BIOLOGIC CRISIS QUIZ 2 FINAL

Name :____________________________ Score:____________

Year /Section Date:__________

Multiple Choice :Select the correct answer and shade in the answer sheet.

1. Which of the following statements describes the action of antacids?

A. Antacids block the production of gastric acid
B. Antacids enhance the action of acetylcholine
C. Antacids block dopamine
D. Antacids neutralize gastric acideeeteeeer

2. Patient Gavin is taking antacids, which instruction would be

included in the
teaching plan?
A. “Avoid taking other medications within 2 hours of this one.”
B. “Continue taking antacids even when pain subsides.”
C. “Weigh yourself daily when taking this medication.”
D. “Take the antacids with 8 oz of water.”

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

5. The hospitalized client with GERD is complaining of chest discomfort

that feels like heartburn following a meal. After administering an
ordered antacid, the nurse encourages the client to lie in which of the
following positions?

A. On the stomach with the head flat

B. Supine with the head of the bed flat
C. On the right side with the head of the bed elevated 30 degrees
D. On the left side with the head of the bed elevated 30 degrees

6. 6. Which of the following best describes the method of action of

medications, such as ranitidine (Zantac), which are used in the
treatment of peptic ulcer disease?

A. Neutralize acid
B. Reduce acid secretions
C. Stimulate gastrin release
D. Protect the mucosal barrier

7. A client is to take one daily dose of ranitidine (Zantac) at home to

treat her peptic ulcer. The nurse knows that the client understands
proper drug administration of ranitidine when she says that she will
take the drug at which of the following times?

A. Before meals
B. With meals
C. At bedtime
D. When pain occurs

8. The nurse provides medication instructions to a client with peptic

ulcer disease. Which statement, if made by the client, indicates the best
understanding of the medication therapy?
A. “The cimetidine (Tagamet) will cause me to produce less stomach acid.”
B. “Sucralfate (Carafate) will change the fluid in my stomach.”
C. “Antacids will coat my stomach.”
D. “Omeprazole (Prilosec) will coat the ulcer and help it heal.”

9. When a client has peptic ulcer disease, the nurse would expect a
priority intervention to be:

A. Assisting in inserting a Miller-Abbott tube

B. Assisting in inserting an arterial pressure line
C. Inserting a nasogastric tube
D. Inserting an I.V.

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:

A. Reduce gastric acid output.

B. Protect the ulcer surface.
C. Inhibit the production of hydrochloric acid (HCl).
D. Inhibit vagus nerve stimulation.

11.  The physician has prescribed Nexium (esomeprazole) for a client

with erosive gastritis. The nurse should administer the medication:

A. 30 minutes after meals

B. 30 minutes before meals
C. With each meal
D. In a single dose at bedtime

12. Proton pump inhibitor use will likely result in:

A. Heartburn
B. Diverticulosis
C. Gastric ulcer formation
D. Achlorhydria

13. . A patient is prescribed with esomeprazole for the treatment of

GERD. Upon review of current medication use, the nurse noted that the
patient is taking clopidogrel. The nurse warned the patient that
esomeprazole:

A. Have no evidence of potential interaction with clopidogrel

B. Increase the effectiveness of clopidogrel
C. Decrease the effectiveness of clopidogrel
D. Increase acid production

14. 14. Prolonged use of Proton Pump Inhibitors will likely result with
the following except:

A. Hypermagnesemia
B. Pneumonia
C. Fractures
D. Hypochlorhydria

15. A Cromolyn sodium (Intal) inhaler is prescribed to a client with

asthma. A nurse provides instructions regarding the side effects of
this medication. The nurse tells the client that which undesirable effect
is associated with this medication?

A. Insomnia
B. Constipation
C. Wheezing
D. Hypotension

16. A nurse is about to administer Albuterol (Ventolin HFA) 2 puff and

Budesonide (Pulmicort Turbohaler) 2 puff by metered dose inhaler. The
nurse plans to administer by?

A. Alternating with a single puff each, starting with albuterol.

B. Alternating with a single puff each, starting with budesonide.
C. Budesonide inhaler first then the albuterol.
D. Albuterol inhaler first then the budesonide.

17. A nurse teaches a client about the use of a respiratory inhaler.

Which action by the client indicated a need for further teaching?

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.

18; A client with acute asthma is prescribed short-term corticosteroid

therapy. What is the rationale for the use of steroids in clients with
asthma?

A. Corticosteroids promote bronchodilation.

B. Corticosteroids act as an expectorant.
C. Corticosteroids have an anti-inflammatory effect.
D. Corticosteroids prevent the development of respiratory infections.

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. The inhaler is held upright.

B. Head is tilted down while inhaling the medication.
C. Client waits 5 minutes between puffs.
D. Mouth is rinsed with water following administration.
E. Client lies supine for 15 minutes following administration

20.Beta-adrenergic agonists such as albuterol are given to Carlo, a child

with asthma. Such drugs are administered primarily to do which of the
following?

A. Reduce airway inflammation

B. Decrease postnasal drip
C. Reduce secondary infections
D. Dilate the bronchioles

21 Maria is rushed to the emergency department during an acute,

severe prolonged asthma attack and is unresponsive to usual
treatment. The condition is referred to as which of the following?

A. Intrinsic asthma
B. Extrinsic asthma
C. Status asthmaticus
D. Reactive airway disease

22. A client is receiving theophylline intravenously. After

several dosages, the client started to become restless and complains of
palpitations. The nurse determines that the client is experiencing
theophylline toxicity in which of the following?

A. Theophylline level of 2.5 mcg/ml

B. Theophylline level of 5 mcg/ml
C. Theophylline level of 20mcg/ml
D. Theophylline level of 25mcg/ml

23. The nurse is giving medication teachings to a client receiving

theophylline. The nurse instructs the client to limit the intake of which
of the following?

A. Strawberries and avocado

B. Butter and cheese
C. Salmon and tuna
D. Hot tea and cocoa

24. When administering the methylxanthine theophylline, the nurse can

expect:

A. Decreased pulmonary function

B. Decreased tidal volume
C. Increased pulmonary function
B. Increased residual volume

25. A nurse is giving teachings to a client receiving Desloratadine

(Clarinex). Which of the following statements made by the client will
need further instructions?

A. “I can eat gum after I drink the medicine”

B. “I can take the medicine on an empty stomach“
C. “I should avoid using alcohol”
D. “I will avoid driving while using this medication”

26. Nurse Zeke is giving instructions to her client who is taking

antihistamine. Which of the following nurse teachings is appropriate for
the client?

A. Expect a relief in 24 hours

B. Be aware that you may have increased saliva
C. Be aware that you may need to take a decongestant
D. Avoid ingesting alcohol

27. Raul, a 20-year-old student, used to buy OTC drugs whenever he

feels sick. Which of the following statements best describes the danger
of self-medication with over-the-counter drugs?

A. Clients are not aware of the action of over-the-counter drugs.

B. Clients are not aware of the side effects of over-the-counter drugs.
C. Clients minimize the effects of over-the-counter drugs because they are
available without a prescription.
D. Clients do not realize the effects of over-the-counter drugs.

28. Which histamine-2 antagonist is associated with the most TOXIC

drug interactions?

A. Prilosec
B. Nizatidine
C. Ranitidine
D. Cimetidine

29. Glucocorticoids are hormones that:

A. are released in response to high glucose levels
B. help to regulate water balance in the body
C. help to regulate electrolyte levels
D. promote the preservation of energy through increased glucose levels,
protein breakdown, and fat formation

30.. Glucocorticoids can reduce inflammation and suppress the immune

system by:

A. forming complex reactions needed to reduce inflammation

B. activating more lymphocytes to reduce inflammation
C. inhibiting the localization of phagocytes so immune system can rest
D. all of the above

31. A patient is started on a regimen of prednisone because of a crisis in

her ulcerative colitis. Nursing care of this patient would need to
include:

A. immunizations to prevent infections

B. increased calories to deal with metabolic changes
C. fluid restriction to decrease water retention
D. administration of the drug around 8 or 9 AM to mimic normal diurnal
rhythm.

32.Andrea, a 15-year-old patient, was newly diagnosed with diabetes

type 1. She is on regular insulin. If she’s prescribed to have a daily shot
of insulin every 8:30 am, when would be the appropriate time that she
should have her meals?

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

34. The sympathomimetic found in many OTC cold products.

A. salmeterol
B. albuterol
C. phenylephrine
D. terbutaline

35. This drug is used to control hypertension and is used as an epidural

infusion for patients suffering from cancer pain.

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?

A. Blood pressure and bowel sounds

B. Weight and appetite
C. Muscle strength and range of motion
D. Respiratory rate, depth, and rhythm

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. Administer medications as they are because they enhance drug actions.

B. Measure patient’s intake and output closely.
C. Arrange for SGPT monitoring.
D. Assess for signs and symptoms of bleeding.

38. Which of the following is a charecteristic of benign tumors?

A. Invasive growth

B. Immature, poorly differentiated tissue

C. Presence of metastasis

D. Fully differentiated tissue

39. 2. Human papilloma virus is known to be associate with:

A. cervical cancer

B. lymphoma

C. hepatocellular cancer

D. gastric cancer

40. Fine-needle aspiration (FNA) is used most commonly to differentiate between:

A. solid and cystic masses.

B. primary and secondary tumors.

C. stage I and II of metastasis.

D. connective and epithelial tissue cancers.

41. 4. Which of the following is NOT a phase in the cell cycle?

A. G1 (gap one) phase

B. S (synthesis) phase

C. G2 (gap two) phase

D. P (Proein) Phase

42. Which of the following chemotherapeutic agent is a plant alkaloid?

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

7. Which of the following is NOT a anti-metabolite group of chemotherapeutic agents?

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:

A. synthetic antiestrogen used in the treatment of breast cancer.

B. anti-metabolite chemotherapeutic agent.

C. human recombinant granulocyte colony–stimulating factor (G-CSF)

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

11. Levamisole is used as a anticancer drug in the treatment of:

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

14. Which of the following chemotherapeutic agent is a folate antagonist group of antimetabolite?

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

1. A 32-year-old male patient is to undergo radiation therapy to the

pelvic area for Hodgkin’s lymphoma. He expresses concern to the nurse
about the effect of chemotherapy on his sexual function. The best
response by the nurse to the patient’s concerns is

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.”

2. A 40-year-old divorced mother of four school-age children is

hospitalized with metastatic cancer of the ovary. The nurse finds the
patient crying, and she tells the nurse that she does not know what will
happen to her children when she dies. The most appropriate response
by the nurse is

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

A. uses the ordered opioid pain medication whenever the pain is greater

than 5 on a 10-point scale.
B. states that nonopioid analgesics may be used when the maximal dose of
the opioid is reached without adequate pain relief.
C. agrees to take the medications by the IV route to improve effectiveness.
D. takes opioids around the clock on a regular schedule and uses additional
doses when breakthrough pain occurs.

4. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with

metastatic renal cell carcinoma. The nurse teaches the patient that the
purpose of therapy with this agent is to

A. protect normal kidney cells from the damaging effects of chemotherapy.

B. enhance the patient’s immunologic response to tumor cells.
C. stimulate malignant cells in the resting phase to enter mitosis.
D. prevent the bone marrow depression caused by chemotherapy.

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. “I have frequent muscle aches and pains.”

B. “I rarely have the energy to get out of bed.”
C. “I take acetaminophen (Tylenol) every 4 hours.”
D. “I experience chills after I inject the interferon.”

6. Which information noted by the nurse reviewing the laboratory

results of a patient who is receiving chemotherapy is most important to
report to the health care provider?

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

7. A bone marrow transplant is being considered for treatment of a

patient with acute leukemia that has not responded to chemotherapy.
In discussing the treatment with the patient, the nurse explains that

A. hospitalization will be required for several weeks after the hematopoietic

stem cell transplant (HSCT).
B. the transplant of the donated cells is painful because of the nerves in the
tissue lining the bone.
C. donor bone marrow cells are transplanted immediately after an infusion
of chemotherapy.
D. the transplant procedure takes place in a sterile operating room to
minimize the risk for infection.

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. Fresh fruit salad

B. Orange sherbet
C. Strawberry yogurt
D. French fries

9. The nurse has identified the nursing diagnosis of imbalanced

nutrition: less than body requirements related to
altered taste sensation in a patient with lung cancer who has had a 10%
loss in weight. An appropriate nursing intervention that addresses the
etiology of this problem is to

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?

A. Acute confusion related to infiltration of leukemia cells into the

central nervous system
B. Knowledge deficit: chemotherapy related to a lack of interest in learning
about treatment
C. Risk for ineffective health maintenance related to anxiety about new
leukemia diagnosis
D. Risk for ineffective adherence to treatment related to denial of need for
chemotherapy

11. A hospitalized patient who has received chemotherapy for leukemia

develops neutropenia. Which observation by the RN caring for the
patient indicates that the nurse should take action?
A. The patient’s visitors bring in some fresh peaches from home.
B. The patient ambulates several times a day in the room.
C. The patient uses soap and shampoo to shower every other day.
D. The patient cleans with a warm washcloth after having a stool.

12. Which action by a nursing assistant (NA) when caring for a patient
who is pancytopenic indicates a need for the nurse to intervene?

A. The NA assists the patient to use dental floss after eating.

B. The NA makes an oral rinse using 1 teaspoon of salt in a liter of water.
C. The NA adds baking soda to the patient’s saline oral rinses.
D. The NA puts fluoride toothpaste on the patient’s toothbrush.

13. A with tumor lysis syndrome (TLS) is taking allopurinol (Zyloprim).

Which laboratory value should the nurse monitor to determine the
effectiveness of the medication?

A. Blood urea nitrogen (BUN)

B. Serum phosphate
C. Serum potassium
D. Uric acid level

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

1. D. Antacids neutralize gastric acid

Option D: Antacids act to bring the pH above 3.
Options A, B, and C: Other choices are incorrect because they describe actions of antiacid drugs.
2. Answer: A. “Avoid taking other medications within 2 hours of this one.”
Option A: The client should be instructed to avoid taking other medications within 2 hours of the
antacid.
Option B: A histamine receptor antagonist should be taken even when the pain subsides.
Option C: Daily weights are indicated if the client is taking a diuretic, not an antacid.
Option D: Water, which dilutes the antacid, should not be taken with an antacid.
3. Answer: C. Alcohol abuse and smoking

 Option C: Risk factors for peptic (gastric and duodenal) ulcers

include alcohol abuse, smoking, and stress.
 Options A & B: A sedentary lifestyle and a history of hemorrhoids
aren’t risk factors for peptic ulcers.
 Option D: Chronic renal failure, not acute renal failure, is associated
with duodenal ulcers. 

4. Answer: C. Esophagogastroduodenoscopy (EGD)

 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.

6. Answer: B. Reduce acid secretions.

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 Option B: Ranitidine is a histamine-2 receptor antagonist that

reduces acid secretion by inhibiting gastrin secretion.

7. Answer: C. At bedtime.

 Option C: Ranitidine blocks secretion of hydrochloric acid. Clients

who take only one daily dose of ranitidine are usually advised to
take it at bedtime to inhibit nocturnal secretion of acid.

8. Answer: A. “The cimetidine (Tagamet) will cause me to produce less

stomach acid.”

 Option A: Cimetidine (Tagamet), a histamine H2 receptor

antagonist, will decrease the secretion of gastric acid.
 Option B: Sucralfate (Carafate) promotes healing by coating the
ulcer.
 Option C: Antacids neutralize acid in the stomach.
 Option D: Omeprazole (Prilosec) inhibits gastric acid secretion.
9. Answer: C. Inserting a nasogastric tube.

 Option C: An NG tube insertion is the most appropriate intervention

because it will determine the presence of active GI bleeding.
 Option A: A Miller-Abbott tube is a weighted, mercury-filled
ballooned tube used to resolve bowel obstructions.
 Options B and D: There is no evidence of shock or fluid overload in
the client; therefore, an arterial line is not appropriate at this time
and an IV is optional.

10. Answer: A. Reduce gastric acid output.

 Option A: These drugs inhibit the action of histamine on the H2

receptors of parietal cells, thus reducing gastric acid output.

11. Answer: B. 30 minutes before meals

 Option B: Proton pump inhibitors reduce the production of acid in

the stomach. Proton pump inhibitors work best when they are taken
30 minutes before the first meal of the day.

12. Answer: D. Achlorhydria.

 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).

13. Answer: C. Decrease the effectiveness of clopidogrel

  Option C: Esomeprazole inhibits CYP2C19 enzyme which serves as a
pathway for certain medication. One of which is clopidogrel, so
taking it with esomeprazole will potentially decrease the
effectiveness of clopidogrel.

14 Answer: A. Hypermagnesemia

 Option A: Long term use of PPIs affects intestinal magnesium

absorption leading to hypomagnesemia.

15. Answer: C. Wheezing

 Option C: Cromolyn Sodium (Intal) is used to prevent asthma

attacks in people with bronchial asthma. Undesirable side effects
associated with the use of inhaler is wheezing, cough, nasal
congestion, bronchospasm, and throat irritation.

16. Answer: D. Albuterol inhaler first then the budesonide.

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 Option D: If two different inhaled medications are prescribed and

one of the medications contains a corticosteroid, administer the
bronchodilator (Albuterol) first and the corticosteroid (Budesonide)
second. This will allow for the widening of the air passages by the
bronchodilator, making the corticosteroids more effective.

17. Answer: C. Inhales the mist and quickly exhales.

 Option C: The client should be instructed to hold his or her breath

at least 10 to 15 seconds before exhaling the mist.

18. Answer: C. Corticosteroids have an anti-inflammatory effect.

  Option C: Corticosteroids have an anti-inflammatory effect and act
to decrease edema in the bronchial airways and decrease mucus
secretion.
 Options A, B, D: Corticosteroids do not have a bronchodilator effect,
act as expectorants, or prevent respiratory infections.

19 Answer: A and D.

 Option A: The inhaler is held upright.

 Option D: Mouth is rinsed with water following administration.

20. Answer: D. Dilate the bronchioles

 Option D: Beta-adrenergic agonists, such as albuterol, are highly

effective bronchodilators and are used to dilate the narrow airways
associated with asthma.
 Option A: Corticosteroids may be used for their anti-inflammatory
effect.
 Option B: Decongestants may be given to decrease postnasal drip.

 Option C: Antibiotics are used to prevent secondary infection.

21. Answer: C. Status asthmaticus

 Option C: Status asthmaticus is an acute, prolonged, severe asthma

attack that is unresponsive to usual treatment. Typically, the child
requires hospitalization.
 Option A: Intrinsic is a term used to denote internal precipitating
factors, such as viruses.
 Option B: Extrinsic is a term used to denote external precipitating
factors, such as allergens.
 Option D: Reactive airway disease is another general term for
asthma
22. Answer: D. Theophylline level of 25mcg/ml

 Option D: Theophylline toxicity is likely to occur when the serum

level is higher than 20 mcg/ml. Early signs of toxicity include
restlessness, nervousness, tachycardia, tremors, and palpitations.

23. Answer: D. Hot tea and cocoa

 Option D: Theophylline is a methylxanthine bronchodilator. The

nurse instructs the client to limit the intake of xanthine-containing
foods such as chocolate, cola, cocoa, tea, and coffee.

24. Answer: C. Increased pulmonary function.

 Option C: Theophylline will improve ventilation so there will be an

overall improvement of pulmonary measurements.
 Options A, B, D: Other choices are the opposite of what will actually
occur with theophylline administration.

25 .Answer: B. “I can take the medicine on an empty stomach”.

 Option B: This medicine should be taken with food or milk to

minimize gastrointestinal upset.
 Option A: Use gum or hard candy to minimize dry mouth.
 Options C and D: The medication causes drowsiness so avoid taking
alcohol or engaging in activities which require mental alertness such
as driving a car.

26.  Answer: D. Avoid ingesting alcohol.

 Option D: Because alcohol and antihistamines have sedating

properties, concurrent administration of these drugs should be
avoided.
  Option A: Not all antihistamines last 24 hours.
 Option B: Dry mouth is a common side effect, not increased
salivation.
 Option C: Antihistamines and decongestants are often given
together.

27.  Answer: C. Clients minimize the effects of over-the-counter drugs

because they are available without a prescription.

 Option C: This choice is correct because it includes the other three

risks noted in choices A, B, and D.28 Answer: D. Cimetidine.

28. Option D: Cimetidine was the first histamine-2 antagonist developed and
is associated with the most toxic drug interactions of the group.

29. Answer: D. promote the preservation of energy through increased

glucose levels, protein breakdown, and fat formation

Glucocorticoids are agents that stimulate an increase in glucose levels for

energy. They also increase the rate of protein breakdown and decrease the
rate of protein formation from amino acids to preserve energy. They are also
capable of lipogenesis, or the formation and storage of fat in the body for
energy source.

30. 30. Answer: A. forming complex reactions needed to reduce

inflammation

They bind to cytoplasmic receptors of target cells to form complex reactions

needed to reduce inflammation and suppress the immune system. They also
limit the activity of lymphocytes to act within the immune system. Lastly, they
inhibit the spread of phagocytes to the bloodstream and injured tissues.
31.Answer: D. administration of the drug around 8 or 9 AM to mimic
normal diurnal rhythm.

Administer drug daily at 8 to 9 AM to mimic normal peak diurnal

concentration levels and thereby minimize suppression of the hypothalamic-
pituitary axis (HPA).

32.Answer: A. 9:00 AM.

The onset of regular insulin is 30-60 minutes. Andrea should be able to eat
by that time to avoid hypoglycemia.

33. mETFORMIN

34. 34 Answer: C. phenylephrine

Phenylephrine is often found in OTC allergy and cold preparations so

primary caregivers should be instructed to check labels for ingredients and
not combine drugs with similar ingredients.

35 Answer: B. clonidine

Clonidine specifically stimulates alpha2-receptors of the CNS leading to

decreased CNS outflow of norepinephrine. Orally and transdermally, it is
used to control hypertension and as an injection, it is for epidural infusion for
controlling cancer pain.

36. Answer: A. Blood pressure and bowel sounds

NSAIDs are associated with CV (hypertension) and GI (constipation, diarrhea,
etc.) adverse effects. All other options are not related.

D. Assess for signs and symptoms of bleeding.

37.Answer: B. Measure patient’s intake and output closely.

Acetaminophen can decrease the diuretic effect of loop diuretics so it is

important to monitor patient for fluid retention.

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.”

The impact on sperm count and erectile function depends on the patient’s

pretreatment status and on the amount of exposure to radiation. The patient
should consider sperm donation before radiation. Radiation (like
chemotherapy or surgery) may affect both sexual function and fertility either
temporarily or permanently.

2. Answer: A. “Why don’t we talk about the options you have for the
care of your children?”

This response expresses the nurse’s willingness to listen and recognizes the

patient’s concern. The responses beginning “Many patients with cancer live
for a long time” and “For now you need to concentrate on getting well” close
off discussion of the topic and indicate that the nurse is uncomfortable with
the topic. In addition, the patient with metastatic ovarian cancer may not
have a long time to plan. Although it is possible that the patient’s ex-husband
will take the children, more assessment information is needed before making
plans.

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3. Answer: D. takes opioids around the clock on a regular schedule and

uses additional doses when breakthrough pain occurs.

For chronic cancer pain, analgesics should be taken on a scheduled basis,

with additional doses as needed for breakthrough pain. Taking the
medications only when pain reaches a certain level does not provide
effective pain control. Although nonopioid analgesics may also be used, there
is no maximum dose of opioid. Opioids are given until pain control is
achieved. The IV route is not more effective than the oral route and the oral
route is preferred.

4. Answer: B. enhance the patient’s immunologic response to tumor

cells.

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.

5. Answer: B. “I rarely have the energy to get out of bed.”

Fatigue can be a dose-limiting toxicity for use of biologic therapies. Flulike

symptoms, such as muscle aches and chills, are common side effects with
interferon use. Patients are advised to use Tylenol every 4 hours.

6. Answer: B. WBC count of 1700/µl

Neutropenia places the patient at risk for severe infection and is an
indication that the chemotherapy dose may need to be lower or that white
blood cell (WBC) growth factors such as filgrastim (Neupogen) are needed.
The other laboratory data do not indicate any immediate life-threatening
adverse effects of the chemotherapy.

7. Answer: A. hospitalization will be required for several weeks after the

hematopoietic stem cell transplant (HSCT).

The patient requires strict protective isolation to prevent infection for 2 to 4

weeks after HSCT while waiting for the transplanted marrow to start
producing cells. The transplanted cells are infused through an IV line, so the
transplant is not painful, nor is an operating room required. The HSCT takes
place 1 or 2 days after chemotherapy to prevent damage to the transplanted
cells by the chemotherapy drugs.

8. Answer: C. Strawberry yogurt

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.

Fresh, thinned-skin peaches are not permitted in a neutropenic diet because

of the risk of bacteria being present. The patient should ambulate in the
room rather than the hospital hallway to avoid exposure to other patients or
visitors. Because overuse of soap can dry the skin and increase infection risk,
showering every other day is acceptable. Careful cleaning after having a
bowel movement will help to prevent perineal skin breakdown and infection.

12. Answer: A. The NA assists the patient to use dental floss after
eating.

Use of dental floss is avoided in patients with pancytopenia because of the

risk for infection and bleeding. The other actions are appropriate for oral
care of a pancytopenic patient.

13. Answer: D. Uric acid level

Allopurinol is used to decrease uric acid levels. BUN, potassium, and

phosphate levels are also increased in TLS but are not affected by allopurinol
therapy.
14. Answer: A. “Can you tell me what has been helpful to you in the past
when coping with stressful events?”

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.