Chapter 39: Biologic Response Modifiers Nursing School Test Banks

Kee: Pharmacology, 7th Edition

Chapter 39: Biologic Response Modifiers

Test Bank

MULTIPLE CHOICE

1. The nurse reviews a medication history for a client prescribed sargramostim (Leukine) for treatment of acute myelogenous leukemia (AML). The client is being treated with all of the following medications. Which one will require the nurse to contact the healthcare provider?

a.

Diphenhydramine (Benadryl)

b.

Furosemide (Lasix)

c.

Lithium (Eskalith)

d.

Risperidone (Risperdal)

ANS: C

Lithium (Eskalith) may increase the effects of sargramostim.

DIF: Cognitive Level: Application REF: p. 577

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A client with leukemia is receiving colony-stimulating factors (CSFs). The nurse anticipates that the client will be affected by the medication by exhibiting:

a.

a decrease in the actual size of the tumor.

b.

a decrease in length of posttreatment neutropenia.

c.

an increase in fungus-destroying ability.

d.

diminished bacterial infection.

ANS: B

CSFs stimulate white blood cell production.

DIF: Cognitive Level: Application REF: pp. 572-573

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

3. What does appropriate client teaching for clients receiving biologic response modifiers (BRMs) include?

a.

Report weight loss and signs of infection or bleeding.

b.

Severe weakness and malaise are expected side effects.

c.

BRM therapy has no teratogenic effects.

d.

Most BRM side effects persist after therapy is discontinued.

ANS: A

Weight loss and signs of infection as well as bleeding are possible side effects of treatment with a biologic response modifier.

DIF: Cognitive Level: Comprehension REF: pp. 582-583

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A client is to receive filgrastim (Neupogen) as a granulocyte-stimulating factor. The nurse recognizes that this medication should not be given when the client has:

a.

severe myelosuppression.

b.

a history of hypertension.

c.

received cytotoxic agents less than 24 hours before.

d.

a neutrophil count lower than 500.

ANS: C

The medication should not be given within 24 hours of receiving chemotherapy agents.

DIF: Cognitive Level: Application REF: p. 575

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A client is receiving interferon. What should be the highest priority nursing intervention to prevent the client from experiencing rigors?

a.

Pretreat with acetaminophen (Tylenol) and meperidine (Demerol).

b.

Provide antiemetics before treatment and around the clock.

c.

Infuse IV fluids as quickly as possible and assess urine output.

d.

Provide analgesia every 4 hours and assess for pain.

ANS: A

Rigors are treated with acetaminophen and meperidine.

DIF: Cognitive Level: Application REF: pp. 582-583

TOP: Nursing Process: Intervention

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A client is taking G-CSF, or filgrastim (Neupogen). Which nursing interventions are indicated for the most common side effect of this medication?

a.

Stool softeners and a high-fiber diet for constipation

b.

High fluid intake and vitamin C for alkaline urine

c.

Acetaminophen (Tylenol) and assessment for fever

d.

Nonnarcotic analgesia and comfort measures for pain

ANS: D

Bone pain is the most common side effect of the granulocyte colony-stimulating factors.

DIF: Cognitive Level: Application REF: p. 576

TOP: Nursing Process: Intervention

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

7. A client is to receive oprelvekin (Neumega). The nurse confirms that the client is experiencing fluid retention related to the medication by monitoring the client for evidence of:

a.

peripheral edema and exertional dyspnea.

b.

bradycardia and hypotension.

c.

restlessness and hypoxia.

d.

hypothermia and ventricular dysrhythmias.

ANS: A

Signs and symptoms of excessive fluid retention include peripheral edema and exertional dyspnea.

DIF: Cognitive Level: Application REF: pp. 578-579

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is administering erythropoietin. The nurse anticipates that the client will experience which side effects of receiving the medication?

a.

Orthostatic hypotension and dizziness

b.

Shortness of breath and tachypnea

c.

Bradycardia and agonal respirations

d.

Headaches and hypertension

ANS: D

Headaches and increased blood pressure occur as a result of the rising red blood cell count (Hct) and increased pressure in the arterial system when the client receives erythropoietin.

DIF: Cognitive Level: Application REF: p. 573

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

9. The highest priority nursing intervention to prevent the client from experiencing fatigue related to biologic response modifiers is to administer the drug:

a.

with iron to prevent anemia.

b.

with high-calorie foods to protect the stomach.

c.

before bedtime to allow the patient to sleep.

d.

with high-fat food to provide quick energy.

ANS: C

Taking medications before bedtime encourages sleep and avoids daytime drowsiness.

DIF: Cognitive Level: Application REF: pp. 582-583

TOP: Nursing Process: Intervention

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

10. The client is scheduled to receive treatment with Leukine. She is currently receiving treatment with lithium. As a result of the interaction of the medications, the nurse anticipates that the client will experience a(n) _____ effect of the _____.

a.

increased; Leukine

b.

increased; lithium

c.

decreased; Leukine

d.

decreased; lithium

ANS: A

Taking Leukine along with lithium will result in an increased effect of the Leukine.

DIF: Cognitive Level: Application REF: p. 577

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The client is being treated with Epoetin Alfa. The nurse notes that his blood pressure, which had a baseline reading of 114/82, has risen to stay consistently at 142/90 or higher. What is the highest priority action on the part of the nurse?

a.

Contact the physician; this is indicative of an adverse reaction to the medication.

b.

Contact the pharmacist; this is indicative of the drug being prepared in error.

c.

Contact the pharmacist; this indicates the client is experiencing an anaphylactic reaction.

d.

Contact the physician; this is an expected side effect of the medication.

ANS: D

Hypertension is an expected side effect of receiving the medication.

DIF: Cognitive Level: Application REF: p. 574

TOP: Nursing Process: Intervention

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

12. The client is being treated with Epoetin Alfa. The nurse expect to see in the clients laboratory values a(n) _____ hematocrit and a(n) _____ plasma volume.

a.

decreased; increased

b.

increased; decreased

c.

decreased; decreased

d.

increased; increased

ANS: B

Epoetin Alfa should cause the client to experience increase hematocrit and decreased plasma volume.

DIF: Cognitive Level: Application REF: p. 574

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

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