Pharmacology-Chapter 46 Antineoplastic Drugs Part 2

A female patient is receiving palliative therapy with androgen hormones as part of treatment for inoperable breast cancer. The nurse will discuss with the patient which potential body image changes that may occur as adverse effects? a. Hirsutism and acne b. Weight gain c. Flushing and hot flashes d. Alopecia and body odor

ANS: A Androgens used for cancer treatment, such as fluoxymesterone and testolactone, can cause menstrual irregularities, virilization of female, gynecomastia, hirsutism, acne, anxiety, headache, and nausea. The patient needs to be told of these effects before therapy begins. The other options are incorrect.

A patient is receiving doxorubicin (Adriamycin) as part of treatment for ovarian cancer. Which nursing diagnosis is related to this antineoplastic drug? a. Decreased cardiac output related to the adverse effect of cardiotoxicity b. Ineffective breathing pattern related to the adverse effect of pulmonary toxicity c. Risk for injury related to the effects of neurotoxicity (ataxia, numbness of hands and feet) d. Impaired urinary elimination pattern related to hyperuricemia

ANS: A Decreased cardiac output related to the adverse effect of cardiotoxicity is a nursing diagnosis related to doxorubicin because adverse effects of doxorubicin include liver and cardiovascular toxicities. The other options are incorrect.

When providing education to a patient undergoing antineoplastic drug therapy, the nurse instructs the patient to immediately notify the health care provider for what signs and symptoms? (Select all that apply.) a. Blood in urine b. Bleeding gums c. Swollen tongue d. Difficulty sleeping e. New and persistent cough f. Nausea on the day of treatment

ANS: A, B, C, E The patient must contact the health care provider immediately if any of the listed signs or symptoms occur: Fever or chills with a temperature higher than 100.5° F (38.1° C), New sores or white patches in the mouth or throat, Swollen tongue with or without cracks and bleeding, Bleeding gums, Dry, burning, "scratchy," or "swollen" throat, A cough that is new and persistent, Changes in bladder function or patterns, Blood in the urine, Changes in gastrointestinal or bowel patterns, including "heartburn" or nausea, vomiting, constipation, or diarrhea lasting longer than 2 or 3 days and Blood in the stools

What are the known severe adverse effects of alkylating agents? (Select all that apply.) a. Ototoxicity b. Neurotoxicity c. Cardiotoxicity d. Nephrotoxicity e. Bone marrow suppression

ANS: A, B, D, E Alkylating drugs are capable of causing pulmonary fibrosis, nephrotoxicity, neurotoxicity, bone marrow suppression, peripheral neuropathy, ototoxicity, and hemorrhagic cystitis. The adverse effects of these drugs are important because of their severity, but they can often be prevented or minimized by prophylactic measures. Cardiotoxicity is not listed as an adverse effect for this class of drugs.

What are the possible severe adverse effects specific to the cytotoxic antibiotics? (Select all that apply.) a. Pneumonitis b. Liver toxicity c. Neurotoxicity d. Nephrotoxicity e. Cardiovascular toxicity

ANS: A, B, D, E As with all of the antineoplastic drugs, cytotoxic antibiotics have the undesirable effects of hair loss, nausea and vomiting, and myelosuppression. Severe adverse effects specific to the cytotoxic antibiotics include pulmonary fibrosis, pneumonitis, liver toxicity, heart failure, cardiovascular toxicity, tissue damage in the event of extravasation, kidney toxicity, and lung toxicity. This class of drugs is not known for neurotoxicity.

When a patient is receiving cisplatin the nurse will monitor the patient for what possible severe adverse effects? (Select all that apply.) a. Ototoxicity b. Nephrotoxicity c. Pulmonary toxicity d. Nausea and vomiting e. Peripheral neuropathy

ANS: A, B, D, E Cisplatin is known to be ototoxic, nephrotoxic, neurotoxic, and emetogenic.

When a patient is receiving cisplatin (Platinol-AQ) chemotherapy, the nurse will monitor for which adverse effects? (Select all that apply.) a. Tinnitus b. Heart failure c. Hearing loss d. Elevated blood urea nitrogen and creatinine levels e. Numbness or tingling in the extremities f. Elevated glucose and ketone levels

ANS: A, C, D, E Cisplatin can cause nephrotoxicity, ototoxicity, and peripheral neuropathy. Nephrotoxicity is manifested by rising blood urea nitrogen and creatinine levels; ototoxicity is manifested by tinnitus, hearing loss, and dizziness; peripheral neuropathy is manifested by numbness or tingling of the extremities.

The nurse is assessing a patient who is receiving chemotherapy with an alkylating drug. Which assessment findings would be considered indications of an oncologic emergency? (Select all that apply.) a. Dry, "scratchy," or "swollen" throat b. Loss of hair c. Decreased red blood cell count d. White patches in the mouth or throat e. Temperature of 100.7° F (38.2° C) f. Decreased urine output

ANS: A, D, E, F Indications of an oncologic emergency include fever and/or chills with a temperature higher than 100.5° F (38.1° C); new sores or white patches in the mouth or throat; changes in bladder function or patterns; dry, burning, "scratchy," or "swollen" throat; and other signs and symptoms (see Box 46-4). The prescriber must be contacted immediately if any of the listed signs or symptoms occur. Loss of hair and decreased red blood cell count (a result of bone marrow suppression) are expected effects of chemotherapy.

The nurse is teaching a class about the various chemotherapy drugs. Which of these statements explains why alkylating drugs are also called "cell cycle-nonspecific drugs"? a. They are cytotoxic during a specific cell cycle. b. They are cytotoxic in any phase of the cell cycle. c. They are effective against several types of neoplasms. d. They are more highly differentiated than cell cycle-specific drugs.

ANS: B Cell cycle-nonspecific drugs kill cancer cells during any phase of the growth cycle, whereas cell cycle-specific drugs kill cancer cells during specific phases of the cell growth cycle. The other options are incorrect.

When giving cisplatin (Platinol-AQ), the nurse is aware that the major dose-limiting effect of this drug is which condition? a. Alopecia b. Kidney damage c. Cardiotoxicity d. Stomatitis

ANS: B Cisplatin may cause nephrotoxicity, and the patient's renal function must be monitored closely while on this drug. Ensuring hydration will help to prevent nephrotoxicity.

The nurse would question a prescription of hydroxyurea for a patient with what laboratory test result? a. Hemoglobin of 15 g/dL b. Platelet count of 8000/mm3 c. Serum creatinine of 1.0 mg/dL d. White blood cell (WBC) count of 8000/mm3

ANS: B Hydroxyurea causes bone marrow suppression, which is evidenced by a decrease in red blood cells, WBCs, and platelets. A platelet count of 8000/mm3 compared with a normal platelet count range of 150,000 to 400,000/mm3 is significantly lower than normal. All of the other options are within normal limits.

A patient is receiving a third session of chemotherapy with daunorubicin (Cerubidine). The nurse will assess the patient for which signs of a potential severe toxic effect of this drug? a. Tinnitus and hearing loss b. Numbness and tingling in the fingers c. A weight gain of 2 pounds or more in 24 hours d. Decreased blood urea nitrogen and creatinine levels

ANS: C Cardiac toxicity may occur, so frequent checking of heart and breath sounds is necessary and daily weights need to be recorded (with reporting of an increase of 2 pounds or more in 24 hours or 5 pounds or more in 1 week).

What is the nurse's priority action if extravasation of an antineoplastic drug occurs during intravenous (IV) administration? a. Reduce the infusion rate. b. Discontinue the IV, and apply warm compresses. c. Stop the infusion immediately, but leave the IV catheter in place. d. Change the infusion to normal saline, and inject the area with hydrocortisone.

ANS: C If extravasation is suspected, administration of the drug must be stopped immediately but the IV catheter left in place and the appropriate antidote instilled through the existing IV tube, after which the needle may be removed. The other options are incorrect.

During chemotherapy, a patient develops severe diarrhea caused by a vasoactive intestinal peptide-secreting tumor (VIPoma). The nurse expects to administer which drug for this problem? a. Dexrazoxane (Zinecard) b. Allopurinol (Zyloprim) c. Octreotide (Sandostatin) d. Bismuth subsalicylate (Pepto-Bismol)

ANS: C Octreotide (Sandostatin) is used for the management of a cancer-related condition called carcinoid crisis and treatment of the severe diarrhea caused by vasoactive intestinal peptide-secreting tumors (VIPomas). The other options are incorrect.

What is considered a major dose-limiting adverse effect of doxorubicin? a. Hepatoxicity b. Nephrotoxicity c. Cardiomyopathy d. Hemorrhagic cystitis

ANS: C Patients receiving doxorubicin need to be monitored for cardiac toxicity. There is a lifetime limited dose that patients s are allowed to receive to minimize the occurrence of cardiomyopathy.

When hanging a new infusion bag of a chemotherapy drug, the nurse accidentally spills a small amount of the solution onto the floor. Which action by the nurse is appropriate? a. Let it dry, and then mop the floor. b. Wipe the area with a disposable paper towel. c. Use a spill kit to clean the area. d. Ask the housekeeping department to clean the floor.

ANS: C Special spill kits are employed to clean up even the smallest chemotherapy spills. These precautions are necessary to protect the health care provider from the cytotoxic effects of these drugs.

The nurse is discussing the use of alkylating drugs with a patient. What is the appropriate way for the nurse to describe the action of alkylating drugs on cancer cells? a. They interact within the cell through intercalation. b. They stop the meiosis of cell division and reproduction. c. They alter the chemical structure of the deoxyribonucleic acid. d. They specifically change the messenger ribonucleic acid sequence.

ANS: C The alkylating drugs work by preventing cancer cells from reproducing. Specifically, they alter the chemical structure of the cells' DNA, which is essential to the reproduction of any cell. This stops the cancer from reproducing or spreading. Cytotoxic antibiotics interact with DNA through a process called intercalation, in which the drug molecule is inserted between the two strands of a DNA molecule, ultimately blocking DNA synthesis.

When a patient is receiving cyclophosphamide the nurse would advise the patient to drink plenty of fluids to prevent what condition? a. Neutropenia b. Renal failure c. Liver dysfunction d. Hemorrhagic cystitis

ANS: D Patients receiving cyclophosphamide should drink at least 2 to 3 L of fluid before, during, and after administration to prevent hemorrhagic cystitis.

When a patient is receiving tamoxifen the nurse would suspect what type of cancer diagnosis? a. Lung b. Renal c. Colon d. Breast

ANS: D Tamoxifen is a selective estrogen receptor modulator drug useful in treating malignancies that require estrogen for growth, such as breast cancer.

Just before the second course of chemotherapy, the laboratory calls to report that the patient's neutrophil count is 450 cells/mm3. The nurse expects that the oncologist will follow which course of treatment? a. Chemotherapy will continue as scheduled. b. Chemotherapy will resume with a lowered dosage. c. Chemotherapy will resume after a transfusion of neutrophils. d. Chemotherapy will be withheld until the neutrophil count returns toward normal levels.

ANS: D The normal range for neutrophils is above 1500 cells/mm3. If neutrophils are decreased to levels of less than 500 cells/mm3 (neutropenia), there is risk for severe infection. Chemotherapy will be held until the count returns toward normal levels.