Ch. 48 Hematological and Oncological Medicationa

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 hypertension An adverse effect specific to etoposide is orthostatic hypotension. Etoposide should be administered slowly over 30 to 60 minutes to avoid hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication.

A client with non-Hodgkin's lymphoma is receiving daunorubicin. Which finding would indicate to the nurse that the client is experiencing an adverse effect related to the medication? 1. Fever 2. Sores in the mouth and throat 3. Complaints of nausea and vomiting 4. Crackles on auscultation of the lungs

4. Crackles on auscultation of the lungs Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as heart failure (lung crackles) is an adverse effect of daunorubicin. Bone marrow depression is also an adverse effect of daunorubicin. Bone marrow depression is also an adverse effect. Fever is a frequent side effect and sores in the mouth and throat can occur occasionally. Nausea and vomiting is a frequent side effect associated with the medication that behind a few hours after administration and lasts 24-48 hours. Options 1, 2, and 3 are not adverse effects.

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 An adverse effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all antineoplastic medications. Chest pain is unrelated to this medication.

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 heat or ice 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, 2, 3, 5 Redness and swelling and a slowed infusion indicate signs of extravasation during the IV administration of an antineoplastic medication, the infusion is stopped and the HCP is notified. Ice or heat may be prescribed for application to the site and an antidote may be prescribed to be administered into the site. Increasing the flow rate can increase damage to the tissues. Restarting an IV in the same vein can increase damage to the site and vein.

The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase, an antineoplastic agent. The nurse contacts the health care provider before administering the medication if which disorder is documented in the client's health history? 1. Pancreatitis 2. Diabetes mellitus 3. Myocardial infarction 4. Chronic obstructive pulmonary disease

1. Pancreatitis Asparaginase is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between dose administrations. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain The conditions noted in options 2, 3, and 4 are not contraindicated with this medication.

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 2000-3000 mL daily. 3. Decrease sodium intake while taking the medication. 4. Increase potassium intake while taking the medication.

2. Increase fluid intake to 2000-3000 mL daily. Hemorrhagic cystitis is an adverse effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake.

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 Busulfan can cause an increase in the uric acid level. Hyperuricemia can produce uric acid neuropathy, renal stones, and acute kidney injury. Options 1, 3, and 4 are not specifically related to this medication.

Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The client asks the nurse if her family with bladder cancer can also take this medication. The nurse *most appropriately* responds by making which statement? 1. "This medication can be used only to treat breast cancer." 2. "Yes, your family member can take yours medication for bladder cancer as well." 3. "This medication can be taken to prevent and treat clients with breast cancer." 4. "This medication can be taken by anyone with cancer as long as their health care provider approves it."

3. "This medication can be taken to prevent and treat clients with breast cancer." Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations 9f receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy and for preventing breast cancer in those that are high risk.

A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication. When implementing the teaching 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." Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without the HCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side/adverse effects.

The nurse is monitoring the laboratory results of a client receiving an antineoplastic medication by the intravenous route. The nurse plans to initiate bleeding precautions if which laboratory result is noted? 1. A clotting time of 10 minutes 2. An ammonia level of 10 mcg/dL (6 mcmol/L) 3. A platelet count of 50,000 mm^3 (50x10^9/L) 4. A white blood cell count of 5000 mm^3 (5.0x10^9/L)

3. A platelet count of 50,000 mm^3 (50x10^9/L) Bleeding precautions need to be initiated when the platelet count decreases. The normal platelet count is 150,000 to 450,000 mm^3 (150-400x^9/L). When the platelet count decreases, the client is at risk for bleeding. The normal white blood cell count is 5000 to 10,000 mm^3 (5.0-10.0x10^9/L). When the white blood cell count drops, neutropenic precautions need to be implemented. The normal clotting time is 8-15 minute. The normal ammonia value is 10 to 80 mcg/dL (6-47 mcmol/L).

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 Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is related specifically to cell destruction.

Chemotherapy dosage is frequently based on total body service area (BSA), so it is important for the nurse perform which is assessment before administering chemotherapy? 1. Measure the clients abdominal girth. 2. Calculate the clients body mass index. 3. Measure the clients current weight and height. 4. Ask the client about his or her weight and height.

3. Measure the client's current weight and height. To insure that the client receives optimal doses chemotherapy, dosing is usually based on the total BSA, which requires a current accurate height and weight for BSA calculation (before each medicatopn Administration). Asking the client about his or her weight and height may lead to inaccuracies in determining the true BSA and dosage. Calculating body mass index and measuring abdominal girth will not provide the data needed.

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 radiology 4. Pulmonary function studies

4. Pulmonary function studies Bleomycin is an antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with Hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication.

Megestrol acetate, an antineoplastic medication, is prescribed for a client with metastatic endometrial carcinoma. The nurse reviews the client's history and should contact the health care provider if which diagnoses is documented in the client's history? 1. Gout 2. Asthma 3. Myocardial infarction 4. Venous thromboembolism

4. Venous thromboembolism Megesterol acetate suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megesterol is used with caution if the client has a history of venous thromboembolism. Options 1, 2, and 3 are not contraindications for this medication.