Chapter 45: Antineoplastic Drugs Part 1: Cancer Overview and Cell Cycle-Specific Drugs

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.

ANS: 1, 2, 3, 5 Rationale: Redness and swelling and a slowed infusion indicate signs of extravasation. If the nurse suspects extravasation during the IV 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.

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 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."

ANS: 3 Rationale: Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without the 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.

The nurse is monitoring the laboratory results of a client receiving an antineoplastic medication by the intravenous route. The nurse plans to initiate bleeding precautions if which laboratory result is noted? 1. A clotting time of 10 minutes 2. An ammonia level of 10 mcg/dL (6 mcmol/L). 3. A platelet count of 50,000 mm3 (50 × 109/L) 4. A white blood cell count of 5000 mm3 (5.0 × 109/L)

ANS: 3 Rationale: Bleeding precautions need to be initiated when the platelet count decreases. The normal platelet count is 150,000 to 450,000 mm3 (150-400 × 109/L). When the platelet count decreases, the client is at risk for bleeding. The normal white blood cell count is 5000 to 10,000 mm3 (5.0-10.0× 109/L). 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 (6-47 mcmol/L).

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

ANS: 3 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.

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. Measure the client's current weight and height. 4. Ask the client about his or her weight and height.

ANS: 3 Rationale: To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total 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 patient is experiencing stomatitis after a round of chemotherapy. Which intervention by the nurse is correct? a. Clean the mouth with a soft-bristle toothbrush and warm saline solution. b. Rinse the mouth with commercial mouthwash twice a day. c. Use lemon-glycerin swabs to keep the mouth moist. d. Keep dentures in the mouth between meals.

ANS: A

The nurse is monitoring a patient who has severe bone marrow suppression following antineoplastic drug therapy. Which is considered a principal early sign of infection? a. Fever b. Diaphoresis c. Tachycardia d. Elevated white blood cell count

ANS: A Fever and/or chills may be the first sign of an oncoming infection. Elevated white blood cell count will not occur because of the bone marrow suppression. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 729 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

One patient has cancer of the bone; another has cancer in the connective tissues of the thigh muscles; a third patient has cancer in the vascular tissues. Which of these is the correct term for these tumors? a. Sarcoma b. Leukemia c. Carcinoma d. Lymphoma

ANS: A Sarcomas are malignant tumors that arise from connective tissues. These tissues can be found in bone, cartilage, muscle, blood, lymphatic, and vascular tissues. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 711 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

During treatment of a patient who has brain cancer, the nurse hears the oncologist mention that the patient has reached the "nadir." The nurse knows that this term means which of these? a. The lowest level of neutrophils reached during therapy. b. The highest level of neutrophils reached during therapy. c. The point at which the adverse effects of chemotherapy will stop. d. The point at which the cytotoxic action against cancer cells is the highest.

ANS: A The lowest neutrophil count reached after a course of chemotherapy is known as the nadir. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 717 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Methotrexate is ordered for a patient with a malignant tumor, and the nurse is providing education about self-care after the chemotherapy is given. Which statements by the nurse are appropriate for the patient receiving methotrexate? (Select all that apply.) a. Report unusual bleeding or bruising. b. Hair loss is not expected with this drug. c. Prepare for hair loss. d. Avoid areas with large crowds or gatherings. e. Avoid foods that are too hot or too cold or rough in texture. f. Restrict fluid intake to reduce nausea and vomiting.

ANS: A, C, D, E Counsel patients who are taking methotrexate to expect hair loss and to report any unusual bleeding or bruising. Because of the possibility of infection, avoid areas with large crowds or gatherings. Foods that are too hot or too cold or rough in texture may be irritating to the oral mucosa. Fluid intake is to be encouraged to prevent dehydration. DIF: COGNITIVE LEVEL: Applying (Application) REF: pp. 731-732 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

When giving chemotherapy as cancer treatment, the nurse recognizes that toxicity to rapidly growing normal cells also occurs. Which rapidly growing normal cells are also harmed by chemotherapy? (Select all that apply.) a. Bone marrow cells b. Retinal cells c. Hair follicle cells d. Nerve myelin cells e. Gastrointestinal (GI) mucous membrane cells

ANS: A, C, E Chemotherapy toxicities generally stem from the fact that chemotherapy drugs affect rapidly dividing cells—both harmful cancer cells and healthy, normal cells. Three types of rapidly dividing human cells are the cells of hair follicles, GI tract cells, and bone marrow cells. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 725 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

The nurse is assessing a patient who has developed anemia after two rounds of chemotherapy. Which of these may be indications of anemia? (Select all that apply.) a. Hypoxia b. Fever c. Infection d. Bleeding e. Fatigue

ANS: A, E

A patient receiving chemotherapy is experiencing severe bone marrow suppression. Which nursing diagnosis is most appropriate at this time? a. Activity intolerance b. Risk for infection c. Disturbed body image d. Impaired physical mobility

ANS: B

The nurse is caring for a patient who becomes severely nauseated during chemotherapy. Which intervention is most appropriate? a. Encourage light activity during chemotherapy as a distraction. b. Provide antiemetic medications 30 to 60 minutes before chemotherapy begins. c. Provide antiemetic medications only upon the request of the patient. d. Hold fluids during chemotherapy to avoid vomiting.

ANS: B

The nurse is administering a combination of three different antineoplastic drugs to a patient who has metastatic breast cancer. Which statement best describes the rationale for combination therapy? a. There will be less nausea and vomiting. b. Increased cancer-cell killing will occur. c. The drugs will prevent metastasis. d. Combination therapy reduces the need for radiation therapy.

ANS: B Because drug-resistant cells commonly develop, exposure to multiple drugs with multiple mechanisms and sites of action will destroy more subpopulations of cells. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 715 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient, diagnosed with lymphoma, has an allergy to one of the proposed chemotherapy drugs. The tumor has not responded to other types of treatment. The nurse expects the oncologist to follow which course of treatment? a. The physician will choose another drug to use. b. The chemotherapy will be given along with supportive measures to treat a possible allergic reaction. c. The patient will receive reduced doses of chemotherapy for a longer period of time. d. The chemotherapy cannot be given because of the patient's allergy.

ANS: B Even if a patient has a known allergic reaction to a given antineoplastic medication, the urgency of treating the patient's cancer may still necessitate administering the medication and then treating any allergic symptoms with supportive medications, such as antihistamines, corticosteroids, and acetaminophen. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 717 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient is receiving high doses of methotrexate and is experiencing severe bone marrow suppression. The nurse expects which intervention to be ordered with this drug to reduce this problem? a. A transfusion of whole blood b. Leucovorin rescue c. Therapy with filgrastim (Neupogen) d. Administration of allopurinol (Zyloprim)

ANS: B High-dose methotrexate is associated with bone marrow suppression, and it is always given in conjunction with the rescue drug leucovorin, which is an antidote for folic acid antagonists. Basically, leucovorin rescues the healthy cells from methotrexate. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 719 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

The nurse is reviewing infection-prevention measures with a patient who is receiving antineoplastic drug therapy. Which statement by the patient indicates the need for further teaching? a. "I will avoid those who have recently had a vaccination." b. "I will eat only fresh fruits and vegetables." c. "I will report a sore throat, cough, or low-grade temperature." d. "It is important for both my family and me to practice good hand washing."

ANS: B Patients who are neutropenic and susceptible to infections need to adhere to a low-microbe diet by washing fresh fruits and vegetables and making sure foods are well cooked. The other options are correct. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 729 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

The nurse is assessing a patient who has experienced severe neutropenia after chemotherapy and will monitor for which possible signs of infection? (Select all that apply.) a. Elevated WBC count b. Fever c. Nausea d. Sore throat e. Chills

ANS: B, D, E

If extravasation of an antineoplastic medication occurs, which intervention will the nurse perform first? a. Apply cold compresses to the site while elevating the arm. b. Inject subcutaneous doses of epinephrine around the IV site every 2 hours. c. Stop the infusion immediately while leaving the catheter in place. d. Inject the appropriate antidote through the IV catheter.

ANS: C

A patient is receiving irinotecan (Camptosar), along with other antineoplastic drugs, as treatment for ovarian cancer. The nurse will monitor for which potentially life-threatening adverse effect that is associated with this drug? a. Severe stomatitis b. Bone marrow suppression c. Delayed-onset cholinergic diarrhea d. Immediate and severe nausea and vomiting

ANS: C In addition to producing hematologic adverse effects, irinotecan has been associated with severe diarrhea, known as cholinergic diarrhea, which may occur during infusions. Delayed diarrhea may occur 2 to 10 days after infusion of irinotecan. It is recommended that this condition be treated with atropine unless use of that drug is strongly contraindicated. This diarrhea can be severe and even life threatening. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 723 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient who has been on methotrexate therapy is experiencing mild pain. The patient is asking for aspirin for the pain. The nurse recognizes that which of these is true in this situation? a. The aspirin will aggravate diarrhea. b. The aspirin will masks signs of infection. c. Aspirin can lead to methotrexate toxicity. d. The aspirin will cause no problems for the patient on methotrexate.

ANS: C Methotrexate interacts with weak organic acids, such as aspirin, and can lead to toxicity by displacing the methotrexate from protein-binding sites. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 720 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse monitors a patient who is experiencing thrombocytopenia from severe bone marrow suppression by looking for a. severe weakness and fatigue. b. elevated body temperature. c. decreased skin turgor. d. excessive bleeding and bruising.

ANS: D

The nurse is developing a plan of care for a patient who is experiencing gastrointestinal adverse effects, including anorexia and nausea, after the first course of antineoplastic therapy. What is an appropriate outcome for this patient when dealing with this problem? a. The patient will eat three balanced meals a day within 2 days. b. The patient will return to normal eating pattern within 4 weeks. c. The patient will maintain normal weight by consuming healthy snacks as tolerated. d. The patient will maintain a diet of small, frequent feedings with nutrition supplements within 2 weeks.

ANS: D Consuming small, frequent meals with nutritional supplements, and maintaining a bland diet help to improve nutrition during antineoplastic therapy. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 729 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

A patient is receiving her third course of 5-fluorouracil therapy and knows that stomatitis is a potential adverse effect of antineoplastic therapy. What will the nurse teach her about managing this problem? a. "You can take aspirin to prevent stomatitis." b. "Be sure to watch for and report black, tarry stools immediately." c. "You need to increase your intake of foods containing fiber and citric acid." d. "Be sure to examine your mouth daily for bleeding, painful areas, and ulcerations."

ANS: D The symptoms of stomatitis consist of pain or burning in the mouth, difficulty swallowing, taste changes, viscous saliva, dryness, cracking, and fissures, with or without bleeding mucosa. Teach patients to avoid consuming foods containing citric acid and foods that are hot or spicy or high in fiber. Assessing stools is important but is not related to stomatitis, and aspirin must not be used during this therapy. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 731 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential