Chemotherapeutic Drugs

18. Stage 3 A. increased metabolite transport B. cancer has spread to regional structures C. unmasks mutations in recessive genes D. methylation of DNA shuts off genes E. "rounded-up" cells F. substances produced by cancer cells increased G. extracellular proteolysis

.18. b

23. CEA a. multiple myeloma b. retinoblastomas c. hepatic, germ cells d. GI, pancreas e. Wilms tumor f. prostate gland

.23. d

1. When administering antineoplastic drugs, the nurse needs to keep in mind that the general adverse ef- fects of these drugs include: (Select all that apply.) a. bone marrow suppression. b. infertility. c. diarrhea. d. urinary retention. e. nausea and vomiting. f. stomatitis.

1. a, b, c, e, f

10. Loss of E-cadherin: a. stimulates protease production. b. digests extracellular matrix. c. increases cellular receptiveness to cancer cells. d. transforms a normal cell to a cancerous cell. e. causes cells to detach from their extracellular attachments.

10.e

11. The p53 gene: a. enables cells to cope with DNA damage. b. blocks the proliferation of cells that have suffered carcinogenic mutations. c. mutations are the most common genetic lesion in human cancer. d. mutations disable an emergency brake on cell proliferation. e. All of the above are correct.

11. e

12. Local invasive factors include all except: a. increased cellular adhesion. b. lytic enzymes. c. mechanical pressure. d. cellular multiplication.

12. a

13. The sequence of carcinogenesis is: a. exposure to carcinogens, selection of subclones, and mutation of genetic molecules. b. ionizing radiation, caretaker gene activity, and point mutations. c. several mutagenic "hits" to DNA, reactivation of telomerase, and development of immortal cells. d. carcinoma in situ, altered genetic molecules, and sequential mutagenic changes.

13. c

14. Adjuvant chemotherapy: a. produces irreversible tissue alteration. b. is well suited to treat localized disease. c. seeks to shrink tumors. d. is used prior to localized surgery. e. follows surgery to eliminate micrometastases.

14. e

17. Autonomy A. variation in size, shape, and arrangement of cells B. differentiation of dividing cells into cellular types not ordinarily found in a given area C.abnormal, proliferating cells possessing a higher degree of autonomy than normal cells D. increase in absolute number of cells E. lack of cellular differentiation or specialization, primitive cells F. cancer cells' independence from normal cellular controls

15. c 16. e 17. f

15. Neoplasia A. variation in size, shape, and arrangement of cells B. differentiation of dividing cells into cellular types not ordinarily found in a given area C.abnormal, proliferating cells possessing a higher degree of autonomy than normal cells D. increase in absolute number of cells E. lack of cellular differentiation or specialization, primitive cells F. cancer cells' independence from normal cellular controls

15. c 16. e 17. f 18. b 19. f 20. c 21. d 22. c 23. d 24. a 25. f

16. Anaplasia A. variation in size, shape, and arrangement of cells B. differentiation of dividing cells into cellular types not ordinarily found in a given area C.abnormal, proliferating cells possessing a higher degree of autonomy than normal cells D. increase in absolute number of cells E. lack of cellular differentiation or specialization, primitive cells F. cancer cells' independence from normal cellular controls

15. c 16. e 17. f 18. b 19. f 20. c 21. d 22. c 23. d 24. a 25. f

19. Tumor markers A. increased metabolite transport B. cancer has spread to regional structures C. unmasks mutations in recessive genes D. methylation of DNA shuts off genes E. "rounded-up" cells F. substances produced by cancer cells increased G. extracellular proteolysis

19. f

2. A patient will be receiving chemotherapy with pacli- taxel (Taxol). What will the nurse expect to do along with administering this drug? a. Administer platelet infusions. b. Provide acetaminophen (Tylenol) as needed. c. Keep the patient on "nothing-by-mouth" status because of expected nausea and vomiting. d. Premedicate with a steroid, H2 receptor antago- nist, and antihistamine.

2. d

2. Tumor cell markers: a. are proteases. b. are absolutely diagnostic for cancer. c. can monitor the course of cancer. d. indicate metastasis.

2.c

20. Loss of heterozygosity A. increased metabolite transport B. cancer has spread to regional structures C. unmasks mutations in recessive genes D. methylation of DNA shuts off genes E. "rounded-up" cells F. substances produced by cancer cells increased G. extracellular proteolysis

20. c

21. Silencing A. increased metabolite transport B. cancer has spread to regional structures C. unmasks mutations in recessive genes D. methylation of DNA shuts off genes E. "rounded-up" cells F. substances produced by cancer cells increased G. extracellular proteolysis

21. d

22. AFP a. multiple myeloma b. retinoblastomas c. hepatic, germ cells d. GI, pancreas e. Wilms tumor f. prostate gland

22. c

24. Urinary Bence-Jones protein a. multiple myeloma b. retinoblastomas c. hepatic, germ cells d. GI, pancreas e. Wilms tumor f. prostate gland

24. a

25. PSA a. multiple myeloma b. retinoblastomas c. hepatic, germ cells d. GI, pancreas e. Wilms tumor f. prostate gland

25. f

3. As the nurse is preparing to give the patient chemotherapy, the patient asks the nurse why more than one drug is used. The nurse will explain that combinations of chemotherapeutic drugs are used to: a. reduce drug resistance. b. reduce the incidence of adverse effects. c. decrease the cost of treatment. d. reduce treatment time.

3. a

3. Telomeres: a. block unlimited cell division. b. activate oncogenes. c. encode repair proteins for damaged DNA. d. lead to increased mutation rates.

3.a

4. If extravasation of an antineoplastic drug occurs, what will the nurse do first? a. Remove the intravenous catheter immediately. b. Stop the drug infusion without removing the in- travenous catheter. c. Aspirate residual drug or blood from the tube if possible. d. Administer the appropriate antidote.

4. b

5. During chemotherapy, the nurse will monitor the patient for which symptoms of stomatitis? a. Indigestion and heartburn b. Severe vomiting and anorexia c. Pain or soreness of the mouth d. Diarrhea and perianal irritation

5. c

6. A patient is receiving leucovorin as part of his che- motherapy regimen. The nurse expects that the pa- tient is receiving which antineoplastic drug? a. cladribine (Leustatin) b. fluorouracil (Adrucil) c. vincristine (Vincasar PFS) d. methotrexate (Trexall)

6. d

6. Known routes of metastasis include: a. continuous extension. b. lymphatic spread. c. bloodstream dissemination. d. Both b and c are correct. e. a, b, and c are correct.

6.e

7. The nurse is monitoring a patient who has developed thrombocytopenia after two rounds of chemotherapy. Which signs or symptoms will the nurse look for in this patient? (Select all that apply.) a. Bruising b. Increased fatigue c. Ulcerations on mucous membranes inside the mouth d. Temperature above 100.5o F (38.1o C) e. Increased bleeding from venipunctures

7. a, e

7. Tumor suppressor genes are: a. genes that have the ability to transform a normal cell into a cancerous cell. b. normal genes that regulate growth and development. c. genes that produce proteins that inhibit cellular division. d. Both b and c are correct.

7.c

8. In the current theory of carcinogenesis: a. the sequence is initiation-promotion-progression. b. several mutagenic "hits" are required. c. mutations in somatic cells are transmitted to future generations. d. sequential genetic changes occur. e. Both b and d are correct.

8.e

9. Which is not involved in metastasis? a. initial establishment b. interference c. invasion d. dissemination e. proliferation

9.b

Musculoskeletal

Back pain, limb pain, bone pain, myalgia, joint stiffness, arthralgia, muscle weakness, fibromyositis

Ms. L. recently underwent biopsy of a lump near her breast. Several days later, her physician calls and tells her that the lump is noncancerous and therefore is not an immediate threat to life. She is relieved to hear, then, that it is __________.

Benign

1. Which characterize(s) cancer cells? a. poorly differentiated b. metastasis c. infiltrative growth mode d. poor cellular cohesiveness e. All of the above are correct.

CHAPTER 9 1.e

4. Metastasis is: a. an alteration in normal cellular growth. b. growth of benign or malignant neoplastic cells. c. mutational. d. the ability to establish a secondary neoplasm at a new site.

CHAPTER 9 4.d

5. Carcinoma in situ is: a. preinvasive. b. a glandular or epithelial lesion. c. a teratoma. d. a carcinoma that has broken through the basement membrane. e. Both a and b are correct.

CHAPTER 9 5.e

Case Study Read the scenario and answer the following questions on a separate sheet of paper. Allen, a 40-year-old physician, has been diagnosed with acute lymphocytic leukemia and will be receiving chemotherapy with methotrexate (Trexall). He is scheduled to receive his first treatment today. 1. What is methotrexate's classification, and how does it work? 2. What laboratory test results should be checked be- fore he receives this medication? 3. Allen tells you that he often has problems with ankle pain from an old injury and takes ibuprofen (Motrin) for pain relief. Is this a concern? 4. What other medications may be given along with the methotrexate chemotherapy and why?

Case Study 1. Methotrexate is an antimetabolite—specifically, a folate antagonist. It inhibits the action of an enzyme that is responsible for converting folic acid to a substance used by the cell to synthesize DNA for cell reproduction. As a result, the cell dies. 2. Laboratory test results should be checked for white blood cell and red blood cell counts, hemoglobin level and hematocrit, platelet counts, and renal and liver function studies. 3. The concurrent administration of nonsteroidal antiinflammatory drugs (NSAIDs) and methotrexate may lead to possible reduced renal elimination of methotrexate with potentially fatal hematologic and GI toxicity. Allen should be instructed to avoid all NSAIDs, including aspirin, while taking methotrex- ate. 4. Antiemetic therapy will be needed to decrease nau- sea and vomiting. Leucovorin may be used to protect the patient from potentially fatal bone marrow sup- pression, a toxic effect of methotrexate.

Mr. Y.'s physician is not surprised to find that Mr. Y. has nausea and vomiting; the methotrexate therapy is displaying a strong __________ potential in this patient. Chapter R

Emetic

Mr. B. has just undergone a series of chemotherapeu- tic treatments when it is discovered that the antineo- plastic drug has leaked into surrounding tissues; in other words, __________ of the drug has occurred.

Extravasation

Ocular

Eye irritation, increased lacrimation, nystagmus, photophobia, visual changes, conjunctivitis, keratitis, dacryostenosis (narrowing of lacrimal duct) COMMON MANIFESTATIONS OF ANTINEOPLASTIC TOXICITY

Connective = Sarcomas

Fibrous tissue Fibrosarcoma Cartilage Chondrosarcoma Bone Osteogenic sarcoma (Ewing's tumor) Blood vessels Kaposi's sarcoma Synovia Synoviosarcoma Mesothelium Mesothelioma TISSUE OF ORIGIN TUMOR CLASSIFICATION BASED ON SPECIFIC TISSUE OF ORIGIN CHAPTER 45 Antineoplastic Drugs Part 1

Your patient is receiving methotrexate. Your instruc- tor asks for a full description of its mechanism of action, so you explain that it will inhibit dihydrofolic reductase from converting __________ acid to a reduced folate, and thus ultimately prevent the syn- thesis of DNA and cell reproduction. The result, you explain, is that the cell will die.

Folic

Epithelial = Carcinomas

Glands or ducts Adenocarcinomas Respiratory tract Small and large cell carcinomas Kidney Renal cell carcinoma Skin Squamous cell, epidermoid, and basal cell carcinoma; melanoma TISSUE OF ORIGIN TUMOR CLASSIFICATION BASED ON SPECIFIC TISSUE OF ORIGIN CHAPTER 45 Antineoplastic Drugs Part 1

Otic

Hearing loss COMMON MANIFESTATIONS OF ANTINEOPLASTIC TOXICITY

Mr. K. has been treated with methotrexate for its folate-antagonistic properties. Now, however, he seems to be experiencing a toxicity reaction. The treatment he will receive will be ________ rescue.

Leucovorin

Ms. H. has a hematologic malignancy. Her bone marrow is being rapidly replaced with leukemic blasts; she also has abnormal numbers (and forms) of immature white blood cells in her circulation, and even her lymph nodes, spleen, and liver are be- ing infiltrated. Ms. H.'s type of cancer is known as _________.

Leukemia

Ms. F. has been given her first chemotherapy treat- ment. However, it soon becomes apparent that the adverse effects she is experiencing prevent her from being given dosages that will be high enough to be effective. These are dose-__________ adverse effects.

Limiting

Lymphatic = Lymphomas

Lymph tissue Lymphomas (e.g., Hodgkin's, non-Hodgkin's) Glia Glioma Adrenal medulla nerves Pheochromocytoma TISSUE OF ORIGIN TUMOR CLASSIFICATION BASED ON SPECIFIC TISSUE OF ORIGIN CHAPTER 45 Antineoplastic Drugs Part 1

Ms. P. had a biopsy performed on the same day that Ms. L. (6 Down) did. When her biopsy specimen is analyzed, however, the results are the opposite of Ms. L.'s; that is, her lump is considered __________.

Malignant

Mr. C. is very interested in his chemotherapy pro- cess. As you are discussing a drug's action, he hears you use the term __________, and he asks you what it means. You explain that this is the point at which the lowest neutrophil count occurs after administra- tion of a chemotherapy agent that causes bone mar- row suppression.

Nadir

Mr. G. is receiving chemotherapy with a drug that is considered cytotoxic during any phase of the cellular growth cycle. This drug is known as cell cycle-________.

Nonspecific

Mr. H. is told that his cancer has metastasized. His physician explains to him that this means it has __________ to other areas of his body.

Spread

Metabolic

Weight loss or gain, anorexia, dehydration, hypokalemia, hypocalcemia, hypomagnesemia, hypertriglyceridemia, hyperglycemia, syndrome of inappropriate secretion of antidiuretic hormone, hypoadrenalism, protein-losing enteropathy, hyperuricemia, tumor lysis syndrome COMMON MANIFESTATIONS OF ANTINEOPLASTIC TOXICITY

Blood and Bone Marrow

White blood cells Leukemia Bone marrow Multiple myeloma TISSUE OF ORIGIN TUMOR CLASSIFICATION BASED ON SPECIFIC TISSUE OF ORIGIN CHAPTER 45 Antineoplastic Drugs Part 1

79 Which fluid within the body surrounds the cells so as to maintain homeostasis? A) tissue fluid B) organ fluid C) synovial fluid D) plasma within blood E) cytoplasm

✅A Tissue fluid within the body surrounds the cells so as to maintain homeostasis. Plasma remains within the bloodstream and synovial fluid is in synovial joints.

78 Which of the following is NOT an example of homeostasis? A) Glucose concentration of blood remains at about 0.1%. B) The pH of blood is always near 7.4. C) Blood pressure in the brachial artery averages near 120/80. D) Blood temperature averages around 37°C. E) In the kidneys, the amount of urine formed each day is constant, no matter how much fluid is taken in or lost by the body.

✅E The kidneys form a variable amount of urine each day to maintain internal fluids, no matter how much fluid is taken in or lost by the body. All other homeostatic descriptions are correct. LID78_2The pH of blood is always near

Homeostasis is ultimately controlled by (the) ____. A) nervous and endocrine systems B) brain alone C) muscles D) heart E) kidneys

✅Homeostasis is ultimately controlled by the nervous and endocrine systems.

83 During homeostasis, the internal environment of the body changes to match or align with the conditions in the external environment. A) True B) False

✅True The internal environment of the body remains fairly constant while the external environment varies widely.