Nokea
A client is receiving the cell cycle-nonspecific alkylating agent thiotepa (thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of a chemotherapeutic regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects?
- A. It interferes with deoxyribonucleic acid (DNA) replication only.
- B. It interferes with ribonucleic acid (RNA) transcription only.
- C. It interferes with DNA replication and RNA transcription.
- D. It destroys the cell membrane, causing lysis.
Correct Answer: C
Rationale: Thiotepa is a cell cycle-nonspecific alkylating agent that exerts its therapeutic effects by interfering with both DNA replication and RNA transcription. The alkylating properties of thiotepa lead to the cross-linking of DNA strands, ultimately inhibiting DNA replication. Additionally, thiotepa can also disrupt RNA synthesis, further affecting protein production and cell function. This combined action on DNA replication and RNA transcription contributes to the cytotoxic effects of thiotepa on rapidly dividing cancer cells.
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A patient returns from surgery ff. a TURP with a three-way Foley catheter and continuous bladder irrigation. Postoperative orders include Meperidine (Demerol) 75 mg IM q3h as needed for pain, belladonna and opium (B&O) suppository q4h as needed, and strict I&O. the patient complains of painful bladder spasms, and the nurse observes blood-tinged urine on the sheets. Which action should the nurse take?
- A. Give Demerol
- B. Give B&O suppository
- C. Warm the irrigation solution to body temperature
- D. Notify the physician stat
Correct Answer: D
Rationale: The nurse should notify the physician stat in this situation. The presence of blood-tinged urine and painful bladder spasms in a patient with a three-way Foley catheter and continuous bladder irrigation post TURP could indicate a potential complication such as hemorrhage or clot retention. It is crucial to ensure prompt medical evaluation and intervention to address these issues effectively. Waiting or administering pain medication without further assessment could delay necessary treatment and lead to worsening of the patient's condition. Therefore, notifying the physician immediately is the most appropriate action in this scenario.
Which of the following BP changes alerts the nurse to increasing ICP, and should be reported immediately?
- A. Gradual increase
- B. Widening pulse pressure
- C. Rapid drop followed by gradual increase
- D. Rapid fluctuations
Correct Answer: B
Rationale: Widening pulse pressure is indicative of increasing intracranial pressure (ICP) and must be reported immediately. Pulse pressure is calculated by subtracting the diastolic blood pressure from the systolic blood pressure. An increasing pulse pressure can suggest a rise in ICP due to factors like cerebral edema or hemorrhage. This change indicates increased pressure exerted on blood vessels within the brain, potentially leading to serious consequences like brain herniation. Thus, recognizing and promptly reporting a widening pulse pressure is crucial to prevent further complications and enable appropriate interventions for the patient.
During the physical assessment, the nurse recalls that the areas most frequently affected by multiple sclerosis are the:
- A. Lateral, 3rd and 4th ventricles
- B. Pons medulla and cerebral peduncles
- C. Optic nerve and chiasm
- D. Above areas
Correct Answer: C
Rationale: Multiple sclerosis (MS) is a disease that primarily affects the central nervous system (CNS) by causing inflammation, damage, and scarring in the myelin sheath that covers nerve fibers. The optic nerve and chiasm are common areas affected by MS, leading to symptoms such as blurred or double vision, loss of color vision, and pain with eye movement. This involvement is known as optic neuritis, a common early symptom of MS. While MS can affect various parts of the CNS, the optic nerve and chiasm are among the most frequently involved areas, making choice C the correct answer in this case.
Before, during and after seizure. The nurse knows that the patient is ALWAYS placed in what position?
- A. Low fowler's
- B. Modified trendelenburg
- C. Side lying
- D. Supine
Correct Answer: C
Rationale: The correct position to place a patient before, during, and after a seizure is on their side, also known as the recovery position. Placing the patient in the side-lying position helps prevent aspiration if the patient vomits and ensures that the airway remains open. This position also helps to prevent choking and allows for drainage of fluids from the mouth. Additionally, it reduces the risk of airway obstruction and helps to maintain proper alignment of the head, neck, and spine. By placing the patient in the side-lying position, the nurse can ensure the patient's safety and well-being during and after a seizure episode.
A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron-deficiency anemia?
- A. Night sweats, weight loss, and diarrhea
- B. Nausea, vomiting, and anorexia
- C. Dyspnea, tachycardia, and pallor
- D. Itching, rash, and jaundice  A1 PASSERS TRAINING, RESEARCH, REVIEW & DEVELOPMENT COMPANY MEDICAL SURGICAL NURSING SET H
Correct Answer: C
Rationale: Iron-deficiency anemia is a common type of anemia characterized by a lack of iron in the body, which leads to decreased production of red blood cells containing hemoglobin. The assessment findings characteristic of iron-deficiency anemia include dyspnea (shortness of breath) due to decreased oxygen-carrying capacity of the blood, tachycardia (rapid heart rate) as the body tries to compensate for decreased oxygen delivery, and pallor (pale skin and mucous membranes) due to reduced red blood cell production. These symptoms result from insufficient iron levels affecting the body's ability to produce an adequate number of healthy red blood cells. Night sweats, weight loss, and diarrhea are not typically associated with iron-deficiency anemia. Nausea, vomiting, anorexia, itching, rash, and jaundice are also not primary manifestations of iron-deficiency an