. Clients become
nauseated and vomit even if they are NPO.
A client being treated for advanced breast cancer with chemotherapy reports that she
must be allergic to one of her drugs because her entire face is swollen. What
assessment does the nurse perform?
A. Asks whether the client has other known allergies
B. Checks the capillary refill on fingernails bilaterally
C. Examines the client's neck and chest for edema and engorged veins
D. Compares blood pressure measured in the right arm with that in the left arm
C. The client's swollen face indicates possible superior vena cava syndrome, which is
an oncologic emergency. Manifestations result from the blockage of venous return from
the head, neck, and upper trunk. Early manifestations occur when the client arises after
a night's sleep and include edema of the face, especially around the eyes, and tightness
of the shirt or blouse collar. As the compression worsens, the client develops engorged
blood vessels and erythema of the upper body, edema in the arms and hands, dyspnea,
and epistaxis. Interventions at this stage are more likely to be successful. Late
manifestations include hemorrhage, cyanosis, mental status changes, decreased
cardiac output, and hypotension. Death results if compression is not relieved.
The nurse is teaching the 47-year-old female client about recommended screening
practices for breast cancer. Which statement by the client indicates understanding of
the nurse's instructions?
A. "My mother and grandmother had breast cancer, so I am at risk."
B. "I get a mammography every 2 years since I turned 30."
C. "A clinical breast examination is performed every month since I turned 40."
D. "A CT scan will be done every year after I turn 50."
A. A strong family history of breast cancer indicates a risk for breast cancer. Annual
screening may be indicated for a strong family history. The client may perform a self-
breast examination monthly; a clinical examination by a health care provider is indicated
annually. An annual mammography is performed after age 40 or in younger clients with
a strong family history.
The nurse is giving a group presentation on cancer prevention and recognition. Which
statement by an older adult client indicates understanding of the nurse's instructions?
A. "Cigarette smoking always causes lung cancer."
B. "Taking multivitamins will prevent me from developing cancer."
C. "If I have only one shot of whiskey a day, I probably will not develop cancer."
D. "I need to report the pain going down my legs to my health care provider."
D. Pain in the back of the legs could indicate prostate cancer in an older man.
A 72-year-old client recovering from lung cancer surgery asks the nurse to explain how
she developed cancer when she has never smoked. Which factor may explain the
possible cause?
A. A diagnosis of diabetes treated with insulin and diet
B. An exercise regimen of jogging 3 miles 4x/wk
C. A history of cardiac disease
D. Advancing age
D. Advancing age is the single most important risk factor for cancer. As a person ages,
immune protection decreases.
The nurse reviews the chart of the client admitted with a diagnosis of glioblastoma with
a T1NXM0 classification. Which explanation does the nurse offer when the client asks
what the terminology means?
A. "Two lymph nodes are involved in this tumor of the glial cells, and another tumor is
present."
B. "The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and
no distant metastasis."
C. "This type of tumor in the brain is small with some lymph node involvement; another
tumor is present somewhere else in your body."
D. "Glioma means this tumor is benign, so I will have to ask your health care provider
the reason for the chemotherapy and radiation."
B. T1 means that the tumor is increasing in size to about 2 cm, and that no regional
lymph nodes are present in the brain. M0 means that no distant metastasis has
occurred.
The client has a diagnosis of lung cancer. To which areas does the nurse anticipate that
this client's tumor may metastasize? Select all that apply.
A. Brain
B. Bone
C. Lymph nodes
D. Kidneys
E. Liver
a-c, e. as well as the pancreas.
Answer keys
E. Tumor cells that enter the bone marrow reduce the production of healthy white blood
cells (WBCs), which are needed for normal immune function. Therefore clients who have
cancer, especially leukemia, are at an increased risk for infection. Other people are not
at risk for becoming infected as a result of contact with a person who has lung cancer.
Lung cancer that has spread to the bone is still lung cancer; it is not a bone marrow
malignancy. It is true that the person with lung cancer may produce more mucus, which
can harbor microorganisms, but this is not the main reason why the client should avoid
crowds and
C. Radiation therapy that is directed in or around the oral cavity has a variety of actions
that increase the risk for dental caries (cavities) and tooth decay. The salivary glands are
affected, which changes the composition of the person's saliva and often causes "dry
mouth." This result allows rapid bacterial overgrowth, which leads to cavity formation. In
addition, the radiation damages the integrity of the enamel and also damages some of
the living cells in the tooth. All contribute to an increased risk fo
C. Epoetin alfa and other erythropoiesis-stimulating agents (ESAs) such as darbepoetin
alfa (Aranesp) and epoetin alfa (Epogen, Procrit) increase the production of many blood
cell types, not just erythrocytes, which increases the client's risk for hypertension, blood
clots, strokes, and heart attacks, especially among older adults. Dosing is based on
individual client hemoglobin and hematocrit levels to ensure that just enough red blood
cells are produced to avoid the need for transfusion but not to bring hemoglobin or
hematocrit levels up to normal. The increased blood pressure is an indication to stop this
therapy immediately.
B. When emetogenic chemotherapy drugs are prescribed, the client should receive
antiemetic drugs before the chemotherapy drugs are administered. This allows time for
prevention of chemotherapy-associated nausea and vomiting; however, the antiemetic
therapy cannot stop until all risks for nausea and vomiting have passed. Clients become
nauseated and vomit even if they are NPO.
C. The client's swollen face indicates possible superior vena cava syndrome, which is
an oncologic emergency. Manifestations result from the blockage of venous return from
the head, neck, and upper trunk. Early manifestations occur when the client arises after
a night's sleep and include edema of the face, especially around the eyes, and tightness
of the shirt or blouse collar. As the compression worsens, the client develops engorged
blood vessels and erythema of the upper body, edema in the arms and hands, dyspnea,
and epistaxis. Interventions at this stage are more likely to be successful. Late
manifestations include hemorrhage, cyanosis, mental status changes, decreased
cardiac output, and hypotension. Death results if compression is not relieved.
A. A strong family history of breast cancer indicates a risk for breast cancer. Annual screening
may be indicated for a strong family history. The client may perform a self-breast examination
monthly; a clinical examination by a health care provider is indicated annually. An annual
mammography is performed after age 40 or in younger clients with a strong family history
D. Pain in the back of the legs could indicate prostate cancer in an older man
ANSWER KEYS
Option C: The EGD can visualize the entire upper GI tract as well as
allow for tissue specimens and electrocautery if needed.
Option A: The barium swallow could locate a gastric ulcer.
Options B and D: A CT scan and an abdominal x-ray aren’t useful in
the diagnosis of an ulcer.
5. 5. Answer: D. On the left side with the head of the bed elevated 30
degrees.
Option D: The left side-lying position with the head of the bed
elevated is most likely to give relief to the client.
Options A, B, C: These include lying flat on the back or on the
stomach after a meal or lying on the right side.
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7. Answer: C. At bedtime.
Option D: Because the proton pump inhibitors stop the final step of
acid secretion, they can block up to 90% of acid secretion, leading to
achlorhydria (absence of acid).
14 Answer: A. Hypermagnesemia
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19 Answer: A and D.
28. Option D: Cimetidine was the first histamine-2 antagonist developed and
is associated with the most toxic drug interactions of the group.
The onset of regular insulin is 30-60 minutes. Andrea should be able to eat
by that time to avoid hypoglycemia.
33. mETFORMIN
35 Answer: B. clonidine
1-15
1. Answer: B. “It is possible you may have some changes in your sexual
function, and you may want to consider pretreatment harvesting of
sperm if you want children.”
2. Answer: A. “Why don’t we talk about the options you have for the
care of your children?”
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IL-2 enhances the ability of the patient’s own immune response to suppress
tumor cells. IL-2 does not protect normal cells from damage caused by
chemotherapy, stimulate malignant cells to enter mitosis, or prevent bone
marrow depression.
Yogurt has high biologic value because of the protein and fat content. Fruit
salad does not have high amounts of protein or fat. Orange sherbet is lower
in fat and protein than yogurt. French fries are high in calories from fat but
low in protein.
9. Answer: B. avoid presenting foods for which the patient has a strong
dislike.
The patient will eat more if disliked foods are avoided and foods that patient
likes are included instead. Additional spice is not usually an effective way to
enhance taste. Adding baby meats to foods will increase calorie and protein
levels, but does not address the issue of taste. Patients will not improve
intake by eating foods that are beneficial but have unpleasant taste.
10. Answer: C. Risk for ineffective health maintenance related to
anxiety about new leukemia diagnosis
The patient who has a new cancer diagnosis is likely to have high anxiety,
which may impact learning and require that the nurse repeat and reinforce
information. The patient’s history of a recent diagnosis suggests that
infiltration of the leukemia is not a likely cause of the confusion. The patient
asks for the information to be repeated, indicating that lack of interest in
learning and denial are not etiologic factors.
11. Answer: A. The patient’s visitors bring in some fresh peaches from
home.
12. Answer: A. The NA assists the patient to use dental floss after
eating.
Information about how the patient has coped with past stressful situations
helps the nurse determine usual coping mechanisms and their effectiveness.
The length of time since the diagnosis will not provide much information
about the patient’s need for support. The patient’s knowledge of typical
stages in adjustment to a critical diagnosis does not provide insight into
patient needs for assistance. The patient with stage I cancer is not
considered to have a terminal illness at this time, and this question is likely to
worry the patient unnecessarily.