Chapter 6

A teenage patient is admitted to the hospital because of acetaminophen (Tylenol) overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which of the following organs? 1\. lungs 2\. liver 3\. kidneys 4\. adrenal glands

A contraindication for topical corticosteroid usage in a patient with atopic dermatitis (eczema) is: 1\. parasite infection. 2\. viral infection. 3\. bacterial infection. 4\. spirochete infection.

In infants and children, the side effects of first generation over-the-counter (OTC) antihistamines, such as diphenhydramine (Benedryl) and hydroxyzine (Atarax) include: 1\. Reye’s syndrome. 2\. cholinergic effects. 3\. paradoxical CNS stimulation. 4\. nausea and diarrhea.

Reye’s syndrome, a potentially fatal illness associated with liver failure and encephalopathy is associated with the administration of which over-the-counter (OTC) medication? 1\. acetaminophen (Tylenol) 2\. ibuprofen (Motrin) 3\. aspirin 4\. brompheniramine/psudoephedrine (Dimetapp)

Patients who are allergic to intravenous contrast media are usually also allergic to which of the following products? 1\. eggs 2\. shellfish 3\. soy 4\. acidic fruits

A 14-month-old child recently arrived in the United States from a foreign country with his parents and needs childhood immunizations. His mother reports that he is allergic to eggs. Upon further questioning, you determine that the allergy to eggs is anaphylaxis. Which of the following vaccines should he not receive? 1\. hepatitis B 2\. inactivated polio 3\. diphtheria, acellular pertussis, tetanus (DTaP) 4\. mumps, measles, rubella (MMR)

The Gell and Coombs classification system categorizes allergic reactions and is useful in describing and classifying patient reactions to drugs. Type I reactions are immediate hypersensitivity reactions and are mediated by: 1\. immunoglobulin E (IgE). 2\. immunoglobulin G (IgG). 3\. immunoglobulin A (IgA). 4\. immunoglobulin M (IgM).

Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the most frequent types of druginduced toxicity. The most serious form of bone marrow toxicity is: 1\. aplastic anemia. 2\. thrombocytosis. 3\. leukocytosis. 4\. granulocytosis.

Serious adverse effects of oral contraceptives include: 1\. increase in skin oil followed by acne. 2\. headache and dizziness. 3\. early or mid-cycle bleeding. 4\. thromboembolic complications.

The most serious adverse effect of Alprostadil (Prostin VR pediatric injection) administration in neonates is: 1\. apnea. 2\. bleeding tendencies. 3\. hypotension. 4\. pyrexia.

Which of the following adverse effects is associated with levothyroxine (Synthroid) therapy? 1\. tachycardia 2\. bradycardia 3\. hypotension 4\. constipation

Which of the following adverse effects is specific to the biguanide diabetic drug metformin (Glucophage) therapy? 1\. hypoglycemia 2\. GI distress 3\. lactic acidosis 4\. somulence

The most serious adverse effect of tricyclic antidepressant (TCA) overdose is: 1\. seizures. 2\. hyperpyrexia. 3\. metabolic acidosis. 4\. cardiac arrhythmias.

. Which of the following solutions is routinely used to flush an IV device before and after the administration of blood to a patient? 1\. 0.9 percent sodium chloride 2\. 5 percent dextrose in water solution 3\. sterile water 4\. heparin sodium

A patient asks the nurse whether all donor blood products are cross-matched with the recipient to prevent a transfusion reaction. Which of the following always require cross-matching? 1\. packed red blood cells 2\. platelets 3\. plasma 4\. granulocytes

A month after receiving a blood transfusion an immunocompromised patient develops fever, liver abnormalities, a rash, and diarrhea. The nurse would suspect this patient has: 1\. nothing related to the blood transfusion. 2\. graft-versus-host disease (GVHD). 3\. myelosuppression. 4\. an allergic response to a recent medication.

. A client comes into the local blood donation center. He says he is here to donate platelets only today. The nurse knows this process is called: 1\. directed donation. 2\. autologous donation. 3\. allogenic do

The nurse knows that the age group that uses the most units of blood and blood products is: 1\. premature infants. 2\. children ages 1–20 years. 3\. adults ages 21–64 years. 4\. the elderly above age 65 years.

A child is admitted with a serious infection. After two days of antibiotics, he is severely neutropenic. The physician orders granulocyte transfusions for the next four days. The mother asks the nurse why? The nurse responds: 1\. “This is the only treatment left to offer the child.” 2\. “This therapy is fast and reliable in treating infections in children.” 3\. “The physician will have to explain his rationale to you.” 4\. “Granulocyte transfusions replenish the low white blood cells until the body can produce its own.”

. A neighbor tells a nurse he has to have surgery and is reluctant to have any blood product transfusions because of a fear of contracting an infection. He asks the nurse what are his options. The nurse teaches the person that the safest blood product is: 1\. an allogenic product. 2\. a directed donation product. 3\. an autologous product. 4\. a cross-matched product

A severely immunocompromised patient requires a blood transfusion. To prevent GVHD, the physician will order: 1\. diphenhydramine hydrochloride (Benadryl). 2\. the transfusion to be administered slowly over several hours. 3\. irradiation of the donor blood. 4\. acetaminophen (Tylenol).

A patient who is to receive a blood transfusion asks the nurse what is the most common type of infection he could receive from the transfusion. The nurse teaches him that approximately 1 in 250,000 patients contract: 1\. human immunodeficiency disease (HIV). 2\. hepatitis C infection. 3\. hepatitis B infection. 4\. West Nile viral disease.

A patient with blood type AB, Rh factor positive needs a blood transfusion. The Transfusion Service (blood bank) sends type O, Rh factor negative blood to the unit for the nurse to infuse into this patient. The nurse knows that: 1\. this donor blood is incompatible with the patient’s blood. 2\. premedicating the patient with diphenhydramine hydrochloride (Benadryl) and acetaminophen (Tylenol) will prevent any transfusion reactions or side effects. 3\. this is a compatible match. 4\. the patient is at minimal risk receiving this product since it is the first time he has been transfused with type O, Rh negative blood.

The physician orders 250 milliliters of packed red blood cells (RBC) for a patient. This therapy is administered for treatment of: 1\. thrombocytopenia. 2\. anemia. 3\. leukopenia. 4\. hypoalbuminemia

A patient needs to receive a unit of whole blood. What type of intravenous (IV) device should the nurse consider starting? 1\. a small catheter to decrease patient discomfort 2\. the type of IV device the patient has had in the past, which worked well 3\. a large bore catheter 4\. the type of device the physician prefers

. Central venous access devices (CVADs) are frequently utilized to administer chemotherapy. What is a distinct advantage of using the CVAD for chemotherapeutic agent administration? 1\. CVADs are less expensive than a peripheral IV. 2\. Once a week administration is possible. 3\. Caustic agents in small veins can be avoided. 4\. The patient or his family can administer the drug at home.

An infection in a central venous access device is not eliminated by giving antibiotics through the catheter. How would bacterial glycocalyx contribute to this? 1\. It protects the bacteria from antibiotic and immunologic destruction. 2\. Glycocalyx neutralizes the antibiotic rendering it ineffective. 3\. It competes with the antibiotic for binding sites on the microbe. 4\. Glycocalyx provides nutrients for microbial growth.

. Central venous access devices are beneficial in pediatric therapy because: 1\. they don’t frighten children. 2\. use of the arms is not restricted. 3\. they cannot be dislodged. 4\. they are difficult to see.

How can central venous access devices (CVADs) be of value in a patient receiving chemotherapy who has stomatitis and severe diarrhea? 1\. The chemotherapy can be rapidly completed allowing the stomatitis and diarrhea to resolve. 2\. Crystalloid can be administered to prevent dehydration. 3\. Concentrated hyperalimentation fluid can be administered through the CVAD. 4\. The chemotherapy dose can be reduced.

Some central venous access devices (CVAD) have more than one lumen. These multilumen catheters: 1\. have an increased risk of infiltration. 2\. only work a short while because the small bore clots off. 3\. are beneficial to patient care but are prohibitively expensive. 4\. allow different medications or solutions to be administered simultaneously.

. Some institutions will not infuse a fat emulsion, such as Intralipid, into central venous access devices (CVAD) because: 1\. lipid residue may accumulate in the CVAD and occlude the catheter. 2\. if the catheter clogs, there is no treatment other than removal and replacement. 3\. lipids are necessary only in the most extreme cases to prevent essential fatty acid (EFA) deficiency. 4\. fat emulsions are very caustic.

A patient needs a percutaneously inserted central catheter (PICC) for prolonged IV therapy. He knows it can be inserted without going to the operating room. He mentions that, “at least the doctor won’t be wearing surgical garb, will he?” How will the nurse answer the patient? 1\. “You are correct. It is a minor procedure performed on the unit and does not necessitate surgical attire.” 2\. “To decrease the risk of infection, the doctor inserting the PICC will wear a cap, mask, and sterile gown and gloves.” 3\. “It depends on the doctor’s preference.” 4\. “Most doctors only wear sterile gloves, not a cap, mask, or sterile gown.”

A patient is to receive a percutaneously inserted central catheter (PICC). He asks the nurse whether the insertion will hurt. How will the nurse reply? 1\. “You will have general anesthesia so you won’t feel anything.” 2\. “It will be inserted rapidly, and any discomfort is fleeting.” 3\. “The insertion site will be anesthetized. Threading the catheter through the vein is not painful.” 4\. “You will receive sedation prior to the procedure.”

What volume of air can safely be infused into a patient with a central venous access device (CVAD)? 1\. It is dependent on the patient’s weight and height. 2\. Air entering the patient through a CVAD will follow circulation to the lungs where it will be absorbed and cause no problems. 3\. It is dependent on comorbidities such as asthma or chronic obstructive lung disease. 4\. None.

What is the purpose of “tunneling” (inserting the catheter 2–4 inches under the skin) when the surgeon inserts a Hickman central catheter device? Tunneling: 1\. increases the patient’s comfort level. 2\. decreases the risk of infection. 3\. prevents the patient’s clothes from having contact with the catheter. 4\. makes the catheter less visible to other people.

The primary complication of a central venous access device (CVAD) is: 1\. thrombus formation in the vein. 2\. pain and discomfort. 3\. infection. 4\. occlusion of the catheter as the result of an intra-lumen clot.

The nurse is doing some patient education related to a patient’s central venous access device. Which of the following statements will the nurse make to the patient? 1\. “These type of devices are essentially risk free.” 2\. “These devices seldom work for more than a week or two necessitating replacement.” 3\. “The dressing should only the changed by your doctor.” 4\. “Heparin in instilled into the lumen of the catheter to decrease the risk of clotting.”

The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they: 1\. cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA. 2\. have few, if any, side effects. 3\. are used to treat multiple types of cancer. 4\. are cell cycle-specific agents.

Hormonal agents are used to treat some cancers. An example would be: 1\. thyroxine to treat thyroid cancer. 2\. ACTH to treat adrenal carcinoma. 3\. estrogen antagonists to treat breast cancer. 4\. glucagon to treat pancreatic carcinoma.

Chemotherapeutic agents often produce a certain degree of myelosuppression including leukopenia. Leukopenia does not present immediately but is delayed several days to weeks because: 1\. the patient’s hemoglobin and hematocrit are normal. 2\. red blood cells are affected first. 3\. folic acid levels are normal. 4\. the current white cell count is not affected by chemotherapy

Estrogen antagonists are used to treat estrogen hormone-dependent cancer, such as breast carcinoma. Androgen antagonists block testosterone stimulation of androgen-dependent cancers. An example of an androgen-dependent cancer would be: 1\. prostate cancer. 2\. thyroid cancer. 3\. renal carcinoma. 4\. neuroblastoma.

. Serotonin release stimulates vomiting following chemotherapy. Therefore, serotonin antagonists are effective in preventing and treating nausea and vomiting related to chemotherapy. An example of an effective serotonin antagonist antiemetic is: 1\. ondansetron (Zofran). 2\. fluoxetine (Prozac). 3\. paroxetine (Paxil). 4\. sertraline (Zoloft)

Methotrexate, the most widely used antimetabolite in cancer chemotherapy does not penetrate the central nervous system (CNS). To treat CNS disease this drug must be administered: 1\. intravenously. 2\. subcutaneously. 3\. intrathecally. 4\. by inhalation.

. Methotrexate is a folate antagonist. It inhibits enzymes required for DNA base synthesis. To prevent harm to normal cells, a fully activated form of folic acid known as leucovorin (folinic acid; citrovorum factor) can be administered. Administration of leucovorin is known as: 1\. induction therapy. 2\. consolidation therapy. 3\. pulse therapy. 4\. rescue therapy

Patients undergoing chemotherapy may also be given the drug allopurinol (Zyloprim, Aloprim). Allopurinol inhibits the synthesis of uric acid. Concomitant administration of allopurinol prevents: 1\. myelosuppression. 2\. gout and hyperuricemia. 3\. pancytopenia. 4\. cancer cell growth and replication.

Superficial bladder cancer can be treated by direct instillation of the antineoplastic antibiotic agent mitomycin (Mutamycin). This process is termed: 1\. intraventricular administration. 2\. intravesical administration. 3\. intravascular administration. 4\. intrathecal administration.

The most common dose-limiting toxicity of chemotherapy is: 1\. nausea and vomiting. 2\. bloody stools. 3\. myelosuppression. 4\. inability to ingest food orally due to stomatitis and mucositis.

Chemotherapy induces vomiting by: 1\. stimulating neuroreceptors in the medulla. 2\. inhibiting the release of catecholamines. 3\. autonomic instability. 4\. irritating the gastric mucosa

Myeloablation using chemotherapeutic agents is useful in cancer treatment because: 1\. it destroys the myelocytes (muscle cells). 2\. it reduces the size of the cancer tumor. 3\. after surgery, it reduces the amount of chemotherapy needed. 4\. it destroys the bone marrow prior to transplant.

Anticipatory nausea and vomiting associated with chemotherapy occurs: 1\. within the first 24 hours after chemotherapy. 2\. 1–5 days after chemotherapy. 3\. before chemotherapy administration. 4\. while chemotherapy is being administered.