NCLEX Pharmacology Quiz 6 (10 Items)

1.

The primary complication of a central venous access device (CVAD) is:
- A.
  
  Thrombus formation in the vein.
- B.
  
  Pain and discomfort.
- C.
  
  Infection.
- D.
  
  Occlusion of the catheter as the result of an intra-lumen clot.
Correct Answer
C. Infection.

Explanation
A foreign body in a blood vessel increases the risk of infection. Catheters that come outside the body have an even higher risk of infection. Most infections are caused by skin bacteria. Other infective organisms include yeasts and fungi. Options 1 and 4 are complications of a CVAD but are not the primary problem. Once placed. these lines do not cause pain and discomfort.

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2.

Nurse Blessy is doing some patient education related to a patient’s central venous access device. Which of the following statements will the nurse make to the patient?
- A.
  
  “These type of devices are essentially risk free.”
- B.
  
  “These devices seldom work for more than a week or two necessitating replacement.”
- C.
  
  “The dressing should only the changed by your doctor.”
- D.
  
  “Heparin in instilled into the lumen of the catheter to decrease the risk of clotting.”
Correct Answer
D. “Heparin in instilled into the lumen of the catheter to decrease the risk of clotting.”

Explanation
A solution containing heparin is used to reduce catheter clotting and maintain patency. The concentration of heparin used depends on the patient’s age. comorbidities. and the frequency of catheter access/flushing. Although patients have few complications. the device is not risk free. Patients may develop infection. catheter clots. vascular obstruction. pneumothorax. hemothorax. or mechanical problems (catheter breakage). Strict adherence to protocol enhances the longevity of central access devices. They routinely last weeks to months and sometimes years. The patient will be taught how to perform dressing changes at home.

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3.

The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they:
- A.
  
  Cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA.
- B.
  
  Have few. if any. side effects.
- C.
  
  Are used to treat multiple types of cancer.
- D.
  
  Are cell cycle-specific agents.
Correct Answer
A. Cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA.

Explanation
Alkylating agents are highly reactive chemicals that introduce alkyl radicals into biologically active molecules and thereby prevent their proper functioning. replication. and transcription. Alkylating agents have numerous side effects including alopecia. nausea. vomiting. and myelosuppression. Nitrogen mustards have a broad spectrum of activity against chronic lymphocytic leukemia. non-Hodgkin’s lymphoma. and breast and ovarian cancer. but they are effective chemotherapeutic agents because of DNA cross-linkage. Alkylating agents are noncell cycle-specific agents.

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4.

Hormonal agents are used to treat some cancers. An example would be:
- A.
  
  Thyroxine to treat thyroid cancer.
- B.
  
  ACTH to treat adrenal carcinoma.
- C.
  
  Estrogen antagonists to treat breast cancer.
- D.
  
  Glucagon to treat pancreatic carcinoma.
Correct Answer
C. Estrogen antagonists to treat breast cancer.

Explanation
Estrogen antagonists are used to treat estrogen hormone-dependent cancer. such as breast carcinoma. A well-known estrogen antagonist used in breast cancer therapy is tamoxifen (Nolvadex). This drug. in combination with surgery and other chemotherapeutic drugs reduces breast cancer recurrence by 30 percent. Estrogen antagonists can also be administered to prevent breast cancer in women who have a strong family history of the disease. Thyroxine is a natural thyroid hormone. It does not treat thyroid cancer. ACTH is an anterior pituitary hormone. which stimulates the adrenal glands to release glucocorticoids. It does not treat adrenal cancer. Glucagon is a pancreatic alpha cell hormone. which stimulates glycogenolysis and gluconeogenesis. It does not treat pancreatic cancer.

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5.

Chemotherapeutic agents often produce a certain degree of myelosuppression including leukopeniA. Leukopenia does not present immediately but is delayed several days to weeks because:
- A.
  
  The patient’s hemoglobin and hematocrit are normal.
- B.
  
  Red blood cells are affected first.
- C.
  
  Folic acid levels are normal.
- D.
  
  The current white cell count is not affected by chemotherapy.
Correct Answer
D. The current white cell count is not affected by chemotherapy.

Explanation
Epoetin alfa (Epogen. Procrit) is a recombinant form of endogenous erythropoietin. a hematopoietic growth factor normally produced by the kidney that is used to induce red blood cell production in the bone marrow and reduce the need for blood transfusion. Glucagon is a pancreatic alpha cell hormone. which cause glycogenolysis and gluconeogenesis. Fenofibrate (Tricor) is an antihyperlipidemic agent that lowers plasma triglycerides. Lamotrigine (Lamictal) is an anticonvulsant.

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6.

Currently. there is no way to prevent myelosuppression. However. there are medications available to elicit a more rapid bone marrow recovery. An example is:
- A.
  
  Epoetin alfa (Epogen. Procrit).
- B.
  
  Glucagon.
- C.
  
  Fenofibrate (Tricor).
- D.
  
  Lamotrigine (Lamictal).
Correct Answer
A. Epoetin alfa (Epogen. Procrit).

Explanation
Prostate tissue is stimulated by androgens and suppressed by estrogens. Androgen antagonists will block testosterone stimulation of prostate carcinoma cells. The types of cancer in options 2-4 are not androgen dependent.

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7.

Estrogen antagonists are used to treat estrogen hormone-dependent cancer. such as breast carcinomA. Androgen antagonists block testosterone stimulation of androgen-dependent cancers. An example of an androgen-dependent cancer would be:
- A.
  
  Prostate cancer.
- B.
  
  Thyroid cancer.
- C.
  
  Renal carcinoma.
- D.
  
  Neuroblastoma.
Correct Answer
A. Prostate cancer.

Explanation
Chemotherapy often induces vomiting centrally by stimulating the chemoreceptor trigger zone (CTZ) and peripherally by stimulating visceral afferent nerves in the GI tract. Ondansetron (Zofran) is a serotonin antagonist that blocks the effects of serotonin and prevents and treats nausea and vomiting. It is especially useful in single-day highly emetogenic cancer chemotherapy (for example. cisplatin). The agents in options 2-4 are selective serotonin reuptake inhibitors. They increase the available levels of serotonin.

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8.

Serotonin release stimulates vomiting following chemotherapy. Therefore. serotonin antagonists are effective in preventing and treating nausea and vomiting related to chemotherapy. An example of an effective serotonin antagonist antiemetic is:
- A.
  
  Ondansetron (Zofran).
- B.
  
  Fluoxetine (Prozac).
- C.
  
  Paroxetine (Paxil).
- D.
  
  Sertraline (Zoloft).
Correct Answer
A. Ondansetron (Zofran).

Explanation
With intrathecal administration chemotherapy is injected through the theca of the spinal cord and into the subarachnoid space entering into the cerebrospinal fluid surrounding the brain and spinal cord. The methods in options A. B. and D are ineffective because the medication cannot enter the CNS.

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9.

Methotrexate. the most widely used antimetabolite in cancer chemotherapy does not penetrate the central nervous system (CNS). To treat CNS disease this drug must be administered:
- A.
  
  Intravenously.
- B.
  
  Subcutaneously.
- C.
  
  Intrathecally.
- D.
  
  By inhalation.
Correct Answer
C. Intrathecally.

Explanation
Leucovorin is used to save or “rescue” normal cells from the damaging effects of chemotherapy allowing them to survive while the cancer cells die. Therapy to rapidly reduce the number of cancerous cells is the induction phase. Consolidation therapy seeks to complete or extend the initial remission and often uses a different combination of drugs than that used for induction. Chemotherapy is often administered in intermittent courses called pulse therapy. Pulse therapy allows the bone marrow to recover function before another course of chemotherapy is given.

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10.

Methotrexate is a folate antagonist. It inhibits enzymes required for DNA base synthesis. To prevent harm to normal cells. a fully activated form of folic acid known as leucovorin (folinic acid; citrovorum factor) can be administered. Administration of leucovorin is known as:
- A.
  
  Induction therapy.
- B.
  
  Consolidation therapy.
- C.
  
  Pulse therapy.
- D.
  
  Rescue therapy.
Correct Answer
B. Consolidation therapy.

Explanation
Prevent uric acid nephropathy. uric acid lithiasis. and gout during cancer therapy since chemotherapy causes the rapid destruction of cancer cells leading to excessive purine catabolism and uric acid formation. Allopurinol can induce myelosuppression and pancytopenia. Allopurinol does not have this function.

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NCLEX Pharmacology Quiz 6 (10 Items)

The primary complication of a central venous access device (CVAD) is:

Nurse Blessy is doing some patient education related to a patient’s central venous access device. Which of the following statements will the nurse make to the patient?

The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they:

Hormonal agents are used to treat some cancers. An example would be:

Chemotherapeutic agents often produce a certain degree of myelosuppression including leukopeniA. Leukopenia does not present immediately but is delayed several days to weeks because:

Currently. there is no way to prevent myelosuppression. However. there are medications available to elicit a more rapid bone marrow recovery. An example is:

Estrogen antagonists are used to treat estrogen hormone-dependent cancer. such as breast carcinomA. Androgen antagonists block testosterone stimulation of androgen-dependent cancers. An example of an androgen-dependent cancer would be:

Serotonin release stimulates vomiting following chemotherapy. Therefore. serotonin antagonists are effective in preventing and treating nausea and vomiting related to chemotherapy. An example of an effective serotonin antagonist antiemetic is:

Methotrexate. the most widely used antimetabolite in cancer chemotherapy does not penetrate the central nervous system (CNS). To treat CNS disease this drug must be administered:

Methotrexate is a folate antagonist. It inhibits enzymes required for DNA base synthesis. To prevent harm to normal cells. a fully activated form of folic acid known as leucovorin (folinic acid; citrovorum factor) can be administered. Administration of leucovorin is known as: