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: The correct answer is C because thiotepa is a cell cycle-nonspecific alkylating agent that interferes with both DNA replication and RNA transcription. Thiotepa works by cross-linking DNA strands, leading to inhibition of DNA replication and transcription, ultimately causing cell death. This mechanism of action makes it effective against actively dividing cells, such as cancer cells.
Choice A is incorrect because thiotepa does not interfere with DNA replication alone. Choice B is incorrect because thiotepa affects both DNA replication and RNA transcription, not just RNA transcription. Choice D is incorrect because thiotepa does not destroy the cell membrane; instead, it acts on the genetic material within the cell.
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Mr. Reyes has a possible skull fracture. The nurse should:
- A. Observe him for signs of Brain injury
- B. Check for hemorrhaging from the oral cavity
- C. Elevate the foot of the bed if he develops symptoms of shock
- D. Observe for symptoms of decreased intracranial pressure and temperature
Correct Answer: A
Rationale: The correct answer is A because observing for signs of brain injury is crucial in assessing a possible skull fracture. Signs may include altered mental status, headache, nausea, vomiting, and unequal pupil size. Choice B is incorrect as hemorrhaging from the oral cavity may not always be present in skull fractures. Choice C is incorrect as elevating the foot of the bed is not recommended for a possible skull fracture. Choice D is incorrect as decreased intracranial pressure and temperature are not typical symptoms of a skull fracture.
Which screening test for colorectal cancer should the nurse recommend?
- A. Carcinoembryonic antigen (CEA) test
- B. Annual digital examination after age 50
- C. Barium enema after age 50
- D. Proctosigmoidoscopy after age 50
Correct Answer: D
Rationale: The correct screening test for colorectal cancer is D: Proctosigmoidoscopy after age 50. This test allows direct visualization of the lower colon and rectum, aiding in the detection of polyps or tumors. It is recommended for individuals over 50 years old to screen for colorectal cancer. A: CEA test is not a primary screening tool but rather used for monitoring cancer progression. B: Annual digital examination is not sufficient for colorectal cancer screening. C: Barium enema is less effective compared to colonoscopy for detecting abnormalities in the colon.
A man with a history of diabetes and chronic lung disease is admitted to the hospital with prostate cancer. He has all the following symptoms. Which should the nurse address first?
- A. Fever of 38.3 Celsius
- B. Difficulty urinating
- C. Respiratory rte 36/min
- D. Painful legs and feet
Correct Answer: C
Rationale: The correct answer is C: Respiratory rate 36/min. In this case, the nurse should address the respiratory rate first due to the patient's chronic lung disease, indicating potential respiratory distress. High respiratory rate may signify hypoxia, infection, or worsening lung function, posing immediate life-threatening risks. Addressing this symptom promptly is crucial to prevent respiratory failure. Fever (A) and difficulty urinating (B) are important but not as urgent as addressing potential respiratory distress. Painful legs and feet (D) may indicate peripheral neuropathy related to diabetes, which is important but not as critical as addressing the respiratory issue.
A client has malignant lymphoma. As part of her chemotherapy, the physician prescribes chlorambucil (Leukeran), 10mg by mouth daily. When caring for the client, the nurse teaches her about adverse reactions to chlorambucil, such as alopecia. How soon after the first administration of chorambucil might this reaction occur?
- A. Immediately
- B. 2 to 3 weeks
- C. 1 week
- D. 1 month
Correct Answer: B
Rationale: The correct answer is B: 2 to 3 weeks. Alopecia is a common adverse reaction to chlorambucil, a type of chemotherapy drug that can cause hair loss. Alopecia typically occurs around 2 to 3 weeks after the first administration of chlorambucil. This is because chemotherapy drugs affect rapidly dividing cells, including hair follicles. Hair loss is a well-known side effect of many chemotherapy drugs, and it is important for the nurse to educate the client about this potential side effect.
Incorrect choices:
A: Immediately - Hair loss does not occur immediately after the first administration of chlorambucil.
C: 1 week - Hair loss typically occurs later than 1 week after starting chemotherapy.
D: 1 month - While hair loss can occur within a month, it is more likely to happen sooner, around 2 to 3 weeks after starting the medication.
Considering Mr. Franco’s conditions, which of the following is most important to include in preparing Franco’s bedside equipment?
- A. Hand bell and extra bed linen
- B. Footboard and splint
- C. Sandbag and trochanter rolls
- D. Suction machine and gloves
Correct Answer: B
Rationale: Step-by-step rationale for choice B: Footboard and splint:
1. Footboard helps prevent foot drop by maintaining proper alignment and preventing pressure ulcers.
2. Splint helps stabilize and support Franco's limbs to prevent contractures and maintain proper positioning.
3. Both items are essential for Franco's safety, comfort, and prevention of complications.
4. Hand bell and extra bed linen (Choice A) are not crucial for Franco's immediate care needs.
5. Sandbag and trochanter rolls (Choice C) are not directly relevant to Franco's specific conditions.
6. Suction machine and gloves (Choice D) are important for airway management but not the priority for bedside equipment in this case.