Ch 14; Drug Therapy for Treatment of Cancer

c) Risk for infection related to suppressed bone marrow function Pg. 261 Because doxorubicin suppresses bone marrow function, the patient is at risk of leukopenia and subsequent infection. Impaired skin integrity is less likely and airway clearance will not normally be affected. Nutritional deficit, not excess, is common.

10. 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? a) Risk for impaired skin integrity related to cytotoxic effects of doxorubicin b) Risk for imbalanced nutrition: more than body requirements related to metabolic effects of doxorubicin c) Risk for infection related to suppressed bone marrow function d) Risk for ineffective airway clearance related to decreased neurological function

a) Weight Pg. 253 It is important to use weight-based dosing to individualize dosing of all cytotoxic drugs to minimize toxicity of normal cells. Considerations such as comorbidities, BSA, and percentage of body water may be relevant for certain clients, but weight-based dosing is the norm.

23. The dosages of the chemotherapy agents that will be administered are based primarily on what client variable? a) Weight b) Body surface area (BSA) c) Percentage of body water d) Comorbidities

a) With food and a large glass of water Pg. 269 Imatinib should be taken with food and a large glass of water.

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

c) Disturbed body image Pg. 257 The physiologic consequences of alopecia are usually inconsequential. This adverse effect does not have a major effect on thermoregulation or tissue integrity. However, many clients find it distressing and experience a disturbance to their body image due to the significant and unwanted change in their appearance. The nurse should choose assessments and interventions accordingly.

12. 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? a) Impaired tissue integrity b) Ineffective thermoregulation c) Disturbed body image d) Hypothermia

c) Tamoxifen Pg. 277 Anti-estrogens are first-line therapy for treating breast cancer in postmenopausal women. Tamoxifen is the most widely recognized anti-estrogen.

4. A postmenopausal woman with breast cancer will most likely be treated with which anti-estrogen drug? a) Cyclophosphamide b) Cisplatin c) Tamoxifen d) Bleomycin

b) The cell increases in size and synthesis of RNA Pg. 250 Gap 1 (G1) phase occurs when the body needs a certain cell immediately. During the G1 phase, the cell increases in size and synthesizes ribonucleic acid (RNA) and the proteins needed for deoxyribonucleic acid (DNA) synthesis. The time a cell spends in this phase varies and can last from hours to days, depending on the cell type. Gap 0 (G0) phase is also known as the resting phase. After RNA and protein synthesis occur, the cell enters the third, or synthesis (S), phase. The cell then enters the fourth, Gap 2 (G2), phase, during which more RNA and protein synthesis takes place in preparation for mitosis (cell division). The fifth phase of the cell cycle is the mitosis (M) phase, which consists of the following orchestrated subphases: prophase, metaphase, anaphase, and telophase.

8. The cell cycle consists of 5 phases. Each cell goes through these phases. How would cell phase G1 be defined? a) Mitosis occurs b) The cell increases in size and synthesis of RNA c) The resting phase of the cell d) Protein synthesis occurs

d) "The reddish urine is an expected response to the drug" Pg. 269 Reassure clients that reddish urine after doxorubicin injection is a harmless and expected response to the drug. This reaction may happen within 1 to 2 days postinfusion.

9. 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? a) "We need to notify the health care provider because this is a complication of the medication" b) "You may have hemorrhagic cystitis" c) "Let's get a urinalysis to confirm a urinary tract infection" d) "The reddish urine is an expected response to the drug"

b) Methotrexate Pg. 259 Methotrexate is absorbed well from the gastrointestinal (GI) tract and can be administered orally. Cytarabine, fluorouracil, and gemcitabine must be administered parenterally because they are not absorbed well from the GI tract.

16. Which agent would the nurse expect to be administered orally? a) Fluorouracil b) Methotrexate c) Cytarabine d) Gemcitabine

c) Specific antigens on the surface of malignant B cells Pg. 275 Rituximab is a type of monoclonal antibody that binds specifically to the CD20 antigen found on the surface of normal and malignant B lymphocytes and causes cell lysis. The drug does not target the complement system, plasma cell DNA, or the cell membrane of malignant cells.

28. A patient has been scheduled to begin treatment with rituximab for non-Hodgkin's lymphoma. The nurse who will administer this drug should understand that it targets a) The DNA of mature plasma cells b) The molecular structure of the cells making up the semipermeable membrane of cancerous cells c) Specific antigens on the surface of malignant B cells d) The function of the complement system

d) Proliferation Pg. 251 Cancer cell growth is not called anaplasia, pleomorphism, or neoplasm.

6. A client asks the nurse what cancer cell growth is called. What would the nurse tell the client? a) Pleomorphism b) Neoplasm c) Anaplasia d) Proliferation

a) Thoroughly rinse the mouth often, especially before and after meals Pg. 266 A client who is experiencing mucositis should rinse the mouth several times daily, especially before meals (to decrease unpleasant taste and increase appetite) and after meals (to remove food particles that promote growth of microorganisms). Fluid intake should be increased, and commercial mouthwashes should be avoided. Analgesia therapy is usually topical, rather than oral.

7. A nurse is providing education to a client who is preparing to begin chemotherapy for the treatment of cancer. What action should the nurse encourage the client to implement to minimize the effects of chemotherapy-triggered mucositis? a) Thoroughly rinse the mouth often, especially before and after meals b) Limit fluid intake to prevent overhydration of mucous membranes c) Gargle with a commercial mouthwash 3 to 4 times daily d) Self-administer 650 mg of acetaminophen 4 times daily

a) Stop the infusion Pg. The client is experiencing a hypersensitivity reaction and the first action by the nurse should be to discontinue the infusion.

2. The client receiving a first infusion of paclitaxel reports chills and dyspnea. The oncology nurse assesses the client and observes facial flushing, wheezing, and extreme anxiety. What is the priority intervention by the nurse? a) Stop the infusion b) Continue the infusion and administer epinephrine 0.3 mg subcutaneously c) Place the client in supine position d) Continue the infusion and administer diphenhydramine 50 mg, intravenously

c) Cardiotxicity Pg. 263 Children who receive an anthracycline drug (e.g., doxorubicin) are at increased risk of developing cardiotoxic effects (e.g., heart failure) during treatment or after receiving the drug. Efforts to reduce cardiotoxicity include using alternative drugs when effective, giving smaller cumulative doses of anthracycline drug, and observing clients closely so that early manifestations can be recognized and treated before heart failure occurs.

30. A child is prescribed an anthracycline drug. The nurse would teach the parents to observe for signs and symptoms of what adverse effect? a) Gallbladder disease b) Esophageal varices c) Cardiotoxicity d) Dehydration

a) Alkylating agents Pg. 253 Malignant cells seem to be more susceptible than normal cells to the effects of the alkylating agents. Antineoplastic antibiotics appear to interfere with DNA and RNA synthesis, thereby delaying or inhibiting cell division and blocking the reproductive ability of malignant cells. The vinca alkaloids interfere with amino acid production in the S phase and formation of microtubules in the M phase. Antimetabolite drugs are substances that incorporate themselves into the cellular components during the S phase of cell division. This interferes with the synthesis of RNA and DNA, making it impossible for the cancerous cell to divide into two daughter cells.

31. Malignant cells seem to be more susceptible than normal cells to the effects of which class of antineoplastic drugs? a) Alkylating agents b) Antineoplastic antibiotics c) Antimetabolites d) Vinca alkaloids

d) Administer a combination of antiemetics prior to the administration of the drug Pg. 266 Antiemetics should be administered proactively rather than waiting until the client's nausea becomes unbearable. A combination approach is often effective. A low-residue diet is unnecessary, and withholding food does not necessarily reduce nausea.

11. 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: a) Place the client on a low-residue diet b) Ensure that the client is NPO from midnight prior to receiving the drug c) Encourage the client to request antiemetics if the nausea becomes unbearable d) Administer a combination of antiemetics prior to the administration of the drug

b) "Liver impairment usually subsides when chemotherapy is complete" Pg. 264 L-Asparaginase is hepatotoxic in most clients; it may increase preexisting hepatic impairment and hepatotoxicity of other medications. Signs of liver impairment, which usually subsides when the drug is discontinued, include increased AST, ALT, alkaline phosphatase, and bilirubin and decreased serum albumin, cholesterol, and plasma fibrinogen.

13. A female client is receiving L-asparaginase. She is at the end of her chemotherapeutic course and is concerned because her liver function tests are abnormal. What is an appropriate response by the nurse? a) "Liver damage is an outcome of chemotherapy; a transplant may be advised after you recover" b) "Liver impairment usually subsides when chemotherapy is complete" c) "You are correct to worry; the chemotherapy may be canceled and your cancer will recur" d) "The liver damage is an acceptable consequence to chemotherapy"

b) Prostatectomy Pg. 279 Bicalutamide is administered in combination with a luteinizing hormone for the treatment of advanced prostate cancer. This medication would not be effective for treating bowel, thyroid or breast cancer because it is a hormone modulator and works only on androgen-receptor sites.

14. The nurse is caring for a client whose current antineoplastic regimen includes bicalutamide. The nurse should anticipate what additional aspect of this client's cancer treatment? a) Hemicolectomy b) Prostatectomy c) Thyroidectomy d) Total mastectomy

d) "Your tumor originated from a single cell that is genetically different from nearby cells" Pg. 250-251 All cancers start with a single cell that is genetically different from the other cells in the surrounding tissue. Determining the site of the first cell to genetically mutate in this client would require more information so it is impossible to say if the originating cell was in the CNS, the pituitary gland, or peripheral nerve tissue.

15. The nurse is caring for a client newly diagnosed with a primary brain tumor. The client asks the nurse where the tumor came from. What would be the nurse's best response? a) "Your tumor most likely originated with a mutation in the pituitary gland that released pathologic hormones" b) "Your tumor is from changes in the nerve tissue somewhere in your body" c) "Your tumor originated from somewhere outside the CNS from a cell just like other cells" d) "Your tumor originated from a single cell that is genetically different from nearby cells"

b) NIOSH-approve respirator c) Gloves d) Safety goggles e) Gown Pg. 268 A nurse should wear a gown, safety goggles, gloves, and a NIOSH-approved respirator when cleaning up a spill of an antineoplastic drug.

17. If the nurse has to clean up a spill of antineoplastic drug, which of the following personal protective equipment should be worn? Select all that apply: a) Chemical spill boots b) NIOSH-approve respirator c) Gloves d) Safety goggles e) Gown

b) Hormonal therapies Pg. 277 Hormonal therapies that block the effects of estrogen (in an estrogen-responsive tumor) and androgen (in an androgen-responsive tumor), respectively, are essential in the treatment of breast and prostate cancers.

18. A male client is diagnosed with prostate cancer. The treatment modality of choice includes both surgery and chemotherapy. What does the chemotherapeutic option include? a) Antidiuretic hormone b) Hormonal therapies c) Diuretics d) Hemoglobin replacement therapy

a) Administer mesna as ordered d) Prehydrate the patient orally and intravenously (IV) with 2 L of normal saline e) Monitor urine output Pg. 281 The incidence of hemorrhagic cystitis can be reduced by a vigorous hydration regimen of at least 2 L of fluid a day and, in high-dose therapy, administering the uroprotectant agent mesna. Prehydrate the patient orally and intravenously with at least 2 L of normal saline solution. Potassium and magnesium additives may also be indicated. Monitor urine output vigilantly to ensure an output of at least half of the intake.

19. A patient who has been taking high-dose cyclophosphamide therapy has had sterile hemorrhagic cystitis. What measures can the oncology nurse take to reduce the risk of recurrence? (Select all that apply.) a) Administer mesna as ordered b) Instill normal saline into the bladder via Foley catheter c) Restrict fluid intake, especially at night d) Prehydrate the patient orally and intravenously (IV) with 2 L of normal saline e) Monitor urine output

a) Use reliable forms of barrier contraception Pg. 267 Antimetabolites are contraindicated for use during pregnancy and lactation because of the potential for severe adverse effects on the fetus and neonate. There is no need to discontinue oral contraceptives, but barrier methods should also be used. There is no need to avoid grapefruit juice and prolonged abstinence from alcohol is not required.

20. A female client is prescribed methotrexate for meningeal leukemia. What health education should the nurse prioritize? a) Use reliable forms of barrier contraception b) Avoid grapefruit juice c) Discontinue oral contraceptives d) Abstain from alcohol until 7 days after treatment

b) Administering the initial doses by slow infusion while observing for adverse reactions Pg. 272 If no reactions are apparent after 30 minutes of rituximab infusion, the dose may be escalated every 30 minutes by 50 mg/h until a maximum infusion rate of 400 mg/h is reached. Admission to an ICU and administration of diphenhydramine do not reduce the risk of adverse effects. Rituximab is not administered through multiple IV sites simultaneously.

21. A patient with chronic lymphocytic leukemia (CLL) will imminently begin a course of treatment with rituximab. In order to minimize the risk of adverse effects, what strategy for administration will be adopted? a) Admitting the patient to the intensive care unit in anticipation of the initial bolus of the drug b) Administering the initial doses by slow infusion while observing for adverse reactions c) Administering the drug by slow infusion to two peripheral IV sites simultaneously d) Administering diphenhydramine 30 minutes prior to the initial dose of rituximab

d) The process of creating new blood vessels to supply oxygen and nutrients to the cells Pg. 251 Angiogenesis refers to the process in which abnormal cells release enzymes that generate blood vessels in the area to supply both oxygen and nutrients to the cells. Metastasis refers to process of traveling from the place of origin to develop new tumors in other areas of the body. Autonomy refers to the process of growing without the usual homeostatic restrictions that regulate cell growth and control. Anaplasia refers to the process in which the cells lose their ability to differentiate and organize, which leads to a loss in their ability to function normally.

22. When describing the process of cancer cell growth to a client, the nurse addresses angiogenesis. Which description would the nurse include? a) The process of growing without the usual homeostatic restrictions that regulate cells b) A process that involves the cells traveling to other areas of the body to develop new tumors c) A process in which the cells lose their ability to differentiate and organize d) The process of creating new blood vessels to supply oxygen and nutrients to the cells

d) "Kepivance is used to protect the normal cells in your body from the chemotherapy" Pg. 281 While a client can refuse a medication, it is important that the client understand why the medication is being given prior to her refusal. Walking away from a client who is screaming may be appropriate, but the nurse will still need to come back to give the medication at a later time. Explaining to the client that cytoprotective agents protect the normal cells in her body from the chemotherapy, and that the Kepivance is used to help epithelial cells recover in the oral cavity, would help educate the client. She would then be more likely to allow the medication to be administered.

24. A client who is being treated with an antineoplastic medication for cancer is prescribed Kepivance. The client is refusing this medication, stating that "all these drugs are making everything worse," including the inside of her mouth. What would be an appropriate response from the nurse? a) "You are upset and need to be left alone. I will come back to speak to you when you are feeling calm" b) "Taking these medications is entirely up to you, it is your body" c) "Cytoprotective agents kill cancer cells so if you don't take them, you will not recover from cancer" d) "Kepivance is used to protect the normal cells in your body from the chemotherapy"

a) Menopausal effects Pg. 277 Tamoxifen belongs to the group of drugs that are hormones or hormone modulators. These agents are hormone specific. This drug competes with estrogen at the receptor sites, ultimately blocking estrogen. The adverse effects specific to this action would involve menopause-associated effects. Bone marrow suppression, GI toxicity, and hepatic dysfunction occur with this drug, but these are not specific to the drug's action.

25. A client is receiving tamoxifen. Which adverse effect would be most specific to the action of this drug? a) Menopausal effects b) Bone marrow suppression c) Gastrointestinal toxicity d) Hepatic dysfunction

d) The nurse should avoid any skin, eye, or mucous membrane contact with the drug Pg. 267 Special care needs to be taken when administering mitotic inhibitors. The nurse should avoid any skin, eye, or mucous membrane contact with the drug. This type of contact can cause serious reactions and toxicity for the nurse. The nurse should check for extravasation frequently during the infusion and not wait until the infusion is completed. A distal vein should be use. Nausea and vomiting are commonly experienced adverse effects of these drugs. Small meals may help the client to maintain adequate nutrition, but this is not the important concern when administering the drug.

26. A client with Hodgkin disease has been prescribed vincristine. What nursing consideration should the nurse prioritize when administering this drug? a) The nurse should check for extravasation when the infusion is over b) The nurse should encourage the client to eat six small meals a day c) The nurse should avoid using a distal vein d) The nurse should avoid any skin, eye, or mucous membrane contact with the drug

a) Ceritinib Pg. 276 Ceritinib carries a risk of interstitial lung disease. Histrelin inhibits gonadotropic secretion and decreases follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and testosterone levels and suppresses testosterone production. Hot flashes are very common with this drug. Triptorelin pamoate decreases FSH and LH levels and also suppresses testosterone production. It has also been associated with sexual dysfunction, urinary tract symptoms, bone pain, and hot flashes. Valrubicin is used in intravesical therapy for carcinoma in situ of the bladder. It is also associated with severe bladder spasms.

27. What antineoplastic agent is associated with severe to fatal interstitial lung disease? a) Ceritinib b) Triptorelin pamoate c) Valrubicin d) Histrelin acetate

a) Monitor the client closely and repeat LFTs routinely Pg. 260 Capecitabine blood levels are significantly increased with hepatic impairment, and clients with liver metastases should be monitored closely.

29. A male client is informed that the latest tests indicate that his cancer has spread to his liver. The client receives capecitabine as part of his treatment regimen. What would the nurse expect the health care provider to do? a) Monitor the client closely and repeat LFTs routinely b) Add routine blood transfusions to the client's treatment regimen c) Discontinue the capecitabine d) Increase the dose of capecitabine

d) Increased risk of nephrotoxicity Pg. 268 The nurse should assess the patient for an increased risk of nephrotoxicity as an interaction of alkylating drugs with an aminoglycoside. Increased risk of bleeding is observed in patients who are administered anticoagulant drugs and certain antineoplastic drugs. Increased risk of hypoglycemia is observed in diabetic patients who are administered insulin and are also undergoing treatment with certain antineoplastic drugs. An increased risk of methotrexate toxicity is observed in patients who are receiving NSAIDs for pain relief and are also under treatment with alkylating agents.

3. A patient undergoing antineoplastic drug therapy is administered an alkylating drug. The patient is also administered an aminoglycoside as an anti-infective agent. Which of the following interactions of the alkylating drug with the aminoglycoside should the nurse assess the patient for? a) Increased risk of methotrexate toxicity b) Increased risk of bleeding c) Increased risk of hypoglycemia d) Increased risk of nephrotoxicity

a) Providing premedication with acetaminophen and diphenhydramine Pg. 275 Following bleomycin drug administration, clients may report fever and chills. Patients may have nausea and vomiting, general weakness, and rare instances of hypotension. These symptoms are considered to be an idiosyncratic reaction, similar to anaphylaxis, and are noted rarely and mostly in lymphoma clients. This problem could be prevented by premedication with acetaminophen and diphenhydramine. It is also helpful if a test dose of 2 units of bleomycin, and not 3 units of acetaminophen, is administered before the first two treatments. Meticulous monitoring during drug administration is important but will not help prevent this adverse effect. Concurrent use of bleomycin and dexrazoxane will not prevent this effect either.

32. Mike, a lymphoma client, is administered bleomycin drug therapy according to the health care provider's instructions. Following the drug administration, he reports fever, chills, nausea, and general weakness. What preventive measure would be helpful in his case? a) Providing premedication with acetaminophen and diphenhydramine b) Administering a test dose of 3 units of acetaminophen before the first two treatments c) Using bleomycin and dexrazoxane concurrently d) Performing meticulous monitoring during drug administration

a) Take special care when shaving or brushing her teeth Pg. 266-267 Special care should be taken when shaving or brushing her teeth because she may bruise more easily than normal and gums may bleed. A cancer patient should not be on a diet during chemotherapy unless prescribed, and care should be taken to avoid crowds and public places where there is a greater risk of infection. Cancer patients should be as active, they should be careful not to over extend themselves physically, and they should remain active to promote optimal health.

33. 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? a) Take special care when shaving or brushing her teeth b) Stay in bed 2 days after each administration c) Continue to go to church or to the mall just as she did before the diagnosis of cancer d) Stay on a low-fat diet during the course of the drug therapy

b) Decrease the development of cell resistance Pg. 252 Malignant cells that remain in a dormant phase for long periods are difficult to destroy. These cells can emerge long after cancer treatment has finished—after weeks, months, or years—to begin their division and growth cycle all over again. For this reason, antineoplastic agents are often given in sequence over periods of time, in the hope that the drugs will affect the cancer cells as they emerge from dormancy or move into a new phase of the cell cycle. A combination of antineoplastic agents targeting different phases of the cell cycle is frequently most effective in treating many cancers. Combinations of drugs do not increase the length of treatment, increase the quantity of medication used, or decrease the adverse effects of the medications used.

34. Many times a combination of antineoplastic medications are used to: a) Increase the length of treatment b) Decrease the development of cell resistance c) Decrease the side effects of each medication d) Increase the quantity of each medication used

d) Ensure that all staff and visitors adhere to infection control precautions Pg. 266 The client's combination of cancer and bone marrow suppression creates an acute risk for infection. As a result, infection control is vital to maintaining the client's health and safety. Nutrition and energy conservation strategies are also important, but infection control is a safety priority. The client likely has a risk for bleeding, but the harm of activity limitation outweighs the benefits for most clients.

35. 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? a) Provide small quantities of food several times per day, as tolerated b) Encourage the client to limit physical activity in order to reduce the risk of bleeding c) Space out the client's care to preserve energy and prevent fatigue d) Ensure that all staff and visitors adhere to infection control precautions

b) Encourage fluids to maintain hydration Pg. 269 To prevent renal damage, the nurse should ensure that the client is well hydrated. Drinking cranberry juice or milk helps to hydrate the client, but what he or she drinks is less important than that he or she drinks adequate amounts of fluid. Wearing cotton underwear is not an intervention the nurse would teach the client.

5. What is the nurse's priority intervention to reduce the risk of renal damage caused by cyclophosphamide? a) Promote adequate rest and sleep b) Encourage fluids to maintain hydration c) Encourage the client to drink cranberry juice d) Instruct the client to wear only cotton underwear