Question 1

A patient is receiving bone marrow transplantation for cancer and receives filgrastim (Neupogen). The patient reports severe abdominal pain in the left upper quadrant. The nurse will perform which action?

A) Administer acetaminophen 650 mg.
B) Administer an antiemetic medication.
C) Report a potentially life-threatening event.
D) Request an order for cardiac enzyme levels.

Accepted Answer

Severe abdominal pain in the left upper quadrant can indicate a spleen injury or rupture, which is a potential life-threatening event in patients receiving filgrastim due to increased splenic size and possible rupture. The nurse should report this immediately to the healthcare provider for further evaluation and intervention. Administering acetaminophen or an antiemetic medication will not address the underlying issue and requesting cardiac enzyme levels is not indicated in this situation.

Question 2

Prior to administration of interferon alpha, the nurse will administer which medications?&#10;A) Acetaminophen and diphenhydramine&#10;B) Heparin and meperidine&#10;C) Lorazepam and furosemide&#10;D) Narcotic analgesics and loratadine

Accepted Answer

Acetaminophen and diphenhydramine are commonly given prior to administration of interferon alpha to decrease flu-like symptoms such as fever, chills, myalgia, headache, and fatigue. Heparin and meperidine are not indicated for pre-medication before interferon alpha administration. Lorazepam and furosemide are also not indicated for this purpose. Narcotic analgesics and loratadine may not adequately address the flu-like symptoms associated with interferon alpha therapy.

Question 3

The nurse is preparing to give sargramostim to a patient who has acute myelogenous leukemia. The nurse assesses a heart rate of 78 beats per minute and a blood pressure of 120/70 mm Hg. The patient reports shortness of breath and has a cough and bilateral crackles. What will the nurse do next?

A) Contact the provider; discuss giving a lower dose.
B) Contact the pharmacist; request a bronchodilator.
C) Contact the pharmacist; request an order for furosemide.
D) Contact the provider; suggest administration of antibiotics.

Accepted Answer

Sargramostim can cause pulmonary symptoms such as shortness of breath and cough. The presence of bilateral crackles indicates fluid accumulation in the lungs, which may worsen with the administration of sargramostim. The nurse should contact the provider to discuss giving a lower dose or holding the medication until the pulmonary symptoms have been evaluated and treated. Contacting the pharmacist to request a bronchodilator or furosemide may not address the underlying cause of the pulmonary symptoms. Antibiotics may be necessary if there is evidence of infection, but this is not the priority intervention in this situation.

Question 4

A patient is receiving interferon alpha (Roferon-A) subcutaneously. The patient experiences chills, fatigue, and malaise, and the nurse assesses a temperature of 102° F. The nurse will notify the provider of the temperature and will anticipate which order?

A) Administer acetaminophen (Tylenol).
B) Change to intravenous (IV) interferon alpha.
C) Give diphenhydramine (Benadryl).
D) Obtain a serum blood urea nitrogen (BUN) and creatinine level.

Accepted Answer

The patient is presenting with flu-like symptoms, which are common side effects of interferon alpha. The high fever indicates that the patient may be experiencing an adverse reaction to the medication. The nurse can administer acetaminophen to reduce the fever and provide comfort to the patient. Changing to IV interferon alpha or giving diphenhydramine would not address the patient's fever, and obtaining a BUN and creatinine level would not be necessary or relevant in this situation.

Question 5

A patient is receiving the erythropoietin-stimulating agent (ESA) epoetin alfa (Procrit). Which assessment finding would cause the nurse to notify the patient's provider?&#10;A) Blood pressure of 90/65 mm Hg&#10;B) Headache and nausea&#10;C) Hemoglobin >11 g/dL&#10;D) Infiltration of the IV

Accepted Answer

Erythropoietin-stimulating agents (ESAs) like epoetin alfa are used to treat anemia by stimulating red blood cell production. However, if the hemoglobin level rises above 11 g/dL, there is an increased risk of cardiovascular events and thrombosis, which necessitates notifying the healthcare provider.

Question 6

A patient who is receiving cancer chemotherapy has been ordered to receive epoetin alfa (Procrit) 150 units/kg 3 times weekly. The nurse reviews the patient's chart and notes a hemoglobin level of 10.9 g/dL. The nurse will perform which action?

A) Administer the medication as ordered.
B) Hold the dose and notify the provider.
C) Reduce the dose by 25%.
D) Request an order for an increased dose.

Accepted Answer

Epoetin alfa is a medication that stimulates the production of red blood cells and is typically given to patients with anemia, often caused by chemotherapy. However, this medication should only be administered if the patient's hemoglobin level is less than 10 g/dL. In this scenario, the patient's hemoglobin level is 10.9 g/dL, which is within the normal range. Therefore, the nurse should hold the dose and notify the provider to determine if the medication should be discontinued or the dose adjusted. Administering the medication could lead to adverse effects such as thromboembolic events, hypertension, and increased risk of mortality. Reducing the dose or requesting an increased dose is not appropriate in this situation.

Question 7

A patient with cancer is receiving aldesleukin. The patient reports black stools, which the nurse recognizes as:&#10;A) a sign of cancer metastasis.&#10;B) an indication of gastrointestinal bleeding.&#10;C) caused by inadequate hydration.&#10;D) renal failure.

Accepted Answer

Black stools are a sign of tarry stool or melena, which is a symptom of gastrointestinal bleeding. Aldesleukin can cause gastrointestinal bleeding as a side effect. It is important for the nurse to report this symptom to the healthcare provider immediately, as it can indicate a serious complication.

Question 8

A patient who has cancer will begin treatment with a colony-stimulating factor. The patient verbalizes understanding of why the drug is being used with which statement?&#10;A) &#34;This drug permit use of higher doses of chemotherapy.&#34;&#10;B) &#34;This drug has antitumor activity.&#34;&#10;C) &#34;This drug has cytotoxic effects.&#34;&#10;D) &#34;This drug has antiviral effects.&#34;

Accepted Answer

Colony-stimulating factors are used to stimulate the production of white blood cells (WBCs) in patients undergoing chemotherapy, which can otherwise lower WBC counts, leading to increased susceptibility to infections. By stimulating the production of more WBCs, the patient can receive higher doses of chemotherapy without increasing the risk of infection. Colony-stimulating factors do not have antitumor, cytotoxic, or antiviral effects.

Question 9

The nurse is preparing to administer interleukin-2 (aldesleukin) to a patient who has cancer. The patient reports shortness of breath. The nurse assesses clear breath sounds, a respiratory rate of 22 breaths per minute, a heart rate of 80 beats per minute, an oxygen saturation of 88% on room air, and a blood pressure of 92/68 mm Hg. The nurse will perform which action?

A) Administer the dose as ordered.
B) Administer oxygen while giving the dose.
C) Discuss permanently discontinuing this treatment with the provider.
D) Hold the dose and notify the provider.

Accepted Answer

The patient's shortness of breath and low oxygen saturation indicate potential respiratory distress. The nurse should hold the dose of interleukin-2 and notify the provider for further assessment and treatment. Administering the medication could worsen the patient's respiratory status and potentially cause harm. Administering oxygen alone may not be sufficient to manage the respiratory distress. Permanently discontinuing the treatment should be discussed with the provider, but it is not the immediate action to take in this situation.

Question 10

Which of the following is an indication for use of IFN-&#223;?&#10;A) Chronic granulomatous disease.&#10;B) Hairy cell leukemia.&#10;C) Multiple sclerosis.&#10;D) Kaposi sarcoma.

Accepted Answer

IFN-ß is indicated for the treatment of multiple sclerosis, as it has antiviral, immunomodulatory, and anti-inflammatory properties that can help reduce the frequency and severity of relapses in patients with MS. It is not indicated for chronic granulomatous disease, hairy cell leukemia, or Kaposi sarcoma.

Question 11

A patient has been receiving an ESA for 8 weeks. The nurse reviews the patient's chart and notes no increase in hemoglobin levels from 8 g/dL on week 3 of therapy. The nurse will request an order for which of the following?

A) a complete blood count and serum iron levels.
B) an increased dose of the ESA.
C) more frequent dosing of the ESA.
D) packed red blood cell infusions.

Accepted Answer

The answer of A patient has been receiving an ESA...

Deck 34: Biologic Response Modifiers