NUR333 PrepU CH. 14

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

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

The oncology nurse understands that chemotherapeutic agents are most effective during a particular phase of the cell cycle. This means the agents are: cell cycle-specific. growth fraction. cell cycle-nonspecific. cell targeting.

Correct response: cell cycle-specific. Explanation: Chemotherapeutic drugs that are most effective during a particular phase of the cycle are known as cell cycle-specific.

A client received an injection of doxorubicin and is now observing a reddish urine. The client reports blood in the urine to the nurse. How should the nurse respond? "You may have hemorrhagic cystitis." "We need to notify the health care provider because this is a complication of the medication." "The reddish urine is an expected response to the drug." "Let's get a urinalysis to confirm a urinary tract infection."

Correct response: "The reddish urine is an expected response to the drug." Explanation: Reassure clients that reddish urine after doxorubicin injection is a harmless and expected response to the drug. This reaction may happen within 1 to 2 days postinfusion.

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

Correct response: Methotrexate Explanation: Methotrexate is absorbed well from the gastrointestinal (GI) tract and can be administered orally. Cytarabine, fluorouracil, and gemcitabine must be administered parenterally because they are not absorbed well from the GI tract.

Among the multiple genetic abnormalities that are characteristic of cancer cells, which gene mutation results in more than 90% of small cell lung cancers and more than 50% of breast and colon cancers? a42p p53 a53 c42

Correct response: p53 Explanation: Mutations of the p53 gene, a common genetic change in cancer, are associated with more than 90% of small cell lung cancers and more than 50% of breast and colon cancers. All other choices are incorrect.

An oncology nurse is reviewing the pathophysiology of cancer and is discussing with a colleague the factors that contribute to the success or failure of a patient's chemotherapy. Which cancerous cell is most susceptible to the effects of chemotherapeutic drugs? Cells with a long generation time Cells that lack a blood supply Cells that lack contact inhibition Cells that have a rapid mitotic rate

Correct response: Cells that have a rapid mitotic rate Explanation: Cells that have a short generation time or rapid mitotic rate are most sensitive to antineoplastic agents. All cells (both cancerous and noncancerous) have a blood supply. A lack of contact inhibition is characteristic of cancer, but this is not associated with susceptibility to chemotherapeutic drugs.

The nurse is assessing a client for adverse effects related to methotrexate therapy. What diagnostic finding should the nurse prioritize? serum osmolality creatinine clearance electrocardiogram (ECG) calcium and magnesium levels

Correct response: creatinine clearance Explanation: Methotrexate is nephrotoxic. Consequently, the nurse must carefully follow indicators of the client's renal function. Electrolyte and water disturbances and cardiac conduction disorders are much less likely adverse effects.

A client is diagnosed with a brain tumor. The client is told that the cancer cells proliferate. The client asks the nurse what this means. What is the nurse's best response?

Correct response: "The proliferation is the growth of cancer cells and the rate of growth." Explanation: The proliferation of cancer cells is the rate of growth of cancer cells. The proliferation of cancer cells is not the metastasis of the tumor, suppression of the cancer cells, or treatment with chemotherapy.

A client has been diagnosed with a brain tumor and is dealing with this diagnosis by seeking detailed information about cancer. The nurse would explain to the client that cancer is essentially a result of the disruption of what? Cell wall Cell cycle Lymphatic system Immune system

Correct response: Cell cycle Explanation: Malignant cells have lost the normal genetic regulation that controls cell growth, invading normal tissues and taking blood and nutrients away from these tissues. In essence, the cell cycle has been pathologically disrupted. None of the other options accurately describe the disruption.

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

Correct response: Intravenous Explanation: Carboplatin is administered IV on day 1 every 4 weeks.

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? Breast Ovaries Skin Testicles

Correct response: Skin Explanation: Skin cells proceed very rapidly through the cell cycle. Breast cells proceed very slowly through the cell cycle. Cells of the testicles proceed very slowly through the cell cycle. The cells of the ovaries proceed very slowly through the cell cycle.

A nurse educator is discussing the role of protooncogenes in the pathophysiology of cancer. What typically triggers protooncogenes to differentiate into oncogenes? exposure to a low-pH environment exposure to carcinogens exposure to chemotherapeutic agents ischemia

Correct response: exposure to carcinogens Explanation: When normal growth-regulating genes (protooncogenes) are exposed to carcinogens, they may undergo genetic alteration and become oncogenes. This can stimulate continuous cell growth, allowing abnormal, disordered, and unregulated cell replication. Exposure to the other factors does not result in this alteration.

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

Correct response: Tamoxifen Explanation: Anti-estrogens are first-line therapy for treating breast cancer in postmenopausal women. Tamoxifen is the most widely recognized anti-estrogen.

A 79-year-old woman has recently moved to a long-term care facility, and the nurse at the facility is conducting a medication reconciliation. The nurse notes that the woman has recently been taking tamoxifen. The nurse is justified in concluding that the woman has a history of what malignancy? Breast cancer Ovarian cancer Cervical cancer Malignant melanoma

Correct response: Breast cancer Explanation: Tamoxifen is an antiestrogen that has been widely used to prevent recurrence of breast cancer after surgical excision in women aged 40 years and older and to treat metastatic breast cancer in postmenopausal women with estrogen receptor-positive disease. Tamoxifen is not effective in preventing recurrence of any of the other options since none of those are estrogen-positive diseases.

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 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.

Correct response: The use of three agents decreases the development of cell resistance. Explanation: Most chemotherapy regimens involve a combination of drugs with different actions at the cellular level, which destroys a greater number of cancer cells and reduces the risk of the cancer developing drug resistance. The rationale for using multiple antineoplastic agents is not accurately explained by any of the other options.

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. take the medication at bedtime. limit fluid intake. increase the protein in her diet.

Correct response: drink a lot of water. Explanation: 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.

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. Targeted therapies achieve the therapeutic benefits of traditional chemotherapy with no risk of adverse effects. Targeted therapies are significantly more cost-effective than traditional chemotherapeutic drugs. Targeted therapies have the potential to provide prophylactic protection against neoplasia in high-risk individuals.

Correct response: Targeted therapies have the potential to damage cancerous cells while leaving normal body cells less affected. Explanation: By focusing on molecular and cellular changes that are specific to cancer, targeted cancer therapies may be more effective than current treatments and less harmful to normal cells so that they may produce fewer adverse effects. However, adverse effects are not wholly absent. These drugs are not normally used as cancer prophylaxis and many are prohibitively expensive.

A middle-aged patient has received a diagnosis of GI stromal tumor following an extensive diagnostic workup. Imatinib has been recommended as a component of the patient's drug regimen. What patient education should the nurse provide to this patient? "You'll likely experience a lot of dry mouth while you're taking this drug, so it's helpful to chew ice chips." "It's important that you let us know if you develop any significant swelling or puffiness." "Try to keep your PICC line dressing as dry as possible at all times." "If you experience significant nausea after taking a dose, stop taking the drug and schedule an appointment at the clinic."

Correct response: "It's important that you let us know if you develop any significant swelling or puffiness." Explanation: Patients must understand the importance of reporting edema or weight gain while taking imatinib. The patient will not likely have a PICC line. Nausea and dry mouth are not common adverse effects and the patient should not unilaterally stop taking the drug.

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 Ineffective Airway Clearance related to decreased neurological function Risk for Imbalanced Nutrition: More Than Body Requirements related to metabolic effects of doxorubicin Risk for Infection related to suppressed bone marrow function Risk for Impaired Skin integrity related to cytotoxic effects of doxorubicin

Correct response: Risk for Infection related to suppressed bone marrow function Explanation: Because doxorubicin suppresses bone marrow function, the patient is at risk of leukopenia and subsequent infection. Impaired skin integrity is less likely and airway clearance will not normally be affected. Nutritional deficit, not excess, is common.

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? Explain it is not life-threatening. Forewarn about hair loss. Suggest the use of a wig or cap. Explain that hair preserves body heat.

Correct response: Suggest the use of a wig or cap. Explanation: The nurse can assist the patient in being comfortable with his or her body image by suggesting that the patient use a wig or cap until the hair grows back. The nurse should forewarn about hair loss to prepare the patient for the outcome of the treatment. The nurse should explain that hair preserves body heat and loss of hair is not life-threatening, and this will put the patient at ease during treatment.

A 49-year-old client is diagnosed with ovarian cancer. What is a characteristic of malignant cells that differentiates them from normal body cells? Cancerous cells do not require an energy source in order to proliferate. Cancerous cells grow in an uncontrollable fashion. Cancerous cells have a theoretically infinite life span. Cancerous cells are not responsive to the presence of drugs.

Correct response: Cancerous cells grow in an uncontrollable fashion. Explanation: Malignant cells have lost the normal genetic regulation that controls cell growth, invading normal tissues and taking blood and nutrients away from these tissues. They grow in an uncontrolled fashion without regard to growth regulation signals (e.g., contact with other cells) that stop the growth of normal cells. Cancerous cells, like all cells, have a finite life span and need energy. Cancerous cells are responsive to drugs; this is the rationale for treatment with antineoplastics.

A client on the oncology unit has begun chemotherapy with a regimen that includes bendamustine. The client has begun to experience alopecia. The nurse should prioritize assessments related to what potential nursing diagnosis? Impaired tissue integrity Hypothermia Disturbed body image Ineffective thermoregulation

Correct response: Disturbed body image Explanation: The physiologic consequences of alopecia are usually inconsequential. This adverse effect does not have a major effect on thermoregulation or tissue integrity. However, many clients find it distressing and experience a disturbance to their body image due to the significant and unwanted change in their appearance. The nurse should choose assessments and interventions accordingly

A 26-year-old man with testicular cancer is prescribed combination chemotherapy that involves using two drugs that are effective against testicular tumors. Combination drug therapy is superior to single-drug therapy because of: Decreased duration of remissions Lower risk for secondary cancers Higher tumor response rates Increased capillary permeability

Correct response: Higher tumor response rates Explanation: Combination therapy is considered superior over single-drug therapy because of higher tumor response rates and increased, not decreased, duration of remissions. Combination therapy does not pose a lower risk for secondary cancers, and increased capillary permeability is not the reason for the preference of combination therapy over monotherapy.

A male client is diagnosed with prostate cancer. The treatment modality of choice includes both surgery and chemotherapy. What does the chemotherapeutic option include? Hemoglobin replacement therapy Diuretics Antidiuretic hormone Hormonal therapies

Correct response: Hormonal therapies Explanation: Hormonal therapies that block the effects of estrogen (in an estrogen-responsive tumor) and androgen (in an androgen-responsive tumor), respectively, are essential in the treatment of breast and prostate cancers.

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

Correct response: Inspect the site frequently for redness or swelling Explanation: Site inspection is a major intervention for preventing extravasation. Distal veins should be used. Small veins in the hand or wrist should be avoided. An infusion pump should be avoided because it can continue to administer the drug under pressure, leading to severe extravasation.

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 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

Correct response: Risk for Infection related to bone marrow suppression Explanation: Like many cancer treatments, imatinib causes bone marrow suppression that creates a consequent risk of infection. The drug does not typically result in cognitive changes, fluid overload, or skin breakdown.

A 42-year-old female with breast cancer has had a radical mastectomy. She will have radiation therapy and then begin chemotherapy. Drug therapy will consist of a combination of doxorubicin, cyclophosphamide, and paclitaxel. What will the nurse include in the teaching plan concerning the drug therapy? Continue to go to church or to the mall just as she did before the diagnosis of cancer. Stay on a low-fat diet during the course of the drug therapy. Take special care when shaving or brushing her teeth. Stay in bed 2 days after each administration.

Correct response: Take special care when shaving or brushing her teeth. Explanation: Special care should be taken when shaving or brushing her teeth because she may bruise more easily than normal and gums may bleed. A cancer patient should not be on a diet during chemotherapy unless prescribed, and care should be taken to avoid crowds and public places where there is a greater risk of infection. Cancer patients should be as active, they should be careful not to over extend themselves physically, and they should remain active to promote optimal health.

A client is undergoing a cytotoxic chemotherapy regimen for the treatment of stage III lung cancer. What effect will this regimen likely have on the client's hemostatic function? The client will be at increased risk of deep vein thrombosis (DVT). The client will likely experience thrombocytosis. The client will require prophylactic heparin. The client's platelet count will decline.

Correct response: The client's platelet count will decline. Explanation: Thrombocytopenia, not thrombocytosis, is a common adverse effect of cytotoxic chemotherapy. Heparin is consequently contraindicated, and DVT is not a priority risk.

The nurse may be asked to administer which medications to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis? leucovorin amifostine allopurinol mesna

Correct response: allopurinol Explanation: The nurse may be asked to administer allopurinol to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis. Amifostine binds with metabolites of cisplatin to protect the kidneys from nephrotoxic effects, reduces xerostomia. Mesna binds with metabolites of ifosfamide to protect the bladder from hemorrhagic cystitis. Leucovorin provides folic acid to cells after methotrexate administration.

A nurse is providing education to a client who is preparing to begin chemotherapy for the treatment of cancer. What action should the nurse encourage the client to implement to minimize the effects of chemotherapy-triggered mucositis? limit fluid intake to prevent overhydration of mucous membranes thoroughly rinse the mouth often, especially before and after meals self-administer 650 mg of acetaminophen 4 times daily gargle with a commercial mouthwash 3 to 4 times daily

Correct response: thoroughly rinse the mouth often, especially before and after meals Explanation: A client who is experiencing mucositis should rinse the mouth several times daily, especially before meals (to decrease unpleasant taste and increase appetite) and after meals (to remove food particles that promote growth of microorganisms). Fluid intake should be increased, and commercial mouthwashes should be avoided. Analgesia therapy is usually topical, rather than oral.