Chapter 14 NCLEX Qs

Cancer cells can rapidly develop a resistance to alkylating agents. FALSE TRUE

FALSE Rationale:Neoplastic cells can rapidly develop resistance to antimetabolites

No cancer cells have been identified that can remain dormant for more than 2 years. FALSE TRUE

FALSE Rationale:No cells have been identified that can remain dormant for more than 5 years.

Cancer is considered the second leading cause of death in the United States. TRUE FALSE

TRUE Rationale:Cancer is the second leading cause of death. Coronary disease is the leading cause of death.

A client with alopecia should cover the head if he or she will be exposed to extremes of temperature. FALSE TRUE

TRUE Rationale:Some clients may choose to get a wig as soon as their hair begins to fall out while others may prefer to remain bald. Whichever choice the client makes, it is important to teach the client to cover his or her head in extremes of temperature or when out in the sun for extended periods of time, because a great deal of heat is lost through the head in cold weather and the skin is very subject to sunburn in warm, sunny weather.

An adverse effect of tamoxifen therapy involves menopausal symptoms. FALSE TRUE

TRUE Rationale:Tamoxifen is a hormone modulator and is antiestrogen, blocking estradiol production without effects on adrenal hormones. As a result, menopausal symptoms like hot flashes, mood swings, edema, and vaginal dryness and itching can occur.

A person is said to be cured of cancer when he or she has been cancer free for a period of 5 years. FALSE TRUE

TRUE Rationale:When a person has been cancer free for 5 years, that person is said to be cured of cancer.

A client with breast cancer is receiving goserelin. What aspect of the client's most recent laboratory results would suggest an adverse effect of this particular drug? a. Elevated serum calcium b. Increased blood urea nitrogen and creatinine c. Decreased hemoglobin and hematocrit d. Increased international normalized ratio

a. Elevated serum calcium Rationale:Goserelin is associated with a risk of hypercalcemia. Renal dysfunction is important to dosage management of almost all antineoplastic drugs and is not specific to goserelin. Changes in INR or red cell indices would not be directly associated with goserelin treatment.

A client with ovarian cancer has just been prescribed carboplatin. What is the nurse's most appropriate action? a. Ensure that the client has reliable intravenous access. b. Assess the client's baseline level of cognition. c. Contact the prescriber to confirm that this is the intended drug. d. Assess skin integrity at the client's deltoid injection sites.

a. Ensure that the client has reliable intravenous access. Rationale:Carboplatin is administered IV on day 1 every 4 weeks. IM administration does not exist, and there is no obvious discontinuity between the client's diagnosis and the choice of medication. Changes in cognition are not common adverse effects.

A client's chemotherapeutic regimen includes procarbazine. What is the client's most likely diagnosis? a. Astrocytoma b. Hodgkin lymphoma c. Pancreatic cancer d. Neuroblastoma

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

The nurse reviews the plan of care for a client receiving antineoplastic therapy and sees a nursing diagnosis of risk for infection. What assessment finding would support this diagnosis? a. Alopecia b. Pancytopenia c. Stomatitis d. Dependent edema

b. Pancytopenia Rationale:Pancytopenia indicates bone marrow suppression, which would reduce the immune response and place the client at increased risk for infection. Stomatitis is painful but rarely progresses to a serious infection. Edema would be largely unrelated to the client's risk for infection. Alopecia may suggest a nursing diagnosis of disturbed body image.

During which phase of the cell cycle would a nurse expect a mitotic inhibitor to act? a. G1 b. S c. M d. G0

c. M Rationale:Mitotic inhibitors act only during the M phase of the cell cycle.

What classification of antineoplastic agents would be considered cancer non-cell cycle-specific agents? a. Mitotic inhibitors b. Antimetabolites c. Protein tyrosine kinase inhibitors d. Alkylating agents

d. 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 nurse is preparing to administer a client's prescribed chemotherapy. The client has developed bone marrow suppression during treatment. What should the nurse include in the client's plan of care? Select all that apply. a. Place the client on protective isolation. b. Monitor the client's laboratory values closely. c. Implement falls prevention measures. d. Administer anticoagulants as prescribed. e. Allow sufficient time for rest between scheduled activities.

a. Place the client on protective isolation. b. Monitor the client's laboratory values closely. c. Implement falls prevention measures. e. Allow sufficient time for rest between scheduled activities. Rationale:Decreased platelets create a risk for bleeding if the client experiences an injury; anemia causes fatigue and activity intolerance; neutropenia creates a serious risk for infection. It is important for the nurse to monitor the client's laboratory values as closely as possible. Anticoagulants would be likely to exacerbate the risks associated with thrombocytopenia.

The nurse would classify what types of cancer as solid tumors? Select all that apply. a. Sarcomas b. Lymphomas c. Leukemias d. Carcinomas e. Hematologic malignancies

a. Sarcomas d. Carcinomas Rationale:Cancers can be divided into two groups: (1) solid tumors and (2) hematological malignancies. Solid tumors may originate in any body organ and may be further divided into carcinomas, or tumors that originate in epithelial cells, and sarcomas, or tumors that originate in the mesenchyme and are made up of embryonic connective tissue cells. Hematological malignancies such as the leukemias and lymphomas occur in the blood-forming organs.

A client is being treated for cancer, and dronabinol has been added to the client's current medication regimen. What assessment finding would indicate a therapeutic effect of this medication? a. Decreased pain b. Absence of nausea c. Stable white blood cell levels d. Increased energy

b. Absence of nausea Rationale:Dronabinol is an antiemetic that is a derivative of delta-9-tetrahydrocannabinol, the active ingredient in marijuana. Absence of nausea would suggest that it is having the intended effect. It is not administered to increase energy, prevent leukopenia, or treat pain.

A client with late-stage colorectal cancer has been prescribed regorafenib. What is a priority point for client education? a. Avoid direct sunlight. b. Avoid grapefruit juice. c. Eat a high-calorie diet, if possible. d. Perform deep breathing and coughing exercises hourly when awake

b. Avoid grapefruit juice. Rationale:Regorafenib reacts with grapefruit juice. It does not induce photosensitivity. Deep breathing and coughing are useful for the prevention of atelectasis in ill clients, but this is not particular to the use of regorafenib. Similarly, a high-calorie diet is not a necessity with this drug.

When describing alkylating agents, the nurse identifies what drug as the prototype? a. Vincristine b. Chlorambucil c. Fluorouracil d. Methotrexate

b. Chlorambucil Rationale:Chlorambucil is the prototype alkylating agent. Fluorouracil is an antimetabolite. Methotrexate is the prototype antimetabolite. Vincristine is the prototype mitotic inhibitor.

The nurse is administering etoposide IV to a client with testicular cancer when extravasation occurs. The nurse has informed the healthcare provider promptly and should perform what action? a. Aspirate from the IV site using a 5-mL syringe. b. Prepare to administer hyaluronidase as prescribed. c. Flush the line with sodium bicarbonate as prescribed. d. Have the client raise the affected site as high as possible.

b. Prepare to administer hyaluronidase as prescribed. Rationale:Hyaluronidase is used for extravasations of etoposide, teniposide, vinblastine, or vincristine. Sodium bicarbonate is used for extravasations of daunorubicin, doxorubicin, vinblastine, or vincristine. Aspiration is not performed in cases of extravasation. Elevating the affected limb is of no benefit.

A client with advanced prostatic cancer has opted for palliative care. At a care conference, the decision is made to pursue histrelin treatment. What should the nurse teach the client about this medication? a. "The advantage of this drug is that it involves just one intramuscular injection every 6 weeks." b. "These pills will likely give you a much higher quality of life." c. "This will involve giving you an implant of the drug" d. "We'll work with your family so that you can receive your IV infusions at home."

c. "This will involve giving you an implant of the drug" Rationale:Histrelin is administered by an implant. It is not administered PO, IM, or IV.

The nurse is caring for a client who has cancer and who is receiving chemotherapy. Thirty minutes ago, the nurse administered a prescribed dose of ondansetron. What assessment should the nurse perform? a. Assess the client's urine output. b. Assess the client's orientation to person, place, and time. c. Assess the client's level of nausea. d. Auscultate the client's bowel sounds

c. Assess the client's level of nausea. Rationale:Ondansetron blocks serotonin receptors in the CTZ, relieving nausea. It would be prudent for the nurse to assess for therapeutic effect after administration. Orientation, bowel motility, and urine output will remain unaffected.

A client is receiving idarubicin. What is the nurse's priority assessment? a. Respiratory function b. Red cell indices c. Cardiac function d. Electrolyte levels

c. Cardiac function 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 with cancer has been prescribed a protein kinase inhibitor. The nurse should describe which likely benefit of this medication? a. Lower cost than most other antineoplastics b. One-time dosing c. Fewer adverse effects than many other chemotherapeutics d. Intramuscular depot administration

c. Fewer adverse effects than many other chemotherapeutics Rationale:Protein kinase inhibitors do not affect healthy human cells, so the patient does not experience the numerous adverse effects associated with antineoplastic chemotherapy. They are administered by the oral route and each requires multiple doses. These drugs are exceedingly expensive.

A client has just received the first scheduled dose of intravenous doxorubicin as treatment for leukemia. What should the nurse teach the client about the course of treatment? a. "You will receive the drug as a one-time dose that cannot be repeated for at least 3 months." b. "You will receive doxorubicin q12h for the next 10 days." c. "You will receive subsequent doses of doxorubicin orally." d. "You will receive another dose in 3 weeks."

d. "You will receive another dose in 3 weeks." Rationale:Doxorubicin is administered as a single IV dose and repeated every 21 days (3 weeks) by IV.

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

d. 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 client with non-Hodgkin lymphoma has been prescribed doxorubicin. What assessment should the nurse perform throughout treatment? a. Assessing the client peripheral nerve function b. Monitoring the client's level of consciousness c. Assessing the client's electrolyte levels d. Monitoring the client's liver enzyme levels

d. Monitoring the client's liver enzyme levels Rationale:Doxorubicin is the prototype antineoplastic antibiotic. Comprehensive assessment is necessary during treatment, due to the significant and varied adverse effects. However, the client's risk of hepatic damage exceeds the risk of neurological effects. Doxorubicin is unlikely to have a direct effect on the client's electrolyte levels.

A client has been prescribed cabazitaxel 25 mg/m2 PO every 3 weeks for the treatment of prostate cancer. What is the nurse's best response to this prescription? a. Question the prescriber about the dose. b. Perform a comprehensive assessment prior to administration. c. Confirm the client's baseline renal and hepatic function. d. Question the prescriber about the route.

d. Question the prescriber about the route. Rationale: Cabazitaxel, like all mitotic inhibitors, is administered intravenously. Confirming the order with the prescriber would consequently be a priority.

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 what cells as an example? a. Testicles b. Breast c. Ovaries d. Skin

d. Skin Rationale:Skin cells proceed very rapidly through the cell cycle. Breast cells, cells of the testicles, and cells of the ovaries proceed very slowly through the cell cycle.

A client with osteosarcoma who is receiving methotrexate is also receiving leucovorin. What finding would suggest to the nurse that leucovorin is having the desired therapeutic effect? a. The client's hair remains intact throughout methotrexate therapy. b. The client's osteosarcoma goes into remission. c. The client remains free of nausea and vomiting during methotrexate therapy. d. The client experiences minimal adverse effects of methotrexate.

d. The client experiences minimal adverse effects of methotrexate. Rationale:Leucovorin is administered with methotrexate to counteract the toxic effects of methotrexate treatment. Leucovorin does not have a synergistic effect on cancer cells. Leucovorin will not relieve nausea and vomiting or alopecia.

A client's breast cancer has been characterized by the oncologist as being "slow-growing." The nurse recognizes that the client has been prescribed an alkylating agent because of which characteristic of antineoplastic drugs? a. They insert themselves between base pairs in the DNA chain to disrupt DNA synthesis. b. They block DNA synthesis to interfere with the cell's ability to divide. c. They can be taken for an indefinite period of time, allowing prolonged courses of treatment. d. They affect cancer cells even when the cells are in their resting phase.

d. They affect cancer cells even when the cells are in their resting phase. Rationale:Alkylating agents are ideal for the treatment of slow-growing cancers because they are still effective during the cell's resting stage. They cannot, however, be taken indefinitely. Mitotic inhibitors interfere with the ability of a cell to divide, blocking or altering DNA synthesis. Antineoplastic antibiotics interfere with cellular DNA synthesis by inserting themselves between base pairs in the DNA chain.