NUR 108 Chapter 101 Basic Principles of Cancer Chemotherapy

B. Persistent proliferation Persistent proliferation is a characteristic of malignancy in which cells are able to continue multiplying under conditions that would suppress further growth and division of normal cells. Invasive growth describes a condition in which malignant cells are free of constraints that inhibit invasion to adjacent tissue. Metastases arise when malignant cells form in areas distant from the site of origin to form new cancers. Telomerase is an enzyme, and its activity allows for infinite cellular divisions in cancer cells. This activity is rarely expressed in normal cells.

"Unresponsiveness to feedback mechanisms that control cellular growth in healthy tissue" describes which of these characteristic of cancer cells? A. Invasive growth B. Persistent proliferation C. Telomerase activity D. Formation of metastases

A. S B. G1 D. M E. G2 Active phases of the cell cycle in which mitotic division are carried out are G1, S, G2, and M. Cells that enter G0 become mitotically dormant (resting) and are not active participants in the cell cycle. Cytotoxic agents are more active against proliferating cells than they are against cells in G0. The ratio of proliferating cells to G0 cells is called the growth fraction. A tissue with a large percentage of proliferating cells and few cells in G0 has a high growth fraction.

A high tissue growth fraction allows chemotherapeutic medications to be more toxic to tissues in which phases of the cell cycle? (Select all that apply.) A. S B. G1 C. G0 D. M E. G2

C. Obtain temperature frequently. The nadir is the lowest neutrophil count, which occurs between days 10 and 14 after chemotherapy. The usual signs of infection depend on a sufficient supply of neutrophils. In a patient who is neutropenic, monitoring fever as the principal early sign of infection is a priority for the diagnosis of infection, which can be life-threatening. Minimizing exposure to pathogens through daily oral hygiene, limiting visitors, and restricting fresh fruits and vegetables are also important, but they are not as important as monitoring fever as an early sign of infection when the usual signs are not present.

A nurse develops a plan of care for a patient receiving chemotherapy whose neutrophil count has reached the nadir. Which nursing action is the priority? A. Provide daily oral hygiene. B. Limit contact with visitors. C. Obtain temperature frequently. D. Restrict all fresh fruits and vegetables.

D. Use minimal cuff inflation when taking the blood pressure. Thrombocytopenia, a reduction in circulating platelets, increases the risk for bleeding. Routine procedures such as blood pressure readings should be performed with care and only as needed, because overinflation of the cuff may cause bruising. Taking the pulse before and after activity may be done to assess a patient's response to anemia. Administering a colony-stimulating factor and obtaining blood cultures are appropriate nursing actions for a patient with neutropenia.

A nurse is caring for a patient who has thrombocytopenia after chemotherapy. Which action should the nurse take? A. Take the pulse before and after activity. B. Administer a colony-stimulating factor. C. Obtain blood cultures and then begin antibiotic therapy. D. Use minimal cuff inflation when taking the blood pressure.

A. The nursing assistant delivers a fresh fruit basket to the patient's room. When working with hospitalized patients who are neutropenic, every precaution must be taken to prevent nosocomial infection. Patients should be given an isolation room and monitored frequently for fever. Certain foods, such as salads and fresh fruit, contain a great deal of pathogenic bacteria and must be avoided.

A patient with cancer who is neutropenic is hospitalized. Which action by the nursing assistant requires the supervising nurse to intervene? A. The nursing assistant delivers a fresh fruit basket to the patient's room. B. The nursing assistant obtains the patient's temperature at frequent intervals. C. The nursing assistant maintains isolation protocol for the patient. D. The nursing assistant assists the patient in basic hygiene as needed.

A. Gastrointestinal lining B. Bone marrow E. Sperm-forming cells Injury to normal cells occurs primarily in tissues with a high growth fraction, such as the bone marrow, gastrointestinal lining, and germinal epithelium of the testes. Chemotherapeutic agents lack selective toxicity, and the dosage cannot exceed an amount that produces the maximally tolerated injury to normal cells. The liver and brain are not considered tissues with high growth fractions.

Chemotherapy is dose limiting primarily because of toxicity to the cells in which tissues? (Select all that apply.) A. Gastrointestinal lining B. Bone marrow C. Liver D. Brain E. Sperm-forming cells

A. Invasive growth Malignant cells are free of the constraints that inhibit invasive growth.

The ability of malignant cells to penetrate adjacent tissues describes which of these characteristic of cancer cells? A. Invasive growth B. Persistent proliferation C. Telomerase activity D. Formation of metastases

B. Cytotoxic drugs Of the four major classes of anticancer drugs, the cytotoxic agents are used most often.

The nurse identifies which class of anticancer drugs as used most often in the treatment of patients? A. Targeted drugs B. Cytotoxic drugs C. Immunomodulating agents D. Biologic response modifiers

A. Administration of fluids B. Prophylactic administration of allopurinol Administration of fluids, prophylactic administration of allopurinol, and administration of rasburicase have been found be effective in minimizing renal injury from hyperurecemia when anticancer drugs are administered. Premedication with dexamethasone and ondansetron has been found to be effective in reducing the occurrence of nausea and vomiting associated with anticancer drug therapy.

When administering anticancer drugs, the nurse identifies which intervention(s) as effective in minimizing renal injury from hyperuricemia? (Select all that apply.) A. Administration of fluids B. Prophylactic administration of allopurinol C. Premedication with dexamethasone D. Premedication with ondansetron

B. Acute lymphocytic leukemia C. Certain testicular cancers As a rule, the most common cancers--solid tumors of the breast, lung, prostate, colon, and rectum--have a LOW growth fraction and therefore respond POORLY to cytotoxic drugs.

Which of the following are cancers with a high growth fraction and therefore respond well to cytotoxic drugs? Select all that apply. A. Breast cancer B. Acute lymphocytic leukemia C. Certain testicular cancers D. Lung cancer E. Prostate cancer

A. Common cancers do not respond well to drugs and must be managed primarily with surgery. Leukemia and Hodgkin's disease are rare types of cancers. The most common cancers are solid tumors of the breast, lung, prostate, colon, and rectum that have a low growth fraction and respond poorly to cytotoxic drugs. Therefore it must be managed with surgery as surgery is the most common treatment for solid cancers. All types of cancers are characterized by all four factors including the ability to form metastases. .

Which of the following statements regarding the most common cancers is correct? A. Common cancers do not respond well to drugs and must be managed primarily with surgery. B. Common cancers include leukemia and Hodgkin's disease. C. Common cancers have a high growth function, so they tend to respond well to cytotoxic drugs. D. Common cancers are cells characterized only by the ability to form metastases. .

A. Drug resistance occurs less frequently. Multiagent chemotherapy can suppress drug resistance, which is acquired through random mutational events. The probability of a cell undergoing the single mutation needed for resistance to one agent is greater than that of the cell undergoing two or more mutations and developing resistance to a combination of agents. Normal cell repopulation is needed for most chemotherapeutic agents, regardless of whether they are used alone or in combination. The intervals between dosages also depend on normal cell recovery. Combination therapy uses agents that are targeted to all phases of the cell cycle, not just the mitotic phase.

Which statement explains why cancer treatment is more effective when multiagent chemotherapy is used? A. Drug resistance occurs less frequently. B. The intervals between dosages are shorter. C. Normal cell repopulation is not necessary. D. The effect occurs during the mitotic phase of the cell cycle.

A. Surgery is the most common treatment for solid cancers. B. Drug therapy is the treatment of choice for disseminated cancers. D. Drug therapy is effective as an adjunct therapy in treating a patient who has had irradiation. Surgery is the most common treatment for solid cancers, drug therapy is the treatment of choice for disseminated cancers, and drug therapy plays an important role as an adjunct to surgery and irradiation. Drug therapy is the treatment of choice for disseminated cancers such as leukemias.

Which statement(s) regarding treatment modalities for treating cancer does the nurse identify as true? (Select all that apply.) A. Surgery is the most common treatment for solid cancers. B. Drug therapy is the treatment of choice for disseminated cancers. C. Drug therapy is not effective in treating a patient with cancer who has had surgery. D. Drug therapy is effective as an adjunct therapy in treating a patient who has had irradiation. E. Irradiation is the treatment of choice for leukemias.