Chemo Pharm Exam 1

991) A client receives doxorubicin infusions for treatment of acute lymphocytic leukemia. Which clinical finding indicates that toxicity has occurred? Alopecia Dyspnea Metallic taste to food Cardiac rhythm abnormalities

Cardiac rhythm abnormalities Rationale: Doxorubicin is cardiotoxic, which is manifested by transient electrocardiogram (ECG) abnormalities. Alopecia is an expected side effect of doxorubicin, not a toxic effect. Dyspnea and a metallic taste to food are not effects of doxorubicin.

771) To minimize the side effects of the vincristine that a client is receiving, which diet would the nurse advise? Low in fat High in iron High in fluids Low in residue

High in fluids Rationale: A common side effect of vincristine is a paralytic ileus that results in constipation. Preventative measures include high-fiber foods and fluids that exceed minimum requirements. These will keep the stool bulky and soft, thereby promoting evacuation. Dietary plans that are low in fat, high in iron, and low in residue will not provide the roughage and fluids needed to minimize the constipation associated with vincristine.

538) A 3-year-old child is prescribed a liquid iron preparation. The nurse would include which intervention when teaching the parent about the administration of this medication? 'Monitor the stools for diarrhea.' 'Administer with meals to improve absorption.' 'Avoid giving the child orange juice with the iron preparation.' 'Have the child drink the diluted iron preparation through a straw.'

'Have the child drink the diluted iron preparation through a straw.' Rationale: A liquid iron preparation may stain tooth enamel; therefore it should be diluted and administered through a straw. Constipation, rather than loose stools, often results from the administration of iron. Iron absorption is improved when taken on an empty stomach. The exception is acidic foods, such as citrus juices, which improve absorption.

1072) A client is receiving doxorubicin as part of a chemotherapy protocol. The nurse will assess the client for which system toxicity? Neurotoxicity Cardiotoxicity Ototoxicity Nephrotoxicity

Cardiotoxicity Rationale: Heart failure and dysrhythmias secondary to cardiotoxicity are the primary life-threatening toxic effects unique to doxorubicin. Neurotoxicity, nephrotoxicity, and ototoxicity are not associated with this medication.

133) Which intervention would the nurse take to improve nutrition after identifying that a client receiving chemotherapy has lost weight? Select all that apply. One, some, or all responses may be . Provide low-carbohydrate meals. Decrease fluid intake at mealtime. Encourage the intake of preferred foods. Promote the intake of small, frequent meals Administer prescribed antiemetics before meals

Encourage the intake of preferred foods. Promote the intake of small, frequent meals Administer prescribed antiemetics before meals

574) The nurse is caring for a child who is receiving vincristine. Which body systems are most important for the nurse to assess after medication administration? Select all that apply. One, some, or all responses may be . Respiratory Neurological Reproductive Hematologic Gastrointestinal

Neurological Hematologic Gastrointestinal Rationale: Vincristine is neurotoxic; therefore the child should be monitored for paresthesias, seizures, footdrop, bowel and bladder problems, and alterations in the function of cranial nerves. Hematologic problems such as anemia, thrombocytopenia, and leukopenia occur, although they are not as severe as with other chemotherapeutic agents, such as cyclophosphamide. Gastrointestinal adverse effects include severe constipation, intestinal necrosis, intestinal perforation, and paralytic ileus, in addition to nausea and vomiting. Respiratory problems are not associated with vincristine therapy. The reproductive system is not affected by vincristine therapy.

457) Which response would the nurse give to a client receiving chemotherapy who develops sores in the mouth and asks the nurse why this happened? "The sores occur because of the direct irritating effects of the medication." "These tissues are poorly nourished because you have a decreased appetite." "The frequently dividing cells of the gastrointestinal tract are damaged by the medication." "This side effect occurs because it targets the cells of the gastrointestinal system."

"The frequently dividing cells of the gastrointestinal tract are damaged by the medication."

452) Which clinical finding indicates that doxorubicin toxicity may have occurred? Fever Blue tinge to the urine Alteration in cardiac rhythm Increasing anxiety

Alteration in cardiac rhythm

937) A client has surgery for the insertion of an implanted infusion port for chemotherapy. How often will the port need to be flushed when not in use? Every day Once a week Every month Twice a year

Every month

16 A nurse is preparing to administer doxorubicin to a client with bladder carcinoma. How will the nurse prepare this medication? While wearing sterile gloves In a biological safety cabinet Inside a temperature-controlled room By withdrawing into a syringe undiluted

In a biological safety cabinet

738) The nurse considers that the safe administration of high-dose methotrexate therapy would include which intervention? Maintaining an acidic urine Restricting intravenous fluids Providing a diet high in folic acid Monitoring plasma levels of the medication

Monitoring plasma levels of the medication Rationale: Plasma levels indicate whether therapeutic or toxic levels are present. Methotrexate crystallizes in the kidneys if urine becomes acidic. The regimen would include hydration with a minimum of intravenous fluids of 125 mL/h 6 to 12 hours before and during therapy. The effectiveness of methotrexate, a folic acid antagonist, is minimized by a diet high in folic acid.

620) A school-age child diagnosed with acute lymphocytic leukemia (ALL) becomes constipated after receiving induction therapy with prednisone, vincristine, and asparaginase. Which would the nurse suspect as the cause? Diet, which lacks bulk Inactivity, which results from illness Vincristine, which decreases peristalsis Prednisone, which causes gastric irritability

Vincristine, which decreases peristalsis Rationale: Constipation, which may progress to paralytic ileus, is a side effect of vincristine. Lack of bulk and inactivity each may contribute to constipation, but neither is the primary cause of this child's constipation. Prednisone may cause nausea and vomiting, but it does not cause constipation.

1123) A client with adenocarcinoma receives doxorubicin intravenously (IV) to reduce the tumor mass. Which clinical finding indicates that doxorubicin toxicity may have occurred? Fever Blue tinge to the urine Alteration in cardiac rhythm Increasing anxiety

Alteration in cardiac rhythm Rationale: Doxorubicin is cardiotoxic and causes dysrhythmias. It increases the risk for infections secondary to myelosuppression, which may result in fever; however, this is not the result of toxicity. Blue-tinged urine is a side effect of doxorubicin, not a toxic effect. Feelings of nervousness are a side effect of doxorubicin, not a toxic effect.

534) The nurse is caring for a child undergoing chemotherapy for acute lymphoid leukemia. The parents ask why the child needs prednisone. Which response by the nurse would be ? 'It decreases inflammation.' 'It suppresses the production of lymphocytes.' 'It increases appetite and a sense of well-being.' 'It may decrease skin irritation and edema.'

'It decreases inflammation.' Rationale: Prednisone is a synthetic glucocorticoid that exerts an active anti-inflammatory effect by stabilizing lysosomal membranes, thereby inhibiting proteolytic enzyme release. Prednisone does not affect the lymphocytes. Although prednisone increases the appetite and creates a sense of well-being, these are not the reasons it is administered. There is no indication the child is receiving radiation.

589) An adolescent who has been prescribed prednisone and vincristine for leukemia tells the nurse that he is constipated. Which reason would the nurse cite as the probable cause of the constipation? It is a side effect of the vincristine. The spleen is compressing the bowel. It is a toxic effect from the prednisone. The leukemic mass is obstructing the bowel.

It is a side effect of the vincristine. Rationale: Constipation is a side effect of vincristine because it slows gastrointestinal motility. An enlarged spleen will put pressure on the stomach and diaphragm, not on the large bowel. Constipation is not a toxic effect of prednisone. It is unlikely that leukemia is causing an obstruction.

1492) The alkylating agent cyclophosphamide is prescribed for a school-age child with cancer. Which clinical manifestation would the nurse be alert for while the child is receiving this medication? Irritability Pain with urination Unpredictable nausea Hyperplasia of the gums

Pain with urination Rationale: Cystitis is a potentially serious adverse reaction to cyclophosphamide; it sometimes can be prevented by increasing hydration because the fluid flushes the bladder. Irritability may be present but is not a result of cyclophosphamide administration. Unpredictable nausea is an expected but manageable side effect of cyclophosphamide. Hyperplasia of the gums is unrelated to cyclophosphamide administration; it may occur with prolonged phenytoin therapy.

1514) A school-age child with leukemia is receiving treatment with vincristine. Which toxic response would the nurse assess the child for? Diarrhea Alopecia Hemorrhagic cystitis Peripheral neuropathy

Peripheral neuropathy

9. A nurse is administering vincristine to a client with cancer. The client asks the nurse how the medication works. Which statement by the nurse is appropriate? "It stops the synthesis of proteins in cancer cells." "It prevents cell division of cancer cells." "It interrupts the S-phase of cancer cell reproduction." "It alters the DNA structure of cancer cells."

"It prevents cell division of cancer cells."

1500) The parent of a toddler taking methotrexate asks the nurse whether the child should be started on vitamin supplements. Which statement by the nurse is appropriate? 'That's a fine suggestion, and I'll ask for a prescription.' 'Vitamin supplements won't help him feel any better right now.' 'He'll benefit from a vitamin supplement and will be getting it soon.' 'Supplements that contain folic acid interfere with the effectiveness of chemotherapy.'

'Supplements that contain folic acid interfere with the effectiveness of chemotherapy.'

27.A client receiving doxorubicin (Adriamycin) intravenously (IV) complains of pain at the insertion site, and the nurse notes edema at the site. Which intervention is most important for the nurse to implement? A. Assess for erythema. B. Administer the antidote. C. Apply warm compresses. D. Discontinue the IV fluids.

D. Discontinue the IV fluids. Save the tissue - it burns it

1081) Leucovorin calcium is prescribed and is to be administered immediately after an infusion of methotrexate. Which result of laboratory testing indicates that leucovorin has been effective? Potassium level normalizes Folic acid level within normal limits Improved white blood cell count Decreased methotrexate level

Decreased methotrexate level

640) A client receives doxorubicin as part of a chemotherapy protocol. The nurse would assess the client for signs and symptoms of which adverse effect? Toxic epidermal necrolysis Heart failure Pulmonary fibrosis Ototoxicity

Heart failure Rationale: Heart failure and dysrhythmias are life-threatening toxic effects unique to doxorubicin. It is a vesicant that can cause severe tissue damage if the medication infiltrates; however, this is different from the tissue destruction associated with toxic epidermal necrolysis. Pulmonary fibrosis and ototoxicity are not adverse effects of doxorubicin.

515) A child with Wilms tumor is prescribed doxorubicin hydrochloride. Which common side effect unique to doxorubicin would the nurse expect to observe in the child? Hair loss Vomiting Red urine Stomatitis

Red urine Rationale: Red urine is a common side effect of doxorubicin administration. The medication is not metabolized and is excreted in the urine. The genitourinary responses to vincristine are nocturia, oliguria, urine retention, and gonadal suppression. Hair loss, vomiting, and stomatitis occur with both medications.

1084) A client with cancer is receiving leucovorin as part of a chemotherapy protocol. Which purpose does leucovorin serve? Potentiating the effect of alkylating agents Diminishing toxicity of folic acid antagonists Limiting vomiting associated with chemotherapy Preventing alopecia

Diminishing toxicity of folic acid antagonists Rationale: Leucovorin limits toxicity of folic acid antagonists, such as methotrexate sodium, by competing for transport into cells. Leucovorin does not potentiate the effect of alkylating agents. It does not have antiemetic properties. It will not prevent hair loss.

755) A client is receiving chemotherapy with doxorubicin. Which development will the nurse teach the client to report immediately? Nausea Sore throat Loss of hair Constipation

Sore throat Rationale: A sore throat is indicative of a respiratory tract infection, which may be the first clinical sign of bone marrow suppression, which can be life-threatening. Nausea is an expected side effect of doxorubicin, but it is not life threatening. Hair loss is not a side effect of doxorubicin but, regardless, is not life-threatening. Constipation is an expected side effect of doxorubicin, but it is not life-threatening.

863) Digoxin and verapamil are prescribed to manage a client's cardiac dysrhythmia. The nurse will monitor the client for signs and symptoms of which adverse effect? Physical agitation Reflex stimulation Myocardial depression Respiratory depression

Myocardial depression

9 The nurse is providing teaching to a client who has been prescribed cyclophosphamide for breast cancer treatment. Which of the following statements made by the client would indicate that additional teaching is needed? "I will probably need to plan on using a wig to cover my hair loss." "I should limit the amount of fluids I drink while taking this medication." "I will need to stay away from children when my white blood cell count is low." "I may have trouble getting pregnant due to the damaging effects of the medication."

"I should limit the amount of fluids I drink while taking this medication." Rationale: Cyclophosphamide is a chemotherapeutic medication. Some of the side effects of this medication include hair loss, low white cell count and infertility. The client is encouraged to drink about 2 to 3 liters of fluid per day to aid in eliminating the chemotherapy from the body.

822) A client with Hodgkin's disease adds doxorubicin to current therapy. Which advice will the nurse provide about this medication? Cease taking any medication that contains vitamin D. Keep the doxorubicin in a dark place protected from light. Expect urine to turn red for a few days after taking this medication. Take the doxorubicin on an empty stomach with large amounts of fluids.

Expect urine to turn red for a few days after taking this medication. Rationale: Doxorubicin causes the urine to turn red for a few days; the client should be informed of this expectation so as not to become alarmed when it occurs. Discontinuing the intake of vitamin D is true for plicamycin, not the medications in this protocol. It is unnecessary to keep doxorubicin in a dark area, protected from light. Doxorubicin is not given orally, only via the intravenous route.

19 The nurse is reinforcing teaching regarding the use of methotrexate with a female client who has systemic lupus erythematosus. Which statement by the client indicates an understanding of the teaching? "I will not take any vitamin that contains folic acid." "Lab work won't be necessary while I take this medication." "I will avoid interacting with people in large crowds." "I should not use contraception that contains estrogen."

"I will not take any vitamin that contains folic acid."

588) An adolescent with leukemia is receiving vincristine. The mother reports that the child is complaining of feeling 'tingles' all over. Which response by the nurse is most appropriate regarding the effect of this medication? 'It is a neurological side effect.' 'It is caused by an autoimmune reaction.' 'The skin becomes sensitive with chemotherapy.' 'The central nervous system has become hyperactive.'

'It is a neurological side effect.' Rationale: Neurotoxicity is an anticipated side effect of vincristine sulfate. Some children report it as 'tingles' or feeling 'funny all over.' It is not usually permanent. Vincristine causes leukopenia, which increases susceptibility to infection; it does not cause an autoimmune reaction. Skin sensitivity is not the reason that the child feels tingly. Hyperactivity of the central nervous system is not a factor in the development of this neurological finding.

596) A child receiving methotrexate and undergoing cranial radiation is very weak. The mother asks the nurse if she should give her child vitamins. Which response by the nurse is most appropriate? 'That's an excellent idea. I'll try to get a prescription for her.' 'Unfortunately, vitamins won't make her feel any better now.' 'That won't be possible. Vitamins interfere with the action of methotrexate.' 'After we receive the laboratory reports, your daughter will be getting vitamins.'

'That won't be possible. Vitamins interfere with the action of methotrexate.' Rationale: Many vitamin supplements contain folic acid, which negates the action of methotrexate, a folic acid antagonist. Vitamin therapy is contraindicated, so the nurse would not try to obtain a prescription, and vitamins will not be prescribed after the laboratory reports have come back. Although vitamins contribute to well-being, stating that the client won't feel any better does not answer the question.

Question 1: A nurse is reviewing laboratory data prior to administering methotrexate to a client with breast cancer. Which clinical finding will the nurse report to the healthcare provider before administering the medication? AALT of 55 IU/mL BWBC of 12,000/mm³ CAST of 34 U/L DHGB of 11.5 g/dL

A ALT of 55 IU/mL Rationale: Alanine transaminase (ALT) is a liver enzyme that is released into the bloodstream when liver damage is present. Methotrexate is an antineoplastic used in the treatment of various carcinomas. Methotrexate is contraindicated in clients with hepatic impairment. A higher than normal white blood cell (WBC) count is an expected finding in a client with carcinoma. Aspartate aminotransferase (AST) is a liver enzyme used to assess hepatic function. An AST level of 34 U/L is a normal finding. Anemia (low hemoglobin) is an expected finding in a client with carcinoma.

684) A client with Hodgkin's disease is to receive the cyclic antineoplastic vincristine as part of a therapy protocol. Which mechanism of action would the nurse associate with this medication? Arresting mitosis in metaphase Inhibiting the synthesis of thymidine Alkylating nucleic acids needed for mitosis Inactivating DNA while inhibiting RNA synthesis

Arresting mitosis in metaphase Rationale: Vincristine is a plant alkaloid that is cell-cycle specific. It affects cell division during metaphase by interfering with spindle formation and causing cell death. Inhibiting the synthesis of thymidine is the typical action of antimetabolites, not plant alkaloids. Alkylating nucleic acids needed for mitosis is typical of the action of alkylating agents, not plant alkaloids. Inactivating DNA and RNA synthesis is the typical action of antineoplastic antibiotics, not plant alkaloids.

522) Which laboratory test result would alert the nurse that fluid intake would need to be increased in a child receiving vincristine? Urine pH of 6 Urine specific gravity of 1.020 Blood uric acid level of 7.5 mg/dL Blood urea nitrogen level of 15 mg/dL

Blood uric acid level of 7.5 mg/dL Rationale: The normal blood uric acid level for children ranges from 2.5 to 5.5 mg/dL. An increase in the uric acid level caused by the destruction of cells may lead to renal problems; increased fluid intake helps dilute the urine. A urine pH of 6 is within the expected range of 4.5 to 8. A urine specific gravity of 1.020 is within the expected range of 1.005 to 1.030 (usually 1.010-1.025). A blood urea nitrogen level of 15 mg/dL is within the expected range of 5 to 18 mg/dL.

245) Which common side effect will the nurse address in the care plan of a client with cancer receiving the plant alkaloid vincristine? Color-blindness Anuria Constipation Hyperphosphatemia

Constipation Rationale: Although most chemotherapy causes diarrhea, vincristine can cause severe constipation, impaction, or paralytic ileus. Visual changes may occur, but color-blindness is not one of them. Polyuria, not anuria, is common. Hyperuricemia may occur, but hyperphosphatemia is not associated with this medication.

416) Which mechanism of action explains the ability of nitrogen mustard to interfere with growth of cancer cells? Interference of the cellular protein synthesis Inhibition of the synthesis of purine and pyrimidine Binding with DNA to interfere with RNA production Combining with DNA strands and interfering with cell replication

Combining with DNA strands and interfering with cell replication Rationale: Alkylating agents such as nitrogen mustard combine with DNA strands and interfere with cell replication. Some chemotherapeutic medications are believed to act by interfering with cellular protein synthesis, but nitrogen mustard does not. Inhibiting the synthesis of purine and pyrimidine is the mechanism of action of antimetabolites.

570) Which nursing assessment is most important for a child receiving cyclophosphamide? Extent of alopecia Changes in appetite Hyperplasia of gums Daily intake and output

Daily intake and output Rationale: Hemorrhagic cystitis is a potentially serious adverse reaction to cyclophosphamide that can sometimes be prevented with increased fluid intake because the fluid flushes the bladder. The extent of hydration can be measured with hourly documentation of intake and output. Alopecia is expected; however, it is a benign side effect, and the hair will regrow when therapy is completed. A change in appetite is expected but is not a serious side effect of cyclophosphamide administration. Hyperplasia of the gums is unrelated to cyclophosphamide administration.

541) A child is prescribed dactinomycin and doxorubicin therapy after a nephrectomy for Wilms tumor. Which intervention would the nurse include in the plan of care? Administering aspirin for pain Offering citrus juices with meals Ensuring meticulous oral hygiene Eliminating spicy foods from the diet

Ensuring meticulous oral hygiene Rationale: Oral hygiene is essential, especially during the administration of medications that have a negative effect on the oral mucosa. Although pain may be present, aspirin is avoided because doxorubicin is also being used, and a side effect of this medication is thrombocytopenia. Aspirin is contraindicated for children because it is associated with Reye syndrome. Citrus juice will aggravate stomatitis, which is a common side effect of dactinomycin. Spicy foods may aggravate the stomatitis that occurs with chemotherapy. However, usually any food that the child requests is permitted.

971) A client with leukemia who is receiving vincristine reports lower leg numbness. Which statement about vincristine explains this occurrence? Vincristine acts on enlarged lymph nodes in the groin. Vincristine affects peripheral vascular circulation. Vincristine increases the risk for vascular occlusion. Peripheral neuropathies can result from vincristine chemotherapy.

Peripheral neuropathies can result from vincristine chemotherapy. Rationale: Muscle weakness, tingling, and numbness are related to medications like vincristine; neuropathies usually are transient if the medication is stopped or reduced. Nodal enlargement produces vascular rather than neural side effects. Most chemotherapeutic regimens do affect the nervous or peripheral vascular system; neuropathies and peripheral vascular adaptations are potential side effects of chemotherapy. Tingling and numbness are characteristic of neuropathy, not vascular occlusion.

258) Which toxic effect would a nurse monitor for in a client who is prescribed vincristine? Peripheral paresthesia Anginal-type chest pain Ophthalmic papilledema Bilateral crackles in the lung

Peripheral paresthesia Rationale: Peripheral paresthesia is an indication of toxicity from a plant alkaloid such as vincristine. Anginal-type chest pain, ophthalmic papilledema, and bilateral crackles in the lung are not side effects of this medication.

62) Which nursing care will be included for a client who is receiving doxorubicin for acute myelogenous leukemia? Increasing citrus foods Providing frequent oral hygiene Encouraging activity Administering medications parenterally

Providing frequent oral hygiene Rationale: Stomatitis and hyperuricemia are possible complications of therapy; therefore oral care and hydration are important. Acidic foods such as citrus foods and fluids will cause pain for clients with stomatitis. Rest, not increased activity, is important for increased fatigability. Abnormal bleeding is a common problem; thus injections (administering medications parenterally) are contraindicated.

862) Intravenous furosemide has been prescribed for a client with severe edema and hypertension. Which subjective clinical manifestations lead the nurse to suspect that the furosemide is infusing too rapidly? Select all that apply. One, some, or all responses may be . Hunger Tinnitus Weakness Leg cramps Excess salivation

Tinnitus Weakness Leg cramps Rationale: Tinnitus is a central nervous system side effect of furosemide. Weakness and leg cramps result from hypokalemia caused by an overload of furosemide. Nausea and anorexia, not hunger, are side effects of dehydration that may occur with an overload of furosemide. Dry mouth, not salivation, results from dehydration caused by an overload of furosemide.

580) Which side effect would the nurse assess for in a child receiving vincristine? Hemolytic anemia Irreversible alopecia Hyperglycemia Neurological complications

Neurological complications Rationale: Vincristine is highly neurotoxic, causing paresthesias, muscle weakness, ptosis, diplopia, paralytic ileus, vocal cord paralysis, and loss of deep tendon reflexes. Hematologic effects are rare; mild anemia may occur, but hemolytic anemia is not anticipated. Alopecia is reversible with cessation of the medication. Hyperglycemia is not an anticipated adverse effect.

864) A client is receiving ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy for Hodgkin's disease. When the client reports burning and tingling of the feet, which medication would the nurse determine is the likely cause? Neurotoxicity caused by vinblastine Hypersensitivity caused by dacarbazine Endocrine alterations caused by doxorubicin Peripheral vasoconstriction caused by bleomycin

Neurotoxicity caused by vinblastine

513) A 5-year-old child is receiving dactinomycin and doxorubicin therapy after nephrectomy for Wilms tumor. Which intervention would the nurse include when planning care? Adding citrus juices to meals Offering warm saline mouthwash Scheduling booster immunizations Reporting red-orange colored urine

Offering warm saline mouthwash Rationale: The use of warm saline mouthwash will minimize oral discomfort; ulceration of the oral mucosa occurs as a result of the antineoplastic effect on the rapidly dividing gastrointestinal epithelium. Oral anesthetics may be prescribed by the health care provider. Adding citrus juices to meals is contraindicated because it will aggravate the stomatitis that is a common side effect of both chemotherapeutic agents. Immunizations must be postponed because of the immunosuppressant effects of chemotherapy. Urine and other body fluids may become red orange during the first 48 hours after doxorubicin is started; this is an expected response that need not be reported.