Chapter 45 Antineoplastic Drugs

a

A patient is experiencing stomatitis after a round of chemotherapy. Which intervention by the nurse is correct? a Clean the mouth with a soft-bristle toothbrush and warm saline solution. b Rinse the mouth with commercial mouthwash twice a day. c Use lemon-glycerin swabs to keep the mouth moist. d Keep dentures in the mouth between meals.

b

A patient receiving chemotherapy is experiencing severe bone marrow suppression. Which nursing diagnosis is most appropriate at this time? a Activity intolerance b Risk for infection c Disturbed body image d Impaired physical mobility

Correct answer: D Rationale: Leucovorin "rescue" is prescribed to reduce the bone marrow suppression that is associated with high-dose methotrexate therapy

A patient who is receiving high-dose chemotherapy with methotrexate is also receiving leucovorin. The purpose of the leucovorin is to: A.produce an additive effect with the methotrexate by increasing its potency against the cancer cells. B. reduce the incidence of cardiomyopathy caused by the methotrexate. C. add its antiinflammatory effects to the treatment regimen. D. reduce the bone marrow suppression caused by the methotrexate.

d

"A patient is receiving leucovorin as part of his che- motherapy regimen. The nurse expects that the patient is receiving which antineoplastic drug? a. cladribine (Leustatin) b. fluorouracil (Adrucil) c. vincristine (Vincasar PFS) d. methotrexate (Trexall)"

"Extravasation"

"Mr. B. has just undergone a series of chemotherapeu- tic treatments when it is discovered that the antineo- plastic drug has leaked into surrounding tissues; in other words, __________ of the drug has occurred."

nadir

"Mr. C. is very interested in his chemotherapy process. As you are discussing a drug's action, he hears you use the term __________, and he asks you what it means. You explain that this is the point at which the lowest neutrophil count occurs after administration of a chemotherapy agent that causes bone marrow suppression."

nonspecific

"Mr. G. is receiving chemotherapy with a drug that is considered cytotoxic during any phase of the cellular growth cycle. This drug is known as cell cycle-________."

spread

"Mr. H. is told that his cancer has metastasized. His physician explains to him that this means it has __________ to other areas of his body."

leucovorin

"Mr. K. has been treated with methotrexate for its folate-antagonistic properties. Now, however, he seems to be experiencing a toxicity reaction. The treatment he will receive will be ________ rescue."

emetic

"Mr. Y.'s physician is not surprised to find that Mr. Y. has nausea and vomiting; the methotrexate therapy is displaying a strong __________ potential in this patient."

limiting

"Ms. F. has been given her first chemotherapy treat- ment. However, it soon becomes apparent that the adverse effects she is experiencing prevent her from being given dosages that will be high enough to be effective. These are dose-__________ adverse effects."

leukemia

"Ms. H. has a hematologic malignancy. Her bone marrow is being rapidly replaced with leukemic blasts; she also has abnormal numbers (and forms) of immature white blood cells in her circulation, and even her lymph nodes, spleen, and liver are be- ing infiltrated. Ms. H.'s type of cancer is known as _________."

benign

"Ms. L. recently underwent biopsy of a lump near her breast. Several days later, her physician calls and tells her that the lump is noncancerous and therefore is not an immediate threat to life. She is relieved to hear, then, that it is __________."

malignant

"Ms. P. had a biopsy performed on the same day that Ms. L. (6 Down) did. When her biopsy specimen is analyzed, however, the results are the opposite of Ms. L.'s; that is, her lump is considered __________."

8.2 mg 8.2 mL

"A patient will be receiving chemotherapy with IV cladribine (Leustatin). The order reads, "Give 0.09 mg/kg each day for 7 days." The medication is to be added to 500 mL of normal saline and is available in a 1-mg/mL solution. The patient weighs 200 pounds." "How many mg is each daily dose?" "How many milliliters of medication will be added to each infusion?"

d

"A patient will be receiving chemotherapy with pacli- taxel (Taxol). What will the nurse expect to do along with administering this drug? a. Administer platelet infusions. b. Provide acetaminophen (Tylenol) as needed. c. Keep the patient on "nothing-by-mouth" status because of expected nausea and vomiting. d. Premedicate with a steroid, H2 receptor antago- nist, and antihistamine."

"25,000 units; yes"

"A patient will be receiving daily doses of aspara- ginase (Elspar). The order is for 200 units/kg/day up to 40,000 units per dose IV. The patient weighs 275 pounds. How many units will the patient re- ceive per dose? Is this dose within the safe limit?

a

"As the nurse is preparing to give the patient chemo- therapy, the patient asks the nurse why more than one drug is used. The nurse will explain that combinations of chemotherapeutic drugs are used to: a. reduce drug resistance. b. reduce the incidence of adverse effects. c. decrease the cost of treatment. d. reduce treatment time."

c

"During chemotherapy, the nurse will monitor the pa- tient for which symptoms of stomatitis? a. Indigestion and heartburn b. Severe vomiting and anorexia c. Pain or soreness of the mouth d. Diarrhea and perianal irritation"

b

"If extravasation of an antineoplastic drug occurs, what will the nurse do first? a. Remove the intravenous catheter immediately. b. Stop the drug infusion without removing the in- travenous catheter. c. Aspirate residual drug or blood from the tube if possible. d. Administer the appropriate antidote."

a e

"The nurse is monitoring a patient who has developed thrombocytopenia after two rounds of chemotherapy. Which signs or symptoms will the nurse look for in this patient? (Select all that apply.) a. Bruising b Increased fatigue c Ulcerations on mucous membranes inside the mouth d. Temperature above 100.5o F (38.1o C) e. Increased bleeding from venipunctures"

a b c e f

"When administering antineoplastic drugs, the nurse needs to keep in mind that the general adverse ef- fects of these drugs include: (Select all that apply.) a. bone marrow suppression. b. infertility. c. diarrhea. d. urinary retention. e. nausea and vomiting. f. stomatitis."

folic

"Your patient is receiving methotrexate. Your instruc- tor asks for a full description of its mechanism of action, so you explain that it will inhibit dihydrofolic reductase from converting __________ acid to a reduced folate, and thus ultimately prevent the syn- thesis of DNA and cell reproduction. The result, you explain, is that the cell will die."

Correct answer: C Rationale: Both radiation and chemotherapy treatments can cause significant permanent fetal harm or death. The greatest risk is during the first trimester. Chemotherapy treatment during the second or third trimester is more likely to improve maternal outcome without significant fetal risk. However, radiation treatment poses great risk to the fetus throughout pregnancy and should be reserved for the postpartum period if possible. Prepubertal patients are more resilient, however, and can have normal puberty and fertility.

A pregnant woman has been diagnosed with cancer and is meeting with her oncologist to plan treatment. Which statement about chemotherapy and pregnancy is true? A She will have to wait until the baby is born before starting chemotherapy. B The greatest risk of fetal harm from chemotherapy is during the third trimester. C Chemotherapy treatment during the second or third trimester poses less risk to the fetus. D Chemotherapy is unsafe during pregnancy, but radiation therapy is safe in low doses.

A B D Administering a combination of antineoplastic drugs allows for smaller doses of each, which can minimize the severity of side effects and help prevent drug resistance. Additionally, there is a synergistic action between some of the medications. Decreasing cost is not a benefit of combination therapy.

Combinations of chemotherapeutic drugs are frequently used for which purpose? (Select all that apply.) A. Preventing drug resistance B. Providing a synergistic action C. Decreasing cost of treatment D. Decreasing the severity of adverse effects E. Decreasing drug tolerance

C Extensive research has indicated that there are cancer-causing viruses that can affect most mammalian species. Examples include human papillomavirus (HPV in humans), the various cat leukemia viruses, the Rous sarcoma virus in chickens, and the Shope papillomavirus in rabbits. The HPV now has a vaccination on market which is likely to decrease the chance of getting the virus which can lead to several different types of cancers.

Current research has lead to discovery of cancer-causing viruses. Which virus that is linked to cancer can be prevented by vaccination in humans? A. Rous sarcoma virus B. Shope papillomavirus C. Human papillomavirus D. Leukemia viruses

B Nadir refers to the average number of days it takes for a chemotherapeutic drug to have its peak effect on the bone marrow, which would coincide with the patient's lowest blood count and highest risk for infection and/or bleeding.

How would the nurse define the term nadir to a patient? A. The average number of days it takes the bone marrow to recover from a dose of chemotherapy B. The average number of days it takes for chemotherapy to have its peak effect on the bone marrow C. The patient's tolerance to the chemotherapy's bone marrow suppressant effect Incorrect D. The maximum dose for a chemotherapy drug in reference to bone marrow suppression

c

If extravasation of an antineoplastic medication occurs, which intervention will the nurse perform first? a Apply cold compresses to the site while elevating the arm. b Inject subcutaneous doses of epinephrine around the IV site every 2 hours. c Stop the infusion immediately while leaving the catheter in place. d Inject the appropriate antidote through the IV catheter.

C It is very important for patients undergoing chemotherapy to maintain adequate nutrition and hydration. Several antiemetic drugs are available that are very successful in controlling this side effect.

Nausea and vomiting are frequent adverse effects associated with antineoplastic therapy. Patients who are experiencing this unpleasant effect will be advised A. to avoid eating any food during chemotherapy. B. that nothing can be done for this effect and that it will pass with time. C. to try to maintain hydration and nutrition, which are very important during treatment. D. to use antacids to relieve the irritation to the stomach, which should stop the nausea.

Correct answer: C Rationale: Vincristine is the most significant neurotoxin of the cytotoxic drug class, but it continues to be used in part because of its relative lack of bone marrow suppression. Special care must be taken not to inadvertently give vincristine via the intrathecal route. Several deaths have been reported due to this error.

The nurse identifies which of the following as the most significant neurotoxin of the cytotoxic drug class? A.paclitaxel (Taxol) B.docetaxel (Taxotere) C.vincristine (Vincasar PFS) D. etoposide (Toposar)

b d e

The nurse is assessing a patient who has experienced severe neutropenia after chemotherapy and will monitor for which possible signs of infection? (Select all that apply.) a Elevated WBC count b Fever c Nausea d Sore throat e Chills

b

The nurse is caring for a patient who becomes severely nauseated during chemotherapy. Which intervention is most appropriate? a Encourage light activity during chemotherapy as a distraction. b Provide antiemetic medications 30 to 60 minutes before chemotherapy begins. c Provide antiemetic medications only upon the request of the patient. d Hold fluids during chemotherapy to avoid vomiting.

Correct answer: C Rationale: Fever is the principal early sign of infection, especially in those with a low white blood cell count. The presence of a fever is of utmost concern and should be reported immediately. Normal white blood cell count is 4,500-10,000 mcL.

The nurse is caring for a patient who received chemotherapy 24 hours ago. The patient's white blood cell count is 4,400 mcL. Which symptom, if experienced by the patient, should the nurse report to the prescriber immediately? A. Fatigue B. Diarrhea C. Fever D. Nausea and vomiting

d

The nurse monitors a patient who is experiencing thrombocytopenia from severe bone marrow suppression by looking for a severe weakness and fatigue. b elevated body temperature. c decreased skin turgor. d excessive bleeding and bruising.

C Leucovorin is given to block the systemic toxic effect of high-dose methotrexate. It is a form of folic acid that does not require dihydrofolate reductase to produce folic acid. Therefore it is used to prevent or treat toxicity induced by methotrexate, a folic acid antagonist. All the other options are chemotherapeutic drugs, which are not specifically associated with methotrexate.

The nurse would anticipate administering which medication to patients receiving high-dose methotrexate (Trexall)? A. bleomycin (Blenoxane) B. cisplatin (Platinol) C. leucovorin D. dactinomycin (Cosmegen)

27,000 units; yes

The order for chemotherapy reads: "Give asparaginase (Elspar) IV 200 units/kg/day." The patient weighs 297 lb. The pharmacy department will prepare the medication for intravenous infusion. How much drug will be given per dose? Is this a safe dose?

C Myalgias and arthralgias are a common side effect of paclitaxel that the patient should be prepared to expect.

When teaching a patient receiving paclitaxel (Taxol), the nurse needs to prepare the patient for which adverse effect? A. Weight gain B. Vertigo C. Arthralgias D. Hypertension

Correct answer: C Rationale: Risk of infection from leukopenia or neutropenia and/or immunosuppression is one of the more significant adverse effects that requires close attention. Following Standard Precautions and using good handwashing technique are most important in preventing transmission of infection in the hospital and home settings.

When working with a patient who is neutropenic, the nurse identifies which as the most effective measure to prevent the patient from developing an infection? A. Administer prophylactic antibiotics B. Stop administration of the chemotherapeutic drug C. Perform hand hygiene D. Vaccinate the patient to prevent bacterial infection

B C Bone marrow suppression (leukopenia, thrombocytopenia, and anemia) and alopecia are common adverse reactions to antineoplastic drugs. Urinary retention, hypertension, and leukocytosis are not expected side effects.

Which are general adverse effects of chemotherapy? (Select all that apply.) A. Leukocytosis B. Thrombocytopenia C. Alopecia D. Urinary retention E. Hypertension

Correct answer: A Rationale: Manifestations of tumor lysis syndrome include hyperphosphatemia, hyperkalemia, and hypocalcemia. These electrolyte abnormalities are often treated with diuretics such as mannitol, IV calcium supplementation, oral or rectal potassium exchange resin, and oral aluminum hydroxide. Hyperuricemia can lead to nephropathy, and hemodialysis may be required in severe cases of tumor lysis syndrome.

Which condition does the nurse anticipate when assessing a patient with tumor lysis syndrome? A. Hyperuricemia B. Hypophosphatemia C. Hypokalemia D. Hypercalcemia