Chapter 50: Antineoplastic Drugs and Targeted Therapies PrepU

7 See full question 22s A young man asks the nurse about the goal of the cancer therapy his mother is receiving. What would be the nurse's best response?

"The goal is to limit the cancer cells so the immune system can respond without causing too much toxicity to your mother." Explanation: The goal of cancer therapy, much like that of anti-infective therapy, is to limit the offending cells to the degree that the immune system can then respond without causing too much toxicity to the host. Therefore the other options are incorrect. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 598. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 598 Add a Note

12 See full question 53s An oncology nurse is performing patient teaching for a woman who is scheduled to begin treatment with a targeted therapy. The woman is unfamiliar with this class of drugs. How should the nurse best describe targeted therapies to this patient?

"These drugs are capable of controlling the signals that tell cancer cells to grow and divide." Explanation: By blocking the signals that tell cancer cells to grow and divide uncontrollably, targeted cancer therapies can help stop the growth and division of cancer cells. Targeted therapies do not enhance immune function or induce mutations in cancer cells. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 598. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 598 Add a Note

15 See full question 1m 15s A client is being treated for pancreatic cancer and has been prescribed streptozocin 500 mg/m2 IV for five consecutive days. The client's body surface area is 1.78 m2 and the client weighs 69.5 kg. The nurse should administer how many mg of this medication? Your Response: 890

890 Explanation: The is calculated by multiplying the ordered dose by the client's body surface area: 500 mg x 1.78 m2 = 890 mg. Weight is not included in this calculation. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 600. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 600 Add a Note

10 See full question 36s In which of these patients would cyclophosphamide not likely be effective?

A 60 year old with a brain tumor Explanation: Cyclophosphamide is the most widely used alkylating agent. It has a broad spectrum of antitumor activity and plays a major role in the treatment of hematologic malignancies such as Hodgkin's and non-Hodgkin's lymphoma and multiple myeloma. It is the only alkylating agent that is effective against acute as well as chronic leukemias. Cyclophosphamide is an important component of regimens used in stem cell transplantation. It is also effective against solid tumors, such as breast cancer, small cell lung cancer, endometrial cancer, and ovarian cancer. Cyclophosphamide is given intravenously or orally. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 608. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 608 Add a Note

18 See full question 51s 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 which of the following?

BUN and creatinine Explanation: 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 607. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 607 Add a Note

9 See full question 15s Your patient is taking ifosfamide as part of their cancer treatment. They are also taking Mesna to prevent cystitis induced by the ifosfamide. How does the Mesna work?

By combining with metabolites of ifosfamide Explanation: Amifostine and mesna are cytoprotective (cell-protecting) drugs that may be given to limit certain effects of cisplatin and ifosfamide, respectively. Mesnex does not work by increasing urine output, decreasing viral load, or increasing white blood cell production. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 597. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 597 Add a Note

4 See full question 9s A client is receiving idarubicin. What is the nurse's priority assessment?

Cardiac function Explanation: 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 610. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 610 Add a Note

2 See full question 14s A patient who is receiving methotrexate is also receiving leucovorin. The nurse understands that this drug is being given for which reason?

Counteract effects of methotrexate Explanation: Leucovorin is administered with methotrexate to counteract the effects of methotrexate treatment. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 597. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 597 Add a Note

5 See full question 16s The part of cell growth that entails RNA and protein synthesis preparing for division is known as which phase?

G2 phase Explanation: The part of cell growth that entails RNA and protein synthesis preparing for division is known as the G2 phase. During the G1 phase, RNA and proteins are built. During the S phase, DNA is made from the components of the G1 phase. Mitotic cell division occurs during the M phase. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 594. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 594 Add a Note

15 See full question 3s The nurse is providing care for an older adult client who has stomatitis secondary to the administration of methotrexate. The nurse should assess for indications of what nursing diagnoses? Select all that apply.

Impaired skin integrity Risk for infection Imbalanced nutrition Risk for bleeding Explanation: Because of the common adverse effects of severe bone marrow suppression, fatigue, malaise, rashes, alopecia, ulcerative stomatitis, hepatic toxicity, interstitial pneumonitis, chills, fever, and anaphylaxis, priority nursing diagnosis would include impaired skin integrity related to rash, risk for infection, and risk for bleeding related to severe bone marrow suppression. Because the client has stomatitis, there is a risk for imbalanced nutrition less than body requirements because eating is uncomfortable and not feeling well will also reduce her appetite. Autonomic dysreflexia is limited to clients who have spinal cord injuries. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 600. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 600 Add a Note

16 See full question 23s 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.

Implement falls prevention measures Place the client on protective isolation Monitor the client's laboratory values closely Allow sufficient time for rest between scheduled activities Explanation: 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, pp. 600-601. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 600-601 Add a Note

16 See full question 15s The client is taking ifosfamide as a component of cancer treatment and the client's oncologist has just added mesna to the client's medication regimen. How should the nurse best assess for the therapeutic effect of mesna?

Monitoring the client's urine output for signs of hematuria Explanation: Mesna combines with a urotoxic metabolite of ifosfamide to reduce the damaging effects of ifosfamide. It addresses the risk of hemorrhagic cystitis, so the absence of hematuria would suggest that it is having the intended effect. Mesna is not given to address diarrhea, pain or nausea. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 597. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 597 Add a Note

6 See full question 10s A client has just started on an alkalating agent to treat their cancer. What is the most common side effect of most alkalating agents?

Myelosuppression Explanation: Hematological effects include bone marrow suppression, with leukopenia, thrombocytopenia, anemia, and pancytopenia, secondary to the effects of the drugs on the rapidly multiplying cells of the bone marrow. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 603. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 603 Add a Note

7 See full question 2s A client has chosen to be placed on hospice. Which is acceptable chemotherapy for a client on hospice?

Palliative chemotherapy Explanation: Palliative chemotherapy is used in advanced cancer to relieve symptoms and treat or prevent complications. Adjuvant chemotherapy is used after surgery or radiation to destroy or reduce microscopic metastasis. Radiation combined with chemotherapy is implemented to treat the cancer and not used in palliation. Neoadjuvant chemotherapy is used before surgery or radiation. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, pp. 608-609. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 608-609 Add a Note

14 See full question 22s A client with breast cancer being treated with tamoxifin is also taking the oral anticoagulant coumadin for chronic atrial fibrillation. What is important to monitor in this client?

Prothrombin time Explanation: Clients taking oral anticoagulants and tamoxifin are at an increased risk for bleeding. Prothrombin times should be monitored. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 599. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 599 Add a Note

20 See full question 10s 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 with normal saline every 4 hours. Offer soft or liquid foods. Explanation: 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.

18 See full question 6s The nurse transfers from the adult oncology unit to the pediatric oncology unit. What will the nurse need to add to the client's plan of care that was not a part of the adult client's care plan?

Social, emotional, and intellectual stimulation Explanation: Children need to play and learn so meeting the child's social, emotional, and intellectual needs is a part of the care plan that was not as significant with adults. Administration of combination drugs, Double-checking dosage calculations and appropriateness of drug dosage, and Monitoring for hydration and nutritional status are all components of adult care as well as pediatric care. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 600. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 600 Add a Note

8 See full question 17s 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?

Targeted therapies have the potential to damage cancerous cells while leaving normal body cells less affected. Explanation: 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 599. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 599 Add a Note

9 See full question 2s The oncology nurse is administering a chemotherapy agent that arrests mitosis by promoting the formation of abnormal spindle fibers and mitotic asters. What classification of drug is the nurse administering?

Taxane Explanation: Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 596. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 596 Add a Note

9 See full question 16s A 54-year-old received a diagnosis of breast cancer several weeks ago and her current treatment regimen includes tamoxifen, a cell cycle-nonspecific antineoplastic drug. What is a characteristic of a cell cycle-nonspecific drug?

The drug is effective regardless of whether a cancerous cell is proliferating. Explanation: Cell cycle-nonspecific drugs act on cells in both the proliferative and the nonproliferative phases of the cell cycle. Cell cycle-nonspecific drugs can help recruit cells into a more actively dividing state, but they do not induce mutations. They are less able to distinguish between normal cells and malignant cells. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 596. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 596 Add a Note

12 See full question 35s What should the oncology nurse understand when administering a cell cycle-nonspecific chemotherapeutic agent about its effect?

The drug will be effective through all phases of the cell cycle. Explanation: Drugs that are effective through all phases of the cell cycle and not limited to a specific phase are classified as cell cycle-nonspecific. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 594. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 594 Add a Note

10 See full question 20s A 51-year-old female patient has been receiving doxorubicin for metastatic breast cancer. Her medical record indicates she has cardiomyopathy and a cumulative dose of 300 mg/m2 of doxorubicin. Which measure would help limit the severity of the cardiomyopathy in this client?

The use of dexrazoxane in conjunction with doxorubicin Explanation: Dexrazoxane, a cardioprotectant, is recommended to reduce the severity and incidence of cardiomyopathy associated with doxorubicin for women with metastatic breast cancer who received a cumulative dose of 300 mg/m2. Meticulous monitoring or multiplying daily doses would not reduce the severity and incidence of cardiomyopathy as effectively as using dexrazoxane, and reducing the dosage is not advisable. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 598. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 598 Add a Note

20 See full question 47s What rationale should the nurse provide to the client when describing the necessity of recovery periods between treatment cycles of chemotherapy?

Time is needed to replace many of the healthy body cells killed by chemotherapy. Explanation: 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.

6 See full question 2s What measure protects the nurse when preparing cytotoxic drugs?

Wearing protective equipment such as gloves, mask, and gown Explanation: Avoid direct skin or eye contact with the drug. Wear protective clothing and goggles while preparing and administering the drug to prevent toxic reaction to the drug. Washing hands prior to preparing the medication, mixing the medication in a 1-L bag, or administering the medication IM does not protect the nurse. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 601. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 601 Add a Note

11 See full question 2s A client is undergoing treatment for metastatic colorectal cancer. The client's chemotherapeutic regimen includes oxaliplatin IV. The nurse is preparing to administer a scheduled dose, and should:

administer antiemetics and dexamethasone as prescribed. Explanation: Like many antineoplastics, oxaliplatin causes nausea and the nurse should anticipate this by premedicating the client. There is no need to establish a new IV site for this particular drug and administration will not normally affect the client's pain. There is no reason to anticipate anxiety during administration unless this is the client's typical response. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 596. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 596 Add a Note

5 See full question 12s The mitotic inhibitors interfere with the ability of a cell to divide, and they block or alter DNA synthesis, thus causing cell death. For clients taking these drugs, the nurse should:

avoid any skin, eye, or mucous membrane contact with the drug. Explanation: Special care needs to be taken when administering these drugs. The nurse should avoid any skin, eye, or mucous membrane contact with the drug. This type of contact can cause serious reactions and toxicity. The nurse should check for extravasation frequently during the infusion, a distal vein should be used, nausea and vomiting are adverse effects of these drugs, and encouraging a patient to eat while having the infusion may not be what is best for the patient. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 603. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 603 Add a Note

3 See full question 30s A nurse is preparing an antineoplastic agent for a 9-year-old cancer patient. Before administering an antineoplastic agent, the nurse's most important action should be to:

check indexes of bone marrow functioning. Explanation: The most important action of the nurse prior to administering the drug would be to check indexes of bone marrow functioning. An increase or decrease of the desired dosage could be harmful to the patient. The nurse should wash the hands prior to administration and correctly identify the patient. The nurse should also create a quiet environment for the patient during the administration of the drug. However, the incorrect dosage could cause toxic effects or be insufficient in treating the cancer. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 603. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 603 Add a Note

19 See full question 3s A client with colorectal cancer is being treated with oxaliplatin. Which potential adverse effect should the nurse explain to the client?

cold-induced neurotoxicity Explanation: 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 599. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 599 Add a Note

16 See full question 9s A client is being treated on the oncology unit and has developed worsening adverse effects over the past several days of chemotherapy. Administration of filgrastim may aid in achieving what desired outcome?

increased leukocytes Explanation: Severe neutropenia can be prevented or its extent and duration minimized by administering filgrastim or sargramostim to stimulate the bone marrow to produce leukocytes. Filgrastim does not address the risk of inflammation (mucositis), abnormal platelet production, or bleeding (hemorrhagic cystitis). Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 603. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 603 Add a Note

19 See full question 10s In caring for clients undergoing chemotherapy, the nurse should monitor for what adverse effective triggered by the cytotoxic effect of the antineoplastic medication therapy? Select all that apply.

mucositis nausea diarrhea Explanation: Common adverse effects of chemotherapy include mucositis, diarrhea, and nausea. Peripheral neuropathy and increased urine output are not typical adverse effects. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, pp. 596-597. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 596-597 Add a Note

19 See full question 7s What is the defining characteristic of a sarcoma?

originates from connective tissue Explanation: Sarcomas are derived from connective tissue such as muscle, bone, cartilage, fibrous tissue, fat, or blood vessels. They are not sequestered within other tissues, and they are not the result of endogenous carcinogens. Sarcomas are not a congenital health problem. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018. Add a Note

1 See full question 20s A client has returned to the outpatient treatment center for a regular IV chemotherapy session. The nurse understands that one of the goals of chemotherapy is to:

prevent or treat adverse drug effects. Explanation: Drugs used in oncologic disorders include those used to kill, damage, or slow the growth of cancer cells, and those used to prevent or treat adverse drug effects. Cancer cells demonstrate uncontrolled cell growth; normal cells grow in a controlled fashion. Biologic targeted therapies are a newer group of anticancer medications. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 596. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 596 Add a Note

18 See full question 20s An oncology nurse is reviewing the medication administration record of a client being treated for advanced prostate cancer. In addition to two chemotherapeutic agents, the nurse reads that the client has been ordered a cytoprotective agent. The goal of this agent is to:

reduce the incidence or severity of adverse drug effects. Explanation: Cytoprotectant agents reduce the adverse effects of cytotoxic drugs, some of which can be severe, debilitating, or life threatening. Cytoprotectant drugs do not potentiate chemotherapy, protect the client from the effects of cancer, or buffer cytotoxins. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 597. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 597 Add a Note

20 See full question 2s A recent nursing graduate is receiving special training to become certified in handling and administering chemotherapy drugs. This special training is necessary because of what nursing diagnosis among clients receiving chemotherapy?

risk for injury related to chemotherapy Explanation: Because of the toxicity of chemotherapeutic agents, nurses who administer intravenous (IV) cytotoxic chemotherapy receive special training and are certified in handling and administering the chemotherapy drugs safely and accurately. Incorrect administration creates a serious risk for injury. Pain, contamination, and impaired health maintenance are not directly associated with incorrect administration.

2 See full question 9s A nurse is caring for an elderly client who is receiving vinblastine intravenously. The nurse suspects that the client is experiencing extravasation based on assessment of which finding?

swelling at the IV site or extremity Explanation: The most common sign of extravasation is swelling at the IV site or extremity; other signs include stinging, burning, or pain at the injection site; redness; and lack of blood return. Fever, sore throat, and chills are signs of infection. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 604. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 604 Add a Note

17 See full question 55s A client has chosen to receive palliative care after lung cancer metastasized to the bones and liver. Which is the most appropriate during palliative cancer care?

the use of chemotherapy to reduce pain Explanation: Palliative chemotherapy is used in advanced cancer to prevent or treat pain and obstruction. Chemotherapy does not need to be stopped abruptly or replaced with CAM. Aggressive chemotherapy would not normally be administered in a palliative context. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 607. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 607 Add a Note

4 See full question 42s A nurse is caring for a client who is to undergo chemotherapy for leukemia. Which should be part of the initial assessment performed by the nurse? Select all that apply.

type and location of the neoplastic lesion previous or concurrent treatments presence of nonmalignant disease Explanation: The initial assessment performed by the nurse for a client who is to receive chemotherapy includes the type and location of the neoplastic lesion, previous or concurrent treatments, and the presence of nonmalignant disease. Results of kidney function tests and radiographic scans are observed as part of ongoing chemotherapy administration. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 600. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 600 Add a Note

15 See full question 11s The nurse on an oncology unit is providing care for several clients with cancer, most of whom are receiving chemotherapy. What client should the nurse prioritize?

A client with hairy cell leukemia receiving pentostatin whose urine output is 35 mL over the past 12 hours Explanation: Oliguria is suggestive of renal failure and requires prompt intervention. It would be prioritized over nausea and mucositis, even though the nurse should address both of these problems. Similarly, the care team should address the client's drop in hemoglobin but it is not so precipitous that it would be more time-dependent than a client with possible acute renal failure. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 608. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 608 Add a Note

12 See full question 12s A client with acute myeloid leukemia has been receiving mitoxantrone IV as part of the chemotherapeutic regimen. When assessing the client for the effects of bone marrow suppression, the nurse should perform what assessment?

Assessment of the client's activity tolerance and energy level Explanation: The decrease in red cells that accompanies bone marrow suppression causes fatigue. Effects of bone marrow suppression on respiratory status, kidney function and electrolytes are not as common or direct, though many antineoplastics affect these domains. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 603. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 603 Add a Note

11 See full question 11s During ongoing assessment of a patient receiving 5-FU therapy, the nurse finds the patient's platelet count to be 92,000 cells/mm3. The nurse should do which of the following?

Consult the prescriber for discontinuation of the drug Explanation: The drug should be discontinued if the patient's platelet count is less than 1,00,000 cells/mm3 because it indicates that the patient has developed thrombocytopenia. Increasing the dosage or continuing the therapy with a decreased dosage is not appropriate. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 602. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 602 Add a Note

14 See full question 1m 7s The nurse is reviewing the lab values for a client who has myelosuppression post chemotherapy treatment. The nurse is likely to see which abnormal values for this client?

Decreased thrombocytes Explanation: Many antineoplastic drugs interfere with the bone marrow's ability to make new cells. This interference is called bone marrow suppression or myelosuppression and is a potentially dangerous adverse reaction. Bone marrow suppression is manifested by abnormal laboratory test results and clinical evidence of leukopenia, thrombocytopenia, or anemia. For example, there is a decrease in the white blood cells or leukocytes (leukopenia), a decrease in the thrombocytes (thrombocytopenia), and a decrease in the red blood cells, resulting in anemia. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 603. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 603 Add a Note

14 See full question 3s A client is experiencing intense nausea while being treated with chemotherapeutics. What actions should the nurse perform? Select all that apply.

Ensure that the client has had a dietician consult Administer antiemetics as prescribed Provide the client with small, frequent meals Explanation: A dietician should consult in the treatment of a client with nausea secondary to chemotherapy. Small, frequent meals and vigilant use of antiemetics are useful as well. There is no need for a low-residue diet and antacids do not normally prevent nausea. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 602. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 602 Add a Note

11 See full question 8s A client is being treated with cyclophosphamide. The client's health care provider is monitoring the client for adverse reactions to the drug. What common adverse reaction would limit increasing of the dose?

Low white blood cells Explanation: The dose-limiting toxicity associated with cyclophosphamide (at high dosage) is leukopenia. Leukocytes reach nadir within 2 weeks, with recovery after 3 to 4 weeks. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 606. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 606 Add a Note

4 See full question 20s The nurse is caring for a patient who has just been diagnosed with adenocarcinoma of the pancreas. What antineoplastic does the nurse suspect the patient will receive?

Mitomycin Explanation: Mitomycin is used in the treatment of disseminated adenocarcinoma of the stomach and pancreas. Bleomycin is used for palliative treatment of squamous cell carcinomas, testicular cancers, and lymphomas. Daunorubicin is first-line treatment of advanced HIV infection and associated Kaposi's sarcoma. Idarubicin is used in combination therapy for treatment of acute myeloid leukemia in adults. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 610. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 610 Add a Note

3 See full question 41s In describing the action of alkylating agents, what would the nurse include?

React chemically with portions of RNA, DNA, and other cellular proteins. Explanation: Alkylating agents react chemically with portions of the RNA, DNA, or other cellular proteins. Antimetabolites inhibit DNA production in cells that depend on certain natural metabolites to produce DNA, replacing the needed metabolites, which prevents normal cellular function. 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 596. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 596 Add a Note

13 See full question 8s A client has been started on vincristine as part of treatment for cancer. What factor will the nurse need to assess with regard to interactions with this medication?

Sensory, motor, and perceptual functions Explanation: Before drug administration, the nurse must determine the patient's sensory, motor, and perceptual functions, because of the potential dysfunctions associated with vincristine. The nurse must also consider bowel elimination patterns and food and fluid intake to assess for risk for constipation. Because the drug does not cause photosensitivity, the patient's exposure to sunlight need not be assessed. The drug is not known to interact with alcohol or nicotine; therefore, alcohol intake and cigarette smoking also need not be assessed. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 606. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 606 Add a Note

13 See full question 40s A patient treated with a left breast lumpectomy and radiation therapy 2 weeks ago has developed redness, blistering, and hyperpigmentaion on the left breast. What does the nurse determine the patient is experiencing?

The patient is a having radiation recall reaction. Explanation: Remind patients who have had radiation therapy that recall reactions, manifested by redness, blistering, and hyperpigmentation, can have a delayed onset and should be reported promptly. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 610. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 610 Add a Note

8 See full question 6s A patient's current course of cancer treatment involves the administration of a conjugated monoclonal antibody. What characteristic of the drug is specified by the fact that it is classified as a conjugated drug?

The targeted therapy is combined with another substance that causes cell death. Explanation: Monoclonal antibodies can be conjugated, meaning that they are combined with another substance such as radiation or a toxic drug that then produces indirect cell destruction as the conjugate infiltrates the cell. A conjugated drug is not necessarily derived from nonhuman sources, and it does not possess the ability to modify pharmacokinetics. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 598. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 598 Add a Note

8 See full question 14s Malignant cells seem to be more susceptible than normal cells to the effects of which class of antineoplastic drugs?

alkylating agents Explanation: Malignant cells seem to be more susceptible than normal cells to the effects of the alkylating agents. Antineoplastic antibiotics appear to interfere with DNA and RNA synthesis, thereby delaying or inhibiting cell division and blocking the reproductive ability of malignant cells. The vinca alkaloids interfere with amino acid production in the S phase and formation of microtubules in the M phase. Antimetabolite drugs are substances that incorporate themselves into the cellular components during the S phase of cell division. This interferes with the synthesis of RNA and DNA, making it impossible for the cancerous cell to divide into two daughter cells. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 596. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 596 Add a Note

5 See full question 2s The nurse should exercise caution when administering antimetabolites to a client with:

bone marrow suppression. Explanation: Bone marrow is often the index for dosing and re-dosing levels. Caution should be used and strict monitoring done for clients who have suppressed bone marrow and receiving an antimetabolite. Diabetes mellitus, hypertension, and seizure activity have not been identified as interfering with this drug therapy. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 593. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 593 Add a Note

1 See full question 26s Which classes of antineoplastic drugs inhibit DNA synthesis during the S phase?

camptothecin analogs Explanation: Camptothecin analogs are the class of antineoplastic drugs that inhibit DNA synthesis during the S phase. Podophyllotoxins are the class of antineoplastic drugs that stop cells in the S and G2 phase, thereby causing cell division to cease. Taxanes also interfere in the M phase with microtubules. The vinca alkaloids, like vinblastine, are the class of antineoplastic drugs that interfere with amino acid production in the S phase and the formation of microtubules in the M phase. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 596. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 596 Add a Note

2 See full question 9s After teaching a group of nursing students about antimetabolite drugs, the instructor determines that the teaching was successful when the students identify which as an example?

capecitabine Explanation: Capecitabine is an example of an antimetabolite drug. Topotecan is a camptothecin analog drug. Ixabepilone is a miscellaneous agent drug. Chlorambucil is a nitrogen mustard derivative drug. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, pp. 601-602. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 601-602 Add a Note

3 See full question 13s Based on the nurse's understanding of antineoplastic drugs, the nurse would anticipate administering which in conjunction with doxorubicin as a cardioprotective agent?

dexrazoxane Explanation: Dexrazoxane is administered concomitantly with doxorubicin as a cardioprotective agent. Leucovorin provides folic acid to cells after methotrexate administration. Mesna binds with metabolites of ifosfamide to protect the bladder from hemorrhagic cystitis. Amifostine binds with metabolites of cisplatin to protect the kidneys from nephrotoxic effects, reduces xerostomia. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 597. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 597 Add a Note

1 See full question 16s The purpose of antineoplastic drugs is to affect cells that rapidly divide and reproduce; however, the adverse effects produced by antineoplastic drugs result from their systemic use, which exposes nonmalignant cells in the body that are rapidly dividing and reproducing. Which is not an example of a rapidly dividing and reproducing cell in the body?

nerve cell Explanation: The normal cells that line the oral cavity and GI tract and the cells of the gonads, bone marrow, hair follicles, and lymph tissues are rapidly dividing cells that are subject to the effects of antineoplastic drugs and are the cause of adverse effects of antineoplastic drugs. Nerve cells are slow reproducing. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 594. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 594 Add a Note

7 See full question 13s Which classes of antineoplastic drugs stop cells in the S and G2 phase, thereby causing cell division to cease?

podophyllotoxins Explanation: Podophyllotoxins are the class of antineoplastic drugs that stop cells in the S and G2 phase, thereby causing cell division to cease. Taxanes also interfere in the M phase with microtubules. The vinca alkaloids, like vinblastine, are the class of antineoplastic drugs that interfere with amino acid production in the S phase and the formation of microtubules in the M phase. DNA synthesis during the S phase is inhibited by camptothecin analog drugs such as irinotecan. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 596. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 596 Add a Note

13 See full question 3s A client has been prescribed cabazitaxel 25 mg/m2 PO every three weeks for the treatment of prostate cancer. What is the nurse's priority response to this prescription?

question the prescriber about the route Explanation: Cabazitaxel, like all mitotic inhibitors, is administer intravenously. Confirming the order with the prescriber would consequently be a priority. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 601. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 601 Add a Note

10 See full question 5s A client who is being treated with an antineoplastic medication for cancer is prescribed Kepivance. The client is refusing this medication, stating that "all these drugs are making everything worse," including the inside of her mouth. What would be an appropriate response from the nurse?

"Kepivance is used to protect the normal cells in your body from the chemotherapy." Explanation: While a client can refuse a medication, it is important that the client understand why the medication is being given prior to her refusal. Walking away from a client who is screaming may be appropriate, but the nurse will still need to come back to give the medication at a later time. Explaining to the client that cytoprotective agents protect the normal cells in her body from the chemotherapy, and that the Kepivance is used to help epithelial cells recover in the oral cavity, would help educate the client. She would then be more likely to allow the medication to be administered. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 597. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 597 Add a Note

17 See full question 5s A client newly diagnosed with chronic myelocytic leukemia (CML) has been prescribed treatment with imatinib. What assessment question is most relevant to this client's care?

"Will paying for this medication be a problem for you and your family?" Explanation: Imatinib is expensive. It is estimated that 1 year of treatment with the drug (which needs to be taken continually) costs the patient between $30,000 and $35,000. For nearly all clients, this is a very significant consideration. The drug is not associated with a risk for depression and it is not contraindicated in clients with a shellfish allergy. Social support is always important, but financial concerns are likely to be paramount. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 600. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 600 Add a Note

17 See full question 12s 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?

a central venous catheter (CVC) Explanation: 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 unstainable for this chemotherapy regimen. Overall, a CVC is preferable to peripheral access. IM administration is uncommon. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 600. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 600 Add a Note

6 See full question 13s Which is an example of an antineoplastic drug that interferes with amino acid production in the S phase and the formation of microtubules in the M phase?

vinblastine Explanation: The vinca alkaloids, like vinblastine, are the class of antineoplastic drugs that interfere with amino acid production in the S phase and the formation of microtubules in the M phase. Etoposide's main effect is at the G2 portion of the cell cycle in mammalian cells. Cells are stopped during the S and G2 phases by the podophyllotoxins such as teniposide and thus are unable to divide. DNA synthesis during the S phase is inhibited by camptothecin analog drugs such as irinotecan. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 50: Antineoplastic Drugs and Targeted Therapies, p. 596. Chapter 50: Antineoplastic Drugs and Targeted Therapies - Page 596 Add a Note