Page 1367 - Saunders Comprehensive Review For NCLEX-RN

Rationale: Tamoxifen may increase calcium, cholesterol, and triglyceride levels.
Before the initiation of therapy, a complete blood count, platelet count, and serum
calcium level should be assessed. These blood levels, along with cholesterol and
triglyceride levels, should be monitored periodically during therapy. The nurse
should assess for hypercalcemia while the client is taking this medication. Signs of
hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting,
constipation, hypotonicity of muscles, and deep bone and flank pain.
Test-Taking Strategy: Focus on the subject, the laboratory value to monitor for
tamoxifen. Think about the action of this medication. Recalling that this medication
causes hypercalcemia will direct you to the correct option.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Pharmacology: Oncology Medications: Selective Estrogen Receptor
Modulators
Health Problem: Adult Health: Cancer: Breast
Priority Concepts: Cellular Regulation; Fluids and Electrolytes
Reference: Hodgson, Kizior (2018), p. 1115.

481. Answer: 4

Rationale: Megestrol acetate suppresses the release of luteinizing hormone from
the anterior pituitary by inhibiting pituitary function and regressing tumor size.
Megestrol is used with caution if the client has a history of venous
thromboembolism. Options 1, 2, and 3 are not contraindications for this medication.
Test-Taking Strategy: Focus on the subject, a contraindication to megestrol
acetate. It is necessary to know the adverse effects associated with this medication.
Recalling that megestrol acetate is a hormonal antagonist enzyme and that an
adverse effect is thrombotic disorders will direct you to the correct option.
Level of Cognitive Ability: Analyzing
Client Needs: Safe and Effective Care Environment
Integrated Process: Nursing Process—Implementation
Content Area: Pharmacology: Oncology Medications: Hormonal and Enzymes
Health Problem: Adult Health: Cancer: Cervical/Uterine/Ovarian
Priority Concepts: Clinical Judgment; Safety
Reference: Skidmore-Roth (2017), pp. 745-746.

482. Answer: 1, 2, 4, 5

Rationale: Redness and swelling and a slowed infusion indicate signs of
extravasation. If the nurse suspects extravasation during the IV administration of an
antineoplastic medication, the infusion is stopped and the PHCP is notified. Ice or
heat may be prescribed for application to the site, and an antidote may be prescribed
to be administered into the site. Increasing the flow rate can increase damage to the
tissues. Restarting an IV in the same vein can increase damage to the site and vein.
Test-Taking Strategy: Focus on the assessment signs in the question and the
words suspects extravasation. Visualize the situation to identify the nursing actions.

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