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《ISPN学习》总第553期
日期：2019-11-23 19:02:00
《ISPN学习》2019年11月01日总第553期
因为你的坚持，才使我有一意前行的勇气
★ From the Programs ★
（From the Programs [课程选粹]栏目摘登奥医及国外NCLEX-RN（ISPN）课程视频讲座，旨在帮助读者了解NCLEX-RN（ISPN）考试内容，指导考生复习，加深考生对考试相关内容的学习、掌握[进一步了解请点击底部阅读原文]。您的需要就是我们的努力方向。
How does NCLEX-RN works 2
| 想提高专业英语听力吗？想边练听力边增加护理专业知识吗？《Listening -- Elementary》(专业英语听力 – 初级)可助你一臂之力。 |
★ ISPN Review ★
ALKYLATING AGENTS
烷化剂
Because alkylating agents can affect cells even in the resting phase, these drugs are said to be non–cell cycle specific. They are most useful in the treatment of slow growing cancers, which have many cells in the resting phase. Alkylating agents include the following drugs: altretamine (Hexalen), bendamustine (Treanda), busulfan (Busulfex, Myleran), carboplatin (Paraplatin), carmustine (BiCNU, Gliadel), chlorambucil (Leukeran), cisplatin (Platinol-AQ), cyclophosphamide (Cytoxan, Neosar), Dacarbazine (DTIC-Dome), ifosfamide (Ifex), lomustine (CeeNU), mechlorethamine (Mustargen), melphalan (Alkeran), oxaliplatin (Eloxatin), procarbazine (Matulane), Streptozocin (Zanosar), temozolomide (Temodar), and thiotepa (Thioplex).
烷化剂可以影响细胞，即便它们处于静止期。这些药物是非细胞周期特异性的，在治疗进展缓慢的癌症时非常有用，而这些癌症的细胞有很多就处于静止期。烷化剂包括下列这些药物：六甲蜜胺（克瘤灵）、苯达莫司汀（特雷安达）、白消安（白舒非、马利兰）、卡铂（伯尔定）、卡莫司汀（BiCNU、卡氮芥糯米纸胶囊）、苯丁酸氮芥（留可然）、顺铂（顺氯氨铂）、环磷酰胺（环磷氮芥、环磷酰胺注射剂）、达卡巴嗪（达卡巴嗪制剂）、异环磷酰胺（异环磷酰胺粉针剂）、洛莫司汀（洛莫司汀胶囊）、氮芥（氮芥）、美法仑（爱克兰）、奥沙利铂（乐沙定）、丙卡巴肼（丙卡巴肼制剂）、链佐星（Zanosar）、替莫唑胺（Temodar）和塞替派（塞替派粉针剂）。
Therapeutic Actions and Indications
Alkylating agents produce their cytotoxic effects by reacting chemically with portions of the RNA, DNA, or other cellular proteins, being most potent when they bind with cellular DNA. The oldest drugs in this class are the nitrogen mustards, and modifications of the structure of these drugs have led to the development of the nitrosoureas.
治疗作用和适应症
烷化剂与RNA、DNA、或其他细胞蛋白质产生化学反应，产生毒性效应，与细胞DNA结合时药效最强。在这一类别药物，最古老的氮芥。通过改变这些药物的结构，人们研制出了亚硝基脲类药。
These drugs are most useful in the treatment of slow growing cancers such as various lymphomas, leukemias, myelomas, some ovarian, testicular, and breast cancers, and some pancreatic cancers. These agents are not used interchangeably.
这些药物在治疗发展缓慢的癌症时是非常有用的，如各种淋巴瘤、白血病、骨髓瘤及某些卵巢、睾丸、乳腺癌，及某些胰腺癌等。这些药物不可互换使用。
Pharmacokinetics
The alkylating agents vary in their degree of absorption, and little is known about their distribution in the tissues. They are metabolized and sometimes activated in the liver, with many of these agents using the cytochrome P450 systems. They are excreted in the urine.
药动学
烷化剂的吸收程度各不相同，其组织分布情况也知之甚少。药物经肝代谢，有时活化于肝，其中很多药物利用了细胞色素P450系统。药物经尿排出。
Contraindications and Cautions
Alkylating agents are contraindicated during pregnancy and lactation due to their potential for severe effects on the fetus and neonate. Caution is necessary when giving alkylating agents to any individual with a known allergy to any of them; with bone marrow suppression, which is often the index for redosing and dosing levels; or with suppressed renal or hepatic function, which may interfere with metabolism or excretion of these drugs and often indicates a need to change the dose.
禁忌症与注意事项
妊娠及哺乳期间禁用烷化剂，因为这些药物对胎儿和新生儿会产生严重的不良效应。对下列患者使用这些药物时，也需要非常小心，如已知对其敏感的个体；有骨髓抑制的个体，骨髓抑制通常是需要调整剂量的一个指标；及肾或肝功能抑制的个体，因为肝、肾功能抑制会影响药物代谢或排泄，常常也需要改变剂量。
Adverse Effects
Adverse effects frequently encountered with the use of these alkylating agents are listed here. Amifostine (Ethyol) and mesna (Mesnex) are cytoprotective (cell-protecting) drugs that may be given to limit certain effects of Cisplatin and ifosfamide, respectively.
不良效应
使用这些药物通常也会面临很多不良效应。氨磷汀（阿密磷定）和美司钠（美钠针剂）属于细胞保护性药物（保护细胞），可以使用，分别限制顺铂和异环磷酰胺的某些效应。
★ Vocabulary for Today ★
alkylate – n. 烷基化
alkylating agents – n. 烷化剂
resting phase – n. 静止期
non–cell cycle specific – 非细胞特异性
altretamine – n. 六甲蜜胺
Hexalen – n. 克瘤灵
bendamustine – n. 苯达莫司汀
Treanda – n. 特雷安达
busulfan – n. 白消安
Busulfex – n. 白舒非
Myleran – n. 马利兰
carboplatin – n. 卡铂
Paraplatin – n. 伯尔定
carmustine – n. 卡莫司汀
BiCNU – n. 卡莫司汀制剂
Gliadel – n. 卡氮芥糯米纸胶囊剂
chlorambucil – n. 苯丁酸氮芥
Leukeran – n. 留可然
cisplatin – n. 顺铂
Platinol-AQ – n. 顺氯氨铂
cyclophosphamide – n. 环磷酰胺
Cytoxan – n. 环磷氮芥
Neosar – n. 环磷酰胺注射剂
dacarbazine – n. 达卡巴嗪
DTIC-Dome – n. 达卡巴嗪制剂
ifosfamide – n. 异环磷酰胺
Ifex – n. 异环磷酰胺粉针剂
lomustine – n. 洛莫司汀
CeeNU – n. 洛莫司汀商标名
| 尽快地从茫然中理清复习思路，准确地抓住复习重点，这是每一个考试复习者的一大愿望。“ISPN考试复习要点提示”即是帮您实现这一愿望的利器！该教程已在www.omedin.com陆续上线。 |
★ Video ★
Alkylating Agents
★ NCLEX-RN Experience ★
考试从来不易，前行者的经验可以使后来者少走不少弯路！
作者的信仰是向上帝祈祷，但作者也说要坚持学习，实际上，在二次复习时，作者的复习及复习内容都加强了很多。
FAILED NCLEX in 122 Questions, PASSED NCLEX in 95 Questions!
by msbee
As I promised to God, I am writing this to share my testimony on how I passed the NCLEX the 2nd time. Yes, I’ve taken the NCLEX twice. The first time I took the NCLEX, it shut off at 122 questions and I was devastated. The second time I took it, the dreaded computer adapted test shut off in 95 questions. I tried the PVC trick after the exam and got the “good popup”! 48 hours later I found out that I PASSED! Here is what I did:
The first time I took the NCLEX, I only used UWorld. I read numerous reviews that lead to promising results and read about people who used UWorld as their ONLY resource and passed the NCLEX. I did all 2,000+ questions (anywhere between 150-200 questions a day). I would read the rationales but would just skim the information because I was determined to do all of the questions the Qbank had to offer. I prayed, but my prayers were rushed as well. I went in to take the test and was discouraged as soon as I saw the question number turn from 75 to 85 to 100 and then finally 122. Went home and tried the PVC trick and got the “bad popup”. 48 hours later, through the quick results, I found out that I failed.
The 2nd attempt at studying involved a lot of prayer. My family, friends, and even people who were not close to me prayed that I will pass the NCLEX. As for studying, I utilized my school’s offer with a program called Virtual ATI that provided me with a tutor who helped me through the program. ATI allowed me to reacquaint myself with topics and subjects I had forgotten about since the end of nursing school. I also had to take a 180 question proctored exam that would predict my chances of passing the NCLEX. I also used LaCharity’s Priority, Delegation, and Assessment book and finished all questions and case studies. Then, I went back to UWorld and continued to do practice questions. I would try my best to actually read the rationales and I tried not to skim any of the information. I would be lying if I said I didn’t skim at all, but it was definitely better than the first time. Aside from ATI and LeCharity, the biggest change to my studying was prayer and trusting God completely. I prayed every chance I had. When I started to feel overwhelmed, I would stop and pray and ask for His guidance.
This is my testimony that God answers prayers. Yes, you will need to put in the effort to actually study, review material, and practice questions... But it is equally important to spend time with God and to see and experience all the good things He has in store for you.
Keep praying, keep studying, and keep praying some more. God is always listening and His plans are perfect. Yes, I put in the work, but ultimately the rest was up to Him. God bless.
★ Test ★
1. The client diagnosed with cancer has developed diarrhea after the third round of chemotherapy. Which intervention should the clinic nurse implement?
A. Have the client take up to 12 Imodium 2-mg tablets per day.
B. Place the client on a clear liquid diet.
C. Medicate the client with Phenergan suppositories.
D. Discuss adding a fiber supplement to the client’s diet.
2. The client has received five treatments of combination chemotherapy for cancer of the lung. Which data indicates the medications are effective?
A. The client’s hair has begun to grow back in again.
B. The client only has nausea during the treatments.
C. The client reports being able to ambulate around the block.
D. The client’s lung sounds are clear.
（答案见页底）
答案
Key to Questions
1. D.
Clients with diarrhea need to add bulk to the diet in the form of fiber supplements or dietary intake to decrease the liquid nature of the stools.
2. C.
The client being able to tolerate activity indicates the client has adequate lung capacity. This indicates the lung cancer has not enveloped the entire lung fields and the medications are effective. Lung cancer has a poor prognosis, and the treatment goal is to improve or maintain quality of life.
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