unite 6 cancer meds

Iron Dextran:

(IM) - use Z-track method for iron deficiency anemia for peopel who can not take it orally

Hydroxyurea (Hydrea)

- This medication is used by people with sickle cell anemia to reduce the number of painful crises caused by the disease and to reduce the need for blood transfusions. Increases Hgb F.

Amoxicillin

- administered to sickle cell patients beginning at age 2 as prophylaxis against infection. This helps prevent crises in these clients by preventing infections

Promethazine (Phenergan)

- n/v only (is in the classification of antihistamine)

Methotrexate

- nephrotoxic - can cause acute renal failure

Allopurinol

- protects the kidney while receiving chemotherapy that is nephrotoxic

Leukovorin

- protects the kidney while receiving chemotherapy that is nephrotoxic (methotrexate)

Darbepoeitin Alfa

- stimulate RBC production

Epoeitin Alfa

- stimulate RBC production and is contraindicated in Leukemia

Filgrastim - Neupogen

- stimulates WBC production

Antihistamines

- used to decrease the risk of allergic reaction

Cyproheptadine

- used to increase appetite

palonosetron - (Aloxi)

- used to prevent n/v before it starts

Aprepitant - (Emend)

- used to prevent nausea and vomiting before they occur. If n/v is present, this medication is useless to treat n/v

Mabex (viscous lidocaine, and diphenhydramine)

- used to soothe the mouth and throat when sores are present. Be careful, this puts the patient at risk for aspiration if they are told to swallow it.

Calcium Acetate

- used to treat hypocalcemia

chlorpromazine(Compazine)

- used to treat nausea and vomiting

Palifermen

- used to treat oral mucosa after mucositis/stomatitis is present. Heals mucous membranes.

In which client would the nurse suspect cancer? 25-year-old with multiple small, round, and smooth lesions on both breasts that are painful during menstruation 40-year-old with nipple retraction and a watery discharge 45-year-old with thickening in one breast with nipple irritation and retraction and a pink discharge 30-year-old with a mobile, rubbery, firm, well-circumscribed, nontender lump

45-year-old with thickening in one breast with nipple irritation and retraction and a pink discharge Explanation: The 25-year-old most likely has fibrocystic breast changes. The 30-year-old most likely has a fibroadenoma. The 40-year-old most likely has an intraductal papilloma. Further assessment is needed to confirm each of these, but this is what the nurse would first suspect.

A nurse is reviewing the medical records of four female clients. The nurse will identify which client at the highest risk for breast cancer? 56-year-old client of African descent with a body mass index (BMI) of 27, stopped taking oral contraceptive pills (OCPs) 2 years ago, and lives a sedentary lifestyle. 32-year-old client of Hispanic heritage who takes oral contraceptive pills (OCPs) daily, lives a sedentary lifestyle, and reports a family history of pancreatic and liver cancer. 21-year-old client of Asian descent who drinks 1 to 2 alcoholic beverages per week, smokes occasionally, and reports having unprotected intercourse with multiple partners. 44-year-old client of European descent who had breast augmentation with implants 10 years ago, drinks wine a few times per week, and reports cocaine use.

56-year-old client of African descent with a body mass index (BMI) of 27, stopped taking oral contraceptive pills (OCPs) 2 years ago, and lives a sedentary lifestyle. Explanation: The nurse knows the 56-year-old client is most at risk with 4 risk factors (age, BMI, OC use, and sedentary lifestyle). The 21-year-old client has 1 risk factor (alcohol use). The 32-year-old client has 2 risk factors (OC use and lifestyle). The 44-year-old client has 2 risk factors (European heritage and alcohol consumption). There are multiple factors that place a woman at increased risk of developing breast cancer. These include alcohol consumption, a lack of physical activity, taking oral contraceptive pills (OCP), age 55 and older, genetics, European descent, being overweight or obese, and a family history of breast cancer. It takes about 10 years after stopping OCPs for a client's risk to decrease. Research also suggests that women keep a maximum BMI of 25 or lower. Factors not related to breast cancer development include breast implants, unprotected intercourse, smoking, and drug use. Reference: Chapter 6: Disorders of the Breasts - Page 231

The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia? An 8-year-old child who carries lunch to school A 3-month-old infant who is totally breastfed A 7-month-old infant who has started table food A 15-year-old adolescent who has heavy menstrual periods

A 15-year-old adolescent who has heavy menstrual periods explanation Adolescents with heavy menstrual flows lose enough blood each month to cause iron-deficiency anemia.

The health care provider suspects a client may have developed a leukemia that originates from the B cells. Which cancers would the nurse associate with B cell lymphocytes? Acute lymphocytic leukemia (ALL) and chronic lymphocytic leukemia (CLL) Chronic myelogenous leukemia (CML) and acute myelogenous leukemia (AML) Acute lymphocytic leukemia (ALL) and acute myelogenous leukemia (AML) Chronic lymphocytic leukemia (CLL) and chronic myelogenous leukemia (CML)

Acute lymphocytic leukemia (ALL) and chronic lymphocytic leukemia (CLL) Explanation: ALL and CLL originate from the B lymphocytes, while CML originates with the myeloid cells. ALL encompasses a group of neoplasms composed of precursor B (pre-B) or T (pre-T) lymphocytes referred to as lymphoblasts. AML originates from the myeloid precursor cells in the bone marrow.

The prototype drug used to create red blood cells (RBCs) is epoetin alfa (Epogen, Procrit). It has many indications for use. Which are selected indications? Select all that apply. Thrombocytopenia from chemotherapy Anemia from chronic renal disease (CRD) Anemia related to chemotherapy in patients with cancer Anemia related to zidovudine therapy in HIV-associated illness Neutropenia due to chemotherapy

Anemia from chronic renal disease (CRD) Anemia related to zidovudine therapy in HIV-associated illness Anemia related to chemotherapy in patients with cancer Explanation: Epoetin alfa, also referred to as erythropoietin or EPO, is used to treat anemia associated with chronic kidney disease, to elevate or maintain the RBC level. It is also used to treat anemia related to zidovudine therapy in HIV-positive patients. It has historically been used to treat chemotherapy-induced anemia in patients with cancer and it may reduce the need for blood transfusions. Filgrastim or granulocyte-colony stimulating factor (G-CSF) (Neupogen) is used to treat neutropenia; oprelvekin or interleukin-11 (IL-11) (Neumega) is used to treat thrombocytopenia. Reference: Chapter 49: Drugs Used to Treat Anemias - Page 862-864

For which health problem is stem cell transplantation likely to be of therapeutic benefit? Anemia resulting from a chronic disease alpha-thalassemia Aplastic anemia Secondary polycythemia

Aplastic anemia Explanation: The etiology of aplastic anemia involves depression of the bone marrow, a problem that can sometimes be treated by stem cell transplantation. Polycythemia, alpha-thalassemia, and anemias caused by chronic diseases are not amenable to stem cell transplantation. Beta-thalassemia (not alpha) has a potential to be cured from stem cell transplantation.

A nurse is assessing a client who displays pale skin and nail beds. Which laboratory data should the nurse evaluate? Erythrocyte sedimentation rate Neutrophil count Hemoglobin level White blood cell count

Hemoglobin level Explanation: RBCs contain the oxygen-carrying protein hemoglobin that functions in the transport of oxygen. Pallor of the skin or nail beds is a sign of anemia, which can be indicated by a low Hgb level. Reference: Chapter 23: Disorders of Red Blood Cells - Page 573

Trastuzumab (Herceptin)

If a patient has breast cancer Her2 positive, then patient will take this Biologic response modifier as opposed to traditional chemotherapy.

The nurse administers epoetin alfa (Epogen). What is the therapeutic response the nurse expects to assess? Increased red blood cell count Elevated white blood cell count Increased resistance to infection Elevated heart rate

Increased red blood cell count

Which factor differentiates chronic leukemias from acute leukemias? Leukemic cells are more fully differentiated in chronic than in acute leukemias. They are cancers of the hematopoietic progenitor cells. The prevalence among individuals with Down syndrome is high. Leukemic cells are disseminated throughout the body by the circulatory system.

Leukemic cells are more fully differentiated in chronic than in acute leukemias. Explanation: In contrast to acute leukemias, chronic leukemias are malignancies involving proliferation of more fully differentiated myeloid and lymphoid cells. Down syndrome is associated with acute leukemias, and both acute leukemias and chronic leukemias involve systemic distribution of leukemic cells.

A nurse is caring for a group of breast cancer survivors after mastectomy. Which teaching point should the nurse reinforce about activities 6 weeks after surgery? Wear tight-fitting shirts for support. Brisk walking and stretching exercises can be introduced. Resume light household work. Exercise only the unaffected side until seen by the healthcare provider.

Resume light household work.

A nurse who works in an oncology practice prepares patients for the side effects of adjuvant hormonal therapy to treat breast cancer. Which of the following is the hormonal agent that has an increased risk of pulmonary embolism and deep vein thrombosis? Tamoxifen Anastrozole Letrozole Exemestane

Tamoxifen

What is bleomycin?

This is an antitumor chemotherapy agent (inhibits G2 phase) Mechanism: causes free radical formation. Radicals cause single & double strand breaks in DNA. Uses: testicular cancer, hodgkin lymphoma Toxicities: Pulmonary fibrosis, skin hyperpigmentation.

what should you tell a patient about vaccines ?

Vaccines: All vaccines should be given on schedule. In addition, the child should receive not only the 7-valent pneumococcal vaccine series in infancy but also the 23-valent pneumococcal conjugate vaccine annually after age 2 years.

Cyanocobalamin (Vitamin B12)

Vitamin B12 (IM) - to treat pernicious anemia

Kayexalate (sodium polystyrene sulfonate)

a medication used to reduce high serum potassium; exchanges sodium for potassium in the intestine

Adriamycin, Doxirubicin -

cardiotoxic - baseline echocardiogram and ECG prior to administration

Insulin can be used in cancer patients for

emergency temporary treatment of hyperkalemia

Pembrolizumab (Keytruda)

oral medication used as an immunotherapy to treat non-small cell lung cancer as first line treatment combined with chemotherapy.

Cisplatin and paclitaxel -

peripheral neuropathy

Bleomycin -

pulmonary toxic - monitor PFT's and for oxygenation problems - causes pulmonary fibrosis

Oprelvekin - (Numega) -

stimulates Platelet production - not used often as administering platelets works faster.

Corticosteroids -

used to treat inflammation and decrease risk of allergic reaction to chemotherapy -long term use can cause avascular necrosis of the femoral head

A client has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The client asks the nurse what this test will tell the doctor. The nurse replies: "They will wash your RBCs. Then mix the cells with a reagent to see if they clump together." "They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis)." "They will be looking to see if you have enough ferritin in your blood." "They are looking for the presence of antibody or complement on the surface to the RBC."

"They are looking for the presence of antibody or complement on the surface to the RBC."

A 9-year-old child with leukemia is scheduled to undergo an allogeneic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include? "You'll need to have an incision in your hip area to instill the cells." "We'll need to have a match to a donor." "The risk for rejection is much less with this type of transplant." "You won't need to receive the high doses of chemotherapy before the transplant."

"We'll need to have a match to a donor." Explanation: n allogeneic hematopoietic stem cell transplantation (HSCT) refers to transplantation using stem cells from another individual that are harvested from the bone marrow, peripheral blood, or umbilical cord blood. With this type of transplant, human leukocyte antibody (HLA) matching must occur. Therefore, the lesser the degree of HLA matching in the donor, the higher the risk for graft rejection and graft-versus-host disease (GVHD). Regardless of the type of transplant, a period of purging of abnormal cells in the child is necessary and accomplished through high-dose chemotherapy or irradiation. The procedure is accomplished by intravenously infusing hematopoietic stem cells into the child.

Chlorpromazine

- used to treat intractable hiccoughs. (Intractable means they won't go away)

Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy? A 20-year-old female A 62-year-old male with cancer A 40-year-old male with a high white blood cell count A 30-year-old pregnant woman

A 62-year-old male with cancer Explanation: Older adults who have cancer and are receiving chemotherapy are especially vulnerable to the adverse effects of anemia as a result of chemotherapy and would therefore be the most likely candidates for epoetin alfa therapy. Young adults over age 18, pregnant women, and patients with a high white blood cell count are not as vulnerable to anemia and would not require epoetin alfa therapy

A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply. Infection Blood loss Abnormal erythrocyte production Destruction of normally formed red blood cells Inadequate formed white blood cells

Blood loss Abnormal erythrocyte production Destruction of normally formed red blood cells Explanation: Most anemias result from (1) blood loss, (2) inadequate or abnormal erythrocyte production, or (3) destruction of normally formed red blood cells. The most common types include hypovolemic anemia, iron-deficiency anemia, pernicious anemia, folic acid deficiency anemia, sickle cell anemia, and hemolytic anemias. Although each form of anemia has unique manifestations, all share a common core of symptoms. Anemia does not result from infection or inadequate formed white blood cells. Reference: Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 913

Which oncologic emergency involves the accumulation of fluid in the pericardial space? Disseminated intravascular coagulation (DIC) Cardiac tamponade Syndrome of inappropriate antidiuretic hormone release (SIADH) Tumor lysis syndrome

Cardiac tamponade Explanation: Cardiac tamponade is an accumulation of fluid in the pericardial space. DIC is a complex disorder of coagulation and fibrinolysis that results in thrombosis and bleeding. SIADH is a result of the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH). Tumor lysis syndrome is a rapidly developing oncologic emergency that results from the rapid release of intracellular contents as a result of radiation- or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia.

The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system? Observing petechiae, purpura, or unusual bruising Child reports facial palsy and vision problems Noting adventitious breath sounds during auscultation Palpation of abdomen reveals enlarged liver and spleen

Child reports facial palsy and vision problems Explanation: The presence of facial palsy and vision problems indicates that the central nervous system has been infiltrated by leukemia cells. The petechiae, purpura, or unusual bruising result from decreased platelet levels and may be present regardless of metastasis. Adventitious breath sounds may indicate pneumonia and may be present whether the disease has metastasized or not. Hepatomegaly and splenomegaly result from infection, not metastasis.

A client has undergone a mastectomy for breast cancer. Which instruction should the nurse include in the postoperative client teaching plan? Avoid moving the affected arm in any way. Elevate the affected arm on a pillow. Breathe rapidly for an hour. Restrict intake of medication.

Elevate the affected arm on a pillow. Explanation: When providing care to the client, the nurse should instruct the client to elevate the affected arm on a pillow. As part of the respiratory care, the nurse should instruct the client to turn, cough, and breathe deeply every 2 hours; rapid breathing is not encouraged. Active range-of-motion and arm exercises are necessary. To counter any pain experienced by the client, analgesics are administered as needed; intake of medication is not restricted.

A client 19 years of age who is a drug addict comes to the emergency department reporting extreme fatigue and shortness of breath. The nurse assesses the client and, after taking a complete history, determines that the client has malnutrition. The nurse knows that malnutrition can cause which type of anemia? Iron deficiency anemia occurs because of a dietary lack of folic acid, a component necessary in the formation of red blood cells. Pernicious anemia occurs because of a dietary lack of folic acid, a component necessary in the formation of red blood cells. Folic acid deficiency anemia occurs because of a dietary lack of folic acid, a component necessary in the formation of red blood cells. Anemia in chronic kidney disease occurs because of a dietary lack of folic acid, a component necessary in the formation of red blood cells.

Folic acid deficiency anemia occurs because of a dietary lack of folic acid, a component necessary in the formation of red blood cells. Explanation: Folic acid deficiency anemia occurs because of a dietary lack of folic acid, a component necessary in the formation of red blood cells. Iron deficiency anemia is due to a lack of iron. Pernicious anemia is due to a lack of intrinsic factor needed to form red blood cells and absorb vitamin B12. Reference: Chapter 49: Drugs Used to Treat Anemias - Page 861

The client presents with a reduction in red blood cells, white blood cells, and platelets. The practitioner is unable to determine the cause of the client's condition. Which type of anemia does the client have? Extrinsic hemolytic Idiopathic aplastic Acquired hemolytic Intrinsic hemolytic

Idiopathic aplastic Explanation: Aplastic anemia describes a disorder that results in a reduction of all three hematopoietic cell lines—red blood cells, white blood cells and platelets. In two-thirds of the cases, the cause is unknown and is called idiopathic aplastic anemia. The other options do not have reduction of all three cell lines.

Hemolytic anemia is characterized by excessive red blood cell destruction and compensatory increase in which physiologic process? Iron retention in the body Shrinkage of the spleen Hypoactive bone marrow Increased erythropoiesis

Increased erythropoiesis Explanation: A compensatory response to hemolysis is to increase erythropoiesis in order to increase red blood cell (RBC) replacement. The bone marrow is hyperactive and releases an increased number of reticulocytes. Iron from the destroyed RBCs is retained, but this is not a compensatory function. The spleen will be abnormally hyperactive, causing hyperplasia and enlargement.

Which would a nurse identify as the primary issue associated with anemias? Defective white blood cells Increased plasma proteins Lack of vitamin B12 Ineffective red blood cells

Ineffective red blood cells Explanation: Anemias are disorders that involve too few or ineffective RBCs that alter the ability of the blood to carry oxygen. White blood cells are associated with the immune response. Plasma proteins are important in the immune response and blood clotting. Lack of vitamin B12 is associated with a specific type of anemia.

A nurse educator is explaining to a group of students the differences between leukemias and lymphomas. With respect to classification of these diseases, which explanation is most accurate? Leukemias originate in lymph nodes, and lymphomas originate in peripheral lymphoid structures. Leukemia arises from precursors in marrow, and lymphomas originate in peripheral lymphoid structures. Leukemia arises from precursors in marrow, and lymphomas originate in spleen or bone marrow. Leukemia arises from peripheral lymphoid structures, and lymphomas originate in precursors in marrow.

Leukemia arises from precursors in marrow, and lymphomas originate in peripheral lymphoid structures. Explanation: The leukemias, which arise from hematopoietic precursors in the bone marrow, can involve the T and B lymphocytes, granulocytes, and other blood cells. The lymphomas originate in peripheral lymphoid structures such as the lymph nodes, where B and T lymphocytes undergo differentiation and proliferation as they interact with antigens.

A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores? There is a strong correlation between iron stores and hemoglobin levels. There is a weak correlation between iron stores and hemoglobin levels. There is an inverse relationship between iron stores and hemoglobin levels. There is a strong correlation between iron stores and hemoglobin characteristics.

There is a strong correlation between iron stores and hemoglobin levels. Explanation: A strong correlation exists between laboratory values that measure iron stores and hemoglobin levels. After iron stores are depleted (as reflected by low serum ferritin levels), the hemoglobin level falls.

A male client is diagnosed with severe neutropenia and is prescribed filgrastim. What is the desired effect? To decrease leukocytes To increase white blood cells To increase electrolytes To increase red blood cells

To increase white blood cells Explanation: Filgrastim is used to increase white blood cells and decrease risks of infection in clients who have or are at high risk for severe neutropenia. Reference: Chapter 17: Immune Modulators - Page 295

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which would not be included in the client's discharge instructions? Plan for frequent periods of rest. Avoid contact with family/friends who are sick. Use a disposable razor when shaving. Encourage frequent handwashing.

Use a disposable razor when shaving. Explanation: People with aplastic anemia usually have insufficient erythrocytes, leukocytes, and platelets. Encourage behaviors that will lower the risk for bleeding. Avoiding contact with people who are sick reduces the risk of acquiring an infection. Handwashing reduces the risk of acquiring an infection. Anemia can cause fatigue and shortness of breath with even mild exertion.

A male client is prescribed interferon. What is his probable diagnosis? Hypertension Viral hepatitis Sepsis Bacteremia

Viral hepatitis Explanation: Interferons are used mainly for viral hepatitis and certain types of cancer. Reference: Chapter 49: Drugs Used to Treat Anemias - Page 876

Lumpectomy is a treatment option for clients diagnosed with breast cancer with tumors smaller than 5 cm. For which clients is lumpectomy contraindicated? Select all that apply. client who has failed to breastfeed for up to 1 year after pregnancy client who has had previous radiation to the affected breast client whose surgery will not result in a clean margin of tissue client who has had an early menarche or late onset of menopause client whose connective tissue is reported to be sensitive to radiation

client whose connective tissue is reported to be sensitive to radiation client whose surgery will not result in a clean margin of tissue client who has had previous radiation to the affected breast Explanation: Lumpectomy is contraindicated for women who have previously undergone radiation to the affected breast, those whose connective tissue is reported to be sensitive to radiation, and those whose surgery will not result in a clean margin of tissue. Clients who have had an early menarche or late onset of menopause and clients who have failed to breastfeed for up to 1 year after pregnancy are at risk for developing breast cancer. Lumpectomy is a treatment option for clients with breast cancer.

Antihistamines: Adverse Effects

dry mouth, difficulty urinating, constipation, changes in vision, mild drowsiness to deep sleep

Vitamin B12 (oral) - Cyanocobalamin

for decreased oral intake of B12

Iron Dextran: (IV)

give a small dose before the full dose to test for allergic reaction IV bolus given over at least 1 minute IV infusion given over 10-15 min monitor for hypotension and other anaphylactic reactions

Ferumoxytol: (IV) -

increases iron stores in the body.

IVIG

intravenous immunoglobulin- increases the body's ability to fight infection.

Meningococcal vaccination

is also warranted. Provide influenza immunization annually before the onset of flu season (after 6 months of age).

A child with sickle cell anemia comes to the emergency department for evaluation. The nurse suspects that the child is experiencing a vaso-occlusive crisis based on assessment of which signs and symptoms? Select all that apply. low back pain increased reticulocyte count distended abdomen fever splenic enlargement

low back pain fever distended abdomen Explanation: Vaso-occlusive crisis is manifested by bone pain (most commonly in the lumbosacral spine), fever, leukocytosis, distended abdomen, and acute abdominal pain. Splenic enlargement and increased reticulocyte count suggest acute splenic sequestration. Reference: Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 171

Pegfilgrastim - Neulasta - stimulates WBC production - This one lasts longer than the others

stimulates WBC production - This one lasts longer than the others

dronabinol

the generic name for prescription THC in oil in a gelatin capsule used to treat n/v, anorexia, cachexia

Platelets and heparin -

treat DIC

Vitamin B9 (Folic Acid) -

used pre-conception and during pregnancy to prevent neural tube defects and is used to correct a dietary B9 deficiency when it is present for males and females.

Acetaminophen -

used to decrease temperature, for mild pain and sometimes given prior to blood transfusions

Insulin -

used to force potassium back into the remaining viable cells after chemotherapy when hyperkalemia is present.

dronabinol another use for this drug ?

used to increase appetite

Megesterol -

used to increase the appetite when anorexia, cachexia, or unexplained significant weight loss occurs

Calcitonin -

used to treat hypercalcemia

Granisetron - (kytril) -

used to treat n/v

Metoclopramide - (Reglan) -

used to treat n/v