N316b- Oncology/heme

A client develops severe bone marrow suppression related to cancer treatment. Which instruction is important for the nurse to include in the client's teaching? Be prepared to experience alopecia. Increase fluids to at least 3 liters per day. Use a soft toothbrush for oral hygiene. Monitor your intake and output of fluids.

Use a soft toothbrush for oral hygiene. Thrombocytopenia occurs with several cancer treatment programs; using a soft toothbrush helps prevent bleeding gums. Although alopecia does occur, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. Monitoring intake and output of fluids is not related to bone marrow suppression.

Which common side effect will the nurse address in the care plan of a client with cancer receiving the plant alkaloid vincristine? Color-blindness Anuria Constipation Hyperphosphatemia

Constipation Rationale Although most chemotherapy causes diarrhea, vincristine can cause severe constipation, impaction, or paralytic ileus. Visual changes may occur, but color-blindness is not one of them. Polyuria, not anuria, is common. Hyperuricemia may occur, but hyperphosphatemia is not associated with this medication.

The nurse is assessing a child receiving chemotherapy for treatment of leukemia. Which side effect would the nurse anticipate? Epistaxis Tachycardia Flushed skin Increased temperature

Epistaxis Rationale Nosebleeds (epistaxis) are expected in a child with leukemia who is undergoing chemotherapy because the bone marrow is depressed and the number of platelets decreases substantially. Tachycardia is not expected unless there is severe anemia. Usually children with leukemia have pale skin. An increased temperature occurs only if there is an infection resulting from the leukemia.

Which systemic side effect would the nurse monitor for in a client receiving combination chemotherapy for the treatment of metastatic carcinoma? Ascites Nystagmus Leukopenia Polycythemia

Leukopenia Rationale Leukopenia, a reduction in white blood cells, is a systemic effect of chemotherapy as a result of myelosuppression. Ascites is not a side effect of chemotherapy. Chemotherapy does not affect the eyes; nystagmus is an involuntary, rapid rhythmic movement of the eyeballs. Also, nystagmus is a local, not a systemic, response. The red blood cells will be decreased, not increased.

A client with anemia has a new prescription for ferrous sulfate. When teaching the client about diet and iron supplements, what should the nurse emphasize about taking an iron supplement? ALie down for about 10 minutes after taking the pill BTake the iron tablet with a glass of orange juice CTake an antacid with the iron supplement to reduce stomach upset DTake the iron tablet with a glass of low-fat milk

B Iron is best taken on an empty stomach, one hour before or two hours after meals, with a full glass of water or orange juice (ascorbic acid enhances the absorption of iron.) The client should not take the medication with antacids, dairy products, coffee or tea because these will decrease the effectiveness of the medicine. The client should not lie down for at least 10 minutes after taking the medicine.

A nurse is administering vincristine to a client with cancer. The client asks the nurse how the medication works. Which statement by the nurse is appropriate? AIt stops the synthesis of proteins in cancer cells BIt prevents cell division of cancer cells CIt interrupts the S-phase of cancer cell reproduction DIt alters the DNA structure of cancer cells

B Rationale: Antimitotics, such as vincristine, kill cancerous cells by inhibiting cell division and mitosis. Stopping the synthesis of proteins in cancer cells is the expected action of antitumor antibiotics. Interruption of the S-phase of cell reproduction is the expected action of antimetabolites. Altering the DNA structure of cancer cells is the expected action of alkylating agents.

The parent of a toddler taking methotrexate asks the nurse whether the child should be started on vitamin supplements. Which statement by the nurse is appropriate? 'That's a fine suggestion, and I'll ask for a prescription.' 'Vitamin supplements won't help him feel any better right now.' 'He'll benefit from a vitamin supplement and will be getting it soon.' 'Supplements that contain folic acid interfere with the effectiveness of chemotherapy.'

'Supplements that contain folic acid interfere with the effectiveness of chemotherapy.' Vitamins are contraindicated because methotrexate is a folic acid antagonist, and folic acid will counteract the effectiveness of methotrexate. Telling the parent that vitamins won't help his or her child feel better doesn't answer the question; the parent is asking about improving her child's strength, not well-being.

Digoxin and verapamil are prescribed to manage a client's cardiac dysrhythmia. The nurse will monitor the client for signs and symptoms of which adverse effect? Physical agitation Reflex stimulation Myocardial depression Respiratory depression

Myocardial depression Both digoxin and verapamil decrease cardiac impulse conduction, with resultant depression of the myocardium; verapamil decreases conduction at the sinoatrial (SA) and atrioventricular (AV) nodes, which may cause bradycardia, AV block, and cardiac arrest. Digoxin and verapamil together do not cause agitation. Side effects of verapamil include fatigue and depression, not agitation. Digoxin and verapamil do not influence the reflexes of the body. Digoxin and verapamil do not influence respirations.

A client with a diagnosis of anemia is receiving packed red blood cells. Which nursing action is important when administering the transfusion? Assessing the client for fluid overload Monitoring the client's response, particularly within the first 10 minutes Assuring that the transfusion flows at a consistent rate during the procedure Having the client tested for human immunodeficiency virus (HIV) before administering the blood transfusion

Monitoring the client's response, particularly within the first 10 minutes Transfusion reactions usually occur early during the administration of a blood transfusion (first 30 mL of blood); early detection of a transfusion reaction will permit a quick termination of the infusion. The risk of fluid overload is unlikely, and this information can be frightening. The donor's, not the recipient's, blood is tested for HIV. The flow rate will be slower during the first 10 to 15 minutes of the infusion to limit the amount of blood infused; this allows time to assess the client's response for signs and symptoms of a transfusion reaction before too much of the blood is infused.

For which side effects will the nurse assess a client with cancer who is being treated with chemotherapeutic agents? Select all that apply. One, some, or all responses may be . Diarrhea Leukocytosis Bleeding tendencies Lowered sedimentation rate Increased hemoglobin levels

Diarrhea Bleeding tendencies Most chemotherapeutic agents interfere with mitosis. The rapidly dividing cells of the mucous membranes of the gastrointestinal tract are affected, causing stomatitis and diarrhea. Bone marrow depression often causes thrombocytopenia, resulting in bleeding tendencies. The bone marrow consists of rapidly dividing cells, and its activity is depressed. Leukopenia, not leukocytosis, can occur. The erythrocyte sedimentation rate generally increases in the presence of tissue inflammation or necrosis. Hemoglobin and hematocrit levels may decrease because of an inadequate number of red blood cells related to bone marrow depression.

The nurse would counsel a pregnant client to take her iron supplement at which time of the day for efficient absorption? Bedtime After lunch Dinnertime Before breakfast

Before breakfast Iron should be taken before breakfast on an empty stomach to permit maximal absorption. Iron should not be taken at bedtime or with meals or after meals.

Which concept is important to teach a client in relation to why medication cocktails are more effective than a single medication in cancer therapy? Medication resistance Tumor doubling time Cellular growth cycle Retained radioactive particles

Cellular growth cycle Rationale Different medications destroy cells at different stages of their replication; rapidly dividing cells not destroyed by one medication may be destroyed by another medication during a different stage of cell replication. Although certain tumors are medication resistant, it is not the reason for multiple chemotherapeutic medications; medication-resistant tumors may be treated with surgery, radiation therapy, or other methods. The doubling time of the tumor is a factor that influences the length of time chemotherapy will be given, but it is not the reason multiple medications are given. Retained radioactive particles can occur with internal radiation therapy, not chemotherapy.

Which action would the nurse take when administering iron dextran? Use a transdermal needle. Massage the injection site. Use the Z-track method. Apply a local anesthetic first.

Use the Z-track method. The Z-track injection method prevents seepage of iron dextran through the needle track, thereby limiting irritation of subcutaneous tissue and staining of the skin. The length of a transdermal needle is too short to reach a muscle; a 1.5-inch (3.8 cm) needle is required. Massage will force iron dextran into the subcutaneous tissue, causing irritation and staining. Although an injection may be uncomfortable, a local anesthetic is unnecessary.

A nurse is providing care to a client with ovarian cancer prescribed intravenous topotecan. The nurse expects to administer the medication via which venous access site? AImplanted port BPICC CCentral line DPeripheral

A Rationale: Topotecan is an antineoplastic medication administered over the course of 21 days. Chemotherapy medications are commonly administered via an implanted port. An implanted port is accessed through the skin only when therapy is needed. A peripherally inserted central line (PICC), a central line, and a peripheral line have continuous external access and have a higher risk of infection.

A client receives doxorubicin infusions for treatment of acute lymphocytic leukemia. Which clinical finding indicates that toxicity has occurred? Alopecia Dyspnea Metallic taste to food Cardiac rhythm abnormalities

Cardiac rhythm abnormalities Doxorubicin is cardiotoxic, which is manifested by transient electrocardiogram (ECG) abnormalities. Alopecia is an expected side effect of doxorubicin, not a toxic effect. Dyspnea and a metallic taste to food are not effects of doxorubicin.

A client is receiving doxorubicin as part of a chemotherapy protocol. The nurse will assess the client for which system toxicity? Neurotoxicity Cardiotoxicity Ototoxicity Nephrotoxicity

Cardiotoxicity Heart failure and dysrhythmias secondary to cardiotoxicity are the primary life-threatening toxic effects unique to doxorubicin. Neurotoxicity, nephrotoxicity, and ototoxicity are not associated with this medication.

Which nursing intervention is a priority for a school-age child with lead poisoning undergoing chelation therapy? Scrupulous skin care Provision of a high-protein diet Careful monitoring of intake and output Daily blood sampling for liver function tests

Careful monitoring of intake and output Kidney function must be adequate to excrete the lead; if it is not adequate, nephrotoxicity or kidney damage may result. Skin breakdown is not associated with chelation therapy. A high-protein diet is not necessary. Liver damage does not occur with chelation therapy.

A client is prescribed epoetin injections. To ensure the client's safety, which laboratory value would the nurse assess before administration? Hemoglobin Platelet count Prothrombin time Partial thromboplastin time

Hemoglobin Epoetin is used to treat anemia by increasing production of red blood cells. The laboratory value the nurse would assess before administration is the hemoglobin because it measures the number of red blood cells. Erythropoietin is specific for increasing red blood cells and does not increase other blood components such as white blood cells or thrombocytes (platelets). The partial thromboplastin time and prothrombin time are measures of the effectiveness of anticoagulant therapy.

Which side effect would the nurse anticipate in a child receiving chelation therapy? Hypocalcemia Hyperkalemia Hypoglycemia Hypernatremia

Hypocalcemia Calcium EDTA removes calcium along with lead, so the serum calcium level should be checked periodically. Hyperkalemia, hypoglycemia, and hypernatremia do not occur with chelation therapy.

The health care provider prescribes cisplatin for a client with metastatic cancer. Which action will the nurse take to prevent toxic effects? Ask the client's health care provider about prescribing leucovorin. Encourage regular vigorous oral care. Increase hydration to promote diuresis. Assist the client in selecting foods appropriate for a high-protein, low-residue diet.

Increase hydration to promote diuresis. Cisplatin is nephrotoxic and can cause kidney damage unless the client is adequately hydrated. Leucovorin, a form of folic acid, is used to combat toxic effects of methotrexate; cisplatin does not interfere with folic acid metabolism. Gentle, not vigorous, oral care is needed to cleanse the mouth without further aggravating the expected stomatitis. A low-residue diet is unnecessary. Prolonged gastrointestinal irritation is not the major concern.

A client with upper gastrointestinal (GI) bleeding develops mild anemia. Which agent is indicated for treatment of this condition? Dextran Iron salts Vitamin B 12 Erythropoietin

Iron salts Rationale Iron salts are needed in the formation of hemoglobin, so iron that is lost through bleeding must be replaced. Erythropoietin increases red blood cell (RBC) production, but the client's anemia is caused by GI bleeding, not impaired RBC production. Dextran is a plasma volume expander; it does not affect erythrocyte production. Vitamin B 12 is a water-soluble vitamin that must be used as a supplement when an individual has pernicious anemia.

Which nursing action is the priority when administering chelation therapy for a toddler? Assessing vital signs Monitoring urine output Conducting a behavioral assessment Providing education to reduce lead exposure

Monitoring urine output Adequate urinary output must be ensured with administration of calcium EDTA, the medication used for chelation therapy. Children receiving the medication intramuscularly must be able to maintain adequate oral intake of fluids. Monitoring vital signs, conducting a behavioral assessment, and providing education to reduce lead exposure are not priority nursing actions when administering chelation therapy.

Which toxic effect would a nurse monitor for in a client who is prescribed vincristine? Peripheral paresthesia Anginal-type chest pain Ophthalmic papilledema Bilateral crackles in the lung

Peripheral paresthesia Rationale Peripheral paresthesia is an indication of toxicity from a plant alkaloid such as vincristine. Anginal-type chest pain, ophthalmic papilledema, and bilateral crackles in the lung are not side effects of this medication.

A child with plumbism is prescribed edetate calcium disodium (calcium EDTA). Which assessment would be the most appropriate for the nurse to conduct before administering EDTA? Reviewing laboratory results for hypocalcemia Checking for protein in the urine Looking for signs of bone marrow depression Monitoring for increased intracranial pressure

Reviewing laboratory results for hypocalcemia Both lead toxicity and calcium EDTA damage the proximal renal tubules, resulting in increased excretion of protein and other substances. Hypocalcemia is attributable to only some chelating agents; however, it is not likely to occur with calcium EDTA, which replaces calcium. Bone marrow damage is caused by lead toxicity, not calcium EDTA. Lead encephalopathy, not calcium EDTA, causes an increase of intracranial pressure.

Which anticipatory guidance would the nurse include when teaching an adolescent about side effects of dactinomycin and doxorubicin therapy? Wear a baseball cap. Eat three meals daily. Avoid dairy products. Dress in light clothing.

Wear a baseball cap. Antineoplastic medications exert their effect on rapidly dividing tissues such as hair follicles, resulting in alopecia. Eating regular meals, avoiding dairy products, and wearing certain types of clothing are not related to the side effects of the antineoplastics that are being used.

Which laboratory test result would alert the nurse that fluid intake would need to be increased in a child receiving vincristine? Urine pH of 6 Urine specific gravity of 1.020 Blood uric acid level of 7.5 mg/dL Blood urea nitrogen level of 15 mg/dL

Blood uric acid level of 7.5 mg/dL Rationale The normal blood uric acid level for children ranges from 2.5 to 5.5 mg/dL. An increase in the uric acid level caused by the destruction of cells may lead to renal problems; increased fluid intake helps dilute the urine. A urine pH of 6 is within the expected range of 4.5 to 8. A urine specific gravity of 1.020 is within the expected range of 1.005 to 1.030 (usually 1.010-1.025). A blood urea nitrogen level of 15 mg/dL is within the expected range of 5 to 18 mg/dL.

Which step would the nurse include during the administration of epoetin prescribed to a client with acquired immunodeficiency syndrome (AIDS)? Administer the medication via the Z-track technique. Shake the vial before withdrawing the solution. Obtain the client's pulse rate before administration. Use a syringe that has a 1-inch (2.5-cm), 25-gauge needle.

Use a syringe that has a 1-inch (2.5-cm), 25-gauge needle. Epoetin is administered via the subcutaneous or intravenous route; a 1-inch (2.5-cm), 25-gauge needle is appropriate for either method of administration. Epoetin is not administered via the intramuscular route, so the Z-track technique is not used. Shaking the vial denatures the glycoprotein, making the medication biologically inactive and therefore ineffective. The client's vital signs, particularly the blood pressure, need to be monitored only routinely to determine the effectiveness of the medication.

The hospice nurse is visiting a client diagnosed with end-stage lung cancer and metastases to the bone. What should the nurse keep in mind when planning for effective pain management? AHigh doses of opioid analgesics will be required. BPain therapy is based on the client's report of pain. CRelief of pain will be achieved quickly. DThe client will most likely become addicted.

B Every person's pain experience is unique and should be treated based on the individual's goals for pain management. Therefore, the amount of medication needed is dependent on the client's needs and reports of pain relief. The nurse should not assume that high doses of analgesics will be needed to alleviate the client's pain. Immediate or quick pain relief might be difficult to achieve, especially in light of the client's type of cancer and bone metastases. Addiction is a psychological condition and not a concern for this client. However, the client may develop a physical dependence and tolerance to pain medications that may require an increase in dosage to manage pain effectively.

A nurse is preparing to administer reconstituted doxorubicin (Myocet) to a client with thyroid carcinoma. Nuclear medicine calls for the client, and the nurse is unable to administer the medication. Which action should the nurse perform with the medication? ASave the medication in a syringe with an aluminum needle BStore the medication in the refrigerator inside the syringe CDiscard the medication in the hazardous waste container DAdd the medication to the intravenous fluids in the client room

B Rationale: Doxorubicin that is stored in a refrigerator is stable for up to 48 hours. The medication remains stable at room temperature for up to 24 hours. Saving the medication with an aluminum needle will cause discoloration of the solution and form a dark precipitate. Discarding the medication is not necessary. The medication can be stored for 24-48 hours. Doxorubicin should not be added to intravenous fluids. The medication should be dissolved completely with a diluent.

A school-age child with leukemia is receiving treatment with vincristine. Which toxic response would the nurse assess the child for? Diarrhea Alopecia Hemorrhagic cystitis Peripheral neuropathy

Peripheral neuropathy Neurotoxicity is a specific response to vincristine; the child may become numb and ataxic. Vincristine causes adynamic ileus, resulting in constipation; diarrhea occurs with other antineoplastics and radiation therapy. Alopecia is an expected side effect rather than a toxic response; it is not considered serious, and hair will regrow after the treatment is completed. Hemorrhagic cystitis is a toxic response to cyclophosphamide, not vincristine.

The nurse is evaluating the results of treatment with erythropoietin. Which assessment finding indicates an improvement in the underlying condition being treated? 2+ pedal pulses Decreased pallor Decreased jaundice 2+ deep tendon reflexes

Decreased pallor Rationale Erythropoietin stimulates red blood cell production, thereby decreasing the pallor that accompanies anemia. It would not have a role in alleviating jaundice. It would not have an appreciable effect on pulses or deep tendon reflexes.

A client with stage III Hodgkin's disease is started on a multiple-drug regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine. Why are so many drugs necessary? Using smaller doses of several drugs reduces the likelihood of serious side effects. Each drug destroys the cancer cell at a different time in the cell cycle. Several drugs are used to destroy cells that are not susceptible to radiation therapy. Because there are stages of Hodgkin's disease, if one drug is ineffective, another will work.

Each drug destroys the cancer cell at a different time in the cell cycle. Cells are vulnerable to specific drugs through the stages of mitosis, and a combination bombards the malignant cells at various stages. The side effects of a drug are not ameliorated by a combination with others. Although the statement that several drugs are used to destroy cells that are not susceptible to radiation therapy is true, it is not the reason for using a combination of drugs. Although there is more than one stage of Hodgkin's disease, this is not the reason for using a combination of drugs.

The nurse administers erythropoietin three times a week to a client receiving chemotherapy for cancer. Which client response demonstrates a therapeutic effect? Increase in band cells Elevated hematocrit Normalization of platelets Increase in the white blood cell (WBC) count

Elevated hematocrit Erythropoietin stimulates red blood cell production, thereby increasing the hematocrit and hemoglobin level. Erythropoietin increases red blood cells (RBCs), not WBCs, not platelets, and not immature neutrophils (band cells).

A client with multiple myeloma who is receiving the alkylating agent melphalan returns to the oncology clinic for a follow-up visit. For which adverse effect will the nurse monitor the client? Hirsutism Leukopenia Constipation Photosensitivity

Leukopenia Melphalan depresses the bone marrow, causing a reduction in white blood cells (leukopenia), red blood cells (anemia), and thrombocytes (thrombocytopenia); leukopenia increases the risk of infection. Hirsutism occurs with the administration of androgens to women. Diarrhea, not constipation, occurs with melphalan. Photosensitivity occurs with 5-fluorouracil, floxuridine, and methotrexate, not with melphalan.

The nurse is caring for a child who is receiving vincristine. Which body systems are most important for the nurse to assess after medication administration? Select all that apply. One, some, or all responses may be . Respiratory Neurological Reproductive Hematologic Gastrointestinal

Neurological Hematologic Gastrointestinal Rationale Vincristine is neurotoxic; therefore the child should be monitored for paresthesias, seizures, footdrop, bowel and bladder problems, and alterations in the function of cranial nerves. Hematologic problems such as anemia, thrombocytopenia, and leukopenia occur, although they are not as severe as with other chemotherapeutic agents, such as cyclophosphamide. Gastrointestinal adverse effects include severe constipation, intestinal necrosis, intestinal perforation, and paralytic ileus, in addition to nausea and vomiting. Respiratory problems are not associated with vincristine therapy. The reproductive system is not affected by vincristine therapy.

A client is receiving ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy for Hodgkin's disease. When the client reports burning and tingling of the feet, which medication would the nurse determine is the likely cause? Neurotoxicity caused by vinblastine Hypersensitivity caused by dacarbazine Endocrine alterations caused by doxorubicin Peripheral vasoconstriction caused by bleomycin

Neurotoxicity caused by vinblastine Neurotoxicity manifested by peripheral neuropathy (burning and tingling of the hands and/or feet) is a common and expected side effect of vinblastine. Dacarbazine and doxorubicin also cause peripheral neuropathy; however, the peripheral neuropathy does not occur as part of a hypersensitivity reaction, as was mentioned for dacarbazine, or due to endocrine function alterations, as was mentioned for doxorubicin. Bleomycin is not known to cause neurotoxicity and peripheral neuropathy.

A client with Hodgkin's disease is started on chemotherapy. The nurse teaches the client to notify the health care provider for which adverse response to chemotherapy? Hair loss Sores in the mouth Moderate diarrhea after treatment Nausea for 6 hours after treatment

Sores in the mouth Rationale Stomatitis is a common response to chemotherapy and should be brought to the health care provider's attention because a swish-and-swallow anesthetic solution can be prescribed to make the client more comfortable. Hair loss is also anticipated with some chemotherapeutic medications; the effects are temporary and reversible. Moderate diarrhea is expected and is not a cause for concern unless dehydration results. Nausea is expected but should be reported if it lasts more than 24 hours.

A client with Hodgkin's disease is to receive the cyclic antineoplastic vincristine as part of a therapy protocol. Which mechanism of action would the nurse associate with this medication? Arresting mitosis in metaphase Inhibiting the synthesis of thymidine Alkylating nucleic acids needed for mitosis Inactivating DNA while inhibiting RNA synthesis

Arresting mitosis in metaphase Rationale Vincristine is a plant alkaloid that is cell-cycle specific. It affects cell division during metaphase by interfering with spindle formation and causing cell death. Inhibiting the synthesis of thymidine is the typical action of antimetabolites, not plant alkaloids. Alkylating nucleic acids needed for mitosis is typical of the action of alkylating agents, not plant alkaloids. Inactivating DNA and RNA synthesis is the typical action of antineoplastic antibiotics, not plant alkaloids.

The nurse instructs a postpartum client on the administration of an iron supplement. Which drink selected by the client indicates the teaching was effective? Milk Water Cream soda Cranberry juice

Cranberry juice Iron is absorbed best when given in an acidic medium. One cup of cranberry juice contains 90 mg of vitamin C (ascorbic acid). Milk, water, and cream soda will all decrease the acidity of the stomach.

Which information will the nurse share about alopecia characteristics to a client who is to receive chemotherapy after surgery for cancer? Usually rare Not permanent Frequently prolonged Usually preventable

Not permanent Rationale Once the medications that interfere with cell division are stopped, the hair will grow back; sometimes the hair will be a different color or texture. Alopecia is a common side effect of chemotherapy. Hair loss persists while the medications are being received; once the medications are withdrawn, the hair grows back. Although ice caps on the head and rubber bands around the scalp have been used to try to limit alopecia, they have not been particularly effective.

A client has surgery for the insertion of an implanted infusion port for chemotherapy. How often will the port need to be flushed when not in use? Every day Once a week Every month Twice a year

Every month Once-a-month flushes usually are adequate to keep an implanted infusion port from clotting. Every day or once a week is unnecessary. Twice a year may jeopardize the viability of the port.

A child receiving methotrexate and undergoing cranial radiation is very weak. The mother asks the nurse if she should give her child vitamins. Which response by the nurse is most appropriate? 'That's an excellent idea. I'll try to get a prescription for her.' 'Unfortunately, vitamins won't make her feel any better now.' 'That won't be possible. Vitamins interfere with the action of methotrexate.' 'After we receive the laboratory reports, your daughter will be getting vitamins.'

'That won't be possible. Vitamins interfere with the action of methotrexate.' Rationale Many vitamin supplements contain folic acid, which negates the action of methotrexate, a folic acid antagonist. Vitamin therapy is contraindicated, so the nurse would not try to obtain a prescription, and vitamins will not be prescribed after the laboratory reports have come back. Although vitamins contribute to well-being, stating that the client won't feel any better does not answer the question.

133) Which intervention would the nurse take to improve nutrition after identifying that a client receiving chemotherapy has lost weight? Select all that apply. One, some, or all responses may be . Provide low-carbohydrate meals. Decrease fluid intake at mealtime. Encourage the intake of preferred foods. Promote the intake of small, frequent meals Administer prescribed antiemetics before meals

-Encourage the intake of preferred foods. -Promote the intake of small, frequent meals -Administer prescribed antiemetics before meals Rationale Selecting preferred foods increases the likelihood of the client eating the food. Small, frequent feedings are better tolerated than large meals. Antiemetics should be administered prophylactically to decrease nausea and enhance appetite. The diet should provide maximum protein and carbohydrates to meet demands related to restoration of body cells and energy. Decreasing fluid intake may have deleterious effects.

The nurse is teaching a 68-year-old, postmenopausal, female client has about adverse effects of newly prescribed tamoxifen for breast cancer with bone metastases. Which information should the nurse include in the teaching? AStroke-like symptoms BInsomnia CSeizures DSymptoms of hypocalcemia

A Tamoxifen is an antineoplastic drug, commonly prescribed for clients with breast cancer or for clients who are at high risk for developing breast cancer. The most common adverse drug effects (ADEs) are hot flashes, fluid retention, vaginal discharge, nausea, vomiting and menstrual irregularities. In women with bone metastases, tamoxifen may cause transient hypercalcemia. Because of its estrogen agonist actions, tamoxifen poses a small risk of thromboembolic events, including deep vein thrombosis, pulmonary embolism and stroke. Insomnia and seizures are not known ADEs of tamoxifen.

The nurse provides teaching regarding vitamin B 12 injections to a client with pernicious anemia. Which statement by the client indicates that teaching was understood? 'I must take this medication for the rest of my life.' 'I should take this vitamin, as needed, when feeling fatigued.' 'Once my symptoms subside, I can stop taking this vitamin.' 'I need to have this available for use during exacerbations of anemia.'

'I must take this medication for the rest of my life.' Because the intrinsic factor does not return to gastric secretions even with therapy, B12 injections will be required for the remainder of the client's life. Vitamin B 12 must be taken on a regular basis for the rest of the client's life.

Which nursing assessment is most important for a child receiving cyclophosphamide? Extent of alopecia Changes in appetite Hyperplasia of gums Daily intake and output

Daily intake and output Rationale Hemorrhagic cystitis is a potentially serious adverse reaction to cyclophosphamide that can sometimes be prevented with increased fluid intake because the fluid flushes the bladder. The extent of hydration can be measured with hourly documentation of intake and output. Alopecia is expected; however, it is a benign side effect, and the hair will regrow when therapy is completed. A change in appetite is expected but is not a serious side effect of cyclophosphamide administration. Hyperplasia of the gums is unrelated to cyclophosphamide administration.

A client with laryngeal cancer is receiving chemotherapy. Which laboratory report is most important for the nurse to monitor when considering the effects of chemotherapy? Platelets Hemoglobin level Red blood cell count White blood cell count

White blood cell count Antineoplastic medications depress bone marrow, which results in leukopenia; the client must be protected from infection, which is a primary cause of death in the client with cancer. Platelets may decrease rapidly, but complications may be limited by infusions of platelets. Although the hemoglobin level diminishes, a transfusion with packed red blood cells (PRBCs) will alleviate the anemia. RBCs diminish slowly and may be replaced with a transfusion of PRBCs.

A school-age child diagnosed with acute lymphocytic leukemia (ALL) becomes constipated after receiving induction therapy with prednisone, vincristine, and asparaginase. Which would the nurse suspect as the cause? Diet, which lacks bulk Inactivity, which results from illness Vincristine, which decreases peristalsis Prednisone, which causes gastric irritability

Vincristine, which decreases peristalsis Constipation, which may progress to paralytic ileus, is a side effect of vincristine. Lack of bulk and inactivity each may contribute to constipation, but neither is the primary cause of this child's constipation. Prednisone may cause nausea and vomiting, but it does not cause constipation.

The nurse teaches an adolescent who has completed chemotherapy for acute lymphocytic leukemia (ALL) about the administration of mercaptopurine. Which statement by the adolescent indicates teaching has been effective? 'This will help prevent a relapse.' 'I guess I'll need an intravenous line for this medication.' 'I guess this medication is a substitute for brain radiation.' 'This will stop the cancer from spreading to my stomach.'

'This will help prevent a relapse.' Mercaptopurine is given as maintenance therapy to prevent relapses. Mercaptopurine is an oral medication. Oral chemotherapy is an adjunct to other therapies in childhood leukemia, not an alternative for other therapies. The prime site of metastasis of ALL is the central nervous system.

The client asks the nurse how long she will have to take tamoxifen for breast cancer treatment. Which response by the nurse is appropriate? 'You'll have to take it for the rest of your life.' 'You'll need to take it for 10 days, like an antibiotic.' 'You'll need to take it for 5 years, after which it will be discontinued.' 'You'll need to take it for several months, until the bone pain subsides.'

'You'll need to take it for 5 years, after which it will be discontinued.' Tamoxifen is an estrogen antagonist antineoplastic medication that has been found to be effective in 50% to 60% of women with estrogen receptor-positive cancer of the breast. After 5 years of administration there is an increased risk of complications, and the medication is discontinued. Tamoxifen usually is prescribed for 5 years after initiation of therapy, not for the rest of the client's life; this duration will not produce positive effects for the client. Tamoxifen usually is prescribed for 5 years after initiation of therapy, not just for 10 days. Tamoxifen may cause the adverse effect of bone pain, which indicates the medication's effectiveness. Medication is given to manage the pain and the tamoxifen is continued.

An adolescent is to begin a chemotherapeutic medication regimen. Which side effect of vincristine is most important for the nurse to prepare the adolescent to expect? Alopecia Constipation Loss of appetite Peripheral neuropathy

Alopecia A side effect of vincristine is alopecia. To adolescents, who are very concerned with identity, hair loss represents a tremendous threat to self-image. Constipation, although very serious, is not as important to the adolescent as a side effect that affects appearance. Although anorexia will be a concern while the adolescent is undergoing chemotherapy, it is not as important before the start of the regimen. Although neurologic side effects are serious, they are not as important to the adolescent before the start of chemotherapy.

Which clinical finding indicates that doxorubicin toxicity may have occurred? Fever Blue tinge to the urine Alteration in cardiac rhythm Increasing anxiety

Alteration in cardiac rhythm Rationale Doxorubicin is cardiotoxic and causes dysrhythmias. It increases the risk for infections secondary to myelosuppression, which may result in fever; however, this is not the result of toxicity. Blue-tinged urine is a side effect of doxorubicin, not a toxic effect. Feelings of nervousness are a side effect of doxorubicin, not a toxic effect.

The nurse is providing teaching to a client who has been prescribed cyclophosphamide for breast cancer treatment. Which of the following statements made by the client would indicate that additional teaching is needed? A"I will probably need to plan on using a wig to cover my hair loss." B"I should limit the amount of fluids I drink while taking this medication." C"I will need to stay away from children when my white blood cell count is low." D"I may have trouble getting pregnant due to the damaging effects of the medication."

B Cyclophosphamide is a chemotherapeutic medication. Some of the side effects of this medication include hair loss, low white cell count and infertility. The client is encouraged to drink about 2 to 3 liters of fluid per day to aid in eliminating the chemotherapy from the body.

A nurse is reviewing laboratory data of a client taking paclitaxel for ovarian cancer. Which finding would the nurse report to the healthcare provider before administering the next dose of medication? APlatelet count of 475,000/mm³ BEosinophil level of 400/mm³ CRed blood cell count of 6.5 million/mm³ DNeutrophil count of 1,200/mm³

B, D Rationale: Paclitaxel is an antineoplastic medication used in the treatment of various cancers. Paclitaxel causes neutropenia and is contraindicated in clients with a neutrophil count below 1,500/mm³. A platelet count of 475,000/mm³ is above normal. Paclitaxel can cause thrombocytopenia (low platelet count). Eosinophils are white blood cells that fight infectious organisms. An eosinophil level of 400/mm³ is a normal finding. A red blood cell (RBC) count of 6.5 million/mm³ is above normal. Paclitaxel can cause anemia (low RBCs).

Leucovorin calcium is prescribed and is to be administered immediately after an infusion of methotrexate. Which result of laboratory testing indicates that leucovorin has been effective? Potassium level normalizes Folic acid level within normal limits Improved white blood cell count Decreased methotrexate level

Decreased methotrexate level The laboratory measurement of the client's methotrexate level is the most objective measure of leucovorin calcium's effectiveness. Leucovorin calcium is considered a 'rescue' medication because it minimizes the effects of methotrexate on healthy cells by competing with methotrexate at the cellular level, thus neutralizing it and causing it to be excreted. Its purpose is not to affect folic acid levels nor to affect potassium or white blood cell counts.

Which medications would the nurse plan to use when administering chelation therapy to a toddler-age client to decrease the pain associated with intramuscular administration? Select all that apply. One, some, or all responses may be . LMX-4 Fentanyl Procaine Ibuprofen Acetaminophen

LMX -4 Procaine LMX-4 is a topical medication that can be applied to the skin to decrease the pain associated with chelation therapy. Procaine is a medication that can be mixed with chelation therapy to decrease the pain associated with chelation therapy. Fentanyl, ibuprofen, and acetaminophen are not medications used to decrease the pain associated with chelation therapy.

Which drink would the nurse instruct a client with iron deficiency anemia to choose to drink with the supplement for efficient absorption? Water Skim milk Orange juice A strawberry milkshake

Orange juice Iron should be taken before breakfast on an empty stomach to permit maximal absorption; the ascorbic acid in orange juice enhances the absorption of iron. Water does not provide the ascorbic acid necessary for absorption of iron. Iron should not be taken with milk or other dairy products, which may interfere with its absorption.

The nurse is caring for a child undergoing chemotherapy for acute lymphoid leukemia. The parents ask why the child needs prednisone. Which response by the nurse would be ? 'It decreases inflammation.' 'It suppresses the production of lymphocytes.' 'It increases appetite and a sense of well-being.' 'It may decrease skin irritation and edema.'

'It decreases inflammation.' Rationale Prednisone is a synthetic glucocorticoid that exerts an active anti-inflammatory effect by stabilizing lysosomal membranes, thereby inhibiting proteolytic enzyme release. Prednisone does not affect the lymphocytes. Although prednisone increases the appetite and creates a sense of well-being, these are not the reasons it is administered. There is no indication the child is receiving radiation.

A client with cancer experiences severe nausea and vomiting from chemotherapy. The client wants to know if it is true that smoking marijuana will help. How will the nurse respond? 'Nurses are not allowed to discuss illegal substances with clients.' 'Marijuana is effective for nausea and vomiting if it is injected.' 'Marijuana is not proven to be effective in preventing chemotherapy-induced nausea and vomiting.' 'There are some tetrahydrocannabinol (THC)-based medications that contain marijuana control chemotherapy-induced nausea and vomiting in some people.'

'There are some tetrahydrocannabinol (THC)-based medications that contain marijuana control chemotherapy-induced nausea and vomiting in some people.' THC, an ingredient in marijuana, acts as an antiemetic in some people and can be absorbed through the gastrointestinal tract or inhaled. THC-based medications, dronabinol and nabilone, are available by prescription to control nausea and vomiting resulting from cancer chemotherapy. Nurses are not forbidden to talk about illegal issues and marijuana is prescribed legally in some states. Marijuana is not injected. THC is an effective antiemetic for some clients.

Allopurinol is prescribed for a child undergoing chemotherapy for cancer of the bone. When given the medication, the child asks, 'Why do I have to take this pill?' Which response by the nurse is most appropriate? 'It protects your body from getting new problems after your treatment is over.' 'It stops your sick white cells from going to other parts of your body.' 'The health care provider wouldn't prescribe anything for you unless it was important.' 'With the other medicines, it helps you get rid of the things that are making you sick.'

'With the other medicines, it helps you get rid of the things that are making you sick.' Rationale Telling the child it helps get rid of the things making the child sick is the most accurate and age-appropriate response to the child's question. Telling the child that the medicine protects the body from new problems is inaccurate, and not being truthful will interfere with the development of the child's trust in the nurse. Telling the child that it stops sick white cells from spreading is inaccurate and may instill more fear. Telling the child that it is needed because the health care provider says so is insensitive to the question and does not provide an explanation.

An adolescent with leukemia is to be given a chemotherapeutic agent. Which time is best for the nurse to administer the prescribed antiemetic? As nausea occurs An hour before meals Just before each meal is eaten Before each dose of chemotherapy

Before each dose of chemotherapy The purpose of an antiemetic before chemotherapy is to prevent the child from experiencing nausea during and after the administration of the medication. Waiting until nausea has occurred is too late; the medication should be given before nausea occurs. The meals are not causing the nausea; the nausea is caused by the chemotherapy, and if nausea is not prevented, the child will not eat.

A client receiving cancer chemotherapy asks the nurse why an antibiotic was prescribed. Which tissue affected by chemotherapy will the nurse consider when formulating a response? Liver Blood Bone marrow Lymph nodes

Bone marrow Prolonged chemotherapy may slow production of leukocytes in bone marrow, thus suppressing the immune system. Antibiotics may be required to help counter infections that the body can no longer handle easily. The liver does not produce leukocytes. Although leukocytes are in both blood and lymph nodes, these cells are more mature than those found in the bone marrow and thus are more resistant to the effects of chemotherapy. STUDY TIP: Laughter is a great stress reliever. Watching a short program that makes you laugh, reading something funny, or sharing humor with friends helps decrease stress.

A 5-year-old child is receiving dactinomycin and doxorubicin therapy after nephrectomy for Wilms tumor. Which intervention would the nurse include when planning care? Adding citrus juices to meals Offering warm saline mouthwash Scheduling booster immunizations Reporting red-orange colored urine

Offering warm saline mouthwash Rationale The use of warm saline mouthwash will minimize oral discomfort; ulceration of the oral mucosa occurs as a result of the antineoplastic effect on the rapidly dividing gastrointestinal epithelium. Oral anesthetics may be prescribed by the health care provider. Adding citrus juices to meals is contraindicated because it will aggravate the stomatitis that is a common side effect of both chemotherapeutic agents. Immunizations must be postponed because of the immunosuppressant effects of chemotherapy. Urine and other body fluids may become red-orange during the first 48 hours after doxorubicin is started; this is an expected response that need not be reported.

A client who is immunosuppressed is receiving filgrastim. When monitoring effectiveness, the nurse will check for an increase in which blood component? Platelets Erythrocytes Lymphocytes White blood cells

White blood cells Rationale Filgrastim, a granulocyte colony-stimulating factor, increases the production of neutrophils with little effect on the production of other blood components. The production of platelets is not stimulated by filgrastim. The production of erythrocytes is not stimulated by filgrastim. Neutrophils, not lymphocytes, are the white blood cells whose production is stimulated by filgrastim.

A client receiving doxorubicin (Adriamycin) intravenously (IV) complains of pain at the insertion site, and the nurse notes edema at the site. Which intervention is most important for the nurse to implement? A. Assess for erythema. B. Administer the antidote. C. Apply warm compresses. D. Discontinue the IV fluids.

Discontinue the IV fluids. Doxorubicin is an antineoplastic agent that causes inflammation, blistering, and necrosis of tissue upon extravasation. First, all IV fluids should be discontinued at the site to prevent further tissue damage by the vesicant.

To minimize the side effects of the vincristine that a client is receiving, which diet would the nurse advise? Low in fat High in iron High in fluids Low in residue

High in fluids A common side effect of vincristine is a paralytic ileus that results in constipation. Preventative measures include high-fiber foods and fluids that exceed minimum requirements. These will keep the stool bulky and soft, thereby promoting evacuation. Dietary plans that are low in fat, high in iron, and low in residue will not provide the roughage and fluids needed to minimize the constipation associated with vincristine.

The nurse is caring for a child receiving prednisone. Which consideration is most important for the nurse to remember when administering adrenocorticosteroid therapy? It suppresses inflammation. It may produce hyperkalemia. Wound healing is accelerated. Antibody production increases.

It suppresses inflammation. Rationale Because of suppression of the inflammatory manifestations of infection, such as increase in body temperature, the nurse must be alert to the subtle signs and symptoms of infection (e.g., changes in appetite, sleep patterns, and behavior). Adrenocorticosteroid therapy may cause hypokalemia, not hyperkalemia, because of the retention of sodium and fluid. Adrenocorticosteroid therapy delays, not accelerates, wound healing. Adrenocorticosteroid therapy decreases, not increases, the production of antibodies.

The nurse considers that the safe administration of high-dose methotrexate therapy would include which intervention? Maintaining an acidic urine Restricting intravenous fluids Providing a diet high in folic acid Monitoring plasma levels of the medication

Monitoring plasma levels of the medication Rationale Plasma levels indicate whether therapeutic or toxic levels are present. Methotrexate crystallizes in the kidneys if urine becomes acidic. The regimen would include hydration with a minimum of intravenous fluids of 125 mL/h 6 to 12 hours before and during therapy. The effectiveness of methotrexate, a folic acid antagonist, is minimized by a diet high in folic acid.

The alkylating agent cyclophosphamide is prescribed for a school-age child with cancer. Which clinical manifestation would the nurse be alert for while the child is receiving this medication? Irritability Pain with urination Unpredictable nausea Hyperplasia of the gums

Pain with urination Cystitis is a potentially serious adverse reaction to cyclophosphamide; it sometimes can be prevented by increasing hydration because the fluid flushes the bladder. Irritability may be present but is not a result of cyclophosphamide administration. Unpredictable nausea is an expected but manageable side effect of cyclophosphamide. Hyperplasia of the gums is unrelated to cyclophosphamide administration; it may occur with prolonged phenytoin therapy.

An adolescent is prescribed an antineoplastic agent. Which instruction would the nurse give to the parents before discharge? Limit contact with all peers and family members. Withhold medications when nausea occurs to prevent vomiting. Schedule laboratory blood tests to evaluate response to the medication. Return weekly for a bone marrow aspiration to monitor effectiveness of therapy.

Schedule laboratory blood tests to evaluate response to the medication. Blood tests indicate response to therapy; if the white blood cell count drops precipitously, therapy may be halted temporarily. Children undergo therapy for extended periods, and prolonged separation from their peers may lead to social isolation. Contact with children who have active infections should be avoided. Although nausea commonly occurs with this therapy, antiemetic measures are instituted; the medication is not withdrawn for this reason. A bone marrow aspiration is a painful procedure and is performed selectively (e.g., to confirm the diagnosis), not routinely.

The nurse is caring for a child with an exacerbation of leukemia. The nurse would plan to administer the prescribed analgesic for bone pain at which time? At scheduled intervals When the child asks for it When pain becomes severe Before the pain becomes severe

At scheduled intervals Rationale For maximal benefit, the analgesic should be administered at scheduled intervals that are individualized for the child; routine administration manages the pain before it becomes too intense. The goal is to keep the child pain free; by the time the child asks for the analgesic, the pain has returned. It is insensitive to allow the child to be in pain; there should be no pain.

A client with cancer is receiving leucovorin as part of a chemotherapy protocol. Which purpose does leucovorin serve? Potentiating the effect of alkylating agents Diminishing toxicity of folic acid antagonists Limiting vomiting associated with chemotherapy Preventing alopecia

Diminishing toxicity of folic acid antagonists Leucovorin limits toxicity of folic acid antagonists, such as methotrexate sodium, by competing for transport into cells. Leucovorin does not potentiate the effect of alkylating agents. It does not have antiemetic properties. It will not prevent hair loss.

A client with Hodgkin's disease adds doxorubicin to current therapy. Which advice will the nurse provide about this medication? Cease taking any medication that contains vitamin D. Keep the doxorubicin in a dark place protected from light. Expect urine to turn red for a few days after taking this medication. Take the doxorubicin on an empty stomach with large amounts of fluids.

Expect urine to turn red for a few days after taking this medication. Rationale Doxorubicin causes the urine to turn red for a few days; the client should be informed of this expectation so as not to become alarmed when it occurs. Discontinuing the intake of vitamin D is true for plicamycin, not the medications in this protocol. It is unnecessary to keep doxorubicin in a dark area, protected from light. Doxorubicin is not given orally, only via the intravenous route.

Which side effect would the nurse assess for in a child receiving vincristine? Hemolytic anemia Irreversible alopecia Hyperglycemia Neurological complications

Neurological complications Rationale Vincristine is highly neurotoxic, causing paresthesias, muscle weakness, ptosis, diplopia, paralytic ileus, vocal cord paralysis, and loss of deep tendon reflexes. Hematologic effects are rare; mild anemia may occur, but hemolytic anemia is not anticipated. Alopecia is reversible with cessation of the medication. Hyperglycemia is not an anticipated adverse effect.

A child with Wilms tumor is prescribed doxorubicin hydrochloride. Which common side effect unique to doxorubicin would the nurse expect to observe in the child? Hair loss Vomiting Red urine Stomatitis

Red urine Rationale Red urine is a common side effect of doxorubicin administration. The medication is not metabolized and is excreted in the urine. The genitourinary responses to vincristine are nocturia, oliguria, urine retention, and gonadal suppression. Hair loss, vomiting, and stomatitis occur with both medications.

A client is diagnosed with multiple myeloma. Which intervention would the nurse expect the plan of care to include? Radiotherapy on an outpatient basis Human leukocyte interferon therapy Surgery to remove the invasive lesions Chemotherapy employing a combination of medications

Chemotherapy employing a combination of medications Chemotherapy employing a combination of drugs is the treatment of choice; a variety of chemotherapeutic medications affect rapidly dividing cells at different stages of cell division. Although radiotherapy on an outpatient basis may be used to alleviate pain and treat acute vertebral lesions, it is not the primary approach. Although human leukocyte interferon therapy may be done, it is not the primary treatment. Multiple myeloma is a diffuse disorder of the bone, and no single lesion can be removed.

A client is scheduled to begin chemotherapy 2 weeks after surgery for colon cancer. Which explanation would the nurse give to explain the delay after surgery? Chemotherapy interferes with cell growth and delays wound healing. Because chemotherapy causes vomiting, it endangers the integrity of the incisional area. Chemotherapy decreases red blood cell production, and the resultant anemia will add to postoperative fatigue. Chemotherapy increases edema in areas distal to the incision by blocking lymph channels with destroyed lymphocytes.

Chemotherapy interferes with cell growth and delays wound healing. Chemotherapeutic agents can attack healthy as well as malignant cells; they generally interfere with protein synthesis and cell division in all rapidly dividing cells, including those regenerating traumatized tissue (as in wound healing), bone marrow, and cutaneous and alimentary tract epithelial tissue. Vomiting should not disturb the integrity of the area. Decreased red blood cell levels caused by bone marrow depression can be ed with transfusions. Chemotherapy should not cause a blockage of lymph channels, with destroyed lymphocytes increasing edema.

The nurse observes bloody expectorant after a 4-year-old child with leukemia brushed his or her teeth. Which action should the nurse take next? Secure a smaller toothbrush for the child to use. Document and report the incident. Tell the child to be more careful when brushing the teeth. Rinse the child's mouth with half-strength hydrogen peroxide.

Document and report the incident. Rationale Because of the increased capillary fragility and decreased platelet count that accompany leukemia, even the slightest trauma can cause hemorrhage. Brushing the teeth has caused gingival bleeding, and the incident should be documented; this information may also help define the treatment plan. It is wiser to eliminate a toothbrush and use a sponge-type applicator. It cannot be assumed that a 4-year-old child will or can follow a direction to be more careful when brushing. Rinsing the child's mouth with half-strength hydrogen peroxide could irritate the gums, causing more trauma. If oral ulcers develop, the mouth should be rinsed with an isotonic solution such as normal saline.

Which response would the nurse give to a client receiving chemotherapy who develops sores in the mouth and asks the nurse why this happened? "The sores occur because of the direct irritating effects of the medication." "These tissues are poorly nourished because you have a decreased appetite." "The frequently dividing cells of the gastrointestinal tract are damaged by the medication." "This side effect occurs because it targets the cells of the gastrointestinal system."

"The frequently dividing cells of the gastrointestinal tract are damaged by the medication." Rationale Many chemotherapeutic agents function by interfering with the DNA replication associated with cellular reproduction (mitosis). Frequent cellular mitosis of the stratified squamous epithelium of the mouth and anus results in these areas being powerfully affected by the medications. The response "The sores occur because of the direct irritating effects of the medication" is inaccurate; most agents are administered parenterally. A decreased appetite (anorexia) does not cause stomatitis. Chemotherapeutic agents affect the most rapidly proliferating cells, which include not only the cells of the gastrointestinal epithelium but also those of the bone marrow and hair follicles.

A 3-year-old child is prescribed a liquid iron preparation. The nurse would include which intervention when teaching the parent about the administration of this medication? 'Monitor the stools for diarrhea.' 'Administer with meals to improve absorption.' 'Avoid giving the child orange juice with the iron preparation.' 'Have the child drink the diluted iron preparation through a straw.'

'Have the child drink the diluted iron preparation through a straw.' Rationale A liquid iron preparation may stain tooth enamel; therefore it should be diluted and administered through a straw. Constipation, rather than loose stools, often results from the administration of iron. Iron absorption is improved when taken on an empty stomach. The exception is acidic foods, such as citrus juices, which improve absorption.

A client is receiving epoetin for the treatment of anemia associated with chronic renal failure. Which client statement indicates to the nurse that further teaching about this medication is necessary? 'I realize it is important to take this medication because it will cure my anemia.' 'Because I am at risk for seizures, I need to avoid hazardous activities.' 'I recognize that I may still need blood transfusions if my hemoglobin is very low.' 'I understand that I will still have to take supplemental iron therapy with this medication.'

'I realize it is important to take this medication because it will cure my anemia.' Epoetin will increase a sense of well-being, but it will not cure the underlying medical problem; this misconception needs to be ed. Seizures are a risk during the first 90 days of therapy, especially if the hematocrit increases more than 4 points in a 2-week period. A dose adjustment may be necessary. Blood transfusions may still be necessary when the client is severely anemic. Supplemental iron therapy is still necessary when receiving epoetin because the increased red blood cell production still requires iron.

An adolescent with leukemia is receiving vincristine. The mother reports that the child is complaining of feeling 'tingles' all over. Which response by the nurse is most appropriate regarding the effect of this medication? 'It is a neurological side effect.' 'It is caused by an autoimmune reaction.' 'The skin becomes sensitive with chemotherapy.' 'The central nervous system has become hyperactive.'

'It is a neurological side effect.' Rationale Neurotoxicity is an anticipated side effect of vincristine sulfate. Some children report it as 'tingles' or feeling 'funny all over.' It is not usually permanent. Vincristine causes leukopenia, which increases susceptibility to infection; it does not cause an autoimmune reaction. Skin sensitivity is not the reason that the child feels tingly. Hyperactivity of the central nervous system is not a factor in the development of this neurological finding.

A client with adenocarcinoma receives doxorubicin intravenously (IV) to reduce the tumor mass. Which clinical finding indicates that doxorubicin toxicity may have occurred? Fever Blue tinge to the urine Alteration in cardiac rhythm Increasing anxiety

Alteration in cardiac rhythm Doxorubicin is cardiotoxic and causes dysrhythmias. It increases the risk for infections secondary to myelosuppression, which may result in fever; however, this is not the result of toxicity. Blue-tinged urine is a side effect of doxorubicin, not a toxic effect. Feelings of nervousness are a side effect of doxorubicin, not a toxic effect.

A client is admitted to the hospital with pancytopenia as a result of chemotherapy. Which information will the nurse provide to minimize the risk for complications? Avoid activities that risk traumatic injuries and exposure to infection. Perform frequent mouth care with a firm toothbrush. Increase oral fluid intake to a minimum of 3 L daily. Report any unusual muscle cramps or tingling sensations in the extremities.

Avoid activities that risk traumatic injuries and exposure to infection. Reduced platelets increase the likelihood of uncontrolled bleeding; reduced lymphocytes increase susceptibility to infection. Aggressive oral hygiene can precipitate bleeding from the gums. Although fluids may be increased to flush out the toxic by-products of chemotherapy, this has no effect on pancytopenia. Muscle cramps or tingling sensations in the extremities are adaptations to hypocalcemia; hypocalcemia is unrelated to pancytopenia.

Which mechanism of action explains the ability of nitrogen mustard to interfere with growth of cancer cells? Interference of the cellular protein synthesis Inhibition of the synthesis of purine and pyrimidine Binding with DNA to interfere with RNA production Combining with DNA strands and interfering with cell replication

Combining with DNA strands and interfering with cell replication Rationale Alkylating agents such as nitrogen mustard combine with DNA strands and interfere with cell replication. Some chemotherapeutic medications are believed to act by interfering with cellular protein synthesis, but nitrogen mustard does not. Inhibiting the synthesis of purine and pyrimidine is the mechanism of action of antimetabolites. Antibiotics, not nitrogen mustard, used in cancer chemotherapy are believed to act by binding with DNA to interfere with RNA production.

The nurse teaches the parents of a child with classic hemophilia how to administer plasma component factor VIII prescribed three times a week. Which instruction would the nurse give the parents about administration time? Whenever a bleed is suspected Give in the morning on scheduled days At bedtime while the child is lying quietly in bed On a regular schedule at the parents' convenience

Give in the morning on scheduled days Rationale Factor VIII has a short half-life; therefore prophylactic treatment involves administering the factor on the scheduled days in the morning, so the child will get the most benefit during the day, while he is most active. Prophylactic treatment is administered on a scheduled basis to prevent bleeds from occurring. Administering the medication at bedtime will limit its effectiveness because bleeds are more common when the child is active. Administering the medicine on a regular schedule at the parents' convenience does not take into consideration the properties of the medication.

A child with iron-deficiency anemia is prescribed oral iron therapy. Anticipatory guidance regarding which side effect would the nurse provide? Bloody stool Orange urine Greenish-black stool Staining of the mouth

Greenish-black stool Iron is excreted in the feces, and the change in color results from the insoluble iron compound excreted in the stool. Blood in the stool is associated with lower intestinal bleeding, not supplemental iron ingestion. Orange urine is not associated with supplemental iron ingestion; it occurs with phenazopyridine hydrochloride or rifampin administration. Staining of the mucous membranes of the mouth should not occur with oral administration of iron if a straw is used and the teeth are brushed immediately after administration. The teeth, not the mucous membranes, may become stained if these precautions are not taken.

A client receives doxorubicin as part of a chemotherapy protocol. The nurse would assess the client for signs and symptoms of which adverse effect? Toxic epidermal necrolysis Heart failure Pulmonary fibrosis Ototoxicity

Heart failure Heart failure and dysrhythmias are life-threatening toxic effects unique to doxorubicin. It is a vesicant that can cause severe tissue damage if the medication infiltrates; however, this is different from the tissue destruction associated with toxic epidermal necrolysis. Pulmonary fibrosis and ototoxicity are not adverse effects of doxorubicin.

When discussing the therapeutic regimen of vitamin B 12 for pernicious anemia with a client, which teaching would the nurse provide? Weekly Z-track injections provide needed control. Daily intramuscular injections are required for control. Intramuscular injections once a month will maintain control. Oral vitamin B 12 tablets taken daily will provide symptom control.

Intramuscular injections once a month will maintain control. Intramuscular injections bypass the vitamin B 12 absorption defect (lack of intrinsic factor, the transport carrier component of gastric juices). A monthly dose usually is sufficient because it is stored in active body tissues, such as the liver, kidney, heart, muscles, blood, and bone marrow. The Z-track method need not be used. Because it is stored and only slowly depleted, daily injections are unnecessary. Vitamin B 12 is ineffective if taken by mouth because clients with pernicious anemia lack intrinsic factor.

An adolescent who has been prescribed prednisone and vincristine for leukemia tells the nurse that he is constipated. Which reason would the nurse cite as the probable cause of the constipation? It is a side effect of the vincristine. The spleen is compressing the bowel. It is a toxic effect from the prednisone. The leukemic mass is obstructing the bowel.

It is a side effect of the vincristine. Rationale Constipation is a side effect of vincristine because it slows gastrointestinal motility. An enlarged spleen will put pressure on the stomach and diaphragm, not on the large bowel. Constipation is not a toxic effect of prednisone. It is unlikely that leukemia is causing an obstruction.

A client receiving chemotherapy develops bone marrow suppression. The nurse will monitor for which thrombocytopenic effect? Select all that apply. One, some, or all responses may be . Deep vein thrombosis Melena Purpura Emboli Hematuria

Melena Purpura Hematuria Black, tarry feces caused by the action of intestinal secretions on blood are associated with bleeding in the gastrointestinal tract; bleeding is related to a reduced number of thrombocytes, which are part of the coagulation process. Hemorrhages into the skin and mucous membranes (purpura) may occur with reduced numbers of thrombocytes, which are part of the coagulation process. Blood in the urine (hematuria) may occur with a reduced number of thrombocytes, which are part of the coagulation process. Deep vein thrombosis and emboli are effects of thrombocytosis.

The nurse understands that megestrol is most often used to treat which issue? Menopause Birth control Premenstrual syndrome (PMS) Palliative management of cancer

Palliative management of cancer Megestrol is most often used for the palliative management of recurrent, inoperable, or metastatic endometrial or breast cancer because it can cause appetite stimulation and weight gain. Megestrol is not typically used in the treatment of menopause symptoms, as birth control, or for PMS.

A client is receiving imatinib for chronic myelogenous leukemia (CML). The nurse will assess for which complication of this protein-tyrosine kinase inhibitor? Select all that apply. One, some, or all responses may be . Hair loss Stomatitis Dehydration Signs of infection Bleeding tendencies

Signs of infection Bleeding tendencies Imatinib affects the bone marrow, causing neutropenia; an adequate number of neutrophils are necessary to fight bacterial infections. Imatinib affects the bone marrow, causing thrombocytopenia; an adequate number of thrombocytes are necessary to prevent bleeding. Hair loss is a complication associated with antimetabolites. Stomatitis is a complication associated with antimetabolites and antitumor antibiotics. Severe fluid retention is a side effect, not dehydration.

Which nursing care will be included for a client who is receiving doxorubicin for acute myelogenous leukemia? Increasing citrus foods Providing frequent oral hygiene Encouraging activity Administering medications parenterally

Stomatitis and hyperuricemia are possible complications of therapy; therefore oral care and hydration are important. A cidic foods such as citrus foods and fluids will cause pain for clients with stomatitis. Rest, not increased activity, is important for increased fatigability. Abnormal bleeding is a common problem; thus injections (administering medications parenterally) are contraindicated.

Which information would the nurse include when teaching parents about the side effects of iron supplements? The urine may turn red. The skin will turn yellow. The teeth may become stained. The stools will take on a clay color.

The teeth may become stained. Rationale Liquid oral iron supplements may stain the teeth; brushing the teeth after administration may limit the discoloration. There should be no change in the color of the urine. Yellowing of the skin is a sign of jaundice; it is not a side effect of an iron supplement. The stools will become black-green; clay-colored stools are a sign of biliary obstruction.

Which benefit is provided by intraarterial chemotherapy for cancer of the liver? It reduces systemic toxicity. It provides for rapid dilution of chemotherapy. The medication bypasses the blood-brain barrier. The chemotherapy is delivered to the peritoneal cavity.

It reduces systemic toxicity. Rationale Higher concentrations of the medication can be delivered to the specific site of the tumor, with reduced systemic toxicity. Providing for rapid dilution of chemotherapy is the purpose of central vascular access devices. The ability to pass the blood-brain barrier is the purpose of intrathecal or intraventricular access devices. Delivering chemotherapy to the peritoneal cavity is the purpose of intraperitoneal chemotherapy.

A client is receiving combination chemotherapy for the treatment of metastatic carcinoma. For which systemic side effect would the nurse monitor the client? Ascites Nystagmus Leukopenia Polycythemia

Leukopenia Leukopenia, a reduction in white blood cells, is a systemic effect of chemotherapy as a result of myelosuppression. Ascites is not a side effect of chemotherapy. Chemotherapy does not affect the eyes; nystagmus is an involuntary, rapid rhythmic movement of the eyeballs. Also, nystagmus is a local, not a systemic, response. The red blood cells will be decreased, not increased.

A client with follicular non-Hodgkin's lymphoma is to be treated with rituximab, a targeted monoclonal antibody. The nurse will monitor the client for which common side effect of rituximab? Polyphagia Leukopenia Constipation Hypertension

Leukopenia Rituximab targets the CD 20 antigen, which regulates cell cycle differentiation and is found on malignant B lymphocytes; as a result, rituximab therapy can cause leukopenia and neutropenia. Anorexia, not polyphagia, may occur with rituximab therapy. Frequent stools and diarrhea, not constipation, may occur with rituximab therapy. Hypotension, not hypertension, may occur as a fatal infusion reaction to rituximab therapy.

Which technique would the nurse use to administer ferrous sulfate to a 12-month-old infant? Through a straw Crushed in applesauce In an intramuscular injection Syringe directed toward the back of the mouth

Syringe directed toward the back of the mouth Rationale Very young children should receive ferrous sulfate elixir through a syringe or medicine dropper placed in the back of the mouth; this limits staining of teeth by the ferrous sulfate. A 12-month-old infant may not be able to suck on a straw. A 12-month-old infant cannot swallow a tablet, and ferrous sulfate should not be crushed. Ferrous sulfate is not available in an injectable form.

A complete blood count is prescribed before each round of a client's cancer chemotherapy. Which component of the complete blood count is of greatest concern to the nurse? Platelets Hematocrit Red blood cells (RBCs) White blood cells (WBCs)

White blood cells (WBCs) Antineoplastic medications depress bone marrow, which causes leukopenia; the client must be protected from infection, which can be life-threatening. RBCs diminish slowly and can be replaced with a transfusion of packed RBCs. Platelets decrease as rapidly as WBCs, but complications can be limited with infusions of platelets.

A client who was admitted with a diagnosis of acute lymphoblastic leukemia is receiving chemotherapy. Which assessment findings would alert the nurse to the possible development of thrombocytopenia? Select all that apply. One, some, or all responses may be . Fever Diarrhea Melena Hematuria Ecchymosis

Melena Hematuria Ecchymosis Thrombocytopenia is a condition characterized by abnormally low levels of thrombocytes, also known as platelets, in the blood. This reduction in platelet activity impairs blood clotting, so any assessment finding associated with potentially abnormal bleeding would alert the nurse to the possibility of thrombocytopenia. This includes melena (digested blood in feces), hematuria (bleeding within the renal system), and ecchymosis (bleeding into skeletal soft tissue). Fever and diarrhea are common side effects of chemotherapy but are not findings specifically attributed to thrombocytopenia.

Chemotherapy via regional perfusion is the treatment of choice for a client's malignant sarcoma of the liver. Which reason would the nurse provide to explain to the client why this method of medication administration probably was selected? Medication therapy can be continued at home with little difficulty. Larger doses of medications can be delivered to the actual site of the tumor. Toxic effects of the chemotherapeutic medications are confined to the area of the tumor. A client develops severe bone marrow suppression related to cancer treatment. Which instruction is important for the nurse to include in the client's teaching? Be prepared to experience alopecia. Increase fluids to at least 3 liters per day. Use a soft toothbrush for oral hygiene. Monitor your intake and output of fluids. Combinations of medications are used to attack neoplastic cells at various stages of the cell cycle.

Toxic effects of the chemotherapeutic medications are confined to the area of the tumor. Regional perfusion therapy permits relative isolation of the tumor area and saturation with the medication(s) selected. This method of medication administration requires medical and nursing supervision and cannot be continued at home. Although toxic effects are confined mainly to the treated area, some migration may still occur. Combinations of chemotherapeutic medications are administered via intravenous or oral routes, not via regional perfusion.

A client is receiving chemotherapy with doxorubicin. Which development will the nurse teach the client to report immediately? Nausea Sore throat Loss of hair Constipation

Sore throat A sore throat is indicative of a respiratory tract infection, which may be the first clinical sign of bone marrow suppression, which can be life-threatening. Nausea is an expected side effect of doxorubicin, but it is not life-threatening. Hair loss is not a side effect of doxorubicin but, regardless, is not life-threatening. Constipation is an expected side effect of doxorubicin, but it is not life-threatening.

Parents of a child with sickle cell anemia ask about their child taking iron supplements to help treat the anemia. How will the nurse respond? Taking supplements will not help with this condition. It is advised that iron be taken with orange juice to aid in absorption. An over-the-counter multivitamin with iron should meet the needs of the child. It is advised that liquid iron supplements be given through a straw to prevent staining the teeth.

Taking supplements will not help with this condition. Taking iron supplements will not help. Sickle cell anemia is not caused by too little iron in the blood; it is caused by destruction of red blood cells, which increases free iron. Taking iron supplements could cause harm, because the extra iron builds up in the body and can damage organs. Although iron is better absorbed when taken with orange juice, in the case of sickle cell anemia supplements are not given. Using a straw when giving liquid iron supplements does prevent staining of the teeth; however, giving iron to this child may be detrimental. A multivitamin may be beneficial for this child; however, the addition of iron could build up in the body.

Which client statement demonstrates an understanding of cyanocobalamin (vitamin B 12) prescribed for pernicious anemia? "I should have a vitamin B 12 injection every month." "I'll take vitamin B 12 supplements every morning with my breakfast." "I'll eat a diet high in green vegetables." "I will increase my intake of processed foods fortified with vitamin B 12."

"I should have a vitamin B 12 injection every month." Rationale Vitamin B 12 is administered via injection on a weekly or monthly basis. For the client with pernicious anemia, there is inadequate intrinsic factor for adequate absorption of vitamin B 12. Green vegetables are not an important source of vitamin B 12. Vitamin B 12 is found primarily in meat, fish, poultry, and eggs. Although there is an abundance of foods fortified with vitamin B 12, for the client with pernicious anemia, the vitamin will not be absorbed in adequate amounts secondary to lack of intrinsic factor.

A client with lymphosarcoma is receiving allopurinol and methotrexate. The nurse can help the client prevent complications related to uric acid nephropathy by administering which medication in relation to which changes in fluid intake? Allopurinol and restricting the fluid intake Methotrexate and restricting fluid intake Allopurinol and encouraging increased fluid intake Methotrexate and encouraging increased fluid intake

Allopurinol and encouraging increased fluid intake Allopurinol decreases serum uric acid levels before and during chemotherapy; increased fluid intake aids in the increased excretion of uric acid. Allopurinol and increased fluids help prevent renal tubular impairment and kidney failure because of hyperuricemia. The client should be encouraged to follow a diet that promotes urine alkalinity. If the oral route is used, administering the methotrexate after providing an antacid will limit gastric irritation, not uric acid nephropathy. Fluid intake should be increased to 2 to 3 liters per day to prevent urate deposits and calculus formation.

A client with leukemia who is receiving vincristine reports lower leg numbness. Which statement about vincristine explains this occurrence? Vincristine acts on enlarged lymph nodes in the groin. Vincristine affects peripheral vascular circulation. Vincristine increases the risk for vascular occlusion. Peripheral neuropathies can result from vincristine chemotherapy.

Peripheral neuropathies can result from vincristine chemotherapy. Muscle weakness, tingling, and numbness are related to medications like vincristine; neuropathies usually are transient if the medication is stopped or reduced. Nodal enlargement produces vascular rather than neural side effects. Most chemotherapeutic regimens do affect the nervous or peripheral vascular system; neuropathies and peripheral vascular adaptations are potential side effects of chemotherapy. Tingling and numbness are characteristic of neuropathy, not vascular occlusion.

A child is prescribed dactinomycin and doxorubicin therapy after a nephrectomy for Wilms tumor. Which intervention would the nurse include in the plan of care? Administering aspirin for pain Offering citrus juices with meals Ensuring meticulous oral hygiene Eliminating spicy foods from the diet

Ensuring meticulous oral hygiene Rationale Oral hygiene is essential, especially during the administration of medications that have a negative effect on the oral mucosa. Although pain may be present, aspirin is avoided because doxorubicin is also being used, and a side effect of this medication is thrombocytopenia. Aspirin is contraindicated for children because it is associated with Reye syndrome. Citrus juice will aggravate stomatitis, which is a common side effect of dactinomycin. Spicy foods may aggravate the stomatitis that occurs with chemotherapy. However, usually any food that the child requests is permitted.

A 9-month-old infant with iron-deficiency anemia has been getting supplements but shows no improvement. The nurse recognizes which action by the parents as the reason for the lack of improvement? Administering iron supplements through a straw Administering iron supplements with whole cow's milk Administering iron supplements along with orange juice Administering iron supplements at the back of the mouth

Administering iron supplements with whole cow's milk Whole cow's milk binds with free iron and reduces medication absorption. The infant has developed medication insufficiency for maximum therapeutic action. Administering iron supplements through a straw does not reduce medication absorption; it prevents the iron from staining the infant's teeth. Orange juice increases the absorption of iron supplements. Administering iron supplements at the back of the mouth does not reduce medication absorption; it prevents the iron from staining the infant's teeth.

The nurse is educating a client receiving chemotherapy about newly prescribed ondansetron regular tablets. What statement by the nurse is appropriate? AThe medication works best if taken before you are nauseous BTake the medication with only a sip of water CThis medication could cause difficulty with sleep DYou may experience constipation with this medication

A Rationale: Ondansetron is a serotonin 5-HT3 receptor antagonist. It works by blocking the action of serotonin to treat nausea and vomiting. When taking ondansetron for nausea that occurs with meals, then the standard tablet should be taken half an hour to 1 hour before meals. Headache and diarrhea are common side effects. It can also cause dizziness and impaired gait and balance. Ondansetron may mask an ileus and gastric distention.

Which instructions would the nurse include when teaching parents how to administer liquid iron to their child? Select all that apply. One, some, or all responses may be . Protect the child from sunlight. Administer the medication with food. Anticipate that stools tend to be blackish-green. Give the medication with a glass of orange juice. Have the child drink it through a straw.

Anticipate that stools tend to be blackish-green. Give the medication with a glass of orange juice. Iron thickens the consistency of stools and may turn stools a blackish-green color. Citrus juices contain vitamin C and are acidic, meaning that they increase the absorption of iron. Direct contact with iron stains the teeth. Use of a needleless syringe permits accurate dosing and limited exposure of the teeth to the medication when given to very young children, but adolescents can drink the medication through a straw, which deposits the medication behind the teeth. The child will not experience photosensitivity when undergoing iron therapy. The medication should be taken between meals because it is best absorbed in an environment that has a low pH.

The nurse receives an order to administer intravenous (IV) iron sucrose to a client with anemia. Which statement best describes the purpose of administering this medication using the IV route? ATo ensure that the entire dose of medication is given BTo prevent the drug from causing tissue irritation CTo provide more even distribution of the drug DTo enhance absorption of the medication

B Iron sucrose is an iron supplement used to treat iron deficiency anemia. If given subcutaneously or intramuscularly, the tissue can become irritated and may result in bleeding into the muscle; therefore, the best route for this medication is intravenous (IV). The rate for administration will vary on the dosage but is typically at a slower rate due to the risk of adverse reactions. The other statements do not accurately describe the purpose for the IV route.

A client is being discharged with a prescription for an iron supplement. Which client statement indicates the need for further teaching by the nurse? A"I will have greenish-black stools from the medication." B"I will not take antacids with my iron supplement." C"I will take the iron supplement with a full glass of milk." D"I will take vitamin C along with the iron supplement."

C Iron supplements should be taken along with Vitamin C, such as orange juice, because this increases the absorption. Conversely, antacids, milk, caffeinated beverages, and calcium supplements can decrease the absorption of iron. Iron should be taken one hour before or two hours after meals to enhance absorption, although clients who report gastrointestinal intolerance may take it with food. Iron will cause stool to turn greenish-black and tarry.

The nurse is caring for a client who recently received an allogeneic bone marrow transplant for the treatment of leukemia. Which nursing intervention is a priority for this client? AProvide education on infection prevention in the community BAssist the client with ambulation every 2 hours CMonitor the client for signs of infection DIntroduce the client to another bone marrow recipient

C Leukemia is cancer that results in the uncontrolled production of immature WBCs (" blast" cells) in the bone marrow. Hematopoietic stem cell transplantation (HSCT), also called bone marrow transplantation (BMT), is standard treatment for the patient with leukemia who has a closely matched donor, e.g., a sibling (allogeneic). The client has an impaired immune system due to the diagnosis of leukemia and the treatment related to the bone marrow transplant, placing the client at an increased risk for infections. The priority if for the nurse to monitor for signs of infection including a temperature above 100.5 °F (38 °C), chills and cough. The other options are also appropriate for this client; however, they are not the priority immediately following a bone marrow transplant.

The nurse is developing a plan of care for a client who has developed blisters and sores in the mouth after receiving chemotherapy. Which interventions should the nurse include? Select all that apply. Examine your mouth frequently. Use strong mouthwashes to kill bacteria. Drink 2 or more liters of water per day. Suck on ice chips during chemotherapy. Visit a dental hygienist weekly. Avoid spicy or acidic foods.

Examine your mouth frequently. Use strong mouthwashes to kill bacteria. Drink 2 or more liters of water per day. Suck on ice chips during chemotherapy. Mucositis is a complex, multiphase process at the cellular level started in response to cytotoxic chemotherapy. The epithelial cells in the mouth are very sensitive to chemotherapy due to their high rate of cell turnover. Oral cryotherapy using ice water or ice chips can be used for the prevention of mucositis. It is believed that vasoconstriction caused by the cold temperature decreases exposure of the oral mucous membranes to the mucositis-causing agents. Frequent mouth assessment, and good and frequent oral hygiene are key in managing mucositis. The client should avoid the use of "strong" mouthwashes that often contain alcohol. Mucositis can be managed at home and does not require seeing a dental hygienist. Increased hydration is generally recommended.

Which intervention would the nurse include in the plan of care for a client with breast cancer who received doxorubicin and cyclophosphamide 12 days ago and now has a white blood cell (WBC) count of 1.4 cells/mm 3 and reports shortness of breath and activity intolerance? Select all that apply. One, some, or all responses may be . Use an electric razor when shaving. Institute neutropenic precautions. Place client on airborne precautions. Transfuse two units of packed red blood cells (RBCs). Instruct nursing staff to wear a dosimeter badge.

Institute neutropenic precautions. Doxorubicin and cyclophosphamide can lower the client's blood cell counts. Clients with low WBC counts need interventions to prevent infection, which include instituting neutropenic precautions. The nurse would instruct the client to use an electric razor if the platelet count was less than 50,000 cells/µL. Airborne precautions would be indicated if the client was ill with an infectious disease. The nurse would transfuse RBCs for a client with anemia (if prescribed by the health care provider). Nursing staff would wear dosimeter badges when caring for a client receiving internal radiation (brachytherapy).

A client develops hemolytic anemia. Which client medication can cause this adverse effect? Famotidine Methyldopa Levothyroxine Ferrous sulfate

Methyldopa is associated with acquired hemolytic anemia and should be discontinued to prevent progression and complications. Famotidine will not cause these symptoms; it decreases gastric acid secretion, which will decrease the risk of gastrointestinal bleeding. Ferrous sulfate is an iron supplement to , not cause, anemia. Levothyroxine is not associated with red blood cell destruction.

The oncology nurse is preparing to administer the initial dose of vincristine to a child diagnosed with acute lymphocytic leukemia. Which interventions should the nurse include in the plan of care? Select all that apply. Apply pressure to the injection site if extravasation occurs. Monitor liver function tests regularly. Monitor for numbness or tingling in the fingers and toes. Select the appropriate catheter for intrathecal administration. Verify blood return before, during and after intravenous administration.

Monitor liver function tests regularly. Monitor for numbness or tingling in the fingers and toes. Verify blood return before, during and after intravenous administration. Acute lymphocytic leukemia (ALL) is the most common type of cancer in children and treatment protocols include vincristine, an anticancer drug. Vincristine is for intravenous use only; intrathecal (i.e., spinal) administration can be fatal. Vincristine is a vesicant that can cause significant local damage if extravasation occurs; treatment includes subcutaneous injection of an antidote and warm compresses (topical cooling may worsen the effect). Peripheral neuropathy is a major side effect associated with vincristine. The nurse should monitor for decreased hepatic functioning because vincristine is metabolized in the liver.

A 32-year-old female with human epidermal growth factor receptor 2-positive (HER2-positive) metastatic breast cancer is scheduled to begin therapy with pertuzumab. What information is important for the nurse to reinforce and discuss with the client? Select all that apply. Other therapies for cancer treatment are no longer needed. Use contraception during and for 6 months following the use of this drug. Take the medication at the same time every day on an empty stomach. Report shortness of breath, lightheadedness, dizziness, cough or swelling of the feet. Report chills, fatigue, or headache during treatment

Use contraception during and for 6 months following the use of this drug. Report shortness of breath, lightheadedness, dizziness, cough or swelling of the feet. Pertuzumab (Perjeta) is used in combination with trastuzumab (Herceptin) as a targeted therapy for HER2+ metastatic breast cancer; these medications are used in combination with chemotherapy and radiation. The most common side effects are fatigue, loss of taste, muscle pain and vomiting; sometimes slowing the infusion rate can help. It is best to eat a small meal before receiving the infusion. Serious side effects include birth defects and fetal death; women of child-bearing age must use a form of effective contraception during and for 6 months following treatment. Drugs that block HER2+ activity decrease left ventricular ejection fraction (LVEF) and will worsen symptoms of congestive heart failure; heart function must be tested before and monitored during treatment.

Which medication would the nurse expect to administer to control bleeding in a child with hemophilia A? Albumin Fresh frozen plasma Factor VIII concentrate Factors II, VII, IX, X complex

Factor VIII concentrate Rationale Factor VIII is the missing plasma component necessary to control bleeding in a child with hemophilia A. Factor VIII is not provided by albumin. Although fresh frozen plasma does contain factor VIII, there is an insufficient amount in a plasma transfusion; a higher volume is required. A complex of factors II, VII, IX, and X is not useful in this situation.

Intravenous furosemide has been prescribed for a client with severe edema and hypertension. Which subjective clinical manifestations lead the nurse to suspect that the furosemide is infusing too rapidly? Select all that apply. One, some, or all responses may be . Hunger Tinnitus Weakness Leg cramps Excess salivation

Tinnitus Weakness Leg cramps Tinnitus is a central nervous system side effect of furosemide. Weakness and leg cramps result from hypokalemia caused by an overload of furosemide. Nausea and anorexia, not hunger, are side effects of dehydration that may occur with an overload of furosemide. Dry mouth, not salivation, results from dehydration caused by an overload of furosemide.

A nurse is reviewing laboratory data prior to administering methotrexate to a client with breast cancer. Which clinical finding will the nurse report to the healthcare provider before administering the medication? Question 1 Answer Choices AALT of 55 IU/mL ALT of 55 IU/mL Answer BWBC of 12,000/mm³ WBC of 12,000/mm³ CAST of 34 U/L AST of 34 U/L DHGB of 11.5 g/dL HGB of 11.5 g/dL

ALT of 55 IU/mL Rationale: Alanine transaminase (ALT) is a liver enzyme that is released into the bloodstream when liver damage is present. Methotrexate is an antineoplastic used in the treatment of various carcinomas. Methotrexate is contraindicated in clients with hepatic impairment. A higher than normal white blood cell (WBC) count is an expected finding in a client with carcinoma. Aspartate aminotransferase (AST) is a liver enzyme used to assess hepatic function. An AST level of 34 U/L is a normal finding. Anemia (low hemoglobin) is an expected finding in a client with carcinoma.

A nurse is preparing to administer doxorubicin to a client with bladder carcinoma. How will the nurse prepare this medication? A While wearing sterile gloves B In a biological safety cabinet C Inside a temperature-controlled room D By withdrawing into a syringe undiluted

B Rationale: Doxorubicin should be prepared in a biological safety cabinet. Doxorubicin is a high-risk medication whose fumes may cause health hazards. A biosafety cabinet controls the airflow while preparing this medication. Sterile gloves are not required. Standard gloves, a gown, and a mask should be worn when preparing this medication. The temperature of the room is not a specified guideline for preparing this medication. Doxorubicin should be diluted with normal saline before administration.

The nurse is reviewing the laboratory results for a client with cancer who is being treated with chemotherapy and recently started prescribed filgrastim. Which laboratory value indicates the treatment is effective? AHemoglobin level of 9.8 g/dL BWhite blood cell count (WBC) of 5,200/mm³ CPlatelet count of 200,000/mm³ DRed blood cell count (RBC) of 4 million/mm³

B Rationale: The client has a normal white blood cell count indicating that filgrastim has been effective. The action of filgrastim is to increase neutrophil production, thereby increasing the white blood cell (WBC) count. Decreased hemoglobin (Hgb) indicates anemia. The hemoglobin and red blood cell (RBC) count are below normal limits for an adult male. Epoetin alfa is used to treat low RBC counts (anemia) caused by chemotherapy. The platelet count is within normal limits for an adult client.

A nurse is teaching a parent how to administer oral iron supplements to a 2-year-old child. Which intervention should be included in the teaching? AStop the medication if the stools become tarry green BAdd the medicine to a bottle of formula CGive the medicine with orange juice and through a straw DAdminister the iron with your child's meals

C Absorption of iron is facilitated in an environment rich in vitamin C. Because liquid iron preparation will stain teeth, a straw should be used. Parents should be informed that dark, tarry stools are expected outcomes of taking iron supplements. Iron is best absorbed on an empty stomach (but it may be given after meals if the child experiences an upset stomach).

Which nursing intervention is most important when caring for a client receiving the antimetabolite cytosine arabinoside (Arc-C) for chemotherapy? A. Hydrate the client with IV fluids before and after infusion. B. Assess the client for numbness and tingling of extremities. C. Inspect the client's oral mucosa for ulcerations. D. Monitor the client's urine pH for increased acidity.

C Cytosine arabinoside (Arc-C) affects the rapidly growing cells of the body, therefore stomatitis and mucosal ulcerations are key signs of antimetabolite toxicity.

The nurse is reinforcing teaching regarding the use of methotrexate with a female client who has systemic lupus erythematosus. Which statement by the client indicates an understanding of the teaching? A"I will not take any vitamin that contains folic acid." B"Lab work won't be necessary while I take this medication." C"I will avoid interacting with people in large crowds." D"I should not use contraception that contains estrogen."

C Methotrexate is an immunosuppressant medication that is used to treat systemic lupus erythematosus (SLE). Due to immunosuppression, clients taking methotrexate should avoid large crowds of people to prevent becoming ill. Methotrexate should be taken with folic acid to decrease gastrointestinal and hepatic toxicity. Clients who are taking this medication should have a complete blood count test done regularly to monitor for decreased white blood cells and platelets, which can indicate bone marrow suppression. Methotrexate is teratogenic, therefore, pregnancy should be avoided while taking this medication. Oral contraceptives that contain estrogen are not contraindicated with this medication or disease.

A client with severe iron-deficiency anemia is prescribed a parenteral form of iron. Which intervention does the nurse prepare to implement before administering the medication? AObtain the client's vital signs. BUse the Z-track administration method. CAdminister a small test dose. DObtain informed consent.

C The most serious adverse effect of iron dextran is an anaphylactic reaction. Although anaphylactic reactions are rare, their possibility demands that iron dextran be used only when clearly required. To reduce this risk, each dose must be preceded by a small test dose and the client must be closely monitored while receiving the test dose. The nurse should be aware that even the test dose can trigger anaphylactic and other hypersensitivity reactions. In addition, even when the test dose is uneventful, patients can still experience anaphylaxis. The medication does not require informed consent and obtaining the client's vital signs does not prevent an anaphylactic reaction. If the medication is ordered to be administered intramuscularly, the Z-track technique should be used to minimize discomfort, leakage and surface discoloration.

The oncology nurse is caring for a female client who is being treated for metastatic breast cancer. The client is scheduled to receive their first dose of trastuzumab. Which assessment finding is most important to notify the health care provider of? AAbsolute neutrophil count 2.5 (2,500 mm3) BIntermittent nausea and vomiting CBlood glucose 130 mg/dL DIrregular apical pulse

D Trastuzumab is a monoclonal antibody used as anticancer therapy for women with HER2-positive breast cancer. The main concern in administering trastuzumab is cardiotoxicity, manifesting as ventricular dysfunction and congestive heart failure. Therefore, the irregular apical pulse is the most important assessment findings. An ejection fraction is obtained as a baseline before treatment and may be monitored every few months while the client is receiving this medication. The other findings are to be expected, normal or near normal and not as important as the irregular apical pulse.

Which statement by a client with metastatic melanoma who is being treated with interferon gamma 1b indicates that teaching was understood? "I will increase my fluid intake to several liters (quarts) every day." "I need to discard any reconstituted solution at the end of the week." "I can continue driving my car as before as long as I have the stamina." "I should be able to continue my usual activity while taking this medication."

"I will increase my fluid intake to several liters (quarts) every day." Rationale Increasing fluid intake to several liters (quarts) every day helps flush the kidneys and prevent nephrotoxicity, especially during the early phase of treatment. Reconstituted solution can be stored in the refrigerator for 1 month. Confusion, dizziness, and hallucinations are adverse effects of this medication; the client should avoid hazardous tasks, such as driving or using machinery. Activity may have to be altered because fatigue and other flu-like symptoms are common with this medication.