Chapter 14: Drug Therapy for Cancer

A patient is receiving cyclophosphamide therapy. Which statement by the patient indicates more teaching is necessary? A. "I will take the medication before bed." B. "I will eat a diet low in organ meats, beans, and peas." C. "I may experience hair loss." D. "I will not visit anyone who has a respiratory infection."

A. "I will take the medication before bed." (Teach patient to take cyclophosphamide early in the day to prevent accumulation of drug in the bladder during the night.)

A female patient with chronic lymphocytic leukemia is beginning to receive an oral cyclophosphamide. Which of the following instructions is most accurate? (Select all that apply) A. Administer the drug with food only with gastric upset B. Take the drug on an empty stomach C. Take the drug at bedtime D. Administer the drug 1 hour after a meal

B. Take the drug on an empty stomach The nurse tells the client to take the oral cyclophosphamide on an empty stomach. If severe gastrointestinal upset occurs, she should take the drug with food. To take cyclophosphamide on an empty stomach, it should be taken 1 hour before a meal or 2 hours afer a meal.

A nurse is caring for a patient being treated with antineoplastic drugs. The patient is at risk for thrombocytopenia due to bone marrow suppression. What should the nurse monitor for in this patient? Bloody urine Concentrated urine Pain in urination Frequent micturition

Bloody urine Explanation: The nurse should monitor for bloody urine in a patient at risk for thrombocytopenia due to bone marrow suppression. Concentrated urine, frequent micturition, or pain in urination is not indicative of thrombocytopenia.

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.

What is the first action by the oncology nurse when observing extravasation with the client receiving vincristine? Obtain a photograph of the site. Stop the infusion. Consult the health care provider. Apply warm compresses.

Stop the infusion. Explanation: The first action by the nurse is to stop the infusion immediately.

Cancer is considered the second leading cause of death in the United States. (True/False)

True

chemotherapy waste is disposed of in a ___________ container.

yellow

When assessing a client for adverse effects related to methotrexate (MTX) therapy, the nurse should prioritize what diagnostic findings? calcium and magnesium levels electrocardiogram (ECG) serum osmolality creatinine clearance

creatinine clearance Explanation: Methotrexate is nephrotoxic. Consequently, the nurse must carefully follow indicators of the client's renal function. Electrolyte and water disturbances and cardiac conduction disorders are much less likely adverse effects.

When caring for clients receiving cytotoxic antineoplastic drugs, the nurse understands that blood and body fluids are contaminated with drugs or metabolites for how long? About 6 to 8 days after a dose About 12 to 24 hours after a dose About 3 to 5 days after a dose About 1 to 2 days after a dose

About 3 to 5 days after a dose Explanation: When caring for clients receiving cytotoxic antineoplastic drugs, wear gloves when handling clients' clothing, bed linens, or excreta. Blood and body fluids are contaminated with drugs or metabolites for about 3 to 5 days after a dose.

Based on the nurse's understanding of antineoplastic drugs, the nurse would anticipate administering which in conjunction with doxorubicin (Doxil) as a cardioprotective agent? mesna dexrazoxane leucovorin amifostine

dexrazoxane Explanation: Dexrazoxane is administered concomitantly with doxorubicin as a cardioprotective agent. Leucovorin provides folic acid to cells after methotrexate administration. Mesna binds with metabolites of ifosfamide to protect the bladder from hemorrhagic cystitis. Amifostine binds with metabolites of cisplatin to protect the kidneys from nephrotoxic effects, reduces xerostomia.

A 57-year-old male patient who has been prescribed doxorubicin for small-cell lung cancer is advised by the nurse to avoid taking aspirin or drugs that contain aspirin because it may:

promote bleeding.

Common causes of primary hypothyroidism include all of the following EXCEPT: Treatment of hyperthyroidism with antithyroid drugs. Treatment with steroid medications. Radiation to the neck. Hashimoto's thyroiditis.

Treatment with steroid medications.

A female client is prescribed methotrexate for meningeal leukemia. What health education should the nurse prioritize? Use reliable forms of barrier contraception. Discontinue oral contraceptives. Avoid grapefruit juice. Abstain from alcohol until 7 days after treatment.

Use reliable forms of barrier contraception. Explanation: Antimetabolites are contraindicated for use during pregnancy and lactation because of the potential for severe adverse effects on the fetus and neonate. There is no need to discontinue oral contraceptives, but barrier methods should also be used. There is no need to avoid grapefruit juice and prolonged abstinence from alcohol is not required.

A patient is receiving a short course of high-dose therapy after radiation and a lumpectomy for the treatment of breast cancer. What type of therapy is this considered? Induction therapy Adjuvant therapy Consolidation therapy Neoadjuvant therapy

Adjuvant therapy Explanation: Adjuvant therapy involves a short course of high-dose drug therapy (usually with a combination of drugs) administered after radiation or surgery to destroy residual tumor cells or micrometastases and prevent recurrence.

A vesicant antineoplastic drug does which of the following? A. It causes minor skin irritation B. It causes extensive tissue damage C. It requires administration with a corticosteroid D. It requires deep intramuscular injection if diluted with normal saline

B. It causes extensive tissue damage Leakage of a vesicant drug into tissues surrounding the venipuncture site can cause severe tissue damage, which should be prevented if possible. Drug administration is ofen at a peripheral IV site, although it may occur via central line. Intramuscular administration is never appropriate.

Nitrosoureas are alkylating agents that interfere with cell division and structuring of DNA during all phases of the malignant cell cycle. They are most effective in hematologic malignancies but are also used for others. After dosing, what needs monitoring and for what time period? Uric acid levels twice weekly for 6 weeks Urinalysis weekly for at least 4 weeks CBC weekly for at least 6 weeks WBC level weekly for 6 weeks

CBC weekly for at least 6 weeks

In explaining antineoplastic therapy to.a family member of a patient who is to receive treatment with a cytotoxic drug, which of the following explanations is most accurate? A. Antineoplastic therapy damages both malignant and nonmalignant cells B. It causes few adverse effects C. It stimulates growth of cancer cells D. It must be given daily

A. Antineoplastic therapy damages both malignant and nonmalignant cells Cytotoxic drugs damage both normal and malignant cells and may cause severe adverse efects. They block or slow cancer cell growth rather than stimulating it. Administration of most of the drugs is cyclical, with cycles of a few days, then a few weeks without the drugs, then a repeat cycle as opposed to daily administration.

A nurse should understand which adverse effects of antineoplastic drugs are related to the death of rapidly growing cells? (Select all that apply.) Alopecia Leukopenia Stomatitis Cardiotoxicity Thrombocytopenia

Alopecia Leukopenia Stomatitis Thrombocytopenia

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."

D. "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 71-year-old male client is receiving chemotherapy as part of the treatment regimen for his cancer. To monitor renal function, what laboratory measurements would the nurse expect the health care provider to order? BUN Serum creatinine Creatinine clearance Electrolytes

Creatinine clearance Explanation: Creatinine clearance (CrCl) should be monitored; serum creatinine level is not a reliable indicator of renal function in older adults because of their decreased muscle mass.

The nurse understands that when administering cisplatin, the drug has a high potential for causing severe nausea and vomiting. What term is used to describe this group of antineoplastic drug? Emetogenic Alkylating drug Estrogen Androgen

Emetogenic

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. Encourage the client to limit physical activity in order to reduce the risk of bleeding. Provide small quantities of food several times per day, as tolerated. 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 male client is receiving parenteral cytotoxic medications in the home. Adjunct therapy may include what substance? Antidiuretic hormone Heparin Normal saline 0.9% intravenously Erythropoietin

Erythropoietin

A patient is to receive doxorubicin as treatment for leukemia. The nurse would instruct the patient that the typical cycle would be repeated at which frequency? Every 4 weeks Every 3 weeks Every other week Every week

Every 3 weeks

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

False

If the nurse has to clean up a spill of antineoplastic drug, which of the following personal protective equipment should be worn? Select all that apply: Safety goggles Gown NIOSH-approve respirator Gloves Chemical spill boots

Gloves Safety goggles Gown NIOSH-approve respirator Explanation: A nurse should wear a gown, safety goggles, gloves, and a NIOSH-approved respirator when cleaning up a spill of an antineoplastic drug.

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 Diuretics Antidiuretic hormone 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 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 Explanation: Combination therapy is considered superior over single-drug therapy because of higher tumor response rates and increased, not decreased, duration of remissions. Combination therapy does not pose a lower risk for secondary cancers, and increased capillary permeability is not the reason for the preference of combination therapy over monotherapy.

A client is being treated on the oncology unit and has developed worsening adverse effects over the past several days of chemotherapy. Administration of filgrastim may aid in achieving what desired outcome? Resolution of mucositis Prevention of hemorrhagic cystitis Increased platelet levels Increased leukocytes

Increased leukocytes

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

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

A male client is prescribed cytotoxic antineoplastic drugs as part of his cancer treatment regimen. His wife is 2 months pregnant. The nurse teaches both the client and his wife that she should avoid contact with the drug, for which reasons? (Select all that apply.) It is hepatogenic. It is teratogenic. It is mutagenic. It is nephrogenic. It is carcinogenic.

It is carcinogenic. It is mutagenic. It is teratogenic. Explanation: Most cytotoxic antineoplastic drugs are carcinogenic, mutagenic, and teratogenic. Exposure during pregnancy increases risks of fetal abnormalities, ectopic pregnancy, and spontaneous abortion.

A patient is diagnosed with ovarian cancer. Why is considered to be an aggressive form of cancer?

It is fed by the hormones produced by the ovaries.

DELETE Which would the nurse expect to administer to counteract the effects of methotrexate?

Leucovorin

The nurse determines a nursing diagnosis of imbalanced nutrition: less than body requirements is the priority for a client receiving chemotherapeutic therapy. Which suggestion would be least appropriate for the nurse to include in the client's plan of care? Offer fatty foods to stimulate the taste buds. Provide foods that are high in protein. Avoid exposure to unpleasant smells. Provide small, frequent meals.

Offer fatty foods to stimulate the taste buds. Explanation: Greasy or fatty foods and unpleasant sights, smells, and tastes should be avoided. Small, frequent meals and foods that are high in protein are appropriate.

A client is prescribed cyclophosphamide as part of her treatment for non-Hodgkin's lymphoma. Which symptoms should the client be instructed to report to her health care provider immediately? Pain and burning with urination Alopecia Nasal congestion Nausea and vomiting

Pain and burning with urination Explanation: At very high doses, cyclophosphamide has a propensity for inducing sterile hemorrhagic cystitis. This problem is manifested by hematuria, pain, and burning on urination caused by the irritation of the bladder wall by acrolein, a metabolic by-product of cyclophosphamide. Nausea, vomiting, alopecia, and nasal congestion are all adverse effects of the medication but do not require immediate medical follow-up.

The normal growth-regulating genes that are present in all cells are referred to by what name? Protooncogenes. Carcinogens Neoplastic transformations. Oncogenes.

Protooncogenes.

A client who is taking chemotherapeutic medications has developed stomatitis. What intervention should the nurse include in the client's plan of care? Encourage the client's family to bring in mouthwash Provide mouth care frequently Provide a minced or pureed diet Administer antifungal mouthwash as prescribed

Provide mouth care frequently

A nurse is caring for a client who has received chemotherapy treatment. The client has developed inflammation of the oral mucous membrane, which is affecting the nutritional aspects of care. What suggestions should the nurse provide to the client for relief? Use lemon or glycerin swabs frequently Rinse oral cavity with alcohol-based mouthwash Provide mouth care with normal saline every 4 hours Brush teeth using toothpaste at regular intervals

Provide mouth care with normal saline every 4 hours Explanation: The nurse should suggest that the client provide mouth care with normal saline every 4 hours. Use of toothpaste, lemon or glycerin swabs, or alcohol-based mouthwash for oral care are not suggested as they cause further irritation to the oral mucosa and complicate stomatitis.

An oncology nurse is reviewing the medication administration record of a client being treated for advanced prostate cancer. In addition to two chemotherapeutic agents, the nurse reads that the client has been ordered a cytoprotective agent. What is the goal of treatment with this agent? Reduce the incidence or severity of adverse drug effects. Buffer the cytotoxins that result from the metabolism of chemotherapeutic agents. Protect the client from pathophysiologic effects of malignancy. Potentiate the beneficial effects of chemotherapy.

Reduce the incidence or severity of adverse drug effects.

A nurse is providing client education to a 50-year-old woman who is taking methotrexate (MTX) for breast cancer. The nurse will instruct the client to avoid which drug? Furosemide Digoxin Acetaminophen Salicylates

Salicylates

The nurse is caring for a client who has leukemia. What aspect of this client's health status should the nurse prioritize when confirming the appropriateness and dosing of antimetabolites? The client currently has bone marrow suppression. The client has a long-standing diagnosis of type 2 diabetes mellitus. The client has had seizure activity in recent months. The client's blood pressure is usually in the range of 140/90 mm Hg.

The client currently has bone marrow suppression.

A client with Hodgkin's disease has been prescribed vincristine. What nursing consideration should the nurse prioritize when administering this drug? - The nurse should avoid using a distal vein. - The nurse should encourage the client to eat six small meals a day. - The nurse should check for extravasation when the infusion is over. - The nurse should avoid any skin, eye, or mucous membrane contact with the drug.

The nurse should avoid any skin, eye, or mucous membrane contact with the drug.

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. The restoration of fluid balance and nutrition is needed before continuing with chemotherapy. There is a need to restore a physiologic reserve of energy before further chemotherapy. Time is required for the successful application of radiotherapy between cycles of 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.

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. encourage the client to request antiemetics if the nausea becomes unbearable. ensure that the client is NPO from midnight prior to receiving the drug. place the client on a low-residue diet.

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 client is undergoing treatment for metastatic colorectal cancer. The client's chemotherapeutic regimen includes oxaliplatin IV. The nurse is preparing to administer a scheduled dose, and should: administer antiemetics and dexamethasone as prescribed. establish a new peripheral intravecnous site. administer benzodiazepines as prescribed to prevent anxiety during chemotherapy. assess the client's baseline paint level to provide a comparison post-administration.

administer antiemetics and dexamethasone as prescribed.

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-nonspecific. growth fraction. cell targeting. cell cycle-specific.

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

The purpose of antineoplastic drugs is to affect cells that rapidly divide and reproduce; however, the adverse effects produced by antineoplastic drugs result from their systemic use, which exposes nonmalignant cells in the body that are rapidly dividing and reproducing. Which is not an example of a rapidly dividing and reproducing cell in the body? hair follicle cell nerve cell oral mucosal cell bone marrow cell

nerve cell

Among the multiple genetic abnormalities that are characteristic of cancer cells, which gene mutation results in more than 90% of small cell lung cancers and more than 50% of breast and colon cancers? a42p a53 p53 c42

p53 Explanation: Mutations of the p53 gene, a common genetic change in cancer, are associated with more than 90% of small cell lung cancers and more than 50% of breast and colon cancers. All other choices are incorrect.

A client has returned to the outpatient treatment center for a regular IV chemotherapy session. The nurse understands that one of the goals of chemotherapy is to:

prevent or treat adverse drug effects.

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

A. Disturbed body image ***The physiologic consequences of alopecia are usually inconsequential. This adverse effect does not have a major effect on thermoregulation or tissue integrity. However, many clients find it distressing and experience a disturbance to their body image due to the significant and unwanted change in their appearance. The nurse should choose assessments and interventions accordingly.

Hormone inhibitor drugs are most effective in which of the following? A. Treating breast or prostate cancer B. Preventing hematologic malignancies C. Treating thyroid and pituitary tumors D. protecting normal cells from cytotoxic cells

A. Treating breast or prostate cancer Malignant tumors of the breast, uterus, ovary, and prostate are influenced by hormones. Sex hormones act as growth factors in some malignancies. For example, some breast tumors have estrogen receptors, whereas prostate cancer in men grows under stimulation by testosterone. Hormone inhibitors slow the growth of cancer cells stimulated by hormones.

A male patient is being treated for Hodgkin's lymphoma with vincristine. He also takes phenytoin daily in the morning for a seizure disorder. How will these two medications interact? A. Vincristine when combined with phenytoin will increase sedation B. Phenytoin and vincristine are metabolized by CYP3A4 increasing vincristine toxicity C. Phenytoin administered with vincristine will decrease cytotoxic drug effects D. Vincristine will increase the patient's risk of having a seizure

A. Vincristine when combined with phenytoin will increase sedation Vincristine causes fatigue. When combined with phenytoin the patient has an increase in central nervous system depression and fatigue.

For a patient receiving a cytotoxic drug that will likely result in bone marrow depression, which of the following teaching considerations should be the priority for the nurse with the patient and family members or caregivers? A. Wash hands often, and avoid people with colds, flu, or other infections B. Do not expect fatigue and weakness, which are uncommon C. Expect gastrointestinal upset, More nausea and vomiting may occur when the blood cell counts are low D. Take acetaminophen for fever

A. Wash hands often, and avoid people with colds, flu, or other infections Clients receiving a drug that depresses bone marrow function are at high risk of developing serious infections. Every effort should be made to prevent infections in the client. Although the client may be included in the vigilance necessary to make sure that those in proximity understand precautions, it is especially important that this be communicated to all others in the client's environment. Fatigue and weakness also ofen occur with bone marrow depression and require medical monitoring. There is no particular correlation between nausea and vomiting and blood cell counts. Any fever should be reported, and antibiotics are given rather than antipyretics.

A patient being treated for cancer is receiving medication for palliation. The nurse understands that palliative therapy is used to A. relieve symptoms. B. kill tumor cells. C. decrease viral load. D. increase body defenses.

A. relieve symptoms. If cancer can no longer be controlled, chemotherapy may be used to relieve disease-related symptoms or improve quality of life. This is called palliative treatment.

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

A. the use of chemotherapy to reduce pain

Mr. Melika is treated with high-dose chemotherapy after a radical prostatectomy. What term would best describe this type of therapy? Induction therapy Adjuvant therapy Maintenance therapy Consolidation therapy

Adjuvant therapy Explanation: Adjuvant therapy: This therapy involves a short course of high-dose drug therapy (usually with a combination of drugs) administered after radiation or surgery to destroy residual tumor cells or micrometastases and prevent recurrence. Induction therapy: refers to the start of chemotherapy. Commonly used in treating hematologic cancers, induction consists of high-dose drug therapy (usually with a combination of drugs) given to induce a complete response when initiating a curative regimen. Consolidation therapy: This strategy consists of chemotherapy given after induction therapy has achieved a complete remission; the regimen is repeated to increase the probability of cure or to prolong patient survival. Maintenance therapy: This therapy involves using low-dose cytotoxic drugs, singly or in combination, on a long-term basis in patients who are in complete remission, to delay the regrowth of residual cancer cells.

A patient is receiving chemotherapy for the treatment of cancer. The nurse anticipates nadir to occur in A. 2 days. B. 8 days. C. 15 days. D. 30 days.

B. 8 days. (Following chemotherapy administration, the time at which the blood count is at the lowest is called the nadir and typically occurs 7 to 10 days after treatment.)

A patient is prescribed fulvestrant, What is the action of this drug? A. Fulvestrant is highly cytotoxic to both cancer cells and normal cells. B. It blocks estrogen receptors and decreases estrogen-mediated growth stimulation C. It boosts the immune response to increase the effectiveness of other chemotherapy agents D. It stops cancer cell maturation in the G1 phase of the cell cycle.

B. It blocks estrogen receptors and decreases estrogen-mediated growth stimulation Fulvestrant blocks estrogen receptors and decreases estrogen-mediated growth simulation in serious advanced breast cancers in postmenopausal women. Hormone inhibitor drugs slow the growth of cancer cells that are stimulated by hormones. They are not cytotoxic. They cause less damage to normal cells than cytotoxic chemotherapy; however, the drugs may still cause serious adverse efects. They do not target specifc antigens or vital processes of cancer cells. Biologic drugs do not have protective effects on normal cells.

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 what? Calcium and magnesium Arterial blood gases BUN and creatinine Sodium and potassium

BUN and creatinine

The client is instructed to return to the clinic after calling and reporting various concerns. The nurse alerts the primary health care provider after noting which signs on the assessment? Select all that apply. Petechiae Bleeding gums Bright green emesis Hematuria Greenish-yellow stools

Bleeding gums Petechiae Hematuria

The nursing instructor is teaching a session about chemotherapeutic antibiotics. The instructor determines the session is successful when the students correctly choose which drug(s) in this category? Select all that apply. Carboplatin Dactinomycin Bleomycin Busulfan Daunorubicin

Bleomycin Dactinomycin Daunorubicin Explanation: chemotherapeutic antibiotics have similar action to alkylating drugs and include bleomycin, dactinomycin, and daunorubicin. Carboplatin is an alkylating agent. Busulfan is an alkyl sulfonate alkylating agent.

A client is receiving bleomycin as part of a chemotherapy regimen. Which would be most important for the nurse to monitor? A) Platelet count B) Electrocardiogram C) Chest x-ray D) Serum electrolytes

C) Chest x-ray (Bleomycin is associated with pulmonary fibrosis. Therefore, the nurse would need to monitor the client's chest x-ray periodically.)

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."

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."

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 what? Lymphatic system Immune system Cell cycle Cell wall

Cell cycle

A patient has been prescribed melphalan, an alkylating agent, for the treatment of an ovarian tumor. The patient wants to know the action of the drug in treating the tumor. Which of the following should the nurse inform the patient? Changes the cell to a neutral environment. Increases the acidity of the cell environment. Neutralizes the alkalinity of the cell environment. Changes the cell to a more alkaline environment.

Changes the cell to a more alkaline environment. Explanation: The nurse should explain to the patient that the alkylating agent changes the cell to a more alkaline environment, which in turn damages malignant cells which are more susceptible to the effects of the alkylating drugs. Alkylating drugs do not increase the acidity of the cell environment, neutralize the alkalinity of the cell environment, or change the cell to a neutral environment.

A nurse is preparing an antineoplastic agent for a school-aged client who has leukemia. What action related to the administration of this drug should the nurse perform first? -Perform thorough hand hygiene. -Check laboratory studies to determine most recent measures of bone marrow function. -Ensure a quiet environment, so the client can rest during administration of the drug. - Identify the client by checking the arm band and asking him or her to state his or her name.

Check laboratory studies to determine most recent measures of bone marrow function.

A client has been prescribed treatment with antineoplastic drugs, which have a depressing effect on the bone marrow. What pre-administration assessment should the nurse perform for this client with respect to the depressing effect of the bone marrow?

Complete blood count

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

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

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.

D. The client's platelet count will decline.

The nurse assesses a patient who is receiving doxorubicin intravenously. The nurse determines extravasation has occurred. The first action by the nurse is to A. attempt to aspirate residual doxorubicin from the patient's vein. B. remove the intravenous catheter. C. pack the intravenous site with ice. D. stop the intravenous infusion of doxorubicin.

D. stop the intravenous infusion of doxorubicin. (If extravasation occurs, stop infusion immediately. Do not remove IV device from the patient. Attempt to aspirate residual vesicant from the IV device using a small syringe and then remove the IV device. Assess the site. Notify health care provider. Apply warm packs for 15 to 20 min at least 4 times per day for first 24 h. For peripheral extravasations elevate extremity. Tissue necrosis may occur 3 to 4 weeks after infiltration into tissue.)

A client has been diagnosed with cancer. The health care provider prescribes antineoplastic drug therapy to the client. How should the nurse explain the use of antineoplastic drugs? Complete relief of symptoms of cancer Destroys only cancerous cells Delays spread of cancer to other sites Leads to complete cure of cancer

Delays spread of cancer to other sites Explanation: The nurse should explain to the client that antineoplastic drugs delay the spread of cancer to other sites in the body. These drugs do not always lead to the complete cure of cancer; instead they slow the growth of the tumor. Antineoplastic drugs destroy not only cancerous cells but all rapidly dividing cells, which may also be noncancerous. These drugs do not provide complete relief from symptoms of cancer but can help in controlling the symptoms.

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. It will cause the health care provider to increase the dose of chemotherapeutic medications. It will ultimately lead to death. It is a rare side effect of the chemotherapy.

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.

The client asks the nurse why many chemotherapy drugs must be given IV. What is the nurse's best response? Most chemotherapy drugs go directly to cancer cells if given IV. Most chemotherapy drugs are given IV because cancer clients are too sick to take the medications orally. Most chemotherapy drugs are inactivated by enzymes in the stomach. Most chemotherapy drugs cause blistering of the lips if taken orally.

Most chemotherapy drugs are inactivated by enzymes in the stomach. Explanation: Many chemotherapeutic drugs must be administered IV because the enzymes in the stomach deactivate the medication.

A client, who is prescribed vinblastine, is also currently administered warfarin. The nurse will carefully monitor the client for which reaction? Seizures Ototoxicity Prolonged bleeding CNS depression

Prolonged bleeding Explanation: The nurse should monitor the client for the increased risk of prolonged bleeding. Increased risk of seizures occurs when phenytoin interacts with a plant alkaloid. Increased risk of ototoxicity is observed in clients receiving plant alkaloids with loop diuretics. Increased risk of CNS depression is observed in clients who are receiving antidepressants along with plant alkaloids.

The client receiving a first infusion of paclitaxel reports chills and dyspnea. The oncology nurse assesses the client and observes facial flushing, wheezing, and extreme anxiety. What is the priority intervention by the nurse? Place the client in supine position. Continue the infusion and administer diphenhydramine 50 mg, intravenously. Stop the infusion. Continue the infusion and administer epinephrine 0.3 mg subcutaneously.

Stop the infusion. Explanation: The client is experiencing a hypersensitivity reaction and the first action by the nurse should be to discontinue the infusion.

The nurse should monitor a client receiving doxorubicin for signs of extravasation that include which of the following? Select all that apply: Lack of blood return Swelling Urticaria Redness Petechiae

Swelling Lack of blood return Redness Explanation: The nurse should monitor a client receiving doxorubicin for signs of extravasation that include: swelling, stinging, burning, or pain at the injection site, redness, and lack of blood return.

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

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

A 54-year-old received a diagnosis of breast cancer several weeks ago and her current treatment regimen includes tamoxifen, a cell cycle-nonspecific antineoplastic drug. What is a characteristic of a cell cycle-nonspecific drug? The drug is capable of inducing cell division and subsequent mutations of cancerous cells. The drug is readily able to distinguish between normal body cells and malignant cells. The drug induces an abnormal cell cycle that results in cancerous cell death. The drug is effective regardless of whether a cancerous cell is proliferating.

The drug is effective regardless of whether a cancerous cell is proliferating.

A female client develops hepatotoxicity from the antineoplastic drugs that she is receiving. She has abnormal levels of AST, ALT, and bilirubin. The health care provider may not decrease the drugs for what reason? These findings may indicate renal dysfunction. These findings do not indicate decreased ability to metabolize drugs. These findings may indicate cardiac dysfunction. These findings do not indicate hepatotoxicity.

These findings do not indicate decreased ability to metabolize drugs. Explanation: Some antineoplastic drugs are hepatotoxic, and many are metabolized in the liver. With impaired hepatic function, risks of further impairment or accumulation of toxic drug levels are increased. However, abnormal values for the usual liver function tests (e.g., aspartate aminotransferase [AST], alanine aminotransferase [ALT], bilirubin, alkaline phosphatase) may indicate liver injury but do not indicate decreased ability to metabolize drugs. Clients with metastatic cancer often have impaired liver function.

A nurse is caring for a client during chemotherapeutic drug therapy and determines a nursing diagnosis of impaired tissue integrity is appropriate. Which action would be appropriate for the nurse to suggest during the teaching session? Scrub and clean skin often. Ensure adequate sunlight. Have frequent baths. Wear loose protective clothing.

Wear loose protective clothing. Explanation: The nurse should suggest to the client to wear loose protective clothing and to watch areas of skinfolds for breakdown. The nurse should not suggest that the client scrub and clean the skin often, ensure adequate sunlight, or have frequent baths as these measures may aggravate the condition and cause further impairment to the tissue. The client is advised to avoid sunlight.

The nurse is preparing to administer doxorubicin for a client who has a diagnosis of neuroblastoma. What action should the nurse perform? Assess the integrity of the client's deltoid sites Perform hand hygiene before administration to protect against cytotoxic effects Wear personal protective equipment Assess the integrity of the client's mucous membranes

Wear personal protective equipment. Explanation: Cytotoxic drugs are toxic chemicals and the nurse who administers them must take adequate precautions to avoid self-exposure. These precautions include protective equipment. Hand hygiene should be performed before administering any medication but this measure does not protect the nurse from cytotoxic effects. The medication is given intravenously, so the status of the client's deltoids is not relevant. The condition of the client's mucous membranes does not directly affect the IV administration of doxorubicin.

A client has just been diagnosed with liver cancer, and the care team is finalizing the extensive chemotherapy regimen that will begin imminently. Administration of chemotherapeutic drugs is best achieved through which route? a central venous catheter (CVC) a peripheral IV in the nondominant forearm peripheral intravenous access in the antecubital fossa an intramuscular depot

a central venous catheter (CVC)

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 amifostine mesna 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. Amifostine binds with metabolites of cisplatin to protect the kidneys from nephrotoxic effects, reduces xerostomia. Mesna binds with metabolites of ifosfamide to protect the bladder from hemorrhagic cystitis. Leucovorin provides folic acid to cells after methotrexate administration.

A client with acute myeloblastic leukemia is taking doxorubicin, and the oncologist has added dexrazoxane to the drug regimen. What system should the nurse assess when monitoring for therapeutic effects of dexrazoxane? gastrointestinal genitourinary cardiac respiratory

cardiac Explanation: Dexrazoxane is a powerful chelating agent that is a cardioprotective drug that interferes with the cardiotoxic effects of doxorubicin. Cardiac assessment would monitor its therapeutic action.

A nurse is preparing an antineoplastic agent for a 9-year-old cancer patient. Before administering an antineoplastic agent, the nurse's most important action should be to: check indexes of bone marrow functioning. wash the hands. ensure a quiet environment so the patient can sleep during administration of the drug. identify the child by checking the arm band and asking them to state their name.

check indexes of bone marrow functioning. Explanation: The most important action of the nurse prior to administering the drug would be to check indexes of bone marrow functioning. An increase or decrease of the desired dosage could be harmful to the patient. The nurse should wash the hands prior to administration and correctly identify the patient. The nurse should also create a quiet environment for the patient during the administration of the drug. However, the incorrect dosage could cause toxic effects or be insufficient in treating the cancer.

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: bradycardia. dyspnea. hypertension. increased body temperature.

dyspnea.

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 Explanation: When normal growth-regulating genes (protooncogenes) are exposed to carcinogens, they may undergo genetic alteration and become oncogenes. This can stimulate continuous cell growth, allowing abnormal, disordered, and unregulated cell replication. Exposure to the other factors does not result in this alteration.

A client is receiving tamoxifen. Which adverse effect would be most specific to the action of this drug? hepatic dysfunction menopausal effects gastrointestinal toxicity bone marrow suppression

menopausal effects

In caring for clients undergoing chemotherapy, the nurse should monitor for what adverse effective triggered by the cytotoxic effect of the antineoplastic medication therapy? Select all that apply. nausea increased urine output peripheral neuropathy mucositis diarrhea

mucositis nausea diarrhea Explanation: Common adverse effects of chemotherapy include mucositis, diarrhea, and nausea. Peripheral neuropathy and increased urine output are not typical adverse effects.

A client asks the nurse what cancer cell growth is called. What would the nurse tell the client? proliferation anaplasia pleomorphism neoplasm

proliferation Explanation: Cancer cell growth is not called anaplasia, pleomorphism, or neoplasm.

Tamoxifen achieves a therapeutic effect by which means? slowing the growth of cancer cells inducing apoptosis of cancer cells causing mutations of cancer cells 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.

The nurse is providing medication education to a client with breast cancer who has been prescribed tamoxifen. How should the nurse explain the action of the drug? slows the growth of cancer cells causes mutations of cancer cells increases the viability of healthy cells that are adjacent to cancerous cells induces apoptosis of cancer cells

slows the growth of cancer cells Explanation: Antineoplastic hormone inhibitors slow the growth of cancer cells. They do not treat cancer by causing apoptosis (cell repair) or mutations. They do not influence healthy body cells in the area of the tumor.

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

use an effective contraceptive. -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 patient is receiving the alkylating drug cyclophosphamide. It is most important for the nurse to provide A. IV hydration and assessment of fluid status. B. vigilant skin care and cleaning with mild soap. C. mouth care using half-strength hydrogen peroxide and a soft toothbrush. D. patient-controlled analgesia with meperidine.

A. IV hydration and assessment of fluid status. The patient should be well hydrated while taking this drug to prevent hemorrhagic cystitis (bleeding as a result of severe bladder inflammation). MESNA (2-mercaptoethane sulfonate sodium [MESNEX]) is a cytoprotectant (chemoprotectant) drug that is often given with high-dose cyclophosphamide to inactivate urotoxic metabolites in the bladder and minimize damage to this organ

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 cycles are the only way to guarantee a cure for the cancer." "The drugs are highly toxic, so the body needs time to recover." "The cycles help to prevent the drugs from destroying the healthy cells." "We want to attack the cells that might be dormant or moving into a new phase."

A recent nursing graduate is receiving special training to become certified in handling and administering chemotherapy drugs. This special training is necessary because of what nursing diagnosis among clients receiving chemotherapy? risk for injury related to chemotherapy risk for ineffective health maintenance related to chemotherapy risk for acute pain related to chemotherapy risk for contamination related to chemotherapy

risk for injury related to chemotherapy Explanation: Because of the toxicity of chemotherapeutic agents, nurses who administer intravenous cytotoxic chemotherapy receive special training and are certified in handling and administering the chemotherapy drugs safely and accurately. Incorrect administration creates a serious risk for injury. Pain, contamination, and impaired health maintenance are not directly associated with incorrect administration.

Which is an example of an antineoplastic drug that interferes with amino acid production in the S phase and the formation of microtubules in the M phase? vinblastine teniposide etoposide irinotecan

vinblastine Explanation: The vinca alkaloids, like vinblastine, are the class of antineoplastic drugs that interfere with amino acid production in the S phase and the formation of microtubules in the M phase. Etoposide's main effect is at the G2 portion of the cell cycle in mammalian cells. Cells are stopped during the S and G2 phases by the podophyllotoxins such as teniposide and thus are unable to divide. DNA synthesis during the S phase is inhibited by camptothecin analog drugs such as irinotecan.

The mitotic inhibitors interfere with the ability of a cell to divide, and they block or alter DNA synthesis, thus causing cell death. For clients taking these drugs, the nurse should: check for extravasation when the infusion is over. encourage the patient to eat 6 small meals a day. avoid using a proximal vein. avoid any skin, eye, or mucous membrane contact with the drug.

avoid any skin, eye, or mucous membrane contact with the drug. Explanation: Special care needs to be taken when administering these drugs. The nurse should avoid any skin, eye, or mucous membrane contact with the drug. This type of contact can cause serious reactions and toxicity. The nurse should check for extravasation frequently during the infusion, a distal vein should be used, nausea and vomiting are adverse effects of these drugs, and encouraging a patient to eat while having the infusion may not be what is best for the patient.

A young client asks the nurse about the goal of the cancer therapy his mother is receiving. What would be the nurse's best response? "The goal is to kill the cancer cells as quickly as possible before they can spread so your mother will be well again." "The goal is to keep the cancer cells from spreading all over your mother's body and choose the drug with the fewest adverse effects." "The goal is to limit the cancer cells so the immune system can respond without causing too much toxicity to your mother." "The goal is to control the speed at which new cancer cells grow so the medication has a better chance to work."

"The goal is to limit the cancer cells so the immune system can respond without causing too much toxicity to your mother." Explanation: The goal of cancer therapy, much like that of anti-infective therapy, is to limit the offending cells to the degree that the immune system can then respond without causing too much toxicity to the host. The role of the client's own immune system is central to treatment and is not described in any of the other listed options.

The nurse is caring for a client newly diagnosed with a primary brain tumor. The client asks the nurse where the tumor came from. What is the nurse's best response? "Your tumor originated from a single cell that is genetically different from nearby cells." "Your tumor originated from changes in the structure of nerve tissue somewhere in your body." "Your tumor originated from somewhere outside the central nervous system from a cell just like other cells." "Your tumor most likely originated with a mutation in the pituitary gland that released pathologic hormones."

"Your tumor originated from a single cell that is genetically different from nearby cells." Explanation: All cancers start with a single cell that is genetically different from the other cells in the surrounding tissue. Determining the site of the first cell to genetically mutate in this client would require more information so it is impossible to say if the originating cell was in the CNS, the pituitary gland, or peripheral nerve tissue.

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. Cancerous cells are not responsive to the presence of drugs. Cancerous cells have a theoretically infinite life span. Cancerous cells do not require an energy source in order to proliferate.

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 group of nursing students are preparing a presentation depicting the cell cycles and the chemotherapeutic agents that work best at each phase. The instructor determines the students have correctly illustrated the information by including antimetabolites at which phase? M phase S phase G1 phase G2 phase

S phase Explanation: Antimetabolite drugs are substances that incorporate themselves into the cellular components during the S phase of cell division. This interferes with the synthesis of RNA and DNA, making it impossible for the cancerous cell to divide into two daughter cells. The vinca alkaloids interfere with amino acid production in the S phase and formation of microtubules in the M phase. Taxanes also interfere in the M phase with microtubules. Cells are stopped during the S and G2 phases by the podophyllotoxins and thus are unable to divide. DNA synthesis during the S phase is inhibited by camptothecin analog drugs such as topotecan.

The nurse is administering a client's chemotherapeutic drug through a peripheral IV site, and the nurse observes that extravasation has occurred. What is the nurse's best action? Establish another IV site so that the antidote can be administered. Administer a bolus of 0.9% NaCl or 0.45% NaCl to dilute the drug. Stop the infusion and inform the health care provider immediately. Stop the infusion, document the event, and monitor the IV site closely.

Stop the infusion and inform the health care provider immediately. Explanation: Extravasation should prompt the nurse to stop the infusion and collaborate promptly with the care provider. A bolus would cause more harm than benefit by distributing the drug in compromised tissue. Monitoring is not a sufficient response, and another IV site may or may not be needed.

A patient with acute myeloblastic leukemia is taking doxorubicin. What is an appropriate nursing intervention for this antineoplastic antibiotic agent? Use safety measures Provide frequent mouth care Plan for appropriate rest periods Report all other drugs and alternative therapies that they might be using

Provide frequent mouth care Explanation: Provide small, frequent meals; frequent mouth care; and dietary consultation as appropriate to maintain nutrition when GI effects are severe. Reporting other drugs taken, planning for appropriate rest periods, and the use of safety measures are implementations for patients taking antimetabolites.

A nurse is caring for a client who has received antineoplastic therapy. The client has developed inflammation of the oral mucous membrane, which is affecting nutritional status. Which action(s) by the nurse would be appropriate? Select all that apply. Provide mouth care with normal saline every 4 hours. Offer soft or liquid foods. Rinse oral cavity with alcohol-based mouthwash. Use lemon or glycerin swabs frequently.

Provide mouth care with normal saline every 4 hours. Offer soft or liquid foods. Explanation: The nurse should suggest that the client provide mouth care with normal saline every 4 hours and offer soft or liquid foods. Use of toothpaste, lemon or glycerin swabs, or alcohol-based mouthwash for oral care is not suggested as they cause further irritation to the oral mucosa and complicate stomatitis.

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? A nurse is teaching a client about the chemotherapeutic agent that has been prescribed. When asked about potential hair loss, which answer should the nurse prioritize? Explain that hair preserves body heat. Forewarn about hair loss. Explain it is not life-threatening. Suggest the use of a wig or cap.

Suggest the use of a wig or cap. Explanation: The nurse can assist the patient in being comfortable with his or her body image by suggesting that the patient use a wig or cap until the hair grows back. The nurse should forewarn about hair loss to prepare the patient for the outcome of the treatment. The nurse should explain that hair preserves body heat and loss of hair is not life-threatening, and this will put the patient at ease during treatment.

A 39-year-old client has begun taking tamoxifen to reduce the risk of contralateral breast cancer. The client is now reporting hot flashes and dysmenorrhea. What is the nurse's best action? Encourage the client to ask her provider about the possible use of dexrazoxane to relieve these effects. Inform the client that these are likely adverse effects of drug therapy. Tell the client to stop taking the drug immediately and contact the prescriber. Encourage the client to speak with her care provider about hormone therapy.

Inform the client that these are likely adverse effects of drug therapy. Explanation: Adverse effects of tamoxifen include hot flashes, rash, nausea, vomiting, vaginal bleeding, menstrual irregularities, edema, pain, cerebrovascular accident, and pulmonary emboli. These effects do not likely warrant discontinuing the drug. Hormone therapy would not be prescribed for the sole purpose of addressing these adverse effects. Dexrazoxane confers cardioprotective effects; it does not address adverse effects of tamoxifen therapy.

A client diagnosed with a malignancy is receiving an antimetabolite as part of medication therapy. What should the nurse teach this client about the use of antimetabolite medication? Select all that apply. -Use safety measures due to possible dizziness, headache, and drowsiness -Report all other drugs and alternative therapies currently being taken -Avoid the consumption of high-tyramine foods -Cover the head at extremes of temperature -Plan for an appropriate exercise regimen

-Use safety measures due to possible dizziness, headache, and drowsiness - Report all other drugs and alternative therapies currently being taken -Cover the head at extremes of temperature

A client is being treated with cyclophosphamide. The client's health care provider is monitoring the client for adverse reactions to the drug. What common adverse reaction would limit increasing of the dose? Nausea and vomiting Low white blood cells Fatigue Fever

Low white blood cells Explanation: The dose-limiting toxicity associated with cyclophosphamide (at high dosage) is leukopenia. Leukocytes reach nadir within 2 weeks, with recovery after 3 to 4 weeks.

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

M Explanation: Mitotic inhibitors act during the M phase of the cell cycle.

Mr. Mass has been diagnosed with lung cancer. The health care provider orders chemotherapy prior to the surgery to reduce the tumor burden. What strategy relates to chemotherapy administered to reduce the tumor burden before surgery or radiation to improve the outcomes of these methods? Consolidation therapy Induction therapy Neoadjuvant therapy Palliative therapy

Neoadjuvant therapy Explanation: Neoadjuvant therapy relates to chemotherapy administered to reduce the tumor burden before surgery or radiation in order to improve the outcomes of these methods. Induction therapy refers to the start of chemotherapy, while consolidation therapy consists of chemotherapy given after induction therapy has achieved a complete remission. Palliative therapy involves the use of chemotherapeutic drugs to control symptoms, provide comfort, and improve the client's quality of life if cure is not achievable.

The nurse is conducting a class for oncologic nurses. What characteristics of chemotherapy for older adults should the nurse identify? Select all that apply. Older adults may be more susceptible to the central nervous system (CNS) and GI effects of these drugs. Older adults are already somewhat immunosuppressed, so further suppression is a concern. Older clients are at risk for dehydration and diminished nutritional status. Dosage adjustments are made on the basis of the age of the older adult. Safety precautions should be instituted once administration begins.

Older adults may be more susceptible to the central nervous system (CNS) and GI effects of these drugs. Older clients are at risk for dehydration and diminished nutritional status. Older adults are already somewhat immunosuppressed, so further suppression is a concern. Explanation: Older adults may be more susceptible to the CNS and GI effects of some of these drugs. Older clients should be monitored for hydration and nutritional status regularly. Safety precautions should be instituted if CNS effects occur but are not needed for every drug as soon as it is initiated. Dosage is adjusted based on hepatic and renal function, not the client's age. Protecting these clients from exposure to infection and injury is a very important aspect of their nursing care because older clients are naturally somewhat immunosuppressed because of age.

A 51-year-old female patient has been receiving doxorubicin (Adriamycin) for metastatic breast cancer. Her medical record indicates she has cardiomyopathy and a cumulative dose of 300 mg/m2 of doxorubicin. Which measure would help limit the severity of the cardiomyopathy in this client? A single large dose instead of multiple doses The use of dexrazoxane in conjunction with doxorubicin A reduced dose Meticulous monitoring during drug administration

The use of dexrazoxane in conjunction with doxorubicin Explanation: Dexrazoxane, a cardioprotectant, is recommended to reduce the severity and incidence of cardiomyopathy associated with doxorubicin for women with metastatic breast cancer who received a cumulative dose of 300 mg/m2. Meticulous monitoring or multiplying daily doses would not reduce the severity and incidence of cardiomyopathy as effectively as using dexrazoxane, and reducing the dosage is not advisable.

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 Calming the activity of the gastrointestinal tract Blocking human substance P/neurokinin 1 receptors Directly blocking the chemoreceptor trigger zone (CTZ)

Blocking serotonin receptors in the CTZ

Which antineoplastic drugs are classified as alkylating agents? (Select all that apply.) A health care provider has prescribed an alkylating agent for a client. The nurse anticipates administering which drug(s) to the client? Select all that apply. Bleomycin (Blenoxane) Chlorambucil (Leukeran) Vinblastine (Velban) Cyclophosphamide (Cytoxan) Ifosfamide (Ifex)

Chlorambucil (Leukeran) Cyclophosphamide (Cytoxan) Ifosfamide (Ifex) Explanation: Alkylating agents make the cell a more alkaline environment, leading to cell damage. Alkylating agents include chlorambucil, cyclophosphamide, and ifosfamide. Bleomycin is classified as a chemotherapeutic antibiotic. Vinblastine is a plant alkaloid.

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

Methotrexate Explanation: Methotrexate is absorbed well from the gastrointestinal (GI) tract and can be administered orally. Cytarabine, fluorouracil, and gemcitabine must be administered parenterally because they are not absorbed well from the GI tract.

Which would the nurse identify as an antineoplastic antibiotic? Vinblastine Mitomycin Docetaxel Teniposide

Mitomycin -Mitomycin is an example of an antineoplastic antibiotic. Increased risk of GI toxicity if taken w/ vincristine.

Mike, a lymphoma client, is administered bleomycin drug therapy according to the health care provider's instructions. Following the drug administration, he reports fever, chills, nausea, and general weakness. What preventive measure would be helpful in his case? Using bleomycin and dexrazoxane concurrently Providing premedication with acetaminophen and diphenhydramine Performing meticulous monitoring during drug administration Administering a test dose of 3 units of acetaminophen before the first two treatments

Providing premedication with acetaminophen and diphenhydramine Explanation: Following bleomycin drug administration, clients may report fever and chills. Patients may have nausea and vomiting, general weakness, and rare instances of hypotension. These symptoms are considered to be an idiosyncratic reaction, similar to anaphylaxis, and are noted rarely and mostly in lymphoma clients. This problem could be prevented by premedication with acetaminophen and diphenhydramine. It is also helpful if a test dose of 2 units of bleomycin, and not 3 units of acetaminophen, is administered before the first two treatments. Meticulous monitoring during drug administration is important but will not help prevent this adverse effect. Concurrent use of bleomycin and dexrazoxane will not prevent this effect either.

Which drug would be classified as a mitotic inhibitor? Chlorambucil Fluorouracil Methotrexate Vincristine

Vincristine

Mr. Reiss is prescribed cyclophosphamide high-dose drug therapy. His health history indicates prior radiation to the pelvis. To minimize the adverse effect of the drug, the nurse encourages him to drink 2 to 3 L of fluid a day. Keeping his prior history in mind, what could be the reason for this suggestion? To minimize his increased risk for hemorrhagic cystitis To minimize his increased risk for renal toxicity To minimize incidents of nausea, vomiting, and anorexia To minimize his increased risk for secondary cancers

To minimize his increased risk for hemorrhagic cystitis Explanation: At very high doses, cyclophosphamide has a propensity to induce sterile hemorrhagic cystitis. Patients who have prior radiation to the pelvis or bladder are especially at increased risk for hemorrhagic cystitis. This incidence of hemorrhagic cystitis can be reduced by a vigorous hydration regimen of at least 2 L to 3 L of fluid a day. Nausea and vomiting can be relieved with antiemetic drug therapy. Risk for secondary cancers or renal toxicity cannot be controlled by fluid intake.

Which agents would be considered cancer non-cell cycle specific agents? mitotic inhibitors antimetabolites alkylating agents protein tyrosine kinase inhibitors

alkylating agents Explanation: Alkylating agents affect cells in all phases of the cell cycle and are considered non-cell cycle specific. Antimetabolites are considered to be S phase specific agents. Mitotic inhibitors are cell cycle-specific agents working in the M phase of the cell cycle. Protein tyrosine kinase inhibitors target specific enzymes needed for protein building by specific tumor cells. They do not affect healthy human cells.

Dosage of cytotoxic drugs for children is based on: height. body surface area. weight. disease process.

body surface area.

A female client is receiving L-asparaginase. She is at the end of her chemotherapeutic course and is concerned because her liver function tests are abnormal. What is an appropriate response by the nurse? "You are correct to worry; the chemotherapy may be canceled and your cancer will recur." "Liver damage is an outcome of chemotherapy; a transplant may be advised after you recover." "The liver damage is an acceptable consequence to chemotherapy." "Liver impairment usually subsides when chemotherapy is complete."

"Liver impairment usually subsides when chemotherapy is complete." Explanation: L-Asparaginase is hepatotoxic in most clients; it may increase preexisting hepatic impairment and hepatotoxicity of other medications. Signs of liver impairment, which usually subsides when the drug is discontinued, include increased AST, ALT, alkaline phosphatase, and bilirubin and decreased serum albumin, cholesterol, and plasma fibrinogen.

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 Explanation: The most common adverse effects of chemotherapy include alopecia, neutropenia, thrombocytopenia, and anemia as well or oral mucositis. Stomach ulcers may occur in some clients, but it is not a common adverse effect.

A patient undergoing antineoplastic drug therapy is administered an alkylating drug. The patient is also administered an aminoglycoside as an anti-infective agent. Which of the following interactions of the alkylating drug with the aminoglycoside should the nurse assess the patient for? Increased risk of nephrotoxicity Increased risk of methotrexate toxicity Increased risk of hypoglycemia Increased risk of bleeding

Increased risk of nephrotoxicity Explanation: The nurse should assess the patient for an increased risk of nephrotoxicity as an interaction of alkylating drugs with an aminoglycoside. Increased risk of bleeding is observed in patients who are administered anticoagulant drugs and certain antineoplastic drugs. Increased risk of hypoglycemia is observed in diabetic patients who are administered insulin and are also undergoing treatment with certain antineoplastic drugs. An increased risk of methotrexate toxicity is observed in patients who are receiving NSAIDs for pain relief and are also under treatment with alkylating agents.

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. Targeted therapies are significantly more cost-effective than traditional chemotherapeutic drugs. Targeted therapies have the potential to provide prophylactic protection against neoplasia in high-risk individuals. Targeted therapies achieve the therapeutic benefits of traditional chemotherapy with no risk of adverse effects.

Targeted therapies have the potential to damage cancerous cells while leaving normal body cells less affected.

A patient who has been taking high doses of cyclophosphamide for the treatment of acute leukemia states that he is having pain and burning on urination and has noticed blood in the urine. What does the nurse identify has occurred? The patient has developed a urinary tract infection. The patient is having a hypersensitivity reaction to the cyclophosphamide. The patient has developed sterile hemorrhagic cystitis. The patient is having a complication from the leukemia that is causing bleeding.

The patient has developed sterile hemorrhagic cystitis. Explanation: At very high doses, cyclophosphamide has a propensity for inducing sterile hemorrhagic cystitis. This problem is manifested by hematuria, pain, and burning on urination caused by the irritation of the bladder wall by acrolein, a metabolic by-product of cyclophosphamide.

A patient with a recent diagnosis of chronic myelogenous leukemia (CML) is discussing treatment options with his care team. What aspect of the patient's condition would contraindicate the use of cyclophosphamide for the treatment of leukemia? The patient's bone marrow function is significantly depressed. The patient has had a history of nonadherence to medical treatment. The patient has decreased renal function. The patient has a diagnosis of type 2 diabetes and takes oral antihyperglycemics.

The patient's bone marrow function is significantly depressed. Explanation: Patients with severely compromised bone marrow functions cannot tolerate treatment with cyclophosphamide. Diabetes, impaired renal function, and previous nonadherence to treatment must be addressed when planning the patient's care, but these factors do not necessarily contraindicate the use of cyclophosphamide.

Malignant cells seem to be more susceptible than normal cells to the effects of which class of antineoplastic drugs? antimetabolites alkylating agents antineoplastic antibiotics vinca alkaloids

alkylating agents Explanation: Malignant cells seem to be more susceptible than normal cells to the effects of the alkylating agents. Antineoplastic antibiotics appear to interfere with DNA and RNA synthesis, thereby delaying or inhibiting cell division and blocking the reproductive ability of malignant cells. The vinca alkaloids interfere with amino acid production in the S phase and formation of microtubules in the M phase. Antimetabolite drugs are substances that incorporate themselves into the cellular components during the S phase of cell division. This interferes with the synthesis of RNA and DNA, making it impossible for the cancerous cell to divide into two daughter cells.

Many times a combination of antineoplastic medications are used to: increase the quantity of each medication used. decrease the side effects of each medication. decrease the development of cell resistance. increase the length of treatment.

decrease the development of cell resistance. Explanation: Malignant cells that remain in a dormant phase for long periods are difficult to destroy. These cells can emerge long after cancer treatment has finished—after weeks, months, or years—to begin their division and growth cycle all over again. For this reason, antineoplastic agents are often given in sequence over periods of time, in the hope that the drugs will affect the cancer cells as they emerge from dormancy or move into a new phase of the cell cycle. A combination of antineoplastic agents targeting different phases of the cell cycle is frequently most effective in treating many cancers. Combinations of drugs do not increase the length of treatment, increase the quantity of medication used, or decrease the adverse effects of the medications used.

What is the defining characteristic of a sarcoma? originates from connective tissue attributable to endogenous carcinogens sequestered within bone or muscle tissue congenital in nature

originates from connective tissue Explanation: Sarcomas are derived from connective tissue such as muscle, bone, cartilage, fibrous tissue, fat, or blood vessels. They are not sequestered within other tissues, and they are not the result of endogenous carcinogens. Sarcomas are not a congenital health problem.

A female client prescribed methotrexate for meningeal leukemia is asking the nurse about adverse effects of the drug. What would the nurse tell this client should be avoided while taking methotrexate? smoking aerobic exercise pregnancy alcohol

pregnancy Explanation: Antimetabolites are contraindicated for use during pregnancy and lactation because of the potential for severe effects on the fetus and neonate. The nurse would not caution the client against aerobic exercise, smoking, or alcohol use because of the medication they were taking.

The nurse should encourage the client to implement which intervention in order to minimize the risk of developing chemotherapy-triggered mucositis? self-administer 650 mg of acetaminophen 4 times daily limit fluid intake to prevent overhydration of mucous membranes thoroughly rinse the mouth often, especially before and after meals gargle with a commercial mouthwash 3 to 4 times daily

thoroughly rinse the mouth often, especially before and after meals

A client is being treated for cancer and dronabinol has been added to the client's current medication regimen. What assessment finding would indicate a therapeutic effect of this medication? Stable white blood cell levels Decreased pain Increased energy Absence of nausea

Absence of nausea

The nurse reviews the plan of care for a patient receiving antineoplastic therapy. The nurse notes a nursing diagnosis of risk for infection. Which adverse effect would the nurse expect the patient to exhibit? dehydration gastrointestinal toxicity alopecia pancytopenia

pancytopenia

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 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 of cancer cells is the metastasis of the tumor." "The proliferation is the growth of cancer cells and the rate of growth." "The proliferation of the cancer cells is the suppression of growth." "The proliferation of the cancer cells is the treatment with chemotherapy."

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

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? "Let's get a urinalysis to confirm a urinary tract infection." "The reddish urine is an expected response to the drug." "You may have hemorrhagic cystitis." "We need to notify the health care provider because this is a complication of the medication."

"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.

An oncology nurse is performing patient teaching for a woman who is scheduled to begin treatment with a targeted therapy. The woman is unfamiliar with this class of drugs. How should the nurse best describe targeted therapies to this patient? "These drugs are capable of controlling the signals that tell cancer cells to grow and divide." "These drugs help your immune system to produce antibodies against cancer cells, which it is not normally able to do." "These drugs cause mutations in the reproduction of cancerous cells so that they no longer pose a threat to your health." "These drugs boost the functioning of your immune system so that it can overcome the cancerous cells in your body."

"These drugs are capable of controlling the signals that tell cancer cells to grow and divide." Explanation: By blocking the signals that tell cancer cells to grow and divide uncontrollably, targeted cancer therapies can help stop the growth and division of cancer cells. Targeted therapies do not enhance immune function or induce mutations in cancer cells.

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? "We can relieve your nausea and vomiting with drugs but you can have them only before and after the chemotherapy." "Not everyone has nausea and vomiting. Just wait to see how you will react to the chemotherapy." "We can relieve your nausea and vomiting with antiemetic drug therapy. You should ask for these medications whenever you need them." "Nausea and vomiting are an unfortunate side effect of the chemotherapy. We will do what we can but you may have it anyway."

"We can relieve your nausea and vomiting with antiemetic drug therapy. You should ask for these medications whenever you need them." **Reassure patients that nausea and vomiting can be relieved with antiemetic drug therapy and emphasize that they should request these agents when needed.

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? "Your hair will grow back, but it will be very thin and straight." "Your hair may not grow back, but we can refer you to a wig specialist." "I think you have more to worry about than if you have hair. You can buy a wig." "Your hair will grow back, but the new hair may be a different color or texture."

"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.

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

A client is experiencing intense nausea while being treated with chemotherapeutics. What actions should the nurse perform? Select all that apply. -Administer antacids as prescribed, 30 minutes before meals -Ensure that the client has had a dietician consult -Administer antiemetics as prescribed -Provide the client with a low-residue diet -Provide the client with small, frequent meals

-Ensure that the client has had a dietician consult -Administer antiemetics as prescribed -Provide the client with small, frequent meals

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

A. Skin -Skin cells proceed very rapidly through 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.

A. The use of three agents decreases 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.

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

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

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

B. 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.

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.

B. 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 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

C. 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.

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

Cardiotoxicity Explanation: Children who receive an anthracycline drug (e.g., doxorubicin) are at increased risk of developing cardiotoxic effects (e.g., heart failure) during treatment or after receiving the drug. Efforts to reduce cardiotoxicity include using alternative drugs when effective, giving smaller cumulative doses of anthracycline drug, and observing clients closely so that early manifestations can be recognized and treated before heart failure occurs.

An oncology nurse is reviewing the pathophysiology of cancer and is discussing with a colleague the factors that contribute to the success or failure of a patient's chemotherapy. Which cancerous cell is most susceptible to the effects of chemotherapeutic drugs? Cells that lack contact inhibition Cells with a long generation time Cells that have a rapid mitotic rate Cells that lack a blood supply

Cells that have a rapid mitotic rate

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 Explanation: Doxorubicin is the prototype antineoplastic antibiotic. Vincristine is the prototype mitotic inhibitor. Imatinib is the prototype protein tyrosine kinase inhibitor. Methotrexate is the prototype antimetabolite.

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

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

What best reflects the action of antimetabolites? Inhibits DNA production via replacing the natural substances needed for it Inserts itself between base pairs in the DNA chain, disrupting DNA synthesis Reacts chemically with portions of RNA, DNA, or other cellular proteins Interferes with the ability of the cell to divide by blocking DNA synthesis

Inhibits DNA production via replacing the natural substances needed for it Explanation: Antimetabolites inhibit DNA production in cells that depend on certain natural metabolites to produce DNA, replacing the needed metabolites, which prevents normal cellular function. Alkylating agents react chemically with portions of the RNA, DNA, or other cellular proteins. Antineoplastic antibiotics interfere with cellular DNA synthesis by inserting themselves between base pairs in the DNA chain. Mitotic inhibitors interfere with the ability of a cell to divide, blocking or altering DNA synthesis.

The nurse is caring for a client receiving cyclophosphamide. What is the priority nursing action for this client? Monitor urinalysis results Administer an antiemetic when needed Provide small, frequent meals Provide vigilant oral care

Monitor urinalysis results. Explanation: The priority nursing action would be to monitor the client's urinalysis results because hemorrhagic cystitis is a potentially fatal adverse effect of cyclophosphamide. Providing small frequent meals, and oral care and administering an antiemetic are necessary to maintain nutrition when GI effects are severe but, assessments come before interventions and these interventions are of lower priority than monitoring for hemorrhagic cystitis.

The nurse is caring for a patient who is receiving a combination of antineoplastic agents. The patient will most likely lose her hair. Why would the nurse suggest that she get a wig or use appropriate head cover? Her self-esteem will be better if the head is covered The hair will likely grow back if the head is covered at all times Most of the heat is lost through the head and it is important to cover it during extremes in temperature People may be uncomfortable seeing her bald head

Most of the heat is lost through the head and it is important to cover it during extremes in temperature

A client has just started on an alkylating agent to treat their cancer. What is the most common side effect of most alkylating agents? Nephrotoxicity Depression Confusion Myelosuppression

Myelosuppression

In describing the action of alkylating agents, what would the nurse include? Block DNA synthesis to interfere with the cell's ability to divide. Insert itself between base pairs in the DNA chain to disrupt DNA synthesis. Inhibit DNA production by replacing the natural substances for cell function. React chemically with portions of RNA, DNA, and other cellular proteins.

React chemically with portions of RNA, DNA, and other cellular proteins. Explanation: Alkylating agents react chemically with portions of the RNA, DNA, or other cellular proteins. Antimetabolites inhibit DNA production in cells that depend on certain natural metabolites to produce DNA, replacing the needed metabolites, which prevents normal cellular function. Mitotic inhibitors interfere with the ability of a cell to divide, blocking or altering DNA synthesis. Antineoplastic antibiotics interfere with cellular DNA synthesis by inserting themselves between base pairs in the DNA chain.

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 Acute Confusion related to adverse neurological effects of imatinib Risk for Impaired Skin Integrity related to exaggerated inflammatory response Risk for Infection related to bone marrow suppression Risk for Deficient Fluid Volume related to changes in osmotic pressure

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

The nurse is providing care for an older adult client who has stomatitis secondary to the administration of methotrexate. The nurse should assess for indications of what nursing diagnoses? Select all that apply. Risk for infection Risk for bleeding Imbalanced nutrition Impaired skin integrity Autonomic dysreflexia

Risk for infection Risk for bleeding Imbalanced nutrition Impaired skin integrity

A 42-year-old female with breast cancer has had a radical mastectomy. She will have radiation therapy and then begin chemotherapy. Drug therapy will consist of a combination of doxorubicin, cyclophosphamide, and paclitaxel. What will the nurse include in the teaching plan concerning the drug therapy? A client with breast cancer will have radiation therapy and then begin chemotherapy. Drug therapy will consist of a combination of doxorubicin, cyclophosphamide, and paclitaxel. What should the nurse include in the client's teaching plan concerning the drug therapy? Select all that apply. -Stay in bed 2 days after each administration -Avoid the use of antiemetics unless absolutely necessary -Take special care when shaving or when brushing her teeth - Stay on a low-fat diet during the course of the drug therapy -Avoid large crowds and public places whenever possible

Take special care when shaving or when brushing her teeth Avoid large crowds and public places whenever possible Explanation: Special care should be taken when shaving or brushing her teeth because she may bruise more easily than normal and gums may bleed. A cancer patient should not be on a diet during chemotherapy unless prescribed, and care should be taken to avoid crowds and public places where there is a greater risk of infection. Cancer patients should be as active, they should be careful not to over extend themselves physically, and they should remain active to promote optimal health.

The nurse is caring for a client receiving a combination of antineoplastic medications. The client asks the nurse why so many different medications are being used instead of just one medication. The nurse should explain what characteristics of combination therapy? Select all that apply. Increases the quantity of each medication used Targets different phases of the cell cycle Decreases the development of cell resistance Decreases the adverse effects of each medication Prolongs the length of treatment

Targets different phases of the cell cycle Decreases the development of cell resistance

The client has just been started on an alkylating agent to treat testicular cancer. What assessment finding would suggest that the client is experiencing a common adverse effect of this medication? The client's most recent laboratory results indicate pancytopenia The client is oriented to person but not to place and time The client describes his mood as "bleak" and "dark" The client describes "bone pain" in his lumbar and thoracic spine

The client's most recent laboratory results indicate pancytopenia

What should the oncology nurse understand when administering a cell cycle-nonspecific chemotherapeutic agent about its effect? The drug will be effective through specific areas of the cell cycle. The drug has intermittent effectiveness throughout the cell cycle. The drug is ineffective throughout all phases of the cell cycle. The drug will be effective through all phases of the cell cycle.

The drug will be effective through all phases of the cell cycle. Explanation: Drugs that are effective through all phases of the cell cycle and not limited to a specific phase are classified as cell cycle-nonspecific.

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

True

Anemia from chemotherapy treatment is the result of bone marrow suppression. (True/False)

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

The nurse is caring for a client who is receiving a combination of antineoplastic agents. The client has been told that alopecia is likely to occur, and the client is tearful and distraught about this. What is the nurse's best response? -Validate the client's sense of impending loss and offer guidance for getting a wig -Encourage the client to view the hair loss as something that indicates cancer is being eradicated -Reassure the client that other people who are treated with cancer also experience this -Reassure the client that the hair loss will be temporary rather than permanent

Validate the client's sense of impending loss and offer guidance for getting a wig. Explanation: The nurse should empathically validate the client's sense of loss. Offering to assist with a practical solution is also useful. The facts that the hair loss is temporary and happens to other people are unlikely to provide any real consolation. Similarly, telling the client to see it as a positive is likely to be interpreted as simplistic.

What measure protects the nurse when preparing cytotoxic drugs? Wearing protective equipment such as gloves, mask, and gown Mixing medication in a 1-L bag Washing hands before preparation Administering medication IM

Wearing protective equipment such as gloves, mask, and gown Explanation: Avoid direct skin or eye contact with the drug. Wear protective clothing and goggles while preparing and administering the drug to prevent toxic reaction to the drug. Washing hands prior to preparing the medication, mixing the medication in a 1-L bag, or administering the medication IM does not protect the nurse.

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: increase the protein in her diet. drink a lot of water. limit fluid intake. take the medication at bedtime.

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 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: asthma. cardiotoxicity. neurotoxicity. constipation.

neurotoxicity.

A client with a diagnosis of cancer is experiencing pain and the early signs of organ dysfunction. The nurse should explain that these signs and symptoms result from: overgrowth of tumor cells. tumor cells invading healthy tissue. enzymes that generate blood vessels. the body's own misguided immune response.

tumor cells invading healthy tissue Explanation: As cancer cells grow, they invade and damage healthy host tissues and this is what causes signs and symptoms of cancer. When cancer metastasizes, the tumor cells invade new tissue, and other signs and symptoms occur. Cancer cells do overgrow, and the abnormal cells do release enzymes that generate blood vessels, but this is not what causes the signs and symptoms of cancer. The effects of neoplasms are not caused by overgrowth of tumor cells, enzymes that generate blood vessels, or the body's own immune response.

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

weight Explanation: It is important to use weight-based dosing to individualize dosing of all cytotoxic drugs to minimize toxicity of normal cells. Considerations such as comorbidities, BSA, and percentage of body water may be relevant for certain clients, but weight-based dosing is the norm.