Oncology meds rationales
Leucovorin (N5-formyl-tetrahydrofolate) is often administered in combination with high doses of methotrexate in the treatment of leukemias because leucovorin: 1 Enhances uptake of methotrexate. 2 Can rescue normal cells from the toxic effects of methotrexate. 3 Prevents methotrexate from entering normal cells. 4 Is required to bioactivate methotrexate. 5 Stimulates cells of the immune system.
2 Can rescue normal cells from the toxic effects of methotrexate. An abundant supply of deoxythymidylate is required for DNA synthesis in rapidly dividing cells. This includes rapidly dividing normal as well as tumor cells.Methotrexate is an antifolate compound that closely resembles the structure of folic acid.
A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? 1. Glucose level 2. Calcium level 3. Potassium level 4. Prothrombin time
2. Calcium level Rationale: Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium level should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.
The nurse should be prepared to institute bleeding precautions in the client receiving antineoplastic medication if which result was reported from the laboratory? 1. Clotting time 12 seconds 2. Ammonia level 28 mcg/dL 3. Platelet count 50,000 cells/mm3 4. White blood cell count (WBC) 4500 cells/mm3
3. Platelet count 50,000 cells/mm3 Rationale: Bleeding precautions need to be initiated when the platelet count decreases. The normal platelet count is 150,000 to 450,000 cells/mmc) When the platelet count decreases, the client is at risk for bleeding. The normal white blood cell count is 4500 to 11,000 cells/mmc) When the white blood cell count drops, neutropenic precautions need to be implemented. The normal clotting time is 8 to 15 minutes. The normal ammonia value is 10 to 80 mcg/dL.
A female client with carcinoma of the breast is admitted to the hospital for treatment with intravenously administered doxorubicin (Adriamycin). The client tells the nurse she has been told by her friends that she is going to lose all her hair. What is the appropriate nursing response? 1. "Your friends are correct." 2. "You will not lose your hair." 3. "Hair loss may occur, but it will grow back just as it is now." 4. "Hair loss may occur, and it will grow back, but it may have a different color or texture."
4. "Hair loss may occur, and it will grow back, but it may have a different color or texture." doxorubicin (Adriamycin) ( Anti- tumor antibiotics) Bone marrow suppression can lead to anemia, leukopenia, increasing the risk of infections, and thrombocytopenia, increasing the risk of bleeding. Moreover, they can all cause alopecia, as well as gastrointestinal toxicity, which can manifest as nausea, vomiting, diarrhea or stomatitis.
The nurse administering a combination chemotherapy regimen understands that it is important to implement which action? 1. Give two agents from the same medication class. 2. Give two agents with like nadirs at the same time. 3. Test the client's knowledge about each agent's nadir. 4. Avoid giving agents with the same nadirs and toxicities at the same time.
4. Avoid giving agents with the same nadirs and toxicities at the same time. Nadir is a term that basically means low point. When a person with cancer reaches their "nadir" following each chemotherapy cycle, it means that the person's blood cell counts are the lowest they will be during that treatment cycle.
Capecitabine (Xeloda) has been prescribed for a client. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication? 1. Liver function tests 2. Bilirubin level assay 3. Triglyceride level determination 4. Complete blood cell count (CBC) 1. Liver function tests 2. Bilirubin level assay 3. Triglyceride level determination 4. Complete blood cell count (CBC)
4. Complete blood cell count (CBC) antimetabolite S/E edema, dermatiti, anemia, fever, fatigue, hyperbilirubinemia, thrombocytopenia, N&V, leukopenia, lympphocytopenia, neutropenia Adverse s/e:cardiotoxicity, diarrhea, hyperbilirubinemia, neutropenia, hand-foot syndrome, lymphocytopenia, leukopenia Instruct patient to report significant diarrhea, nausea, vomiting, or dehydration. Warn female patient to avoid pregnancy during treatmentInstruct patient to swallow tablets with water within 30 minutes after a meal. Instruct patients to report allergic rxn
A client with non-Hodgkin's lymphoma is receiving daunorubicin (DaunoXome). Which finding would indicate to the nurse that the client is experiencing an adverse effect related to the medication? 1. Fever 2. Sores in the mouth and throat 3. Complaints of nausea and vomiting 4. Crackles on auscultation of the lungs
4. Crackles on auscultation of the lungs daunorubicin (DaunoXome) Anti-Tumor Antibioitic Monitor EF Vesication (If it leaks it cause necrosis). Alopecia, Anorexia Rationale: Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as heart failure (lung crackles) is an adverse effect of daunorubicin. Bone marrow depression is also an adverse effect. Fever is a frequent side effect and sores in the mouth and throat can occur occasionally. Nausea and vomiting is a frequent side effect associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. Options 1, 2, and 3 are not adverse effects.
The nurse is monitoring a client with leukemia who is receiving doxorubicin (Adriamycin PFS) by intravenous infusion. The nurse should monitor for which assessment finding that would indicate toxicity to the medication? 1. Elevated creatinine 2. Red coloration in the urine 3. Elevated blood urea nitrogen 4. Electrocardiogram (ECG) changes
4. Electrocardiogram (ECG) changes Doxorubicin (Adriamycin) Nursing Implications Reduce dosage in patients with hepatic failure, Drug should be administered under physician supervision, Severe myelosuppression may occur, Myocardial toxicity may occur , Monitor CBC, electrolytes, ECG Doxorubicin (Adriamycin) Patient Teaching Advise patient to watch for signs and symptoms of infection, Advise patient that orange to red urine for 1-2 days is normal, Inform patient that hair loss may occur, Advise patient to take antiemetics
The nurse tells a client with leukemia who is receiving chemotherapy that allopurinol (Zyloprim) has been added to the medication list. When the client asks the purpose of the new medication, the nurse responds that the allopurinol is intended to prevent which problem? 1. Nausea 2. Diarrhea 3. Muscle spasms 4. Hyperuricemia
4. Hyperuricemia
Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The nurse administering the medication understands that which is the primary action of this medication? 1. It increases DNA and RNA synthesis. 2. It promotes the biosynthesis of nucleic acids. 3. It increases estrogen concentration and estrogen response. 4. It competitively binds to estrogen receptors on tumors and other tissue targets.
4. It competitively binds to estrogen receptors on tumors and other tissue targets. Rationale: Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNA synthesis and estrogen response.
Chemotherapy dosage is frequently based on total body surface area (BSA), so it is important for the nurse to perform which assessment before administering chemotherapy? 1. Measure the client's abdominal girth. 2. Calculate the client's body mass index. 3. Ask the client about his or her weight and height. 4. Measure the client's current weight and height.
4. Measure the client's current weight and height. Rationale: To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total body surface area (BSA), which requires a current accurate height and weight for BSA calculation (before each medication administration). Asking the client about his or her height and weight may lead to inaccuracies in determining a true BSA and dosage. Calculating body mass index and measuring abdominal girth will not provide the data needed.
A client with small cell lung cancer is being treated with etoposide (Toposar). The nurse monitors the client during administration, knowing that which adverse effect is specifically associated with this medication? 1. Alopecia 2. Chest pain 3. Pulmonary fibrosis 4. Orthostatic hypotension
4. Orthostatic hypotension Toposar- antineoplastic, cytotoxic, plant alkaloid Rationale: An adverse effect specific to etoposide is orthostatic hypotension. Etoposide should be administered slowly over 30 to 60 minutes to avoid hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication.
A client with cancer is receiving a continuous intravenous infusion of morphine sulfate. The nurse monitoring the client for adverse effects would become most concerned about which vital sign? 1. Temperature of 99.1° F 2. Apical heart rate of 90 beats/min 3. Blood pressure of 110/70 mm Hg 4. Respirations of 10 breaths per minute
4. Respirations of 10 breaths per minute Morphine sulfate can depress the respiratory system, leading to potentially life-threatening breathing difficulties. If a nurse is monitoring a client receiving a continuous intravenous infusion of morphine sulfate, the finding that should prompt the nurse to contact the physician is the client's respiratory rate dropping significantly or becoming excessively slow (respiratory depression).
John is receiving combination chemotherapy for leukemia to suppress bone marrow activity. Since his admission, only family members have been permitted to visit as a prophylactic measure. On the second day of therapy, his daily complete blood count indicates a neutrophil count of 0.9 x 109/L.John experiences a peripheral extravasation of the cytotoxic agent doxorubicin (Adriamycin). Which of the following is the immediate nursing action following removal of the IV device? A. Apply a hot compress to the infiltration site B. Apply a sterile dressing to the infiltration site C. Apply a cold compress to the infiltration site D. Book an OR time for surgical debridement
C. Doxorubicin (Adriamycin) extravasation is complex and will follow a series of steps. For the first 24 hours, the hand is cooled to patient tolerance.
The licensed practical nurse (LPN) is assisting the registered nurse (RN) to create a teaching plan for the client receiving an antineoplastic medication. The LPN expects which information to be included? Select all that apply. inse the mouth after meals and use a soft toothbrushmaintain oral hygiene and inspect mouth for sores dailyconsult with HCP before receiving immunizations
Clients with cancer treated with antineoplastic medications must be aware of how to care for themselves and it is important that client teaching is included in the care plan. Because antineoplastic medications affect the bone marrow, clients are often anemic, have lower immunity, and may be at risk for bleeding. Oral hygiene is important and clients should inspect their mouths daily, rinse after meals, and use a soft toothbrush. The client should check with the PHCP before receiving any immunizations. The client should notify the PHCP for a low grade temperature such as 99.5° F (39.7° C) and a sore throat. These are often associated with low white blood cell counts.
As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed if the client makes which statement? 1."I should avoid blowing my nose." 2."I may need a platelet transfusion if my platelet count is too low." 3."I'm going to take aspirin for my headache as soon as I get home." 4."I will count the number of pads and tampons I use when menstruating."
Correct Answer: 3 Rationale: During the period of greatest bone marrow suppression (the nadir), the platelet count may be low, less than 20,000 cells mm3 (20.0 × 109/L). The correct option describes an incorrect statement by the client. Aspirin and nonsteroidal antiinflammatory drugs and products that contain aspirin should be avoided because of their antiplatelet activity. Options 1, 2, and 4 are correct statements by the client to prevent and monitor bleeding.
The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer, and tells the staff that which is a late sign or symptom of this oncological emergency? 1.Headache 2.Dysphagia 3.Constipation 4.Electrocardiographic changes
Correct Answer: 4 Rationale: Hypercalcemia is a manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. Electrocardiogram changes include shortened ST segment and a widened T wave.
Which of the following best describes the term nadir? A. The recovery of bone marrow suppression after cancer treatment B. The time it takes for cancer treatment to destroy all cancer cells in bone marrow C. The highest level reached by bone marrow cells in response to cancer treatment D. The lowest level reached by bone marrow cells in response to cancer treatment
D. Nadir refers to the peak effect of cancer treatment (chemotherapy or radiation) on the bone marrow, which coincides with the patient's lowest blood count.
A client who has been diagnosed with cancer is to receive chemotherapy with both cisplatin (Platinol-AQ) and vincristine (Oncovin). The client asks the nurse why both medications must be given together. The nurse's response is based on the understanding that the purpose of using both medications is to promote which action? 1. Increase the destruction of tumor cells. 2. Prevent the destruction of normal cells. 3. Decrease the risk of the alopecia and stomatitis. 4. Increase the likelihood of erythrocyte and leukocyte recovery.
1. Increase the destruction of tumor cells. :Given in combination to get more coverage against the cancer cell, and intervals to decrease drug resistance and give the patient a break from destroying the good cells. Gives normal cells a break to recover.
A client with squamous cell carcinoma is receiving bleomycin. To determine whether adverse effects of this medication are occurring, the nurse should carefully assess which item? 1. Lung sounds 2. Platelet count 3. Blood pressure 4. White blood cell count
1. Lung sounds Rationale: Bleomycin is an antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication.
The client with breast cancer has been given a prescription for cyclophosphamide. The nurse determines that the client understands the proper use of the medication if the client states that he or she will take which measure? 1. Increase dietary intake of potassium. 2. Increase fluid intake to 2 to 3 L/day. 3. Take the medication with large meals. 4. Decrease dietary intake of magnesium.
2. Increase fluid intake to 2 to 3 L/day.
The nurse reviewing a medical record notes that high concentrations of methotrexate followed by leucovorin (citrovorum factor, folic acid) are being given to the client with cancer. The nurse correctly interprets that which is the reason for therapy with leucovorin? 1. Preserve normal cells. 2. Promote protein synthesis. 3. Promote medication excretion. 4. Hasten the effect of the methotrexate.
1. Preserve normal cells. The administration of leucovorin with methotrexate is known as leucovorin rescue. High concentrations of methotrexate cause harm and damage to normal cells. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting normal cells to synthesize. Leucovorin rescue is potentially hazardous because failure to administer leucovorin in the right dose at the right time can be fatal.
The nurse is caring for a client on the oncology unit who has developed stomatitis during chemotherapy. The nurse should plan which measure to treat this complication? 1. Rinse the mouth with diluted baking soda or saline. 2. Use lemon and glycerin swabs liberally on painful oral lesions. 3. Place the client on NPO status for 12 hours, and then resume liquids. 4. Brush the teeth and use non-waxed dental floss at least twice a day.
1. Rinse the mouth with diluted baking soda or saline.
The nurse is monitoring the intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. On inspection of the site, the nurse notes redness and swelling and that the infusion of the medication has slowed in rate. The nurse suspects extravasation and should take which actions? Select all that apply 1. Stop the infusion. 2. Notify the health care provider (HCP). 3. Prepare to apply ice or heat to the site. 4. Restart the IV at a distal part of the same vein. 5. Prepare to administer a prescribed antidote into the site. 6. Increase the flow rate of the solution to flush the skin and subcutaneous tissue. .
1. Stop the infusion. 2. Notify the health care provider (HCP). 3. Prepare to apply ice or heat to the site. 5. Prepare to administer a prescribed antidote into the site. Rationale: Redness and swelling and a slowed infusion indicate signs of extravasation. If the nurse suspects extravasation during the intravenous administration of an antineoplastic medication, the infusion is stopped and the HCP is notified. Ice or heat may be prescribed for application to the site and an antidote may be prescribed to be administered into the site. Increasing the flow rate can increase damage to the tissues. Restarting an IV in the same vein can increase damage to the site and vein.
The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action? 1. Take the medication with food. 2. Increase fluid intake to 2000 to 3000 mL daily. 3. Decrease sodium intake while taking the medication. 4. Increase potassium intake while taking the medication.
2. Increase fluid intake to 2000 to 3000 mL daily. Rationale: Hemorrhagic cystitis is an adverse effect that can occur with the use of cyclophosphamide (Alkylating agent). The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake.
The nurse transcribes a medication prescription for ifosfamide (Ifex) for a client with a diagnosis of germ cell cancer of the testes. The nurse reviews the client's history and looks for another prescription for which medication, which usually is administered with the antineoplastic medication? 1. Prednisone 2. Mesna (Mesnex) 3. Bleomycin sulfate 4. Melphalan (Alkeran)
2. Mesna (Mesnex) Protects against bladder bleeding and irritation
Megestrol acetate (Megace), an antineoplastic medication, is prescribed for a client with metastatic endometrial carcinoma. The nurse reviews the client's history and should contact the health care provider if which diagnosis is documented in the client's history? 1. Gout 2. Asthma 3. Thrombophlebitis 4. Myocardial infarction
3. Thrombophlebitis Rationale: Megestrol acetate (Megace) suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of thrombophlebitis. Options 1, 2, and 4 are not contraindications for this medication.
A client with cancer is about to be started on mitomycin (Mutamycin). The nurse should contact the health care provider after noting that the client is also taking which medication? 1. Furosemide (Lasix) 2. Ondansetron (Zofran) 3. Warfarin (Coumadin) 4. Allopurinol (Zyloprim)
3. Warfarin (Coumadin) Mutamycin contraindications include coagulopathy, thrombocytopenia, or any bleeding diathesis.
What are monoclonial Antibiotics?
Special type of Cancer agents that are specific to cancer cell types.
The nurse caring for a client receiving vincristine (Oncovin) is monitoring the client for toxicity. The nurse interprets that the client is experiencing a toxic effect of this medication on the basis of which assessment finding? 1. Nausea and vomiting 2. Decreased platelet count 3. Decreased white blood cell count 4. Weakness and sensory loss in the legs
4. Weakness and sensory loss in the legs Vincristine is an antineoplastic medication that works by binding to tubulin, a major protein component of the cytoskeleton. Neurotoxicity is the most devastating side effect of vincristine, and peripheral numbness, constipation, and diminished reflexes may all be signs of this toxicity, and the nurse should be vigilant when monitoring patients receiving this drug.
Mrs. Wong is receiving chemotherapy for blood-related cancer. She has received two rounds of chemotherapy in the past few days, and she is scheduled for her next round today. Routine blood work was performed early in the morning, and the results have just been received on the unit.Which of the following pieces of nursing assessment data confirms the nurse's concern regarding chemotherapy administration today? A. Evidence of oral candidasis B. Blood-tinged urine C. Oxygen saturation level of 96% D. Lack of energy for activities of daily living
B. Mrs. Wong is at risk for bleeding tendencies, and blood-tinged urine confirms a thrombocytopenia interpretation of the results.
Which of the following is the rationale for the nurse teaching a patient who is receiving cyclophosphamide (Procytox) to drink plenty of fluids? A. To prevent renal failure B. To prevent nephrotoxicity C. To prevent liver dysfunction D. To increase the red blood cell count
B. Patients receiving cyclophosphamide (Procytox) should drink at least 2 to 3 L of fluid before, during, and after administration to prevent hemorrhagic cystitis.
Mrs. Wong is receiving chemotherapy for blood-related cancer. She has received two rounds of chemotherapy in the past few days, and she is scheduled for her next round today. Routine blood work was performed early in the morning, and the results have just been received on the unit.Which of the following laboratory results would cause the nurse to question antineoplastic therapy administration today? A. Hemoglobin of 150 g/L B. Platelet count of 45 x 109/L C. Red cell count of 5 x 1012/L D. Hematocrit value of 0.45
C. Antineoplastic therapy causes bone marrow suppression, which is evidenced by a decrease in red blood cells, white blood cells, and platelets. The thrombocyte count is significantly lower than normal. Hemoglobin, platelet, and hematocrit values are within normal limits.
When assessing a patient for adverse effects related to cisplatin, the nurse should monitor for which of the following? A. Hepatoxicity B. Pulmonary fibrosis C. Peripheral neuropathy D. Severe gout
C. Cisplatin is known to be ototoxic, nephrotoxic, neurotoxic, and emetogenic.
Which of the following statements is required when caring for a patient experiencing the adverse effect of nausea and vomiting associated with antineoplastic therapy? A. "It is best to avoid eating any food during chemotherapy." B. "It is best to cope with the nausea, as it will pass with time." C. "Together, we can formulate a plan to maintain your hydration and nutritional status." D. "I will give you an antacid to relieve the irritation to your stomach and decrease the nausea."
C. It is important for patients undergoing chemotherapy to maintain adequate nutrition and hydration. Several antiemetic drugs are available that are very successful in controlling this adverse effect
The nurse is caring for a client with lung cancer and bone metastasis. What signs and symptoms would the nurse recognize as indications of a possible oncological emergency? Select all that apply. 1.Facial edema in the morning 2.Weight loss of 20 lb (9 kg) in 1 month 3.Serum calcium level of 12 mg/dL (3.0 mmol/L) 4.Serum sodium level of 136 mg/dL (136 mmol/L) 5.Serum potassium level of 3.4 mg/dL (3.4 mmol/L) 6.Numbness and tingling of the lower extremities
Correct Answer: 1,3,6 Rationale: Oncological emergencies include sepsis, disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, superior vena cava syndrome, and tumor lysis syndrome. Blockage of blood flow to the venous system of the head resulting in facial edema is a sign of superior vena cava syndrome. A serum calcium level of 12 mg/dL (3.0 mmol/L) indicates hypercalcemia. Numbness and tingling of the lower extremities could be a sign of spinal cord compression. Mild hypokalemia and weight loss are not oncological emergencies. A sodium level of 136 mg/dL (136 mmol/L) is a normal level.
What should patients watch for and report if taking an immunosuppressant? Why is it important to report any signs of infection?
It decreases immune function, and increases chance of developing an infection or organ rejection. Report fever, chills, swollen glands, sore throat, tiredness, malaise, which are all signs of infection or organ rejection.
A patient was prescribed tamoxifen and was told to take it after her breast tumors were removed. Why? What is this drug?
It is an anti-estrogen and it is taken daily to decrease any remaining cancer cells in the surrounding area and decrease tumor recurrences. It is prescribed for 5 years.
What are the most serious adverse effect that can occur after methotrexate therapy?
Nausea, vomiting, diarrhea, anemias, GI irritation, mucositis, alopecia, and myelosuppression.
A client has been receiving chemotherapy to treat cancer. What assessment finding suggests that the client has developed stomatitis?
Stomatitis is the condition of inflammation in and around the oral mucosa. The diagnosis of stomatitis is made clinically and a patient is said to have developed stomatitis when there are red, open sores on the oral mucosa. These may be painful, which could lead to difficulty in eating. This is a common adverse effect of cancer treatments and patients should be properly educated about the onset of these lesions.
A client is receiving chemotherapy that is known to cause nausea and vomiting. Which medication should the nurse administer to help prevent chemotherapy-induced nausea and vomiting? a) Morphine b) Diphenhydramine c) Metoprolol d) Ondansetron
The correct answer is d) Ondansetron. Rationale: Ondansetron is a common antiemetic medication used to prevent and treat chemotherapy-induced nausea and vomiting. Morphine (a) is an opioid analgesic, diphenhydramine (b) is an antihistamine, and metoprolol (c) is a beta-blocker; none of these medications are typically used for preventing chemotherapy-induced nausea and vomiting.
The nurse instructs a client receiving chemotherapy on actions to prevent the development of stomatitis. Which client statement indicates to the nurse that teaching has been effective?
Use prescription mouth rinses no spicy foods eat soft foods use soft tooth brush and salt rinses
Given the drugs(mechlorethamine, vincristine, procarbazine, and prednisone, which one may cause a feeling of numbness of the hands and feet?
Vincristine causes peripheral neuropathy(paraesthesias--needle and pin feeling and loss of reflexes).
The client with ovarian cancer is being treated with vincristine. The nurse monitors the client, knowing that which adverse effect is specific to this medication?
extremity numbness Vincristine is a vinca alkaloid antineoplastic (miotic inhibitor) medication that has an adverse effect, specifically peripheral neuropathy. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation, rather than diarrhea, is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication.
A client with cancer is receiving chemotherapy and develops thrombocytopenia. Which intervention is a priority in the nursing plan of care?
monitor the client for bleeding Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Monitoring the temperature relates to infection, particularly if leukopenia is present. The options indicating to ambulate the client and monitor for pathological fractures are also important to the plan of care but are not directly related to thrombocytopenia.
When a client receives vincristine, an antineoplastic agent that inhibits DNA and protein synthesis, the client needs to be informed to report which symptoms that would be expected side effects of motor neuropathy? Select all that apply.
muscle weakness cramps and spasms in the legs loss of balance and coordination Vincristine- Miotic Inhibitor- Plant Alkaloid- Remember peripheral neuropathies affected
A client with acute myelocytic leukemia is being treated with busulfan (Myleran, Busulfex). Which laboratory value would the nurse specifically monitor during treatment with this medication? 1. Clotting time 2. Uric acid level 3. Potassium level 4. Blood glucose level
2. Uric acid level (antineoplastic) medication Alkylating agent- stops cell DNA replication Monitor: BUN, Creatinine, Must hydrate PT Nephron toxicity Rationale: Busulfan (Myleran, Busulfex) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute kidney injury. Options 1, 3, and 4 are not specifically related to this medication.
The client with bladder cancer is receiving cisplatin and vincristine (Vincasar PFS). The nurse preparing to give the medication understands that which is the purpose of administering both of these medications? 1. To prevent alopecia 2. To decrease the destruction of cells 3. To increase the therapeutic response 4. To prevent gastrointestinal side effects
3. To increase the therapeutic response Overall, the combination of vincristine and cisplatin and IMRT in patients with advanced cervical cancer is a preferable technique in terms of boosting the quality of life and improving the clinical indicators of patients The rationale for combination therapy is to use drugs that work by different mechanisms, thereby decreasing the likelihood that resistant cancer cells will develop. Combination therapy delays the development of drug resistance and also provides a greater killing effect on cancer cells
The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an earlysign of this oncological emergency? 1.Cyanosis 2.Arm edema 3.Periorbital edema 4.Mental status changes
Correct Answer: 3 Rationale: Superior vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens, the client experiences edema of the hands and arms. Cyanosis and mental status changes are late signs.
General adverse effects of chemotherapy include which of the following? A. Weight gain B. Leukocytosis C. Urinary retention D. Thrombocytopenia
D. Bone marrow suppression (leukopenia, thrombocytopenia, and anemia) and alopecia are common adverse reactions to antineoplastic agents.
A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication. When implementing the plan, the nurse should make which statement to the client? 1. "You can take aspirin (acetylsalicylic acid) as needed for headache." 2. "You can drink beverages containing alcohol in moderate amounts each evening." 3. "You need to consult with the health care provider (HCP) before receiving immunizations." 4. "It is fine to receive a flu vaccine at the local health fair without HCP approval because the flu is so contagious."
3. "You need to consult with the health care provider (HCP) before receiving immunizations." Rationale: Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without an HCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side/adverse effects.
A nurse is assigned to care for a client with metastatic breast cancer who is taking tamoxifen citrate. The nurse plans to monitor for which changes in laboratory values for this client? Select all that apply. 1. Increase in lipase level 2. Increase in blood glucose level 3. Increase in serum calcium level 4. Increase in serum potassium level 5. Decrease in low-density lipoprotein levels
3. Increase in serum calcium level 5. Decrease in low-density lipoprotein levels All patients on tamoxifen should have routine lab work, including a complete blood count with platelets, serum calcium, and liver function tests.
A client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? 1. Echocardiography 2. Electrocardiography 3. Cervical radiography 4. Pulmonary function studies
4. Pulmonary function studies Rationale: Bleomycin is an antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication.
A client with non-Hodgkin's lymphoma is receiving daunorubicin. Which finding would indicate to the nurse that the client is experiencing an adverse effect related to the medication? 1.Fever 2.Sores in the mouth and throat 3.Complaints of nausea and vomiting 4.Crackles on auscultation of the lungs
Correct Answer: 4 Rationale: Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as heart failure (lung crackles) is an adverse effect of daunorubicin. Bone marrow depression is also an adverse effect. Fever is a frequent side effect and sores in the mouth and throat can occur occasionally. Nausea and vomiting is a frequent side effect associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. Options 1, 2, and 3 are not adverse effects.
A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently reported swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms?
Stomatitis
A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication?
Extravasation Extravasation: the unintentional leakage of vesicant fluids or medications from the vein into the surrounding tissue. Vesicant: agents capable of causing blistering, tissue sloughing or necrosis. . Extravasation - if the fluid is a vesicant (a fluid that irritates tissue), it is called an extravasation.
What is the immediate treatment for methotrexate overdosage? What is this treatment called?
Give leucovorin rescue, which is folic acid, which activates the bone marrow to resume blood cell production again.
Eight days after methotrexate use, a patient became extremely debilitated with fever, breathing difficulty, blood in the urine, and evidence of a bacterial infection. What do you suppose is happening?
Immunosuppression, increasing chance of infection and anemias.
High doses of methotrexate were administered to a young patient, for the treatment of Acute Lymphocytic Leukemia(ALL). How does this drug work to kill these cancer cells?
It is an antimetabolite, it decreases cancer cell growth. It is a folic acid antagonist. Works on the S phase blocking DNA synthesis, of the cell cycle phases.
What is the major precaution to be observed in the handling and administration of mechlorethamine and vincristine?
Since these drugs are vesicants, we need to look for blistering and necrosis if accidently exposed to skin, and signs of extravasation at the injection site. This is severe tissue necrosis, severe pain and local toxicity.
A client is receiving intravesical chemotherapy for cancer of the bladder. The nurse should plan to take which action after the completion of each treatment? 1. Encourage increased intake of oral fluids. 2. Provide increased doses of opioid analgesics. 3. Place the client on strict contact isolation for 24 hours. 4. Keep the client on nothing by mouth (nil per os [NPO]) status for 6 hours.
1. Encourage increased intake of oral fluids. For about 2 days after each treatment, you will usually be asked to drink at least 2 to 3 litres (3½ to 5 pints) of fluid a day. This helps to flush the drug out of your bladder.
A client with lung cancer is receiving a high dose of methotrexate (Trexall). Leucovorin (citrovorum factor, folic acid) is also prescribed. The nurse planning care for the client should understand that the purpose of administering the leucovorin is to promote which action? 1. Preserve normal cells. 2. Promote DNA synthesis. 3. Enable medication excretion. 4. Facilitate the synthesis of nucleic acids.
1. Preserve normal cells. Leucovorcin- a medication used in the treatment of methotrexate toxicity and chemotherapy regimens. Leucovorin is a folate analog. This activity reviews the indications, action, and contraindications for leucovorin as a valuable agent in the reversal of methotrexate toxicity and as a part of chemotherapy regimens.
The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? 1. Anemia 2. Decreased platelets 3. Increased uric acid level 4. Decreased leukocyte count
3. Increased uric acid level Rationale: Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is related specifically to cell destruction.
The nurse is assisting with caring for a client with cancer who is receiving cisplatin. Which adverse effects are associated with this medication? Select all that apply. tinnitus ototoxicity nephrotoxicity hypomagnesemia
Cisplatin is an alkylating medication. Alkylating medications are cell cycle phase nonspecific and affect the synthesis of DNA by causing its cross-linking to inhibit cell reproduction. Cisplatin may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine may be administered before cisplatin to reduce the potential for renal toxicity.
A client with cancer has received a course of chemotherapy and received fluorouracil (Adrucil). The nurse should tell the client to report which finding immediately? 1. Alopecia 2. Headache 3. Stomatitis and diarrhea 4. Changes in color vision
3. Stomatitis and diarrhea Fluorouracil is in a class of medications called antimetabolites. It works by killing fast-growing cells such as the abnormal cells in actinic keratoses and basal cell carcinoma.
A client with ovarian cancer is being treated with vincristine (Vincasar). The nurse monitors the client, knowing that which manifestation indicates an adverse effect specific to this medication? 1. Diarrhea 2. Hair loss 3. Chest pain 4.Peripheral neuropathy
4. Peripheral neuropathy Rationale: An adverse effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication.
The clinic nurse prepares instructions for a client who developed stomatitis after the administration of a course of antineoplastic medications. The nurse should provide the client with which instruction? 1. Avoid foods and fluids for the next 24 hours. 2. Swab the mouth daily with lemon and glycerin pads. 3. Brush the teeth and use waxed dental floss three times a day. 4. Rinse the mouth with a diluted solution of baking soda or saline.
4. Rinse the mouth with a diluted solution of baking soda or saline. Do not use a mouthwash or other over-the-counter rinse with alcohol. These can dry out your mouth or cause more pain. If your doctor gave you mouthwash or lozenges to treat your yeast infection, use them as directed.
Which assessment data indicates John is experiencing an adverse effect of doxorubicin (Adriamycin) that could be life altering? A. Clear lung sounds on auscultation B. Pulse oximetry level of 92% C. Respiratory rate of 22 D. Shortness of breath at rest
D. Pulmonary fibrosis is a potential adverse event that cannot be reversed. The nurse should be diligent in thorough respiratory assessments during therapy. Shortness of breath at rest is an indication of poor oxygenation, which will need intervention.
