36Qw/some exp **YASS* Antineoplastic PrepU KARCH

An adult client who has been diagnosed with a rectal tumor is scheduled to begin treatment with cisplatin.The nurse has conducted client teaching about the possibility of nausea and vomiting. In order to reduce the client's risk of severe nausea, the nurse should: place the client on a low-residue diet. ensure that the client is NPO from midnight prior to receiving the drug. administer a combination of antiemetics prior to the administration of the drug. encourage the client to request antiemetics if the nausea becomes unbearable.

administer a combination of antiemetics prior to the administration of the drug. Chapter 14: Antineoplastic Agents - Page 223 Antiemetics should be administered proactively rather than waiting until the client's nausea becomes unbearable. A combination approach is often effective. A low-residue diet is unnecessary, and withholding food does not necessarily reduce nausea.

A patient has just received the first dose of imatinib and the nurse on the oncology unit is amending the patient's care plan accordingly. What nursing diagnosis is most appropriate in light of this addition to the patient's drug regimen? Risk for Infection related to bone marrow suppression Risk for Acute Confusion related to adverse neurological effects of imatinib Risk for Impaired Skin Integrity related to exaggerated inflammatory response Risk for Deficient Fluid Volume related to changes in osmotic pressure

Risk for Infection related to bone marrow suppression Chapter 14: Antineoplastic Agents - Page 245

client has been started on vincristine as part of treatment for cancer. What factor will the nurse need to assess with regard to interactions with this medication? Alcohol intake Sensory, motor, and perceptual functions Exposure to sunlight Cigarette smoking

Sensory, motor, and perceptual functions Chapter 14: Antineoplastic Agents - Page 232 Before drug administration, the nurse must determine the patient's sensory, motor, and perceptual functions, because of the potential dysfunctions associated with vincristine. The nurse must also consider bowel elimination patterns and food and fluid intake to assess for risk for constipation. Because the drug does not cause photosensitivity, the patient's exposure to sunlight need not be assessed. The drug is not known to interact with alcohol or nicotine; therefore, alcohol intake and cigarette smoking also need not be assessed.

A patient is to start with chemotherapy. The patient is worried about going bald in the course of the treatment. How can the nurse assist the patient in being comfortable with his or her body image? Forewarn about hair loss. Explain it is not life-threatening. Suggest the use of a wig or cap. Explain that hair preserves body heat.

Suggest the use of a wig or cap.

A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to: drink a lot of water. limit fluid intake. take the medication at bedtime. increase the protein in her diet.

drink a lot of water. An adverse effect of this drug is the incidence of hemorrhagic cystitis. The nurse should encourage the patient to drink at least 2 liters of fluid a day and, in high-dose therapy, administer the uroprotectant agent mesna. Therapy should include prehydrating the patient orally and intravenously with at least 2 liters of normal saline solution. Potassium and magnesium additives may be indicated. The nurse will monitor urine output vigilantly to ensure an output of at least half of the intake. Taking the medication at bedtime and increasing protein in her diet are not associated with limiting the possible adverse effects of the drug.

The nurse may be asked to administer which medication to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis? Allopurinol (Zyloprim) Amifostine (Ethyol) Mesna (Mesnex) Leucovorin (Wellcovorin)

Allopurinol Chapter 14: Antineoplastic Agents - Page 220

The nurse is preparing a client who will begin chemotherapy in a few days. The nurse knows that which are the most common adverse effects encountered by most clients who receive chemotherapy? (Select all that apply.) Alopecia Neutrocytosis Thrombocytopenia Anemia Stomach ulcers

Alopecia Thrombocytopenia Anemia Chapter 14: Antineoplastic Agents - Page 220

A patient is experiencing antineoplastic-induced nausea and vomiting. The health care provider prescribes ondansetron. The nurse understands that this agent acts in which way? Blocking serotonin receptors in the CTZ Blocking human substance P/neurokinin 1 receptors Directly blocking the chemoreceptor trigger zone (CTZ) Calming the activity of the gastrointestinal tract

Blocking serotonin receptors in the CTZ Chapter 14: Antineoplastic Agents - Page 223 Ondansetron blocks serotonin receptors in the CTZ. Aprepitant blocks human substance P/neurokinin 1 receptors in the central nervous system. Benzodiazepines directly block the CTZ. Metoclopramide calms the activity of the GI tract. Ondansetron blocks serotonin receptors in the chemoreceptor trigger zone (CTZ) and is one of the most effective antiemetics. Antihistamines help to reduce the risk of hypersensitivity reactions and decrease secretions ; corticosteroids help to relieve inflammation and may aid in reducing possible hypersensitivity.

A client is receiving idarubicin. What is the nurse's priority assessment? Cardiac function Respiratory function Red cell indices Electrolyte levels

Cardiac function Chapter 14: Antineoplastic Agents - Page 229 The client's cardiac function needs to be monitored closely because idarubicin is specifically toxic to the heart. The pancytopenia that accompanies antineoplastics can cause decreased red cell indices, but this does not address the particular threat to the cardiac system posed by idarubicin. Respiratory function is not commonly impacted by idarubicin. Electrolyte levels should be monitored in clients receiving any antineoplastic study due to adverse effects impacting nutrition and kidney function, but are not specific to idarubicin.

Which antineoplastic drugs are classified as antineoplastic antibiotics? (Select all that apply.) Bleomycin (Blenoxane) Carboplatin (Paraplatin) Dactinomycin (Cosmegen) Daunorubicin (DaunoXome) Busulfan (Busulfex)

Dactinomycin (Cosmegen) Bleomycin (Blenoxane) Daunorubicin (DaunoXome)

A patient with acute lymphoblastic leukemia (ALL) is receiving imatinib on an inpatient basis. When planning the care of this patient, what assessment should be specified in the patient's plan of nursing care? daily weights assessment of deep tendon reflexes bilateral blood pressures pupillary response

Daily Weights Chapter 14: Antineoplastic Agents, p. 240,table 14.6.

A client with breast cancer is receiving goserelin (Zoladex). What aspect of the client's most recent laboratory results would suggest an adverse effect of this particular drug? Elevated serum calcium Decreased hemoglobin and hematocrit Increased international normalized ratio Increased blood urea nitrogen and creatinine

Elevated serum calcium Chapter 14: Antineoplastic Agents - Page 235 Goserelin is associated with a risk of hypercalcemia. Renal dysfunction is important to dosage management of almost all antineoplastic drugs and is not specific to goserelin. Changes in INR or red cell indices would not be directly associated with goserelin treatment.

A male client is receiving parenteral cytotoxic medications in the home. Adjunct therapy may include what substance? Erythropoietin Heparin Normal saline 0.9% intravenously Antidiuretic hormone

Erythropoietin Chapter 14: Antineoplastic Agents - Page 223

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

False Neoplastic cells can rapidly develop resistance to antimetabolites.

After teaching a group of students about antineoplastic agents and their effect on cancer and healthy cells, the instructor determines that the teaching was successful when the students identify which drug as having the least effect on healthy cells?

Getitinib Chapter 14: Antineoplastic Agents - Page 239

A client's chemotherapeutic regimen includes procarbazine. What is the client's most likely diagnosis? Hodgkin lymphoma Neuroblastoma Astrocytoma Pancreatic cancer

Hodgkin lymphoma Procarbazine (Matulane) is used in combination therapy for treatment of stages III and IV of Hodgkin disease.

The nurse is preparing to administer a client's prescribed chemotherapy. The client has developed bone marrow suppression during treatment. What should the nurse include in the client's plan of care? Select all that apply. Implement falls prevention measures Administer anticoagulants as prescribed Place the client on protective isolation Monitor the client's laboratory values closely Allow sufficient time for rest between scheduled activities

Implement falls prevention measures Place the client on protective isolation Monitor the client's laboratory values closely Allow sufficient time for rest between scheduled activities Decreased platelets create a risk for bleeding if the client experiences an injury; anemia causes fatigue and activity intolerance; neutropenia creates a serious risk for infection. It is important for the nurse to monitor the client's laboratory values as closely as possible. Anticoagulants would be likely to exacerbate the risks associated with thrombocytopenia.

A patient is receiving carboplatin. The nurse would expect to administer this drug by which route? Intravenous Oral

Intravenous

A patient is diagnosed with ovarian cancer. Why is considered to be an aggressive form of cancer? It is fed by calcium in women who take estrogen. It is fed by the hormones produced by the ovaries. The younger the client, the more aggressive the form. The woman has a supply of testosterone from the ovaries.

It is fed by the hormones produced by the ovaries.

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

M Mitotic Inhibitors act in M phase (mitosis)

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

Methotrexate Chapter 14: Antineoplastic Agents - Page 225

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

No cancer cells have been identified that can remain dormant for more than 2 years. Rationale: No cancer cells have been identified that can remain dormant for more than 5 years.

An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease? Lymphoma Lung cancer Skin cancer Prostate cancer

Prostate cancer

A patient with non-Hodgkin's lymphoma (NHL) will be starting a course of doxorubicin shortly. When planning this patient's care, what nursing diagnosis should the nurse prioritize? Risk for Infection related to suppressed bone marrow function Risk for Impaired Skin integrity related to cytotoxic effects of doxorubicin Risk for Imbalanced Nutrition: More Than Body Requirements related to metabolic effects of doxorubicin Risk for Ineffective Airway Clearance related to decreased neurological function

Risk for Infection related to suppressed bone marrow function Chapter 14: Antineoplastic Agents - Page 230

When describing the various effects of antineoplastic agents, the nurse explains that antineoplastic drugs primarily affect human cells that are rapidly multiplying, going through the cell cycle quickly. The nurse would identify which cells as an example? Skin Breast Testicles Ovaries

Skin

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

Tamoxifen

A nurse educator who coordinates the staff education on an oncology unit is conducting an inservice on targeted therapies. What potential benefit of targeted therapies should the nurse highlight in this education session?

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

A patient is administered mesna (Mesnex) to prevent cystitis induced by ifosfamide. How will this medication combination prevent cystitis? The medications increase urine output related to ifosfamide. The medications decrease viral load related to ifosfamide. The medications increase white blood cells related to ifosfamide. The medication combines with the metabolite of ifosfamide.

The medication combines with the metabolite of ifosfamide Chapter 14: Antineoplastic Agents, box 14.3, p. 221. Mesna is used with ifosfamide, which produces a metabolite that causes hemorrhagic cystitis. Mesna combines with and inactivates the metabolite, thereby decreasing cystitis.

A client with a diagnosis of bladder cancer is started on a chemotherapeutic regimen that includes three agents. What is the rationale for using multiple antineoplastic agents? The use of three agents decreases the development of cell resistance. The use of three agents increases the length of treatment. The use of three agents increases the quantity of one of the agents. The use of three agents decreases the adverse effects.

The use of three agents decreases the development of cell resistance.

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

True

Anemia from chemotherapy treatment is the result of bone marrow suppression. True or False

True

A nurse is caring for a 46-year-old female patient who is taking paclitaxel for ovarian cancer. Two or three days after the infusion of the drug, the nurse must closely monitor for: cardiotoxicity. constipation. neurotoxicity. asthma.

neurotoxicity Chapter 14: Antineoplastic Agents - Page 232 Neurotoxicity is a major problem associated with paclitaxel therapy, and close monitoring is needed. Neurotoxicity generally begins 2 to 3 days after the infusion. Cardiotoxicity is observed in less than 1% of patients. The drug is not known to cause constipation or asthma.

When preparing to administer ondansetron for a patient's nausea and vomiting, the nurse understands that this agent blocks: serotonin. dopamine. norepinephrine. GABA.

serotonin Chapter 14: Antineoplastic Agents - Page 223

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

use an effective contraceptive.

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

Inspect the site frequently for redness or swelling

When planning the care for a client receiving imatinib, the nurse would identify which nursing diagnosis as most likely? Excess fluid volume related to fluid retention Imbalanced nutrition, less than body requirements, related to severe nausea and vomiting Risk for infection related to bone marrow suppression Disturbed body image related to hair loss An older adult woman has been diagnosed with acute lymphoblastic leukemia (ALL) and her care team has identified potential benefits of imatinib. Which characteristic of this patient's current health status may preclude the use of imatinib? The patient has type 2 diabetes mellitus that is controlled using diet and oral antihyperglycemics. The patient has chronic heart failure resulting in significant peripheral edema. The patient experienced a mild ischemic stroke several years ago and had transient ischemic attacks last year. The patient had a total knee arthroplasty several months earlier.

Excess fluid volume related to fluid retention Chapter 14: Antineoplastic Agents - Page 240 The adverse effects associated with imatinib include GI upset, muscle cramps, heart failure, fluid retention, and skin rash. Thus a nursing diagnosis of excess fluid volume would be most likely. The severe bone marrow suppression, alopecia, and severe GI effects associated with the more traditional antineoplastic therapy do not occur. The patient has chronic heart failure resulting in significant peripheral edema. Imatinib may be associated with edema. Patients should be weighed regularly and assessed for signs of fluid retention that could be severe. The risk of edema increases with higher doses of imatinib and age greater than 65 years. Previous strokes, orthopedic surgery, or well-controlled diabetes may not contraindicate the use of imatinib.