Chapter 14: Antineoplastic

How can a nurse best prevent tissue damage caused by an antineoplastic extravasation? Inspect the site frequently for redness or swelling Administer through a hand vein, if possible Infuse into proximal veins whenever possible Use an infusion pump

Inspect the site frequently for redness or swelling - 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 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 what? Immune system Cell wall Cell cycle Lymphatic system

Cell cycle - 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 client with colorectal cancer is being treated with oxaliplatin. Which potential adverse effect should the nurse explain to the client? Dysuria Diarrhea Cold-induced neurotoxicity Insomnia

Cold-induced neurotoxicity - Cold-induced neurotoxicity is an adverse effect of oxaliplatin resulting from an effect on peripheral nerves, especially in the hands and feet. Dysuria, diarrhea, and insomnia are not closely associated with oxaliplatin as a result of its pharmacologic actions.

A client's chemotherapy regimen has been deemed successful, but the client is experiencing debilitating nausea and vomiting. These adverse effects should signal the nurse to the possibility of what nursing diagnosis? Adult failure to thrive Ineffective therapeutic regimen management Imbalanced nutrition: less than body requirements Acute pain

Imbalanced nutrition: less than body requirements - Nausea and vomiting are major threats to the client's nutrition. Failure to thrive is typically a chronic, rather than acute, health problem. Pain does not necessarily accompany nausea, and there is no indication that this client is not maintaining the necessary regimen.

A patient is receiving carboplatin. The nurse would expect to administer this drug by which route? Oral Intravenous Subcutaneous Intramuscular

Intravenous - Carboplatin is administered IV on day 1 every 4 weeks.

Which would the nurse identify as an antineoplastic antibiotic? Mitomycin Vinblastine Teniposide Docetaxel

Mitomycin - Mitomycin is an example of an antineoplastic antibiotic. Teniposide, vinblastine, and docetaxel are examples of mitotic inhibitors.

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? Lung cancer Skin cancer Prostate cancer Lymphoma

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.

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? Forewarn about hair loss. Explain that hair preserves body heat. Explain it is not life-threatening. Suggest the use of a wig or cap.

Suggest the use of a wig or cap. - 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.

A client is undergoing a cytotoxic chemotherapy regimen for the treatment of stage III lung cancer. What effect will this regimen likely have on the client's hemostatic function? The client will likely experience thrombocytosis. The client will be at increased risk of deep vein thrombosis (DVT). The client will require prophylactic heparin. The client's platelet count will decline.

The client's platelet count will decline. - Thrombocytopenia, not thrombocytosis, is a common adverse effect of cytotoxic chemotherapy. Heparin is consequently contraindicated, and DVT is not a priority risk.

A nurse educator is discussing the role of protooncogenes in the pathophysiology of cancer. What typically triggers protooncogenes to differentiate into oncogenes? exposure to a low-pH environment ischemia exposure to carcinogens exposure to chemotherapeutic agents

exposure to carcinogens - When normal growth-regulating genes (protooncogenes) are exposed to carcinogens, they may undergo genetic alteration and become oncogenes. This can stimulate continuous cell growth, allowing abnormal, disordered, and unregulated cell replication. Exposure to the other factors does not result in this alteration.

A nurse is providing education to a client who is preparing to begin chemotherapy for the treatment of cancer. What action should the nurse encourage the client to implement to minimize the effects of chemotherapy-triggered mucositis? thoroughly rinse the mouth often, especially before and after meals self-administer 650 mg of acetaminophen 4 times daily gargle with a commercial mouthwash 3 to 4 times daily limit fluid intake to prevent overhydration of mucous membranes

thoroughly rinse the mouth often, especially before and after meals - A client who is experiencing mucositis should rinse the mouth several times daily, especially before meals (to decrease unpleasant taste and increase appetite) and after meals (to remove food particles that promote growth of microorganisms). Fluid intake should be increased, and commercial mouthwashes should be avoided. Analgesia therapy is usually topical, rather than oral.

"The proliferation of cancer cells is the metastasis of the tumor." "The proliferation is the growth of cancer cells and the rate of growth." "The proliferation of the cancer cells is the treatment with chemotherapy." "The proliferation of the cancer cells is the suppression of growth."

"The proliferation is the growth of cancer cells and the rate of growth." - The proliferation of cancer cells is the rate of growth of cancer cells. The proliferation of cancer cells is not the metastasis of the tumor, suppression of the cancer cells, or treatment with chemotherapy.

A client received an injection of doxorubicin and is now observing a reddish urine. The client reports blood in the urine to the nurse. How should the nurse respond? "You may have hemorrhagic cystitis." "The reddish urine is an expected response to the drug." "We need to notify the health care provider because this is a complication of the medication." "Let's get a urinalysis to confirm a urinary tract infection."

"The reddish urine is an expected response to the drug." - Reassure clients that reddish urine after doxorubicin injection is a harmless and expected response to the drug. This reaction may happen within 1 to 2 days postinfusion.

A client has just been diagnosed with liver cancer, and the care team is finalizing the extensive chemotherapy regimen that will begin imminently. Administration of chemotherapeutic drugs is best achieved through which route? An intramuscular depot A peripheral IV in the nondominant forearm A central venous catheter (CVC) Peripheral intravenous access in the antecubital fossa

A central venous catheter (CVC) - Insertion of an indwelling central venous catheter is often appropriate for clients who have poor peripheral venous access, who require many doses of chemotherapy, or who require continuous infusions. The antecubital IV insertion site would be unlikely unsustainable for this chemotherapy regimen. Overall, a CVC is preferable to peripheral access. IM administration is uncommon.

A male client is diagnosed with prostate cancer. The treatment modality of choice includes both surgery and chemotherapy. What does the chemotherapeutic option include? Diuretics Hemoglobin replacement therapy Antidiuretic hormone Hormonal therapies

Hormonal therapies - Hormonal therapies that block the effects of estrogen (in an estrogen-responsive tumor) and androgen (in an androgen-responsive tumor), respectively, are essential in the treatment of breast and prostate cancers.

A client's chemotherapy regimen has been deemed successful, but the client is experiencing debilitating nausea and vomiting. These adverse effects should signal the nurse to the possibility of what nursing diagnosis? Ineffective therapeutic regimen management Imbalanced nutrition: less than body requirements Adult failure to thrive Acute pain

Imbalanced nutrition: less than body requirements - Nausea and vomiting are major threats to the client's nutrition. Failure to thrive is typically a chronic, rather than acute, health problem. Pain does not necessarily accompany nausea, and there is no indication that this client is not maintaining the necessary regimen.

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 Deficient Fluid Volume related to changes in osmotic pressure Risk for Infection related to bone marrow suppression Risk for Impaired Skin Integrity related to exaggerated inflammatory response Risk for Acute Confusion related to adverse neurological effects of imatinib

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.

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? Ovaries Skin Testicles Breast

Skin - Skin cells proceed very rapidly through the cell cycle. Breast cells proceed very slowly through the cell cycle. Cells of the testicles proceed very slowly through the cell cycle. The cells of the ovaries proceed very slowly through the cell cycle.

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

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

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. The use of three agents increases the length of treatment. The use of three agents decreases the adverse effects. The use of three agents increases the quantity of one of the agents.

The use of three agents decreases the development of cell resistance. - Most chemotherapy regimens involve a combination of drugs with different actions at the cellular level, which destroys a greater number of cancer cells and reduces the risk of the cancer developing drug resistance. The rationale for using multiple antineoplastic agents is not accurately explained by any of the other options.

The nurse may be asked to administer which medications to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis? amifostine mesna allopurinol leucovorin

allopurinol - The nurse may be asked to administer allopurinol to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis. Amifostine binds with metabolites of cisplatin to protect the kidneys from nephrotoxic effects, reduces xerostomia. Mesna binds with metabolites of ifosfamide to protect the bladder from hemorrhagic cystitis. Leucovorin provides folic acid to cells after methotrexate administration.

A 57-year-old male patient who has been prescribed doxorubicin for small-cell lung cancer is advised by the nurse to avoid taking aspirin or drugs that contain aspirin because it may: promote bleeding. cause extravasation injury. cause acute nausea and vomiting. cause a radiation recall reaction.

promote bleeding. - It is essential to caution the client against taking aspirin or drugs that contain aspirin while on doxorubicin drug therapy because aspirin may promote bleeding during periods of suppressed bone marrow function. Aspirin will not cause extravasation injury, radiation recall reaction, or acute nausea and vomiting; these are adverse effects of doxorubicin.

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? Breast cancer Ovarian cancer Malignant melanoma Cervical cancer

Breast cancer - 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 26-year-old man with testicular cancer is prescribed combination chemotherapy that involves using two drugs that are effective against testicular tumors. Combination drug therapy is superior to single-drug therapy because of: Higher tumor response rates Decreased duration of remissions Increased capillary permeability Lower risk for secondary cancers

Higher tumor response rates - Combination therapy is considered superior over single-drug therapy because of higher tumor response rates and increased, not decreased, duration of remissions. Combination therapy does not pose a lower risk for secondary cancers, and increased capillary permeability is not the reason for the preference of combination therapy over monotherapy.

Dosage of cytotoxic drugs for children is based on: disease process. height. weight. body surface area.

body surface area. - Dosage of cytotoxic drugs for children should be based on body surface area, because this measurement takes size into account.

A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to: take the medication at bedtime. increase the protein in her diet. limit fluid intake. drink a lot of water.

drink a lot of water. - An adverse effect of this drug is the incidence of hemorrhagic cystitis. The nurse should encourage the patient to drink at least 2 liters of fluid a day and, in high-dose therapy, administer the uroprotectant agent mesna. Therapy should include prehydrating the patient orally and intravenously with at least 2 liters of normal saline solution. Potassium and magnesium additives may be indicated. The nurse will monitor urine output vigilantly to ensure an output of at least half of the intake. Taking the medication at bedtime and increasing protein in her diet are not associated with limiting the possible adverse effects of the drug.

A client is prescribed doxorubicin drug therapy for carcinoma of the breast. On the second day of drug therapy, she calls in to report reddish urine. What should the nurse do? Suggest some nonpharmacologic interventions. Reassure the client that it is a harmless and expected response to the drug. Reassure the client about adequate monitoring and follow-up in her home setting. Caution the client against taking aspirin or caffeine.

Reassure the client that it is a harmless and expected response to the drug. - Reddish urine is observed within a day or two after doxorubicin injection. The client should be reassured that it is a harmless and expected response to the drug. Nonpharmacologic interventions should be reviewed only if the client reports nausea and vomiting. Though it is necessary to reassure the client about adequate monitoring and follow-up in her home setting and caution her against taking aspirin, these suggestions do not pertain to the occurrence of reddish urine.

A 42-year-old female with breast cancer has had a radical mastectomy. She will have radiation therapy and then begin chemotherapy. Drug therapy will consist of a combination of doxorubicin, cyclophosphamide, and paclitaxel. What will the nurse include in the teaching plan concerning the drug therapy? Stay in bed 2 days after each administration. Stay on a low-fat diet during the course of the drug therapy. Take special care when shaving or brushing her teeth. Continue to go to church or to the mall just as she did before the diagnosis of cancer.

Take special care when shaving or brushing her teeth. - Special care should be taken when shaving or brushing her teeth because she may bruise more easily than normal and gums may bleed. A cancer patient should not be on a diet during chemotherapy unless prescribed, and care should be taken to avoid crowds and public places where there is a greater risk of infection. Cancer patients should be as active, they should be careful not to over extend themselves physically, and they should remain active to promote optimal health.

The nurse is describing the necessity of recovery periods between treatment cycles to a client receiving chemotherapy. How should the nurse best explain the need? Time is required for the successful application of radiotherapy between cycles of chemotherapy. There is a need to restore a physiologic reserve of energy before further chemotherapy. The restoration of fluid balance and nutrition is needed before continuing with chemotherapy. Time is needed to replace many of the healthy body cells killed by chemotherapy.

Time is needed to replace many of the healthy body cells killed by chemotherapy. - Cyclic administration involves taking the drugs for a specific period, with a recovery period following each treatment cycle. The recovery period allows time for the client to produce new, healthy cells to replace the normal rapidly dividing cells that have been affected by the drugs. Recovery time is unrelated to energy reserves, fluid balance, and nutrition. Recovery time does not necessarily correspond to the schedule for radiation therapy; not every client who receives chemotherapy will receive radiation therapy.