Chapter 55: Targeted Therapies

Rituximab has been prescribed for a patient who has longstanding history of severe rheumatoid arthritis that has been minimally responsive to standard therapies. When assessing the patient prior to the start of the course of treatment, what assessment question is the nurse's priority? "Do you have any history of heart disease or irregular heart rhythms?" "How would you describe your normal diet?" "Have you been in contact with anyone who has tuberculosis in the last several months?" "Are all of your vaccinations currently up to date?"

"Do you have any history of heart disease or irregular heart rhythms?"

A patient newly diagnosed with CML has been prescribed treatment with imatinib. The patient asks the nurse how imatinib works. What would be the nurse's best response? "Imatinib inhibits folic acid reductase, leading to inhibition of DNA synthesis and inhibition of cellular replication." "Imatinib binds to DNA and inhibits DNA synthesis in susceptible cells, causing cell death." "Imatinib alkylates cellular DNA." "Imatinib inhibits the enzyme created by the Philadelphia chromosome abnormality in CML."

"Imatinib inhibits the enzyme created by the Philadelphia chromosome abnormality in CML."

Basiliximab (Simulect) is a monoclonal antibody that is an IL-2 receptor antagonist. A pharmacology professor asks the class to describe this drug's characteristics. Which of the following responses indicates the students understand the drug? Select all that apply. "Patients will report gastrointestinal upset." "A patient taking this drug will have a WBC count above 6,000 cells/mL." "It acts by binding to and blocking the CD25 antigen receptor site." "It helps with allograft rejection."

"It acts by binding to and blocking the CD25 antigen receptor site." "It helps with allograft rejection." "Patients will report gastrointestinal upset."

Infliximab (Remicade) is a monoclonal antibody, a chimeric human-murine IgG antibody. A pharmacology professor asks the class to describe this drug. Which of the following statements indicate a student knows all about infliximab? Select all that apply. "The patient may report having acne breakouts." "It is licensed for treating moderate to severe Crohn's disease." "It acts by blocking tumor necrosis factor (TNF)." "The most common adverse effect is gastric upset."

"It acts by blocking tumor necrosis factor (TNF)." "It is licensed for treating moderate to severe Crohn's disease." "The patient may report having acne breakouts."

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? "The proliferation of cancer cells is the metastasis of the tumor." "The proliferation of the cancer cells is the suppression of growth." "The proliferation of the cancer cells is the treatment with chemotherapy." "The proliferation is the growth of cancer cells and the rate of growth."

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

The nursing student asks the instructor why the newer targeted therapies are more effective than what is currently being used for cancer treatment. What is the best response by the instructor? "The targeted cancer therapies will eliminate the need for other drugs to be used with them." "The targeted cancer therapies are less expensive than the current therapies, and more patients are seeking treatment." "The targeted cancer therapies have fewer adverse effects than current therapies." "The targeted cancer therapies are more toxic and more effective than current therapies."

"The targeted cancer therapies have fewer adverse effects than current therapies."

Which of the following patients has the greatest potential to benefit from treatment with rituximab? A lifelong smoker who has been diagnosed with non-small cell lung cancer A woman who has been diagnosed with ductal carcinoma in situ A man with AIDS who is currently being treated for Kaposi's sarcoma A woman who has chronic lymphocytic leukemia

A woman who has chronic lymphocytic leukemia

Alemtuzumab (Campath 1-H) is humanized monoclonal antibody directed against the CD52 cell surface antigen. Which of the following best describes this drug? Select all that apply. Lymphocyte counts only need to be monitored monthly risk for cytomegalovirus B- and T-cell chronic lymphocytic leukemia only given intravenously

B- and T-cell chronic lymphocytic leukemia risk for cytomegalovirus

The nurse is caring for a patient with a history of uncontrolled hypertension. For which chemotherapy agent should the nurse question an order? Panitumumab (Vectibix) Ofatumumab (Arzerra) Abciximab (ReoPro) Bevacizumab (Avastin)

Bevacizumab (Avastin)

What discharge instructions should the nurse provide to the patient going home after rituximab therapy? Consume large amounts of water and report decreased urine output. Eat a bland diet for 24 hours after therapy. Limit fluid intake to 1 L per 24 hour period and report increased urine output. Take acetaminophen for the discomfort related to the transfusion.

Consume large amounts of water and report decreased urine output.

A patient has been diagnosed with cancer. The physician prescribes antineoplastic drug therapy to the patient. How should the nurse explain the use of antineoplastic drugs? Complete relief of symptoms of cancer. Delays spread of cancer to other sites. Leads to complete cure of cancer. Destroys only cancerous cells.

Delays spread of cancer to other sites.

The nurse is preparing to administer temsirolimus (Torisel) to a patient with metastatic renal carcinoma. With what should the nurse prepare to premedicate the patient? Solu-Cortef Solu-Medrol Diphenhydramine Epinephrine

Diphenhydramine

A patient taking antihypertensive medication is beginning rituximab therapy. What should the nurse instruct the patient to do prior to starting the rituximab? Hold the antihypertensive medications for 24-48 hours after the rituximab has been administered. Take the antihypertensive medication 30 minutes before rituximab therapy and hold 12 hours after. Be sure and take the antihypertensive medication the morning prior to rituximab therapy. Hold the antihypertensive medication for 12 hours before rituximab administration and 12-24 hours after.

Hold the antihypertensive medication for 12 hours before rituximab administration and 12-24 hours after.

A 46-year-old woman is undergoing treatment for breast cancer, and her current course of chemotherapy will be supplemented with trastuzumab (Herceptin). The nurse should anticipate which of the following routes of administration? Subcutaneous injection once a day for 1 week and then twice daily for the duration of treatment Oral administration of trastuzumab once a week in the home setting Intravenous administration with a dosage based on the patient's body weight Weekly intramuscular injections, either as an inpatient or an outpatient

Intravenous administration with a dosage based on the patient's body weight

A patient is administered bevacizumab (Avastin) to treat tumor growth in a breast tumor. What is the action of bevacizumab (Avastin)? It binds to the 30S ribosome. It inhibits the formation of blood vessels. It changes the RNA of the tumor cell. It blocks the cell wall synthesis.

It inhibits the formation of blood vessels.

A patient has received a large amount of chemotherapy to treat leukemia. The patient develops gastrointestinal upset, hypertension, and paresthesias. What syndrome is the patient developing? Epidermal nevus syndrome Irritable bowel syndrome Lysis syndrome Fröhlich's syndrome

Lysis syndrome

A nurse is caring for a patient who is undergoing chemotherapy. The patient has experienced several episodes of vomiting. Which of the following activities should the nurse perform as part of ongoing assessment for signs of dehydration and electrolyte imbalances? Measure and record patient's temperature Measure and record patient's blood pressure Observe the results of liver function tests Measure all fluid intake and output

Measure all fluid intake and output

The nurse is caring for a patient who had renal transplantation. What drug will the nurse administer to prevent allograft rejection in this patient? Muromonab-CD3 (Orthoclone OKT3) Basiliximab (Simulect) Denosumab (Xgeva) Daclizumab (Zenapax)

Muromonab-CD3 (Orthoclone OKT3)

For which condition does the nurse understand the physician will order a combination therapy of rituximab and methotrexate? Rheumatoid arthritis Osteoarthritis Ulcerative colitis Pseudomembranous colitis

Rheumatoid arthritis

The nurse is administering rituximab to a patient who develops an infusion-related reaction. What should the first action by the nurse be? Administer only one half of the dose until the medication is complete. Administer epinephrine 0.3 mL subcutaneously. Administer a corticosteroid medication. Stop the drug until the symptoms resolve.

Stop the drug until the symptoms resolve.

The nurse is caring for a patient taking erlotinib (Tarceva) for the treatment of non-small cell lung cancer. In providing discharge instructions, how should the nurse inform the patient to take this medication? Take the pills with food. The pills may have a bitter taste and can be crushed and taken with applesauce. Take the pills with milk. Take the medication on an empty stomach 1 hour before and 2 hours after food.

Take the medication on an empty stomach 1 hour before and 2 hours after food.

The nurse is administering rituximab therapy when the patient has a seizure and then progresses into a comatose state. What does the nurse recognize has possibly occurred with this patient? The patient has developed meningococcal meningitis. The patient has a pre-existing electrolyte disorder. The patient had an undiagnosed seizure disorder. The patient has progressive multifocal leukoencephalopathy.

The patient has progressive multifocal leukoencephalopathy.

The nurse is administering rituximab to a patient who states "My heart feels like it is beating out of my chest." When the nurse connects the patient to the monitor, ventricular tachycardia is observed. What does the nurse understand is happening with this patient? The patient is having a dissecting aortic aneurysm. The patient is most likely having an infusion reaction syndrome. The patient is having a myocardial infarction. The patient is having a catecholamine response to fear.

The patient is most likely having an infusion reaction syndrome.

A patient has been administered a cytotoxic antineoplastic agent. The patient is a 32-year-old female. Which of the following is the most important instruction related to teratogenicity? The patient will not get pregnant due to the elimination of ova. The patient should protect herself from infections and take Bactrim. The medication will be completely eliminated 24 hours after the administration. The patient should not become pregnant for several months.

The patient should not become pregnant for several months.

A patient is started on chemotherapy. The chemotherapy regimen includes three agents. What is the rationale for using three different antineoplastic agents? The use of three agents decreases the adverse effects. The use of three agents increases the quantity of one of the agents. The use of three agents increases the length of treatment. The use of three agents decreases the development of cell resistance.

The use of three agents decreases the development of cell resistance.

A nurse is caring for a patient being treated with antineoplastic drugs. The patient reports recently experiencing bloody urine. What complication might this patient be experiencing? Hodgkin's disease Thrombocytopenia Megaloblastic anemia Crystalluria

Thrombocytopenia

Which treatment would be appropriate for a patient with breast cancer and an HER2-expressing tumor? Abciximab (ReoPro) Panitumumab (Vectibix) Ofatumumab (Arzerra) Trastuzamab (Herceptin)

Trastuzamab (Herceptin)

Which treatment would be appropriate for a patient with breast cancer and an HER2-expressing tumor? Ofatumumab (Arzerra) Trastuzamab (Herceptin) Panitumumab (Vectibix) Abciximab (ReoPro)

Trastuzamab (Herceptin)

What medication should the nurse prepare to administer to prevent Pneumocystis jirovechi for a patient taking alemtuzumab who has lymphopenia? Trimethoprim-sulfamethoxazole DS Rocephin 1 GM IV prior to injection Acyclovir Famciclovir

Trimethoprim-sulfamethoxazole DS

The nurse is caring for a 72-year-old patient receiving imatinib. What intervention should the nurse perform regularly to prevent pulmonary complications? Have the patient use incentive spirometry daily. Administer Lasix 40 mg IV. Have the patient deep breathe and cough. Weigh the patient on a regular basis to assess for fluid retention.

Weigh the patient on a regular basis to assess for fluid retention.

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? Thirty minutes before breakfast and in the early evening, at least 2 hours after dinner On an empty stomach With food and a large glass of water With a glass of grapefruit or cranberry juice

With food and a large glass of water

Abciximab (ReoPro) is a monoclonal antibody that actually is a fragment called the "Fab fragment." There are many ways to describe this drug. Choose all that apply. can be used for ischemic heart disease may be given immediately following a total knee replacement binds to a glycoprotein receptor on human platelets and inhibits their aggregation may be given in conjunction with coumadin

binds to a glycoprotein receptor on human platelets and inhibits their aggregation can be used for ischemic heart disease

Palivizumab (Synagis) is a monoclonal antibody like rituximab; unlike rituximab, it has a unique function. Which of the following characteristics describe palivizumab? Choose all that apply. injection given only once cytotoxic to the respiratory syncytial virus (RSV) administered within 6 hours of reconstitution can cause injection site erythema

cytotoxic to the respiratory syncytial virus (RSV) administered within 6 hours of reconstitution can cause injection site erythema

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 assessment of deep tendon reflexes bilateral blood pressures pupillary response

daily weights

The antibody prototype is the monoclonal antitumor antibody called rituximab (Rituxan). The adverse effects of this drug are described by which of the following? Choose all that apply. respiratory distress, more common if tumor is larger fever, flushing, chills, and rigors increased appetite Hgb > 13 g/dL

fever, flushing, chills, and rigors respiratory distress, more common if tumor is larger

Ofatumumab (Arzerra™) is a fully human monoclonal antibody licensed by the Food and Drug Administration in 2009. Please choose which of the following best describes this drug. Select all that apply. indicated for fludarabine-resistant CD20 CLL creates direct antibody cytotoxicity causes leukocyte elevation may cause rash and nausea

indicated for fludarabine-resistant CD20 CLL creates direct antibody cytotoxicity may cause rash and nausea