Frandsen Chapter 14 - Cancer Drugs

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. Changes in cognition and personality changes C. Ischemic heart disease D. Bronchoconstriction and pulmonary edema

ANS: A Rationale: Although some adverse effects of monoclonal antibodies are rare, they are serious (e.g., heart failure, bleeding problems, electrolyte imbalances) and vary with a particular drug. None of the other options are adverse reactions associated with this therapy.

A client develops lysis syndrome during the administration of chemotherapy agents. Which treatment is implemented to resolve this health problem? A. Administration of potassium IV B. Administration of anti-inflammatory agents C. Limiting of fluid intake and reduction in IV fluid rate D. Administration of IV normal saline and sodium bicarbonate

ANS: D Rationale: The client experiencing lysis syndrome should receive regular insulin and IV sodium bicarbonate. The client suffers from hyperkalemia and should not be administered potassium. The client would not be administered anti-inflammatory agents. The client should be aggressively hydrated. The client should not have fluids limited or decreased.

An oncology nurse is preparing to administer cytotoxic chemotherapy medications. Which measure best protects the nurse from harm related to the chemotherapy? A. Wearing protective equipment B. Performing thorough hand hygiene C. Mixing medication in a 1000-mL bag D. Administering medication intramuscularly whenever possible

ANS: A Rationale: Because of the drugs' toxicity, nurses who administer IV cytotoxic chemotherapy should be specially trained to administer the medications safely and use protective equipment when handling the medication. Hand hygiene is important during care but will only minimally protect from harm. The medication is mixed in a variety of solutions and amounts. The medication is not administered intramuscularly.

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 what? A. Cell cycle B. Cell wall C. Lymphatic system D. Immune system

ANS: A Rationale: Malignant cells have lost the normal genetic regulation that controls cell growth, invading normal tissues and taking blood and nutrients away from these tissues. In essence, the cell cycle has been pathologically disrupted. None of the other options accurately describe the disruption.

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

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

ANS: A Rationale: Thrombocytopenia, not thrombocytosis, is a common adverse effect of cytotoxic chemotherapy. Heparin is consequently contraindicated, and DVT is not a priority risk. Human cells do not contain cell walls.

A client has been administered methotrexate, which is a purine antagonist used to treat a rapidly growing tumor. The client develops stomatitis. What is the priority nursing diagnosis for a client suffering from stomatitis? A. Impaired skin integrity B. Activity intolerance C. Self-care deficit: hygiene D. Risk for disuse syndrome

ANS: A Rationale: Toxic effects of methotrexate include stomatitis, which is an alteration in skin integrity. Disuse syndrome, lack of hygiene, and activity intolerance are less directly related to stomatitis.

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? A. Sodium and potassium B. BUN and creatinine C. Calcium and magnesium D. Arterial blood gases

ANS: B Rationale: Antimetabolites may 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.

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? A. Resolution of mucositis B. Increased leukocytes C. Increased platelet levels D. Prevention of hemorrhagic cystitis

ANS: B Rationale: 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 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 client has recently been taking tamoxifen. The nurse is justified in concluding that the client has a history of what malignancy? A. Ovarian cancer B. Breast cancer C. Malignant melanoma D. Cervical cancer

ANS: B Rationale: 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 client is being treated with cyclophosphamide. Which laboratory values should the nurse follow most closely? A. D-dimer B. Complete blood count C. C-reactive protein level D. Arterial blood gases

ANS: B Rationale: The client's complete blood count should be assessed frequently because of the adverse effect of bone marrow depression. Potassium, sodium, and magnesium are important to assess because of imbalances in fluid and electrolytes but are not as critical as the CBC.

A client is administered bevacizumab to treat tumor growth in a breast tumor. What is the action of a monoclonal antibody such as bevacizumab? A. It changes the RNA of the tumor cell to a normal form. B. It binds to the 30S ribosome. C. It prevents the activation of intracellular growth factors. D. It blocks the cell wall synthesis.

ANS: C Rationale: Bevacizumab binds to growth factor receptors found on blood vessels to prevent intracellular growth factors from becoming activated and stimulating cell growth. Bevacizumab does not change the RNA of the tumor cell. Bevacizumab does not bind to the 30S ribosome or block cell wall synthesis.

A 32-year-old female client is being treated with a cytotoxic antineoplastic agent. Which is the most important instruction related to the potential for teratogenicity? A. The medication will be completely eliminated 24 hours after the administration. B. The client should protect against infections by taking trimethoprim and sulfamethoxazole. C. The client should not become pregnant for several months. D. The client will not get pregnant due to the elimination of ova.

ANS: C Rationale: Most cytotoxic antineoplastic drugs are potentially teratogenic, and pregnancy should be avoided during and for several months after drug therapy is stopped. The medication is not completely eliminated in 24 hours. The client should be protected from infection, but this characteristic is not related to pregnancy. Administration of the medication does not prevent pregnancy.

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

ANS: C Rationale: Palliative chemotherapy is used in advanced cancer to prevent or treat pain and obstruction. Chemotherapy does not need to be stopped abruptly or replaced with CAM. Aggressive chemotherapy would not normally be administered in a palliative context.

A client has chosen to be placed on hospice. Which is acceptable chemotherapy for a client on hospice? A. Adjuvant chemotherapy B. Radiation combined with chemotherapy C. Palliative chemotherapy D. Neoadjuvant chemotherapy

ANS: C Rationale: Palliative chemotherapy is used in advanced cancer to relieve symptoms and treat or prevent complications. Adjuvant chemotherapy is used after surgery or radiation to destroy or reduce microscopic metastasis. Radiation combined with chemotherapy is implemented to treat the cancer and not used in palliation. Neoadjuvant chemotherapy is used before surgery or radiation.

A client with colorectal cancer is being treated with oxaliplatin. Which potential adverse effect should the nurse explain to the client? A. Dysuria B. Diarrhea C. Insomnia D. Cold-induced neurotoxicity

ANS: D Rationale: Cold-induced neurotoxicity is an adverse effect of oxaliplatin resulting from an effect on peripheral nerves, especially in the hands and feet. Dysuria, diarrhea, and insomnia are not closely associated with oxaliplatin as a result of its pharmacologic actions.

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? A. Buffer the cytotoxins that result from the metabolism of chemotherapeutic agents. B. Protect the client from pathophysiologic effects of malignancy. C. Potentiate the beneficial effects of chemotherapy. D. Reduce the incidence or severity of adverse drug effects.

ANS: D Rationale: 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 has just been diagnosed with liver cancer, and the care team is finalizing the extensive chemotherapy regimen that will begin imminently. Administration of chemotherapeutic drugs is best achieved through which route? A. An intramuscular depot B. A peripheral IV in the nondominant forearm C. Peripheral intravenous access in the antecubital fossa D. A central venous catheter (CVC)

ANS: D Rationale: Insertion of an indwelling central venous catheter is often appropriate for clients who have poor peripheral venous access, who require many doses of chemotherapy, or who require continuous infusions. The antecubital IV insertion site would be unlikely unsustainable for this chemotherapy regimen. Overall, a CVC is preferable to peripheral access. IM administration is uncommon.

A client is administered mesna to prevent cystitis induced by ifosfamide. How will this medication combination prevent cystitis? A. Mesna increases urine output related to ifosfamide. B. Mesna decreases viral load related to ifosfamide. C. Mesna increases white blood cells related to ifosfamide. D. Mesna combines with the metabolite of ifosfamide.

ANS: D Rationale: 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'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. Acute pain B. Adult failure to thrive C. Ineffective therapeutic regimen management D. Imbalanced nutrition: less than body requirements

ANS: D Rationale: 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 client has received a large amount of chemotherapy to treat leukemia. The client develops gastrointestinal upset, hypertension, and paresthesias. What syndrome is the client developing? A. Fröhlich's syndrome B. Epidermal nevus syndrome C. Irritable bowel syndrome D. Tumor lysis syndrome

ANS: D Rationale: With the treatment of leukemias and lymphomas, a serious, life-threatening adverse effect called tumor lysis syndrome may occur. This syndrome occurs when large numbers of cancer cells are killed or damaged, releasing their contents into the bloodstream. The client may have metabolic imbalances, which include gastrointestinal upset, hypertension, and paresthesias. Fröhlich's syndrome is noted in adolescent boys who have an increase in fat and atrophy of the genitals. Epidermal nevus syndrome is associated with multiple nevi. Irritable bowel syndrome is marked with abdominal pain and disturbances of evacuation.