Focus on Nursing Pharmacology 6th Edition by Amy M. Karch – Test Bank A+

Description

1.	A nurse is preparing a drug for administration to a patient. The drug does not have an indicated use for the patient’s medical diagnosis. What should the nurse do?
	A)	Administer the drug as ordered.
	B)	Question the prescriber concerning the ordered drug.
	C)	Ask a coworker his or her thoughts about the ordered drug for the patient.
	D)	Ask the patient why the drug has been prescribed for him or her.
	Ans:	B
	Feedback:
	If the nurse is not sure about giving a drug, the order should be questioned. The nurse should never give a medication that is not clear. Mistakes do happen and the drug ordered, if not approved for the condition that the patient has, could be an error on someone’s part. The person who wrote the order should be questioned, not a co worker, who probably does not know why an off-label drug is being used. It would be unprofessional and inappropriate to ask the patient about the drug.

2.	According to Center for Disease Control and Prevention (CDC) recommendations, what is the role of the nurse in preparing for the possibility of bioterrorism?
	A)	Post updated information on signs and symptoms of infections caused by biological agents
	B)	Provide guidelines for treating patients exposed to, or potentially exposed to, biological agents
	C)	Remain current on recognition and treatment of infections caused by biological weapons
	D)	Advocate for increased funding for research involving bioterrorism and patient treatment
	Ans:	C
	Feedback:
	Nurses need to remain current about recognition of and treatment for those exposed to biological weapons because nurses are often called upon to answer questions, reassure the public, offer educational programs, and serve on emergency preparedness committees. The CDC posts updated information on signs and symptoms of infections caused by biological agents that nurses would read. The CDC also provides guidelines for how to treat patients exposed to biological agents and the nurse must remain current on this information. Although nurses could advocate for funding, this is not usually the role of the nurse.

3.	How can the nurse find the most up-to-date information about emergency preparedness related to bioterrorism agents?
	A)	Read textbooks devoted to the topic.
	B)	Ask coworkers to explain current events.
	C)	Read journal articles about bioterrorism agents.
	D)	Visit the Centers for Disease Control and Prevention (CDC) Web site.
	Ans:	D
	Feedback:
	The most current information will be found on the CDC Web site because new information can be posted immediately whereas textbooks and journal articles take time to print. Coworkers may or may not remain current on emergency preparedness and should not be the primary source of information.

4.	The nurse is assessing a diabetic patient who has presented at the clinic reporting several hypoglycemic episodes during the past 3 weeks. The nurse questions the patient about the use of herbal or alternative therapies, suspecting what herbal remedy could cause the hypoglycemic episodes?
	A)	St. John’s wort
	B)	Kava
	C)	Fish oil
	D)	Ginseng
	Ans:	D
	Feedback:
	Ginseng is known to decrease blood sugar levels. If the patient used this in combination with his or her oral antidiabetic agent, diet, and exercise, his or her blood sugar could drop below therapeutic levels. St. John’s wort interacts with many drugs, but not with antidiabetic agents. Kava is associated with liver toxicity. Fish oil has been associated with decreased coronary artery disease.

5.	A 22-year-old patient calls the clinic and tells the nurse that she has been depressed and is thinking about taking St. John’s wort but wants to know if it is safe first. The nurse begins by questioning what other medications the patient takes and would be concerned about a drug-alternative drug interaction if the patient is also taking what type of medication?
	A)	Antihistamines
	B)	Analgesics
	C)	Antibiotics
	D)	Oral contraceptives
	Ans:	D
	Feedback:
	St. John’s wort can interact with oral contraceptives that alter drug metabolism, which can decrease the effectiveness of the contraceptive. Analgesics, antibiotics, and antihistamines can be taken in combination with St. John’s wort without known adverse effects.

6.	A patient tells the clinic nurse that he or she has been taking over-the-counter (OTC) Pepcid to relieve acid indigestion for several years. This is the first time the patient has ever reported this issue to a health care provider. As part of the teaching plan for this patient, the nurse explains what risk associated with not sharing OTC drug use with the provider?
	A)	The OTC drug could be more expensive than seeking health care advice.
	B)	The drug could mask symptoms of a serious problem that is undiagnosed.
	C)	Use of the drug could cause a rebound effect of Pepcid.
	D)	The drug could interact with several cold medicines.
	Ans:	D
	Feedback:
	OTC drugs allow patients to self-diagnose and treat routine signs and symptoms without seeing a health care provider. This self-prescribed treatment, however, could mask a more serious underlying medical problem and result in a poor outcome for the patient. The issues of drug rebound and drug interaction need to be considered, but the safety issue related to self-diagnosis and self-prescription presents the greatest risk to the patient. Patients should always be encouraged to discuss the use of OTC products with their health care provider.

7.	What patient populations would the nurse expect is most likely to be prescribed a drug for an off-label use?
	A)	Adolescent and middle-aged adult patients
	B)	Patients with diabetes or heart disease
	C)	Obstetric and neonatal patients
	D)	Pediatric and geriatric patients
	Ans:	D
	Feedback:
	Drugs being used for an off-label purpose are commonly prescribed for pediatric and geriatric populations due to the lack of drug trial information and minimal premarket testing. Often a trial-and-error method is used in treating both the pediatric and geriatric populations when only adult information is known. The geriatric population responds to medication more like children because of their decreased ability to metabolize medications. Adolescents, especially later adolescents, use medications similarly to young adults as do middle-aged adults. Patients with different diagnoses are often involved in drug testing including those with diabetes and heart disease. Drugs are discouraged for use in obstetric patients.

8.	A patient calls the clinic and asks to speak to a nurse. The patient questions the nurse about the use of a drug that was advertised on TV. The patient tells the nurse he or she is sure that the drug will make him or her feel the same way as described in the commercial. What response is most appropriate for the nurse to make?
	A)	“I’m glad that you want to be involved in treatment decisions but you are not qualified to decide what medications are best for your condition.”
	B)	“It’s important to remember that drug advertisements emphasize the positive effects of drug therapy and not the adverse effects or contraindications.”
	C)	“You need to remember that the drugs being advertised are much more expensive than other drugs that have the same effect.”
	D)	“I’ve seen those advertisements and I would want to take that medication too if I had the condition it was designed to treat.”
	Ans:	B
	Feedback:
	It would be important for the nurse to remind the patient that advertisements always emphasize the positive effects of drug therapy. The patient should not be discouraged from contributing to the plan of care by being told she is not adequately qualified to make decisions because no one is more qualified to make decisions about her own body. Although the drug may be more expensive, this is not a reason to choose or avoid a medication that could be more effective. Agreeing with the patient is not meeting the nurse’s obligation to teach and inform.

9.	The clinic nurse is talking with a patient about information concerning a drug her or she bought online. What is the nurse’s responsibility to the patient concerning this information?
	A)	Encourage the patient to seek information about drugs from a pharmacist.
	B)	Explain that information obtained from the Internet is not always accurate.
	C)	Offer the patient a drug reference guide to read and learn more about the drug.
	D)	Interpret the information and explain it in terms that the patient will understand.
	Ans:	D
	Feedback:
	The Internet can be a good reference for drug information. However, the amount and reliability of the information can be overwhelming. The nurse should always try to interpret the information and explain it in terms that the patient will understand. A pharmacist is a good resource person but may not be able to teach from a holistic perspective. Drug reference guides may be hard for the patient to understand and he or she would still need someone to interpret the information.

10.	The triage nurse in the emergency department sees a patient suspected of abusing amphetamines brought in by friends. While assessing this patient, what would the nurse be likely to find if steroids are being abused?
	A)	Hypertension
	B)	Bradycardia
	C)	Drowsiness
	D)	Elated mood
	Ans:	A
	Feedback:
	Increases in blood pressure, tachycardia, and insomnia are symptoms of amphetamine abuse. Elation can indicate abuse of cannabis.

11.	The nursing instructor is discussing the off-label use of drugs. What group of drugs would the instructor tell the nursing students is often used for off-label indications?
	A)	Drugs used to treat psychiatric problems
	B)	Drugs used to treat gastrointestinal (GI) problems
	C)	Drugs used to treat cardiovascular problems
	D)	Drugs used to treat musculoskeletal problems
	Ans:	A
	Feedback:
	Drugs often used for off-label indications include the drugs used to treat various psychiatric problems. Drugs used to treat GI, cardiovascular, or musculoskeletal problems do not fall in the category of frequent off-label uses.

12.	The patient calls the clinic nurse and says, “I looked this medication up on the Internet after it was prescribed yesterday and there is nothing in the literature about this drug being used to treat my disorder. Should I still take it?” What is the nurse’s best response?
	A)	“No, stop taking it immediately until I can consult with the doctor because it is obvious a mistake was made.”
	B)	“Oh, that’s okay. Go ahead and take it because the doctor wouldn’t order it if he or she didn’t think it would be effective.”
	C)	“It is quite common for drugs to be found to have positive effects for a condition not originally intended so it is safe to take.”
	D)	“Let me talk with the physician about why this medication was ordered for you and I will call you back.”
	Ans:	D
	Feedback:
	Off-label use is relatively common because new information is gathered when the drug is used by large numbers of people that may indicate another condition for which the drug is effective. However, if the nurse does not know for a fact that the drug prescribed is the right drug for the patient’s condition, it is always best to consult with the prescriber to make sure the patient is taking the right drug and to avoid a medication error. The medication may be perfectly safe so the patient should not be told the doctor made a mistake.

13.	When a drug is ordered off-label, what must the nurse be clear about before administering the drug? (Select all that apply.)
	A)	Why the drug is being given
	B)	Its potential for problems
	C)	The research that has been done
	D)	The age group it was pretested on
	E)	The intended use
	Ans:	A, B, E
	Feedback:
	Liability issues surrounding many of these uses are very unclear, and the nurse should be clear about the intended use, why the drug is being given, and its potential for problems. Knowing the age group it was pretested on and knowing the research that has been done are not factors the nurse needs to know before administering the drug.

14.	It is important for the nurse to be aware of what related to the way drugs are marketed?
	A)	The adverse effects the advertisements do not mention
	B)	What magazines and Web sites contain the advertisement
	C)	What patients are seeing in the advertisements about these drugs
	D)	The name of the cheerful, happy models who are advertising these drugs
	Ans:	C
	Feedback:
	As the marketing power for prescription drugs continues to grow, the nurse must be constantly aware of what patients are seeing, what the ads are claiming, and the real data behind the indications and contraindications for these “hot” drugs. The Food and Drug Administration regulates the information that needs to be contained within medication ads. Where the patient saw the ad and the actors in the ads are unimportant.

15.	When evaluating information accessed over the Internet, an important question the nurse should teach the patient to ask is what?
	A)	Is the information anecdotal?
	B)	Where has this information been obtained?
	C)	Is this information paid for by the drug company?
	D)	How many patients have had input into the information?
	Ans:	A
	Feedback:
	Many people do not know how to evaluate the drug-related information that they can access over the Internet. Is it accurate or anecdotal is an important concept for the nurse to teach the patient to assess to verify the accuracy of the information. Where the information came from is unimportant. It would be expected that all drug advertising is paid for by the drug company and this is not an important concern. Number of patients with input into the information is most likely none because information is gathered from health care professionals.

16.	How has the patient’s access to drug information changed the way the patient interacts with the nurse and other health care providers?
	A)	Patients share information from research reports with health care providers.
	B)	Patients are contacting drug companies to see what their latest reports say.
	C)	Patients are more likely to challenge the health care provider with their own research.
	D)	Patients are more likely to self-prescribe and not obtain prescriptions from their health care provider.
	Ans:	C
	Feedback:
	Access to consumer advertising, mass media health reports, and the Internet influence some patients to request specific treatments, to question therapy, and to challenge the health care provider. Consumers do not generally read research reports from medical facilities and contact drug companies to see what their reports say, and they cannot self-medicate because many of these drugs require a prescription to obtain them.

17.	What can make a nurse or any health care provider lose credibility with the patient?
	A)	Being unprepared to deal with “the disease of the week”
	B)	Refusing to write prescriptions for the drug the patient requests
	C)	Not being knowledgeable about diseases described on House
	D)	Being prepared to discuss the role of “concierge” doctor
	Ans:	A
	Feedback:
	Some health care providers have learned to deal with the “disease of the week” as seen on talk shows; others can be unprepared to deal with what was presented and may lose credibility with the patient.

18.	Today, an abundance of information is available in the health care arena for consumers, resulting in the nurse encountering patients who have a much greater use of what?
	A)	Over-the-counter (OTC) therapies
	B)	Alternative therapies
	C)	Prescription drugs
	D)	Off-label drugs
	Ans:	B
	Feedback:
	The patient now comes into the health care system burdened with the influence of advertising, the Internet, and a growing alternative therapy industry. Many patients no longer calmly accept whatever medication is selected for them. Indeed, an increasing number of patients are turning to alternative therapies with the belief that they will treat their disorder and reduce risk of adverse effects. Although more prescription drugs are used today, that is not related to abundant information. No indication exists of an increase in use of OTC or off-label drugs.

19.	Because of the amount of care now being done in the home care setting, it is imperative that the nurse teach the patients what? (Select all that apply.)
	A)	Care givers’ educational level.
	B)	Generic names of medication
	C)	Over-the-counter (OTC) drugs that need to be avoided
	D)	Alleviation of adverse effects
	E)	How to calculate safe dosages
	Ans:	B, C, D
	Feedback:
	The responsibility of meeting the tremendous increase in teaching needs of patients frequently resides with the nurse. Patients need to know exactly what medications they are taking (generic and brand names), the dose of each medication, and what each is supposed to do. Patients also need to know what they can do to alleviate some of the adverse effects that are expected with each drug (e.g., small meals if gastrointestinal upset is common, use of a humidifier if secretions will be dried and make breathing difficult), which OTC drugs or alternative therapies they need to avoid while taking their prescribed drugs, and what to watch for that would indicate a need to call the health care provider.

20.	What concerns might the nurse legitimately have related to the use of alternative therapies? (Select all that apply.)
	A)	The Food and Drug Administration (FDA) does not test or regulate active ingredients.
	B)	The incidental ingredients are clearly marked on the label.
	C)	The dosage contained in each tablet may vary greatly.
	D)	No alternative therapies have been found to be effective.
	E)	Advertising of alternative products is not as restrictive or accurate.
	Ans:	A, C, E
	Feedback:
	Alternative products are not controlled or tested by the FDA and advertising is not as restrictive or accurate as with classic drugs. Incidental ingredients are often unknown and strength of tablets may vary within the bottle depending on the conditions under which they were grown. While some alternative therapies have been found to be effective, there are others who have not been studied.

21.	The nurse provides teaching to the patient using herbal therapies and includes what important information related to the effects of the herbal therapy?
	A)	They can interact with prescription drugs.
	B)	They always contain known ingredients.
	C)	They are natural so they are effective and safe.
	D)	The ingredients are natural, meaning toxicity is not a concern.
	Ans:	A
	Feedback:
	Herbal therapies can produce unexpected adverse effects and toxic reactions, can interact with prescription drugs, and can contain various unknown ingredients that alter the therapies’ effectiveness and toxicity.

22.	When patients do not understand the information provided with their medication, whose responsibility is it to help them sort through and comprehend the meaning?
	A)	Care giver
	B)	Nurse
	C)	Patient
	D)	Physician
	Ans:	B
	Feedback:
	Many pharmacies provide written information with each drug that is dispensed, but trying to organize these sheets of information into a usable and understandable form is difficult for many patients. The nurse is often the one who needs to sort through the provided information to organize, simplify, and make sense of it for the patient.

23.	The nurse is providing an inservice on alternative therapies for peers and explains that the term “alternative therapies” includes what?
	A)	Holistic drug therapy
	B)	Hospice care
	C)	Nondrug measures
	D)	Home care
	Ans:	C
	Feedback:
	Herbal medicines and alternative therapies are found in ancient records and have often been the basis for discovery of an active ingredient that is later developed into a regulated medication. Today, alternative therapies can also include non-drug measures, such as imaging and relaxation. Options A, B, and D are not included in alternative therapies.

24.	The patient calls the clinic and talks to the nurse saying, “I found the same drug the provider prescribed on the Internet and it is much cheaper. Is it safe for me to order my drug from this site?” What is the nurse’s best response?
	A)	“It is usually safe to order drugs from Internet Web sites if it is a reliable site.”
	B)	“Most drugs ordered online come from another country and are safely used there.”
	C)	“The drug you get will be the same chemical prescribed but the dosage may differ.”
	D)	“The Food and Drug Administration (FDA) has issued warnings to consumers about the risk of taking unregulated drugs.”
	Ans:	D
	Feedback:
	The FDA has begun checking these drugs when they arrive in this country and have found many discrepancies between what was ordered and what is in the product, as well as problems in the storage of these products. Some foreign brand names are the same as brand names in this country but are associated with different generic drugs. The FDA has issued many warnings to consumers about the risk of taking some of these drugs without medical supervision, reminding consumers that they are not protected by U.S. laws or regulations when they purchase drugs from other countries.

25.	With the need to protect our environment, what is it now important for the nurse to teach patients to do?
	A)	Dispose of drugs no longer used on an annual basis.
	B)	Flush drugs down the toilet.
	C)	Bury unused in the yard.
	D)	Throw unused pill bottles in the trash in original containers.
	Ans:	A
	Feedback:
	Patients should go through their medicine cabinet annually and dispose of drugs no longer used. Unused drugs should not be flushed down the toilet or buried in the yard because they seep into the community water supply. Pills should be removed from their bottle and mixed with an undesirable substance to prevent someone from using the medication if found.

26.	The nurse receives a call from a frantic mother saying, “My child swallowed some of my birth control pills. Should I give Ipecac?” What is the nurse’s best response?
	A)	“Yes, give Ipecac and follow the dosage directions on the bottle.”
	B)	“Ipecac is not effective for this use so you should not give it to your child.”
	C)	“Give the Ipecac only if you are absolutely sure your child swallowed the pills.”
	D)	“No, don’t give Ipecac because it will cause your child to vomit and make a mess.”
	Ans:	B
	Feedback:
	Ipecac is a drug that the Food and Drug Administration tested in 2003 and found, despite its use for many years, that it was not effective in inducing vomiting in children suspected of poisoning. As a result, it is no longer used. The mother should be instructed not to give it and to call poison control to get up-to-date instructions on how to deal with this emergency. Whether the pills were swallowed, this child requires appropriate intervention because it is better to err on the side of caution. Making a mess is not a concern.

27.	The patient tells the nurse that he or she has begun ordering his or her medications over the Internet because it is cheaper. What statement made by the nurse in response to this information is accurate?
	A)	All drugs are manufactured with the same quality controls.
	B)	Any drug that is shipped into this country is safe to use.
	C)	Foreign drugs may have the same name as domestic drugs, but they are not the same drug.
	D)	If you order from Canada or Mexico, the drugs are safe because they undergo testing.
	Ans:	C
	Feedback:
	The Food and Drug Administration has begun checking these drugs when they arrive in this country and have found many discrepancies between what was ordered and what is in the product, as well as problems in the storage of these products. Some foreign brand names are the same as brand names in this country but are associated with different generic drugs. Options A, B, and D are incorrect because not all drugs are manufactured the same and they are not always safe coming from another country.

28.	The increasing number of patients who go to their health care provider and request a drug they have seen advertised on television or in a magazine has created what continuing challenge to health care providers?
	A)	Treating infections appropriately
	B)	Treating sicker patients
	C)	Prescribing cost-effectively
	D)	Staying knowledgeable about drug therapy
	Ans:	D
	Feedback:
	As the marketing power for prescription drugs continues to grow, the health care provider must be constantly aware of what patients are seeing (or reading), what the commercials and ads are promising, and the real data behind the indications and contraindications for these “hot” drugs. It is a continuing challenge to stay up-to-date and knowledgeable about drug therapy.

29.	Ipecac, formerly used as the drug of choice by parents for treatment of suspected poisoning in children, was tested by the Food and Drug Administration (FDA) in 2003. What was the finding of this testing?
	A)	Ipecac is ineffective for its intended use.
	B)	Ipecac is the safest treatment for poisoning in children.
	C)	Ipecac was “grandfathered” in as an ineffective drug.
	D)	Ipecac induces vomiting.
	Ans:	A
	Feedback:
	Ipecac, a formerly standard over-the-counter drug, was used for many years by parents to induce vomiting in children in cases of suspected poisoning or suspected drug overdose. The drug was finally tested and in 2003, the FDA announced that it was not found to be effective for its intended use. Although it was grandfathered in as an effective drug, this was not what the study researched. Ipecac is not effective and does not consistently induce vomiting.

30.	Federal guidelines state that when advertising a drug, if the company states what the drug is used for, what other information must also be included in the advertisement? (Select all that apply.)
	A)	Symptoms
	B)	Contraindications
	C)	Adverse effects
	D)	Precautions
	E)	Cost
	Ans:	B, C, D
	Feedback:
	If a drug advertisement states what the drug is used for, it must also state contraindications, adverse effects, and precautions. The advertisement does not have to state symptoms or cost.

31.	The parent of a 2-year-old child is visiting his or her pediatric health care provider and shows the nurse the advertisement for allergy medication found in a magazine in the waiting room saying, “This drug sounds like it would be far more effective to treat my son’s asthma and I’d only have to give it once a day.” What is the nurse’s best response?
	A)	“Talk with your health care provider about this drug, but be aware that advertisements do not always provide all the important information you need to know.”
	B)	“Oh, I need to throw that magazine away because so many people show me that ad and it is all complete nonsense with no truth to it at all.”
	C)	“I’ve been seeing amazingly positive results from that medication so you are absolutely right to want to give it to your child.”
	D)	“That drug is dangerous and should not be given to children under the age of 5 unless there are no other good options.”
	Ans:	A
	Feedback:
	The health care provider should make the decision about what medications are to be prescribed, not the nurse. However, the nurse can make the mother aware of the fact that there is often more that goes into choosing the correct drug than the bit of information disclosed in the advertisement. Becoming upset with the mother, agreeing with the mother, or frightening the mother about the medication is the wrong approach for the nurse to use.

32.	The local news has been discussing a specific rare disorder that killed a child in the community this week, describing the symptoms of the disease as including nasal congestion, ear pain, and a cough. The pediatrician’s office is receiving numerous calls asking to make appointments to rule out this rare disease. What is the nurse’s best action?
	A)	Prepare a handout that describes the disorder discussed in the news in greater detail.
	B)	Tell parents their child is experiencing the common cold and do not need to be seen.
	C)	Direct all calls to the local news agency to answer questions and provide details.
	D)	Become familiar with the disorder and screen each call for more specific symptoms.
	Ans:	A
	Feedback:
	The nurse needs to not only become more familiar with the disorder in the news, but also needs to be prepared to teach parents about the “disease of the week” to allay fears so a handout with detailed information would allow the parents to have something to consult after leaving the provider’s office. Turning parents away without seeing their child will increase fears and the office will lose credibility for lack of interest in their child’s well-being. Directing calls to the news agencies will not provide parents with essential information. Screening calls without seeing the child could be potentially very dangerous.

33.	The nurse is teaching the patient how to safely use the Internet for health information and includes what information in the teaching plan?
	A)	The Web site where information is obtained needs to be evaluated for credibility.
	B)	Most information found on the Internet is accurate.
	C)	Information on the Internet is most reliable when people give their reviews of the drug.
	D)	Only a health care professional can tell whether a Web site is reliable.
	Ans:	A
	Feedback:
	There are excellent sites for reliable drug information, but each site must be evaluated for credibility and the nurse can teach the patient things to look for to increase confidence in the site. However, a lot of information on the Internet is not accurate; the patient needs to learn how to recognize unreliable information when he or she comes across these sites. Just because a person reviews a drug and gives it multiple stars or a thumbs up does not mean the drug is any more effective or useful in the patient’s care.

34.	The nursing instructor is teaching the class about how prescription drugs become over-the-counter (OTC) drugs and lists what factor as preventing a drug from becoming classified as OTC?
	A)	If the patient cannot reliably self-diagnose the condition the drug is intended to treat
	B)	If it would mask signs and symptoms of an underlying problem, the drug remains available by prescription only.
	C)	If the drug would cause toxic effects if not taken as directed, it remains a prescription drug.
	D)	OTC drugs must not have any adverse effects that could harm the patient.
	Ans:	A
	Feedback:
	If a diagnosis requires medical intervention, such as hyperlipidemia, which can only be diagnosed through laboratory studies, there is no point in making the drug an OTC medication. Most, if not all, OTC drugs have the capacity to mask signs and symptoms of an underlying disease so this is not a factor in deciding if a drug can be sold OTC. All drugs have the potential for toxic effects if not taken as directed and virtually all drugs have the potential for adverse effects.

35.	The nurse needs to ask what specific questions when collecting a drug history? (Select all that apply.)
	A)	“Do you take any over-the-counter medications?”
	B)	“Do you take any herbal supplements?”
	C)	“Do you use any alternative therapies?”
	D)	“Do you take any natural supplements or vitamins?”
	E)	“What unusual therapies do you take?”
	Ans:	A, B, D
	Feedback:
	The nurse needs to specifically question the patient’s use of over-the-counter drugs, herbal supplements, natural supplements, and vitamins. Use of terms like “alternative therapies” or “unusual therapies” is too vague and may not elicit the kind of information needed.

1.	A researcher is studying chromosomal disorders. What part of the human cell would the researcher be interested in studying?
	A)	Cytoplasm
	B)	Membrane
	C)	Nucleus
	D)	Organelles
	Ans:	C
	Feedback:
	The nucleus of a cell contains all of the genetic material that is necessary for cell reproduction. The nucleus also contains genes or sequences of deoxyribonucleic acid (DNA). Genes are responsible for the formation of messenger ribonucleic acid (mRNA) and transcription RNA, which are involved in production of proteins unique to the cells. This is the area where chromosomal disorders originate. The cell cytoplasm lies within the cell membrane and is the site of activities of cellular metabolism and special cellular functions. The organelles are contained within the cytoplasm and are structures with specific functions. They include the mitochondria, endoplasmic reticulum, free ribosomes, Golgi apparatus, and lysosomes. The membrane is a thin barrier, which separates the intracellular fluid from the extracellular fluid and is essential for cellular integrity; it also maintains cell homeostasis.

2.	Which of these body cells has the greatest number of mitochondria?
	A)	Tibia bone cells
	B)	Breast tissue
	C)	Cardiac muscle
	D)	Subcutaneous skin
	Ans:	C
	Feedback:
	Mitochondria are very abundant in cells that consume energy. The cardiac muscle cells, which must work continually to keep the heart contracting, contain a great number of mitochondria. Milk-producing cells in breast tissue, which are normally dormant, contain very few. Cells of bone and of subcutaneous tissue do not consume a great deal of energy; therefore, they have smaller numbers of mitochondria than cardiac muscle.

3.	When hormones, formed within the cell, move across the cell membrane, the process is called what?
	A)	Endocytosis
	B)	Exocytosis
	C)	Phagocytosis
	D)	Pinocytosis
	Ans:	B
	Feedback:
	Exocytosis is the movement of substances such as waste products, hormones, and neurotransmitters out of the cell. Pinocytosis is the movement of nutrients and needed substances into the cell through specific receptors on the cell surface. Phagocytosis involves the destruction of engulfed proteins or bacteria. Endocytosis involves incorporation of material into the cell.

4.	What substances move freely in and out of a cell by diffusion?
	A)	Electrolytes
	B)	Enzymes
	C)	Hormones
	D)	Proteins
	Ans:	A
	Feedback:
	Sodium, potassium, calcium, carbonate, oxygen, bicarbonate, and water move freely in and out of cells. These substances move through channels or pores in the cell membrane through movement from a region of higher concentration to a region of lower concentration. Hormones, enzymes, and proteins are considered carriers. If a substance cannot move freely on its own, it may attach itself to another carrier to be diffused.

5.	There can be interference with cancer chemotherapy in what phase of the cell cycle?
	A)	G0 phase
	B)	G1 phase
	C)	G2 phase
	D)	S phase
	Ans:	A
	Feedback:
	During the G0 phase, the cell is stable. Cells in this phase can interfere with cancer chemotherapy because these drugs usually work on actively dividing cells, leaving resting cells mostly untouched. When the resting cells are stimulated to become active and regenerate, the cancer can return. This is the reason that cancer chemotherapy regimens are complicated and extended over a period of time. In the G1 phase, a cell is stimulated to emerge from its resting phase. During this time, the cell synthesizes the substances needed for DNA formation. The S phase involves the actual synthesis of DNA, and during the G2 phase, the cell produces all the substances that are required for the manufacture of the mitotic spindles.

6.	The pharmacology instructor is discussing the histocompatibility of the cell. What is the importance of a cell’s histocompatibility antigen?
	A)	It reproduces cells when other cells die.
	B)	It recognizes cells as self-cells that belong in the body.
	C)	The antigen produces antibodies to viral invaders.
	D)	The antigen stimulates the production of white blood cells.
	Ans:	B
	Feedback:
	The histocompatibility antigens are proteins that are seen on the top of the cell membrane. T cells use these antigens as the identifying proteins that identify a cell as a self-cell. If these antigens are not present on a cell membrane, the T cells will destroy that cell, determining that it is foreign. The histocompatibility antigens are not involved in reproduction. They do not produce antibodies nor do they stimulate white blood cell production.

7.	A patient on the unit has a deep decubitus ulcer. The family asks why the nurse debrides the ulcer and removes the dead cells. What is the nurse’s best response to explain to the family why debridement is performed?
	A)	The lysosomes released by the dead cells in the area continue to kill other cells, destroying more tissue.
	B)	The dead cells no longer contain histocompatible antigens causing a greater inflammatory response.
	C)	Removing dead tissue forces oxygen to enter the damaged cells to regenerate them and to promote healing.
	D)	The doctor ordered the procedure to be performed so it is done the way it is ordered because orders are always followed.
	Ans:	A
	Feedback:
	When a cell dies, its cell membrane ruptures and the lysosomes release lysozymes, which dissolve protein. When many cells die, lysozymes accumulate and dissolve the proteins that the dead cells leave behind, but the lysozymes also destroy the cell membrane of healthy cells in the area. Those cells then die, releasing lysozymes, which destroy more cells, and a vicious cycle occurs. A decubitus ulcer is an area of many dead cells, which are killing healthy cells. The area needs to be scraped clean to remove the dead cells so that the lysozymes will stop destroying healthy cells and allow oxygen to return to the area through the capillary bed, which allows healing to occur. Many treatments exist for decubitus ulcers, all of which depend on the return of blood flow to the area and removal of the dead tissue. No procedure should ever be performed only because it was ordered. The nurse should understand why each procedure is needed.

8.	A patient is extremely dehydrated from vomiting and diarrhea causing his or her blood to become hypertonic. What effect does the nurse expect this will have on the red blood cells?
	A)	They will swell and eventually rupture.
	B)	Red blood cells will migrate to the bone narrow.
	C)	The cells will shrink and shrivel, decreasing their oxygen-carrying ability.
	D)	The red cells will precipitate out of circulation.
	Ans:	C
	Feedback:
	A hypertonic solution will draw the water out of the red blood cell, causing it to shrink and shrivel, decreasing the oxygen carrying ability of the red blood cell. A hypotonic solution would result in water moving into the red blood cell, causing it to swell and burst. Red blood cells will not migrate back to the bone marrow or precipitate out of circulation.

9.	The nurse is caring for four patients. Which patient would the nurse expect to have a faster recovery period based only on the process of mitosis?
	A)	A 32-year-old female patient who had surgery for ulcerated colitis
	B)	A 72-year-old man who had surgery for colon cancer
	C)	A 28-year-old woman who had breast reduction surgery
	D)	A 65-year-old man who had surgery for breast cancer
	Ans:	A
	Feedback:
	Cells lining the GI tract reproduce very quickly (72 hours) compared with breast tissue, which takes 2 to 3 months to reproduce. The older the person is, the longer it will take for recovery due to the aging process that reduces rate of circulation of blood cells carrying oxygen to and from cells.

10.	When chemotherapeutic agents interfere with cellular physiology, it results in what?
	A)	Cellular death or alterations
	B)	Diffusion
	C)	Endocytosis
	D)	Homeostasis
	Ans:	A
	Feedback:
	Drugs may alter the cell membrane, causing the cell to rupture and die or they may deprive the cell of certain nutrients, altering the proteins that the cell produces. This could interfere with normal cell functioning and cell division. Diffusion is the movement of a substance from a region of higher concentration to a region of lower concentration. Endocytosis involves gathering of material into a cell. Homeostasis refers to keeping the cytoplasm stable within the cell membrane. Diffusion, endocytosis, and homeostasis are not the result of chemotherapeutic agents but may be impacted by the agent.

11.	When learning about the physiology of the human body, a student would learn that cellular metabolism takes place where?
	A)	Organelles
	B)	Mitochondria
	C)	Endoplasmic reticulum
	D)	Cytoplasm
	Ans:	D
	Feedback:
	The cell cytoplasm lies within the cell membrane and outside the nucleus and is the site of activities of cellular metabolism and special cellular functions. Organelles, mitochondria, and endoplasmic reticulum are all part of the cytoplasm of the cell and each has a specific function that contributes to cellular function.

12.	What is the function of the rough endoplasmic reticulum (ER) within a cell?
	A)	Produces proteins
	B)	Combines protein with other components of the cytoplasm
	C)	Exports protein from the cell
	D)	Destroys ribosomes
	Ans:	A
	Feedback:
	Many granules that contain enzymes and ribosomes, which produce protein, are scattered over the surface of the rough endoplasmic reticulum. Production of proteins, phospholipids, and cholesterol takes place in the rough endoplasmic reticulum. The rough ER segregates (rather than combines) these proteins from other components of the cytoplasm and modifies their structure for a specific function. Rough ER does not transport anything through the cell membrane. Rough ER is studded with ribosomes; it does not destroy them.

13.	What is one purpose of the Golgi apparatus?
	A)	Produces bile
	B)	Prepares hormones or other substances for secretion-producing excretory granules
	C)	Stimulates production of new red blood cells
	D)	Produces small carbohydrate molecules
	Ans:	B
	Feedback:
	The Golgi apparatus is a series of flattened sacs that may be part of the endoplasmic reticulum. These structures prepare hormones or other substances for secretion by processing them and packaging them in vesicles to be moved to the cell membrane for excretion from the cell. Golgi bodies do not produce bile. They produce secretory, not excretory, granules and they produce large carbohydrate molecules rather than small ones.

14.	Mitochondria produce energy in the form of what?
	A)	Deoxyribonucleic acid (DNA)
	B)	Red blood cells
	C)	Lactic acid
	D)	Adenosine triphosphate (ATP)
	Ans:	D
	Feedback:
	Mitochondria are rod-shaped “power plants” within each cell that produce energy in the form of ATP, which allows the cell to function. Red blood cells and DNA are not formed in the mitochondria. If oxygen is not available, lactic acid builds up as a by-product of cellular respiration. Lactic acid leaves the cell and is transported to the liver for conversion to glycogen and carbon dioxide.

15.	The physiology instructor is explaining cell death to the nursing students. The instructor explains that what organelle digests worn or damaged sections of a cell when the cell dies?
	A)	Golgi apparatus
	B)	Lysosomes
	C)	Endoplasmic reticulum
	D)	Mitochondria
	Ans:	B
	Feedback:
	Lysosomes are membrane-covered organelles that contain specific digestive enzymes that can break down proteins, nucleic acids, carbohydrates, and lipids. They are responsible for digesting worn or damaged sections of a cell when the membrane ruptures and the cell dies. The Golgi apparatus prepares substances for secretion by processing and packaging them in vehicles to move through the cell membrane. The endoplasmic reticulum provides a large surface for chemical reactions within the cell. Mitochondria are the power plants of the cell.

16.	What is the function of the mitochondria within the cell?
	A)	Convert small substances into energy
	B)	Convert hormones into secretory substances
	C)	Produce energy in the form of adenosine triphosphate (ATP)
	D)	Move electrolytes into and out of a cell
	Ans:	C
	Feedback:
	Mitochondria are rod-shaped organelles that produce energy in the form of ATP for use by cells. They do not convert small substances into energy; they do not convert hormones into secretory substances; and they do not move electrolytes into and out of a cell.

17.	Two types of ribosomes exist within a cell. Ribosomes that are not bound to the endoplasmic reticulum exist throughout the cytoplasm of the cell and produce proteins with what purpose?
	A)	Bind themselves to the Golgi apparatus
	B)	Bind to produce the endoplasmic reticulum
	C)	Denature unnecessary enzymes within the cell
	D)	Contribute to the structure of the cell
	Ans:	D
	Feedback:
	Ribosomes that are not bound to the surface of the endoplasmic reticulum exist throughout the cytoplasm. These free-floating ribosomes produce proteins that are important to the structure of the cell and some of the enzymes that are necessary for cellular activity. Free-floating ribosomes do not bind themselves to Golgi apparatus; produce endoplasmic reticulum; or denature any part of the cell or its contents.

18.	When a cell uses energy to move ions against an electrical or chemical gradient, what is the process called?
	A)	Passive transport
	B)	Neutral transport
	C)	Cotransport
	D)	Active transport
	Ans:	D
	Feedback:
	Active transport is what happens when cells use energy to move ions against an electrical or chemical gradient. Passive transport is another term for diffusion. There is no such thing as neutral transport. Cotransport is when the sodium ion and the solute are transported in the same direction.

19.	When making a presentation on the cell, what would the students say are the main parts of the cell? (Select all that apply.)
	A)	The nucleus
	B)	The cytoplasm
	C)	The cell membrane
	D)	The mitochondria
	E)	The organelles
	Ans:	A, B, C
	Feedback:
	The cell is composed of a nucleus, which contains genetic material and controls the production of proteins by the cell; a cell membrane, which separates the inside of the cell from the outside environment; and cytoplasm, which contains various organelles important to cell function. The mitochondria and the organelles are units within the cytoplasm but are not main parts of the cell.

20.	The cell membrane has embedded within it a series of peripheral proteins that function in several ways. One of these proteins is known as a receptor site. What does this receptor site do?
	A)	Maintains contact with outside proteins to prevent lysis of the cell wall
	B)	Maintains contact with inside proteins to prevent lysis of the cell wall
	C)	Reacts with specific chemicals inside the cell to stimulate a reaction outside the cell
	D)	Reacts with specific chemicals outside the cell to stimulate a reaction within a cell
	Ans:	D
	Feedback:
	Embedded in the cell membrane are a series of peripheral proteins with several functions. One type of protein located on the cell membrane is known as a receptor site. This protein reacts with specific chemicals outside the cell to stimulate a reaction within a cell. Receptor sites do not prevent lysis of the cell wall nor do they stimulate a reaction outside of the cell.

21.	Proteins within the cell wall allow the passage of several substances into and out of the cell. What is one of these substances?
	A)	Calcium
	B)	Phosphorous
	C)	Magnesium
	D)	Manganese
	Ans:	A
	Feedback:
	Channels or pores within the cell membrane are made by proteins in the cell wall that allow the passage of small substances in or out of the cell. Specific channels have been identified for sodium, potassium, calcium, chloride, bicarbonate, and water; other channels may also exist. Some drugs are designed to affect certain channels specifically. For example, calcium channel blockers prevent the movement of calcium into a cell through calcium channels. Options B, C, and D are not known to have their own channels at this time.

22.	After the cell has produced all substances necessary for the formation of a new cell, mitosis occurs in what phase of the cell cycle?
	A)	G0 phase
	B)	M phase
	C)	S phase
	D)	G2 phase
	Ans:	B
	Feedback:
	After the cell has produced all substances necessary for formation of a new cell, or daughter cell, it undergoes cell division. This occurs during the M phase of the cell cycle. During this phase, the cell splits to form two identical daughter cells, a process called mitosis. The S phase involves the actual synthesis of DNA. In the G2 phase, the cell produces all the substances required for manufacture of the mitotic spindles.

23.	During the cell cycle, the cell is stimulated to emerge from its resting phase and enter what stage?
	A)	M phase
	B)	S phase
	C)	G1 phase
	D)	G2 phase
	Ans:	C
	Feedback:
	When a cell is stimulated to emerge from its resting phase, it enters what is called the G1 phase, which lasts from the time of stimulation from the resting phase until the formation of deoxyribonucleic acid (DNA). During this period, the cell synthesizes substances needed for DNA formation. The cell is actively collecting materials to make these substances and producing the building blocks for DNA.

24.	When a substance must attach to another molecule, called a carrier, to move into or out of a cell, it is called what?
	A)	Active transport
	B)	Osmosis
	C)	Passive transport
	D)	Facilitated diffusion
	Ans:	D
	Feedback:
	Sometimes a substance cannot move freely on its own in or out of a cell. Such a substance may attach to another kind of molecule, called a carrier, to be diffused. This form of diffusion, known as facilitated diffusion, does not require energy, only the presence of the carrier. Active transport requires energy to move the substance against the concentration gradient. Osmosis is a special form of diffusion where water moves across a semipermeable membrane from an area low in solutes to one that is higher in solutes to dilute solutes. Passive transport does not require energy to move solutions across a semipermeable membrane and includes diffusion, osmosis, and facilitated diffusion.

25.	A group of students are diagramming the cycle of a cell. What phase would they diagram as actually synthesizing deoxyribonucleic acid (DNA)?
	A)	S phase
	B)	G0 phase
	C)	M phase
	D)	G2 phase
	Ans:	A
	Feedback:
	The next phase, called the S phase, involves the actual synthesis of DNA, which is an energy-consuming activity. The cell remains in this phase until the amount of cellular DNA has doubled. The G0 phase is considered the resting phase of the cell cycle. The M phase is when cell replication occurs. The G2 phase is when the cell produces all substances it needs to replicate.

26.	What is the purpose of the G1 phase of the cell cycle?
	A)	Reproduction
	B)	Synthesizes substances needed for deoxyribonucleic acid (DNA) formation
	C)	Rest
	D)	Production of mitotic spindles
	Ans:	B
	Feedback:
	The G1 phase lasts from the time of stimulation from the resting phase until the formation of DNA. During this period, the cell synthesizes substances needed for DNA formation. Mitotic spindles are produced in the S phase; rest is accomplished in the G0 phase; and reproduction is in the M phase.

27.	What is the cell membrane composed of? (Select all that apply.)
	A)	Glycolipids
	B)	Lysosomes
	C)	Cholesterol
	D)	Glycoprotein
	E)	Phospholipids
	Ans:	A, C, E
	Feedback:
	The cell membrane is a lipoprotein structure, meaning it is mainly composed of proteins and lipids—phospholipids, glycolipids, and cholesterol; bipolar arrangement of the lipids monitors substances passing in and out of the cell. Lysosomes are organelles within the cytoplasm. Glycoprotein is a distracter.

28.	The Krebs cycle provides a common pathway for the metabolism of nutrients by the body. The Krebs cycle uses carbohydrates, proteins, and what other nutrient to make adenosine triphosphate (ATP)?
	A)	NADH + H+
	B)	Vitamins
	C)	Fat
	D)	H2O
	Ans:	C
	Feedback:
	The mitochondria can take carbohydrates, fats, and proteins from the cytoplasm and make ATP via the Krebs cycle, which depends on oxygen. Cells use the ATP to maintain homeostasis, produce proteins, and carry out specific functions. NADH + H+ is an end-product of glycolysis. Vitamins are not used to make ATP and neither is water.

29.	A patient is discussing a liver transplant with the transplant team. The physician is explaining the effort made to match what in the donor tissue?
	A)	Histocompatability antigens
	B)	Lipoproteins
	C)	Non-self-markers
	D)	Receptor sites
	Ans:	A
	Feedback:
	The body’s immune system recognizes these proteins and acts to protect self-cells and to destroy non-self-cells. When an organ is transplanted from one person to another, a great effort is made to match as many histocompatibility antigens as possible to reduce the chance that the “new” body will reject the transplanted organ.

30.	The cell membrane, an integral part of the cell, is essential for what? (Select all that apply.)
	A)	Cell movement
	B)	Cellular integrity
	C)	Cell life
	D)	Cell homeostasis
	E)	Cell maturation
	Ans:	B, C, D
	Feedback:
	The membrane is essential for cellular integrity and is equipped with many mechanisms for maintaining cell homeostasis. Options A and E are distracters for this question.

31.	The pharmacology instructor explains to the nursing students that drugs will have the least effect on the cell during what phase of the cell cycle?
	A)	G0 phase
	B)	G1 phase
	C)	S phase
	D)	G2 phase
	Ans:	A
	Feedback:
	During the G0 phase, or resting phase, the cell is stable. It is not making any proteins associated with cell division and is basically dormant in terms of reproduction. These cells are functioning to do whatever they are supposed to do. Most drugs, particularly chemotherapy for cancer, work on active cells so cells that are resting are less susceptible to chemical action. The other options are active phases when drugs will be most effective.

32.	The nurse is caring for a patient with acute renal failure with an elevated potassium level. The health care provider orders administration of insulin that causes potassium to return to the cell, thereby lowering serum potassium levels and the risks associated with hyperkalemia. The nurse recognizes this as a type of what?
	A)	Passive transport
	B)	Active transport
	C)	Osmosis
	D)	Diffusion
	Ans:	A
	Feedback:
	Moving potassium back into the cell, an area with a higher concentration gradient than the bloodstream, requires energy. Insulin helps to activate the sodium-potassium pump. Passive transport is a means of moving substances in and out of the cell without the use of energy. Potassium levels are elevated and will not diffuse into the cell independently because potassium levels are higher inside the cell than outside and require energy to cross the concentration gradient. Osmosis involves diffusion of water.

33.	The nurse is caring for a patient with edema caused by escape of fluid from the intravascular compartment to the extracellular compartment. An IV solution will be administered to draw the fluid back into the intravascular compartment. What type of solution will the nurse expect to administer?
	A)	Isotonic solution
	B)	Hypertonic solution
	C)	Hypotonic solution
	D)	Osmotic solution
	Ans:	B
	Feedback:
	Hypertonic solutions are those with a higher concentration of solutes than human plasma. They draw water from cells, which would help to draw fluid back into the intravascular space. Hypotonic solutions are fluids that contain a lower concentration of solutes than human plasma, which causes water to be pushed into the cells. Isotonic fluids contain the same concentration of solutes as human plasma and will not cause fluids to shift from one compartment to another. Osmotic solution is a distracter.

34.	The cytoplasm within the cell is stable so that the cell is said to be in what state?
	A)	Homeostasis
	B)	Activity
	C)	Excitability
	D)	Mitosis
	Ans:	A
	Feedback:
	The main goal of a cell is to maintain homeostasis, which means keeping the cytoplasm stable within the cell membrane. Options B, C, and D are distracters for the question.

35.	The patient has been diagnosed with multiple sclerosis, a disease that reduces the amount of available adenosine triphosphate (ATP) in the body. The nurse recognizes that this reduction in ATP is caused by the impact of the disease on what part of the cell?
	A)	Cell neuron
	B)	Endoplasmic reticulum
	C)	Golgi bodies
	D)	Mitochondria
	Ans:	D
	Feedback:
	The mitochondria are rod-shaped “power plants” within each cell that produce energy in the form of ATP, which allows the cell to function. Inadequate production of ATP would indicate damage to the functioning of the mitochondria. The neuron, endoplasmic reticulum, and Golgi bodies do not produce ATP.

1.	A 17-year-old male patient with athlete’s foot is extremely upset that he cannot get rid of it. He calls the clinic and asks the nurse whether the doctor can give him an antibiotic to “cure the infection.” What should the nurse include in the explanation of treatment for fungal infections?
	A)	“Fungi differ from bacteria in that the fungus has flexible cell walls that allow for free transfer into and out of the cell.”
	B)	“Protective layers contain sterols, which change the membrane permeability.”
	C)	“The composition of the protective layers of the fungal cell makes the organism resistant to antibiotics.”
	D)	“Fungi cell walls contain Candida, which makes the cells rigid.
	Ans:	C
	Feedback:
	The nurse should tell the patient that the composition of the protective layers of the fungal cell makes the organism resistant to antibiotics so that antibiotics would not have any positive effect. Fungi do differ from bacteria, but the fungus has rigid cell walls that allow for free transfer in and out of the cell. The protective layers contain ergosterol, not Candida, that helps keep the cell wall rigid, not permeable.

2.	The nurse admits a 1-year-old child to the pediatric intensive care unit (ICU) with cryptococcal meningitis. What drug will the nurse anticipate receiving an order for to treat this child?
	A)	Amphotericin B (Fungizone)
	B)	Fluconazole (Diflucan)
	C)	Griseofulvin (Fulvicin)
	D)	Ketoconazole (Nizoral)
	Ans:	B
	Feedback:
	Fluconazole is used in the treatment of cryptococcal meningitis and is safe to use in a 1-year-old child. Amphotericin B has many unpleasant adverse effects and is very potent, so it would not be the first or best medication to administer initially but would be reserved for use if fluconazole was not effective. Griseofulvin is given to treat tinea pedis and tinea unguium in children. Ketoconazole is not given to children younger than 2 years because safety has not been established.

3.	The nurse is teaching the patient about a newly prescribed systemic antifungal drug. What sign or symptom will the nurse instruct the patient to report to the provider immediately?
	A)	Unusual bruising and bleeding
	B)	Constipation or diarrhea
	C)	Red and dry eyes
	D)	Increased appetite with weight gain
	Ans:	A
	Feedback:
	Unusual bruising and bleeding can be an indication of hepatic toxicity, which should be reported immediately. Yellowing of the eyes, not redness, and tearing are also indicative of hepatic toxicity. Usually GI symptoms include nausea and vomiting with antiviral drugs, which could cause decreased appetite and weight loss. These symptoms should be reported if they persist but are not emergency symptoms to report immediately.

4.	A patient who has a tinea infection calls the clinic and complains of intense local burning and irritation with use of a topical antifungal drug. Even before asking the patient, the nurse suspects he or she is applying what medication?
	A)	Butoconazole (Gynazole I)
	B)	Ciclopirox (Loprox)
	C)	Econazole (Spectazole)
	D)	Haloprogin (Halotex)
	Ans:	C
	Feedback:
	Econazole can cause intense local burning and irritation in treatment of tinea infections. Butoconazole is used to treat vaginal Candida infections. Ciclopirox is used to treat toenail and fingernail tinea infections and does not produce intense burning and irritation. Haloprogin is used to treat athlete’s foot, jock itch, and ringworm infections and is not associated with burning or irritation.

5.	A patient asks the nurse if he or she should use a topical antifungal. The nurse is aware that the most important contraindication to topical antifungals is what?
	A)	Hepatic impairment
	B)	Renal impairment
	C)	Congestive heart failure
	D)	Known allergy to any of the antifungal drugs
	Ans:	D
	Feedback:
	Topical antifungals are not absorbed systemically so they are not metabolized and excreted. As a result, the only contraindication would be an allergy to the drug. Hepatic and renal impairment and congestive heart failure would not be a contraindication because these drugs do not enter the bloodstream and impact these organ systems.

6.	A patient with high cholesterol is taking lovastatin (Mevacor). What drug would the nurse question if it was ordered for this patient?
	A)	Nifedipine (Procardia)
	B)	Ciprofloxacin (Cipro)
	C)	Itraconazole (Sporanox)
	D)	Oxazepam (Serax)
	Ans:	C
	Feedback:
	Itraconazole is an azole antifungal drug that has been associated with severe cardiovascular events when taken with lovastatin. Nifedipine, ciprofloxacin, and oxazepam have no drug interactions with lovastatin. Nifedipine is an antihypertensive drug whose effects can be increased when taken with cimetidine. The effects of ciprofloxacin are altered when taken with antacids and theophyllines. Oxazepam is an antianxiety drug that should not be taken with alcohol or theophyllines.

7.	An 85-year-old man who is a resident in an extended-care facility has athlete’s foot. After applying an antifungal cream, what is the nurse’s next action?
	A)	Wipe away excess medication from the affected area.
	B)	Wrap a sterile kling dressing around both feet.
	C)	Elevate the feet for 30 minutes.
	D)	Apply clean dry socks.
	Ans:	D
	Feedback:
	Clean dry socks should be applied when treating athlete’s foot to help eradicate the infection because they will keep the feet dry as well as prevent the cream from being wiped away. A kling dressing is not necessary as it would bind the feet and interfere with mobility and increase the risk of systemic absorption. Medication should not be removed once applied, and there is no need to elevate the feet unless another medical condition warrants this action.

8.	A patient comes to the clinic and is diagnosed with a vaginal fungal infection. The nurse provides patient information for self-administration of a vaginal antifungal medication. What will the nurse include in the instructions?
	A)	“Insert low into the opening of the vagina.”
	B)	“Discontinue use during menstruation.”
	C)	“Remain recumbent for at least 15 minutes after insertion.”
	D)	“Rub the cream into the vaginal wall after insertion.”
	Ans:	C
	Feedback:
	The patient should remain recumbent at least 10 to 15 minutes after the medication is deposited high in the vagina so that leakage will not occur and absorption will take place. The effectiveness of the medication is determined by the consistent application for each specified dose for maximal results. The nurse would instruct the patient to continue the medication during menstruation. Stopping the drug and restarting it later can lead to the development of resistant strains of the drug. The cream need not be rubbed into the vaginal wall as it will coat the wall naturally after insertion.

9.	A patient who is using a topical antifungal agent to treat mycosis calls the clinic to report a severe rash that is accompanied by blisters. What will the nurse instruct the patient to do?
	A)	“Continue the drug as the prescription indicates.”
	B)	“Scrub the rash with soap and water.”
	C)	“Stop using the drug immediately.”
	D)	“Decrease the amount of the medication used.”
	Ans:	C
	Feedback:
	The patient should stop using the drug. The rash could indicate sensitivity to the drug or worsening of the condition being treated. Scrubbing the rash could cause further irritation and increase the risk for other infections. Continuing the drug could cause further complications. Decreasing the medication would be ineffective in treating the infection while continuing to risk further complications.

10.	The nurse admitted a 25-year-old woman to the unit. What would be the most important thing for the nurse to assess before administering ketoconazole?
	A)	Complete blood count (CBC) and blood glucose
	B)	Eating and sleeping habits
	C)	Height and weight
	D)	Renal and hepatic function
	Ans:	D
	Feedback:
	It would be important for the nurse to know the patient’s CBC, blood glucose level, eating and sleeping habits, and height and weight. All of these factors could help determine a specific dosage. However, the most important factor would be the patient’s renal and hepatic function because hepatic or renal toxicity could occur quickly if the organs are not functioning properly.

11.	What drug would the nurse administer orally without the need to question when treating infections caused by Candida albicans?
	A)	Amphotericin B (Abelcet)
	B)	Tolnaftate (Tinactin)
	C)	Griseofulvin (Fulvicin)
	D)	Fluconazole (Diflucan)
	Ans:	D
	Feedback:
	Fluconazole is available for oral use and is effective in treating C. albicans. Amphotericin B is reserved for severe and potentially fatal infections, so it would not be used for a C. albicans infection. Tolnaftate is used to treat athlete’s foot and is applied topically, not given orally. Griseofulvin is applied topically and is used to treat tinea, not C. albicans.

12.	When administering a topical antifungal via the vaginal route, what action would the nurse take?
	A)	Place the patient in left lateral Sims’ position.
	B)	Applied using sterile technique
	C)	Administered high into the vagina.
	D)	Insert a tampon after insertion.
	Ans:	C
	Feedback:
	Vaginal antifungals should be administered high into the vagina. The patient should be placed in a recumbent position for insertion. Clean technique (not sterile) should be used. Inserting a tampon after administration is not necessary.

13.	By what route would the nurse administer amphotericin B?
	A)	Intravenously
	B)	Intramuscularly
	C)	Orally
	D)	Topically
	Ans:	A
	Feedback:
	Amphotericin B is only administered by the IV route. It cannot be given intramuscularly, orally, or topically.

14.	What classification of medication will the nurse administer concurrently with amphotericin B (Fungizone) to help minimize the adverse reactions to this medication?
	A)	Sedatives
	B)	Antipyretics
	C)	Beta-adrenergic blockers
	D)	Diuretics
	Ans:	B
	Feedback:
	Amphotericin B is often given with antipyretics to improve patient comfort and to minimize adverse reactions. Sedatives, beta-adrenergic blockers, and diuretics are not indicated for use with amphotericin B unless the patient has a coexisting diagnosis that would indicate a need for these drugs.

15.	The nurse provides teaching about amphotericin B (Fungizone) for an 82-year-old patient. The nurse evaluates the patient understood teaching when he says he could develop what condition?
	A)	Diabetes
	B)	Liver necrosis
	C)	Kidney damage
	D)	Pancreatitis
	Ans:	C
	Feedback:
	Amphotericin B is nephrotoxic so the patient needs to understand the risk of kidney damage. Other risks of amphotericin B include bone marrow suppression; GI irritation with nausea, vomiting, and potentially severe diarrhea; anorexia and weight loss; and pain at the injection site with the possibility of phlebitis or thrombophlebitis, but it does not cause diabetes, liver necrosis, or pancreatitis.

16.	The nurse is reviewing the patient’s medications and sees fluconazole has been ordered. The nurse will question this order when finding the patient is taking what other medication?
	A)	Digoxin
	B)	Humulin insulin
	C)	Acetaminophen
	D)	Hydrochlorothiazide
	Ans:	A
	Feedback:
	Fluconazole strongly inhibit the cytochrome P450 (CYP450) enzyme system in the liver and are associated with many drug–drug interactions, such as increased serum levels of the following agents: cyclosporine, digoxin, oral hypoglycemics, warfarin, oral anticoagulants, and phenytoin. Diphenhydramine, acetaminophen, and hydrochlorothiazide have no impact on fluconazole. There is no indication that humulin insulin, acetaminophen, and hydrochlorothiazide are contraindicated when taking fluconazole.

17.	The nurse administers nystatin (Mycostatin) to a patient with thrush (oral candidiasis). How does the medication work in the body?
	A)	Changes membrane permeability
	B)	Prevents reproduction of fungal cells
	C)	Fungistatic
	D)	Inhibits glucan synthesis
	Ans:	A
	Feedback:
	Nystatin binds to sterols in the cell wall, changing membrane permeability and allowing leaking of the cellular components, which will result in cell death. Nystatin is not a fungistatic (prevents reproduction of fungal cells) and it does not inhibit glucan synthesis.

18.	The nurse teaches the patient to administer butoconazole (Gynazole) for vaginal candidal infection. What instructions will the nurse supply?
	A)	“Fill the applicator with the medication and insert it into the vagina at bedtime.”
	B)	“Apply the medication to the perineal area twice a day and wear white cotton underwear.”
	C)	“Soak in a sitz bath twice daily and insert the medication into the vagina after the bath.”
	D)	“Take one tablet by mouth and be sure to follow the medication with a full glass of water.”
	Ans:	A
	Feedback:
	Butoconazole (Gynazole) is administered once daily and should be inserted high into the vagina with the patient remaining recumbent for at least 10 to 15 minutes after insertion. Using the medication at bedtime helps decrease losing the medication by gravity and extends the time the medication will be in contact with the vaginal wall. The medication is not usually applied to the perineum unless the infection has traveled outside the vagina. Sitz baths are contraindicated because fungi flourish in moist environments. This medication is not administered orally and can only be applied topically.

19.	What medication could the nurse administer in a single dose for effective treatment of the patient’s vaginal candidal infection?
	A)	Caspofungin (Cancidas)
	B)	Terbinafine (Lamisil)
	C)	Ketoconazole (Nizoral)
	D)	Tioconazole (Monistat-1)
	Ans:	D
	Feedback:
	Tioconazole may be given as one dose for treatment of vaginal candidal infection. Caspofungin is given IV to treat invasive aspergillosis in patients who did not respond to other treatments and would not be used for a vaginal candidal infection. Terbinafine is administered twice daily for 1 to 4 weeks to treat topical mycosis. Ketoconazole is administered orally or topically to treat aspergillosis, leishmaniasis, cryptococcosis, blastomycosis, moniliasis, coccidioidomycosis, histoplasmosis, and mucormycosis but would not be used to treat vaginal candidal infections.

20.	The nurse works on a renal transplant unit and receives an order for posaconazole (Noxafil) for the patient which the nurse interprets to mean the patient has what infection?
	A)	Blastomycosis
	B)	Aspergillus
	C)	Mucormycosis
	D)	Coccidioidomycosis
	Ans:	B
	Feedback:
	Posaconazole is used for prophylaxis treatment of invasive Aspergillus and Candida infections in adults and children older than 13 years who are immunosuppressed secondary to antineoplastic, chemotherapy, graft-versus-host disease following transplants, or hematological malignancies. Posaconazole would not be used to treat blastomycosis, mucormycosis, or coccidioidomycosis.

21.	The nurse admits a patient diagnosed with a systemic fungal infection and is ordered IV fluconazole. When developing the plan of care for this patient, the nurse would use what nursing diagnosis related to this medication?
	A)	Chronic pain related to the gastrointestinal (GI) system, central nervous system (CNS), and local effects of drug
	B)	Risk for altered perfusion secondary to system cardiovascular effects of drug
	C)	Disturbed sensory perception (kinesthetic) related to CNS effects
	D)	Monitor IV sites to ensure that phlebitis or infiltration does not occur.
	Ans:	C
	Feedback:
	Nursing diagnoses related to drug therapy might include disturbed sensory perception (kinesthetic) related to CNS effects. Cardiovascular effects are not a concern with this medication; acute, not chronic, pain is associated with GI, CNS, and local effects of the drug; option D is an intervention, not a nursing diagnosis.

22.	The nurse is caring for a patient receiving an oral fungicide to treat a systemic fungal infection. What intervention would the nurse include in the plan of care?
	A)	Maintain complete bed rest.
	B)	Assess for cyanosis every 4 hours.
	C)	Administer medication 1 hour before meals.
	D)	Monitor nutritional status.
	Ans:	D
	Feedback:
	Monitor nutritional status and arrange a dietary consultation as needed to ensure nutritional status secondary to gastrointestinal (GI) upset related to medication. Complete bed rest is unnecessary. Cyanosis is not an anticipated problem. Medications should be given with food not before meals.

23.	What factors would the nurse indicate as contributing to an increase in diagnosed fungal infections? (Select all that apply.)
	A)	Acquired immunodeficiency syndrome (AIDS)-related complex
	B)	Increased prevalence of cancer
	C)	Rise in birth rates across the country
	D)	Greater number of older adults
	E)	Increased use of immunosuppressants
	Ans:	A, D, E
	Feedback:
	The incidence of fungal infections has increased with the rising number of immunocompromised people—patients with AIDS and AIDS-related complex (ARC), those taking immunosuppressant drugs, those who have undergone transplantation surgery or cancer treatment, and members of the increasingly larger elderly population, who are no longer able to protect themselves from the many fungi that are found throughout the environment. Cancer rates and birth rates are declining and do not contribute to the increase in diagnosis of fungal infection.

24.	A patient who has received a heart transplant is taking cyclosporine. The patient is found to have a systemic Aspergillus infection. What drug would the nurse question if ordered for this patient?
	A)	Terbinafine
	B)	Posaconazole
	C)	Itraconazole
	D)	Ketoconazole
	Ans:	D
	Feedback:
	Ketoconzaole and fluconazole strongly inhibit the cytochrome P450 (CYP450) enzyme system in the liver and is associated with many drug–drug interactions such as increased serum levels of the following agents: cyclosporine, digoxin, oral hypoglycemics, warfarin, oral anticoagulants, and phenytoin. There is no known drug interaction between cyclosporins and terbinafine, posaconazole, or itraconazole.

25.	When caring for a patient with a secondary immunodeficiency disease following kidney transplantation being treated for candidemia the nurse can anticipate receiving an order for what medication?
	A)	Amphotericin B
	B)	Anidulafungin
	C)	Flucytosine
	D)	Butoconazole
	Ans:	B
	Feedback:
	Anidulafungin (Eraxis) is used for the treatment of candidemia (infection of the bloodstream) and other forms of candidal infections, intra-abdominal infections, and esophageal candidiasis. Amphotericin B is not indicated in the treatment of candidemia. Flucytosine is indicated for the treatment of candidemia but is excreted primarily in the urine so would be contraindicated in a patient with a transplanted kidney. Butoconazole is a topical medication that would not be appropriate for use treating a systemic bloodborne fungal infection.

26.	Which antifungal would the nurse explain works by inhibiting glucan synthesis
	A)	Flucytosine
	B)	Terbinafine
	C)	Micafungin
	D)	Ketoconazole
	Ans:	C
	Feedback:
	The antifungal medications called echinocandins work by inhibiting glucan synthesis and micafungin is one of the drugs in this classification. Flucytosine is a miscellaneous antifungal agent, whereas terbinafine and ketoconazole are topical agents.

27.	What antifungal would be appropriate for the nurse to administer to treat a patient with an oropharyngeal candidiasis?
	A)	Itraconazole
	B)	Fluconazole
	C)	Posaconazole
	D)	Clotrimazole
	Ans:	D
	Feedback:
	Clotrimazole is an effective treatment for oropharyngeal candidiasis (in troche form) or to prevent oropharyngeal candidiasis in patients receiving radiation or chemotherapy. Itraconazole, fluconazole, and posaconazole would not be appropriate for this patient because they do not treat oropharyngeal candidiasis infections.

28.	What drug would the nurse recognize as contraindicated for pediatric use?
	A)	Fluconazole
	B)	Terbinafine
	C)	Griseofulvin
	D)	Flucytosine
	Ans:	D
	Feedback:
	Flucytosine does not have proven safety and efficacy in children, and extreme caution should be exercised if it is ordered. Fluconazole, terbinafine, and griseofulvin have established pediatric doses and would be drugs of choice if appropriate for a particular infection.

29.	When caring for a 92-year-old patient, the nurse would anticipate the need for what interventions related to administration of any antifungal medications? (Select all that apply.)
	A)	Dose reduction
	B)	Frequent monitoring
	C)	Frequent testing of liver function
	D)	Shorter course of treatment
	E)	Continuous cardiorespiratory monitoring
	Ans:	A, B, C
	Feedback:
	Patients over age 85 are at increased risk for some liver dysfunction and require more careful monitoring, lower dosages, and frequent assessment of liver function studies. Course of treatment should not be shortened, but dosage should be reduced. Continuous cardiorespiratory monitoring is not indicated.

30.	A 15-year-old patient is immunocompromised because of the adverse effects of chemotherapy. He or she has developed severe migraine headaches and is being treated with ergot. What drug would be contraindicated in this patient?
	A)	Caspofungin
	B)	Ketoconazole
	C)	Posaconazole
	D)	Terbinafine
	Ans:	C
	Feedback:
	Patients being treated with voriconazole or posaconazole should be cautioned about the risk of ergotism if they combine this drug with ergot, an herb frequently used to treat migraine headache and menstrual problems. If the patient is using voriconazole, it should be suggested that ergot not be used until the antifungal therapy is finished. The other options do not have a known drug interaction with ergot.

31.	The nurse is reading the patient’s medical record and discovers the patient has a mycosis and interprets this as meaning what?
	A)	An infection caused by a fungus
	B)	A fungus normally found on mucous membranes
	C)	A systemic fungal infection
	D)	A fungal infection with a secondary bacterial infection
	Ans:	A
	Feedback:
	A mycosis is simply a fungal infection. It does not give any indication of type or where it is found and has nothing to do with a bacterial infection.

32.	The nurse admits a patient suspected of having a fungal infection. What action will the nurse need to take before a systemic antifungal can be prescribed? (Select all that apply.)
	A)	Initiate IV therapy.
	B)	Assess history of liver or kidney disease.
	C)	Obtain a culture of the fungus.
	D)	Request the patient sign a consent form.
	E)	Assess history of lymphatic disease.
	Ans:	B, C
	Feedback:
	The nurse would assess the patient for history of liver or kidney disease because systemic antifungals carry a higher risk of adverse effects and toxicity in patients with disease of these organs. A culture to determine the type of fungus should also be performed to increase the likelihood of the correct medication being prescribed. Not all antifungals are administered IV so this may not be necessary and would not be initiated until a drug was prescribed. A consent form is not needed by most facilities. History of lymphatic disease would not be associated with concern related to antifungal medications.

33.	The patient is admitted for IV administration of antifungal medication with the plan to discharge the patient on oral medication in a few days. What medication would the nurse be able to administer both IV and orally?
	A)	Fluconazole
	B)	Itraconazole
	C)	Posaconazole
	D)	Terbinafine
	Ans:	A
	Feedback:
	Fluconazole and voriconazole are available in oral and IV preparations, making it possible to start the drug IV for a serious infection and then switch to an oral form when the patient’s condition improves and he or she is able to take oral medications. Itraconazole, posaconazole, and terbinafine are administered only orally.

34.	The nurse admits a patient diagnosed with diabetes who has been undergoing fertility treatment in the hopes of becoming pregnant but is not pregnant at this time. The patient has a life-threatening fungal infection and requires systemic antifungal therapy. What medication would be contraindicated in this patient?
	A)	Ketoconazole
	B)	Fluconazole
	C)	Posaconazole
	D)	Itraconazole
	Ans:	A
	Feedback:
	Ketoconazole is not the drug of choice for patients with endocrine or fertility problems because of its effects on these processes. It is not known whether posaconazole crosses the placenta or enters breast milk, so it should not be used during pregnancy or lactation unless the benefits clearly outweigh the potential risks but has no risk to those with fertility or endocrine problems. Fluconazole and itraconazole would be safe for this patient.

35.	The nurse is assessing the patient’s medication history and learns the patient received a prescription for voriconazole from one provider and a prescription for an ergot alkaloid from another provider. The nurse realizes this patient is at risk for, and needs to be assessed for, what condition?
	A)	Liver toxicity
	B)	Central nervous system (CNS) depression
	C)	Ergotism
	D)	Renal toxicity
	Ans:	C
	Feedback:
	This patient is at risk for ergotism and would require an electrocardiographic or rhythm strip to assess the QT interval because ergotism manifests with prolonged QT intervals. The drug combination does not contribute to hepatic or renal toxicity or depression of the central nervous system.

1.	A patient has been diagnosed with hairy cell leukemia. The patient is to begin taking interferon alfa 2b. What will the nurse include in her instructions to the patient concerning this drug?
	A)	Avoid drinking alcohol while taking the drug.
	B)	Continue to maintain maximal physical activity.
	C)	Increase fluid intake while taking the drug.
	D)	Treat constipation with over-the-counter laxatives.
	Ans:	C
	Feedback:
	Interferon alfa 2b is metabolized in the kidney so adequate fluid intake is needed to promote metabolism and excretion of the drug as well as to minimize common adverse effects including dry skin and dizziness. Maintaining maximal physical activity is a good idea but has no relationship to the use of the drug. Fluids should be increased not decreased while taking the drug. Constipation is not an associated adverse effect of this medication.

2.	The health care provider plans to inject an interferon directly into the patient’s wart. What interferon will the nurse prepare?
	A)	Interferon alfa 2a (Roferon-A)
	B)	Interferon alfacon 1 (Infergen)
	C)	Interferon alfa n3 (Alferon N)
	D)	Interferon beta 1a (Avonex)
	Ans:	C
	Feedback:
	Interferon alf n3 is used for intralesional treatment of warts. Interferon alfa 2a is used in the treatment of leukemia. Interferon alfacon 1 is used in the treatment of chronic hepatitis C infection in adults. Interferon beta 1a is used to treat multiple sclerosis in adults.

3.	A 30-year-old woman has been diagnosed with leukemia and will be using an immune modulator for treatment. What will be important to discuss with the patient when the nurse provides patient teaching about her treatment?
	A)	The need to continue oral contraceptives
	B)	The need to use barrier contraceptives while taking the drug
	C)	The need to avoid sexual intercourse while taking the drug
	D)	The importance of taking an aspirin daily to decrease the adverse effects of the drug
	Ans:	B
	Feedback:
	A patient taking an immune modulator would be advised to use barrier contraceptives to prevent pregnancy. The interaction of the immune modulator and the oral contraceptive may interfere with the oral contraceptive’s ability to work properly. Asking patients to avoid sexual intercourse is not necessary if barrier methods are properly used. Daily aspirin would not decrease adverse effects of this drug.

4.	The nurse has an order to administer oprelvekin (Neumega) to a patient for the first time. Before administering the drug, what allergy would the nurse want to specifically question the patient about?
	A)	Egg products
	B)	Escherichia coli–produced products
	C)	Lactose intolerance
	D)	Penicillin
	Ans:	B
	Feedback:
	The interleukins are produced using deoxyribonucleic acid technology and E. coli bacteria. Patients with known allergy to E. coli products should not receive oprelvekin. The allergies to penicillin, egg products, or lactose intolerance would not be of concern with this drug.

5.	The physician has decided to prescribe T- and B-cell suppressors for a patient diagnosed with psoriasis. What drug will be ordered for this patient?
	A)	Alefacept (Amevive)
	B)	Azathioprine (Imuran)
	C)	Cyclosporine (Neoral)
	D)	Glatiramer acetate (Copaxone)
	Ans:	A
	Feedback:
	Alefacept is prescribed for patients with severe chronic plaque psoriasis. Cyclosporine is used to suppress rejection in a variety of transplant situations. Azathioprine is used to treat patients with rheumatoid arthritis and in prevention of rejection in renal homotransplants. Tacrolimus is used for prevention of rejection after renal or liver transplantation.

6.	A patient who is receiving an immune suppressant has been admitted to the unit. What would be a priority action by the nurse?
	A)	Monitor nutritional status.
	B)	Provide patient teaching regarding the drug.
	C)	Protect the patient from exposure to infection.
	D)	Provide support and comfort measures in relation to adverse effects of the drug.
	Ans:	C
	Feedback:
	Patients taking immune suppressant drugs are more susceptible to infection because the patient’s normal body defenses will be diminished. As a result, the priority action by the nurse would to protect the patient from exposure to infection through room selection, good hand hygiene, and taking care to avoid exposure to sick staff members. Teaching will need to include avoiding crowded places and people with known infection and those working in soil. Nutritional status is important as are comfort and support measures and other instructions concerning the drug. However, protecting the patient from infection should be the priority action.

7.	A nurse is discussing interferon alfa 2b with a patient. What will the nurse encourage the patient to do while taking this drug?
	A)	To avoid crowds
	B)	To increase salt intake
	C)	To decrease milk intake
	D)	To eat three meals a day
	Ans:	A
	Feedback:
	Potential adverse effects in addition to the types of conditions interferon alfa 2b is prescribed to contribute to the need for the patient to take care to avoid people with infections so the patient should be taught to avoid crowds whenever possible. Adverse effects include dizziness, confusion, rash, dry skin, anorexia, nausea, bone marrow suppression, and flu-like syndrome. Salt, diet, and milk do not interfere with this drug.

8.	A 70-year-old patient with acute myelocytic leukemia is receiving sargramostim (Leukine). What is a priority nursing action for this patient?
	A)	Providing a quiet environment
	B)	Increasing fluids
	C)	Providing comfort measures related to nausea
	D)	Encouraging appropriate dietary intake
	Ans:	B
	Feedback:
	A common adverse effect of this drug is vomiting and diarrhea. Due to the patient’s age it would be important to keep him hydrated. Vomiting and diarrhea can cause dehydration quickly in the elderly. Providing a quiet environment and comfort measures for the nausea would be important but not as critical as increasing fluids. Diet is very important to this patient; however, usually this drug causes a loss of appetite. Therefore, increasing fluids would be extremely important to the patient’s nutritional status.

9.	The nurse is caring for a patient in the immediate postoperative period following cardiac transplantation who is receiving mycophenolate (CellCept) twice a day IV. What will the nurse teach the patient regarding drug therapy? (Select all that apply.)
	A)	“The drug will be given orally as soon as possible.
	B)	“Take the medication three times a day.”
	C)	“Avoid people with contagious diseases.”
	D)	“Ask a pharmacist about drug–drug interactions before taking any over-the-counter (OTC) drug.”
	E)	“Never miss a dose of medication.”
	Ans:	A, C, D, E
	Feedback:
	The nurse will explain that the IV medication will be changed to oral therapy when the patient is able to tolerate oral medications. The patient will take the medication twice a day, not three times a day. Care should be taken to never miss a dose. The patient should avoid other medications that are hepatotoxic or nephrotoxic due to a risk of increased toxicity so the patient should be taught to always consult a doctor or pharmacist before beginning an OTC drug. Patients who have immune suppression must be taught how to reduce risk of infection, including avoiding people with contagious diseases, such as colds or viruses.

10.	The nurse administers aldesleukin to a patient diagnosed with renal cell carcinoma. When assessing the patient a few days later, what abnormal findings would the nurse attribute to the medication? (Select all that apply.)
	A)	Increased lymphocyte count
	B)	Increased red blood cell count
	C)	Increased platelet count
	D)	Irregular pulse rate
	E)	Increased blood pressure
	Ans:	A, C, D
	Feedback:
	Aldesleukin activates human cellular immunity and inhibits tumor growth through increases in lymphocytes, platelets, and cytokines. Common adverse effects include hypotension, sinus tachycardia, arrhythmias, as well as pruritus, nausea, vomiting, diarrhea, anorexia, GI bleeding, bone marrow suppression, respiratory difficulties, fever, chills, pain, mental status changes, and dizziness. There is no impact on red blood cell count. It does not raise blood pressure.

11.	While studying for a pharmacology test, a student asks his peers about interferons. What statement about interferons is accurate?
	A)	They stimulate B-lymphocyte activity.
	B)	They interfere with multiplication of stem cells.
	C)	They stimulate growth and differentiation of lymphoid cells into lymphocytes.
	D)	They interfere with the ability of viruses in infected cells to replicate.
	Ans:	D
	Feedback:
	Interferons are substances naturally produced and released by human cells that have been invaded by viruses. They may also be released from cells in response to other stimuli, such as cytotoxic T-cell activity. Interferons do not stimulate B-lymphocyte activity, interfere with multiplication of stem cells, nor do they stimulate growth and differentiation of lymphoid cells into lymphocytes.

12.	How do immune suppressants work when ordered for a patient who has had an organ transplant?
	A)	Blocking normal effects of the immune system
	B)	Stimulating immune system to fight off infection
	C)	Working with corticosteroids to enhance healing
	D)	Working with corticosteroids to promote suppressor cells
	Ans:	A
	Feedback:
	Immune suppressants are used to block the normal effects of the immune system in cases of organ transplantation (in which non–self-cells are transplanted into the body and destroyed by the immune reaction) and in autoimmune disorders (in which the body’s defenses recognize self-cells as foreign and work to destroy them) in some cancers. Options B, C, and D are distracters for this question.

13.	A patient has just been told that her cancer has metastasized to her right kidney. An interferon (Aldesleukin) has been prescribed to treat this metastasis. The patient asks why this interferon is ordered. What is the nurse’s best response?
	A)	“Aldesleukin has been shown to protect autologous tumor cells.”
	B)	“Aldesleukin has been shown to inhibit tumor growth.”
	C)	“Aldesleukin has been shown to enhance allogeneic stem-cell transplantation.”
	D)	“Aldesleukin has been shown to have a direct proliferative effect on renal tumors.”
	Ans:	B
	Feedback:
	Aldesleukin is prescribed for metastatic renal cell carcinoma in adults and treatment of metastatic melanomas (orphan drug use) working by activating human cellular immunity and inhibiting tumor growth through increases in lymphocytes, platelets, and cytokines. Aldesleukin does not protect autologous tumor cells, enhance allogeneic stem-cell transplantation, or have a direct proliferative effect on renal tumors.

14.	The nurse admits a patient who was newly diagnosed with Kaposi’s sarcoma to the unit. The physician has ordered an IV infusion of an interferon. What drug would be appropriate?
	A)	Interferon beta1a
	B)	Interferon gamma 1b
	C)	Interferon alfa 2b
	D)	Peginterferon alfa 2b
	Ans:	C
	Feedback:
	Interferon alfa 2b indications include hairy cell leukemia, melanoma, AIDS-related Kaposi’s sarcoma, chronic hepatitis B and C infection, intralesional treatment of condyloma acuminatum in patients 18 years of age or older. No other interferons are indicated for treatment of Kaposi’s sarcoma.

15.	The pharmacology instructor is talking about interferon. The instructor explains that agents, such as interferons, have more than one biologic function. What are the functions of interferons? (Select all that apply.)
	A)	Antibacterial
	B)	Antiviral
	C)	Immunomodulatory
	D)	Antiproliferative
	E)	Anticancer
	Ans:	B, C, D
	Feedback:
	Interferons act to prevent virus particles from replicating inside the cells. They also stimulate interferon receptor sites on noninvaded cells to produce antiviral proteins, which prevent viruses from entering the cell. In addition, interferons have been found to inhibit tumor growth and replication, to stimulate cytotoxic T-cell activity, and to enhance the inflammatory response. Options A and E are incorrect.

16.	The nursing class is studying monoclonal antibodies. What monoclonal antibody reacts to human T cells, disabling them and acting as an immune suppressor?
	A)	Adalimumab
	B)	Cetuximab
	C)	Rituximab
	D)	Muromonab-CD3
	Ans:	D
	Feedback:
	Muromonab-CD3, the first monoclonal antibody approved for use, is a T-cell–specific antibody, that is available as an IV agent. It reacts as an antibody to human T cells, disabling the T cells, acting as an immune suppressor. Adalimumab is an antibody specific for human tumor necrosis factor. Cetuximab is an antibody specific to epidermal growth factor receptor sites. Rituximab is an antibody specific to sites on activated B lymphocytes.

17.	What monoclonal antibody is used to prevent respiratory syncytial virus (RSV) in high risk children?
	A)	Palivizumab
	B)	Natalizumab
	C)	Belimumab
	D)	Eculizumab
	Ans:	A
	Feedback:
	Palivizumab is specific to the antigenic site on respiratory syncytial virus (RSV); it inactivates that virus. It is used to prevent RSV disease in high-risk children. Natalizumab is an antibody specific to surface receptors on all leukocytes except neutrophils. Belimumab is a specific inhibitor of B-lymphocyte stimulator that inhibits the survival of B-lymphocytes and their differentiation into immune-globulin producing cells. Eculizumab binds to complement proteins and prevents the formation of the complement complex.

18.	The nurse is caring for a patient with an allograft transplant. The physician orders a monoclonal antibody to prevent rejection of the transplant. What monoclonal antibody would the nurse expect to be ordered?
	A)	Alemtuzumab
	B)	Daclizumab
	C)	Erlotinib
	D)	Omalizumab
	Ans:	B
	Feedback:
	Daclizumab is specific to interleukin-2 receptor sites on activated T lymphocytes; it reacts with those sites and blocks cellular response to allograft transplants. Alemtuzumab is an antibody specific for lymphocyte receptor sites used to treat chronic lymphocytic leukemia patients who have been treated with alkylating agents and have been failed by fludarabine therapy. Erlotinib is effective against specific malignant receptor sites. Omalizumab is an antibody to immunoglobulin E, an important factor in allergic reactions.

19.	The pharmacology instructor is explaining interleukins to the class. What would be the best definition of interleukins?
	A)	They are substances naturally produced and released by human cells that have been invaded by viruses.
	B)	They block the inflammatory reaction and decrease initial damage to cells.
	C)	They are chemicals used to communicate between leukocytes and stimulate immunity.
	D)	They attach to specific receptor sites and respond to very specific situations.
	Ans:	C
	Feedback:
	Interleukins are chemicals produced by T cells to communicate between leukocytes and stimulate cellular immunity and inhibit tumor growth. Immune suppressants block the inflammatory reaction and decrease initial damage to cells. Interferons are naturally produced and released by human cells that have been invaded by viruses. Monoclonal antibodies attach to specific receptor sites and respond to very specific situations.

20.	The nurse is caring for a female patient, aged 62, who has been admitted for treatment of metastatic melanoma. What agent would the nurse anticipate the physician is likely to order?
	A)	Aldesleukin
	B)	Interferon alfa 2b
	C)	Cyclosporine
	D)	Ipilimumab
	Ans:	D
	Feedback:
	Ipilimumab is a human cytotoxic T-cell antigen-4 blocking antibody. By blocking this site, T cells are activated and proliferate at a faster rate. It is used to treat patients with unresectable or metastatic melanoma. Aldesleukin is an interleukin, used for metastatic renal cell carcinoma in adults; a treatment of metastatic melanomas. Interferon alfa 2b is indicated for hairy cell leukemia, melanoma, AIDS-related Kaposi’s sarcoma, chronic hepatitis B and C infections, intralesional treatment of condyloma acuminatum in patients 18 years of age or older. Cyclosporine is a T and B cell suppressor and is indicated for prophylaxis for organ rejection in kidney, liver, and heart transplants (used with corticosteroids); treatment of chronic rejection in patients previously treated with other immunosuppressants; treatment of rheumatoid arthritis; and recalcitrant psoriasis.

21.	While studying the T- and B-cell immune suppressors, the nursing students learn that the most commonly used immune suppressant is what?
	A)	Cyclosporine (Sandimmune)
	B)	Azathioprine (Imuran)
	C)	Pimecrolimus (Elidel)
	D)	Glatiramer (Copaxone)
	Ans:	A
	Feedback:
	Several T- and B-cell immune suppressors are available for use. Of the numerous agents available, cyclosporine is the most commonly used immune suppressant. Options B, C, and D are all T- and B-cell immune suppressors, they are simply not the most commonly prescribed.

22.	What interleukin receptor antagonist would the nurse anticipate is most likely to be ordered for a patient, 25 years old, who has not responded to traditional antirheumatic drugs?
	A)	Natalizumab (Tysabri)
	B)	Anakinra (Kineret)
	C)	Eculizumab (Soliris)
	D)	Adalimumab (Humira)
	Ans:	B
	Feedback:
	Anakinra is used to reduce the signs and symptoms of moderately to severely active rheumatoid arthritis in patients 18 years of age and older who have not responded to the traditional antirheumatic drugs. Options A, C, and D are monoclonal antibodies, therefore they are incorrect answers.

23.	A patient with chronic hepatitis C has been prescribed peginterferon alfa 2b (PEG-INTRON). By what route would the nurse administer this drug?
	A)	Subcutaneously (SQ)
	B)	Intramuscularly (IM)
	C)	Intralesionally (IL)
	D)	Orally
	Ans:	A
	Feedback:
	PEG-INTRON, like many of the interferons, is administered subcutaneously. Avonex is given intramuscularly. Interferon alfa n3 is given intralesionally. There are no interferons given orally.

24.	The patient has arrived in the short stay unit for an infusion of tositumomab with 131 tositumomab (Bexxar). Before beginning the infusion, the nurse assesses the patient’s vital signs and finds the patient has a temperature of 101.5ºF, What is the nurse’s priority action?
	A)	Holding the infusion until patient is afebrile
	B)	Notifying the physician
	C)	Starting the infusion and inform the physician
	D)	Treating the fever before beginning the therapy
	Ans:	D
	Feedback:
	Monoclonal antibodies should be used cautiously with fever (treat the fever before beginning therapy). This makes Options A, B, and C incorrect.

25.	A 72-year-old male patient has arrived at the outpatient unit to receive an infusion of alemtuzumab (Compath). The patient tells the nurse this is the second time his chronic lymphocytic leukemia has relapsed and the second time he will receive this drug because he failed alemtuzumab therapy after being treated with an alkylating agent. What is the priority nursing action?
	A)	Calling the physician and questioning the order
	B)	Washing your hands
	C)	Beginning an intravenous infusion
	D)	Canceling the infusion
	Ans:	A
	Feedback:
	Monoclonal antibodies should be used cautiously in patients who have had previous administration of the monoclonal antibody (serious hypersensitivity reactions can occur with repeat administration). The nursing priority would be to question the order because the patient has already received alemtuzumab (Compath) previously and if the order is verified, this patient should be monitored very carefully, perhaps starting to infuse more slowly until the patient’s reaction can be determined. Only after questioning the order and having it verified would the nurse perform hand hygiene and begin the infusion.

26.	The nurse is writing a plan of care for a patient receiving immune suppressants for leukemia. What would be an appropriate nursing diagnosis for this patient?
	A)	Anxiety related to diagnosis and drug therapy
	B)	Acute pain related to central nervous system (CNS), gastrointestinal (GI), and flu-like effects
	C)	Risk for infection related to immune stimulation
	D)	Imbalanced nutrition: More than body requirements
	Ans:	B
	Feedback:
	Nursing diagnoses related to drug therapy might include: Acute pain related to CNS, GI, and flu-like effects. Anxiety related to diagnosis and drug therapy is a nursing diagnosis for a patient on an immune stimulant. There is no risk for infection related to immune stimulation unless an adverse effect occurs. Imbalanced nutrition would be less than body requirements due to flu-like symptoms resulting in diminished appetite.

27.	The nurse is preparing a patient to receive immunosuppressant drugs on an outpatient basis. What is the priority for the nurse to arrange for this patient in the home environment?
	A)	A caregiver who is skilled in cardiopulmonary resuscitation (CPR)
	B)	A caregiver who will provide adequate nutrition
	C)	Supportive care and comfort measures
	D)	Arrange for a home care nurse to administer injections
	Ans:	C
	Feedback:
	Arrange for supportive care and comfort measures for flu-like symptoms (rest, environmental control, acetaminophen) to decrease patient discomfort and increase therapeutic compliance. Patients may also need support and comfort measures related to diagnosis and drug therapy. Although knowledge of CPR and providing appropriate nutrition are always positive actions, they are not related to administration of immunosuppressants. The patient or caregiver can be taught to administer injections unless the medication is to be given IV, in which case the patient would go to an infusion center.

28.	The nurse is caring for a patient who has a diagnosis of chronic hepatitis B infection and has been prescribed an immune stimulant. After teaching the patient about the treatment plan, how might the nurse evaluate the effectiveness of teaching?
	A)	The patient can state where to go to get the medication.
	B)	The patient can state who will administer the medication.
	C)	The patient can state what positive effects to watch for.
	D)	The patient can state specific measures to avoid adverse effects.
	Ans:	D
	Feedback:
	The nurse would evaluate that the teaching plan was successful if the patient can name drug, dosage, adverse effects to watch for, and specific measures to avoid adverse effects. Knowing where to get the medication, who will administer it, and the positive effects to watch for would not be an adequate assessment of the teaching plan.

29.	The patient underwent an allograft renal transplant 48 hours earlier and is showing signs of rejection. What drug would the nurse expect the physician to order?
	A)	Muromonab
	B)	Anakinra
	C)	Mycophenolate
	D)	Sirolimus
	Ans:	A
	Feedback:
	Muromonab is indicated for the treatment of acute allograft rejection in patients undergoing renal transplantation. It also is indicated for the treatment of steroid-resistant acute allograft rejection in those receiving heart or liver transplants. Anakinra, mycophenolate, and sirolimus are useful for preventing renal or liver transplant rejection.

30.	The nurse, working with a nursing student, is caring for a patient who is to receive interleukins. The student nurse asks you what happens physiologically when a patient receives interleukins. What is the nurse’s best response?
	A)	“It really helps the patient!”
	B)	“The patient has increases in the number of natural killer cells.”
	C)	“The patient has decreased cytokine activity.”
	D)	“The patient gets really sick from flu-like symptoms and then they get better.”
	Ans:	B
	Feedback:
	When interleukins are administered, there are increases in the numbers of natural killer cells and lymphocytes, in cytokine activity, and in the number of circulating platelets. Options A, C, and D are incorrect.

31.	The nurse is caring for a child requiring cyclosporine to prevent rejection. Cyclosporine is given to adults using a dosage of 15 mg/kg. The nurse calculates the child’s dosage is 20 mg/kg. What is the nurse’s priority action?
	A)	Administer the drug.
	B)	Hold the dose and question the ordering provider.
	C)	Complete an incident report if this dosage has already been given before.
	D)	Notify the nursing supervisor of the medication error.
	Ans:	A
	Feedback:
	The nurse would administer the medication as ordered because doses larger than those given to adults are often needed when cyclosporine is administered to children. This is not an error so the nurse would not hold the drug, question the provider, complete an incident report, or notify the nursing supervisor.

32.	When caring for older adults receiving immune modulators, what are the nurse’s priorities of care? (Select all that apply.)
	A)	Assess carefully for infection.
	B)	Obtain baseline liver function studies and monitor follow-up studies.
	C)	Determine dosage based on renal and liver function.
	D)	Minimize teaching to avoid causing confusion.
	E)	Encourage the family to visit often, especially young children.
	Ans:	A, B, C
	Feedback:
	Older patients may be more susceptible to the effects of the immune modulators, partly because the aging immune system is less efficient and less responsive. These patients need to be monitored closely for infection, GI, renal, hepatic, and central nervous system effects. Baseline renal and liver function tests can help to determine whether a decreased dosage will be needed before beginning therapy. Because these patients are more susceptible to infection, they need to receive extensive teaching, not less teaching, about ways to avoid infection and injury. Contact with young children and large groups of people increase the risk of infection.

33.	The nurse teaches the female patient receiving immune modulating drugs about the need to use barrier contraceptives. The patient says, “I hate using barrier contraceptives. Why can’t I just take oral contraceptives?” What is the nurse’s best response?
	A)	“Effects of oral contraceptives may be altered by liver changes or changes in immune response.”
	B)	“Oral contraceptives increase the action of immune modulating drugs so dosage needs to be reduced.”
	C)	“Immune modulators make oral contraceptives ineffective because of hormonal impact of drugs.”
	D)	“Oral contraceptives are acceptable if barrier contraceptives are distasteful, but only high-estrogen pills can be used.”
	Ans:	A
	Feedback:
	The use of barrier contraceptives is advised because the effects of oral contraceptives may be altered by liver changes or by changes in the body’s immune response, potentially resulting in unexpected pregnancy. The other options conflict with this information and are incorrect.

34.	The nurse is caring for a young adult woman taking immune modulating medications who has been advised to use barrier contraceptives but she wants to start her family. What information can the nurse provide about these drugs to help this patient with her decision-making?
	A)	“Discuss the desire to start a family with the provider so risk can be minimized.”
	B)	“Immune modulating drugs will need to be discontinued if pregnancy occurs.”
	C)	“Immune modulating drugs have been proven to be highly teratogenic.”
	D)	“Pregnancy is not an option when taking immune modulating drugs but adoption is an option.”
	Ans:	A
	Feedback:
	If a patient taking immune modulators becomes pregnant or decides that she wants to become pregnant, she should discuss this with her health care provider and review the risks associated with use of the drug or drugs being taken. Monoclonal antibodies should be used with caution during pregnancy and lactation. Because results of long-term studies of most of these drugs are not yet available, it may be prudent to advise patients taking these drugs to avoid pregnancy if possible. Immune modulating drugs do not need to be discontinued, but the safest drug should be prescribed. Most immune modulating drugs have not been studied and there is not enough information to know whether they are teratogenic. The nurse cannot tell a patient that pregnancy is not an option.

35.	The nurse is caring for a patient diagnosed with rheumatoid arthritis (RA) who recently underwent a liver transplant. What immunosuppressant could this patient be prescribed that would treat both diagnoses?
	A)	Anakinra (Kineret)
	B)	Adalimumab (Humira)
	C)	Sirolimus (Rapamune)
	D)	Cyclosporine (Sandimmune)
	Ans:	A
	Feedback:
	Anakinra is used to prevent rejection after kidney or liver transplantation and also reduces signs and symptoms of RA in patients who have had inadequate response to other drugs. Adalimumab would be effective for the patient’s RA but would not prevent rejection of the transplanted liver. Sirolimus is used to prevent rejection of kidney transplants but would not be effective for either of the patient’s diagnoses. Cyclosporine would be appropriate to prevent liver rejection but would not treat RA.