Chapter 54: Biological Response–Modifying Drugs

Multiple Choice

1. A patient is receiving interferon therapy. What expected adverse effect should the nurse tell this patient about?

a. Anemia b. Increased appetite c. Constipation d. Flulike effects

ANS: D

Patients who receive interferon therapy may experience flulike effects, fatigue, anorexia, dizziness, nausea, vomiting, and diarrhea. Patients on interferon therapy will not experience anemia, increased appetite, or constipation.

DIF: Cognitive Level: Comprehension REF: p. 1010 a. They directly inhibit deoxyribonucleic acid (DNA) and protein synthesis. b. They destroy cancer cells and ignore normal cells. c. They destroy cancer cells by destroying all types of cells. d. They prevent virus replication and prevent viruses from penetrating healthy cells.

2. Lymphokine-activated killer (LAK) cells, which multiply as a result of interleukin therapy, do what?

ANS: B

LAK cells recognize cancer cells, ignore normal cells, and destroy the cancer cells on contact, thus avoiding the toxic effects of antineoplastic drugs.

DIF: Cognitive Level: Knowledge REF: p. 1014 a. Renal failure b. Asthma c. Ecchymosis d. Heart failure

3. Capillary leak syndrome during interleukin therapy may result in which problem?

ANS: D

When capillary leak syndrome occurs, the capillaries lose their ability to retain vital colloids, and these substances migrate into the surrounding tissues, resulting in massive fluid retention. As a result, heart failure, myocardial infarction, and dysrhythmias may occur.

DIF: Cognitive Level: Comprehension REF: p. 1016 a. Multiplication of T cells b. Decreased neutrophil counts c. Increased cytotoxic activity of natural killer (NK) cells d. Stimulation of certain immune cells

4. Which is an effect of colony-stimulating factors (CSFs)?

ANS: D

CSFs prevent the decrease of neutrophil counts and stimulate certain immune cells (macrophages and granulocytes) to destroy or inhibit the growth of tumour cells and virus- or fungus-infected cells.

DIF: Cognitive Level: Knowledge REF: p. 1008 a. Dosages should be administered in the morning. b. The patient should be encouraged to drink up to 2 to 3 L of fluids per day while taking these medications. c. To minimize allergic reactions, oral dosing is preferred. d. Shake the drug vial well before drawing up a dose.

5. Which is true in regard to therapy with interferon drugs?

ANS: B

Encourage the patient to drink fluids up to 2 to 3 L/day (unless contraindicated) to promote excretion of the by-products of cellular breakdown and to maintain cellular hydration. Interferon has a fatiguing effect and therefore should not be taken in the morning. Interferon is given either intramuscularly or subcutaneously. The drug vial should be swirled, not shaken.

DIF: Cognitive Level: Application REF: p. 1022 a. Interleukins cannot be self-administered. b. Any temperature higher than 39.5°C needs to be reported to the health care provider. N R I G B.C M c. Pregnancy should be avoidUed fSor 6NmoTnths. O d. Adverse effects usually disappear within 72 to 96 hours after therapy is discontinued.

6. When providing patient education related to biological response–modifying drugs, which is important information to give the patient?

ANS: D

It is important to inform the patient that adverse effects associated with biological response–modifying drugs usually disappear within 72 to 96 hours after therapy is discontinued. Interleukins can be self-administered. Any temperature higher than 38.1°C needto be reported, and pregnancy should be avoided for at least 2 years.

DIF: Cognitive Level: Application REF: p. 1023, Pt Teaching a. filgrastim (Neupogen®) b. interferon c. epoetin alfa (Eprex®) d. sargramostim (Leukine®)

7. A patient with end-stage renal failure has been admitted to hospital for severe anemia but is refusing blood transfusions. Which drugs will likely be used to stimulate the production of red blood cells (RBCs)?

ANS: C

Epoetin alfa is a colony-stimulating factor that is responsible for erythropoiesis, or the formation of RBCs.

DIF: Cognitive Level: Comprehension REF: pp. 1007-1008 a. Anorexia b. Neuropathy c. Respiratory problems d. Heart failure

8. A patient is to take antineoplastic therapy with monoclonal antibodies such as rituximab (Rituxan®). The nurse should carefully assess this patient for which condition?

ANS: C

Monoclonal antibodies such as rituximab may cause respiratory problems.

DIF: Cognitive Level: Application REF: p. 1012, Table 54-3 a. thalidomide (Thalomid®) b. tretinoin (Vesanoid®) c. bacillus Calmette-Guérin (BCG) vaccine (Immuncyst®) d. etanercept (Enbrel®)

9. Which medication is indicated in the treatment of rheumatoid arthritis?

ANS: D

Etanercept is a tumour necrosis factor receptor antagonist and is indicated in the treatment of rheumatoid arthritis.

DIF: Cognitive Level: Comprehension REF: p. 1017, Table 54-4 a. 6 months b. 12 months c. 18 months d. 24 months

10. A female patient is being treated with biological response–modifying drugs. After the completion of her treatment, she should be cautioned to avoid pregnancy for what time period?

ANS: D

Contraception should be used for up to 24 months following the completion of treatment with a biological response–modifying drug.

DIF: Cognitive Level: Comprehension REF: p. 1023, Pt Teaching

Multiple Choice

1. A patient is to receive iron dextran (Dexiron®) injections. What should the nurse use to administer this medication?

a. Intravenous (IV) injection mixed with 5% dextrose b. Intramuscular (IM) injection in the upper arm c. IM injection using the Z-track method d. Subcutaneous injection with a half-inch, 29-gauge needle

ANS: C

With the Z-track method, IM iron should be given deep into a large muscle mass.

DIF: Cognitive Level: Application REF: p. 1036 a. Take the iron tablets with milk or antacids. b. Crush the pills as needed to help swallowing. c. Avoid reclining positions for up to 30 minutes after taking the drug. d. You do not need to eat foods that are high in iron, such as meat, dark green leafy vegetables, and dried beans.

2. A patient is prescribed oral iron supplementation. What should the nurse tell the patient to do while on this treatment?

ANS: C

To prevent esophageal irritatN ioU n RorScIorNroGsiTonB ,.paCtiOenMts on an iron supplement should avoid reclining positions for 15 to 30 minutes after taking the drug. Antacids and milk may cause decreased iron absorption; iron tablets should be taken whole and not crushed; and clients should continue to eat foods high in iron.

DIF: Cognitive Level: Application REF: p. 1036 a. Palpitations b. Dizziness and syncope c. Black and red tarry stools d. Yellow discoloration of the urine

3. What may occur as a result of therapy with iron preparations?

ANS: C

Black and red tarry stools and other gastrointestinal disturbances may occur as a result of taking iron preparations.

DIF: Cognitive Level: Comprehension REF: p. 1032 a. Decreased weight b. Absence of fatigue c. Decreased palpitations d. Decreased visual disturbances

4. A patient has been taking iron supplements for anemia for 4 weeks. Which therapeutic response should the patient be taught to watch for?

ANS: B

Absence of fatigue, increased activity tolerance and well-being, and increased nutritional status are therapeutic responses to iron supplementation.

DIF: Cognitive Level: Application REF: p. 1036 a. Poor nutrition b. Hemolytic anemia c. Weakness and fatigue d. Decreased hemoglobin

5. Before administering iron supplements, the nurse should assess for which contraindication?

ANS: B

Hemolytic anemia is a contraindication to the use of iron supplements. Poor nutrition, weakness and fatigue, and decreased hemoglobin are related to iron deficiency anemia.

DIF: Cognitive Level: Analysis REF: p. 1031 a. 10 to 12 hours b. 24 to 48 hours c. 3 to 10 days d. 14 to 21 days

6. When ferrous fumarate (Palafer®) is given to infants, what is the onset of action time period?

ANS: C

The onset of action for ferrou

DIF: Cognitive Level: Comprehension REF: p. 1033, Drug Profile a. Milk b. Yogourt c. Antacids d. Ascorbic acid

7. The nurse is teaching a patient about the oral administration of iron preparations. What will increase the absorption of iron?

ANS: D

Ascorbic acid enhances the absorption of oral iron. Antacids, milk, and yogourt may interfere with absorption.

DIF: Cognitive Level: Comprehension REF: p. 1035 a. Follow the dose with milk. b. Take the medication through a plastic straw. c. Mix the dose with juice and sip slowly. d. Drink the medication undiluted from a measured medicine cup.

8. A patient is taking a liquid form of an iron product. What should the nurse tell the patient to do when taking this product?

ANS: B

Liquid oral forms of iron should be taken through a plastic straw to avoid discoloration of tooth enamel. Milk may decrease absorption. Because liquid iron can stain the teeth, the patient should not sip or drink it directly.

DIF: Cognitive Level: Comprehension REF: p. 1036 a. Vitamin B12 b. Vitamin C c. Iron d. Folic acid

9. A woman is planning to become pregnant in the next year. To reduce the risk for fetal neural tube defects, she should ensure that she receives adequate levels of what?

ANS: D

To reduce the risk for fetal neural tube defects, administration of folic acid is recommended to begin at least 1 month before pregnancy and to continue through early pregnancy.

DIF: Cognitive Level: Comprehension REF: p. 1032 a. Folic acid is used to treat any type of anemia. b. The cause of the anemia should be determined before treatment with folic acid. c. Folic acid is used to treat pernicious anemia. d. Folic acid is used to treat iron deficiency anemia.

10. The nurse is administering medications to a patient with a new diagnosis of anemia. Which is a true statement about treatment with folic acid?

ANS: B

Folic acid should not be usedNto R treaI t aneGmiaBu.nCtil tM he underlying cause and type of anemia are identified. Administering folic acid to a patient with pernicious anemia may correct the hematological changes of anemia, but the symptoms of pernicious anemia (which is due to a vitamin B12 deficiency, not a folic acid deficiency) may be deceptively masked.

DIF: Cognitive Level: Application REF: p. 1032

Multiple Response

1. A patient will be taking oral iron supplements. Which statements should the nurse include when teaching this patient? (Select all that apply.) Give your answer with small letters followed by a comma and a space (e.g., a, b, c, d).

a. Take the iron tablets with an antacid.

b. Take the iron on an empty stomach 1 hour before meals.

c. Take the iron with meals.

d. Drink 250 mL of milk with each iron dose.

e. Taking iron supplements with orange juice enhances iron absorption.

f. Stools may become loose and light-coloured.

g. Stools may become black and tarry.

h. Iron tablets may be crushed to enhance iron absorption.

ANS: C, E, G

Iron tablets should be taken with meals in order to reduce gastrointestinal distress, but antacids and milk interfere with absorption. Stools may become black and tarry in patients who are on iron supplements. Tablets should be taken whole, not crushed, and the patient should be encouraged to eat foods high in iron. There is no evidence that taking iron supplements with orange juice enhances absorption.

DIF: Cognitive Level: Application REF: p. 1035

Chapter 56: Dermatological Drugs

Multiple Choice

1. A father calls the clinic because his son has head lice. He reports to the nurse that he has used ―that special stuff you spray on to the hair, but nothing is happening.‖ What should be the nurse‘s first recommendation?

a. Get a prescription for a second product, malathion.

b. Add a lotion product that remains on the scalp for 8 hours.

c. Use a nit comb to remove nits from the hair shafts.

d. Comb through the hair with mineral oil to loosen the lice from the hair shafts.

ANS: C

Before another product is tried, the nurse should ensure that the father is performing the current product correctly. It is to be sprayed onto dry hair, massaged in, and left for 30 minutes. Then the dead lice are removed with a lice comb. Once the hair dries (8 hours), it is shampooed.

DIF: Cognitive Level: Analysis REF: p. 1049 a. He should avoid foods heavy in salt and oils. b. The drug may cause increased redness of the skin. c. He should use abrasive cleansers to remove old skin layers. d. Extremes of weather and suUnligSht s NhouTld not bOother him during therapy.

2. A teenage boy is taking tretinoin (Rejuva-A®) for his acne. What important information should the nurse give him?

ANS: B

Tretinoin may cause increased skin redness and drying. Patients taking tretinoin should avoid weather extremes, ultraviolet (UV) light, and abrasive cleansers. Eating foods that are heavy in salt and oils is not a contraindication to this medication, although consumption of these types of foods is not good for one‘s health.

DIF: Cognitive Level: Analysis REF: p. 1044 a. The dermis does not have a direct blood supply. b. It forms the protective layer of the entire body. c. Outer dead cells contain a water-repellent protein known as keratin. d. It provides extra support with blood vessels, with nerves, and with lymphatic, elastic, and connective tissues.

3. Which is a true statement regarding the dermis layer of the skin?

ANS: D

The dermis layer provides extra support and nourishment with the blood vessels, nerves, elastic tissue, lymphatic tissue, and connective tissue. The epidermis layer of the skin does not have a direct blood supply. It forms a protective layer for the entire body and has outer dead cells that contain a water-repellent protein known as keratin.

DIF: Cognitive Level: Knowledge REF: p. 1040 a. Gel b. Lotion c. Cream d. Ointment

4. A patient is to receive a topical corticosteroid for the treatment of psoriasis. Which form is generally the most penetrating when applied to the skin?

ANS: D

Ointments are generally the most penetrating vehicles for topical forms of corticosteroids.

DIF: Cognitive Level: Comprehension REF: p. 1047 a. The area should not be cleansed before reapplication. b. The cream should be massaged completely into the wound. c. A thick layer of the cream should be applied over the burned area, and the area should be left open. d. A thin layer of the cream should be applied with a sterile gloved hand to debrided, clean areas.

5. A woman has suffered a second-degree burn on her arm and hand while cooking breakfast. After examination in the emergency department, silver sulfadiazine (Flamazene®) is recommended for her burns. What important information should the nurse give the patient in regard to the application of this cream?

ANS: D

A layer 0.15 cm (1/16-inch) thick should be applied with a sterile, gloved hand to debrided, clean wounds.

N R I G B.C M

DIF: Cognitive Level: Application REF: p. 1043, Drug Profile a. The product is applied once daily, in the morning. b. Systemic absorption of topically applied minoxidil is rare. c. Results may be seen as soon as 2 weeks after beginning therapy. d. Systemic absorption may cause tachycardia, fluid retention, and weight gain.

6. A patient is receiving treatment with minoxidil (Rogaine®) for thinning hair. What important information should the nurse give the patient in regard to this treatment?

ANS: D

Systemic absorption of minoxidil may cause tachycardia, fluid retention, and weight gain. Minoxidil is applied twice daily, in the morning and evening, Results may not be seen for 4 months after beginning therapy, and systemic effects may result due to absorption.

DIF: Cognitive Level: Application REF: p. 1050, Drug Profile a. minoxidil (Loniten®) b. nystatin (Flagylstatin®) c. acyclovir (Zovirax®) d. mupirocin (Bactroban®)

7. Which medication is likely to be prescribed for a child with impetigo?

ANS: D

Mupirocin is an antibacterial product available only by prescription. It is used on the skin for treatment of staphylococcal and streptococcal impetigo. Minoxidil (Loniten) is a vasodilating drug that is administered systemically to control hypertension. Acyclovir is an antiviral drug, and nystatin is an antifungal drug.

DIF: Cognitive Level: Comprehension REF: p. 1043, Drug Profile a. Fungal infections often require prolonged therapy. b. Fungal infections usually subside in a week or so; the patient must have caught a new infection. c. If the cream is messy, the patient should apply a dressing. d. This infection will probably never be cured.

8. A 55-year-old obese patient was diagnosed with candidiasis in the skin folds under her breasts. At a follow-up visit 2 months after diagnosis, she reports that the candidiasis has returned. She tells the nurse that she applied the medicine for a week and then stopped because the itching went away and the cream was messy. What is the best information she can give this patient in regard to the patient‘s fungal infection?

ANS: A

Topical fungal infections are difficult to treat and may require prolonged therapy of several weeks to even a year. Occlusive dressings should not be applied unless recommended by the medication‘s manufacturer.

DIF: Cognitive Level: Application REF: p. 1045 a. clindamycin b. isotretinoin c. ciclopirox d. clotrimazole

9. Which medication is not to be used during pregnancy?

ANS: B

Isotretinoin is one of relatively few acne medications that are not to be used during pregnancy. This means that it is a proven human teratogen, or a chemical that is known to induce birth defects. Clindamycin, ciclopirox, and clotrimazole are all safe to use during pregnancy.

DIF: Cognitive Level: Comprehension REF: p. 1044, Drug Profile

Multiple Response

1. Which are true statements regarding topical dermatological drugs? Select all that apply. Express answer with small letters, followed by a comma and a space, (e.g. a, b, c, d) a. Lotion should be applied liberally to affected sites. b. Lotion should be applied sparingly to affected areas. c. Affected areas should be covered with occlusive dressings. d. Exposure to sunlight should be avoided by using a sunscreen. e. Exposure to sunlight helps the skin by drying the affected areas. f. The use of tanning beds should be avoided. g. Treatment should be discontinued when skin condition improves.

ANS: B, D, F

Correct actions for the use of topical dermatological drugs for acne include applying lotions sparingly to affected areas, avoiding weather extremes and UV radiation, and avoiding abrasive cleansers. Applying lotion liberally to affected sites, covering affected areas with occlusive dressings, exposing the skin to sunlight to dry the affected areas, and discontinuing treatment when the skin‘s condition improves are incorrect practices and may cause harm to the skin.

DIF: Cognitive Level: Application REF: p. 1054, Pt Teaching

NURSINGTB.COM

Chapter 57: Ophthalmic Drugs

Lilley: Pharmacology for Canadian Health Care Practice, 3rd Canadian Edition

Multiple Choice

1. Which drug is used to reduce intraocular pressure?

a. cromolyn (Opticrom®) b. polypeptides c. osmotic diuretics d. hyperosmolar sodium chloride

ANS: C

Drugs used to reduce intraocular pressure include osmotic diuretics.

DIF: Cognitive Level: Knowledge REF: p. 1069 a. Ocular infections b. Blurred vision c. Open-angle glaucoma d. Cataracts

2. Which condition is an indication for the use of direct- and indirect-acting miotics?

ANS: C

Indications for the direct- and indirect-acting miotics include open-angle glaucoma, convergent strabismus, and ocular surgery.

DIF: Cognitive Level: KnowlN a. atropine sulphate b. epinephrine c. acetylcholine (Miochol E®) d. cyclopentolate hydrochloride solution (Cyclogyl®)

3. A patient is being treated for uveitis. Which drug does the nurse expect that the patient is using?

ANS: A

Atropine is used to treat uveal tract inflammatory states. The usual dose for uveitis (inflammation of the choroid, iris, or ciliary body) in children and adults is 1 to 2 drops of the solution 2 to 3 times daily. The dose for an eye examination is 1 drop of solution, ideally 1 hour before the procedure.

DIF: Cognitive Level: Comprehension REF: p. 1074, Drug Profile a. Dizziness and syncope b. Bradycardia or heart block c. Dry mouth and constipation d. Increased heart rate or blood pressure

4. Although dipivefrin has localized effects in the eye, it mimics the effects of the sympathetic nervous system neurotransmitters and can cause systemic effects. Which systemic effects can occur?

ANS: D

Dipivefrin can cause increased cardiovascular effects, mimicking the sympathetic nervous system and resulting in increased heart rate or blood pressure.

DIF: Cognitive Level: Application REF: p. 1065 a. The infection may become systemic. b. The effects of the gentamicin may become more potent. c. The corticosteroid may cause the overgrowth of nonsusceptible organisms. d. Immunosuppression may make elimination of the eye infection more difficult.

5. A patient has been taking the corticosteroid dexamethasone (AK Dex®) but has developed bacterial conjunctivitis. The patient is given a prescription for gentamicin (Diogent®) ointment. What interaction is possible if the two drugs are used concurrently?

ANS: D

Concurrent use of corticosteroids, such as dexamethasone, and ophthalmic antibiotics may cause immunosuppression, which may make elimination of the eye infection more difficult.

DIF: Cognitive Level: Analysis REF: p. 1070 a. Apply the drops into the conjunctival sac instead of directly onto the eye. b. Apply the drops directly to the cornea for the best effectiveness. c. Blot the eye with a tissue immediately after applying the drops. d. Gently touch the tip of the dropper to the eye surface before administering the drop.

6. A patient has been prescribed timolol maleate (Timoptic®) eye drops. What should the nurse tell the patient to do to apply these eye drops properly?

ANS: A

All ophthalmic agents should be dropped into the conjunctival sac. Touching the eye with the tip of the dropper should be avoided to prevent contamination of the product. Excess eye medication should be removed only with a tissue.

DIF: Cognitive Level: Application REF: p. 1076 a. glycerin b. tetracaine (Minims®) c. acetazolamide d. apraclonidine 1% (Iopidine®)

7. Which medication is used for local anaesthesia in preparation for ocular surgery?

ANS: B

Tetracaine is used as a local anaesthetic for ocular surgery or other ocular procedures.

DIF: Cognitive Level: Comprehension REF: p. 1073 a. dapiprazole b. fluorescein sodium (AK-Fluor®) c. atropine sulphate d. cromolyn sodium

8. A patient with an eye injury requires an ocular examination to detect the presence of a foreign body. Which drug is used for this examination?

ANS: B

Fluorescein sodium is an ophthalmic diagnostic dye used to identify corneal defects and to locate foreign objects in the eye.

DIF: Cognitive Level: Comprehension REF: p. 1074, Drug Profile

Multiple Response

1. The nurse is administering ophthalmic drops. Identify the correct administration steps and place them in the correct order. Not all steps will be used. Express your answer with small letters followed by a comma and a space (e.g., a, b, c, d).

a. Thoroughly shake the solution.

b. Close the eye tightly.

c. Apply gentle pressure to the inner canthus for 1 minute.

d. Place the drop into the conjunctival sac.

e. Place the drops onto the cornea.

f. Clean debris from the eye with a cotton-tipped applicator.

g. Have the patient tilt the head back and look up at the ceiling.

h. Remove excess medication gently from around the eyes.

ANS: A, C, D, G, H

Shake all solutions and mix the contents thoroughly. Do not use any solutions with particulate matter. One of the most important standards to follow during the instillation of drops or the application of ointment is to avoid touching the eye with the tip of the dropper or container, to prevent contamination of the product. Remove any excess medication promptly, and apply pressure to the inner canthus for 1 minute (or other specified duration). Applying pressure to the inner canthus after instillinU g thS e mN edicTation isOneeded to prevent or decrease systemic absorption and subsequent systemic adverse effects. Apply ointments and any other ophthalmic topical drug dosage form to the conjunctival sac and never directly onto the eye (cornea). To facilitate the instillation of ophthalmic medication, tilt the patient‘s head back and have the patient look up at the ceiling during administration.

DIF: Cognitive Level: Analysis REF: p. 1076

Drugs

Multiple Choice

1. Which is a contraindication to the use of neomycin sulphate otic preparation?

a. Escherichia coli infection b. Perforated eardrum c. Klebsiella infection d. Bacterial otitis

ANS: B

Neomycin sulphate, polymyxin B sulphate, and hydrocortisone acetate otic preparations are contraindicated in patients with a perforated eardrum because of the risk for ototoxicity. Ciprofloxacin and dexamethasone can be used with perforated eardrums.

DIF: Cognitive Level: Comprehension REF: p. 1082 a. To soften and eliminate cerumen b. To reduce pain associated with ear infections c. To act as an antifungal agent in certain types of ear infections d. To reduce inflammation and itching associated with ear infections

2. Hydrocortisone is commonly used in combination with otic antibiotics to do what?

ANS: D

Hydrocortisone is commonly used in combination with otic antibiotics to reduce inflammation and itching associated with eN arUinRfeScItioNnG s.

DIF: Cognitive Level: Comprehension REF: p. 1083, Drug Profile a. Pull the child‘s pinna down and back. b. Pull the child‘s pinna up and back. c. Pull the child‘s pinna down and forward. d. Pull the child‘s pinna up and forward.

3. A 12-month-old infant is prescribed ear drops. What does the nurse direct the parents to do when they administer the drops?

ANS: A

The pinna should be pulled down and back when giving ear drops to children under 3 years of age.

DIF: Cognitive Level: Comprehension REF: p. 1084 a. To reduce inflammation b. To reduce production of cerumen c. To loosen the cerumen for easier removal d. To inhibit growth of microorganisms in the external canal

4. Which describes the use of carbamide peroxide?

ANS: C