A health care professional is caring for a patient who is about to begin taking mercaptopurine (purinethol) to treat leukemia. Which of the following instructions should the health care professional include when talking with the patient about the drug?

Use contraception if pregnancy is a risk is correct. Mercaptopurine, a purine analog, is a pregnancy risk category D drug. Women of childbearing age who take the drug should use contraception, and the health care professional should confirm non-pregnancy before starting therapy.

Perform oral hygiene frequently is correct. Mercaptopurine can cause stomatitis. The health care professional should tell the patient to perform frequent oral hygiene to help prevent or minimize this adverse effect.

Avoid activities that require mental alertness is incorrect. Mercaptopurine is unlikely to cause sedation or dizziness. Trastuzumab (Herceptin), a monoclonal antibody, is an immune system drug that can cause dizziness, which would warrant avoiding activities that require mental acuity.

Perform hand hygiene frequently is correct. Mercaptopurine can cause neutropenia. The health care professional should tell the patient either to wash hands thoroughly or use an alcohol-based hand rub frequently and to avoid crowds and contact with people who have communicable infections.

Avoid activities that can cause injury is correct. Mercaptopurine can cause thrombocytopenia. The health care professional should monitor patients’ CBC throughout treatment, and tell them to avoid activities that can cause injury and report easy or unexplained bruising or bleeding.

A health care professional is caring for a patient who is about to begin receiving cisplatin to treat testicular cancer. The health care professional should tell the patient to report which of the following adverse effects?

Paresthesias is correct. Cisplatin, a platinum compound, can cause peripheral neuropathy. The health care professional should tell the patient to report numbness, tingling, or decreased sensation in the hands or feet.

Sore throat is correct. Cisplatin can cause bone marrow depression. The health care professional should tell the patient to report fever, sore throat, bruising, or fatigue.

Flank pain is correct. Cisplatin can cause kidney toxicity. Prior to therapy, the health care professional should hydrate the patient with 1 to 2 L of IV fluid and continue for 24 hr following therapy to flush the kidneys and help prevent indications of kidney toxicity, such as flank pain.

Tinnitus is correct. Cisplatin can cause ototoxicity. The health care professional should monitor the patient’s hearing, and tell him to report hearing loss, vertigo, or tinnitus.

Conjunctivitis is incorrect. Cisplatin is unlikely to cause conjunctivitis, although it can cause blurred vision, papilledema, and optic neuritis.

While assessing a patient who is receiving interferon alfa-2a (Roferon-A) to treat Kaposi's sarcoma, the health care professional should check for which of the following possible indications of an adverse reaction?

Bradycardia

Dilated pupils

Fever

Constipation

Fever

Interferon alfa-2a, a biologic-response modifier, can cause a flu-like reaction, manifesting as fever, myalgia, and fatigue. For this effect, the health care professional should give the patient acetaminophen (Tylenol).

A health care professional should understand that enfuvirtide (Fuzeon) is an appropriate choice for patients who have which of the following?

Advanced prostate cancer

Primary brain tumors

Advanced HIV disease

Metastatic ovarian cancer

Advanced HIV disease

Enfuvirtide, a fusion inhibitor, treats HIV disease that is advanced or resistant to other types of treatment. Health care professionals should always give the drug along with other antiretroviral drugs.

A health care professional is caring for a patient who is receiving IV carmustine (BiCNU) to treat multiple myeloma. The health care professional should recognize that the patient is at the greatest risk for infection for which of the following lengths of time after the infusion?

24hr

1wk

2wks

4-6 wks

4 to 6 weeks

Carmustine, a nitrosourea drug, can cause delayed bone marrow suppression. Thrombocytes and leukocytes reach nadirs at 4 to 6 weeks following IV infusion. The patient should use hand hygiene often and wash fruits and vegetables thoroughly. It is crucial to avoid contact with crowds and people who have communicable infections.

A health care professional is caring for a patient who is about to begin intrathecal cytarabine (DepoCyt) therapy to treat meningeal leukemia. The health care professional should explain that the patient should also receive which of the following drugs to reduce the risk of neurotoxicity?

Diphenhydramine

Leucovorin

Folic acid

Dexamethasone

Dexamethasone

With the intrathecal form of cytarabine, the patient should also receive dexamethasone, a glucocorticoid, to help decrease the inflammation of the arachnoid that the drug can cause. IV dexamethasone reduces the patient’s risk for neurotoxicity.

A health care professional is caring for a patient who is about to begin taking tamoxifen (soltamox) to treat breast cancer. The health care professional should recognize the need for cautious use of the drug if the patient also has which of the following?

Cataracts

COPD

Diabetes mellitus

Alcohol use disorder

Cataracts

Tamoxifen, an estrogen-receptor blocker, can cause retinopathy, cataracts, and decreased visual acuity. Its use requires caution with patients who already have cataracts.

When talking to a patient who is about to begin vincristine therapy to treat lymphoma, the health care professional should include which of the following instructions?

Increase fiber intake.

Report tinnitus or vertigo.

Take the drug with 8 oz of water.

Allow 4 hr before taking an antacid.

Increase fiber intake.

Vincristine, a vinca alkaloid, can cause severe constipation and upper colon fecal impaction. The health care professional should monitor the patient’s bowel function and palpate the abdomen for distention. The patient should increase fluid and fiber intake, and take stool softeners.

A health care professional is caring for a patient who is about to begin taking imatinib (gleevec) to treat chronic myeloid leukemia. Which of the following instructions should the health care professional include when talking to the patient about taking the drug?

Clean fruits and vegetables thoroughly is correct. Imatinib, a targeted antineoplastic drug, can cause bone marrow suppression. The health care professional should tell the patient to clean fruits and vegetables carefully and completely to prevent transmission of bacteria.

Increase calcium intake is incorrect. Imatinib is more likely to cause hypokalemia than hypocalcemia or bone loss.

Weigh yourself daily is correct. Imatinib can cause fluid retention and weight gain. The health care professional should tell the patient to record daily weights and watch for edema.

Perform hand hygiene frequently is correct. Imatinib can cause bone marrow suppression. The health care professional should tell the patient to wash hands or use an alcohol-based hand rub frequently and prevent exposure to illness.

Avoid herbal supplements is correct. St John's wort can decrease imatinib levels. The health care professional should tell the patient to avoid herbal supplements and check with the primary care provider before taking any.

A health care professional is caring for a patient who is about to begin topotecan (Hycamtin) therapy to treat resistant, small-cell lung cancer. The health care professional should caution the patient about taking which of the following types of over-the-counter drugs while receiving the therapy?

Ibuprofen (Advil)

NSAIDs, anticoagulants, and antiplatelet drugs increase the patient’s risk for bleeding while receiving topotecan, a topoisomerase inhibitor. The health care professional should advise the patient against taking aspirin, ibuprofen (Advil), and other NSAIDs during the therapy.

health care professional is assessing a patient following a trastuzumab (Herceptin) infusion to treat metastatic breast cancer. Which of the following findings indicates an adverse reaction to the drug?

Wheezing

Dysrhythmias

Hypotension

FeverAscites

Wheezing is correct. Trastuzumab, a monoclonal antibody, can cause a severe allergic reaction, manifesting as hives, bronchospasm, dyspnea, and wheezing. The health care professional should have epinephrine ready to treat anaphylaxis.

Dysrhythmias is correct. Trastuzumab can cause cardiotoxicity, manifesting as ventricular dysfunction, heart failure, and dysrhythmias. The health care professional should monitor the patient’s ECG.

Hypotension is correct. Trastuzumab can cause a severe allergic reaction, manifesting as hives, dyspnea, hypotension, and hypoxia. The health care professional should have epinephrine ready to treat anaphylaxis.

Fever is correct. Trastuzumab can cause flu-like reactions, manifesting as fever, chills, nausea, and headache. The health care professional should monitor the patient’s temperature.

Ascites is incorrect. Trastuzumab is unlikely to cause ascites, although it can cause abdominal pain, nausea, and vomiting. The health care professional should monitor the patient’s fluid and electrolyte balance.

When talking with a patient who is about to begin methotrexate (trexall) therapy to treat non-Hodgkin lymphoma, the health care professional should include which of the following instructions?

Take echinacea supplements.

Use a soft-bristled toothbrush.

Take aspirin to reduce muscle pain.

Urinate every 4 hr.

Use a soft-bristled toothbrush.

Methotrexate, a folic acid antagonist, can cause severe bone marrow suppression with decreased thrombocyte counts and also oral and GI ulceration. Patients should use a soft-bristled toothbrush to prevent gum bleeding and mouth trauma.

A health care professional is caring for a patient who is about to start ritonavir (norvir) and zidovudine (retrovir) therapy to treat HIV-1. The health care professional should explain that the patient will receive ritonavir along with at least one reverse transcriptase inhibitor to

prevent drug resistance.

Give zidovudine, a nucleoside reverse transcriptase inhibitor, along with ritonavir, a protease inhibitor, to reduce the risk for drug resistance and to increase drug effectiveness. Monotherapy with zidovudine quickly results in drug resistance, as is also the case with monotherapy with ritonavir.

A health care professional should question the use of cyclophosphamide for a patient who has?

Dehydration

Cyclophosphamide, a nitrogen mustard, is contraindicated for patients who have a fluid-volume deficit because dehydration increases the risk for renal toxicity.

A health care professional is caring for a patient who is about to begin delavirdine (rescriptor) therapy to treat HIV-1. The health care professional should tell the patient to report which of the following adverse reactions to the drug?

Rash, Insomnia, Rhinitis, or Alopecia

Rash

Delavirdine, a non-nucleoside reverse transcriptase inhibitor, can cause a rash. The health care professional should tell the patient to report a rash, which can occur 1 to 3 weeks after therapy, because it can develop into Stevens-Johnson syndrome, a potentially life-threatening complication.

When considering drug therapy options for a patient who has metastatic breast cancer that is positive for human epidermal growth factor receptor 2 (HER2), the health care professional should choose which of the following drugs?

Trastuzumab (Herceptin)Imatinib (Gleevec)Leuprolide (Lupron)Flutamide

Trastuzumab (Herceptin)

Trastuzumab, a monoclonal antibody and a pregnancy risk category D drug, treats metastatic breast cancer with tumors that over express. This type accounts for up to 30% of metastatic breast tumors.

A health care professional should question the use of anastrozole (Arimidex) for a patient who is

allergic to salicylates.premenopausal.hearing impaired.immunocompromised.

premenopausal.

Anastrozole, an aromatase inhibitor, treats early or advanced estrogen receptor-positive breast cancer in postmenopausal women. It is contraindicated for women who are premenopausal as well as for women who are postmenopausal but are taking estrogen. Anastrozole stops tumor growth by inhibiting estrogen synthesis.

When caring for a patient who is receiving vincristine to treat lung cancer, the health care professional should monitor for which of the following findings that indicates an adverse effect?

Weak hand graspsConstricted pupilsBradycardiaCrackles

Weak hand grasps

Vincristine, a vinca alkaloid, can cause peripheral neuropathy. The health care professional should monitor deep-tendon reflexes and the strength and movement of the hands and feet. The health care professional should tell the patient to report paresthesias or reduced sensation in the hands or feet.

Unless there are any specific contraindications, which of the following immunizations should adults receive once each year?

VaricellaTetanusInfluenzaHepatitis B

Influenza

All adults should receive the seasonal influenza immunization once per year. All children 6 months older and older adults should also receive this immunization once per year.

A health care professional should question the use of maraviroc (selzentry) for a patient who has which of the following?

Diabetes mellitusMeningeal infectionPancreatitisNon-chemokine receptor 5 (CCR5)-tropic HIV-1

Non-chemokine receptor 5 (CCR5)-tropic HIV-1

Maraviroc, a CCR5 antagonist, acts by binding to CCR5 and preventing HIV-1 from entering the cell. It is only effective for patients who have CCR5-tropic HIV-1. It is contraindicated for those who do not have CCR5-tropic HIV-1.

A health care professional is about to administer IV paclitaxel (taxol) to a patient who has ovarian cancer. Which of the following actions should the health care professional take?

Give the patient an antihistamine.Infuse the drug over 1 hr.Administer the drug through non-PVC tubing.Use an in-line filter.Add heparin to the paclitaxel solution.

Give the patient an antihistamine is correct. Prior to administering paclitaxel, an antimitotic drug, the health care professional should give the patient an antihistamine, such as diphenhydramine, a proton-pump inhibitor, such as cimetidine (Tagamet), and a glucocorticoid, such as dexamethasone, to prevent a hypersensitivity reaction.

Infuse the drug over 1 hr is incorrect. The health care professional should infuse paclitaxel over 3 hr, not 1 hr.

Administer the drug through non-PVC tubing is correct. Paclitaxel is incompatible with PVC tubing. Paclitaxel (Abraxane) is compatible with PVC tubing.

Use an in-line filter is correct. Paclitaxel requires administration through an in-line filter. Paclitaxel (Abraxane) does not require an in-line filter.

Add heparin to the paclitaxel solution is incorrect. The health care professional should not mix paclitaxel with any other drugs. Heparin and other anticoagulants increase the risk for bleeding.

A health care professional should understand that raltegravir (Isentress) treats patients who have which of the following?

Hairy cell leukemiaThyroid cancerKaposi's sarcomaResistant HIV disease

Resistant HIV disease

Raltegravir, an integrase inhibitor, along with other antiretroviral drugs, treats HIV disease that is resistant to other drugs. Health care professionals should always give the drug along with other antiretroviral drugs.

A health care professional is caring for a patient who is about to begin maraviroc (selzentry) therapy. The health care professional should tell the patient to report which of the following adverse effects of the drug?

ParesthesiasCoughTinnitusJaundiceFever

Paresthesias is correct. Maraviroc, a chemokine receptor 5 antagonist, can cause paresthesias, dizziness, and musculoskeletal pain.

Cough is correct. Maraviroc can cause a cough and upper respiratory infection.

Tinnitus is incorrect. Maraviroc is unlikely to cause tinnitus. Cisplatin, a platinum compound, is an immune system drug that can cause ototoxicity and hearing loss.

Jaundice is correct. Maraviroc can cause liver damage. The health care professional should tell the patient to report an allergic reaction, such as a rash, because it can precede liver damage, manifested as jaundice or abdominal pain.

Fever is correct. Maraviroc can cause a fever and sinus infection.

When caring for a patient who is taking flutamide to treat prostate cancer, the health care professional should monitor the patient for which of the following adverse effects of the drug?

​Dehydration

​Gynecomastia

​Constipation

​Tachycardia

​Gynecomastia

Flutamide, an androgen receptor blocker, treats early and metastatic prostate cancer. It can cause gynecomastia, or growth of breast tissue, decreased libido, and impotence.

A health care professional is about the administer enfuvirtide (Fuzeon) to a patient. The health care professional should perform which of the following actions?

Administer the drug subcutaneously.Discard unused portion.Roll the vial gently to reconstitute the solution.Inject the solution at room temperature.Expect a cloudy solution.

Administer the drug subcutaneously is correct. The health care professional should administer enfuvirtide, a fusion inhibitor, subcutaneously, twice a day. This is the only appropriate route of administration for the drug.

Discard unused portion is incorrect. The health care professional should refrigerate the unused portion. The health care professional should also warm the solution to room temperature prior to giving the next dose out of the vial.

Roll the vial gently to reconstitute the solution is correct. The health care professional should roll the vial of enfuvirtide gently between the palms of the hands after adding sterile water for injection. This reconstitutes the drug.

Inject the solution at room temperature is correct. The health care professional may store unused solutions of enfuvirtide in a refrigerator up to 24 hr but must restore it to room temperature before injection.

Expect a cloudy solution is incorrect. Enfuvirtide should be clear and without particulates after reconstitution. The health care professional should not administer a cloudy solution.