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Immune System ATI- posttest & drills

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DRILL 1: You’re about to administer *cisplatin* to a patient who has ovarian cancer. Before beginning the infusion, you should take which of the following *actions*? (Select all that apply.) a. Infuse 1 to 2 L of IV fluid. b. Check the patient’s peripheral pulses. c. Administer an antiemetic. d. ​Evaluate the patient’s hearing. e. Determine the patient’s weight.
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*a. Infuse 1 to 2 L of IV fluid.* *c. Administer an antiemetic.* *d. ​Evaluate the patient’s hearing.* *e. Determine the patient’s weight.* Cisplatin, a platinum compound, can cause *renal toxicity*. Prior to therapy, you should *hydrate the patient with 1 to 2 L of IV fluid and continue for 24 hr following therapy* to help prevent renal impairment. Monitor *serum creatinine, BUN, fluid I&O, and weight*. Cisplatin can cause severe nausea and vomiting. Administer an *antiemetic 30 min before* starting the infusion. This drug can cause *ototoxicity*, so make sure to evaluate the patient’s hearing *prior to therapy and periodically thereafter*, and to tell the patient to report tinnitus, vertigo, or hearing loss. Cisplatin is unlikely to affect peripheral circulation, but it can cause *peripheral neuropathy*.
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DRILL 2: A patient is about to start taking *mercaptopurine (Purinethol)* to treat acute lymphocytic leukemia. You should instruct the patient to *watch for and report* which of the following indications of an *adverse effect* of this drug? a. Bruising b. Paresthesias c. Blurred vision d. Tinnitus
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*a. Bruising* Mercaptopurine, a purine analog, can cause *bone marrow suppression*, so you should instruct the pt to report easy or unexplained bruising or bleeding, sore throat, or fever. Monitor CBC throughout treatment and advise the pt to avoid activities that can cause injury. Mercaptopurine can also cause *liver toxicity* and gastrointestinal symptoms, including *stomatitis (mouth sores)*, *esophagitis*, and *anorexia*.
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DRILL 3: A patient is about to start therapy with topotecan (Hycamtin) to treat metastatic ovarian cancer. To minimize neutropenia, an adverse effect of topotecan, you should administer filgrastim (Neupogen) at which of the following times? a. 24 hr before the topotecan infusion b. At the same time as the topotecan infusion c. 24 hr after the topotecan infusion d. 1 hr before the topetecan infusion
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*c. 24 hr after the topotecan infusion* Filgrastim, a colony stimulating factor, stimulates neutrophil proliferation for patients with neutropenia due to bone marrow suppression. The combination of filgrastim and topotecan, a topoisomerase 1 inhibitor, *can worsen bone marrow suppression*. To avoid this interaction, administer filgrastim 24 hr after the topotecan infusion, *not before or during the infusion*.
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DRILL 4 (MATCHING): 1. Tamoxifen (Soltamox) 2. Enfuvirtide (Fuzeon) 3. Delavirdine (Rescriptor) 4. Flutamide a. Advanced or resistant HIV disease b. Estrogen-receptor-positive breast cancer c. Prostate cancer d. HIV-1 infection
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1. Tamoxifen (Soltamox) — estrogen-receptor-positive breast cancer 2. Enfuvirtide (Fuzeon) — advanced or resistant HIV disease 3. Delavirdine (Rescriptor) — HIV-1 infection 4. Flutamide — prostate cancer
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DRILL 5: You’re assessing a patient who is receiving *imatinib (Gleevec)* to treat chronic myeloid leukemia. Which of the following findings may indicate an *adverse reaction* to this drug? a. Bradycardia b. Dry mouth c. Constricted pupils d. Crackles at lung bases
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*d. Crackles at lung bases* Imatinib, a targeted antineoplastic drug, can cause *fluid retention and pulmonary edema*. You should monitor the patient’s weight and *report weight gain*. Assess for *peripheral edema* by listening to breath sounds and monitoring for shortness of breath. Report crackles in the lung bases as they might indicate pulmonary edema. Imatinib can also cause muscle pain and cramping.
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DRILL 6: While administering *trastuzumab (Herceptin) IV* to a patient who has breast cancer, you should ensure that you *have which of the following drugs available* to treat an adverse reaction to this drug? a. Protamine b. Epinephrine c. Glucagon (GlucaGen) d. Atropine
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*b. Epinephrine* Trastuzumab, a monoclonal antibody, can cause an *allergic reaction*. You should have epinephrine available to *treat anaphylaxis*. Monitor the patient for hives, wheezing, or hypotension.
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DRILL 7: You’re caring for a patient who is *pregnant and is HIV-positive*. Which of the following drugs helps *prevent the transfer of HIV to the fetus*? a. Anastrozole b. Zidovudine (Retrovir) c. Tamoxifen (Soltamox) d. Trastuzumab (Herceptin)
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*b. Zidovudine (Retrovir)* The patient should take the drug *orally five times daily from 14 weeks of gestation until delivery*. During delivery, the patient should receive the drug via *IV infusion until the birth attendant clamps the newborn’s cord*.
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DRILL 8: A patient is about to start taking *ritonavir (Norvir)* to treat HIV-1 infection. Which of the following *instructions* should you include when talking with the patient about taking this drug? (Select all that apply.) a. Expect periodic blood glucose testing. b. Take it on an empty stomach. c. Watch for and report jaundice. d. Increase weight-bearing activity. e. Expect periodic cholesterol testing.
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*a. Expect periodic blood glucose testing.* *c. Watch for and report jaundice.* *d. Increase weight-bearing activity.* *e. Expect periodic cholesterol testing.* Ritonavir, a protease inhibitor, can cause *hyperglycemia and diabetes mellitus*. Tell the patient to expect periodic blood glucose checks. Patients who already have diabetes should check their blood glucose levels frequently and report elevations as well as increased hunger, thirst, or urination. Tell the patient to *take the drug with food to maximize absorption and minimize gastrointestinal upset*. Ritonavir can cause *liver toxicity*, so tell the patient to watch for and report indications of liver toxicity, such as yellowed sclera and skin. Ritonavir can *reduce bone density*, so instruct the patient to *increase weight-bearing activity and calcium and vitamin D intake*. Tell the patient to *expect periodic cholesterol checks*.
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DRILL 9 (MATCHING): 1. Paclitaxel (Taxol) 2. Cytarabine (Cytosar-U) 3. Cyclophosphamide 4. Carmustine (BiCNU, Gliadel) a. Multiple myeloma b. Gastrointestinal adenocarcinoma c. Kaposi’s sarcoma d. Acute myelocytic leukemia
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1. Paclitaxel (Taxol) — Kaposi’s sarcoma, ovarian and breast cancer, and non-small cell lung cancer 2. Cytarabine (Cytosar-U) — acute myelocytic leukemia & non-Hodgkin’s lymphoma 3. Cyclophosphamide — multiple myeloma; leukemia; lymphomas; and head, ovary, breast, and lung cancer 4. Carmustine (BiCNU, Gliadel) — gastrointestinal adenocarcinoma, brain tumors, lymphomas, multiple myeloma, melanoma, hepatoma
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DRILL 10: You should instruct a patient who is taking *tamoxifen (Soltamox)* to treat breast cancer to *watch for and report* which of the following *serious adverse effects* of this drug? a. Abnormal menstrual bleeding b. Muscle pain and weakness c. Yellowing of skin and eyes d. Peripheral edema
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*a. Abnormal menstrual bleeding* Tamoxifen, an estrogen receptor blocker, can cause *uterine cancer*. Instruct the patient to watch for and report *abnormal uterine bleeding, pelvic pain, or pressure* and make sure she has *regular gynecologic examinations*.
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Unless there are any specific contraindications, which of the following *immunizations should adults receive once each year*? a. Varicella b. Tetanus c. Influenza d. Hepatitis B
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*c. Influenza* All adults should receive the seasonal influenza immunization once per year. All children 6 mo. and older adults should also receive this immunization once per year. Adults who have no demonstrated immunity to varicella should receive this immunization in a two-dose series 28 days apart. It is not repeated each year. Adults should receive a tetanus toxoid immunization every 10 years as a booster, along with diphtheria toxoid. Adults at risk for acquiring Hep B should receive this immunization in a 3-dose series. It is not repeated each year.
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A health care professional is caring for a patient who is about to start *ritonavir (Norvir) and zidovudine (Retrovir)* therapy to treat HIV-1. The health care professional should *explain* that the patient will receive ritonavir along with at least one reverse transcriptase inhibitor to
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*Prevent drug resistance* Combo tx to reduce the risk for drug resistance and to increase drug effectiveness
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A health care professional is caring for a patient who is about to begin taking *tamoxifen (Soltamox)* to treat breast cancer. The health care professional should recognize the need for *cautious use* of the drug if the patient also has which of the following?
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*Cataracts* can cause retinopathy, cataracts, and decreased visual acuity
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When considering *drug therapy options* for a patient who has *metastatic breast cancer* that is *positive for human epidermal growth factor receptor 2 (HER2)*, the health care professional should choose which of the following drugs?
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*Trastuzumab (Herceptin)*
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While assessing a patient who is receiving *interferon alfa-2a (Roferon-A)* to treat Kaposi’s sarcoma, the health care professional should check for which of the following possible indications of an *adverse reaction*?
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*Fever* can cause a flu-like reaction, manifesting as fever, myalgia, and fatigue. for this effect, the HCP should give acetaminophen (Tylenol)
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When caring for a patient who is taking *flutamide* to treat prostate cancer, the health care professional should monitor the patient for which of the following *adverse effects* of the drug?
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*Gynecomastia* can cause gynecomastia, decreased libido, and impotence
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A health care professional is about to administer *enfuvirtide (Fuzeon)* to a patient. The health care professional should perform which of the following *actions*? (Select all that apply)
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*1. Administer the drug subcutaneously* *2. Roll the vial gently to reconstitute the solution* *3. Inject the solution at room temperature* Admin SC BID. To reconstitute, roll gently in palms after adding sterile water; should be clear. Refrigerate unused portion for up to 24 hr; must warm solution to room temp before giving next dose out of the vial.
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A health care professional is caring for a patient who is about to begin receiving *cisplatin* to treat testicular cancer. The health care professional should tell the patient to report which of the following *adverse effects*? (Select all that apply)
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*1. Paresthesias* *2. Sore throat* *3. Flank pain* *4. Tinnitus* *Bone marrow suppression:* report fever, sore throat, bruising, fatigue. *Kidney toxicity:* hydrate with 1-2 L IV fluid before tx, continue for 24 hr after to flush kidneys (flank pain) *Ototoxicity:* monitor hearing; report tinnitus, hearing loss, or vertigo Can also cause blurred vision, papilledema, and optic neuritis
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A health care professional is caring for a patient who is about to begin *maraviroc (Selzentry)* therapy. The health care professional should tell the patient to report which of the following *adverse effects* of the drug? (Select all that apply)
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*1. Paresthesias* *2. Cough* *3. Jaundice* *4. Fever* *Neuromuscular:* paresthesias, dizziness, and musculoskeletal pain *Infections:* cough and upper respiratory infection. fever and sinus infection. *Liver damage:* report allergic reaction (rash) bc it can precede liver damage (jaundice or abd pain)
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A health care professional should *question the use of maraviroc (Selzentry)* for a patient who has which of the following?
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*Non-chemokine receptor 5 (CCR5)-tropic HIV-1*
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A health care professional should understand that *raltegravir (Isentress) treats* patients who have which of the following?
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*Resistant HIV disease*
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A health care professional is about to administer *IV paclitaxel (Taxol)* to a patient who has ovarian cancer. Which of the following *actions* should the health care professional take? (Select all that apply)
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*1. Give the patient an antihistamine* *2. Administer the drug through non-PVC tubing* *3. Use an in-line filter* Before admin, give an *antihistamine* (diphenhydramine), a *proton-pump inhibitor* (cimetidine), and a *glucocorticoid* (dexamethasone) to prevent a hypersensitivity reaction Infuse over 3 hr.
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When talking to a patient who is about to begin *vincristine* therapy to threat lymphoma, the health care professional should include which of the following *instructions*?
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*Increase fiber intake* can cause severe constipation and upper colon fecal impaction. monitor bowel fxn and palpate abd for distention. increase fluid and fiber intake, and take stool softeners
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A health care professional is caring for a patient who is about to begin taking *imatinib (Gleevec)* to treat chronic myeloid leukemia. Which of the following *instructions* should the health care professional include when talking to the patient about taking the drug? (Select all that apply)
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*1. Clean fruits and vegetables thoroughly* *2. Weigh yourself daily* *3. Perform hand hygiene frequently* *4. Avoid herbal supplements* can cause bone marrow suppression (infection precautions). can cause fluid retention and weight gain. St. John’s wort can decrease levels. can also cause hypokalemia.
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A health care professional should understand that *efuvirtide (Fuzeon) is an appropriate choice for* patients who have which of the following?
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*Advanced HIV disease*
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A health care professional should *question the use of anastrozole (Arimidex)* for a patient who is
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*Premenopausal*
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A health care professional is caring for a patient who is about to begin *topotecan (Hycamtin)* therapy to treat resistant, small-cell lung cancer. The health care professional should *caution* the patient about taking which of the following types of *over-the-counter drugs* while receiving the therapy?
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*Ibuprofen (Advil)* NSAIDS, anticoags, and antiplatelet drugs increase risk for bleeding
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A health care professional is assessing a patient following a *trastuzumab (Herceptin)* infusion to treat metastatic breast cancer. Which of the following findings indicates an *adverse reaction* to the drug? (Select all that apply)
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*1. Wheezing* *2. Dysrhythmias* *3. Hypotension* *4. Fever* *Anaphylaxis:* have Epi ready. hives, bronchospasm, dyspnea, wheezing, hypoxia, hypotension. *Cardiotoxic:* ventricular dysfunction, HF, and dysrhythmias. monitor ECG. *Flu-like Rxn:* fever, chills, nausea, headache. monitor temp.
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A health care professional should *question the use of cyclophosphamide* for a patient who has which of the following?
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*Dehydration*
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A health care professional is caring for a patient who is about to begin *delavirdine (Rescriptor*) therapy to treat HIV-1. The health care professional should tell the patient to report which of the following *adverse reactions* to the drug?
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*Rash* rash can occur 1-3 wk after therapy. can develop into SJS.
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A health care professional is caring for a patient who is about to begin *intrathecal cytarabine (DepoCyt)* therapy to treat meningeal leukemia. The health care professional should explain that the patient *should also receive* which of the following drugs *to reduce the risk of neurotoxicty*?
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*Dexamethasone* w/ the intrathecal form, they should also receive dexamethasone (glucocorticoid) to help decrease the inflammation of the arachnoid that the drug can cause. IV dexamethasone reduces the risk of neurotoxicity
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A health care professional is caring for a patient who is receiving *IV carmustine (BiCNU)* to treat multiple myeloma. The health care professional should recognize that the patient is *at the greatest risk for infection* for which of the following *lengths of time after the infusion*?
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*4 to 6 weeks* delayed bone marrow suppression
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When talking with a patient who is about to begin *methotrexate (Trexall)* therapy to treat non-Hodgkin lymphoma, the health care professional should include which of the following *instructions*?
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*Use a soft-bristled toothbrush* can cause severe bone marrow suppression (decreased thrombocyte counts & oral and GI ulcerations)
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A health care professional is caring for a patient who is about to begin taking *mercaptopurine (Purinethol)* to treat leukemia. Which of the following *instructions* should the health care professional include when talking with the patient about the drug? (Select all that apply)
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*1. Use contraception is pregnancy is a risk* *2. Perform oral hygiene frequency* *3. Perform hand hygiene frequently* *4. Avoid activities that can cause injury* Preg Category D Can cause stomatitis, neutropenia, thrombocytopenia
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When caring for a patient who is receiving *vincristine* to treat lung cancer, the health care professional should monitor for which of the following findings that indicates an *adverse effect*?
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*Weak hand grasps* Peripheral neuropathy: monitor DTRs, strength and movement of hands and feet. Report paresthesias or reduced sensations in hands or feet.