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A client has squamous cell cancer of the right lung that has metastasized to the brain. In addition to chemotherapy for lung cancer, the physician prescribes lomustine (CeeNU), 100 mg/m2 as a single dose, to treat the brain metastasis. What are the major administration and excretion routes of lomustine?
- A. Oral administration and urinary
- B. I.V. administration and urinary excretion
- C. I.V administration and fecal excretion
- D. Oral administration and fecal excretion
Correct Answer: B
Rationale: The correct answer is B: I.V. administration and urinary excretion. Lomustine is typically administered intravenously, allowing for rapid systemic distribution. The drug is metabolized in the liver and excreted primarily through the kidneys, thus the urinary route. This choice is correct as lomustine's pharmacokinetics align with this pattern.
A: Oral administration and urinary - While some drugs are administered orally, lomustine is not typically given orally due to poor bioavailability.
C: I.V. administration and fecal excretion - Lomustine is not primarily excreted via the feces, making this choice incorrect.
D: Oral administration and fecal excretion - Lomustine is not primarily excreted via the feces, making this choice incorrect.
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In which of the ff circumstances should a nurse avoid using midline and mid clavicular sites for IV therapy? Choose all that apply.
- A. To administer solutions with a pH greater than 5 and less than 9
- B. To administer antineoplastic chemotherapy
- C. To administer slow, low-volume infusions
- D. To administer high-pressure bolus injections
Correct Answer: B
Rationale: The correct answer is B: To administer antineoplastic chemotherapy. This is because antineoplastic chemotherapy agents are highly irritating and toxic to the surrounding tissues. Using midline and mid clavicular sites for IV therapy in this case can increase the risk of extravasation, leading to tissue damage and potential complications.
Incorrect choices:
A: To administer solutions with a pH greater than 5 and less than 9 - pH of the solution does not directly affect the choice of site for IV therapy.
C: To administer slow, low-volume infusions - Midline and mid clavicular sites can be appropriate for slow, low-volume infusions.
D: To administer high-pressure bolus injections - While midline and mid clavicular sites may not be ideal for high-pressure bolus injections, the question specifically mentions IV therapy, not bolus injections.
Management of hypercalcemia includes all of the following actions except administration of:
- A. Fluid to dilute the calcium le⁺vels
- B. The diuretic furosemide (Lasix), without saline, to increase calcium excretion through kidneys
- C. Inorganic phosphate salts
- D. Intravenous phosphate therapy
Correct Answer: B
Rationale: The correct answer is B because administration of the diuretic furosemide without saline is not recommended for managing hypercalcemia. Furosemide can lead to volume depletion and potentially exacerbate hypercalcemia by concentrating calcium levels in the blood.
A: Fluid administration helps dilute calcium levels by increasing urine output.
C: Inorganic phosphate salts can bind with calcium in the gut, reducing absorption.
D: Intravenous phosphate therapy can help lower calcium levels by promoting calcium-phosphate complex formation.
In summary, B is incorrect as it may worsen hypercalcemia, while A, C, and D are valid strategies for managing hypercalcemia.
A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg PO daily. Which finding should the nurse recognize as an adverse effect?
- A. Dysuria
- B. Tachycardia
- C. Leg cramps
- D. Blurred vision
Correct Answer: B
Rationale: The correct answer is B: Tachycardia. Levothyroxine is a synthetic form of thyroid hormone used to treat hypothyroidism. If the dose is too high, it can lead to symptoms of hyperthyroidism, including tachycardia (rapid heartbeat). This is because an excess of thyroid hormone can increase the heart rate. Dysuria (choice A) is not a common adverse effect of levothyroxine. Leg cramps (choice C) are more commonly associated with electrolyte imbalances. Blurred vision (choice D) is not a typical adverse effect of levothyroxine.
The nurse is conducting a nursing history of a client with a respiratory rate of 30, audible wheezing, and nasal flaring. During the interview, the client denies problems with breathing. What action should the nurse take next?
- A. Clarify discrepancies of assessment data with the client.
- B. Validate client data with members of the health care team.
- C. Document all data collected in the nursing history and physical examination.
- D. Seek input from family members regarding the client’s breathing at home.
Correct Answer: A
Rationale: Step-by-step rationale:
1. The nurse should clarify discrepancies of assessment data with the client to ensure accurate information.
2. The client's denial of breathing problems conflicts with physical signs, indicating a potential lack of awareness or reluctance to disclose symptoms.
3. By clarifying with the client, the nurse can address any misunderstandings or encourage honest communication.
4. This approach promotes client-centered care and ensures a comprehensive understanding of the client's health status.
Summary:
- Choice A is correct as it addresses the need to clarify discrepancies with the client for accurate assessment.
- Choice B is incorrect as validation with the healthcare team may not provide insight into the client's perception.
- Choice C is incorrect as it does not address the need to resolve conflicting assessment data.
- Choice D is incorrect as family input may not provide accurate information if the client denies symptoms.
Which of the following risk factors presents the greatest threat for respiratory disease?
- A. Smoking
- B. Exposure to radiation
- C. High-fat diet
- D. Alcohol consumption
Correct Answer: A
Rationale: The correct answer is A: Smoking. Smoking presents the greatest threat for respiratory disease due to the harmful chemicals in tobacco that can damage the lungs and lead to conditions like COPD and lung cancer. Smoking is a well-known risk factor for various respiratory issues. Exposure to radiation (B) can increase cancer risk but is not as directly linked to respiratory diseases. High-fat diet (C) may impact overall health but is not a primary risk factor for respiratory diseases. Alcohol consumption (D) can contribute to respiratory issues, but smoking is considered the most significant risk factor.