Pharmacology Chapter 14- Antineoplastic Agents
A patient asks the nurse what a cancer cell's growth rate is called. What is the nurse's best response? A) Cancer cell's growth rate is called proliferation. B) Cancer cell's growth rate is called anaplasia. C) Cancer cell's growth rate is called pleomorphism. D) Cancer cell's growth rate is called neoplasm.
A Feedback: A cancer cell growth rate is called proliferation. Anaplasia is the loss of organization and structure, pleomorphism is the occurrence of more than one shape of the cell, and a neoplasm is the term for a new or cancerous growth occurring when abnormal cells have the opportunity to multiply and grow.
The nurse should exercise caution when administering antimetabolites to a patient diagnosed with what? A) Bone marrow suppression B) Diabetes mellitus C) Hypertension D) Seizure activity
A Feedback: Bone marrow is often the index for dosing and redosing levels. Caution should be used and strict monitoring done for patients with suppressed bone marrow who are receiving an antimetabolite. Diabetes mellitus, hypertension, and seizure activity have not been identified as interfering with this drug therapy.
The process of cancerous cells exhibiting a loss of cellular differentiation and organization leading to a loss of their ability to function normally is called what? A) Anaplasia B) Angiogenesis C) Autonomy D) Metastasis
A Feedback: Cancerous cells exhibit anaplasia, which is a loss of cellular differentiation and organization that leads to a loss of their ability to function normally. Angiogenesis refers to the abnormal cells releasing enzymes that generate blood vessels in the area to supply both oxygen and nutrients to the cells. Cancerous cells exhibit autonomy, which is the ability to grow without the usual homeostatic restrictions that regulate cell growth and control. Metastasis is the process of the cancerous cells traveling from the place of origin to develop new tumors.
A nurse on the oncology unit is caring for a patient with an astrocytoma. The patient has just been told that the tumor is growing very fast. The patient asks the nurse how these tumors grow. What is the nurse's best response? A) Brain tumors infiltrate the surrounding tissue. B) Brain tumors grow by invading the surrounding grey matter. C) Brain tumors grow by invading the surrounding white matter. D) Brain tumors spread down the spinal cord.
A Feedback: Over time, these neoplastic cells grow uncontrollably, invading and damaging healthy tissue in the area and even undergoing metastasis (traveling from the place of origin to develop new tumors in other areas of the body where conditions are favorable for cell growth). The abnormal cells release enzymes that generate blood vessels. Brain tumors can invade either grey or white matter or they can spread down the spinal cord. These responses do not answer the patient's question.
The nurse is caring for a patient receiving cyclophosphamide (Cytoxan). What is the priority nursing action for this patient? A) Monitor urinalysis results. B) Provide small, frequent meals. C) Administer an antiemetic when needed. D) Provide oral care.
A Feedback: The priority nursing action would be to monitor the patient'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.
A patient diagnosed with a malignancy is receiving an antimetabolite as part of his or her medication therapy. What would the nurse be sure to teach this patient about his or her antimetabolite medication? (Select all that apply.) A) Report all other drugs and alternative therapies he or she is taking. B) Use safety measures due to possible dizziness, headache, and drowsiness. C) Cover the head at extremes of temperature. D) Plan for appropriate exercise regimens. E) Avoid being alone as much as possible.
A, B, C Feedback: Provide the following patient teaching: Follow the appropriate dosage regimen, including dates to return for further doses. Patients need to be reminded to report all other drugs and alternative therapies that they might be using; maintain nutrition if GI effects are severe; cover the head at extremes of temperature if alopecia is anticipated; plan for appropriate rest periods because fatigue and weakness are common adverse effects of the drugs; avoid infection including avoiding crowded places, sick people, and working in soil; and use safety measures such as not driving or using dangerous equipment due to possible dizziness, headache, and drowsiness. The nurse would not tell the patient to plan for appropriate exercise regimens because patients are more likely to need encouragement to rest; there is no reason he cannot be alone.
The nurse is caring for a patient receiving a combination of different antineoplastic medications. The patient asks why they use so many different medications instead of just one drug. The nurse explains that a combination does what? (Select all that apply.) A) Decreases the development of cell resistance B) Increases the length of treatment C) Increases the quantity of each medication used D) Decreases the side effects of each medication E) Targets different phases of the cell cycle
A, E Feedback: Malignant cells that remain in a dormant phase for long periods are difficult to destroy. These cells can emerge long after cancer treatment has finishedafter weeks, months, or yearsto 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.
The nurse is caring for a patient at risk of severe-to-fatal interstitial lung disease. What antineoplastic agent is the nurse administering that carries this risk? A) Valrubicin (Valstar) B) Erlotinib (Tarceva) C) Histrelin acetate (Vantas) D) Triptorelin pamoate (Trelstar Depot)
B Feedback: Erlotinib inhibits tyrosine kinase associated with epidermal growth factor found on surfaces of normal and cancer cells and causes serious-to-fatal interstitial lung disease. Histrelin inhibits gonadotropic secretion and decreases follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and testosterone levels and suppresses testosterone production. Hot flashes are very common with this drug. Triptorelin pamoate decreases FSH and LH levels and also suppresses testosterone production. It has also been associated with sexual dysfunction, urinary tract symptoms, bone pain, and hot flashes. Valrubicin is used in intravesical therapy for carcinoma in situ of the bladder. It is also associated with severe bladder spasms.
The mitotic inhibitors interfere with the ability of a cell to divide and they block or alter deoxyribonucleic acid (DNA) synthesis, thus causing cell death. What is important for the nurse to remember when administering these drugs? A) The nurse should encourage the patient to eat six small meals a day. B) The nurse should avoid any skin, eye, or mucous membrane contact with the drug. C) The nurse should avoid using a distal vein. D) The nurse should check for extravasation when the infusion is over.
B Feedback: 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 for the nurse. The nurse should check for extravasation frequently during the infusion and not wait until the infusion is completed, a distal vein should be used, nausea and vomiting are commonly experienced adverse effects of these drugs, and small meals may help the patient to maintain adequate nutrition but this is not the important concern when administering the drug.
A 42-year-old woman 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 her teaching plan concerning the drug therapy? A) Stay on a low-fat diet during the course of the drug therapy. B) Take special care when shaving or when brushing her teeth. C) Continue to go to church or to the mall just as she did before the diagnosis of cancer. D) Stay in bed 2 days after each administration.
B Feedback: Special care should be taken when shaving or when 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. Care should be taken to avoid crowds and public places where risk of infection is greater. Cancer patients should remain as active as tolerated, but they should be careful not to overextend themselves physically to promote optimal health.
The nurse is caring for a patient newly diagnosed with a primary brain tumor. The patient asks the nurse where his or her tumor came from. What is the nurse's best response? A) Your tumor originated from somewhere outside the CNS from a cell just like other cells. B) Your tumor is from the pituitary gland in origin. C) Your tumor originated from a single cell that is genetically different from nearby cells. D) Your tumor is from nerve tissue somewhere in your body.
C Feedback: 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 patient 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.
The nurse explains that the signs and symptoms caused by cancer are a result of what? A) Overgrowth of tumor cells B) Enzymes that generate blood vessels C) Tumor cells invading healthy tissue D) Metastasis
C Feedback: 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 metastasis.
The nurse is caring for a patient who has just been diagnosed with adenocarcinoma of the pancreas. What antineoplastic does the nurse suspect the patient will receive? A) Bleomycin (Blenoxane) B) Daunorubicin (DaunoXome) C) Idarubicin (Idamycin) D) Mitomycin (Mutamycin)
D Feedback: Mitomycin is used in before the treatment of disseminated adenocarcinoma of the stomach and pancreas. Bleomycin is used for palliative treatment of squamous cell carcinomas, testicular cancers, and lymphomas. Daunorubicin is the first-line treatment of advanced HIV infection and associated Kaposi's sarcoma. Idarubicin is used in combination therapy for treatment of acute myeloid leukemia in adults.
The nurse is caring for a patient who is receiving a combination of antineoplastic agents. The patient will most likely lose his or her hair. Why would the nurse suggest that he or she get a wig or use appropriate head cover? A) People may be uncomfortable seeing his or her bald head. B) The hair will likely grow back if the head is covered at all times. C) His or her self-esteem will be better if the head is covered. D) Heat is lost through the head and it is important to cover it during extremes in temperature.
D Feedback: Most of the heat is lost through the head and it is important to cover the head to prevent extreme changes in core temperature, which could affect all biochemical processes in the body. Other people's feelings should not be an issue in whether she wears a wig or not. Even though loss of hair could decrease self-esteem, patients are usually more concerned about their prognosis. Whether the head is covered or not has nothing to do with hair growing back.
A patient with leukemia receives rasburicase (Elitek) before administering chemotherapy. What is the nurse's priority assessment after administration of this medication? A) Blood glucose levels B) Serum potassium levels C) Serum calcium levels D) Uric acid levels
D Feedback: Rasburicase is approved for the management of plasma uric acid levels in patients with leukemia, lymphoma, and solid malignancies who are receiving antineoplastic therapy associated with tumor lysis and elevated serum uric acid levels. Uric acid levels should be analyzed within 4 hours of each dose of rasburicase. Blood glucose, potassium, and calcium levels should not be affected by administration of the drug.
A nurse is preparing an antineoplastic agent for a 9-year-old cancer patient. Before administering an antineoplastic agent, what is the nurse's priority action? A) Wash his or her hands. B) Identify the child by checking the arm band and asking him or her to state his or her name. C) Ensure a quiet environment so the patient can sleep during administration of the drug. D) Check laboratory studies to determine most recent measures of bone marrow function.
D Feedback: The most important action of the nurse before administering the drug would be to check indexes of bone marrow functioning because these results will help to determine the proper dosage. Smaller dosages are administered if bone marrow function declines, whereas larger dosages can be given if bone marrow function is good. Only after this is checked will the nurse begin the process of actually administering the medication by performing hand hygiene, identifying the patient, and creating a quiet environment.