Chapter 14: Antineoplastic Agents Prep-U Q's and A's

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 Rationale: 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 female client will soon begin targeted therapy as a component of her treatment plan for chronic leukemia. The nurse is conducting health education about this new aspect of the client's drug regimen and the client has asked about the potential side effects of treatment. How should the nurse best respond?

"Both classes of drugs have adverse effects, but targeted therapies tend to have less of an effect on healthy body cells. Rationale: Targeted therapies are generally considered to be less toxic than traditional chemotherapy drugs. However, adverse reactions to targeted therapies can occur such as severe skin reactions, GI toxicities, skin reactions, and thrombosis.

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 Selected:

"The reddish urine is an expected response to the drug." Rationale: 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 nurse on the oncology unit is caring for a client with an astrocytoma. The client has just been told that the tumor is growing very fast. The client asks the nurse how these tumors grow. What would be the nurse's best response?

Brain tumors infiltrate the surrounding tissue. Rationale: Over time, these neoplastic cells grow uncontrollably, invading and damaging healthy tissue in the area and even undergoing metastasis, or traveling from the place of origin to develop new tumors in other areas of the body where conditions are favorable for cell growth. The abnormal cells release enzymes that generate blood vessels. Brain tumors can invade either grey or white matter or they can spread down the spinal cord. These responses do not answer the patient's question.

A client is receiving idarubicin. What is the nurse's priority assessment?

Cardiac fuction Rationale: The client's cardiac function needs to be monitored closely because idarubicin is specifically toxic to the heart. The pancytopenia that accompanies antineoplastics can cause decreased red cell indices, but this does not address the particular threat to the cardiac system posed by idarubicin. Respiratory function is not commonly impacted by idarubicin. Electrolyte levels should be monitored in clients receiving any antineoplastic study due to adverse effects impacting nutrition and kidney function, but are not specific to idarubicin.

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?

Cell cycle Rationale: 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 leukemia is being treated with a combination of antineoplastics, including methotrexate. The client's most recent laboratory results indicate the client is experiencing bone marrow suppression. What is the nurse's priority action?

Ensure that all staff and visitors adhere to infection control precautions. Rationale: The client's combination of cancer and bone marrow suppression creates an acute risk for infection. As a result, infection control is vital to maintaining the client's health and safety. Nutrition and energy conservation strategies are also important, but infection control is a safety priority. The client likely has a risk for bleeding, but the harm of activity limitation outweighs the benefits for most clients.

A client is administered mesna to prevent cystitis induced by ifosfamide. Mesna will prevent what adverse effect?

Hemorrhagic cystitis Rationale: Mesna is used to protect against cystitis. It does not prevent extravasation, alopecia or vomiting.

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 Rationale: 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.

A client's chemotherapeutic regimen includes procarbazine. What is the client's most likely diagnosis?

Hodgkin lymphoma Rationale: Procarbazine (Matulane) is used in combination therapy for treatment of stages III and IV of Hodgkin disease.

A male client is diagnosed with prostate cancer. The treatment modality of choice includes both surgery and chemotherapy. What does the chemotherapeutic option include?

Hormonal therapies Rationale: 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.

How can a nurse best prevent tissue damage caused by an antineoplastic extravasation?

Inspect the site frequently for redness or swelling Rationale: 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 receiving carboplatin. The nurse would expect to administer this drug by which route?

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

Chlorambucil has been ordered for a patient with Hodgkin's disease. The patient's son asks the nurse what this drug does. What would be the nurse's best answer

It is palliative chemotherapy used to relieve pain associated with tumor. Rationale: The indications for Chlorambucil is as palliative treatment of chronic lymphocytic leukemia, malignant lymphomas, and Hodgkin's disease. Chlorambucil is not used to prevent tumor growth, destroy tumor, or to prevent metastasis.

Which would the nurse identify as an antineoplastic antibiotic?

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

A male client is informed that the latest tests indicate that his cancer has spread to his liver. The client receives capecitabine as part of his treatment regimen. What would the nurse expect the health care provider to do?

Monitor the client closely and repeat LFTs routinely. Rationale: Capecitabine blood levels are significantly increased with hepatic impairment, and clients with liver metastases should be monitored closely.

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

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 Rationale: 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 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?

Suggest the use of a wig or cap Rationale: 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 postmenopausal woman with breast cancer will most likely be treated with which anti-estrogen drug?

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

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

When describing the process of cancer cell growth to a client, the nurse addresses angiogenesis. Which description would the nurse include?

The process of creating new blood vessels to supply oxygen and nutrients to the cells Rationale: Angiogenesis refers to the process in which abnormal cells release enzymes that generate blood vessels in the area to supply both oxygen and nutrients to the cells. Metastasis refers to process of traveling from the place of origin to develop new tumors in other areas of the body. Autonomy refers to the process of growing without the usual homeostatic restrictions that regulate cell growth and control. Anaplasia refers to the process in which the cells lose their ability to differentiate and organize, which leads to a loss in their ability to function normally.

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 Rationale: 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.

What potential benefit is unique to biologic agent therapies?

They may affect cancer cells while leaving normal body cells unaffected Rationale: 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. They require exceedingly careful administration and necessitate close monitoring by specially trained staff.

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 needed to replace many of the healthy body cells killed by chemotherapy Rationale: 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.

A nurse is performing discharge teaching with a client who will soon return home. The client will continue taking imatinib for the foreseeable future, and the nurse is teaching the client about the safe administration of this drug. How should the nurse instruct the client to take imatinib?

With food and a large glass of water Rationale: Imatinib should be taken with food and a large glass of water.

Which agents would be considered cancer non-cell cycle specific agents?

alkylating agents Rationale: Alkylating agents affect cells in all phases of the cell cycle and are considered non-cell cycle specific. Antimetabolites are considered to be S phase specific agents. Mitotic inhibitors are cell cycle-specific agents working in the M phase of the cell cycle. Protein tyrosine kinase inhibitors target specific enzymes needed for protein building by specific tumor cells. They do not affect healthy human cells.

The oncology nurse understands that chemotherapeutic agents are most effective during a particular phase of the cell cycle. This means the agents are:

cell cycle-specific. Rationale: Chemotherapeutic drugs that are most effective during a particular phase of the cycle are known as cell cycle-specific.

A patient with acute lymphoblastic leukemia (ALL) is receiving imatinib on an inpatient basis. When planning the care of this patient, what assessment should be specified in the patient's plan of nursing care?

daily weights Rationale: Imatinib may be associated with edema and significant fluid overload. Patients should be weighed regularly and assessed for signs of fluid retention. Reflexes, bilateral inequalities in blood pressure, and alterations in pupil response are not associated with the use of ima

A nurse educator is discussing the role of protooncogenes in the pathophysiology of cancer. What typically triggers protooncogenes to differentiate into oncogenes?

exposure to carcinogens Rationale: 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 client asks the nurse what cancer cell growth is called. What would the nurse tell the client?

proliferation Rationale: Cancer cell growth is not called anaplasia, pleomorphism, or neoplasm.

The nurse is providing medication education to a client with breast cancer who has been prescribed tamoxifen. How should the nurse explain the action of the drug?

slows the growth of cancer cells Rationale: Antineoplastic hormone inhibitors slow the growth of cancer cells. They do not treat cancer by causing apoptosis (cell repair) or mutations. They do not influence healthy body cells in the area of the tumor.

A female client is ending an extensive chemotherapeutic regimen that included cytotoxic antineoplastic drugs. What does the nurse understand about bone marrow toxicity in this client?

It is a common adverse effect of her treatment. Rationale: Traditional cytotoxic antineoplastic drugs are nonselective in their effect on proliferating cells; therefore, bone marrow toxicity is a common adverse effect of many cytotoxic drugs. These drugs kill the same fraction of cells with each cycle of chemotherapy treatment; repeated cycles of cytotoxic drugs potentially lower the number of cancer cells to a level where a person's immune responses are able to take over and destroy the remaining cancer cells.

The community health nurse is planning care for a client who will be prescribed an oral chemotherapy drug for the next several months while recovering at home. What health education topic should the nurse emphasize?

techniques for safely handling the drug Rationale: All cytotoxic drugs are hazardous substances and require special handling and disposal, per safety guidelines, in the home. It is not possible for the client to independently monitor liver status in the home. Herbal substitutes for chemotherapy drugs do not exist, and doses are not adjusted based on short-term symptoms.

An adult client has recently begun cancer treatment with methotrexate (MTX). When reviewing this client's laboratory work, the nurse should consequently prioritize assessment of what?

BUN and creatinine Rationale: The antimetabolites may also be nephrotoxic. MTX use in clients with impaired renal function may lead to accumulation of toxic amounts or additional renal damage. Evaluation of the client's renal status should take place before and during MTX therapy. This adverse effect of MTX treatment supersedes the importance of electrolytes and ABGs, though these would also be considered.

Which drug would have the least effect on healthy human cells?

Imatinib Rationale: Imatinib belongs to the group of drugs called protein tyrosine kinase inhibitors, which do not affect healthy human cells. Etoposide and vincristine, both mitotic inhibitors, and doxorubicin, an antineoplastic antibiotic, damage both healthy and cancer cells.

A patient newly diagnosed with CML has been prescribed treatment with imatinib. The patient asks the nurse how imatinib works. What would be the nurse's best response?

Imatinib inhibits the enzyme created by the Philadelphia chromosome abnormality in CML Rationale: Imatinib is a tyrosine kinase inhibitor that selectively inhibits the Bcr-Abl tyrosine kinase created by the Philadelphia chromosome abnormality in CML and certain tumor cells present in GIST; blocking this enzyme inhibits proliferation and induces cell division. Alkylating agents alkylate cellular DNA; antimetabolites inhibit folic acid reductase, leading to inhibition of DNA synthesis and inhibition of cellular replication; antineoplastic antibiotics bind to DNA and inhibits DNA synthesis in susceptible cells, causing cell death.

Many times a combination of antineoplastic medications are used to:

decrease the development of cell resistance. Rationale: Malignant cells that remain in a dormant phase for long periods are difficult to destroy. These cells can emerge long after cancer treatment has finished—after weeks, months, or years—to begin their division and growth cycle all over again. For this reason, antineoplastic agents are often given in sequence over periods of time, in the hope that the drugs will affect the cancer cells as they emerge from dormancy or move into a new phase of the cell cycle. A combination of antineoplastic agents targeting different phases of the cell cycle is frequently most effective in treating many cancers. Combinations of drugs do not increase the length of treatment, increase the quantity of medication used, or decrease the adverse effects of the medications used.

The nurse is caring for a patient who is receiving a combination of antineoplastic agents. The patient will most likely lose her hair. Why would the nurse suggest that she get a wig or use appropriate head cover?

Most of the heat is lost through the head and it is important to cover it during extremes in temperature Rationale: Most of the heat is lost through the head and it is important to cover the head to prevent extreme changes in core temperature, which could affect all biochemical processes in the body. Other people's feelings should not be an issue in whether she wears a wig or not. Even though loss of hair could decrease self-esteem, patients are usually more concerned about their prognosis. Whether the head is covered or not has nothing to do with hair growing back.

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?

Imbalanced nutrition: less than body requirements Rationale: 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 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?

Take special care when shaving or brushing her teeth. Rationale: 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.