N406 Unit 9 Exam 3

The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? A. Extravasation B. Stomatitis C. Nausea and vomiting D. Bone pain

A. Extravasation Extravasation: leakage of blood, lymph, other fluid, into tissue around it. The nurse needs to monitor IV administration of antineoplastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action.

A patient is to receive Bacille Calmette- Guerin (BCG), a nonspecific biologic response modifier. Why would the patient receive this form of treatment? A. For cancer of the bladder B. For cancer of the breast C. For cancer of the lungs D. For skin cancer

A. For cancer of the bladder Explanation: Early investigations of the stimulation of the immune system involved nonspecific agents such as bacille Calmette-Guérin (BCG) and Corynebacterium parvum. When injected into the patient, these agents serve as antigens that stimulate an immune response. The hope is that the stimulated immune system will then eradicate malignant cells. Extensive animal and human investigations with BCG have shown promising results, especially in treating localized malignant melanoma. In addition, BCG bladder instillation is a standard form of treatment for localized bladder cancer (Polovich et al, 2009).

A client with ovarian cancer is ordered hydroxyurea (Hydrea), an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with: A. cell division or mitosis during the M phase of the cell cycle. B) normal cellular processes during the S phase of the cell cycle. C) the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA molecules (cell cycle-nonspecific). D) one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or both (cell cycle-nonspecific).

B) normal cellular processes during the S phase of the cell cycle. Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They're most effective against rapidly proliferating cancers. Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells. Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction.

An adult client has recently begun cancer treatment with methotrexate (MTX). When reviewing this client's laboratory work, the nurse should consequently prioritize assessment of which of the following? A. Sodium and potassium B. BUN and creatinine C. Calcium and magnesium D. Arterial blood gases

B. BUN and creatinine Explanation:The antimetabolites may also be nephrotoxic. MTX use in clients with impaired renal function may lead to accumulation of toxic amounts or additional renal damage. Evaluation of the client's renal status should take place before and during MTX therapy. This adverse effect of MTX treatment supersedes the importance of electrolytes and ABGs, though these would also be considered.

Anorexia and cachexia are common problems at the end of life. The nurse plays an important role in managing symptoms and preventing complications. Which of the following are appropriate nursing interventions for these problems? Select all that apply. A. Suggest a daily weighing time to monitor treatment plan. B. Encourage the patient to eat in an upright position. C. Teach the patient how to increase the nutritional value of meals (i.e., add dry milk powder to milk). D. Advise the patient and family about the importance of a balanced diet. E. Recommend that the patient eat when hungry, regardless of usual meal times.

B. Encourage the patient to eat in an upright position. C. Teach the patient how to increase the nutritional value of meals (i.e., add dry milk powder to milk). E. Recommend that the patient eat when hungry, regardless of usual meal times.

Chemotherapeutic agents have different specific classifications. The following medications are antineoplastic antibiotics except: A. Doxorubicin (Adriamycin) B. Fluorouracil (Adrucil) C. Mitoxantrone (Novantrone) D. Bleomycin (Blenoxane)

B. Fluorouracil (Adrucil) -Chemotheraphydrug , class: Antimetabolite, it can treat skin cancer, rough, raised areas of heavily sun-exposed skin.

adverse effects of auranofin

Bone marrow suppression, renal toxicity, dermatitis, nausea, vomiting, stomatitis.

A 74-year-old woman was diagnosed with rheumatoid arthritis 1 year ago, but has achieved adequate symptom control through the regular use of celecoxib (Celebrex), a COX-2 selective NSAID. The nurse should recognize that this drug, like other NSAIDs, influences what aspect of the pathophysiology of nociceptive pain? A. Distorting the action potential that is transmitted along the A-delta (d) and C fibers B. Diverting noxious information from passing through the dorsal root ganglia and synapses in the dorsal horn of the spinal cord C. Blocking modulation by limiting the reuptake of serotonin and norepinephrine D. Inhibiting transduction by blocking the formation of prostaglandins in the periphery

C. Blocking modulation by limiting the reuptake of serotonin and norepinephrine

A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention? A. The client begins to shiver. B. The client states he is nauseous. C. The I.V. site is red and swollen. D. The laboratory reports a white blood cell (WBC) count of 1,000/mm3.

C. The I.V. site is red and swollen. Explanation: A red, swollen IV site indicates possible infiltration. Daunorubicin is a vesicant chemotherapeutic agent and can be very damaging to tissue if it infiltrates → nurse should stop infusion immediately

treatment involving gold salts is called what?

Chrysotherapy

A nurse is assessing a client with a terminal illness and finds that the client has cachexia. The nurse interprets this as indicating which of the following? A. Extreme anorexia B. Severe asthenia C. Starvation D. Profound protein loss

D. Profound protein loss

A cancer client has been prescribed 5-fluorouracil, an antimetabolite chemotherapy agent. This medication stops normal development and division by interrupting the S phase of the cell cycle. When teaching this client, the nurse explains that during the S phase of the cell cycle: A. the cell is in a prolonged resting state and only leaves this state when cellular destruction is occurring. B. the DNA synthesis stops, but RNA synthesis continues. C. nuclear division occurs. D. the synthesis of DNA occurs, causing two separate sets of chromosomes to develop.

D. the synthesis of DNA occurs, causing two separate sets of chromosomes to develop. Explanation:During the S phase, DNA synthesis occurs, causing two separate sets of chromosomes to develop. Antimetabolites can cause abnormal timing of DNA synthesis. Because of their S-phase specificity, the antimetabolites are more effective when given as a prolonged infusion.

if NSAIDs don't work for a client, what might be used? What example might that be?

Gold compounds would be used, such as auranofin

BCG have shown promising results, especially in treating what?

Localized malignant melanoma

the formation of prostaglandins in the periphery is a central component of what?

Pathophysiology of transduction

IV administration of vesicant chemotherapy drugs can cause what complication?

Tissue necrosis to blood vessels; can be very damaging to vessels.

Which of the following classes of antineoplastic agents is cell cycle-specific? a) Antimetabolites (5-FU) b) Alkylating agents (cisplatin) c) Nitrosoureas (carmustine) d) Antitumor antibiotics (bleomycin)

a. Antimetabolites (5-FU)

Which of the following types of chemotherapy crosses the blood-brain barrier and therefore is often used to treat brain tumors? A. Nitrosoureas B. Camptothecins C. Plant alkaloids D. Antimetabolites

a. Nitrosoureas

how do antimetabolites work?

antimetabolites interfere with normal cellular processes during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication

A client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis? a. White, cottage cheese-like patches on the tongue b. Yellow tooth discoloration c. Red, open sores on the oral mucosa d. Rust-colored sputum

c. Red, open sores on the oral mucosa The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese-like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? a) Withholding fluids for the first 4 to 6 hours after chemotherapy administration b) Serving small portions of bland food c) Encouraging rhythmic breathing exercises d) Administering metoclopramide and dexamethasone as ordered

d) Administering metoclopramide and dexamethasone as ordered. Metoclopramide (Reglan): Antiemetic and gut motility stimulator. Dexamethasome: Steroid, can treat inflammation. The nurse should assign highest priority to administering an antiemetic, such as metoclopramide, and an anti-inflammatory agent, such as dexamethasone, because it may reduce the severity of chemotherapy-induced nausea and vomiting. This intervention, in turn, helps prevent dehydration, a common complication of chemotherapy. Serving small portions of bland food, encouraging rhythmic breathing exercises, and withholding fluids for the first 4 to 6 hours are less likely to achieve this outcome.

how is auranofin excreted?

excreted in the urine and feces

auranofin action

gold taken up by macrophages, which inhibits phagocytosis and release of lysosomal enzymes that cause damage associated with inflammation.

for a patient receiving a vesicant chemotherapy drug, the RN would place the IV where and with what?

in the forearm using a soft plastic catheter, NOT a butterfly

how does BCG bladder instillation work?

medication is inserted directly into the bladder through a catheter

auranofin indications

treatment of selected adults with rheumatoid arthritis, who have insufficient response to or intolerance to NSAIDs.

The nurse is to administer a vesicant chemotherapeutic drug to a client who had a right mastectomy and inserts the intravenous line A. With a butterfly needle B. With a soft, plastic catheter C. In the client's right forearm D. In the client's left hand

B. With a soft, plastic catheter Vesicant chemotherapy should never be administered in the peripheral veins involving the hand or wrist. A person with breast cancer is to avoid injections in the affected extremity. A soft, plastic catheter should be used, not a butterfly needle. Chapter 15: Management of Patients with Oncologic Disorders - Page 342

what is the standard form of tx for localized bladder cancer?

Bacille Calmette-Guérin (BCG) bladder instillation

Bacillus Calmette-Guerin or BCG may be used for the treatment of what?

Bladder cancer

explain how Bacillus Calmette-Guerin or BCG works

when injected into the patient, these agents serve as antigens that stimulate an immune response; the hope is that the stimulated immune system will then eradicate malignant cells