Chapter 32: Anticancer Drugs
The nurse is monitoring a patient receiving doxorubicin. What intervention is a priority for this patient? A) administering dexrazoxane B) encouraging fluids to 3 L/day C) keeping patient away from crowds D) administering antiemetic 60 min before infusion
A) administering dexrazoxane Patients receiving doxorubicin need to be monitored for cardiac toxicity. Dexrazoxane is a cytoprotective (chemoprotective) agent that may be given to help prevent cardiac toxicities associated with doxorubicin administration.
When teaching a patient receiving paclitaxel, the nurse plans to instruct the patient to monitor for which side effect? A) arthralgias B) hypertension C) vertigo D) weight gain
A) arthralgias Myalgias (muscle pains) and arthralgias (joint pains) are a common side effect of paclitaxel that the patient should be prepared to expect.
A patient is scheduled to receive chemotherapy drugs that will cause myelosuppression. Which action by the nurse will be most important? A) monitor for a change in temperature B) evaluate GI function C) assess for evidence of cardiac compromise D) question the patient about changes in sense of taste
A) monitor for a change in temperature Myelosuppression can occur when there is a significant decrease in the bone marrow activity that results in decreased white blood cells, platelets, and red blood cells. If the patient is not producing enough white blood cells, the patient is at an increased risk for infection. One of the first signs of infection is a change in temperature so the patient's temperature should be monitored closely.
The nurse is caring for a patient with colorectal cancer who is to receive fluorouracil. Which symptom will be most important for the nurse to report to the health care provider? A) nausea B) decreased appetite C) bleeding gums D) constipation
C) bleeding gums Bleeding gums is a sign that the patient's blood may be getting too thin which could mean that the patient could bleed out from a minor injury.
A patient is receiving chemotherapy for the treatment of cancer. The nurse anticipates nadir to occur in: A) 2 days B) 8 days C) 15 days D) 30 days
B) 8 days Following chemotherapy administration, the time at which the blood count is at the lowest point (nadir) is typically between 7-10 days.
A patient is to receive a chemotherapy protocol that includes an alkylating agent, an antimetabolite, and an antitumor antibiotic. The patient asks the nurse why so much chemotherapy is needed. What is the nurse's best response? A) a protocol that uses a combination of chemotherapeutic agents works in the S phase to kill cells B) combination chemotherapy increases the extent of tumor cell killing C) combination chemotherapy uses drugs that work the same way D) an outcome of the use of combination chemotherapy is that it has no dose-limiting toxicities
B) combination chemotherapy increases the extent of tumor cell killing
A patient is scheduled to receive high-dose cyclophosphamide via an intravenous infusion as treatment for cancer. Which will be most important for the nurse to include when teaching the patient about cyclophosphamide? A) an indwelling urinary catheter will be placed B) drink at least 2 L of fluid per day C) empty the bladder every 4 to 6 hours D) limit fluid intake during chemotherapy
B) drink at least 2 L of fluid per day Patients should increase their fluid intake to reduce the risk of developing hemorrhagic cystitis. Patients should also be instructed to empty their bladder every 2 to 3 hours.
The nurse is caring for a patient receiving cyclophosphamide. What is a priority intervention for this patient? A) assessing blood pressure hourly B) encouraging fluids before, during, and after drug administration C) drawing peak and trough levels D) keeping patient isolated until drug is excreted
B) encouraging fluids before, during, and after drug administration Patients receiving cyclophosphamide should drink at least 2-3 L of fluid before, during, and after administration to prevent hemorrhagic cystitis.
A patient receiving chemotherapy for the treatment of cancer experiences "stocking/glove" syndrome. The nurse identifies which drug class as most likely associated with this adverse effect? A) antitumor antibiotics B) plant alkaloids C) alkylating drugs D) hormonal agents
B) plant alkaloids Plant alkaloids can damage peripheral nerve fibers and can cause reversible or irreversible neurotoxicity. Stocking/glove syndrome is a sign of neurotoxicity and is characterized by numbness and tingling of the fingers and toes.
The nurse is completing an admission assessment for a patient admitted for treatment with doxorubicin (Adriamycin). The nurse plans to contact the health care provider if the patient is taking which supplement? A) goldenrod leaves B) orange juice C) St. John's wort D) vitamin D
C) St. John's wort St. John's wort may decrease the concentration of doxorubicin (Adriamycin). Use of St. John's wort should be reported to the health care provider.
A patient in the outpatient oncology clinic has developed mucositis after receiving fluorouracil. Which statement made by the patient indicates the need for additional teaching about mucositis? A) I will frequently rinse out my mouth with normal saline B) to relieve my mouth pain, I will use ice pops or ice chips C) I will used mouthwash with alcohol to clean my mouth D) using a soft toothbrush will clean my teeth and freshen my breath
C) I will used mouthwash with alcohol to clean my mouth Patients should rinse their mouth every 2 hours with normal saline and should avoid use of commercial mouthwashes that contain alcohol.
The nurse is caring for a patient receiving high-dose methotrexate (MTX) therapy. What intervention is a priority for this patient? A) administering bleomycin immediately after treatment with MTX B) infusing IV dextrose at 100 mL/h throughout the drug therapy C) encouraging oral fluids to 4 L/day while being treated with MTX D) administering leucovorin within 2 days of treatment with MTX
D) administering leucovorin within 2 days of treatment with MTX Leucovorin calcium is given within the first 24-42 hrs of starting methotrexate to block the systemic toxic effect of high-dose MTX. It is a form of folic acid that does not require dihydrofolate reductase to produce folic acid. Therefore, it is used to prevent or treat toxicity induced by methotrexate, a folic acid antagonist. Bleomycin is not administered with MTX; IV dextrose is not necessary with MTX therapy, and increased fluids to this degree are not necessary with MTX.
A patient is receiving cyclophosphamide therapy. Which statement by the patient indicates more teaching is necessary? A) "I will take the medication before bed" B) "I will eat a diet low in organ meats, beans, and peas" C) "I may experience hair loss" D) "I will not visit anyone who has a respiratory infection"
A) "I will take the medication before bed" Cyclophosphamide should be taken early in the day to prevent accumulation of the drug in the bladder (and to therefore decrease the risk for hemorrhagic cystitis).
A patient is experiencing mucositis (stomatitis) after receiving chemotherapy. Which symptomatic treatments will be appropriate? (Select all that apply) A) frequent mouth rinses B) antiemetics C) topical anesthetics D) stress reduction E) antibiotics
A) frequent mouth rinses C) topical anesthetics E) antibiotics
A patient is nauseated and vomiting after receiving chemotherapy. How will the nurse best intervene? A) tell the patient to avoid eating any food during chemotherapy treatments B) inform the patient that the nausea will pass with time C) maintain hydration and nutrition and administer antinausea medications D) use antacids to relieve the irritation to the stomach, which should stop the nausea
C) maintain hydration and nutrition and administer antinausea medications It is very important for patients undergoing chemotherapy to maintain adequate nutrition and hydration. Several antiemetic drugs are available that are very successful in controlling nausea and vomiting. The patient will most likely remain nauseated even without food intake.
The nurse is caring for several patients receiving chemotherapy. Which patient will the nurse assess first? A) the patient receiving doxorubicin with a history of angina B) the patient receiving fluorouracil (with an elevated platelet count) C) the patient taking cyclophosphamide who is urinating 100 mL/h D) the patient receiving mechlorethamine with pain at the IV insertion site
D) the patient receiving mechlorethamine with pain at the IV insertion site Mechlorethamine (nitrogen mustard) is a severe vesicant and can cause tissue necrosis if it infiltrates into the tissues. Pain at the IV site is an indication of possible infiltration and needs to be addressed. History of angina is a concern because doxorubicin is cardiotoxic; however, this patient is not the priority.
A patient asks, "Why am I getting three drugs for my cancer if they all do the same thing?" What is the nurse's best response? A) "administering more than one drug prevents drug resistance" B) "more than one drug is administered in case you don't respond to one of them" C) "this makes your treatment more cost-effective" D) "we are not sure what drug will be the most effective, so this combination ensures success"
A) "administering more than one drug prevents drug resistance" Administering a combination of antineoplastic agents allows for smaller doses of each, which can minimize the severity of side effects and help prevent drug resistance.
A patient is receiving the alkylating drug cyclophosphamide. It is most important for the nurse to provide: A) IV hydration and assessment of fluid status B) vigilant skin care and cleaning with mild soap C) mouth care using half-strength hydrogen peroxide and a soft toothbrush D) patient-controlled analgesia with meperidine
A) IV hydration and assessment of fluid status The patient should be well hydrated to prevent hemorrhagic cystitis (bleeding as a result of severe bladder infection).
A patient in the outpatient oncology clinic complains of fatigue after receiving chemotherapy. What initial nursing intervention will be most appropriate? A) assess for other factors contributing to her fatigue, such as trouble sleeping B) encourage a high-protein, high-calorie diet, and design it with the patient C) refer the patient to a physical therapist to develop a strenuous exercise program D) encourage the patient to sleep as much as possible during the day to ease fatigue
A) assess for other factors contributing to her fatigue, such as trouble sleeping
A patient is receiving IV cyclophosphamide. Which intervention is a priority for this patient? A) ensuring that the patient is well hydrated B) monitoring the white blood cell count C) administering an antianxiety agent D) running IV dextrose with the chemotherapy
A) ensuring that the patient is well hydrated The patient should be well hydrated while taking this drug to prevent hemorrhagic cystitis (bleeding as a result of severe bladder inflammation). Normal saline is used as the maintenance IV when administering chemotherapy. Although it is important to monitor the patient's white blood cell count while receiving chemotherapy, avoiding hemorrhagic cystitis is the priority because it can be life-threatening. Antianxiety agents can be used if needed for the patient but on an individual basis, not routinely.
A patient being treated for cancer is receiving medication for palliation. The nurse understands that palliative therapy is used to: A) relieve symptoms B) kill tumor cells C) decrease viral load D) increase body defenses
A) relieve symptoms If cancer can no longer be controlled, chemotherapy can be used to relieve disease-related symptoms or improve quality of life.
A nurse is teaching a patient who will receive chemotherapy that will cause thrombocytopenia. Which instructions will the nurse include in the patient's teaching plan? (Select all that apply) A) use an electric razor when shaving B) use a soft-bristled toothbrush C) use aspirin for pain or headache D) monitor oral temperature daily E) report any bleeding (gums, petechiae, bruises, hematuria, melena) to the health care provider
A) use an electric razor when shaving B) use a soft-bristled toothbrush E) report any bleeding (gums, petechiae, bruises, hematuria, melena) to the health care provider Thrombocytopenia occurs when there is a decrease in platelets which puts the patient at an increased risk for bleeding.
A nurse is administering doxorubicin to a patient in the outpatient oncology clinic. Which information would be most important for the nurse to include in patient teaching? A) blood counts will most likely remain normal B) complete alopecia rarely occurs with this drug C) report any shortness of breath, palpitations, or edema to the health care provider D) tissue necrosis usually occurs 2 to 3 days after administration
C) report any shortness of breath, palpitations, or edema to the health care provider
The nurse assesses a patient who is receiving doxorubicin intravenously. The nurse determines extravasation has occurred. The first action by the nurse is to: A) attempt to aspirate residual doxorubicin from the patient's vein B) remove the intravenous catheter C) pack the intravenous site with ice D) stop the intravenous infusion of doxorubicin
D) stop the intravenous infusion of doxorubicin The first action by the nurse is to stop the intravenous infusion of doxorubicin immediately. The next action by the nurse is to aspirate any residual vesicant from the IV device using a small syringe. The third action by the nurse is to remove the IV device. The fourth action by the nurse is to assess the IV site, notify the health care provider, apply warm packs for 15-20 minutes at least 4 times every 24 hours, and elevate the extremity. The nurse should also be aware that tissue necrosis typically occurs 3-4 weeks after infiltration.