NCLEX Pharmacology Adams/Holland Ch 38: Drugs for Neoplasia NCLEX

A patient reports nausea after initiation of chemotherapy. Which instruction should the nurse provide to the patient? "Avoid very hot or very cold foods." "Drink at least 1 liter of fluid per day." "You should eat when you feel hungry." "Add some spices to your food, so it tastes better."

"Avoid very hot or very cold foods." The patient should be encouraged to avoid excessively hot or cold foods during periods of nausea. The patient should be encouraged to take in 2 L of fluid per day, taken in frequent small amounts as allowed. The fluid loss from the diarrhea should be replaced to prevent dehydration. The patient should be encouraged to eat small, high-calorie, nutrient-dense meals, with nutritional supplements added if necessary. It is common for a patient with nausea to lose their appetite, but they should be encouraged to maintain their nutrition. The patient should be encouraged to avoid any spicy, highly scented foods during periods of nausea.

A patient receiving doxorubicin (Adriamycin) intravenously reports that the medication burns. Which response should the nurse make? "I will dilute the drug, so it is not so painful." "That is a common side effect of the medication." "I will slow the rate of the infusion down, so it is not so uncomfortable." "I am going to stop the treatment."

"I am going to stop the treatment." Doxorubicin is a severe vesicant and precautions must be taken to avoid contact with the skin and soft tissues. Skin contact or extravasation must be treated immediately with local ice packs to reduce the absorption of the drug. Doxorubicin must not be diluted, nor should the rate of infusion be decreased. By continuing to infuse the drug, the patient is at risk for further tissue damage. Pain or burning during the infusion is not a common side effect of the medication, and the treatment should be stopped.

A patient scheduled to receive chemotherapy every 3 weeks for six treatments asks why the treatment will continue for so long. Which response should the nurse provide? ANSWER "Treatments are scheduled to allow the absolute neutrophil count to drop as much as possible before the next treatment." "Treatments are arranged to facilitate your immune system to remove the excess cancer cells in between treatments." "Treatments are planned over a longer period of time to prevent the mutation of remaining cancer cells." "Treatments are spaced out to achieve more cancer cell kill and to allow you to recover in between treatments."

"Treatments are spaced out to achieve more cancer cell kill and to allow you to recover in between treatments." Chemotherapy is administered over time to promote more cancer cell kill and to allow the patient's immune system to recover in between treatments. Chemotherapy kills all rapidly dividing cells, including neutrophils, which leaves the patient at high risk for infection. The immune system will eliminate the few remaining cancer cells after all of the rounds of chemotherapy, not in between treatments. Mutation occurs due to exposure to chemotherapy drugs over time and does not affect the timing of the doses.

The nurse who is presenting community education about cancer prevention would evaluate understanding of the message when he overhears which statements at the break?Select all that apply. 1. "I've been thinking about trying a vegetarian diet. Now may be a good time." 2. "I am going to call my doctor and schedule a pap smear." 3. "I think I will start taking vitamin A and selenium." 4. "I've never been a drinker, but I am going to start drinking a glass of wine with dinner." 5. "I am going to read the label on that new bottle of sunscreen I bought."

1, 2, 5

A nurse has just initiated a patient's first dose of doxorubicin (Adriamycin). Which assessment finding would cause the nurse to stop the infusion and seek immediate collaboration with the oncologist? Select all that apply. 1. The patient's cardiac monitor reveals sinus bradycardia. 2. The patient reports being nauseated. 3. The patient mentions drinking green tea for breakfast. 4. The patient becomes dyspneic. 5. The patient becomes pale.

1, 4

A client is prescribed methotrexate (Rheumatrex) for treatment of osteogenic sarcoma. The client says, My friend took methotrexate, but she has never had cancer. How should the nurse respond to this statement? Select all that apply. 1. Does your friend have rheumatoid arthritis? 2. She must have had cancer and not told you. 3. Methotrexate is used to treat some autoimmune disorders as well. 4. You must have misinterpreted what your friend said. 5. Methotrexate is used to treat some forms of liver disease.

1,3

A patient is prescribed doxorubicin liposomal (Doxil, Evacet). Which statement should the nurse make that explains the mechanism of action for this medication? 1. "It does not release until it is in the tumor." 2. "It indirectly targets the cancer cells in the blood." 3. "It absorbs into the cells, interfering with the replication." 4. "It induces myelosuppression and then attacks the viable cancer cells."

1. "It does not release until it is in the tumor." Doxorubicin liposomal (Doxil, Evacet) is a form of the drug incorporated into the lysosomes—closed, spherical molecules that encase the drug. The lysosomes stay in the body's circulatory system until they reach the tumor, and once inside the tumor, the drug is released from its carrier. The drug does not specifically target cancer cells; it has to be absorbed in the tumor. The drug does not induce myelosuppression.

The patient has been prescribed interferon as treatment against cancer. What information should the nurse provide? Select all that apply. 1. "You can increase your intake of interferon by eating grapes and drinking a glass of red wine daily." 2. "Interferons act to suppress cancer cell division." 3. "Interferons enhance your body's ability to remove cancer cells." 4. "Interferons are a type of hormone therapy, so side effects are limited." 5. "The danger with using interferons is that they may cause cancer to develop in sites distant from your original tumor."

2, 3

A nurse suspects that the IV line infusing vincristine (Oncovin) has infiltrated. The nurse discontinued the line. Which other actions are indicated? Select all that apply. 1. Apply local ice packs. 2. Inject hyaluronidase per protocol. 3. Place a tourniquet on the clients arm above the IV site. 4. Place warm compresses on the site. 5. Administer prednisone per protocol.

2,4

In understanding the difference between normal cells and cancer cells, the nurse knows that cancer is the result of 1. cell division occurring extensively in normal cells. 2. cell division occurring via controlled cell division. 3. damage to genes controlling cell growth 4. suppressor genes continuing cell growth for cell division.

3

In understanding the growth fraction as it pertains to the success of chemotherapy, the nurse knows that the growth fraction is a ratio of 1. the number of replicating cells to the number of active cells. 2. the number of non-replicating cells to the active cells. 3. the number of replicating cells to the number of resting cells. 4. The number of non-replicating cells to the number of resting cells.

3

The client is prescribed tamoxifen for the treatment of breast cancer. The nurse should advise the client to monitor for which adverse effect? 1. Fatigue 2. Cough 3. Vaginal discharge 4. Signs of dehydration

3

The client receives several chemotherapeutic agents as treatments for cancer. The client asks the nurse why he needs so many drugs. What is the best response by the nurse? 1. Using multiple drugs means a shorter treatment time. 2. Using multiple drugs decreases the incidence of side effects. 3. Using multiple drugs will help kill more of the cancer. 4. Using multiple drugs is more cost-effective in treating cancer.

3

What is the nurse's priority when preparing to administer intravenous vesicant chemotherapy? 1. Notify the physician that a central line is necessary. 2. Wear gloves when drawing up the medication. 3. Know the protocol for extravasation. 4. Wear a mask when injecting the medication.

3

The client experiences nausea and vomiting soon after chemotherapy treatments. What is the best action by the nurse? 1. Administer a sleeping medication during chemotherapy. 2. Increase fluid intake to flush the kidneys prior to chemotherapy. 3. Administer an antiemetic 12 hours before chemotherapy. 4. Restrict food on the day the client receives chemotherapy.

3 For maximum effect, patients should be given an antiemetic prior to the start of treatment. Options 1, 2, and 4 are incorrect. Waiting to give an antiemetic until after the chemotherapy has started may result in a delay in treatment of the nausea and vomiting. IM injections are usually avoided during chemotherapy because of an increased risk of infection. Fluids are encouraged throughout chemotherapy but will not prevent or treat the nausea and vomiting that may occur.

A nurse suspects that the IV line through which doxorubicin (Adriamycin) is infusing has infiltrated. The nurse has discontinued the IV site. What additional action should be taken? 1. No special action is necessary. 2. A warm wet compress should be placed on the site. 3. Wash the area thoroughly with soap and water. 4. Apply ice packs to the area immediately.

4

The client receives cyclophosphamide (Cytoxan). The nurse evaluates the clients laboratory work. Which laboratory finding would support canceling the clients next treatment with this drug? 1. Hemoglobin of 14 g/dl 2. Blood urea nitrogen of 12 mg/dl 3. WBC count of 8,000 cells/mcl 4. Platelet count of 8,000/mm

4

The client receives methotrexate (Rheumatrex). The nurse assesses for side effects of this drug. Which side effects are a primary concern for the nurse? 1. Hyperglycemia and fatigue 2. Nausea and vomiting 3. Hypertension and seizures 4. Ulcerative stomatitis and diarrhea

4

The most important nursing consideration for clients receiving alkylating agents is 1. monitoring nausea and vomiting. 2. monitoring nutritional intake. 3. monitoring skin integrity. 4. monitoring CBC with differential.

4

A client is being treated with vincristine​ (Marqibo, Oncovin). Which adverse effect should the nurse find most​ concerning? A. Hoarseness B. Stomatitis C. Abdominal distention D. Vomiting

A Hoarseness can be an indication of cranial nerve palsy associated with neurotoxicity. The​ dose-limiting toxicity of vincristine is neurotoxicity. Abdominal distention may be a result of severe​ constipation, which may occur in a client taking​ vincristine, but is not the most concerning adverse effect.​ Gastrointestinal-related adverse effects include vomiting and​ stomatitis, but these are not the most concerning.

A client asks about ways to prevent cancer. Which should the nurse provide about primary cancer​ prevention? (Select all that​ apply.) A. Receive the human papillomavirus​ (HPV) vaccination. B. Stop using tobacco. C. Maintain a healthy diet. D. Obtain screening tests. E. Avoid prolonged sun exposure.

A, B, C, E Primary cancer prevention includes interventions that keep cancer from developing. These include stopping the use of all tobacco​ products, maintaining a healthy​ diet, receiving the HPV​ vaccination, and avoiding prolonged sun exposure. Obtaining​ cancer-screening tests is secondary cancer prevention.

The nurse is teaching about adverse effects that are common to most chemotherapy medications. Which adverse effect should the nurse​ include? (Select all that​ apply.) A. Vomiting B. Pneumonitis C. Stomatitis D. Nausea E. Fatigue

A, C, D, E Chemotherapy kills all rapidly dividing​ cells, including red blood cells and those in the gastrointestinal tract. This leads to​ fatigue, nausea,​ vomiting, and stomatitis. Pneumonitis is not a common adverse effect.

A client is receiving cyclophosphamide​ (Cytoxan). Which intervention should the nurse include to prevent urinary​ complications? (Select all that​ apply.) A. Provide intravenous and oral fluids B. Administer dexrazoxane​ (Zinecard) C. Assess for numbness and tingling in extremities D. Perform urine dipstick for red blood cells E. Monitor intake and output

A, D, E Cyclophosphamide is a chemotherapy drug that can cause urinary damage. Because of​ this, intake and output should be assessed to ensure renal​ function, intravenous and oral fluids should be provided to maintain​ hydration, and urine should be assessed for hemorrhagic cystitis. Dexrazoxane​ (Zinecard) is used to prevent cardiac toxicity with certain chemotherapy drugs. Numbness and tingling in the extremities are neurological complications.

A 2-year-old patient is receiving vincristine (Oncovin) for Wilms' tumor. Which of the following findings will the nurse monitor to prevent or limit the main adverse effect for this patient? (Select all that apply.) A. Numbness of the hands or feet B. Angina or dysrhythmias C. Constipation D. Diminished reflexes E. Dyspnea and pleuritis

A. Numbness of the hands or feet C. Constipation D. Diminished reflexes The most serious adverse effect of vincristine is nervous system toxicity. Numbness of the feet or hands, constipation related to decreased peristalsis, and diminished reflexes are all signs of neurotoxicity. Options 2 and 5 are incorrect. Cardiac and pulmonary toxicities are not associated with vincristine.

The nursing instructor teaches student nurses about chemotherapy for cancer. Which statement best explains why lung cancers are less sensitive to antineoplastic agents than other types of cancers? 1. "Lung cancer cells have a low-growth fraction, which means there isn't much difference between the number of replicating and resting cells." 2. "Lung cancer cells have been growing for a long time before detection, so they are less sensitive to antineoplastic agents." 3. "Lung cancer cells grow in a high-oxygen environment, so they are not very sensitive to antmeoplastic agents." 4. "Lung cancer cells have a very erratic cell cycle, and this is why there isn't much difference between the number of replicating and resting cells."

Answer: 1

The client receives tamoxifen (Nolvadex) for treatment of breast cancer. She asks the nurse why the medicine works. What is the best response by the nurse? 1. "Tamoxifen (Nolvadex) works by inhibiting the metabolism of breast cancer cells." 2. "Tamoxifen (Nolvadex) works by blocking estrogen receptors on breast tissue." 3. "Tamoxifen (Nolvadex) works by inhibiting the cellular mitosis of breast cancer." 4. "Tamoxifen (Nolvadex) works by binding to the DNA of breast cancer cells."

Answer: 2

The nurse assesses several clients for their potential risk for developing cancer. Which client does the nurse assess to be at highest risk for developing cancer? 1. The client who usually applies sunscreen when arriving at the beach 2. The client who drinks alcohol daily and eats red meats at most meals. 3. The client who is 1 0 pounds over weight, but exercises regularly 4. The client who frequently forgets self~breast exam, but has routine mammograms

Answer: 2

The client has recently been diagnosed with cancer. The nurse develops a plan to teach the client about the most effective treatment(s) for cancer. What will the best plan(s) of the nurse include? Select all that apply. 1. Alternative medicine 2. Surgery 3. Radiation therapy 4. Chemotherapy 5. Photodynamic therapy

Answer: 2, 3, 4

The client has cancer. He asks the nurse where cancer comes from. What is the best explanation by the nurse? 1. "Cigarette smoking and second-hand smoke are the primary causes of cancer." 2. "Cancer is genetic; you inherited the predisposition for your cancer." 3. "Cancer is caused primarily by viruses in the environment." 4. "Cancer cells are your body's cells that have lost the ability to control their growth."

Answer: 4

A client receiving cyclophosphamide​ (Cytoxan) for the treatment of breast cancer. Which finding should indicate that this medication is​ effective? A. Increased levels of testosterone B. Decreased levels of estrogen C. Immunosuppression D. Myelosuppression

C Cyclophosphamide is an alkylating agent intentionally used to cause immunosuppression. Myelosuppression is not a therapeutic​ finding; it is an adverse effect in which the bone marrow activity is decreased. Aromatase is a classification of drug that reduces the level of estrogen in the blood. Cyclophosphamide does not increase testosterone levels.

A client is prescribed doxorubicin​ (Adriamycin). Which client statement should indicate that teaching about this medication was​ effective? A. ​"I understand that this drug may cause pain when it is​ administered." B. ​"I can take Advil if I am experiencing​ discomfort." C. ​"I should report if my heart feels like it is beating​ faster." D. ​"I understand that I will no longer be able to have​ children."

C Doxorubicin can cause cardiac adverse effects which can be​ life-threatening and include sinus tachycardia. Nonsteroidal​ anti-inflammatory drugs such as Advil should be avoided because they place the client at risk for bleeding. Doxorubicin causes temporary decreased fertility that may not result in permanent infertility. Pain is an abnormal finding during the administration of the drug. The drug is given intravenously and can cause major damage to the​ skin, subcutaneous​ tissues, and nerves if extravasation occurs.

A client is diagnosed with a solid tumor of the bone. Which medication should the nurse anticipate being prescribed for this​ client? A. Procarbazine​ (Matulane) B. Anastrozole​ (Arimidex) C. Doxorubicin​ (Adriamycin) D. Cladribine​ (Leustatin)

C Doxorubicin is a cytotoxic antibiotic that has a wide spectrum of antitumor activity and is considered one of the most effective drugs against a solid tumor. Cladribine is a purine analog that is used to treat leukemia. Anastrozole is an aromatase inhibitor that is used to treat​ hormone-sensitive tumors. Procarbazine is an alkylating agent that is used to treat​ Hodgkin's disease.

A client is receiving methotrexate​ (MTX, Rheumatrex,​ Trexall). Which assessment finding should the nurse find most​ concerning? A. Immunosuppression B. Headache C. Diarrhea D. Weight loss

C Methotrexate is an antimetabolite that is primarily used in combination therapy to maintain induced remission in those individuals who have had a surgical resection or amputation for a primary tumor. Diarrhea and ulcerative stomatitis require the suspension of the therapy because it may lead to hemorrhagic enteritis and death from intestinal perforation. A headache is an adverse effect of the drug but is not the most concerning assessment finding. Weight loss may occur due to the nausea and vomiting associated with the treatment and should be monitored but is not the most concerning finding. Immunosuppression is expected with the use of an antineoplastic drug.

Which of the following statements by a patient who is undergoing antineoplastic therapy would be of concern to the nurse? (Select all that apply.) A. "I have attended a meeting of a cancer support group." B. "My husband and I are planning a short trip next week." C. "I am eating six small meals plus two protein shakes a day." D. "I am taking my 15-month-old granddaughter to the pediatrician next week for her baby shots." E. "I am going to go shopping at the mall next week."

D. "I am taking my 15-month-old granddaughter to the pediatrician next week for her baby shots." E. "I am going to go shopping at the mall next week." Patients and family members should avoid receiving live virus vaccinations or exposure to chickenpox. The patient could have an exacerbation or a more pronounced episode of the disease. The patient should not care for the granddaughter if vaccination with live viruses is planned. The patient should also avoid crowds, especially in enclosed spaces when possible, to minimize exposure risk. The nurse should discuss measures to minimize the risk of infections if the patient desires to go shopping. Options 1, 2, and 3 are incorrect. Attending a support group, maintaining normal activities when possible, and eating small, frequent meals with sufficient protein are routine care measures during chemotherapy.

A patient is receiving vincristine (Oncovin). For which adverse effect should the nurse monitor in the patient? Myelosuppression Neurotoxicity Hematologic toxicity Diarrhea

Neurotoxicity Vincristine is a toxic medication, and even therapeutic doses may result in serious adverse effects. The major dose-limiting toxicity of vincristine is neurotoxicity. Myelosuppression is the dose-limiting toxicity for many other antineoplastic drugs. Hematologic toxicity is the dose-limiting toxicity for irinotecan (Camptosar). Diarrhea is the dose-limiting toxicity for capecitabine (Xeloda), as well as other drugs used for the treatment of cancers or tumors.

A patient who had chemotherapy 10 days ago develops a temperature of 100.5°F and a cough. For which additional finding should the nurse suspect the development of neutropenia? Neutrophil count of 850 cells/mL Decreased RBC count Platelet count of 100,000 cells/mL Increased uric acid levels

Neutrophil count of 850 cells/mL Elevated temperature, cough, and recent chemotherapy treatment places the patient at an increased risk for infection. A neutrophil count of 850 cells/mL supports an infection. A low RBC count causes fatigue and hypoxia. A diminished platelet count can cause bleeding. Increased uric acid levels can precipitate renal failure.

A patient has inoperable metastatic cancer to the spinal cord that causes severe pain. Which type of chemotherapy should the nurse expect to alleviate symptoms? Curative Palliative Chemoprophylaxis Adjuvant

Palliative Palliative chemotherapy is used when cure or control of the cancer is not possible. It is used to decrease the tumor size, ease pain, or alleviate other symptoms and improve the quality of life. Curative chemotherapy is not an option because the cancer is inoperable. Chemoprophylaxis is used to prevent cancer from occurring in patients at high risk for developing tumors. Adjuvant chemotherapy is administered to remove all cancer cells that may remain after surgical removal of the tumor.

A patient who had chemotherapy 10 days ago develops petechiae and ecchymosis on the extremities. Which laboratory value should the nurse assess? Platelet count WBC count RBC count Potassium level

Platelet count Petechiae and ecchymosis indicates bleeding. Because chemotherapy kills all rapidly dividing cells, including platelets, the nurse should assess the platelet count. The WBC count would be assessed if the patient has a fever or signs of infection. The RBC count would be assessed if the patient reports increased fatigue and shortness of breath. The potassium level is affected by dehydration and fluid losses.

A patient with a history of gout is receiving chemotherapy to treat lymphoma. Which intervention should the nurse include to decrease the risk of renal failure? Provide intravenous and oral fluids. Administer ondansetron (Zofran). Allow frequent rest periods. Administer mesna (Mesnex).

Provide intravenous and oral fluids. Hyperuricemia occurs after administering chemotherapy due to rapid cell kill. Uric acid crystals can accumulate in the renal tubules, leading to renal failure. The patient should receive intravenous and oral fluids to keep hydrated and flush out the microscopic crystals. Ondansetron (Zofran) is an antiemetic given for nausea and vomiting. Frequent rest periods help alleviate fatigue. Mesna (Mesnex) is administered to prevent hemorrhagic cystitis when administering cyclophosphamide (Cytoxan).

The nurse assesses the intravenous catheter (IV) insertion site during a patient's infusion of doxorubicin (Adriamycin). For which finding should the nurse stop the infusion immediately? Positive blood return from the IV catheter Onset of nausea and vomiting Tissue swelling at the IV insertion site Oral temperature of 98.2°F

Tissue swelling at the IV insertion site Doxorubicin (Adriamycin) is a known vesicant and can cause tissue necrosis if it leaks out of the blood vessel. The infusion should be stopped immediately if tissue swelling is noted at the IV insertion site. The presence of a positive blood return should be assessed routinely during the infusion of this medication to ensure the IV is still within the vein. Nausea and vomiting are expected adverse effects of many chemotherapy medications. An oral temperature of 98.2°F is normal and would not cause the infusion to be stopped.

Which finding should the nurse instruct the client receiving tamoxifen to immediately report to the healthcare provider? a. A temperature of 101.1°F b. Weight gain of 3 pounds in 1 week c. Size increase of the tumor d. Nausea and vomiting

a. A temperature of 101.1°F

Which intervention should the nurse integrate into the plan of care for a client receiving cyclophosphamide (Cytoxan) experiencing oral irritation? a. Instruct the client to avoid extreme temperatures of food selections. b. Instruct the client to use an antiseptic mouthwash. c. Instruct the client to rinse her mouth with normal saline. d. Instruct the client to drink cold beverages.

a. Instruct the client to avoid extreme temperatures of food selections.

Which should the nurse understand can be used to minimize bone marrow toxicity? Select all that apply. a. Alkylating agents b. Bone marrow transplantation c. Hormone antagonists d. Platelet administration e. Growth factor therapy

b. Bone marrow transplantation d. Platelet administration e. Growth factor therapy

Which adverse effect should the nurse monitor the client receiving doxorubicin (Adriamycin) for? a. Neurotoxicity b. Cardiotoxicity c. Nephrotoxicity d. Hepatotoxicity

b. Cardiotoxicity