Question

A patient diagnosed with breast cancer will have radiation therapy and then begin chemotherapy. Drug therapy will consist of a combination of doxorubicin, cyclophosphamide, and paclitaxel. What should the nurse include in the patient's teaching plan concerning the drug therapy? Select TWO (2) that apply.

Answer 1

Correct Answers:

Avoid large crowds and public places whenever possible
Take special care when shaving or brushing their teeth

Rationale :

🦠These chemotherapy agents can cause myelosuppression and neutropenia, which increase susceptibility to infection; avoiding crowds and people who are ill is an appropriate protective strategy during periods of reduced neutrophil counts.

🩸Thrombocytopenia can also occur during cytotoxic chemotherapy, increasing the patient's risk for bruising and bleeding.

🪥Clients at increased bleeding risk should use a soft toothbrush and exercise special care with oral hygiene to avoid traumatizing the gums.

🪒Using an electric shaver rather than a blade razor is also recommended when platelet suppression increases the risk of bleeding from minor cuts.

📌Core Message:

Chemotherapy-associated neutropenia and thrombocytopenia make infection avoidance and careful bleeding precautions essential patient teaching.

Answer 2

Correct Answers:

Monitoring the patient's urine output for signs of hematuria

Rationale :

🛡️Mesna is a cytoprotective medication specifically used to reduce the incidence of ifosfamide-induced hemorrhagic cystitis.

🩸Ifosfamide metabolites can injure the urinary bladder, producing hemorrhagic cystitis and hematuria.

🚽The absence or reduction of blood in the urine provides evidence that mesna is achieving its intended uroprotective effect.

💧Monitoring urinary findings is therefore more directly related to mesna effectiveness than gastrointestinal symptoms or pain assessment.

📌Core Message:

Mesna protects the urinary bladder from ifosfamide-induced hemorrhagic cystitis, so monitoring for hematuria evaluates its therapeutic effectiveness.

Answer 3

Correct Answers:

Probenecid

Rationale :

💊IV cidofovir must be administered with probenecid according to its prescribing information.

🛡️Probenecid reduces renal tubular exposure to cidofovir, helping decrease the substantial risk of cidofovir-associated nephrotoxicity.

💧Cidofovir therapy also requires intravenous saline prehydration as an additional nephroprotective measure.

🧪Because renal toxicity is a major dose-limiting concern with cidofovir, these protective interventions are integral to safe administration.

📌Core Message:

IV cidofovir is administered with probenecid and saline hydration to reduce the risk of serious nephrotoxicity.

Answer 4

Correct Answers:

Digoxin

Rationale :

💊This is a legacy pharmacology test-bank item whose expected answer is digoxin because older nursing references describe systemic azole antifungals as capable of increasing serum concentrations of interacting medications, including digoxin.

⚠️The intended teaching concept is that fluconazole inhibits drug-metabolizing pathways and therefore requires medication-interaction review when used with drugs having narrow therapeutic ranges.

📋Current fluconazole labeling documents numerous clinically important drug interactions, although digoxin is not prominently listed as a specific major interaction in the current label.

💧Current labeling also notes that hydrochlorothiazide increases fluconazole concentrations by about 40%, but specifically states that this magnitude does not normally require a fluconazole dosage change.

📌Core Message:

The exam-expected answer is digoxin, reflecting the broader principle that systemic azoles require careful review for clinically significant drug interactions.

Answer 5

Correct Answers:

Consult a drug guide to check for interactions

Rationale :

💊When multiple medications are scheduled together, the nurse should first determine whether there are clinically significant drug-drug interactions or compatibility concerns before administration.

🔍Medication safety requires nurses to assess for interactions, allergies, contraindications, and relevant clinical findings before giving the drugs.

🛡️Identifying an important interaction before medication preparation or administration can prevent avoidable adverse drug events.

📚A reliable drug reference therefore provides essential safety information before proceeding with the remaining medication-administration steps when several drugs are due simultaneously.

📌Core Message:

When several medications are due together, first verify drug interactions and compatibility before proceeding with administration.

Answer 6

Correct Answers:

1

Rationale :

💊The prescribed methylphenidate dose is 5 mg, and each available scored tablet contains 5 mg.

🧮The required calculation is 5 mg ÷ 5 mg/tablet, which produces 1 tablet.

✅Because the available tablet contains the exact prescribed dose, no tablet splitting is necessary.

📋The nurse should therefore administer 1 tablet for the ordered 5-mg dose.

📌Core Message:

When the prescribed and available strengths are both 5 mg, the correct dose is one tablet.

Answer 7

Correct Answers:

Unusual bruising and bleeding

Rationale :

🩸Unusual bruising or bleeding can indicate a serious systemic adverse reaction and warrants prompt healthcare-provider evaluation in a patient receiving systemic antifungal therapy.

🧪Systemic antifungal medications can produce significant hepatic or hematologic toxicity, depending on the specific agent, making unexpected bleeding clinically important.

🚨The exam item specifically uses unexplained bruising and bleeding as a warning manifestation requiring immediate reporting rather than routine monitoring.

🩺Prompt reporting allows assessment of liver function, coagulation status, and blood counts when clinically indicated.

📌Core Message:

Unexpected bruising or bleeding during systemic antifungal therapy requires prompt evaluation for potentially serious toxicity.

Answer 8

Correct Answers:

Take the medication on an empty stomach

Rationale :

💊Oral tetracycline absorption is reduced by food and certain dairy products, so administration away from meals improves absorption.

🥛Calcium-containing dairy products can bind tetracycline and interfere with gastrointestinal absorption.

💧Tetracycline capsules should also be taken with an adequate amount of water to reduce the risk of esophageal irritation and ulceration.

⏰Therefore, taking tetracycline on an empty stomach with sufficient water is the best instruction among the choices.

📌Core Message:

Oral tetracycline should be taken on an empty stomach with adequate water, while dairy products should be separated because they impair drug absorption.

Answer 9

Correct Answers:

245

Rationale :

🧮First determine the required volume using 671 mg ÷ 486 mg × 68 mL, which gives approximately 93.88 mL.

⏱️The prescribed infusion duration is 23 minutes, which must be converted when determining an hourly pump rate.

💧The rate calculation is 93.88 mL ÷ 23 minutes × 60 minutes/hour, which produces approximately 244.92 mL/hr.

✅Rounding to the nearest whole number gives 245 mL/hr.

📌Core Message:

The prescribed penicillin dose requires approximately 93.88 mL over 23 minutes, producing an IV pump setting of 245 mL/hr.

Answer 10

Correct Answers:

Monitor the urinalysis result

Rationale :

🚽Cyclophosphamide can cause hemorrhagic cystitis, hematuria, and other urinary-tract toxicity, making urinary assessment a major safety priority.

🩸Current prescribing information recommends regular examination of urinary sediment for erythrocytes and other evidence of urotoxicity.

💧Adequate hydration, frequent bladder emptying, and forced diuresis when appropriate can help decrease the frequency and severity of bladder toxicity.

🚨Because hemorrhagic cystitis can become severe or even fatal, monitoring urinalysis takes priority among the listed interventions.

📌Core Message:

Cyclophosphamide can cause hemorrhagic cystitis, making urinalysis monitoring for hematuria and urinary toxicity a priority nursing intervention.

2 :
The patient is taking ifosfamide as a component of cancer treatment, and the patient's oncologist has just added mesna to the patient's medication regimen. How should the nurse best assess for the therapeutic effects of mesna?

3 :
The nurse is caring for a patient who is receiving IV cidofovir. The nurse should anticipate administering what other drug with cidofovir?

4 :
The nurse is reviewing the patient's medication regimen and sees that fluconazole has been prescribed. The nurse recognizes that they should question the healthcare provider if the patient is also taking which medication?

5 :
A nurse is caring for a patient who is scheduled to receive three medications at the same time. What action should the nurse perform FIRST?

6 :
The client has an order for methylphenidate (Ritalin) 5 mg orally. The medication available is methylphenidate 5 mg per scored tablet. How many tablets will the nurse administer? tab (If needed, round to the nearest whole number.)

7 :
The nurse is teaching the patient about a newly prescribed systemic antifungal drug. What sign or symptom should the nurse instruct the patient to report to the healthcare provider immediately?

8 :
The nurse is providing discharge teaching to a patient who is being sent home on oral tetracycline. What instructions should the nurse include?

9 :
The client has an order for penicillin 671 mg IV to infuse over 23 minutes. The medication available is penicillin 486 mg/68 mL NS. At what rate will the nurse set the infusion? _mL/hr (If needed, round to the nearest whole number)

10 :
The nurse is caring for a patient receiving cyclophosphamide. What is the priority nursing action for this patient?

2 : The patient is taking ifosfamide as a component of cancer treatment, and the patient's oncologist has just added mesna to the patient's medication regimen. How should the nurse best assess for the therapeutic effects of mesna?

3 : The nurse is caring for a patient who is receiving IV cidofovir. The nurse should anticipate administering what other drug with cidofovir?

4 : The nurse is reviewing the patient's medication regimen and sees that fluconazole has been prescribed. The nurse recognizes that they should question the healthcare provider if the patient is also taking which medication?

5 : A nurse is caring for a patient who is scheduled to receive three medications at the same time. What action should the nurse perform FIRST?

6 : The client has an order for methylphenidate (Ritalin) 5 mg orally. The medication available is methylphenidate 5 mg per scored tablet. How many tablets will the nurse administer? tab (If needed, round to the nearest whole number.)

7 : The nurse is teaching the patient about a newly prescribed systemic antifungal drug. What sign or symptom should the nurse instruct the patient to report to the healthcare provider immediately?

8 : The nurse is providing discharge teaching to a patient who is being sent home on oral tetracycline. What instructions should the nurse include?

9 : The client has an order for penicillin 671 mg IV to infuse over 23 minutes. The medication available is penicillin 486 mg/68 mL NS. At what rate will the nurse set the infusion? _mL/hr (If needed, round to the nearest whole number)

10 : The nurse is caring for a patient receiving cyclophosphamide. What is the priority nursing action for this patient?

2 :
The patient is taking ifosfamide as a component of cancer treatment, and the patient's oncologist has just added mesna to the patient's medication regimen. How should the nurse best assess for the therapeutic effects of mesna?

3 :
The nurse is caring for a patient who is receiving IV cidofovir. The nurse should anticipate administering what other drug with cidofovir?

4 :
The nurse is reviewing the patient's medication regimen and sees that fluconazole has been prescribed. The nurse recognizes that they should question the healthcare provider if the patient is also taking which medication?

5 :
A nurse is caring for a patient who is scheduled to receive three medications at the same time. What action should the nurse perform FIRST?

6 :
The client has an order for methylphenidate (Ritalin) 5 mg orally. The medication available is methylphenidate 5 mg per scored tablet. How many tablets will the nurse administer? tab (If needed, round to the nearest whole number.)

7 :
The nurse is teaching the patient about a newly prescribed systemic antifungal drug. What sign or symptom should the nurse instruct the patient to report to the healthcare provider immediately?

8 :
The nurse is providing discharge teaching to a patient who is being sent home on oral tetracycline. What instructions should the nurse include?

9 :
The client has an order for penicillin 671 mg IV to infuse over 23 minutes. The medication available is penicillin 486 mg/68 mL NS. At what rate will the nurse set the infusion? _mL/hr (If needed, round to the nearest whole number)

10 :
The nurse is caring for a patient receiving cyclophosphamide. What is the priority nursing action for this patient?