Pharm - Cancer Drugs
myelosuppression
-bone marrow suppression -leads to ↓ WBC, ↓RBC, ↓ platelets (leukopenia, anemia, thrombocytopenia)
doxorubicin adverse effects (2)
-cardiotoxicity, dysrhythmias -cardiomyopathy, heart failure
daunorubicin adverse effects (2)
-heart failure -dysrhythmias
tamoxifen adverse efffects (6)
-hypercalcemia -nausea, vomiting -pulmonary embolus -hot flashes -vaginal discharge or bleeding -endometrial cancer (ATI)
Capecitabine has been prescribed for a client, and the client asks the nurse about the side effects of the medication. The nurse responds that a frequent side effect of this medication is which finding? 1. Diarrhea 2. Weakness 3. Irritability 4. Increased appetite
1. Diarrhea NCLEX
A client admitted to the hospital is taking capecitabine. The nurse should monitor the client for which symptom that is a side or adverse effect of the medication? 1. Dyspnea 2. Dizziness 3. Headache 4. Constipation
1. Dyspnea (adverse effects include bone marrow depression, cardiovascular toxicity, respiratory toxicity) NCLEX
A client is receiving intravesical chemotherapy for cancer of the bladder. The nurse should plan to take which action after the completion of each treatment? 1. Encourage increased intake of oral fluids. 2. Provide increased doses of opioid analgesics. 3. Place the client on strict contact isolation for 24 hours. 4. Keep the client on nothing by mouth (NPO) status for 6 hours.
1. Encourage increased intake of oral fluids. NCLEX
The nurse is monitoring the intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. On inspection of the site, the nurse notes redness and swelling and that the infusion of the medication has slowed in rate. The nurse suspects extravasation and should take which actions? (Select all that apply) 1. Stop the infusion. 2. Notify the health care provider (HCP). 3. Prepare to apply ice or heat to the site. 4. Restart the IV at a distal part of the same vein. 5. Prepare to administer a prescribed antidote into the site. 6. Increase the flow rate of the solution to flush the skin and subcutaneous tissue.
1. Stop the infusion. 2. Notify the health care provider (HCP). 3. Prepare to apply ice or heat to the site. 5. Prepare to administer a prescribed antidote into the site. NCLEX
A female client with a diagnosis of breast cancer is taking cyclophosphamide. The client calls the health care clinic and tells the nurse that the medication is upsetting her stomach. Which instruction should the nurse provide to the client? 1. Take the medication with food. 2. Avoid drinking fluids while taking the medication. 3. Try to take the medication with a small amount of orange juice. 4. Continue to take the medication on an empty stomach, and lie down after taking the medication.
1. Take the medication with food. NCLEX
A client with cancer is about to be started on mitomycin. The nurse should contact the health care provider after noting that the client is also taking which medication? 1. Warfarin 2. Furosemide 3. Allopurinol 4. Ondansetron
1. Warfarin (mitomycin = thrombocytopenia) NCLEX
Capecitabine has been prescribed, and the nurse provides instructions to the client about the medication. Which statement by the client indicates the need for further instruction? 1. "I need to monitor my temperature." 2. "I need to be sure to go to the clinic to receive my yearly flu vaccine." 3. "I may have some diarrhea, but if it becomes severe, I will call my health care provider." 4. "It's important for me to contact my health care provider if I have any fever or other signs of infection."
2. "I need to be sure to go to the clinic to receive my yearly flu vaccine." (lowers body's resistance to infection - talk to health care provider first) NCLEX
A client with lung cancer is receiving a high dose of methotrexate. A health care provider also prescribes leucovorin to the client. The nurse should explain to the client that leucovorin is prescribed for which reason? 1. "It promotes DNA synthesis." 2. "It helps to preserve normal cells." 3. "It promotes excretion of the medication." 4. "It facilitates the synthesis of nucleic acids."
2. "It helps to preserve normal cells." (High concentrations of methotrexate harm and damage normal cells. To save normal cells, leucovorin is given; this is known as leucovorin rescue.) NCLEX
A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? 1. Glucose level 2. Calcium level 3. Potassium level 4. Prothrombin time
2. Calcium level (tamoxifen = hypercalcemia) NCLEX
The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action? 1. Take the medication with food. 2. Increase fluid intake to 2000 to 3000 mL daily. 3. Decrease sodium intake while taking the medication. 4. Increase potassium intake while taking the medication.
2. Increase fluid intake to 2000 to 3000 mL daily. NCLEX
Capecitabine has been prescribed for a client, and the client asks the nurse about the action of the medication. The nurse formulates a response based on which mechanism of action of this medication? 1. Promotes DNA synthesis 2. Interferes with protein synthesis 3. Assists with the processing of RNA 4. Processes enzymes needed for cellular growth
2. Interferes with protein synthesis (antimetabolite) NCLEX
A client with acute myelocytic leukemia is being treated with busulfan. Which laboratory value would the nurse specifically monitor during treatment with this medication? 1. Clotting time 2. Uric acid level 3. Potassium level 4. Blood glucose level
2. Uric acid level (can cause hyperuricemia) NCLEX
A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication. When implementing the plan, the nurse should make which statement to the client? 1. "You can take aspirin as needed for headache." 2. "You can drink beverages containing alcohol in moderate amounts each evening." 3. "You need to consult with the health care provider (HCP) before receiving immunizations." 4. "It is fine to receive a flu vaccine at the local health fair without HCP approval because the flu is so contagious."
3. "You need to consult with the health care provider (HCP) before receiving immunizations." NCLEX
The nurse is caring for a chemotherapy client with a low platelet aggregation level. Which likely caused this decreased platelet production? 1. Anemia 2. Thrombocytopenia 3. Bone marrow suppression 4. Low hemoglobin and hematocrit (H&H) counts
3. Bone marrow suppression NCLEX
The nurse is assigned to care for a client with metastatic breast cancer who is taking tamoxifen citrate. The nurse plans to monitor for which changes in laboratory values for this client? (Select all that apply) 1. Increase in lipase level 2. Increase in blood glucose level 3. Increase in serum calcium level 4. Increase in serum potassium level 5. Decrease in low-density lipoprotein levels
3. Increase in serum calcium level 5. Decrease in low-density lipoprotein levels NCLEX
The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? 1. Anemia 2. Decreased platelets 3. Increased uric acid level 4. Decreased leukocyte count
3. Increased uric acid level (increased uric acid level is related specifically to cell destruction) NCLEX
Chemotherapy dosage is frequently based on total body surface area (BSA), so it is important for the nurse to perform which assessment before administering chemotherapy? 1. Measure the client's abdominal girth. 2. Calculate the client's body mass index. 3. Measure the client's current weight and height. 4. Ask the client about his or her weight and height.
3. Measure the client's current weight and height. NCLEX
The nurse should be prepared to institute bleeding precautions in the client receiving antineoplastic medication if which result was reported from the laboratory? 1. Clotting time 10 min 2. Ammonia level 10 mcg/dL 3. Platelet count 50,000 mm³ 4. White blood cell count 5000 mm³
3. Platelet count 50,000 mm³ -normal platelet count = 150,000-400,000 mm³ -normal clotting time = 8-15 min -normal ammonia level = 10-80 mcg/dL -normal WBC = 5,000-10,000 mm³ NCLEX
The clinic nurse prepares instructions for a client who developed stomatitis after the administration of a course of antineoplastic medications. The nurse should provide the client with which instruction? 1. Avoid foods and fluids for the next 24 hours. 2. Swab the mouth daily with lemon and glycerin 4 times a day. 3. Rinse the mouth with a diluted solution of baking soda or saline. 4. Brush the teeth with a stiff-bristled toothbrush, and use dental floss 3 times a day.
3. Rinse the mouth with a diluted solution of baking soda or saline. NCLEX
A client with cancer has received a course of chemotherapy with fluorouracil. The nurse should tell the client to report which finding immediately? 1. Alopecia 2. Headache 3. Stomatitis and diarrhea 4. Changes in color vision
3. Stomatitis and diarrhea NCLEX
A health care provider prescribes cisplatin and vincristine to a client with bladder cancer. The nurse should explain to the client that 2 medications are administered together for which reason? 1. To prevent alopecia 2. To decrease the destruction of cells 3. To increase the therapeutic response 4. To prevent gastrointestinal side effects
3. To increase the therapeutic response (combinations of medications are used to increase the destruction of tumor cells) NCLEX
The nurse is preparing a plan of care for a client who will be receiving intravenous mitomycin for the treatment of cancer. In developing the plan of care, the nurse includes monitoring which as the priority? 1. Heart rate 2. Lung sounds 3. White blood cell count 4. Level of consciousness
3. White blood cell count NCLEX
A female client with carcinoma of the breast is admitted to the hospital for treatment with intravenously administered doxorubicin. The client tells the nurse that she has been told by her friends that she is going to lose all her hair. What is the most appropriate nursing response? 1. "Your friends are correct." 2. "You will not lose your hair." 3. "Hair loss may occur, but it will grow back just as it is now." 4. "Hair loss may occur, and it will grow back, but it may have a different color or texture."
4. "Hair loss may occur, and it will grow back, but it may have a different color or texture." NCLEX
The nurse is caring for a client receiving combination chemotherapy. Which nursing intervention is the most appropriate? 1. Give 2 agents from the same medication class. 2. Give 2 agents with like nadirs at the same time. 3. Test the client's knowledge about each agent's nadir. 4. Avoid giving agents with the same nadirs and toxicities at the same time.
4. Avoid giving agents with the same nadirs and toxicities at the same time. (Administering several medications with different mechanisms of action and different onsets of nadirs and toxicities enhances tumor cell destruction while minimizing medication resistance and overlapping toxicities.) NCLEX
The health care provider (HCP) writes a prescription for capecitabine for a client who was admitted to the hospital. The nurse should contact the HCP to verify the prescription if which condition is noted in the assessment data? 1. Myalgia 2. Psoriasis 3. Rheumatoid arthritis 4. Chronic kidney disease
4. Chronic kidney disease (capecitabine = antimetabolite, renal impairment is a contraindication) NCLEX
Capecitabine has been prescribed for a client. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication? 1. Liver function tests 2. Bilirubin level assay 3. Triglyceride level determination 4. Complete blood cell count (CBC)
4. Complete blood cell count (CBC) (bone marrow depression) NCLEX
The nurse is monitoring a client with leukemia who is receiving doxorubicin by intravenous infusion. The nurse should monitor for which finding that would indicate doxorubicin toxicity? 1. Elevated creatinine 2. Red coloration in the urine 3. Elevated blood urea nitrogen 4. Electrocardiogram (ECG) changes
4. Electrocardiogram (ECG) changes (cardiotoxicity) NCLEX
The nurse tells a client with leukemia who is receiving chemotherapy that allopurinol has been added to the medication list. When the client asks the purpose of the new medication, the nurse responds that the allopurinol is intended to prevent which problem? 1. Nausea 2. Diarrhea 3. Muscle spasms 4. Hyperuricemia
4. Hyperuricemia NCLEX
A client with small cell lung cancer is being treated with etoposide. The nurse monitors the client during administration, knowing that which adverse effect is specifically associated with this medication? 1. Alopecia 2. Chest pain 3. Pulmonary fibrosis 4. Orthostatic hypotension
4. Orthostatic hypotension NCLEX
A client with ovarian cancer is being treated with vincristine. The nurse monitors the client, knowing that which manifestation indicates an adverse effect specific to this medication? 1. Diarrhea 2. Hair loss 3. Chest pain 4. Peripheral neuropathy
4. Peripheral neuropathy NCLEX
A client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? 1. Echocardiography 2. Electrocardiography 3. Cervical radiography 4. Pulmonary function studies
4. Pulmonary function studies (bleomycin = pulmonary toxicity) NCLEX
A nurse is teaching a client who is to begin taking tamoxifen for the treatment of breast cancer. What adverse effect should the nurse include in the teaching? a. hot flashes b. urinary retention c. constipation d. bradycardia
a. hot flashes ATI
The nurse is assessing a pt who has developed anemia after 2 rounds of chemotherapy. Which of these may be indications of anemia? (select all that apply) a. hypoxia b. fever c. infection d. bleeding e. fatigue
a. hypoxia e. fatigue pharm ch 45
cyclophosphamide
alkylating agent
capecitabine
antimetabolite
The nurse is assessing a pt who has experienced severe neutropenia after chemotherapy and will monitor for which possible signs of infection? (select all that apply) a. elevated WBC count b. fever c. nausea d. sore throat e. chills
b. fever d. sore throat e. chills pharm ch 45
tamoxifen
breast cancer medication, estrogen receptor blocker
doxorubicin
cytotoxic antibiotics, anthracycline
The nurse monitors a pt who is experiencing thrombocytopenia from severe bone marrow depression by looking for: a. severe weakness and fatigue b. elevated body temperature c. decreased skin turgor d. excessive bleeding and bruising
d. excessive bleeding and bruising pharm ch 45
bleomycin adverse effect
pulmonary toxicity
nadir
the lowest level of WBCs in the blood following chemotherapy or radiation treatment
