Ch 14: Antineoplastics
A 63-year-old male patient has just begun treatment with IV paclitaxel. About 10 minutes into the infusion, the nurse becomes concerned about a possible anaphylactic reaction to the drug because the patient is experiencing:
dyspnea.
A female client prescribed methotrexate for meningeal leukemia is asking the nurse about adverse effects of the drug. What would the nurse tell this client should be avoided while taking methotrexate?
pregnancy
A female client is ending an extensive chemotherapeutic regimen that included cytotoxic antineoplastic drugs. What does the nurse understand about bone marrow toxicity in this client?
It is a common adverse effect of her treatment.
A patient has just received the first dose of imatinib and the nurse on the oncology unit is amending the patient's care plan accordingly. What nursing diagnosis is most appropriate in light of this addition to the patient's drug regimen?
Risk for Infection related to bone marrow suppression
A female client will soon begin targeted therapy as a component of her treatment plan for chronic leukemia. The nurse is conducting health education about this new aspect of the client's drug regimen and the client has asked about the potential side effects of treatment. How should the nurse best respond?
"Both classes of drugs have adverse effects, but targeted therapies tend to have less of an effect on healthy body cells."
A nurse on the oncology unit is caring for a client with an astrocytoma. The client has just been told that the tumor is growing very fast. The client asks the nurse how these tumors grow. What would be the nurse's best response?
"Brain tumors infiltrate the surrounding tissue."
A client is diagnosed with a brain tumor. The client is told that the cancer cells proliferate. The client asks the nurse what this means. What is the nurse's best response?
"The proliferation is the growth of cancer cells and the rate of growth."
A client received an injection of doxorubicin and is now observing a reddish urine. The client reports blood in the urine to the nurse. How should the nurse respond?
"The reddish urine is an expected response to the drug."
A patient who will begin chemotherapy voices concern to the nurse about the accompanying nausea and vomiting. What is the best response by the nurse?
"We can relieve your nausea and vomiting with antiemetic drug therapy. You should ask for these medications whenever you need them."
A patient is experiencing antineoplastic-induced nausea and vomiting. The health care provider prescribes ondansetron. The nurse understands that this agent acts in which way?
Blocking serotonin receptors in the CTZ
A child is prescribed an anthracycline drug. The nurse would teach the parents to observe for signs and symptoms of what adverse effect?
Cardiotoxicity
After teaching a group of students about antineoplastic antibiotics, the instructor determines that the teaching was successful when the students identify which drug as an example?
Doxorubicin
The nurse understands that when administering cisplatin, the drug has a high potential for causing severe nausea and vomiting. What term is used to describe this group of antineoplastic drug?
Emetogenic
A male client is receiving parenteral cytotoxic medications in the home. Adjunct therapy may include what substance?
Erythropoietin
A 26-year-old man with testicular cancer is prescribed combination chemotherapy that involves using two drugs that are effective against testicular tumors. Combination drug therapy is superior to single-drug therapy because of:
Higher tumor response rates
A client's chemotherapeutic regimen includes procarbazine. What is the client's most likely diagnosis?
Hodgkin lymphoma
A male client is diagnosed with prostate cancer. The treatment modality of choice includes both surgery and chemotherapy. What does the chemotherapeutic option include?
Hormonal therapies
A client's chemotherapy regimen has been deemed successful, but the client is experiencing debilitating nausea and vomiting. These adverse effects should signal the nurse to the possibility of what nursing diagnosis?
Imbalanced nutrition: less than body requirements
A client is being treated on the oncology unit and has developed worsening adverse effects over the past several days of chemotherapy. Administration of filgrastim may aid in achieving what desired outcome?
Increased leukocytes
During which phase of the cell cycle would a nurse expect a mitotic inhibitor to act?
M
Which agent would the nurse expect to be administered orally?
Methotrexate
Which would the nurse identify as an antineoplastic antibiotic?
Mitomycin
A client has just started on an alkylating agent to treat their cancer. What is the most common side effect of most alkylating agents?
Myelosuppression
A client develops leukopenia after receiving chemotherapy. Which nursing diagnosis would be most appropriate?
Risk for infection
A client is undergoing a cytotoxic chemotherapy regimen for the treatment of stage III lung cancer. What effect will this regimen likely have on the client's hemostatic function?
The client's platelet count will decline.
What should the oncology nurse understand when administering a cell cycle-nonspecific chemotherapeutic agent about its effect?
The drug will be effective through all phases of the cell cycle.
A client has chosen to receive palliative care after lung cancer metastasized to the bones and liver. Which is the most appropriate during palliative cancer care?
The use of chemotherapy to reduce pain
A client with a diagnosis of bladder cancer is started on a chemotherapeutic regimen that includes three agents. What is the rationale for using multiple antineoplastic agents?
The use of three agents decreases the development of cell resistance.
Prior to administering a dose of 5-FU to a patient with pancreatic cancer, the nurse is conducting the necessary drug research. The nurse is aware that 5-FU is a cell cycle-specific chemotherapeutic agent. Which statement best describes cell cycle-specific drugs?
They affect cancerous cells during a particular phase of cellular reproduction.
A nurse is performing discharge teaching with a client who will soon return home. The client will continue taking imatinib for the foreseeable future, and the nurse is teaching the client about the safe administration of this drug. How should the nurse instruct the client to take imatinib?
With food and a large glass of water
After teaching a group of nursing students about antimetabolite drugs, the instructor determines that the teaching was successful when the students identify which as an example?
capecitabine
A patient with acute lymphoblastic leukemia (ALL) is receiving imatinib on an inpatient basis. When planning the care of this patient, what assessment should be specified in the patient's plan of nursing care?
daily weights
Many times a combination of antineoplastic medications are used to:
decrease the development of cell resistance.
A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to:
drink a lot of water.
A client is receiving tamoxifen. Which adverse effect would be most specific to the action of this drug?
menopausal effects
Among the multiple genetic abnormalities that are characteristic of cancer cells, which gene mutation results in more than 90% of small cell lung cancers and more than 50% of breast and colon cancers?
p53
The nurse reviews the plan of care for a patient receiving antineoplastic therapy. The nurse notes a nursing diagnosis of risk for infection. Which adverse effect would the nurse expect the patient to exhibit?
pancytopenia
When preparing to administer ondansetron for a patient's nausea and vomiting, the nurse understands that this agent blocks:
serotonin.
A client with leukemia has been prescribed rasburicase to be administered before chemotherapy. Which assessment should the nurse complete after administration of this medication?
uric acid levels
A parent hears the health care provider using the word extravasation. The parent asks the nurse what extravasation means. What would be a correct answer?
"Extravasation is when fluid escapes from a blood vessel into the surrounding tissue."
Which antineoplastic drugs are classified as alkylating agents? (Select all that apply.)
- Chlorambucil (Leukeran) - Cyclophosphamide (Cytoxan) - Ifosfamide (Ifex)
A client is being treated for pancreatic cancer and has been prescribed streptozocin 500 mg/m2IV for five consecutive days. The client's body surface area is 1.78 m2 and the client weighs 69.5 kg. The nurse should administer how many mg of this medication?
890
A client with acute myeloid leukemia has been receiving mitoxantrone IV as part of the chemotherapeutic regimen. When assessing the client for the effects of bone marrow suppression, the nurse should perform what assessment?
Assessment of the client's activity tolerance and energy level
A 49-year-old client is diagnosed with ovarian cancer. What is a characteristic of malignant cells that differentiates them from normal body cells?
Cancerous cells grow in an uncontrollable fashion.
When describing the use of the various agents for combating chemotherapy-induced nausea and vomiting, the nurse understands that the majority of these agents block:
Chemoreceptor trigger zone
A client with leukemia is being treated with a combination of antineoplastics, including methotrexate. The client's most recent laboratory results indicate the client is experiencing bone marrow suppression. What is the nurse's priority action?
Ensure that all staff and visitors adhere to infection control precautions.
How can a nurse best prevent tissue damage caused by an antineoplastic extravasation?
Inspect the site frequently for redness or swelling
Which would the nurse expect to administer to counteract the effects of methotrexate?
Leucovorin
A nurse is preparing to administer imatinib to a client. The nurse expects to administer this drug by which route?
Oral
A patient with a diagnosis of chronic myeloid leukemia has met with the oncologist, who has recommended treatment with the kinase inhibitor imatinib. What route of administration will the client receive?
Oral administration of imatinib in a home setting
In describing the action of alkylating agents, what would the nurse include?
React chemically with portions of RNA, DNA, and other cellular proteins.
A patient with non-Hodgkin's lymphoma (NHL) will be starting a course of doxorubicin shortly. When planning this patient's care, what nursing diagnosis should the nurse prioritize?
Risk for Infection related to suppressed bone marrow function
A postmenopausal woman with breast cancer will most likely be treated with which anti-estrogen drug?
Tamoxifen
A nurse educator who coordinates the staff education on an oncology unit is conducting an inservice on targeted therapies. What potential benefit of targeted therapies should the nurse highlight in this education session?
Targeted therapies have the potential to damage cancerous cells while leaving normal body cells less affected.
An older adult woman has been diagnosed with acute lymphoblastic leukemia (ALL) and her care team has identified potential benefits of imatinib. Which characteristic of this patient's current health status may preclude the use of imatinib?
The patient has chronic heart failure resulting in significant peripheral edema.
When describing the process of cancer cell growth to a client, the nurse addresses angiogenesis. Which description would the nurse include?
The process of creating new blood vessels to supply oxygen and nutrients to the cells
An adult client who has been diagnosed with a rectal tumor is scheduled to begin treatment with cisplatin. The nurse has conducted client teaching about the possibility of nausea and vomiting. In order to reduce the client's risk of severe nausea, the nurse should:
administer a combination of antiemetics prior to the administration of the drug.
The oncology nurse understands that chemotherapeutic agents are most effective during a particular phase of the cell cycle. This means the agents are:
cell cycle-specific.
A client asks the nurse what cancer cell growth is called. What would the nurse tell the client?
proliferation
A patient who is receiving methotrexate is also receiving leucovorin. The nurse understands that this drug is being given for which reason?
Counteract effects of methotrexate
A 42-year-old female with breast cancer has had a radical mastectomy. She will have radiation therapy and then begin chemotherapy. Drug therapy will consist of a combination of doxorubicin, cyclophosphamide, and paclitaxel. What will the nurse include in the teaching plan concerning the drug therapy?
Take special care when shaving or brushing her teeth.
A client on the oncology unit has begun chemotherapy with a regimen that includes bendamustine. The client has begun to experience alopecia. The nurse should prioritize assessments related to what potential nursing diagnosis?
Disturbed body image
