Pharmacology PrepU Chapter 14: Antineoplastic Agents

A male patient has been on long-term bicalutamide (Casodex) therapy. In order to assess adverse effects of the drug therapy, the nurse will closely monitor: A. Visual function B. Pap test results C. Blood counts D. Liver function

Liver function

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? A. The client will require prophylactic heparin. B. The client will be at increased risk of deep vein thrombosis (DVT). C. The client will likely experience thrombocytosis. D. The client's platelet count will decline.

The client's platelet count will decline

A client asks the nurse why the chemotherapy is often administered in cycles. Which response by the nurse would be most appropriate? A. "The cycles are the only way to guarantee a cure for the cancer." B. "The cycles help to prevent the drugs from destroying the healthy cells." C. "We want to attack the cells that might be dormant or moving into a new phase." D. "The drugs are highly toxic, so the body needs time to recover."

"We want to attack the cells that might be dormant or moving into a new phase."

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

Cancerous cells grow in an uncontrollable fashion

A male client is informed that the latest tests indicate that his cancer has spread to his liver. The client receives capecitabine as part of his treatment regimen. What would the nurse expect the health care provider to do? A. Increase the dose of capecitabine. B. Monitor the client closely and repeat LFTs routinely. C. Add routine blood transfusions to the client's treatment regimen. D. Discontinue the capecitabine.

Monitor the client closely and repeat LFTs routinely -Capecitabine blood levels are significantly increased with hepatic impairment, and clients with liver metastases should be monitored closely.

An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease? A. Lymphoma B. Skin cancer C. Prostate cancer D. Lung cancer

Prostate Cancer -In male patients, antiandrogens are used to treat prostate cancer.

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? A. The use of three agents decreases the development of cell resistance. B. The use of three agents increases the length of treatment. C. The use of three agents increases the quantity of one of the agents. D. The use of three agents decreases the adverse effects.

The use of three agents decrease the development of cell resistance -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.

True or False: Anemia from chemotherapy treatment is the result of bone marrow suppression.

True -Adverse reactions common to many of the antineoplastic drugs include bone marrow suppression which in turn causes anemia, leukopenia and thrombocytopenia.

A parent hears the health care provider using the word extravasation. The parent asks the nurse what extravasation means. What would be a correct answer? A. "Extravasation is when blood vessels are severed." B. "Extravasation is when fluid is pooled in one part of the body." C. "Extravasation is a disease that causes shock." D. "Extravasation is when fluid escapes from a blood vessel into the surrounding tissue."

"Extravasation is when fluid escapes from a blood vessel into the surrounding tissue." -Extravasation is the escape of fluid from a blood vessel into surrounding tissues. Blood vessels are not cut for this to happen.

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? A. Disturbed body image B.Ineffective thermoregulation C. Impaired tissue integrity D. Hypothermia

Disturbed body image -Women of childbearing age should use an effective contraceptive during therapy with methotrexate. When taking methotrexate, the client should be instructed to notify the primary health care provider immediately at first sign of a rash or sore throat.

A male client is receiving parenteral cytotoxic medications in the home. Adjunct therapy may include what substance? A. Antidiuretic hormone B. Normal saline 0.9% intravenously C. Erythropoietin D. Heparin

Erythropoietin

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

Exposure to carcinogens

True or False: No cancer cells have been identified that can remain dormant for more than 2 years.

False -No cells have been identified that can remain dormant for more than 5 years.

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

Hormonal therapies -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? A. Infuse into proximal veins whenever possible B. Use an infusion pump C. Inspect the site frequently for redness or swelling D. Administer through a hand vein, if possible

Inspect the site frequently for redness or swelling -Site inspection is a major intervention for preventing extravasation. Distal veins should be used.

Which would the nurse identify as an antineoplastic antibiotic? A. Mitomycin B. Docetaxel C. Teniposide D. Vinblastine

Mitomycin -Mitomycin is an example of an antineoplastic antibiotic.

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? A. Skin B. Breast C. Testicles D. Ovaries

Skin -Skin cells proceed very rapidly through the cell cycle.

A nurse is performing discharge teaching with a client who will soon return home. The client will continue taking imatinib for the foreseeable future, and the nurse is teaching the client about the safe administration of this drug. How should the nurse instruct the client to take imatinib? A. With a glass of grapefruit or cranberry juice B. Thirty minutes before breakfast and in the early evening, at least 2 hours after dinner C. With food and a large glass of water D. On an empty stomach

With food and a large glass of water

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

Cell cycle specific -Chemotherapeutic drugs that are most effective during a particular phase of the cycle are known as cell cycle-specific.

A patient who is receiving methotrexate is also receiving leucovorin. The nurse understands that this drug is being given for which reason? A. Counteract effects of methotrexate B. Synergistic effect on the cancer cells C. Relief of nausea and vomiting D. Reduction of renal toxicity risk

Counteract effects of methotrexat -Leucovorin is administered with methotrexate to counteract the effects of methotrexate treatment.

A client is prescribed doxorubicin drug therapy for carcinoma of the breast. On the second day of drug therapy, she calls in to report reddish urine. What should the nurse do? A. Suggest some nonpharmacologic interventions. B. Caution the client against taking aspirin or caffeine. C. Reassure the client about adequate monitoring and follow-up in her home setting. D. Reassure the client that it is a harmless and expected response to the drug.

Reassure the patient that it is a harmless and expected response to the drug -Reddish urine is observed within a day or two after doxorubicin injection. The client should be reassured that it is a harmless and expected response to the drug.

What health education topic should the community health nurse emphasize when planning care for a client who will be prescribed an oral chemotherapy drug for the next several months while recovering at home? A. ways to match the dose to the severity of the symptoms B. appropriate herbal substitutes for the chemotherapy agent C. techniques for safely handling the drug D. techniques for self-monitoring of liver status

Techniques for safely handling the drug -All cytotoxic drugs are hazardous substances and require special handling and disposal, per safety guidelines, in the home. It is not possible for the client to independently monitor liver status in the home.

Fewer adverse effects are associated with monoclonal antibody therapy than those of cytotoxic drugs. However, some of the potential adverse effects of monoclonal antibodies can be life threatening, including which effect? A. heart failure and bleeding problems B. ischemic heart disease C. bronchoconstriction and pulmonary edema D. changes in cognition and personality changes

Heart failure and bleeding problems

A client's chemotherapy regimen has been deemed successful, but the client is experiencing debilitating nausea and vomiting. These adverse effects should signal the nurse to the possibility of what nursing diagnosis? A. Ineffective therapeutic regimen management B. Imbalanced nutrition: less than body requirements C. Adult failure to thrive D. Acute pain

Imbalanced nutrition: less than body requirements -Nausea and vomiting are major threats to the client's nutrition.

Which antineoplastic drugs are classified as antimetabolites? (Select all that apply.) A. Mercaptopurine (Purinethol) B. Irinotecan (Camptosar) C. Etoposide (Toposar) D. Capecitabine (Xeloda) E. Fluorouracil (Adrucil)

Mercaptopurine, Capecitabine, Fluorouracil -Antimetabolite drugs are substances that incorporate themselves into the cellular components during the S phase of cell division .

When preparing to administer ondansetron for a patient's nausea and vomiting, the nurse understands that this agent blocks: A. dopamine. B. norepinephrine. C. GABA. D. serotonin.

Seratonin

A patient is diagnosed with a brain tumor. The patient is told that the cancer cells proliferate. The patient asks the nurse what this means. What is the nurse's best response? A. "The proliferation of the cancer cells is the treatment with chemotherapy." B. "The proliferation is the growth of cancer cells and the rate of growth." C. "The proliferation of the cancer cells is the suppression of growth." D. "The proliferation of cancer cells is the metastasis of the tumor."

"The proliferation is the growth of cancer cells and the rate of growth."

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? A. "We need to notify the health care provider because this is a complication of the medication." B. "The reddish urine is an expected response to the drug." C. "Let's get a urinalysis to confirm a urinary tract infection." D. "You may have hemorrhagic cystitis."

"The reddish urine is an expected response to the drug." -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.

A 25-year-old female client is prescribed methotrexate to treat rheumatoid arthritis (RA). The nurse should teach the client to: A. use an effective contraceptive. B. drink milk with the medication. C. expect a mild rash and itching. D. take a pain reliever for sore throat.

use an effective contraception -Women of childbearing age should use an effective contraceptive during therapy with methotrexate. When taking methotrexate, the client should be instructed to notify the primary health care provider immediately at first sign of a rash or sore throat.

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? A. "If you experience significant nausea after taking a dose, stop taking the drug and schedule an appointment at the clinic." B. "You'll likely experience a lot of dry mouth while you're taking this drug, so it's helpful to chew ice chips." C. "It's important that you let us know if you develop any significant swelling or puffiness." D. "Try to keep your PICC line dressing as dry as possible at all times."

"It's important that you let us know if you develop any significant swelling or puffiness."

True or False: An adverse effect of tamoxifen therapy involves menopausal symptoms.

True

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

Intravenous -Carboplatin is administered IV on day 1 every 4 weeks.

A female client is ending an extensive chemotherapeutic regimen that included cytotoxic antineoplastic drugs. What does the nurse understand about bone marrow toxicity in this client? A. It is a rare side effect of the chemotherapy. B. It is a common adverse effect of her treatment. C. It will ultimately lead to death. D. It will cause the health care provider to increase the dose of chemotherapeutic medications.

It is a common adverse effect of her treatment -Traditional cytotoxic antineoplastic drugs are nonselective in their effect on proliferating cells; therefore, bone marrow toxicity is a common adverse effect of many cytotoxic drugs.

During which phase of the cell cycle would a nurse expect a mitotic inhibitor to act? A. S B. G1 C. G0 D. M

M

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

Risk for infection related to suppressed bone marrow function -Because doxorubicin suppresses bone marrow function, the patient is at risk of leukopenia and subsequent infection.

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? A.Risk for Deficient Fluid Volume related to changes in osmotic pressure B. Risk for Infection related to bone marrow suppression C. Risk for Impaired Skin Integrity related to exaggerated inflammatory response D. Risk for Acute Confusion related to adverse neurological effects of imatinib

Risk for infections related to bone marrow suppression -Like many cancer treatments, imatinib causes bone marrow suppression that creates a consequent risk of infection.

Tamoxifen achieves a therapeutic effect by which means? A. inducing apoptosis of cancer cells B. slowing the growth of cancer cells C. causing mutations of cancer cells D. increasing the viability of healthy cells that are adjacent to cancerous cells

Slowing the growth of cancer cells -Antineoplastic hormone inhibitors slow the growth of cancer cells.

The dosages of the chemotherapy agents that will be administered are based primarily on what client variable? A. weight B. body surface area (BSA) C. percentage of body water D. comorbidities

Weight

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? A. allopurinol B. amifostine C. mesna D. leucovorin

allopurinol -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.

A child is prescribed an anthracycline drug. The nurse would teach the parents to observe for signs and symptoms of what adverse effect? A. Esophageal varices B. Gallbladder disease C. Dehydration D. Cardiotoxicity

Cardiotoxicity

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 the: A. cell cycle. B. cell wall. C. immune system. D. lymphatic system.

Cell cycle

A female client will soon begin targeted therapy as a component of her treatment plan for chronic leukemia. The nurse is conducting health education about this new aspect of the client's drug regimen and the client has asked about the potential side effects of treatment. How should the nurse best respond? A. "Both classes of drugs have adverse effects, but targeted therapies tend to have less of an effect on healthy body cells." B. "Targeted therapies are often more effective than traditional chemotherapy, but the downside of this effectiveness is that adverse effects are more common and severe." C. "The adverse effects to targeted therapies are most often a result of the client's cancer, not the drugs themselves." D. "Chemotherapy causes a lot of unpleasant side effects, and the advantage of targeted therapies is that these are all avoided."

"Both classes of drugs have adverse effects, but targeted therapies tend to have less of an effect on healthy body cells." -Targeted therapies are generally considered to be less toxic than traditional chemotherapy drugs. However, adverse reactions to targeted therapies can occur such as severe skin reactions, GI toxicities, skin reactions, and thrombosis.

A client with a diagnosis of non-small-cell lung cancer is currently undergoing chemotherapy. At the encouragement of a family member, the client has announced to the nurse the intention to complement this treatment with a regimen of herbal remedies. How should the nurse respond to this client's statement? A. "It's likely best to begin taking herbal remedies after you've completed this round of chemotherapy." B. "Unfortunately, your current chemotherapy program will likely preclude the use of herbs." C. "It's important to discuss what herbs you'll be taking with your health care provider or the pharmacist to make sure there aren't any interactions." D. "If that's something in which you and your family see potential benefit, I'd encourage you to pursue it."

"It's important to discuss what herbs you'll be taking with your health care provider or the pharmacist to make sure there aren't any interactions."

A patient who will begin chemotherapy voices concern to the nurse about the accompanying nausea and vomitting. What is the best response by the nurse? A. "Not everyone has nausea and vomiting. Just wait to see how you will react to the chemotherapy." B. "Nausea and vomiting are an unfortunate side effect of the chemotherapy. We will do what we can but you may have it anyway." C. "We can relieve your nausea and vomiting with antiemetic drug therapy. You should ask for these medications whenever you need them." D. "We can relieve your nausea and vomiting with drugs but you can have them only before and after the chemotherapy."

"We can relieve your nausea and vomiting with antiemetic drug therapy. You should ask for these medications whenever you need them."

A patient having chemotherapy is losing her hair. She asks the nurse if her hair will come back as it originally was. What is the best response by the nurse? A. "I think you have more to worry about than if you have hair. You can buy a wig." B. "Your hair will grow back, but the new hair may be a different color or texture." C. "Your hair will grow back, but it will be very thin and straight." D. "Your hair may not grow back, but we can refer you to a wig specialist."

"Your hair will grow back, but the new hair may be a different color or texture." -Reassure patients that hair regrowth will occur; however, advise them that the new hair may be a different color or texture.

An adult client who has been diagnosed with a rectal tumor is scheduled to begin treatment with cisplatin.The nurse has conducted client teaching about the possibility of nausea and vomiting. In order to reduce the client's risk of severe nausea, the nurse should: A. encourage the client to request antiemetics if the nausea becomes unbearable. B. ensure that the client is NPO from midnight prior to receiving the drug. C. place the client on a low-residue diet. D. administer a combination of antiemetics prior to the administration of the drug.

Administer a combination of antiemetics prior to the administration of the drug -Antiemetics should be administered proactively rather than waiting until the client's nausea becomes unbearable. A combination approach is often effective.

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

Cancerous cells grow in an uncontrollable fashion -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.

When describing alkylating agents, the nurse would explain that this medication is seen as the prototype: A. Chlorambucil B. Fluorouracil C. Methotrexate D. Vincristine

Chlorambucil -Chlorambucil is the prototype alkylating agent.

A patient with acute lymphoblastic leukemia (ALL) is receiving imatinib on an inpatient basis. When planning the care of this patient, what assessment should be specified in the patient's plan of nursing care? A. bilateral blood pressures B. daily weights C. pupillary response D. assessment of deep tendon reflexes

Daily weights

After teaching a group of students about antineoplastic antibiotics, the instructor determines that the teaching was successful when the students identify which drug as an example? A. Vincristine B. Imatinib C. Doxorubicin D. Methotrexate

Doxorubicin

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: A. increase the protein in her diet. B. take the medication at bedtime. C. drink a lot of water. D. limit fluid intake.

Drink a lot of water -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.

A client with leukemia is being treated with a combination of antineoplastics, including methotrexate. The client's most recent laboratory results indicate the client is experiencing bone marrow suppression. What is the nurse's priority action? A. Provide small quantities of food several times per day, as tolerated. B. Encourage the client to limit physical activity in order to reduce the risk of bleeding. C. Ensure that all staff and visitors adhere to infection control precautions. D. Space out the client's care to preserve energy and prevent fatigue.

Ensure that all staff and visitors adhere to infection control precautions -The client's combination of cancer and bone marrow suppression creates an acute risk for infection. As a result, infection control is vital to maintaining the client's health and safety.

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: A. Increased capillary permeability B. Higher tumor response rates C. Lower risk for secondary cancers D. Decreased duration of remissions

Higher tumor response rates

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

Hodgkin Lymphoma -Procarbazine (Matulane) is used in combination therapy for treatment of stages III and IV of Hodgkin disease.

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

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

When describing the process of cancer cell growth to a client, the nurse addresses angiogenesis. Which description would the nurse include? A. A process that involves the cells traveling to other areas of the body to develop new tumors B. A process in which the cells lose their ability to differentiate and organize C. The process of creating new blood vessels to supply oxygen and nutrients to the cells D. The process of growing without the usual homeostatic restrictions that regulate cells

The process of creating new blood vessels to supply oxygen and nutrients to the cells

A client has chosen to receive palliative care after lung cancer metastasized to the bones and liver. Which is the most appropriate during palliative cancer care? A. the use of chemotherapy to reduce pain B. aggressive chemotherapy to reduce malignant cell proliferation C. Abrupt cessation of chemotherapy immediately prior to entering palliative care D. the replacement of chemotherapy with complementary and alternative treatments

The use of chemotherapy to reduce pain

What potential benefit is unique to biologic agent therapies? A. They may affect cancer cells while leaving normal body cells unaffected. B. Cytotoxic adverse effects are rarely experienced. C. They may be administered long term without the need for regular blood work. D. Administered does not require a certified chemotherapeutic nurse.

They may affect cancer cells while leaving normal body cells unaffected -Biologic agents target cellular differences between the malignant and normal cells. Consequently, they may kill cancer cells while leaving normal body cells unaffected.

What rationale should the nurse provide to the client when describing the necessity of recovery periods between treatment cycles of chemotherapy? A. The restoration of fluid balance and nutrition is needed before continuing with chemotherapy. B. Time is required for the successful application of radiotherapy between cycles of chemotherapy. C. Time is needed to replace many of the healthy body cells killed by chemotherapy. D. There is a need to restore a physiologic reserve of energy before further chemotherapy.

Time is needed to replace many of the healthy body cells killed by chemotherapy -Cyclic administration involves taking the drugs for a specific period, with a recovery period following each treatment cycle.

True or False: Cancer is considered the second leading cause of death in the United States.

True