Question 1

A client has scabies and will be using permethrin 5% cream (Nix). What is the best instruction by the nurse?&#10;A) &#34;Leave the medication on the body for 24 hours.&#34;&#10;B) &#34;Apply the medication twice, so it can be more effective.&#34;&#10;C) &#34;Apply the medication topically to the affected area.&#34;&#10;D) &#34; Do not use on areas of skin that have abrasions, or inflammation.&#34;&#10;

Accepted Answer

Rationale 1: The medication does not need to be left on the body for 24 hours.
Rationale 2: One application of the medication should be sufficient.
Rationale 3: Telling the client to apply it topically is not specific enough.
Rationale 4:.Systemic absorption of permethrin is not desired.

Question 2

A client has a minor infection of the skin around the fingernails. What can the nurse suggest the client use for this infection?&#10;A) Bacitracin ointment&#10;B) Neomycin with polymyxin B (Neosporin) ointment&#10;C) Benzoyl peroxide (Benzac)&#10;D) Sulphacetamide&#10;E) Acyclovir (Zovirax)&#10;

Accepted Answer

Rationale 1: Bacitracin ointment is an over-the-counter medication for minor skin infections.
Rationale 2: Neomycin with polymyxin B (Neosporin) ointment is an over-the-counter medication for minor skin infections.
Rationale 3: This medication is used for acne.
Rationale 4: Sulphacetamide is used for rosacea.
Rationale 5: This medication is used for viral infections.

Question 3

A student nurse is preparing to administer methotrexate to a client with psoriasis. What does the student include in her care planning for this client?&#10;A) Use gloves when touching the pills&#10;B) Report any incidences of headache&#10;C) Take ASA if needed for pain&#10;D) Echinacea is advised to boost immune system&#10;

Accepted Answer

Rationale 1: Avoid skin exposure to the drug. Avoid inhaling drug particles.
Rationale 2: Headache is not an adverse effect of methotrexate.
Rationale 3: Acetylsalicylic acid (ASA [Aspirin]) may interfere with excretion of methotrexate, leading to increased serum levels and toxicity.
Rationale 4: The use of Echinacea is not advised, it may interfere with the drug's immunosuppressant
effects.

Question 4

The nurse is caring for an older client who has difficulty hearing because of suspected wax accumulation. What measures will the nurse take to help this client?&#10;A) Instil a cerumen emulsifier as prescribed prior to the irrigation.&#10;B) Warm the irrigating solution to normal body temperature.&#10;C) After instilling the irrigating solution, use a cotton-tipped applicator to gently dry the ear canal.&#10;D) Use a large-bore syringe to apply enough pressure to loosen the impacted cerumen.&#10;E) Pull the pinna up and back prior to instilling any medications.&#10;

Accepted Answer

Rationale 1: Cerumen emulsifiers used prior to irrigation can loosen and help remove impacted cerumen from the ear.
Rationale 2: Solutions placed in the ear should be warmed prior to instillation to prevent the client from experiencing dizziness.
Rationale 3: The risk of cerumen impaction increases with the use of cotton-tipped applicators.
Rationale 4: Ear irrigations should be done with gentle pressure.
Rationale 5: The pinna of adults should be gently pulled up and back prior to instilling ear medications.

Question 5

Nursing students are writing their final exam in pharmacology. A question asks why it is important to know about toxicology in relation to their practice. What is the best response by the student?&#10;A) Nurses have a role in preventing and managing of toxicity&#10;B) Nurses may be required to identify specific toxins and their antidotes.&#10;C) Poisoning is the third leading cause of hospitalizations in Canada&#10;D) Nurses will need to be prepared to set up field hospitals when needed.&#10;E) Nurses are responsible for mass vaccinations against viruses used for bioterrorism.&#10;

Accepted Answer

Rationale 1. Nurses play a key role in preventing and minimizing harm form toxicity.
Rationale 2. While it is important for nurses to have some knowledge in poisons and their antidotes, and the signs and symptoms of other toxins, it is not their responsibility to identify the specific toxin.
Rationale 3 Poisoning ranks as the third most frequent type of injury after falls and MVAs
Rationale 4. This is not the nurses responsibility, this is the responsibility of the National Emergency Stockpile System (NESS)
Rationale 5. Vaccinations are not administered for agents that might be used in bioterrorism, only for those considered to be at risk.

Question 6

A client has been diagnosed with stage 4 pancreatic cancer. The family asks the nurse what staging is. What is the nurse's response?&#10;A) &#34;Staging determines the location of the cancer.&#34;&#10;B) &#34;The involvement of lymph nodes is assessed during staging.&#34;&#10;C) &#34;Staging changes as the cancer progresses.&#34;&#10;D) &#34;The lower the stage of cancer at diagnosis, the better the prognosis.&#34;&#10;E) &#34;Staging examines cancerous cells under a microscope and compares them to normal cells.&#34;&#10;

Accepted Answer

Rationale 1: Staging does determine the location of the cancer.
Rationale 2: When solid tumours are staged, diagnostic testing also determines the involvement of the lymph nodes.
Rationale 3: Once a cancer is staged, the level does not change even if the cancer progresses.
Rationale 4: Clients with cancer at a lower stage have a better prognosis than those who are diagnosed at a higher stage.
Rationale 5: This describes cancer grading, not cancer staging.

Question 7

The nurse is preparing to administer methotrexate by mouth to a client with cancer. For what reasons would the nurse use the PO route rather than the other routes of administration?&#10;A) The PO route is more acceptable to the client.&#10;B) The PO route decreases the risk for phlebitis.&#10;C) The PO route decreases the risk for tissue necrosis.&#10;D) The PO route decreases the risk for nausea.&#10;E) The PO route decreases the risk for vomiting.&#10;

Accepted Answer

Rationale 1: The PO route is more acceptable to clients than the other routes of administration.
Rationale 2: Receiving chemotherapeutic agents by mouth rather than intravenously decreases the risk for phlebitis.
Rationale 3: Receiving chemotherapeutic agents by mouth rather than intravenously decreases the risk for tissue necrosis.
Rationale 4: Receiving chemotherapeutic agents by mouth does not decrease the risk for nausea.
Rationale 5: Receiving chemotherapeutic agents by mouth does not decrease the risk for vomiting.

Question 8

A female client has experienced alopecia due to chemotherapy. She is distraught and feels that no one will want to look at her. How can the nurse best address the client's concerns?&#10;A) Show the client photos of cancer survivors whose hair grew back more thickly&#10;B) Discuss the client's feelings about the effects of her hair loss&#10;C) Have a cancer survivor visit the client and discuss wearing a wig&#10;D) Tell the client that her hair will grow back in a few weeks&#10;

Accepted Answer

Rationale 1: Showing the client photos will not help, as her hair might not grow back more thickly.
Rationale 2: The client needs to discuss and explore the meaning of her hair loss to deal with her feelings.
Rationale 3: Having a cancer survivor visit is a good plan but is premature at this time.
Rationale 4: The client's hair will grow back, but this is not the most therapeutic plan.

Question 9

A student on the oncology is working with an experienced nurse preparing medications for administration. The student asks the nurse why she is gowning up to give Doxorubicin (Adriamycin). What is the best response of the nurse?

A) "I use full protective devices because the client is immunosuppressed."
B) "Clients are often nauseated, and may vomit during administration."
C) "This drug is highly toxic and can be absorbed through my skin."
D) "This medication must remain in a sterile state to maintain effectivemness."

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Accepted Answer

Rationale 1 While this may be true, it is not the most important reason the wear full PPD.
Rationale 2 This is not the reason why the nurse wears protective devices.
Rationale 3 The nurse must be extremely cautious when administering antitumour antibiotics. Doxorubicin is easily absorbed through the skin and by inhalation and may cause fetal death or birth defects as well as liver disease
Rationale 4 This is not the reason for the nurse wearing full protective devices.

Question 10

The nurse is speaking with a client recently diagnosed with cancer. He asks why he is receiving more than one drug to treat it over such a long period of time? What is the best response by the nurse?&#10;A) The other drugs are just for the side effects.&#10;B) It gives normal cells a chance to recover from the effects of the chemotherapy&#10;C) It decreases toxicity of medication.&#10;D) Different drugs attack certain stages of cancer cell growth&#10;E) It is necessary for when cancer metastasizes&#10;

Accepted Answer

Rationale 1 Combination therapy is common for treating particular cancers and are not just used for treatment of side effects.
Rationale 2 This gives normal cells time to recover from the adverse effects of the drugs and allows tumour cells that may not have been replicating at the time of the first dose to begin dividing and become more sensitive to the next round of chemotherapy
Rationale 3 Combination chemotherapy also allows for lower dosages of each individual agent, thereby reducing toxicity and slowing the development of resistance.
Rationale 4 Using multiple drugs affects the different stages of the cancer cell's life cycle and attacks the various clones within the tumour via several mechanisms of action, thus increasing the percentage of cell kill. 
Rationale 5 This is not a true statement.

Question 11

The nurse is preparing a teaching pamphlet on cancer prevention to distribute at the local health clinic Which of the following guidelines should the nurse include?&#10;A) Eliminate tobacco use and exposure to secondhand smoke&#10;B) Women should have periodic mammograms&#10;C) Choose a diet high in protein and complex carbohydrates&#10;D) Have periodic diagnostic testing performed at recommended intervals.&#10;E) Males between 9 and 26 years should be vaccinated for HPV&#10;

Accepted Answer

The answer of The nurse is preparing a teaching pamphlet...

Question 12

A client is in hospital for an infusion of doxorubicin (Adriamycin). What assessment finding would cause the nurse to immediately notify physician? A) Hematuria B) Angioedema C) Respiratory collapse D) Temperature of 39 ^oC

Accepted Answer

The answer of A client is in hospital for an...

Deck 23: Pharmacotherapy of Dermatologic Disorders