Nursing Elites

1. Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that the primary action of this medication is to:

• A. Increase DNA and RNA synthesis.
• B. Promote the biosynthesis of nucleic acids.
• C. Increase estrogen concentration and estrogen response.
• D. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.

Correct answer: D

Rationale: The primary action of tamoxifen, an antineoplastic medication used in metastatic breast carcinoma, is to compete with estradiol for binding to estrogen receptors in tissues with high receptor concentrations. By doing so, tamoxifen reduces DNA synthesis and estrogen response, leading to its therapeutic effect in inhibiting the growth of estrogen-sensitive breast cancer cells.

2. A client with rheumatoid arthritis is prescribed methotrexate. Which instruction should the nurse include in the client's teaching plan?

• A. Avoid taking folic acid supplements.
• B. Report any signs of infection immediately.
• C. Take the medication with a full meal.
• D. Limit fluid intake while on this medication.

Correct answer: B

Rationale: The correct instruction for the nurse to include in the client's teaching plan when taking methotrexate is to report any signs of infection immediately. Methotrexate can suppress the immune system, making the client more susceptible to infections. It is important for the client to promptly report any signs of infection to receive timely medical intervention. Choice A is incorrect because folic acid supplements are often recommended to reduce side effects of methotrexate. Choice C is incorrect as methotrexate is usually taken on an empty stomach unless the client experiences gastrointestinal upset. Choice D is incorrect as there is no need to limit fluid intake while on methotrexate; in fact, maintaining adequate fluid intake is important to prevent complications such as kidney damage.

3. A healthcare professional prepares to reinforce instructions to a client who is taking allopurinol (Zyloprim). The healthcare professional plans to include which of the following in the instructions?

• A. Instruct the client to drink 3000 mL of fluid per day.
• B. Instruct the client to take the medication with food.
• C. Inform the client that the effect of the medication will occur immediately.
• D. Instruct the client that, if swelling of the lips occurs, this is a normal expected response.

Correct answer: A

Rationale: Allopurinol is an antigout medication that works by reducing the production of uric acid in the body. To prevent kidney stones and promote the excretion of uric acid, increased fluid intake is essential. Instructing the client to drink 3000 mL of fluid per day helps to reduce the risk of kidney stones and assists in the elimination of uric acid, thereby enhancing the effectiveness of allopurinol therapy.

4. The clinic nurse is reviewing a teaching plan for a client receiving antineoplastic medication. When implementing the plan, the nurse should advise the client:

• A. To take aspirin (acetylsalicylic acid) as needed for a headache
• B. To avoid drinking beverages containing alcohol
• C. To consult with healthcare providers (HCPs) before receiving immunizations
• D. That it is necessary to consult HCPs before receiving a flu vaccine at the local health fair

Correct answer: C

Rationale: The correct advice for a client receiving antineoplastic medication is to consult with healthcare providers (HCPs) before receiving immunizations. Antineoplastic medications can lower the body's resistance, making it crucial to seek guidance from healthcare providers to prevent potential complications that may arise due to the medication's impact on the immune system. Choices A, B, and D are incorrect because taking aspirin for a headache, avoiding alcohol, and consulting only before a flu vaccine at a local health fair do not directly address the specific risk related to antineoplastic medications and immunizations.

5. A client is receiving an intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. The nurse notes redness and swelling at the site, along with a slowed infusion rate. What is the appropriate action for the nurse to take?

• A. Notify the healthcare provider.
• B. Administer pain medication to reduce discomfort.
• C. Apply ice and maintain the infusion rate as prescribed.
• D. Elevate the extremity of the IV site and slow the infusion rate.

Correct answer: A

Rationale: When a client complains of pain at the IV insertion site, and there are signs of extravasation such as redness and swelling, it is crucial to notify the healthcare provider immediately. Extravasation of antineoplastic medications can cause tissue damage, pain, and necrosis if they escape into surrounding tissues. Prompt action is necessary to prevent further complications and ensure appropriate management of the situation. Administering pain medication, applying ice, or elevating the extremity are not appropriate actions in cases of suspected extravasation. These actions do not address the underlying issue of potential tissue damage and necrosis that can occur due to the leakage of antineoplastic medication.

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