Ch 14 Karch
A nurse educator is discussing the role of protooncogenes in the pathophysiology of cancer. What typically triggers protooncogenes to differentiate into oncogenes?
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 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?
"Your hair will grow back, but the new hair may be a different color or texture." Explanation: Reassure patients that hair regrowth will occur; however, advise them that the new hair may be a different color or texture.
A patient who is receiving methotrexate is also receiving leucovorin. The nurse understands that this drug is being given for which reason?
Counteract effects of methotrexate Explanation: Leucovorin is administered with methotrexate to counteract the effects of methotrexate treatment.
Start of Ch 14 Karch . A patient is receiving carboplatin. The nurse would expect to administer this drug by which route?
Intravenous Explanation: 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?
It is a common adverse effect of her treatment. Explanation: 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. These drugs kill the same fraction of cells with each cycle of chemotherapy treatment; repeated cycles of cytotoxic drugs potentially lower the number of cancer cells to a level where a person's immune responses are able to take over and destroy the remaining cancer cells.
A nurse is preparing to administer imatinib to a client. The nurse expects to administer this drug by which route?
Oral Explanation: Imatinib is administered orally.
A client who is taking chemotherapeutic medications has developed stomatitis. What intervention should the nurse include in the client's plan of care?
Provide mouth care frequently. Explanation: Stomatitis requires frequent mouth care. Commercial mouthwashes are likely to burn any open lesions, and stomatitis does not have a fungal etiology. Spicy or exceptionally hard foods should be avoided, but there is no need to limit the client's diet to minced and pureed foods.
. Cancer drugs are given in combination and over a period of time because it is difficult to affect
cells in the dormant phase of the cell cycle.
. Cancer can be a difficult disease to treat because
cells remain dormant, emerging months to years later.
Carcinomas are tumors that originate in
epithelial cells.
Which would the nurse identify as an antineoplastic antibiotic?
mitomycin Explanation: Mitomycin is an example of an antineoplastic antibiotic. Teniposide, vinblastine, and docetaxel are examples of mitotic inhibitors
Some properties of neoplastic cells are the same as the properties of normal cells, including
mitosis
A recent nursing graduate is receiving special training to become certified in handling and administering chemotherapy drugs. This special training is necessary because of what nursing diagnosis among clients receiving chemotherapy?
risk for injury related to chemotherapy Explanation: Because of the toxicity of chemotherapeutic agents, nurses who administer intravenous cytotoxic chemotherapy receive special training and are certified in handling and administering the chemotherapy drugs safely and accurately. Incorrect administration creates a serious risk for injury. Pain, contamination, and impaired health maintenance are not directly associated with incorrect administration.
The nurse is assessing a client for adverse effects related to methotrexate therapy. What diagnostic finding should the nurse prioritize?
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
In caring for clients undergoing chemotherapy, the nurse should monitor for what adverse effective triggered by the cytotoxic effect of the antineoplastic medication therapy? Select all that apply.
mucositis nausea diarrhea Explanation: Common adverse effects of chemotherapy include mucositis, diarrhea, and nausea. Peripheral neuropathy and increased urine output are not typical adverse effects.
The goal of traditional antineoplastic drug therapy is to
reduce the size of abnormal cell mass for immune system destruction
Cancer treatment usually occurs in several different treatment phases. In assessing the appropriateness of another round of chemotherapy for a particular patient the nurse would evaluate which of the following as most important?
Bone marrow function
How can a nurse best prevent tissue damage caused by an antineoplastic extravasation?
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
An oncology nurse is reviewing the medication administration record of a client being treated for advanced prostate cancer. In addition to two chemotherapeutic agents, the nurse reads that the client has been ordered a cytoprotective agent. What is the goal of treatment with this agent?
Reduce the incidence or severity of adverse drug effects. Explanation: Cytoprotectant agents reduce the adverse effects of cytotoxic drugs, some of which can be severe, debilitating, or life threatening. Cytoprotectant drugs do not potentiate chemotherapy, protect the client from the effects of cancer, or buffer cytotoxins.
A client with acute myeloid leukemia has been receiving mitoxantrone IV as part of the chemotherapeutic regimen. When assessing the client for the effects of bone marrow suppression, the nurse should perform what assessment?
Assessment of the client's activity tolerance and energy level Explanation: The decrease in red cells that accompanies bone marrow suppression causes fatigue. Effects of bone marrow suppression on respiratory status, kidney function and electrolytes are not as common or direct, though many antineoplastics affect these domains
Which of the following instructions would be most appropriate for a patient who is receiving temsirolimus?
Avoiding grapefruit juice Explanation: Although rest, fluids, and nutrition are important for any patient receiving an antineoplastic, a patient receiving temsirolimus needs to avoid grapefruit juice because of possible drug-food interaction.
A child is prescribed an anthracycline drug. The nurse would teach the parents to observe for signs and symptoms of what adverse effect?
Cardiotoxicity Explanation: Children who receive an anthracycline drug (e.g., doxorubicin) are at increased risk of developing cardiotoxic effects (e.g., heart failure) during treatment or after receiving the drug. Efforts to reduce cardiotoxicity include using alternative drugs when effective, giving smaller cumulative doses of anthracycline drug, and observing clients closely so that early manifestations can be recognized and treated before heart failure occurs.
The nurse is administering a client's chemotherapeutic drug through a peripheral IV site, and the nurse observes that extravasation has occurred. What is the nurse's best action?
Stop the infusion and inform the health care provider immediately. Explanation: Extravasation should prompt the nurse to stop the infusion and collaborate promptly with the care provider. A bolus would cause more harm than benefit by distributing the drug in compromised tissue. Monitoring is not a sufficient response, and another IV site may or may not be needed.
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?
Imbalanced nutrition: less than body requirements Explanation: Nausea and vomiting are major threats to the client's nutrition. Failure to thrive is typically a chronic, rather than acute, health problem. Pain does not necessarily accompany nausea, and there is no indication that this client is not maintaining the necessary regimen.
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. 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 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?
daily weights Explanation: Imatinib may be associated with edema and significant fluid overload. Patients should be weighed regularly and assessed for signs of fluid retention. Reflexes, bilateral inequalities in blood pressure, and alterations in pupil response are not associated with the use of imatinib.
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?
"Both classes of drugs have adverse effects, but targeted therapies tend to have less of an effect on healthy body cells." Explanation: 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?
"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." Explanation: Herbal remedies are not necessarily contraindicated during chemotherapy, but their safety must be carefully assessed to prevent adverse interactions.
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?
"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 patient who will begin chemotherapy voices concern to the nurse about the accompanying nausea and vomiting. What is the best response by the nurse?
"We can relieve your nausea and vomiting with antiemetic drug therapy. You should ask for these medications whenever you need them." Explanation: Reassure patients that nausea and vomiting can be relieved with antiemetic drug therapy and emphasize that they should request these agents when needed.
A client is being treated for cancer and dronabinol has been added to the client's current medication regimen. What assessment finding would indicate a therapeutic effect of this medication?
Absence of nausea Explanation: Dronabinol is an antiemetic that is a derivative of delta-9-tetrahydrocannabinol, the active ingredient in marijuana. Absence of nausea would suggest that it is having the intended effect. It is not administered to increase energy, prevent leukopenia or treat pain.
A client is receiving idarubicin. What is the nurse's priority assessment?
Cardiac function Explanation: The client's cardiac function needs to be monitored closely because idarubicin is specifically toxic to the heart. The pancytopenia that accompanies antineoplastics can cause decreased red cell indices, but this does not address the particular threat to the cardiac system posed by idarubicin. Respiratory function is not commonly impacted by idarubicin. Electrolyte levels should be monitored in clients receiving any antineoplastic study due to adverse effects impacting nutrition and kidney function, but are not specific to idarubicin.
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 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.
When describing the use of the various agents for combating chemotherapy-induced nausea and vomiting, the nurse understands that the majority of these agents block:
Chemoreceptor trigger zone Explanation: The majority of agents used to control nausea and vomiting secondary to chemotherapy directly block the CTZ. They do not affect neurotransmitters, gastric acidity, or the gag reflex.
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?
Doxorubicin Explanation: Doxorubicin is the prototype antineoplastic antibiotic. Vincristine is the prototype mitotic inhibitor. Imatinib is the prototype protein tyrosine kinase inhibitor. Methotrexate is the prototype antimetabolite.
The nurse understands that when administering cisplatin, the drug has a high potential for causing severe nausea and vomiting. What term is used to describe this group of antineoplastic drug?
Emetogenic Explanation: Cisplatin belongs to a group of antineoplastic drugs called emetogenics, which have high potential for causing severe nausea and vomiting.
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?
Ensure that all staff and visitors adhere to infection control precautions. Explanation: 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. Nutrition and energy conservation strategies are also important, but infection control is a safety priority. The client likely has a risk for bleeding, but the harm of activity limitation outweighs the benefits for most clients
A male client is receiving parenteral cytotoxic medications in the home. Adjunct therapy may include what substance?
Erythropoietin Explanation: Clients may receive parenteral cytotoxic drugs as outpatients and return home, or these and other antineoplastic drugs may be administered at home by the client or a caregiver. If a client is receiving erythropoietin or oprelvekin subcutaneously, the client or a caregiver may need to be taught injection technique
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?
Extravasation is when fluid escapes from a blood vessel into the surrounding tissue." Explanation: Extravasation is the escape of fluid from a blood vessel into surrounding tissues. Blood vessels are not cut for this to happen. Edema is when fluid is pooled in one area of the body. Extravasation is not a disease. In some types of shock, extravasation occurs.
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
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 client's chemotherapeutic regimen includes procarbazine. What is the client's most likely diagnosis?
Hodgkin lymphoma Explanation: Procarbazine (Matulane) is used in combination therapy for treatment of stages III and IV of Hodgkin disease.
A male client is diagnosed with prostate cancer. The treatment modality of choice includes both surgery and chemotherapy. What does the chemotherapeutic option include?
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 client is being treated on the oncology unit and has developed worsening adverse effects over the past several days of chemotherapy. Administration of filgrastim may aid in achieving what desired outcome?
Increased leukocytes Explanation: Severe neutropenia can be prevented or its extent and duration minimized by administering filgrastim or sargramostim to stimulate the bone marrow to produce leukocytes. Filgrastim does not address the risk of inflammation (mucositis), abnormal platelet production, or bleeding (hemorrhagic cystitis).
A male patient has been on long-term bicalutamide therapy. In order to assess adverse effects of the drug therapy, the nurse will closely monitor:
Liver function Explanation: It is important for the nurse to monitor the client's liver function closely if the client is on prolonged therapy with an antiandrogenic agent. Adverse effects of the therapy include gynecomastia, diarrhea, hot flashes, breast pain, impotence, loss of libido, and abnormal liver functions. Monitoring of blood counts, an annual pap smear, and regular visual function tests are advised for clients undergoing tamoxifen therapy.
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?
Monitor the client closely and repeat LFTs routinely. Explanation: 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?
Prostate cancer Explanation: In male patients, antiandrogens are used to treat prostate cancer. They are not included in treatment of lymphomas, skin cancer, or lung cancer.
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 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?
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.
The client has just been started on an alkylating agent to treat testicular cancer. What assessment finding would suggest that the client is experiencing a common adverse effect of this medication?
The client's most recent laboratory results indicate pancytopenia. Explanation: Hematological effects include bone marrow suppression, with leukopenia, thrombocytopenia, anemia, and pancytopenia, secondary to the effects of the drugs on the rapidly multiplying cells of the bone marrow. Bone pain, depression, and disorientation are not common adverse effects of alkylating agents.
What should the oncology nurse understand when administering a cell cycle-nonspecific chemotherapeutic agent about its effect?
The drug will be effective through all phases of the cell cycle. Explanation: Drugs that are effective through all phases of the cell cycle and not limited to a specific phase are classified as cell cycle-nonspecific.
A nurse is caring for a client who has received antineoplastic therapy. The client has developed inflammation of the oral mucous membrane, which is affecting his nutritional status. Which action by the nurse would be most appropriate? Select all that apply.
The nurse should suggest that the client provide mouth care with normal saline every 4 hours and offer soft or liquid foods. Use of toothpaste, lemon or glycerin swabs, or alcohol-based mouthwash for oral care is not suggested as they cause further irritation to the oral mucosa and complicate stomatitis.
When describing the process of cancer cell growth to a client, the nurse addresses angiogenesis. Which description would the nurse include?
The process of creating new blood vessels to supply oxygen and nutrients to the cells Explanation: Angiogenesis refers to the process in which abnormal cells release enzymes that generate blood vessels in the area to supply both oxygen and nutrients to the cells. Metastasis refers to process of traveling from the place of origin to develop new tumors in other areas of the body. Autonomy refers to the process of growing without the usual homeostatic restrictions that regulate cell growth and control. Anaplasia refers to the process in which the cells lose their ability to differentiate and organize, which leads to a loss in their ability to function normally.
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 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.
Prior to administering a dose of 5-FU to a patient with pancreatic cancer, the nurse is conducting the necessary drug research. The nurse is aware that 5-FU is a cell cycle-specific chemotherapeutic agent. Which statement best describes cell cycle-specific drugs?
They affect cancerous cells during a particular phase of cellular reproduction. Explanation: Chemotherapeutic drugs that are most effective during a particular phase of the cycle are known as cell cycle- (or cell phase) specific, whereas drugs that act independently of a specific cell cycle (or cell phase) are cell cycle-nonspecific. Not all cell cycle-specific drugs achieve a synergistic effect with cell cycle-nonspecific drugs. These drugs are not named because of the particular sequence of cytotoxic events that they cause
The nurse is describing the necessity of recovery periods between treatment cycles to a client receiving chemotherapy. How should the nurse best explain the need?
Time is needed to replace many of the healthy body cells killed by chemotherapy. Explanation: Cyclic administration involves taking the drugs for a specific period, with a recovery period following each treatment cycle. The recovery period allows time for the client to produce new, healthy cells to replace the normal rapidly dividing cells that have been affected by the drugs. Recovery time is unrelated to energy reserves, fluid balance, and nutrition. Recovery time does not necessarily correspond to the schedule for radiation therapy; not every client who receives chemotherapy will receive radiation therapy.
Which drug would be classified as a mitotic inhibitor?
Vincristine Explanation: Vincristine is classified as a mitotic inhibitor. Fluorouracil and methotrexate are classified as antimetabolites. Chlorambucil is classified as an alkylating agent.
The nurse is caring for a client whose current chemotherapy regimen includes mitomycin. What is the client's most likely diagnosis?
adenocarcinoma of the pancreas Explanation: Mitomycin is used before the treatment of disseminated adenocarcinoma of the stomach and pancreas. It is not indicated in the treatment of non-Hodgkin lymphoma, lung cancer, or neuroblastoma.
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:
administer a combination of antiemetics prior to the administration of the drug. Explanation: Antiemetics should be administered proactively rather than waiting until the client's nausea becomes unbearable. A combination approach is often effective. A low-residue diet is unnecessary, and withholding food does not necessarily reduce nausea
Which agents would be considered cancer non-cell cycle specific agents?
alkylating agents Explanation: Alkylating agents affect cells in all phases of the cell cycle and are considered non-cell cycle specific. Antimetabolites are considered to be S phase specific agents. Mitotic inhibitors are cell cycle-specific agents working in the M phase of the cell cycle. Protein tyrosine kinase inhibitors target specific enzymes needed for protein building by specific tumor cells. They do not affect healthy human cells.
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?
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.
Antineoplastic drugs destroy human cells. They are most likely to cause cell death among healthy cells that
are rapidly turning over.
A client is receiving tamoxifen. Which adverse effect would be most specific to the action of this drug?
menopausal effects Explanation: Tamoxifen belongs to the group of drugs that are hormones or hormone modulators. These agents are hormone specific. This drug competes with estrogen at the receptor sites, ultimately blocking estrogen. The adverse effects specific to this action would involve menopause-associated effects. Bone marrow suppression, GI toxicity, and hepatic dysfunction occur with this drug, but these are not specific to the drug's action.
A nurse is caring for a 46-year-old female patient who is taking paclitaxel for ovarian cancer. Two or three days after the infusion of the drug, the nurse must closely monitor for:
neurotoxicity. Explanation: Neurotoxicity is a major problem associated with paclitaxel therapy, and close monitoring is needed. Neurotoxicity generally begins 2 to 3 days after the infusion. Cardiotoxicity is observed in less than 1% of patients. The drug is not known to cause constipation or asthma.
When preparing to administer ondansetron for a patient's nausea and vomiting, the nurse understands that this agent blocks:
serotonin. Explanation: Ondansetron blocks serotonin receptors in the chemoreceptor trigger zone.
The community health nurse is planning care for a client who will be prescribed an oral chemotherapy drug for the next several months while recovering at home. What health education topic should the nurse emphasize?
techniques for safely handling the drug Explanation: 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. Herbal substitutes for chemotherapy drugs do not exist, and doses are not adjusted based on short-term symptoms.
It is important to explain to women that chemotherapeutic agents should not be used during pregnancy because
of potential serious adverse effects on the rapidly multiplying cells of the fetus.
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?
"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 of the following points would be most important for the nurse to stress when developing a patient-teaching plan for a patient receiving antineoplastic therapy?
- The importance of keeping the head covered at extremes of temperature. - The need to use barrier contraceptives because of the risk of serious fetal effects. - The importance of avoiding exposure to infection because the ability to heal or to fight infection is impaired. - The importance of avoiding digging in the dirt without protective coverings because of the many pathogens that live in the dirt that could cause infection. - The importance of taking periodic rest periods during the day because you will feel tired when your red blood cell count falls.
The nurse on an oncology unit is providing care for several clients with cancer, most of whom are receiving chemotherapy. What client should the nurse prioritize?
A client with hairy cell leukemia receiving pentostatin whose urine output is 35 mL over the past 12 hours Explanation: Oliguria is suggestive of renal failure and requires prompt intervention. It would be prioritized over nausea and mucositis, even though the nurse should address both of these problems. Similarly, the care team should address the client's drop in hemoglobin but it is not so precipitous that it would be more time-dependent than a client with possible acute renal failure.
During which phase of the cell cycle would a nurse expect a mitotic inhibitor to act?
M Explanation: Mitotic inhibitors act during the M phase of the cell cycle.
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?
Reassure the client that it is a harmless and expected response to the drug. Explanation: 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. Nonpharmacologic interventions should be reviewed only if the client reports nausea and vomiting. Though it is necessary to reassure the client about adequate monitoring and follow-up in her home setting and caution her against taking aspirin, these suggestions do not pertain to the occurrence of reddish urine.
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 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 postmenopausal woman with breast cancer will most likely be treated with which anti-estrogen drug?
Tamoxifen Explanation: Anti-estrogens are first-line therapy for treating breast cancer in postmenopausal women. Tamoxifen is the most widely recognized anti-estrogen.
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. 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 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'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.
A client is administered mesna to prevent cystitis induced by ifosfamide. How will this medication combination prevent cystitis?
The medication combines with the metabolite of ifosfamide. Explanation: Mesna is used with ifosfamide, which produces a metabolite that causes hemorrhagic cystitis. Mesna combines with and inactivates the metabolite, thereby decreasing cystitis.
A client with Hodgkin disease has been prescribed vincristine. What nursing consideration should the nurse prioritize when administering this drug?
The nurse should avoid any skin, eye, or mucous membrane contact with the drug. Explanation: Special care needs to be taken when administering mitotic inhibitors. The nurse should avoid any skin, eye, or mucous membrane contact with the drug. This type of contact can cause serious reactions and toxicity for the nurse. The nurse should check for extravasation frequently during the infusion and not wait until the infusion is completed. A distal vein should be use. Nausea and vomiting are commonly experienced adverse effects of these drugs. Small meals may help the client to maintain adequate nutrition, but this is not the important concern when administering the drug.
A 51-year-old female patient has been receiving doxorubicin for metastatic breast cancer. Her medical record indicates she has cardiomyopathy and a cumulative dose of 300 mg/m2 of doxorubicin. Which measure would help limit the severity of the cardiomyopathy in this client?
The use of dexrazoxane in conjunction with doxorubicin Explanation: Dexrazoxane, a cardioprotectant, is recommended to reduce the severity and incidence of cardiomyopathy associated with doxorubicin for women with metastatic breast cancer who received a cumulative dose of 300 mg/m2. Meticulous monitoring or multiplying daily doses would not reduce the severity and incidence of cardiomyopathy as effectively as using dexrazoxane, and reducing the dosage is not advisable.
The nurse is caring for a client who is receiving a combination of antineoplastic agents. The client has been told that alopecia is likely to occur, and the client is tearful and distraught about this. What is the nurse's best response?
Validate the client's sense of impending loss and offer guidance for getting a wig. Explanation: The nurse should empathically validate the client's sense of loss. Offering to assist with a practical solution is also useful. The facts that the hair loss is temporary and happens to other people are unlikely to provide any real consolation. Similarly, telling the client to see it as a positive is likely to be interpreted as simplistic.
Based on the nurse's understanding of antineoplastic drugs, the nurse would anticipate administering which in conjunction with doxorubicin as a cardioprotective agent?
dexrazoxane Explanation: Dexrazoxane is administered concomitantly with doxorubicin as a cardioprotective agent. Leucovorin provides folic acid to cells after methotrexate administration. Mesna binds with metabolites of ifosfamide to protect the bladder from hemorrhagic cystitis. Amifostine binds with metabolites of cisplatin to protect the kidneys from nephrotoxic effects, reduces xerostomia.
The nurse is caring for a client whose current antineoplastic regimen includes bicalutamide. The nurse should anticipate what additional aspect of this client's cancer treatment?
prostatectomy Explanation: Bicalutamide is administered in combination with a luteinizing hormone for the treatment of advanced prostate cancer. This medication would not be effective for treating bowel, thyroid or breast cancer because it is a hormone modulator and works only on androgen-receptor sites.
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?
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.
Hair loss, or alopecia, is an adverse effect of many antineoplastic agents. If a client is receiving a drug that usually causes alopecia, it is important that the nurse do which of the following?
- Warn the patient that alopecia will occur. - Encourage the patient to arrange for an appropriate head covering at extremes of temperature. - Encourage the patient to arrange for a wig or other head covering before the hair loss occurs. Advise the patient that people will stare and can be rude when hair loss occurs.
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 what?
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.
Which antineoplastic drugs are classified as antineoplastic antibiotics? (Select all that apply.)
Bleomycin (Blenoxane) Dactinomycin (Cosmegen) Daunorubicin (DaunoXome) Explanation: Antineoplastic antibiotics have similar action to alkylating drugs and include bleomycin , dactinomycin , and Daunorubicin .
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 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 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?
With food and a large glass of water Explanation: Imatinib should be taken with food and a large glass of water.
The nurse is providing medication education to a client with breast cancer who has been prescribed tamoxifen. How should the nurse explain the action of the drug?
slows the growth of cancer cells Explanation: Antineoplastic hormone inhibitors slow the growth of cancer cells. They do not treat cancer by causing apoptosis (cell repair) or mutations. They do not influence healthy body cells in the area of the tumor.
