Free Learning NCLEX PN with Answers (Pharmacology) 76th Edition pdf doc

Free Learning NCLEX PN with Answers (Pharmacology) 76th Edition pdf doc

1. Cyclophosphamide (Cytoxan) is prescribed for a client with a diagnosis of breast cancer. The nurse has provided instructions to the client regarding the medication. Which statement by the client indicates an understanding of this chemotherapeutic regimen?

A. “I need to take the medication with food.”
B. “I need to avoid salt while taking this medication.”
C. “I need to eat a banana and drink a glass of orange juice every day.”
D. “I need to increase my fluid intake to 2000 to 3000 mL daily.”

Answer: D. “I need to increase my fluid intake to 2000 to 3000 mL daily.”

Rationale: Hemorrhagic cystitis is a toxic effect that can occur with the use of cyclophosphamide (Cytoxan). The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients should also monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication therefore the client would not be encouraged to increase potassium intake (bananas and orange juice). The client would not be instructed to alter their sodium intake.

Test-Taking Strategy: Focus on the name of the medication. Correlate cyclophosphamide with hemorrhagic cystitis to direct you to option D. Review the adverse effects of this medication if you had difficulty with this question.

Level of Cognitive Ability: Analysis
Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process/Evaluation
Content Area: Pharmacology
Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 272.

2. A client with carcinoma is admitted to the hospital for a chemotherapy treatment with intravenous bleomycin sulfate (Blenoxane). The nurse assisting in caring for the client understands that during administration of the bleomycin sulfate, which of the following would receive the highest priority?

A. Checking the peripheral pulses
B. Monitoring the heart rate
C. Monitoring the level of consciousness
D. Monitoring the respiratory status

Answer: D. Monitoring the respiratory status

Rationale: Bleomycin sulfate is an antineoplastic medication that can cause interstitial pneumonitis that can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor the respiratory status for dyspnea and rales that indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs.

Test-Taking Strategy: Note the key words “highest priority.” Eliminate options 1 and 2 first because they are similar in nature. From this point, use the ABCs, airway, breathing, and circulation and select option 4 because it relates to airway. Review the adverse effects of this medication if you had difficulty with this question.

Level of Cognitive Ability: Analysis
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Data Collection
Content Area: Pharmacology
Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 132.

3. A student nurse is caring for a client with lung cancer receiving chemotherapy. The client is receiving a high dose of methotrexate (Folex). The student nurse informs the nursing instructor that leucovorin (Citrovorum Factor, folinic acid) is also prescribed for the client. The instructor asks the student about the purpose of the leucovorin. Which statement by the student indicates a need to further research the purpose of the medication?

A. “It preserves normal cells.”
B. “It promotes DNA synthesis.”
C. “It is also known as leucovorin rescue.”
D. “Leucovorin bypasses the metabolic block caused by methotrexate.”

Answer: B. “It promotes DNA synthesis.”

Rationale: High concentrations of methotrexate cause harm and damage to normal cells. To save normal cells, leucovorin is given. This is known as leucovorin rescue. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting normal cells to synthesize. It should be noted that leucovorin rescue is potentially hazardous. Failure to administer leucovorin in the right dose at the right time can be fatal.

Test-Taking Strategy: Note the key words indicates a need to further research. These words indicate a false-response question, and that you need to select the incorrect student statement. Eliminate options 1 and 4 first because they are similar. Additionally, note the similarity between the words “leucovorin” in the question and in options 3 and D. If you had difficulty with this question, review leukovorin rescue.

Level of Cognitive Ability: Analysis
Client Needs: Physiological Integrity
Integrated Process: Teaching/Learning
Content Area: Pharmacology
Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 62C.

4. A client with tuberculosis is receiving cycloserine (Seromycin Pulvules) 250 mg orally twice daily. The nurse instructs the client to return to the clinic in 1 week for a blood test to measure the serum concentration of the medication. Which of the following instructions would the nurse provide to the client regarding this blood test?

A. “Take the morning dose and the blood test will be drawn 2 hours after the dose.”
B. “Hold the morning dose on the day of the scheduled blood test.”
C. “Hold the evening dose before the blood test and the dose scheduled for the morning of the test.”
D. “Double the dose on the evening before the test and hold the morning dose on the day of the test.”

Answer: A. “Take the morning dose and the blood test will be drawn 2 hours after the dose.”

Rationale: Cycloserine is an antitubercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity and other adverse effects. Peak concentrations measured 2 hours after dosing should be 25 to 35 mcg/mL. Options 2, 3, and 4 are incorrect.

Test-Taking Strategy: Knowledge regarding the toxicity associated with this medication and the serum drug levels that determine the therapeutic dosage is required to answer the question. Use general principles related to medication administration to eliminate options 3 and D. From the remaining options, it is necessary to know that the blood is drawn 2 hours after dosing. Review this medication if you are unfamiliar with it.

Level of Cognitive Ability: Application
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Implementation
Content Area: Pharmacology
Reference: Lehne, R. (2004). Pharmacology for nursing care (5th ed.). Philadelphia: W.B. Saunders, p. 947.

Source : NCLEX Questions and answer

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