week 14

The order for chemotherapy reads: "Give asparaginase (Elspar) IV 200 units/kg/day." The patient weighs 297 lb. The pharmacy department will prepare the medication for intravenous infusion. How much drug will be given per dose? Is this a safe dose?

27,000 units; yes

The nurse is preparing to add a dose of bevacizumab (Avastin) to a patient's intravenous infusion. The dose is 70 mg of bevacizumab in 100 mL of normal saline, and it is to infuse over 90 minutes. The nurse will set the infusion pump to what rate for this dose?

67 mL/hour (66.66 rounds to 67)

The nurse is caring for a patient who is to receive paclitaxel. To help prevent a hypersensitivity reaction, what medications should the nurse give before starting the paclitaxel? (Select all that apply.) A. A steroid (e.g., dexamethasone) B. An H1 receptor antagonist (diphenhydramine) C. An H2 receptor antagonist (rantidine) D. An aspirin tablet

A. A steroid (e.g., dexamethasone) B. An H1 receptor antagonist (diphenhydramine) C. An H2 receptor antagonist (rantidine) Many patients tolerate paclitaxel poorly and show hypersensitivity associated with infusion. For this reason, before patients receive paclitaxel, they are premedicated with a steroid (dexamethasone), an H1 receptor antagonist (diphenhydramine), and an H2 receptor antagonist (ranitidine).

The nurse is caring for a patient who is taking an alkylating agent. What should the nurse monitor in this patient? (Select all that apply.) A. Nausea B. Increased bleeding C. Renal failure D. Severe depression E. Respiratory depression

A. Nausea B. Increased bleeding With alkylating drugs, the patient will more than likely experience problems related to bone marrow suppression, such as anemia, leukopenia, and thrombocytopenia. Most nursing interventions are focused on preventing infection, conserving energy, preventing bleeding and injury, and reducing nausea.

A patient is receiving methotrexate therapy through a Hickman catheter. Which finding is a clinical indication of antineoplastic toxicity in this patient? A. Injection-site excoriation B. Oral Candida overgrowth C. Moderate peripheral edema D. Severe, prolonged vomiting

B. Oral Candida overgrowth Oral candidiasis is a clinical indicator of gastrointestinal toxicity from methotrexate therapy because folate antagonist antimetabolites are associated with gastrointestinal abnormalities but not with vomiting. Excoriation at the injection site is probably related to repeated injections in a small area; this tissue should gradually become less sensitive to the needlesticks and keratinize. Edema, an indication of cardiovascular toxicity, is unrelated to methotrexate therapy; in addition, a clinical indicator that is moderate is less likely to indicate an extreme situation such as toxicity.

The nurse will suspect which type of cancer in a patient receiving tamoxifen (Soltamox)?

Breast cancer

A patient who is taking St. John's wort for depression has been prescribed irinotecan. What instructions about these two medications should the nurse provide? A. "Take the St. John's wort prior to receiving irinotecan." B. "Take the St. John's wort on the days you don't take the irinotecan." C. "Stop taking the St. John's wort 2 weeks before starting irinotecan." D. "Continue to take the St. John's wort daily for your depression."

C. "Stop taking the St. John's wort 2 weeks before starting irinotecan." St. John's wort reduces the effects of irinotecan therapy. The patient should be instructed to stop taking St. John's wort 2 weeks before initiating irinotecan therapy.

What is the priority nursing intervention to help prevent infection in this patient? A. Instructing the patient to avoid sick people B. Providing hand soap and paper towels C. Checking for a decreasing leukocyte level D. Monitoring the patient for fever higher than 101° F

C. Checking for a decreasing leukocyte level Paclitaxel can cause severe neutropenia as a result of bone marrow suppression, so the most important nursing intervention to prevent infection in a patient who is receiving paclitaxel is to analyze the leukocyte count, in particular, the neutrophils, to detect downward trends in serum levels. This is because the serum levels related to bone marrow suppression (hemoglobin, hematocrit, platelets, leukocytes, etc.) can decrease before the patient exhibits clinical indicators of infection or bleeding. Instructing the patient to avoid sick people, providing the means for hand-washing, and monitoring the patient for fever are reasonable nursing interventions by the nurse to prevent an infection, but none is as important as a means of detecting a life-threatening complication of paclitaxel therapy.

The nurse is caring for a patient who is receiving vincristine. What method of administration should the nurse use to administer this medication? A. Intramuscular B. Oral C. Intravenous D. Intrathetical

C. Intravenous Special care must be taken not to inadvertently give vincristine via the intrathecal route. Several deaths have been reported due to this error. The World Health Organization and the Institute for Safe Medication Practices suggest that vincristine be diluted in 25 mL of fluid and never dispensed via a syringe to prevent this lethal error from occurring. A special warning is required for all vincristine products dispensed that states "Use Only Intravenous—Fatal if Given by Other Routes."

What is considered a major dose-limiting side effect of doxorubicin (Adriamycin)?

Cardiomyopathy

A patient has been started on methotrexate. What over-the-counter medications should the patient be instructed to avoid? A. All cold medications B. All diet medications C. All antacids D. All NSAIDs

D. All NSAIDs A patient undergoing methotrexate therapy should avoid NSAIDs. They can reduce renal elimination of methotrexate and can have potentially fatal hematologic and gastrointestinal toxicity.

A patient is receiving mitomycin (Mutamycin) with vincristine (Oncovin) for pancreatic cancer. Which finding or parameter should the nurse assess to facilitate early detection of a toxic effect of the combination therapy? A. Jaundice B. Vomiting C. Serum lipase level D. Breath sounds

D. Breath sounds Chemotherapy that includes mitomycin and vincristine greatly increases the patient's risk of pulmonary toxicity, so the nurse monitors the patient's breath sounds to detect nonventilated lung fields, crackling, wheezing, and areas of consolidation because these may be clinical indicators of pneumothorax, atelectasis, bronchospasm, and pleural effusion, respectively. Liver toxicity, denoted by jaundice, is an indication of liver toxicity related to vincristine therapy alone. Neither mitomycin nor vincristine has a high emetic potential. An increased serum lipase level may indicate a pathologic condition of the pancreas.

A patient receives cyclophosphamide (Cytoxan) to shrink an ovarian tumor, after which the nurse prepares the patient for discharge home. Which instruction does the nurse plans to repeat to the patient and the family to help prevent a devastating complication of this therapy? A. Stay in a warm environment. B. Avoid crowds and sick people. C. Use a soft-bristled toothbrush. D. Drink 2 to 3 L/day of fluid.

D. Drink 2 to 3 L/day of fluid. Hemorrhagic cystitis is a potential adverse effect of cyclophosphamide therapy that develops in the bladder as a result of the drug's irritating effects. The nurse instructs the patient repeatedly to maintain hydration because adequate hydration can help minimize adverse effects on the bladder. The nurse emphasizes this information because hemorrhagic cystitis is an oncologic emergency for which the patient should seek emergency care.

The nurse assigns two nursing diagnoses to a male patient who is receiving leuprolide (Lupron) for prostate cancer: imbalanced nutrition less than body requirements and activity intolerance related to anemia, fatigue, and lethargy. Which patient assessment finding reveals that the nursing care is effective? A. No complaints of anorexia or pain B. Urinary pattern approaching baseline C. A statement by the patient that he lacks energy and stamina D. Performance of self-care to maintain nutrition

D. Performance of self-care to maintain nutrition Nutrition and activity intolerance are nursing care issues for this patient; to determine the effectiveness of the nursing care, the nurse analyzes patient assessment findings related to these nursing diagnoses. Therefore, because the patient is taking an active role in maintaining nutrition, the nurse can determine that the related nursing care is effective. However, nursing care related to energy and endurance has apparently not been effective because the patient complains that he lacks energy and stamina. Complaints related to anorexia and pain and the urinary pattern are pertinent to the patient's clinical improvement and are not used to evaluate the nursing care specifically.

When a patient is receiving cyclophosphamide (Cytoxan), he or she should be advised to drink plenty of water/fluids to prevent which condition?

Hemorrhagic cystitis

The nurse is discussing the use of alkylating drugs with the patient. What is the best way to describe the mechanism of action of alkylating drugs on cancer cells?

They alter the chemical structure of the DNA.

Which laboratory test result would cause the nurse to question administration of hydroxyurea (Hydrea)?

Thrombocyte count of 8000/mm3

While administering bevacizumab (Avastin), what will the nurse assess to look for drug-related toxicities? (Select all that apply) a. Blood pressure b. Color of the skin and sclera of the eye (for jaundice) c. Blood glucose level d. Urine protein level e. Hearing

a. Blood pressure d. Urine protein level

A patient is experiencing stomatitis after a round of chemotherapy. Which intervention by the nurse is correct? a. Clean the mouth with a soft-bristle toothbrush and warm saline solution b. Rinse the mouth with commercial mouthwash twice a day c. Use lemon-glycerin swabs to keep the mouth moist d. Keep dentures in the mouth between meals

a. Clean the mouth with a soft-bristle toothbrush and warm saline solution

When chemotherapy with alkylating drugs is planned, the nurse expects to implement which intervention to prevent nephrotoxicity? a. Hydrating the patient with intravenous fluids before chemotherapy b. Limiting fluids before chemotherapy c. Monitoring drug levels during chemotherapy d. Assessing creatinine clearance during chemotherapy

a. Hydrating the patient with intravenous fluids before chemotherapy

The nurse is assessing a patient who has experienced severe neutropenia after chemotherapy and will monitor for which possible signs of infections? (Select all that apply) a. Elevated WBC count b. Fever c. Nausea d. Sore throat e. Chills

b. Fever d. Sore throat e. Chills

The nurse is caring for a patient who becomes severely nauseated during chemotherapy. Which intervention is most appropriate? a. Encourage light activity during chemotherapy as a distraction b. Provide antiemetic medications 30 to 60 minutes before chemotherapy begins c. Provide antiemetic medications only upon the request of the patient d. Hold fluids during chemotherapy to avoid vomiting

b. Provide antiemetic medications 30 to 60 minutes before chemotherapy begins

A patient receiving chemotherapy is experiencing severe bone marrow suppression. Which nursing diagnosis is most appropriate? a. Activity intolerance b. Risk for infection c. Disturbed body image d. Impaired physical mobility

b. Risk for infection

While teaching a patient who is about to receive cyclophosphamide (Cytoxan) chemotherapy, the nurse will instruct the patient to watch for potential adverse effects, such as a. cholinergic diarrhea b. hemorrhagic cystitis c. peripheral neuropathy d. ototoxicity

b. hemorrhagic cystitis

During treatment with doxorubicin (Adriamycin), the nurse must monitor closely for which potentially life-threatening adverse effect? a. Nephrotoxicity b. Peripheral neuritis c. Cardiomyopathy d. Ototoxicity

c. Cardiomyopathy

If extravasation of an antineoplastic medication occurs, which intervention will the nurse perform first? a. Apply cold compress to the site while elevating the arm b. Inject subcutaneous doses of epinephrine around the IV site every 2 hours c. Stop the infusion immediately while leaving the catheter in place d. Inject the appropriate antidote through the IV catheter

c. Stop the infusion immediately while leaving the catheter in place

During therapy with the cytotoxic antibiotic bleomycin, the nurse will assess for a potentially serious adverse effect by monitoring a. blood urea nitrogen and creatinine levels b. cardiac ejection fraction c. respiratory function d. cranial nerve function

c. respiratory function

A patient who is receiving chemotherapy with cisplatin (Platinol) has developed pneumonia. The nurse would be concerned about nephrotoxicity if which type of antibiotic was ordered as treatment for the pneumonia at this time? a. Penicillin b. Sulfa drug c. Fluoroquinolone d. Aminoglycoside

d. Aminoglycoside

The nurse monitors a patient who is experiencing thrombocytopenia from severe bone marrow suppression 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