InstructiоnsReаd eаch questiоn cаrefully.Answer each questiоn by bubbling your answer on the Scantron answer sheet.After you have finished answering all questions, select TRUE.Click Finish Attempt at the bottom of the page.On the next page, click Submit All and Finish.If a confirmation message appears, click Submit All and Finish again to complete your submission.Once your assessment has been submitted successfully, notify your proctor that you are finished. Please wait for the proctor's instructions before proceeding to the next step.Chapters 29-31; 33-35 Key/Variation B ____ 1. What nursing intervention represents the priority action when verifying an anticancer drug order before administration? a. Administering the prescribed anticancer drug immediately and documenting any questions about the order after administration c. Preparing the chemotherapy medication in the patient's room to allow immediate administration after order verification b. Ensuring the drug order is complete and contacting the healthcare provider to clarify any incomplete or unclear orders d. Delegating the verification process to the pharmacy department while focusing on patient education about adverse effects ____ 2. What mechanism of action characterizes antimetabolites as anticancer drugs during the cell cycle? a. Antimetabolites interfere with substances needed for normal cell function during the S phase of DNA synthesis and metabolism c. Antimetabolites block peripheral conversion of androgens to estrogens in postmenopausal women with breast cancer b. Antimetabolites bind directly to DNA strands during any phase of the cell cycle including the dormant resting phase d. Antimetabolites cause mitochondrial damage to cardiac cells by preventing superoxide radical conversion back to oxygen ____ 3. A nurse is caring for a 58-year-old client who has been taking ethambutol for tuberculosis for 6 weeks. During a follow-up visit, the client reports difficulty distinguishing between red and green colors. What is the nurse's priority action? a. Document the finding as an expected side effect and reinforce the importance of medication adherence. c. Hold the next dose of ethambutol and notify the healthcare provider immediately for evaluation. b. Instruct the client to take the medication with food to minimize gastrointestinal absorption and reduce toxicity. d. Administer pyridoxine supplementation and continue ethambutol therapy with monthly vision screening. ____ 4. What mechanism describes the action of calcineurin inhibitors in transplant maintenance therapy? a. Preventing antigen presentation by interfering with major histocompatibility complex expression c. Binding to cytoplasmic proteins that inhibit calcineurin phosphatase and suppress T-lymphocyte proliferation b. Blocking antibody production by inhibiting B-lymphocyte differentiation and maturation processes d. Depleting lymphocyte populations through direct cytotoxic effects on activated immune cells ____ 5. What half-life characteristic differentiates basiliximab from antithymocyte globulin in rejection treatment pharmacokinetics? a. Basiliximab has a half-life of 36 days while ATG has a half-life of 18 hours c. Basiliximab has a half-life of 18 hours while ATG has a half-life of 36 days b. Basiliximab has a half-life of 2-3 days while ATG has a half-life of 7.2 days d. Basiliximab has a half-life of 7.2 days while ATG has a half-life of 2-3 days ____ 6. What is the primary clinical use of nystatin in antifungal therapy? a. Treatment of cryptococcal meningitis through intrathecal administration with penetration of the blood-brain barrier. c. Treatment of localized Candida infections through topical application or oral suspension with minimal systemic absorption. b. Treatment of systemic candidiasis through oral administration with high gastrointestinal absorption and distribution. d. Treatment of invasive aspergillosis through intravenous administration requiring close monitoring of renal function. ____ 7. What group of vaccine-preventable diseases includes infections that are routinely administered to healthy children in the United States? a. Rabies, tuberculosis, SARS-CoV-2, herpes zoster, and meningococcal disease for routine infant vaccination protocols c. Diphtheria, measles, mumps, rubella, and varicella for routine childhood immunization schedules from birth to age six b. Hepatitis A, influenza, human papillomavirus, tetanus, and polio for exclusive adolescent vaccination from ages seven to eighteen d. Anthrax, smallpox, Japanese encephalitis, yellow fever, and typhoid for routine childhood immunization schedules ____ 8. Which antibiotic class was specifically developed to overcome resistance in vancomycin-resistant Enterococcus faecium (VREF)? a. Oxazolidinones with reduced toxicity profiles c. Fluoroquinolones with improved tissue penetration b. Fourth-generation cephalosporins with enhanced activity d. Carbapenems with extended gram-positive coverage ____ 9. What severe adverse reaction is associated with bacitracin administration that requires monitoring during therapy? a. Hepatotoxicity with elevated liver enzymes and jaundice c. Cardiotoxicity with dysrhythmias and decreased cardiac output b. Pulmonary toxicity with decreased oxygen saturation and dyspnea d. Renal damage with decreased urine output and elevated creatinine ____ 10. What primary preventive measure is most effective in controlling malaria transmission in endemic regions? a. Implementation of insecticide-treated mosquito nets and environmental spraying to control the Anopheles mosquito vector. c. Distribution of vitamin supplements and nutritional support to enhance immune system resistance against Plasmodium parasites. b. Establishment of mandatory blood screening programs to identify and isolate individuals with asymptomatic tissue-phase infections. d. Administration of prophylactic antimalarial medications to all residents in high-risk geographic areas throughout the year. ____ 11. What adverse reaction is specifically associated with rifampin therapy that distinguishes it from other antitubercular medications? a. Development of peripheral neuropathy that requires prophylactic pyridoxine supplementation during therapy. c. Manifestation of ototoxicity and nephrotoxicity requiring close monitoring of auditory and renal function. b. Discoloration of body fluids to an orange color and potential permanent staining of soft contact lenses. d. Occurrence of optic neuritis requiring baseline and periodic ophthalmic examinations throughout treatment. ____ 12. A nurse is caring for a 45-year-old client receiving trimethoprim-sulfamethoxazole (TMP-SMZ) for a complicated urinary tract infection. On day 5 of therapy, the client reports severe fatigue, sore throat, and fever. Laboratory results reveal WBC 2,800/mm³, hemoglobin 9.2 g/dL, and platelets 85,000/mm³. What is the nurse's priority action? a. Document the findings as expected side effects and continue monitoring the client's vital signs. c. Obtain blood cultures before administering the next scheduled dose of the antibiotic as ordered. b. Hold the next dose of TMP-SMZ and notify the healthcare provider immediately of the findings. d. Administer acetaminophen for fever and encourage increased oral fluid intake to 3000 mL daily. ____ 13. What phase of the malaria parasitic life cycle is responsible for producing clinical symptoms of chills, fever, and sweating in infected individuals? a. The sporozoite phase when Plasmodium parasites are transmitted through the saliva of infected Anopheles mosquitoes. c. The erythrocytic phase when Plasmodium parasites invade red blood cells after completing the tissue invasion stage. b. The tissue phase when Plasmodium parasites invade body tissues following mosquito transmission to the human host. d. The gametocyte phase when Plasmodium parasites develop sexual forms that can infect feeding mosquito vectors. ____ 14. What nursing intervention represents a key strategy for promoting adherence in transplant recipients on complex drug regimens? a. Scheduling monthly telephone calls to verify prescription refill dates and pharmacy contact information c. Providing standardized written instructions about drug names and dosages at hospital discharge b. Documenting nonadherence episodes in the medical record for provider review at annual visits d. Incorporating education, motivational strategies, and coping skills into an individually tailored care plan ____ 15. What nursing practice reduces exposure to hazardous chemotherapy drugs during administration in outpatient settings? a. Delegating chemotherapy administration to unlicensed assistive personnel trained in basic medication safety procedures c. Following strict protocols established by the oncologist and health care agency when administering anticancer medications b. Administering chemotherapy drugs without gloves to maintain tactile sensation for accurate intravenous catheter placement d. Preparing anticancer medications in patient rooms to minimize transportation time and reduce drug degradation risks ____ 16. What dosing duration distinguishes basiliximab from muromonab-CD3 in rejection treatment protocols? a. Basiliximab requires 2 doses over 4 days while muromonab-CD3 requires daily dosing for 10-14 days c. Basiliximab requires weekly dosing for 4 weeks while muromonab-CD3 requires twice-daily dosing b. Basiliximab requires monthly maintenance dosing while muromonab-CD3 requires daily dosing indefinitely d. Basiliximab requires continuous infusion for 7 days while muromonab-CD3 requires single-dose therapy ____ 17. A nurse is providing discharge teaching to a client who will begin taking mefloquine for malaria prophylaxis before traveling to an endemic region. The client reports a history of anxiety disorder currently managed with sertraline. What is the nurse's priority teaching point? a. Expect temporary visual disturbances and tinnitus as common side effects that will resolve after completing the prophylactic regimen. c. Monitor for worsening anxiety, mood changes, or unusual thoughts and report these symptoms immediately to the healthcare provider. b. Discontinue sertraline 2 weeks before starting mefloquine to prevent serotonin syndrome and drug interaction complications. d. Take mefloquine with a full glass of water on an empty stomach to enhance absorption and therapeutic effectiveness. ____ 18. Which toxic reaction represents a serious neurologic complication of metronidazole therapy? a. Seizures and peripheral neuropathies c. Extrapyramidal symptoms with tremors and rigidity b. Optic neuritis with vision changes and blindness d. Ototoxicity with hearing loss and tinnitus ____ 19. What factor represents one of the top three reasons for transplant failure in organ recipients? a. Inadequate surgical technique during organ implantation with vascular complications and anastomotic issues c. Insufficient immunosuppression dosing during the initial hospitalization period following transplant surgery b. Nonadherence to the posttransplant regimen including drug therapy and health promotion activities d. Delayed recognition of hyperacute rejection episodes within the first 48 hours post-transplantation ____ 20. What information does the vaccine information statement (VIS) provide for each vaccine according to CDC guidelines? a. Route of administration, routine vaccine schedule, minimum dosing intervals, contraindications, and standing orders for vaccine administration c. Historical development timeline, clinical trial participant demographics, adverse event litigation records, and patent expiration dates b. State-specific legal requirements, parental consent documentation templates, religious exemption procedures, and school enrollment verification forms d. Manufacturer contact information, wholesale pricing data, insurance reimbursement codes, and pharmacy distribution networks for vaccine procurement ____ 21. What nursing assessment finding indicates a priority concern during bacitracin therapy? a. Slight elevation in body temperature within normal range variations c. Mild nausea with decreased appetite during medication administration b. Decreased urinary output with elevated blood urea nitrogen levels d. Transient dizziness upon standing with normal blood pressure readings ____ 22. A nurse is providing discharge teaching to a 52-year-old client prescribed metronidazole 500 mg orally three times daily for 7 days to treat bacterial vaginosis. The client mentions planning to attend a wedding reception this weekend. What is the most important information for the nurse to include in the teaching plan? a. Increase dietary intake of yogurt and probiotics to prevent antibiotic-associated diarrhea. c. Avoid consuming any alcoholic beverages during therapy and for 48 hours after completion. b. Take the medication with food or milk to minimize gastrointestinal upset and nausea. d. Use barrier contraception methods as metronidazole decreases oral contraceptive effectiveness. ____ 23. What electrolyte imbalance is most characteristic of amphotericin B toxicity during antifungal therapy? a. Hyperkalemia and hypermagnesemia requiring potassium and magnesium restriction during treatment. c. Hypercalcemia and hyperphosphatemia requiring calcium channel blockers and phosphate binders. b. Hypokalemia and hypomagnesemia requiring close monitoring and electrolyte replacement therapy. d. Hypocalcemia and hypophosphatemia requiring calcium and phosphate supplementation throughout therapy. ____ 24. A nurse is monitoring a 62-year-old client receiving quinupristin-dalfopristin intravenously for vancomycin-resistant Enterococcus faecium bacteremia. The client reports severe pain and burning at the peripheral IV site in the left forearm, and the nurse observes redness and swelling along the vein. What is the nurse's priority intervention? a. Document the findings as expected side effects and continue monitoring the infusion site. c. Slow the infusion rate to decrease venous irritation and apply a warm compress to the site. b. Stop the infusion immediately, remove the IV catheter, and notify the healthcare provider. d. Flush the IV line with normal saline and continue the infusion through the same site. ____ 25. What condition represents a contraindication to administering live attenuated vaccines to a patient? a. Convalescent phase of acute gastroenteritis and current treatment with over-the-counter antihistamines c. Immunosuppression from high-dose systemic corticosteroid therapy for treatment of autoimmune disease b. Mild upper respiratory infection with low-grade fever and antimicrobial therapy for acute otitis media d. Recent exposure to varicella-zoster virus in a household contact and history of premature birth at 34 weeks ____ 26. What characteristic of methicillin-resistant Staphylococcus aureus (MRSA) distinguishes it from standard penicillin-resistant strains? a. Resistance to all penicillins and cephalosporins through altered cell wall structure c. Resistance limited to methicillin while remaining sensitive to other penicillins b. Resistance that develops only in community settings rather than hospitals d. Resistance that responds effectively to first-generation cephalosporin therapy ____ 27. What serious neuropsychiatric adverse effect requires monitoring when mefloquine is dispensed with an FDA medication guideline? a. Occurrence of severe anxiety, depression, hallucinations, and suicidal thoughts that may continue after drug discontinuation. c. Manifestation of optic neuritis with color vision disturbances requiring baseline ophthalmic examinations. b. Development of peripheral neuropathy with paresthesias that may persist after discontinuation of therapy. d. Presentation of ototoxicity with cranial nerve VIII involvement causing hearing loss and vestibular dysfunction. ____ 28. What consideration is essential when administering doxorubicin to patients receiving anthracycline therapy? a. Assessing bilirubin levels and cardiac function due to reduced clearance and risk of mitochondrial damage to cardiac cells c. Administering the medication during the S phase of the cell cycle to maximize cytotoxic effects on rapidly dividing cells b. Monitoring for hemorrhagic cystitis as the primary dose-limiting toxicity requiring bladder irrigation and hydration protocols d. Evaluating testosterone levels in postmenopausal women to determine effectiveness of palliative breast cancer treatment ____ 29. Which bacterial organism demonstrates inherent resistance to penicillin G without prior drug exposure? a. Staphylococcus aureus producing penicillinase enzymes c. Pseudomonas aeruginosa through natural resistance mechanisms b. Streptococcus pyogenes with altered penicillin-binding proteins d. Enterococcus faecium after vancomycin exposure ____ 30. A nurse is caring for a 38-year-old client newly diagnosed with multidrug-resistant tuberculosis (MDR TB) after failing initial therapy with isoniazid and rifampin. Susceptibility testing confirms resistance to both medications. What medication regimen should the nurse anticipate the healthcare provider will prescribe? a. Monotherapy with streptomycin administered intramuscularly for 9 months with directly observed therapy. c. A combination of at least four drugs including levofloxacin, amikacin, ethambutol, and pyrazinamide. b. A two-drug regimen of ethambutol and pyrazinamide for an initial 2-month intensive phase. d. Continuation of isoniazid and rifampin at increased dosages with the addition of pyrazinamide. ____ 31. What adverse reaction requires immediate discontinuation of polymyxin therapy? a. Temporary skin flushing with mild pruritus at infusion site c. Respiratory paralysis with decreased respiratory effort and apnea b. Mild gastrointestinal upset with nausea and abdominal cramping d. Transient headache with dizziness during initial administration ____ 32. Which laboratory value requires close monitoring during colistimethate therapy due to its primary adverse effect? a. Serum potassium levels for electrolyte imbalances c. Serum creatinine levels for renal function impairment b. Liver enzyme levels for hepatotoxicity development d. White blood cell counts for bone marrow suppression ____ 33. What characteristic of sulfonamide pharmacokinetics contributes to their potential for drug-drug interactions with other highly protein-bound medications? a. Sulfonamides have poor oral bioavailability requiring parenteral administration routes. c. Sulfonamides are rapidly excreted unchanged without undergoing protein binding. b. Sulfonamides undergo extensive first-pass metabolism in the liver before distribution. d. Sulfonamides are highly protein-bound and compete for albumin binding sites. ____ 34. What term describes the use of chemicals to destroy cancer cells through systemic or localized administration? a. Cryotherapy refers to extreme cold application through liquid nitrogen to freeze and destroy abnormal tissue growth c. Radiotherapy refers to ionizing radiation delivered externally or internally to target malignant cells in specific body regions b. Immunotherapy refers to biologic response modifiers administered intravenously to stimulate the immune system against malignancies d. Chemotherapy refers to pharmaceutical agents used alone or combined with radiation and surgery to kill cancer cells ____ 35. What is the primary mechanism of action by which bacitracin exerts its antibacterial effect? a. Blocking bacterial protein synthesis at the ribosomal level c. Inhibiting bacterial cell wall synthesis and damaging the cell membrane b. Interfering with bacterial folic acid metabolism and nucleotide production d. Disrupting bacterial DNA synthesis and inhibiting cellular replication ____ 36. What characteristic distinguishes cell cycle–nonspecific anticancer drugs from cell cycle–specific anticancer drugs? a. Cell cycle–nonspecific drugs exert cytotoxic effects during the synthesis phase only and include antimetabolites and purine analogues c. Cell cycle–specific drugs act during the dormant resting phase and include most hormones and antitumor antibiotics b. Cell cycle–nonspecific drugs act during any phase of the cell cycle including the dormant phase and include alkylating drugs d. Cell cycle–specific drugs demonstrate activity against slow-growing tumors in gap zero phase and include nitrogen mustard agents ____ 37. What information should be included in patient teaching regarding the nadir period following chemotherapy administration? a. The nadir occurs immediately after chemotherapy infusion when nausea and vomiting symptoms are most severe and uncontrolled c. The nadir occurs during the first 24 hours after treatment when extravasation risk is highest and requires cold compresses b. The nadir occurs 3 to 4 weeks after treatment when hair loss becomes permanent and requires cosmetic intervention d. The nadir occurs 7 to 10 days after treatment when blood counts are lowest and infection risk is highest ____ 38. What is the primary mechanism of action that distinguishes azole antifungals from polyene antifungals? a. Azoles work by inhibiting fungal DNA synthesis, while polyenes prevent fungal cell wall formation by blocking beta-glucan synthesis. c. Azoles bind directly to ergosterol causing membrane disruption, while polyenes inhibit fungal protein synthesis at the ribosomal level. b. Azoles require intravenous administration for systemic infections, while polyenes can be administered orally with excellent absorption. d. Azoles inhibit cytochrome P450 to interfere with ergosterol formation, while polyenes bind directly to ergosterol in the fungal cell membrane. ____ 39. What characteristic distinguishes active immunity from passive immunity in vaccine administration? a. Active immunity transfers maternal antibodies through breast milk while passive immunity uses attenuated pathogens c. Active immunity stimulates antibody production by the recipient while passive immunity provides preformed antibodies b. Active immunity requires pooled human immunoglobulins while passive immunity uses toxoid vaccine formulations d. Active immunity provides immediate protection lasting weeks while passive immunity develops slowly over months ____ 40. What is the primary mechanism by which sulfonamides exert their bacteriostatic effect? a. Inhibiting bacterial synthesis of folic acid required for DNA and RNA production. c. Preventing bacterial acquisition of dietary folic acid from the host. b. Blocking bacterial ribosomal protein synthesis at the 30S subunit. d. Disrupting bacterial cell wall formation during the replication phase.
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