Chapter 39: Biologic Response Modifiers Nursing School Test Banks

Chapter 39: Biologic Response Modifiers
Test Bank

MULTIPLE CHOICE

1. A patient is receiving interferon alpha (Roferon-A) subcutaneously. The patient experiences chills, fatigue, and malaise, and the nurse assesses a temperature of 102 F. The nurse will notify the provider of the temperature and will anticipate which order?
a. Administer acetaminophen (Tylenol).
b. Change to intravenous interferon alpha.
c. Give diphenhydramine (Benadryl).
d. Obtain a serum BUN and creatinine level.
ANS: A
The major side effects of interferon are flulike symptoms with chills, fever, fatigue, malaise, and myalgia. Acetaminophen is given to treat this initially. Changing to an IV form does not alter the side effects. Diphenhydramine is given for nausea caused by interferon alpha. It is not necessary to obtain laboratory work when these symptoms initially occur.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 556
TOP: NURSING PROCESS: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. Prior to administration of interferon alpha, the nurse will administer which medications?
a. Acetaminophen and diphenhydramine
b. Heparin and meperidine
c. Lorazepam and furosemide
d. Narcotic analgesics and loratadine
ANS: A
Patients receiving these drugs should be premedicated with acetaminophen to reduce chills and fever and with diphenhydramine to reduce nausea.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 562
TOP: NURSING PROCESS: Planning/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A patient receiving interferon experiences confusion, somnolence, and aphasia. The nurse will perform which action?
a. Discontinue the medication immediately.
b. Inform the family that these symptoms may persist for years.
c. Reassure the patient that these side effects are reversible.
d. Request an order for lorazepam.
ANS: C
Neurologic side effects, such as confusion, somnolence, and aphasia, are reversible after the drug is stopped. It is not necessary to stop the medication unless the symptoms progress and become severe. Lorazepam is not indicated.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 557
TOP: NURSING PROCESS: Evaluation/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. The nurse is teaching a young adult patient who will begin receiving interferon. Which statement by the patient indicates understanding of the teaching?
a. I may have a low-grade fever while taking this medication.
b. I may have serious cardiovascular side effects because of this drug.
c. I should take antiemetics prior to each dose of this medication.
d. I may need to avoid people who are sick while Im taking this drug.
ANS: C
Antiemetics should be given prior to treatment to prevent nausea from occurring. Fevers are common and are usually high. Cardiovascular side effects tend to occur in older patients. Neutropenia is rare with interferon and does not predispose patients to infection.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 568
TOP: NURSING PROCESS: Planning/Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A patient who has cancer will begin treatment with a colony-stimulating factor. The patient verbalizes understanding of this drugs action with which statement?
a. This drug allows higher doses of chemotherapy.
b. This drug has antitumor activity.
c. This drug has cytotoxic effects.
d. This drug has antiviral effects.
ANS: A
Colony-stimulating factors permit the delivery of higher doses of drugs because they counter myelosuppression. They do not have antitumor activity, cytotoxic effects, or antiviral effects.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 557
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A patient is receiving the erythropoietin-stimulating agent epoietin alfa (Procrit). Which assessment finding would cause the nurse to notify the patients provider?
a. Blood pressure of 90/65 mm Hg
b. Headache and nausea
c. Hemoglobin > 12 g/dL
d. Infiltration of the IV
ANS: C
There is an increased risk of death and serious cardiovascular events when the hemoglobin is greater than 12 g/dL. There is no need to notify the provider of the other findings.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 558
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. A patient who is receiving cancer chemotherapy has been ordered to receive epoetin alfa (Procrit) 150 units/kg 3 times weekly. The nurse reviews the patients chart and notes a hemoglobin level of 10.1 g/dL. The nurse will perform which action?
a. Administer the medication as ordered.
b. Hold the dose and notify the provider.
c. Reduce the dose by 25%.
d. Request an order for an increased dose.
ANS: B
For patients receiving cancer chemotherapy, erythropoietin-stimulating agents should not be initiated at a hemoglobin level greater than or equal to 10 g/dL.

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TOP: NURSING PROCESS: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. A patient has been receiving an erythropoietin-stimulating agent (ESA) for 8 weeks. The nurse reviews the patients chart and notes no increase in hemoglobin levels from 8 g/dL on week 3 of therapy. The nurse will request an order for
a. a complete blood count and serum iron levels.
b. an increased dose of the erythropoietin-stimulating agent.
c. more frequent dosing of the ESA.
d. packed red blood cell infusions.
ANS: A
If there is no response, ESAs should be discontinued after 8 weeks of therapy. If a patient does not respond, iron deficiency or underlying hematologic disease should be considered and evaluated.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 559
TOP: NURSING PROCESS: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A patient is receiving bone marrow transplantation for cancer and receives filgrastim (Neupogen). The patient reports abdominal pain in the left upper quadrant. The nurse will perform which action?
a. Administer acetaminophen 650 mg.
b. Administer an antiemetic medication.
c. Report a potentially life-threatening event.
d. Request an order for cardiac enzyme levels.
ANS: C
Splenic rupture can occur with this drug and is manifested by pain in the left upper quadrant. The nurse should report the abdominal pain to the provider so the patient can be evaluated for splenic rupture.

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TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A patient with cancer is receiving pegfilgrastim (Neulasta). The patient reports bone pain, which the nurse recognizes as
a. a sign of cancer metastasis.
b. an indication of expansion of bone marrow.
c. caused by osteomyelitis.
d. worsening neutropenia.
ANS: B
Bone pain is common with these drugs and is caused by expansion of the bone marrow. It does not indicate metastasis. The bone pain is not due to osteomyelitis or neutropenia.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 561
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The nurse is preparing to give sargramostim to a patient who has acute myelogenous leukemia (AML). The nurse assesses a heart rate of 78 beats per minute and a blood pressure of 120/70 mm Hg. The patient reports shortness of breath and has a cough and bilateral crackles. What will the nurse do next?
a. Contact the provider; discuss giving a lower dose.
b. Contact the pharmacist; request a bronchodilator.
c. Contact the pharmacist; request an order for furosemide.
d. Contact the provider; suggest administration of antibiotics.
ANS: A
Patients receiving this drug can experience sequestration of granulocytes in the pulmonary circulation and may experience dyspnea. The sargramostim infusion should be reduced in half if this occurs. Bronchospasm, pulmonary edema, and infection are not common side effects.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 563
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. The nurse is preparing to administer interleukin-2 to a patient who has cancer. The patient reports shortness of breath. The nurse assesses clear breath sounds, a respiratory rate of 22 breaths per minute, a heart rate of 80 beats per minute, an oxygen saturation of 93% on room air, and a blood pressure of 92/68 mm Hg. The nurse will perform which action?
a. Administer the dose as ordered.
b. Administer oxygen while giving the dose.
c. Discuss permanently discontinuing this treatment with the provider.
d. Hold the dose and notify the provider.
ANS: D
Because of pulmonary symptoms associated with interleukin-2, the drug should be held if the patient has an oxygen saturation <94% on room air. It may be given when the patients oxygen saturation improves. The drug does not need to be permanently discontinued.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 565
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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