PrepU Antineoplastic, Pharm Ch 14 Prepu, Pharmacology PrepU Chapter 14: Antineoplastic Agents

A client with a diagnosis of non-small-cell lung cancer is currently undergoing chemotherapy. At the encouragement of a family member, the client has announced to the nurse the intention to complement this treatment with a regimen of herbal remedies. How should the nurse respond to this client's statement? A. "It's likely best to begin taking herbal remedies after you've completed this round of chemotherapy." B. "Unfortunately, your current chemotherapy program will likely preclude the use of herbs." C. "It's important to discuss what herbs you'll be taking with your health care provider or the pharmacist to make sure there aren't any interactions." D. "If that's something in which you and your family see potential benefit, I'd encourage you to pursue it."

"It's important to discuss what herbs you'll be taking with your health care provider or the pharmacist to make sure there aren't any interactions."

A client received an injection of doxorubicin and is now observing a reddish urine. The client reports blood in the urine to the nurse. How should the nurse respond?

"The reddish urine is an expected response to the drug."

An adult client who has been diagnosed with a rectal tumor is scheduled to begin treatment with cisplatin.The nurse has conducted client teaching about the possibility of nausea and vomiting. In order to reduce the client's risk of severe nausea, the nurse should: A. encourage the client to request antiemetics if the nausea becomes unbearable. B. ensure that the client is NPO from midnight prior to receiving the drug. C. place the client on a low-residue diet. D. administer a combination of antiemetics prior to the administration of the drug.

Administer a combination of antiemetics prior to the administration of the drug -Antiemetics should be administered proactively rather than waiting until the client's nausea becomes unbearable. A combination approach is often effective.

A 49-year-old client is diagnosed with ovarian cancer. What is a characteristic of malignant cells that differentiates them from normal body cells? A. Cancerous cells are not responsive to the presence of drugs. B. Cancerous cells do not require an energy source in order to proliferate. C. Cancerous cells grow in an uncontrollable fashion. D. Cancerous cells have a theoretically infinite life span.

Cancerous cells grow in an uncontrollable fashion

A 49-year-old client is diagnosed with ovarian cancer. What is a characteristic of malignant cells that differentiates them from normal body cells?

Cancerous cells grow in an uncontrollable fashion.

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

Cardiac function Chapter 14: Antineoplastic Agents - Page 229 The client's cardiac function needs to be monitored closely because idarubicin is specifically toxic to the heart. The pancytopenia that accompanies antineoplastics can cause decreased red cell indices, but this does not address the particular threat to the cardiac system posed by idarubicin. Respiratory function is not commonly impacted by idarubicin. Electrolyte levels should be monitored in clients receiving any antineoplastic study due to adverse effects impacting nutrition and kidney function, but are not specific to idarubicin.

A child is prescribed an anthracycline drug. The nurse would teach the parents to observe for signs and symptoms of what adverse effect? A. Esophageal varices B. Gallbladder disease C. Dehydration D. Cardiotoxicity

Cardiotoxicity

A client has been diagnosed with a brain tumor and is dealing with this diagnosis by seeking detailed information about cancer. The nurse would explain to the client that cancer is essentially a result of the disruption of the: A. cell cycle. B. cell wall. C. immune system. D. lymphatic system.

Cell cycle

A male client is receiving parenteral cytotoxic medications in the home. Adjunct therapy may include what substance? A. Antidiuretic hormone B. Normal saline 0.9% intravenously C. Erythropoietin D. Heparin

Erythropoietin

A male client is receiving parenteral cytotoxic medications in the home. Adjunct therapy may include what substance? Erythropoietin Heparin Normal saline 0.9% intravenously Antidiuretic hormone

Erythropoietin Chapter 14: Antineoplastic Agents - Page 223

Cancer cells can rapidly develop a resistance to alkylating agents. True False

False Neoplastic cells can rapidly develop resistance to antimetabolites.

A client's chemotherapy regimen has been deemed successful, but the client is experiencing debilitating nausea and vomiting. These adverse effects should signal the nurse to the possibility of what nursing diagnosis? A. Ineffective therapeutic regimen management B. Imbalanced nutrition: less than body requirements C. Adult failure to thrive D. Acute pain

Imbalanced nutrition: less than body requirements -Nausea and vomiting are major threats to the client's nutrition.

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 Administer anticoagulants as prescribed Place the client on protective isolation Monitor the client's laboratory values closely Allow sufficient time for rest between scheduled activities

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 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.

A nurse is administering an antineoplastic extravasation occurs. How can the nurse best prevent tissue damage caused by extravasation?

Inspect the site frequently for redness or swelling

A patient is receiving carboplatin. The nurse would expect to administer this drug by which route? Intravenous Oral

Intravenous

A patient is receiving carboplatin. The nurse would expect to administer this drug by which route? A. Intramuscular B. Intravenous C. Subcutaneous D. Oral

Intravenous -Carboplatin is administered IV on day 1 every 4 weeks.

A female client is ending an extensive chemotherapeutic regimen that included cytotoxic antineoplastic drugs. What does the nurse understand about bone marrow toxicity in this client?

It is a common adverse effect of her treatment.

An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease? A. Lymphoma B. Skin cancer C. Prostate cancer D. Lung cancer

Prostate Cancer -In male patients, antiandrogens are used to treat prostate cancer.

A client is prescribed doxorubicin drug therapy for carcinoma of the breast. On the second day of drug therapy, she calls in to report reddish urine. What should the nurse do?

Reassure the client that it is a harmless and expected response to the drug.

A client is prescribed doxorubicin drug therapy for carcinoma of the breast. On the second day of drug therapy, she calls in to report reddish urine. What should the nurse do? A. Suggest some nonpharmacologic interventions. B. Caution the client against taking aspirin or caffeine. C. Reassure the client about adequate monitoring and follow-up in her home setting. D. Reassure the client that it is a harmless and expected response to the drug.

Reassure the patient that it is a harmless and expected response to the drug -Reddish urine is observed within a day or two after doxorubicin injection. The client should be reassured that it is a harmless and expected response to the drug.

A patient has just received the first dose of imatinib and the nurse on the oncology unit is amending the patient's care plan accordingly. What nursing diagnosis is most appropriate in light of this addition to the patient's drug regimen?

Risk for Infection related to bone marrow suppression

A patient with non-Hodgkin's lymphoma (NHL) will be starting a course of doxorubicin shortly. When planning this patient's care, what nursing diagnosis should the nurse prioritize?

Risk for Infection related to suppressed bone marrow function

When describing the various effects of antineoplastic agents, the nurse explains that antineoplastic drugs primarily affect human cells that are rapidly multiplying, going through the cell cycle quickly. The nurse would identify which cells as an example? Skin Breast Testicles Ovaries

Skin

A postmenopausal woman with breast cancer will most likely be treated with which anti-estrogen drug?

Tamoxifen

A postmenopausal woman with breast cancer will most likely be treated with which anti-estrogen drug? Tamoxifen Bleomycin Cyclophosphamide Cisplatin

Tamoxifen

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.

A patient is administered mesna (Mesnex) to prevent cystitis induced by ifosfamide. How will this medication combination prevent cystitis? The medications increase urine output related to ifosfamide. The medications decrease viral load related to ifosfamide. The medications increase white blood cells related to ifosfamide. The medication combines with the metabolite of ifosfamide.

The medication combines with the metabolite of ifosfamide Chapter 14: Antineoplastic Agents, box 14.3, p. 221. Mesna is used with ifosfamide, which produces a metabolite that causes hemorrhagic cystitis. Mesna combines with and inactivates the metabolite, thereby decreasing cystitis.

An older adult woman has been diagnosed with acute lymphoblastic leukemia (ALL) and her care team has identified potential benefits of imatinib. Which characteristic of this patient's current health status may preclude the use of imatinib?

The patient has chronic heart failure resulting in significant peripheral edema.

When describing the process of cancer cell growth to a client, the nurse addresses angiogenesis. Which description would the nurse include?

The process of creating new blood vessels to supply oxygen and nutrients to the cells

When describing the process of cancer cell growth to a client, the nurse addresses angiogenesis. Which description would the nurse include? A. A process that involves the cells traveling to other areas of the body to develop new tumors B. A process in which the cells lose their ability to differentiate and organize C. The process of creating new blood vessels to supply oxygen and nutrients to the cells D. The process of growing without the usual homeostatic restrictions that regulate cells

The process of creating new blood vessels to supply oxygen and nutrients to the cells

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? A. the use of chemotherapy to reduce pain B. aggressive chemotherapy to reduce malignant cell proliferation C. Abrupt cessation of chemotherapy immediately prior to entering palliative care D. the replacement of chemotherapy with complementary and alternative treatments

The use of chemotherapy to reduce pain

A client with a diagnosis of bladder cancer is started on a chemotherapeutic regimen that includes three agents. What is the rationale for using multiple antineoplastic agents?

The use of three agents decreases the development of cell resistance.

A client with a diagnosis of bladder cancer is started on a chemotherapeutic regimen that includes three agents. What is the rationale for using multiple antineoplastic agents? The use of three agents decreases the development of cell resistance. The use of three agents increases the length of treatment. The use of three agents increases the quantity of one of the agents. The use of three agents decreases the adverse effects.

The use of three agents decreases the development of cell resistance.

What potential benefit is unique to biologic agent therapies? A. They may affect cancer cells while leaving normal body cells unaffected. B. Cytotoxic adverse effects are rarely experienced. C. They may be administered long term without the need for regular blood work. D. Administered does not require a certified chemotherapeutic nurse.

They may affect cancer cells while leaving normal body cells unaffected -Biologic agents target cellular differences between the malignant and normal cells. Consequently, they may kill cancer cells while leaving normal body cells unaffected.

What potential benefit is unique to biologic agent therapies?

They may affect cancer cells while leaving normal body cells unaffected.

What rationale should the nurse provide to the client when describing the necessity of recovery periods between treatment cycles of chemotherapy? A. The restoration of fluid balance and nutrition is needed before continuing with chemotherapy. B. Time is required for the successful application of radiotherapy between cycles of chemotherapy. C. Time is needed to replace many of the healthy body cells killed by chemotherapy. D. There is a need to restore a physiologic reserve of energy before further chemotherapy.

Time is needed to replace many of the healthy body cells killed by chemotherapy -Cyclic administration involves taking the drugs for a specific period, with a recovery period following each treatment cycle.

True or False: Anemia from chemotherapy treatment is the result of bone marrow suppression.

True -Adverse reactions common to many of the antineoplastic drugs include bone marrow suppression which in turn causes anemia, leukopenia and thrombocytopenia.

The dosages of the chemotherapy agents that will be administered are based primarily on what client variable? A. weight B. body surface area (BSA) C. percentage of body water D. comorbidities

Weight

A 79-year-old woman has recently moved to a long-term care facility, and the nurse at the facility is conducting a medication reconciliation. The nurse notes that the woman has recently been taking tamoxifen. The nurse is justified in concluding that the woman has a history of what malignancy?

breast cancer

The oncology nurse understands that chemotherapeutic agents are most effective during a particular phase of the cell cycle. This means the agents are:

cell cycle-specific.

A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to:

drink a lot of water.

A 63-year-old male patient has just begun treatment with IV paclitaxel. About 10 minutes into the infusion, the nurse becomes concerned about a possible anaphylactic reaction to the drug because the patient is experiencing:

dyspnea.

A nurse is caring for a 46-year-old female patient who is taking paclitaxel for ovarian cancer. Two or three days after the infusion of the drug, the nurse must closely monitor for: cardiotoxicity. constipation. neurotoxicity. asthma.

neurotoxicity Chapter 14: Antineoplastic Agents - Page 232 Neurotoxicity is a major problem associated with paclitaxel therapy, and close monitoring is needed. Neurotoxicity generally begins 2 to 3 days after the infusion. Cardiotoxicity is observed in less than 1% of patients. The drug is not known to cause constipation or asthma.

When preparing to administer ondansetron for a patient's nausea and vomiting, the nurse understands that this agent blocks: serotonin. dopamine. norepinephrine. GABA.

serotonin Chapter 14: Antineoplastic Agents - Page 223

What health education topic should the community health nurse emphasize when planning care for a client who will be prescribed an oral chemotherapy drug for the next several months while recovering at home?

techniques for safely handling the drug

A 25-year-old female client is prescribed methotrexate to treat rheumatoid arthritis (RA). The nurse should teach the client to: A. use an effective contraceptive. B. drink milk with the medication. C. expect a mild rash and itching. D. take a pain reliever for sore throat.

use an effective contraception -Women of childbearing age should use an effective contraceptive during therapy with methotrexate. When taking methotrexate, the client should be instructed to notify the primary health care provider immediately at first sign of a rash or sore throat.

A 25-year-old female client is prescribed methotrexate to treat rheumatoid arthritis (RA). The nurse should teach the client to:

use an effective contraceptive.

A middle-aged patient has received a diagnosis of GI stromal tumor following an extensive diagnostic workup. Imatinib has been recommended as a component of the patient's drug regimen. What patient education should the nurse provide to this patient? A. "If you experience significant nausea after taking a dose, stop taking the drug and schedule an appointment at the clinic." B. "You'll likely experience a lot of dry mouth while you're taking this drug, so it's helpful to chew ice chips." C. "It's important that you let us know if you develop any significant swelling or puffiness." D. "Try to keep your PICC line dressing as dry as possible at all times."

"It's important that you let us know if you develop any significant swelling or puffiness."

A patient who will begin chemotherapy voices concern to the nurse about the accompanying nausea and vomitting. What is the best response by the nurse? A. "Not everyone has nausea and vomiting. Just wait to see how you will react to the chemotherapy." B. "Nausea and vomiting are an unfortunate side effect of the chemotherapy. We will do what we can but you may have it anyway." C. "We can relieve your nausea and vomiting with antiemetic drug therapy. You should ask for these medications whenever you need them." D. "We can relieve your nausea and vomiting with drugs but you can have them only before and after the chemotherapy."

"We can relieve your nausea and vomiting with antiemetic drug therapy. You should ask for these medications whenever you need them."

A client asks the nurse why the chemotherapy is often administered in cycles. Which response by the nurse would be most appropriate? A. "The cycles are the only way to guarantee a cure for the cancer." B. "The cycles help to prevent the drugs from destroying the healthy cells." C. "We want to attack the cells that might be dormant or moving into a new phase." D. "The drugs are highly toxic, so the body needs time to recover."

"We want to attack the cells that might be dormant or moving into a new phase."

The nurse may be asked to administer which medication to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis? Allopurinol (Zyloprim) Amifostine (Ethyol) Mesna (Mesnex) Leucovorin (Wellcovorin)

Allopurinol Chapter 14: Antineoplastic Agents - Page 220

The nurse is preparing a client who will begin chemotherapy in a few days. The nurse knows that which are the most common adverse effects encountered by most clients who receive chemotherapy? (Select all that apply.) Alopecia Neutrocytosis Thrombocytopenia Anemia Stomach ulcers

Alopecia Thrombocytopenia Anemia Chapter 14: Antineoplastic Agents - Page 220

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

The oncology nurse understands that chemotherapeutic agents are most effective during a particular phase of the cell cycle. This means the agents are: A. cell targeting. B. cell cycle-specific. C. growth fraction. D. cell cycle-nonspecific.

Cell cycle specific -Chemotherapeutic drugs that are most effective during a particular phase of the cycle are known as cell cycle-specific.

When describing alkylating agents, the nurse would explain that this medication is seen as the prototype: A. Chlorambucil B. Fluorouracil C. Methotrexate D. Vincristine

Chlorambucil -Chlorambucil is the prototype alkylating agent.

Which antineoplastic drugs are classified as antineoplastic antibiotics? (Select all that apply.) Bleomycin (Blenoxane) Carboplatin (Paraplatin) Dactinomycin (Cosmegen) Daunorubicin (DaunoXome) Busulfan (Busulfex)

Dactinomycin (Cosmegen) Bleomycin (Blenoxane) Daunorubicin (DaunoXome)

A patient with acute lymphoblastic leukemia (ALL) is receiving imatinib on an inpatient basis. When planning the care of this patient, what assessment should be specified in the patient's plan of nursing care? A. bilateral blood pressures B. daily weights C. pupillary response D. assessment of deep tendon reflexes

Daily weights

After teaching a group of students about antineoplastic antibiotics, the instructor determines that the teaching was successful when the students identify which drug as an example? A. Vincristine B. Imatinib C. Doxorubicin D. Methotrexate

Doxorubicin

A client with leukemia is being treated with a combination of antineoplastics, including methotrexate. The client's most recent laboratory results indicate the client is experiencing bone marrow suppression. What is the nurse's priority action? A. Provide small quantities of food several times per day, as tolerated. B. Encourage the client to limit physical activity in order to reduce the risk of bleeding. C. Ensure that all staff and visitors adhere to infection control precautions. D. Space out the client's care to preserve energy and prevent fatigue.

Ensure that all staff and visitors adhere to infection control precautions -The client's combination of cancer and bone marrow suppression creates an acute risk for infection. As a result, infection control is vital to maintaining the client's health and safety.

A nurse educator is discussing the role of protooncogenes in the pathophysiology of cancer. What typically triggers protooncogenes to differentiate into oncogenes? A. exposure to chemotherapeutic agents B. exposure to carcinogens C. exposure to a low-pH environment D. ischemia

Exposure to carcinogens

Fewer adverse effects are associated with monoclonal antibody therapy than those of cytotoxic drugs. However, some of the potential adverse effects of monoclonal antibodies can be life threatening, including which effect? A. heart failure and bleeding problems B. ischemic heart disease C. bronchoconstriction and pulmonary edema D. changes in cognition and personality changes

Heart failure and bleeding problems

A 26-year-old man with testicular cancer is prescribed combination chemotherapy that involves using two drugs that are effective against testicular tumors. Combination drug therapy is superior to single-drug therapy because of: A. Increased capillary permeability B. Higher tumor response rates C. Lower risk for secondary cancers D. Decreased duration of remissions

Higher tumor response rates

A client's chemotherapeutic regimen includes procarbazine. What is the client's most likely diagnosis? A. Neuroblastoma B. Pancreatic cancer C. Astrocytoma D. Hodgkin lymphoma

Hodgkin Lymphoma -Procarbazine (Matulane) is used in combination therapy for treatment of stages III and IV of Hodgkin disease.

A client's chemotherapeutic regimen includes procarbazine. What is the client's most likely diagnosis?

Hodgkin lymphoma

A female client is ending an extensive chemotherapeutic regimen that included cytotoxic antineoplastic drugs. What does the nurse understand about bone marrow toxicity in this client? A. It is a rare side effect of the chemotherapy. B. It is a common adverse effect of her treatment. C. It will ultimately lead to death. D. It will cause the health care provider to increase the dose of chemotherapeutic medications.

It is a common adverse effect of her treatment -Traditional cytotoxic antineoplastic drugs are nonselective in their effect on proliferating cells; therefore, bone marrow toxicity is a common adverse effect of many cytotoxic drugs.

A patient is diagnosed with ovarian cancer. Why is considered to be an aggressive form of cancer? It is fed by calcium in women who take estrogen. It is fed by the hormones produced by the ovaries. The younger the client, the more aggressive the form. The woman has a supply of testosterone from the ovaries.

It is fed by the hormones produced by the ovaries.

A male patient has been on long-term bicalutamide (Casodex) therapy. In order to assess adverse effects of the drug therapy, the nurse will closely monitor: A. Visual function B. Pap test results C. Blood counts D. Liver function

Liver function

During which phase of the cell cycle would a nurse expect a mitotic inhibitor to act? A. S B. G1 C. G0 D. M

M

Which antineoplastic drugs are classified as antimetabolites? (Select all that apply.) A. Mercaptopurine (Purinethol) B. Irinotecan (Camptosar) C. Etoposide (Toposar) D. Capecitabine (Xeloda) E. Fluorouracil (Adrucil)

Mercaptopurine, Capecitabine, Fluorouracil -Antimetabolite drugs are substances that incorporate themselves into the cellular components during the S phase of cell division .

Which agent would the nurse expect to be administered orally? Cytarabine Fluorouracil Gemcitabine Methotrexate

Methotrexate Chapter 14: Antineoplastic Agents - Page 225

A male client is informed that the latest tests indicate that his cancer has spread to his liver. The client receives capecitabine as part of his treatment regimen. What would the nurse expect the health care provider to do? A. Increase the dose of capecitabine. B. Monitor the client closely and repeat LFTs routinely. C. Add routine blood transfusions to the client's treatment regimen. D. Discontinue the capecitabine.

Monitor the client closely and repeat LFTs routinely -Capecitabine blood levels are significantly increased with hepatic impairment, and clients with liver metastases should be monitored closely.

A male client is informed that the latest tests indicate that his cancer has spread to his liver. The client receives capecitabine as part of his treatment regimen. What would the nurse expect the health care provider to do?

Monitor the client closely and repeat LFTs routinely.

No cancer cells have been identified that can remain dormant for more than 2 years. True or False

No cancer cells have been identified that can remain dormant for more than 2 years. Rationale: No cancer cells have been identified that can remain dormant for more than 5 years.

An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease? Lymphoma Lung cancer Skin cancer Prostate cancer

Prostate cancer

A patient has just received the first dose of imatinib and the nurse on the oncology unit is amending the patient's care plan accordingly. What nursing diagnosis is most appropriate in light of this addition to the patient's drug regimen? Risk for Infection related to bone marrow suppression Risk for Acute Confusion related to adverse neurological effects of imatinib Risk for Impaired Skin Integrity related to exaggerated inflammatory response Risk for Deficient Fluid Volume related to changes in osmotic pressure

Risk for Infection related to bone marrow suppression Chapter 14: Antineoplastic Agents - Page 245

A client develops leukopenia after receiving chemotherapy. Which nursing diagnosis would be mostappropriate?

Risk for infection

When preparing to administer ondansetron for a patient's nausea and vomiting, the nurse understands that this agent blocks: A. dopamine. B. norepinephrine. C. GABA. D. serotonin.

Seratonin

Tamoxifen achieves a therapeutic effect by which means? A. inducing apoptosis of cancer cells B. slowing the growth of cancer cells C. causing mutations of cancer cells D. increasing the viability of healthy cells that are adjacent to cancerous cells

Slowing the growth of cancer cells -Antineoplastic hormone inhibitors slow the growth of cancer cells.

A postmenopausal woman with breast cancer will most likely be treated with which anti-estrogen drug? A. Bleomycin B. Cisplatin C. Cyclophosphamide D. Tamoxifen

Tamoxifen -Anti-estrogens are first-line therapy for treating breast cancer in postmenopausal women. Tamoxifin is the most widely recognized anti-estrogen.

A client is undergoing a cytotoxic chemotherapy regimen for the treatment of stage III lung cancer. What effect will this regimen likely have on the client's hemostatic function? A. The client will require prophylactic heparin. B. The client will be at increased risk of deep vein thrombosis (DVT). C. The client will likely experience thrombocytosis. D. The client's platelet count will decline.

The client's platelet count will decline

A client is undergoing a cytotoxic chemotherapy regimen for the treatment of stage III lung cancer. What effect will this regimen likely have on the client's hemostatic function?

The client's platelet count will decline.

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.

An adverse effect of tamoxifen therapy involves menopausal symptoms. True or False

True

Anemia from chemotherapy treatment is the result of bone marrow suppression. True or False

True

True or False: An adverse effect of tamoxifen therapy involves menopausal symptoms.

True

True or False: Cancer is considered the second leading cause of death in the United States.

True

A nurse is performing discharge teaching with a client who will soon return home. The client will continue taking imatinib for the foreseeable future, and the nurse is teaching the client about the safe administration of this drug. How should the nurse instruct the client to take imatinib? A. With a glass of grapefruit or cranberry juice B. Thirty minutes before breakfast and in the early evening, at least 2 hours after dinner C. With food and a large glass of water D. On an empty stomach

With food and a large glass of water

The nurse may be asked to administer which medications to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis? A. allopurinol B. amifostine C. mesna D. leucovorin

allopurinol -The nurse may be asked to administer allopurinol to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis.

A 26-year-old man with testicular cancer is prescribed combination chemotherapy that involves using two drugs that are effective against testicular tumors. Combination drug therapy is superior to single-drug therapy because of:

Higher tumor response rates

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

Hodgkin lymphoma Procarbazine (Matulane) is used in combination therapy for treatment of stages III and IV of Hodgkin disease.

A male client is diagnosed with prostate cancer. The treatment modality of choice includes both surgery and chemotherapy. What does the chemotherapeutic option include?

Hormonal therapies

A male client is diagnosed with prostate cancer. The treatment modality of choice includes both surgery and chemotherapy. What does the chemotherapeutic option include? A. Antidiuretic hormone B. Diuretics C. Hormonal therapies D. Hemoglobin replacement therapy

Hormonal therapies -Hormonal therapies that block the effects of estrogen (in an estrogen-responsive tumor) and androgen (in an androgen-responsive tumor), respectively, are essential in the treatment of breast and prostate cancers.

A client's chemotherapy regimen has been deemed successful, but the client is experiencing debilitating nausea and vomiting. These adverse effects should signal the nurse to the possibility of what nursing diagnosis?

Imbalanced nutrition: less than body requirements

Which would the nurse identify as an antineoplastic antibiotic? A. Mitomycin B. Docetaxel C. Teniposide D. Vinblastine

Mitomycin -Mitomycin is an example of an antineoplastic antibiotic.

An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease?

Prostate cancer

A patient with non-Hodgkin's lymphoma (NHL) will be starting a course of doxorubicin shortly. When planning this patient's care, what nursing diagnosis should the nurse prioritize? Risk for Infection related to suppressed bone marrow function Risk for Impaired Skin integrity related to cytotoxic effects of doxorubicin Risk for Imbalanced Nutrition: More Than Body Requirements related to metabolic effects of doxorubicin Risk for Ineffective Airway Clearance related to decreased neurological function

Risk for Infection related to suppressed bone marrow function Chapter 14: Antineoplastic Agents - Page 230

A patient with non-Hodgkin's lymphoma (NHL) will be starting a course of doxorubicin shortly. When planning this patient's care, what nursing diagnosis should the nurse prioritize? A. Risk for Ineffective Airway Clearance related to decreased neurological function B. Risk for Infection related to suppressed bone marrow function C. Risk for Imbalanced Nutrition: More Than Body Requirements related to metabolic effects of doxorubicin D. Risk for Impaired Skin integrity related to cytotoxic effects of doxorubicin

Risk for infection related to suppressed bone marrow function -Because doxorubicin suppresses bone marrow function, the patient is at risk of leukopenia and subsequent infection.

A client has been diagnosed with a brain tumor and is dealing with this diagnosis by seeking detailed information about cancer. The nurse would explain to the client that cancer is essentially a result of the disruption of the:

cell cycle.

A 25-year-old female client is prescribed methotrexate to treat rheumatoid arthritis (RA). The nurse should teach the client to: use an effective contraceptive. drink milk with the medication. expect a mild rash and itching. take a pain reliever for sore throat.

use an effective contraceptive.

A female client will soon begin targeted therapy as a component of her treatment plan for chronic leukemia. The nurse is conducting health education about this new aspect of the client's drug regimen and the client has asked about the potential side effects of treatment. How should the nurse best respond? A. "Both classes of drugs have adverse effects, but targeted therapies tend to have less of an effect on healthy body cells." B. "Targeted therapies are often more effective than traditional chemotherapy, but the downside of this effectiveness is that adverse effects are more common and severe." C. "The adverse effects to targeted therapies are most often a result of the client's cancer, not the drugs themselves." D. "Chemotherapy causes a lot of unpleasant side effects, and the advantage of targeted therapies is that these are all avoided."

"Both classes of drugs have adverse effects, but targeted therapies tend to have less of an effect on healthy body cells." -Targeted therapies are generally considered to be less toxic than traditional chemotherapy drugs. However, adverse reactions to targeted therapies can occur such as severe skin reactions, GI toxicities, skin reactions, and thrombosis.

A parent hears the health care provider using the word extravasation. The parent asks the nurse what extravasation means. What would be a correct answer? A. "Extravasation is when blood vessels are severed." B. "Extravasation is when fluid is pooled in one part of the body." C. "Extravasation is a disease that causes shock." D. "Extravasation is when fluid escapes from a blood vessel into the surrounding tissue."

"Extravasation is when fluid escapes from a blood vessel into the surrounding tissue." -Extravasation is the escape of fluid from a blood vessel into surrounding tissues. Blood vessels are not cut for this to happen.

A patient is diagnosed with a brain tumor. The patient is told that the cancer cells proliferate. The patient asks the nurse what this means. What is the nurse's best response?

"The proliferation is the growth of cancer cells and the rate of growth."

A patient is diagnosed with a brain tumor. The patient is told that the cancer cells proliferate. The patient asks the nurse what this means. What is the nurse's best response? A. "The proliferation of the cancer cells is the treatment with chemotherapy." B. "The proliferation is the growth of cancer cells and the rate of growth." C. "The proliferation of the cancer cells is the suppression of growth." D. "The proliferation of cancer cells is the metastasis of the tumor."

"The proliferation is the growth of cancer cells and the rate of growth."

A client received an injection of doxorubicin and is now observing a reddish urine. The client reports blood in the urine to the nurse. How should the nurse respond? A. "We need to notify the health care provider because this is a complication of the medication." B. "The reddish urine is an expected response to the drug." C. "Let's get a urinalysis to confirm a urinary tract infection." D. "You may have hemorrhagic cystitis."

"The reddish urine is an expected response to the drug." -Reassure clients that reddish urine after doxorubicin injection is a harmless and expected response to the drug. This reaction may happen within 1 to 2 days postinfusion.

A patient having chemotherapy is losing her hair. She asks the nurse if her hair will come back as it originally was. What is the best response by the nurse? A. "I think you have more to worry about than if you have hair. You can buy a wig." B. "Your hair will grow back, but the new hair may be a different color or texture." C. "Your hair will grow back, but it will be very thin and straight." D. "Your hair may not grow back, but we can refer you to a wig specialist."

"Your hair will grow back, but the new hair may be a different color or texture." -Reassure patients that hair regrowth will occur; however, advise them that the new hair may be a different color or texture.

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

M Mitotic Inhibitors act in M phase (mitosis)

A patient is experiencing antineoplastic-induced nausea and vomiting. The health care provider prescribes ondansetron. The nurse understands that this agent acts in which way? Blocking serotonin receptors in the CTZ Blocking human substance P/neurokinin 1 receptors Directly blocking the chemoreceptor trigger zone (CTZ) Calming the activity of the gastrointestinal tract

Blocking serotonin receptors in the CTZ Chapter 14: Antineoplastic Agents - Page 223 Ondansetron blocks serotonin receptors in the CTZ. Aprepitant blocks human substance P/neurokinin 1 receptors in the central nervous system. Benzodiazepines directly block the CTZ. Metoclopramide calms the activity of the GI tract. Ondansetron blocks serotonin receptors in the chemoreceptor trigger zone (CTZ) and is one of the most effective antiemetics. Antihistamines help to reduce the risk of hypersensitivity reactions and decrease secretions ; corticosteroids help to relieve inflammation and may aid in reducing possible hypersensitivity.

A 49-year-old client is diagnosed with ovarian cancer. What is a characteristic of malignant cells that differentiates them from normal body cells? A .Cancerous cells do not require an energy source in order to proliferate. B. Cancerous cells grow in an uncontrollable fashion. C. Cancerous cells have a theoretically infinite life span. D. Cancerous cells are not responsive to the presence of drugs.

Cancerous cells grow in an uncontrollable fashion -Malignant cells have lost the normal genetic regulation that controls cell growth, invading normal tissues and taking blood and nutrients away from these tissues. They grow in an uncontrolled fashion without regard to growth regulation signals (e.g., contact with other cells) that stop the growth of normal cells.

A patient who is receiving methotrexate is also receiving leucovorin. The nurse understands that this drug is being given for which reason? A. Counteract effects of methotrexate B. Synergistic effect on the cancer cells C. Relief of nausea and vomiting D. Reduction of renal toxicity risk

Counteract effects of methotrexat -Leucovorin is administered with methotrexate to counteract the effects of methotrexate treatment.

A patient with acute lymphoblastic leukemia (ALL) is receiving imatinib on an inpatient basis. When planning the care of this patient, what assessment should be specified in the patient's plan of nursing care? daily weights assessment of deep tendon reflexes bilateral blood pressures pupillary response

Daily Weights Chapter 14: Antineoplastic Agents, p. 240,table 14.6.

A client on the oncology unit has begun chemotherapy with a regimen that includes bendamustine. The client has begun to experience alopecia. The nurse should prioritize assessments related to what potential nursing diagnosis?

Disturbed body image

A client on the oncology unit has begun chemotherapy with a regimen that includes bendamustine. The client has begun to experience alopecia. The nurse should prioritize assessments related to what potential nursing diagnosis? A. Disturbed body image B.Ineffective thermoregulation C. Impaired tissue integrity D. Hypothermia

Disturbed body image -Women of childbearing age should use an effective contraceptive during therapy with methotrexate. When taking methotrexate, the client should be instructed to notify the primary health care provider immediately at first sign of a rash or sore throat.

A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to: A. increase the protein in her diet. B. take the medication at bedtime. C. drink a lot of water. D. limit fluid intake.

Drink a lot of water -An adverse effect of this drug is the incidence of hemorrhagic cystitis. The nurse should encourage the patient to drink at least 2 liters of fluid a day and, in high-dose therapy, administer the uroprotectant agent mesna.

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

Elevated serum calcium Chapter 14: Antineoplastic Agents - Page 235 Goserelin is associated with a risk of hypercalcemia. Renal dysfunction is important to dosage management of almost all antineoplastic drugs and is not specific to goserelin. Changes in INR or red cell indices would not be directly associated with goserelin treatment.

A client with leukemia is being treated with a combination of antineoplastics, including methotrexate. The client's most recent laboratory results indicate the client is experiencing bone marrow suppression. What is the nurse's priority action?

Ensure that all staff and visitors adhere to infection control precautions.

When planning the care for a client receiving imatinib, the nurse would identify which nursing diagnosis as most likely? Excess fluid volume related to fluid retention Imbalanced nutrition, less than body requirements, related to severe nausea and vomiting Risk for infection related to bone marrow suppression Disturbed body image related to hair loss An older adult woman has been diagnosed with acute lymphoblastic leukemia (ALL) and her care team has identified potential benefits of imatinib. Which characteristic of this patient's current health status may preclude the use of imatinib? The patient has type 2 diabetes mellitus that is controlled using diet and oral antihyperglycemics. The patient has chronic heart failure resulting in significant peripheral edema. The patient experienced a mild ischemic stroke several years ago and had transient ischemic attacks last year. The patient had a total knee arthroplasty several months earlier.

Excess fluid volume related to fluid retention Chapter 14: Antineoplastic Agents - Page 240 The adverse effects associated with imatinib include GI upset, muscle cramps, heart failure, fluid retention, and skin rash. Thus a nursing diagnosis of excess fluid volume would be most likely. The severe bone marrow suppression, alopecia, and severe GI effects associated with the more traditional antineoplastic therapy do not occur. The patient has chronic heart failure resulting in significant peripheral edema. Imatinib may be associated with edema. Patients should be weighed regularly and assessed for signs of fluid retention that could be severe. The risk of edema increases with higher doses of imatinib and age greater than 65 years. Previous strokes, orthopedic surgery, or well-controlled diabetes may not contraindicate the use of imatinib.

True or False: No cancer cells have been identified that can remain dormant for more than 2 years.

False -No cells have been identified that can remain dormant for more than 5 years.

After teaching a group of students about antineoplastic agents and their effect on cancer and healthy cells, the instructor determines that the teaching was successful when the students identify which drug as having the least effect on healthy cells?

Getitinib Chapter 14: Antineoplastic Agents - Page 239

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

Inspect the site frequently for redness or swelling

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

Inspect the site frequently for redness or swelling -Site inspection is a major intervention for preventing extravasation. Distal veins should be used.

A patient has just received the first dose of imatinib and the nurse on the oncology unit is amending the patient's care plan accordingly. What nursing diagnosis is most appropriate in light of this addition to the patient's drug regimen? A.Risk for Deficient Fluid Volume related to changes in osmotic pressure B. Risk for Infection related to bone marrow suppression C. Risk for Impaired Skin Integrity related to exaggerated inflammatory response D. Risk for Acute Confusion related to adverse neurological effects of imatinib

Risk for infections related to bone marrow suppression -Like many cancer treatments, imatinib causes bone marrow suppression that creates a consequent risk of infection.

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? Alcohol intake Sensory, motor, and perceptual functions Exposure to sunlight Cigarette smoking

Sensory, motor, and perceptual functions Chapter 14: Antineoplastic Agents - Page 232 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.

When describing the various effects of antineoplastic agents, the nurse explains that antineoplastic drugs primarily affect human cells that are rapidly multiplying, going through the cell cycle quickly. The nurse would identify which cells as an example? A. Skin B. Breast C. Testicles D. Ovaries

Skin -Skin cells proceed very rapidly through the cell cycle.

A patient is to start with chemotherapy. The patient is worried about going bald in the course of the treatment. How can the nurse assist the patient in being comfortable with his or her body image? Forewarn about hair loss. Explain it is not life-threatening. Suggest the use of a wig or cap. Explain that hair preserves body heat.

Suggest the use of a wig or cap.

What health education topic should the community health nurse emphasize when planning care for a client who will be prescribed an oral chemotherapy drug for the next several months while recovering at home? A. ways to match the dose to the severity of the symptoms B. appropriate herbal substitutes for the chemotherapy agent C. techniques for safely handling the drug D. techniques for self-monitoring of liver status

Techniques for safely handling the drug -All cytotoxic drugs are hazardous substances and require special handling and disposal, per safety guidelines, in the home. It is not possible for the client to independently monitor liver status in the home.

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.

A client with a diagnosis of bladder cancer is started on a chemotherapeutic regimen that includes three agents. What is the rationale for using multiple antineoplastic agents? A. The use of three agents decreases the development of cell resistance. B. The use of three agents increases the length of treatment. C. The use of three agents increases the quantity of one of the agents. D. The use of three agents decreases the adverse effects.

The use of three agents decrease the development of cell resistance -Most chemotherapy regimens involve a combination of drugs with different actions at the cellular level, which destroys a greater number of cancer cells and reduces the risk of the cancer developing drug resistance.

An adult client who has been diagnosed with a rectal tumor is scheduled to begin treatment with cisplatin.The nurse has conducted client teaching about the possibility of nausea and vomiting. In order to reduce the client's risk of severe nausea, the nurse should:

administer a combination of antiemetics prior to the administration of the drug.

An adult client who has been diagnosed with a rectal tumor is scheduled to begin treatment with cisplatin.The nurse has conducted client teaching about the possibility of nausea and vomiting. In order to reduce the client's risk of severe nausea, the nurse should: place the client on a low-residue diet. ensure that the client is NPO from midnight prior to receiving the drug. administer a combination of antiemetics prior to the administration of the drug. encourage the client to request antiemetics if the nausea becomes unbearable.

administer a combination of antiemetics prior to the administration of the drug. Chapter 14: Antineoplastic Agents - Page 223 Antiemetics should be administered proactively rather than waiting until the client's nausea becomes unbearable. A combination approach is often effective. A low-residue diet is unnecessary, and withholding food does not necessarily reduce nausea.

The nurse may be asked to administer which medications to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis?

allopurinol

A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to: drink a lot of water. limit fluid intake. take the medication at bedtime. increase the protein in her diet.

drink a lot of water. An adverse effect of this drug is the incidence of hemorrhagic cystitis. The nurse should encourage the patient to drink at least 2 liters of fluid a day and, in high-dose therapy, administer the uroprotectant agent mesna. Therapy should include prehydrating the patient orally and intravenously with at least 2 liters of normal saline solution. Potassium and magnesium additives may be indicated. The nurse will monitor urine output vigilantly to ensure an output of at least half of the intake. Taking the medication at bedtime and increasing protein in her diet are not associated with limiting the possible adverse effects of the drug.