Antineoplastic Drugs (Ch. 14)

A patient having chemotherapy is losing her hair. She asks the nurse if her hair will come back as it originally was. What is the best response by the nurse?

"Your hair will grow back, but the new hair may be a different color or texture." ***Reassure patients that hair regrowth will occur; however, advise them that the new hair may be a different color or texture.

A nurse is caring for a client who has received antineoplastic therapy. The client has developed inflammation of the oral mucous membrane, which is affecting his nutritional status. Which action by the nurse would be most appropriate? Select all that apply.

-provide mouth care w/ normal saline every 4 hours -offer soft or liquid foods The nurse should suggest that the client provide mouth care with normal saline every 4 hours and offer soft or liquid foods. Use of toothpaste, lemon or glycerin swabs, or alcohol-based mouthwash for oral care is not suggested as they cause further irritation to the oral mucosa and complicate stomatitis.

Anemia from chemotherapy treatment is the result of bone marrow suppression.

Adverse reactions common to many of the antineoplastic drugs include bone marrow suppression which in turn causes anemia, leukopenia and thrombocytopenia.

What potential benefit is unique to biologic agent therapies?

Biologic agents target cellular differences between the malignant and normal cells. Consequently, they may kill cancer cells while leaving normal body cells unaffected. Like all drugs, they have adverse effects. Like chemotherapy drugs, they require exceedingly careful administration and necessitate close monitoring by specially trained staff.

A nurse educator who coordinates the staff education on an oncology unit is conducting an inservice on targeted therapies. What potential benefit of targeted therapies should the nurse highlight in this education session?

By focusing on molecular and cellular changes that are specific to cancer, targeted cancer therapies may be more effective than current treatments and less harmful to normal cells so that they may produce fewer adverse effects. However, adverse effects are not wholly absent. These drugs are not normally used as cancer prophylaxis and many are prohibitively expensive.

A client on the oncology unit has begun chemotherapy with a regimen that includes bendamustine. The client has begun to experience alopecia. The nurse should prioritize assessments related to what potential nursing diagnosis?

Disturbed body image ***The physiologic consequences of alopecia are usually inconsequential. This adverse effect does not have a major effect on thermoregulation or tissue integrity. However, many clients find it distressing and experience a disturbance to their body image due to the significant and unwanted change in their appearance. The nurse should choose assessments and interventions accordingly.

A 63-year-old male patient has just begun treatment with IV paclitaxel. About 10 minutes into the infusion, the nurse becomes concerned about a possible anaphylactic reaction to the drug because the patient is experiencing:

Dyspnea, hypotension, tachycardia, wheezing, and chest pain are manifestations of anaphylactoid reaction. ***This hypersensitivity reaction usually occurs during the first 20 minutes of the infusion and happens on the first or second exposure to the drug. Increased body temperature is not associated with an anaphylactoid reaction.

A client has been diagnosed with a brain tumor and is dealing with this diagnosis by seeking detailed information about cancer. The nurse would explain to the client that cancer is essentially a result of the disruption of the:

Malignant cells have lost the normal genetic regulation that controls cell growth, invading normal tissues and taking blood and nutrients away from these tissues. In essence, the cell cycle has been pathologically disrupted. None of the other options accurately describe the disruption.

A patient has just received the first dose of imatinib and the nurse on the oncology unit is amending the patient's care plan accordingly. What nursing diagnosis is most appropriate in light of this addition to the patient's drug regimen?

Risk for Infection related to bone marrow suppression ***Like many cancer treatments, imatinib causes bone marrow suppression that creates a consequent risk of infection. The drug does not typically result in cognitive changes, fluid overload, or skin breakdown.

A patient with non-Hodgkin's lymphoma (NHL) will be starting a course of doxorubicin shortly. When planning this patient's care, what nursing diagnosis should the nurse prioritize?

Risk for Infection related to suppressed bone marrow function ***Because doxorubicin suppresses bone marrow function, the patient is at risk of leukopenia and subsequent infection. Impaired skin integrity is less likely and airway clearance will not normally be affected. Nutritional deficit, not excess, is common.

A nurse is administering an antineoplastic extravasation occurs. How can the nurse best prevent tissue damage caused by extravasation?

Site inspection is a major intervention for preventing extravasation. Distal veins should be used. Small veins in the hand or wrist should be avoided. An infusion pump should be avoided because it can continue to administer the drug under pressure, leading to severe extravasation.

A patient is diagnosed with a brain tumor. The patient is told that the cancer cells proliferate. The patient asks the nurse what this means. What is the nurse's best response?

Site inspection is a major intervention for preventing extravasation. Distal veins should be used. Small veins in the hand or wrist should be avoided. An infusion pump should be avoided because it can continue to administer the drug under pressure, leading to severe extravasation.

When describing the various effects of antineoplastic agents, the nurse explains that antineoplastic drugs primarily affect human cells that are rapidly multiplying, going through the cell cycle quickly. The nurse would identify which cells as an example?

Skin ***ovaries, breast, and testicle cells proceed very slowly through the cell cycle

A postmenopausal woman with breast cancer will most likely be treated with which anti-estrogen drug?

Tamoxifen ***Anti-estrogens are first-line therapy for treating breast cancer in postmenopausal women. Tamoxifin is the most widely recognized anti-estrogen.

A 79-year-old woman has recently moved to a long-term care facility, and the nurse at the facility is conducting a medication reconciliation. The nurse notes that the woman has recently been taking tamoxifen. The nurse is justified in concluding that the woman has a history of what malignancy?

Tamoxifen is an antiestrogen that has been widely used to prevent recurrence of breast cancer after surgical excision in women aged 40 years and older and to treat metastatic breast cancer in postmenopausal women with estrogen receptor-positive disease. Tamoxifen is not effective in preventing recurrence of any of the other options since none of those are estrogen-positive diseases.

A patient is to start with chemotherapy. The patient is worried about going bald in the course of the treatment. How can the nurse assist the patient in being comfortable with his or her body image?

The nurse can assist the patient in being comfortable with his or her body image by suggesting that the patient use a wig or cap until the hair grows back. The nurse should forewarn about hair loss to prepare the patient for the outcome of the treatment. The nurse should explain that hair preserves body heat and loss of hair is not life-threatening, and this will put the patient at ease during treatment.

Which drug would be classified as a mitotic inhibitor?

Vincristine ***Vincristine is classified as a mitotic inhibitor. Fluorouracil and methotrexate are classified as antimetabolites. Chlorambucil is classified as an alkylating agent.

A patient is diagnosed with ovarian cancer. Why is considered to be an aggressive form of cancer?

it is fed by the hormones produced by the ovaries ***Factors that influence the growth of tumors include blood and nutrient supply, immune response, and hormonal stimulation. The client's tumor is fed by the hormones produced by the ovaries. The tumor is not fed by calcium. A younger client may have more aggressive forms of cancer based on the increased hormone production in the younger client. The client is not producing testosterone from the ovaries.

An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease?

prostate cancer **In male patients, antiandrogens are used to treat prostate cancer. They are not included in treatment of lymphomas, skin cancer, or lung cancer.

An antineoplastic extravasates, and the antidote is administered. The nurse would apply warmth to the site if extravasation involved which drug?

teniposide ***Heat/warm compresses are applied if teniposide extravasates. Ice compresses are applied if mechlorethamine extravasates. Cold compresses are applied if doxorubicin extravasates. Cold compresses are applied if dactinomycin extravasates.

A client with a diagnosis of bladder cancer is started on a chemotherapeutic regimen that includes three agents. What is the rationale for using multiple antineoplastic agents?

the use of three agents decreases the development of cell resistance.

A nurse is caring for a client who has received antineoplastic therapy. The client has developed inflammation of the oral mucous membrane, which is affecting his nutritional status. Which action by the nurse would be most appropriate? Select all that apply.

they may affect cancer cells while leaving body cells unaffected ***Biologic agents target cellular differences between the malignant and normal cells. Consequently, they may kill cancer cells while leaving normal body cells unaffected. Like all drugs, they have adverse effects. Like chemotherapy drugs, they require exceedingly careful administration and necessitate close monitoring by specially trained staff.