ch 38 drugs for neoplasia
12) Which finding should the nurse instruct the client receiving tamoxifen to immediately report to the healthcare provider? A temperature of 101.1°F Weight gain of 3 pounds in 1 week Size increase of the tumor Nausea and vomiting
Answer: 1 Explanation: A temperature of 101.1°F should be immediately reported to the healthcare provider. The client should be instructed to report a weight gain of 2 lbs in a 24-hour period. An increase in the size of the tumor is an expected therapeutic event for the client taking tamoxifen. Nausea and vomiting are common adverse effects of tamoxifen.
7) Which intervention should the nurse integrate into the plan of care for a client receiving cyclophosphamide (Cytoxan) experiencing oral irritation? Instruct the client to avoid extreme temperatures of food selections. Instruct the client to use an antiseptic mouthwash. Instruct the client to rinse her mouth with normal saline. Instruct the client to drink cold beverages.
Answer: 1 Explanation: Avoiding extreme temperatures of foods will help prevent further trauma and mucosal irritation. Most mouthwashes contain alcohol, which will increase irritation to the mucosa. Normal saline will irritate the oral mucosa. The client should be instructed to avoid temperature extremes to prevent further trauma and mucosal irritation.
5) A client asks why tamoxifen is so effective for the treatment of breast cancer. Which response should the nurse provide the client? "Tamoxifen works by blocking estrogen receptors on breast tissue." "Tamoxifen works by inhibiting the cellular mitosis of breast cancer." "Tamoxifen works by inhibiting the metabolism of breast cancer cells." "Tamoxifen works by binding to the DNA of breast cancer cells."
Answer: 1 Explanation: Breast cancer is dependent on estrogen for growth. Tamoxifen (Nolvadex) acts by blocking estrogen receptors; thus, the tumor is deprived of estrogen. Tamoxifen does not inhibit the cellular mitosis of breast cancer. Tamoxifen does not inhibit the metabolism of breast cancer cells. Tamoxifen does not bind to the DNA of breast cancer cells.
10) Which clinical finding indicates the nurse should hold the dose of methotrexate (MTX)? Ulcerative stomatitis Elevated serum uric acid level Deep vein thrombosis Elevated white blood cell count
Answer: 1 Explanation: Ulcerative stomatitis and diarrhea require suspension of therapy because they may lead to hemorrhagic enteritis and death from intestinal perforation. An elevated serum uric acid level is a finding associated with the use of methotrexate. The administration of methotrexate is not contraindicated in a client with deep vein thrombosis. An elevated white blood cell count is not an indication to hold a dose of methotrexate.
26) A client asks the nurse when she should start having Pap tests to help detect cervical cancer? "You should start the testing by age 21." "You should start testing by age 21 or if you begin using alcohol." "By age 21, but earlier if you have a family history of cancer." "By age 21 or earlier if you are smoking."
Answer: 1 Explanation: All women should start having Pap tests at age 21. Alcohol use is not a determining factor. A family history of cancer is not a determining factor as to when Pap tests should begin. Tobacco use is not the determining factor as to when Pap tests should begin. Page Ref: 576
11) Which adverse effects should the nurse monitor the client receiving vincristine (Oncovin) for? 1. Neurotoxicity 2. Cardiotoxicity 3. Nephrotoxicity 4. Hepatotoxicity
Answer: 1 Explanation: The most serious dose-limiting adverse effects of vincristine relate to nervous system toxicity. Cardiotoxicity is not a common adverse effect of vincristine. Nephrotoxicity is not a common adverse effect of vincristine. Hepatotoxicity is not a common adverse effect of vincristine.
3) Which therapeutic interventions should the nurse include when teaching a client about the primary treatments for cancer? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Surgery Chemotherapy Nutrition therapy Alternative medicine Radiation therapy
Answer: 1, 2, 5 Explanation: Surgery continues to be a primary treatment for cancer. Pharmacologic controls for cancer, or chemotherapy, is one of the standard effective treatments for cancer. Support of nutrition is essential for the cancer client, but in itself not a primary treatment. Alternative medicine is not considered a very effective treatment for cancer at this point. Radiation is one of the three primary treatments for cancer.
30) Which topics should the nurse include in the education of the client prescribed testosterone treatment for cancer? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Weight gain Sweating Hair loss Constipation Nervousness
Answer: 1, 2, 5 Explanation: Weight gain is an adverse effect of the use of testosterone treatment for cancer. Sweating is an adverse effect of the use of testosterone treatment for cancer. Hirsutism is an adverse effect of the use of testosterone treatment for cancer. Diarrhea is an adverse effect of the use of testosterone treatment for cancer. Nervousness is an adverse effect of the use of testosterone treatment for cancer. Page Ref: 589
23) Which should the nurse identify as pharmacotherapy with natural products that have antineoplastic activity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Taxanes Antimetabolites Vinca alkaloids Topoisomerase inhibitors Alkylating agents
Answer: 1, 3, 4 Explanation: Natural products that have antineoplastic activity include taxanes, vinca alkaloids, and topoisomerase inhibitors. Antimetabolites are not natural products. Natural products that have antineoplastic activity include taxanes, vinca alkaloids, and topoisomerase inhibitors. Natural products that have antineoplastic activity include taxanes, vinca alkaloids, and topoisomerase inhibitors. Alkylating agents are not natural products.
29) For which should the nurse monitor the older adult receiving chemotherapy?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Hypotension Incontinence Peripheral neuropathy Urinary retention Reduced deep tendon reflexes
Answer: 1, 3, 5 Explanation: Problems with autonomic regulation with symptoms such as hypotension, and other neurotoxic effects, may increase the risk for falls and injury. Chemotherapy does not cause incontinence in the older adult. Many chemotherapy drugs used to treat cancer have neurotoxic affects, which is of particular concern in the older adult. Peripheral neuropathy caused by chemotherapy can be severe in the older adult. Chemotherapy does not cause urinary retention in the older adult. Reduced deep tendon reflexes occur as chemotherapy affects autonomic regulation. Page Ref: 590
2) Which should the nurse include as the causes of cancer when providing client education? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "Some cancers have a strong genetic component." "Cancer can result from tissue trauma." "Cancers have a very strong environmental component." "Cancer can result from increased levels of stress." "Cancer can result from damaged tumor suppressor genes."
Answer: 1, 3, 5 Explanation: Some cancers have a strong genetic component. There is no evidence to support that cancer occurs as a result of tissue trauma. Cancers have a very strong environmental component. There is no evidence to support that cancer occurs as a result of increased levels of stress. Cancer can result from damaged tumor suppressor genes.
24) A client with a benign tumor on his arm asks the nurse why he is not being treated with anything. Which response should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "Benign tumors do not metastasize." "Many of the tumors are resistant to treatment." "Treatment will only be required if the tumor continues to grow." "Your tumor is slow growing." "Benign tumors rarely require treatment."
Answer: 1, 4, 5 Explanation: Benign tumors are slow growing, do not metastasize, and rarely require prescriptive treatment. Benign tumors are not resistant to treatment. Benign tumors are slow growing, do not metastasize, and rarely require prescriptive treatment. Benign tumors are slow growing, do not metastasize, and rarely require prescriptive treatment. Benign tumors are slow growing, do not metastasize, and rarely require prescriptive treatment.
14) A client with leukemia asks the nurse where the cancer in her body is located. Which response should the nurse provide the client? Epithelial tissue Bone marrow Connective tissue Lymphoid tissue
Answer: 2 Explanation: Carcinoma is cancer in the epithelial tissue. Leukemia is cancer of the blood-forming cells in the bone marrow. Sarcoma is cancer of the connective tissue. Lymphoma is cancer of the lymphoid tissue.
19) A client with Hodgkin's disease asks the nurse why he is receiving corticosteroids for chemotherapy. Which response should the nurse include in the discussion? "The red blood cells are destroyed." "They suppress cell division in lymphocytes." "The prescription causes bone marrow suppression." "The prescription blocks substances for tumor growth."
Answer: 2 Explanation: Corticosteroids do not destroy the red blood cells. Because of the natural ability of corticosteroids to suppress cell division in lymphocytes, the principal value of these hormones is in the treatment of lymphomas, Hodgkin's disease, and leukemias. Corticosteroids do not cause bone marrow suppression. Corticosteroids do not block substances essential for tumor growth.
9) Which adverse effect should the nurse monitor the client receiving doxorubicin (Adriamycin) for?1. Neurotoxicity2. Cardiotoxicity 3. Nephrotoxicity 4. Hepatotoxicity
Answer: 2 Explanation: Neurotoxicity is not a serious adverse effect associated with doxorubicin. Doxorubicin has many adverse effects, some of which are serious. The most serious dose-limiting adverse effect of doxorubicin is cardiotoxicity. Nephrotoxicity is not a serious adverse effect associated with doxorubicin. Hepatotoxicity can occur with the use of other drugs, such as phenytoin, but is not a general adverse effect associated with doxorubicin.
1) A client with cancer asks the nurse how cancer occurs. Which response should the nurse provide the client? "Cancer is genetic; you inherited the predisposition for cancer." "Cancer cells are the body's cells that have lost the ability to control their growth." "Cancer is caused primarily by viruses in the environment." "Cigarette smoking and second-hand smoke are the primary causes of cancer."
Answer: 2 Explanation: Some cancer is genetic, but this is not the best answer. Cancer is thought to result from damage to the genes controlling cell growth. Viruses are associated with only about 15% of all human cancers. Cigarette smoking and second-hand smoke are carcinogens that can lead to the development of cancer, but this is not the best answer.
22) Which describes the action of aromatase inhibitors? Block the estrogen receptors that stimulate the growth of ER-positive tumors Block an enzyme that catalyzes the final step in the synthesis of estrogen Suppress the ovary and adrenal gland from producing estrogen Weaken the effect of estrogen on ER-positive tumors
Answer: 2 Explanation: Estrogen-receptor modifiers block estrogen-receptor sites. Aromatase inhibitors block an enzyme that catalyzes the final step in the synthesis of estrogen. Aromatase inhibitors do not suppress the ovary and adrenal gland from producing estrogen. Aromatase inhibitors do not weaken the effect of estrogen on ER-positive tumors.
21) Which action should the nurse take after discontinuing an intravenous infusion of vincristine (Oncovin) that has extravasated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Apply local ice packs. Inject hyaluronidase per protocol. Place a tourniquet on the client's arm above the IV site. Place warm compresses on the site. Administer prednisone per protocol.
Answer: 2, 4 Explanation: Cold compresses will significantly increase the toxicity of vinca alkaloids. Hyaluronidase is used as treatment for vincristine extravasation. There is no need to place a tourniquet on the client's arm. Warm compresses are recommended as treatment. Prednisone is not given concurrently with vincristine due to increased bone marrow toxicity.
28) Which should the nurse understand can be used to minimize bone marrow toxicity?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Alkylating agents Bone marrow transplantation Hormone antagonists Platelet administration Growth factor therapy
Answer: 2, 4, 5 Explanation: Alkylating agents are used for the treatment of cancer cells and act by changing the shape of the DNA double helix and preventing the nucleic acid from completing normal cell division. Efforts to minimize bone marrow toxicity may include bone marrow transplantation, platelet infusions, or therapy with growth factors. Hormone antagonists are antineoplastic drugs that slow the growth of hormone- dependent tumors of the breast or prostate. Efforts to minimize bone marrow toxicity may include bone marrow transplantation, platelet infusions, or therapy with growth factors. Efforts to minimize bone marrow toxicity may include bone marrow transplantation, platelet infusions, or therapy with growth factors.
25) A client with cancer that has not responded to treatment asks the nurse why he is being offered palliative chemotherapy. Which information should the nurse include in the discussion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "Palliative chemotherapy can continue to help slow the growth of the cancer." "Sometimes the chemotherapy can reduce the size of the tumor." "The cancer may still respond to treatment." "Chemotherapy can sometimes reduce the pain." "Chemotherapy may well improve your quality of life."
Answer: 2, 4, 5 Explanation: Chemotherapy that is used as palliation is not used to help slow the growth of the cancer. Chemotherapy can be used as palliation. This treatment includes chemotherapy drugs that are administered to reduce the size of the tumor, easing the severity of pain and other tumor symptoms, thus improving the quality of life. Chemotherapy used as palliation is not intended to treat the cancer. This statement is inappropriate to make to the client. Chemotherapy can be used as palliation. This treatment includes chemotherapy drugs that are administered to reduce the size of the tumor, easing the severity of pain and other tumor symptoms, thus improving the quality of life. Chemotherapy can be used as palliation. This treatment includes chemotherapy drugs that are administered to reduce the size of the tumor, easing the severity of pain and other tumor symptoms, thus improving the quality of life.
27) Which is the nurse's priority when preparing to administer intravenous vesicant chemotherapy? Notify the healthcare provider for a central line placement. Wear gloves when drawing up the medication. Understand the protocol for extravasation. Place the client in reverse isolation prior to administering the vesicant.
Answer: 3 Explanation: Central lines are preferred and should be used whenever possible, but this is not the priority. The nurse should wear gloves, but this is not the priority. Before administering intravenous (IV) antineoplastic drugs, nurses should know the emergency treatment for extravasation. The client does not require reverse isolation unless significantly immunocompromised.
4) A client asks the nurse why lung cancers are less sensitive to antineoplastic agents. Which response should the nurse provide the client? "Lung cancer cells have a very erratic cell cycle, and this is why there isn't much difference between the number of replicating and resting cells." "Lung cancer cells have been growing for a long time before detection, so they are less sensitive to antineoplastic agents." "Lung cancer cells have a low growth fraction, which means there isn't much difference between the number of replicating and resting cells." "Lung cancer cells grow in a high-oxygen environment, so they are not very sensitive to antineoplastic agents."
Answer: 3 Explanation: Lung cancer cells do not have a very erratic cell cycle. Lung cancer cells may grow for a long time before detection, but this is not the primary reason they are less susceptible to antineoplastic agents. Growth fraction is a ratio of the number of replicating cells to the number of resting cells. Antineoplastic drugs are much more toxic to tissues and tumors with high growth fractions. Breast and lung cancers have low growth fractions. A high-oxygen environment is not the reason why lung cancer cells are less sensitive to antineoplastic agents.
18) Which describes the main mechanism of action of alkylating agents? The agents can become incorporated into the structures of DNA and RNA, resulting in a disruption of nucleic acid function. When cancer cells attempt to synthesize proteins, RNA, or DNA metabolic pathways are disrupted and the cancer cells die or their growth is slowed. They change the shape of the DNA double helix and prevent nucleic acid from completing normal cell division. They either directly or indirectly bind to cancer cells causing an activation of the immune response which results in the destruction of the cancer cells.
Answer: 3 Explanation: Purine and pyrimidine analogs themselves can become incorporated into the structures of DNA and RNA, resulting in a disruption of nucleic acid function. When cancer cells attempt to synthesize proteins, RNA, or DNA using the antimetabolites, metabolic pathways are disrupted and the cancer cells die or their growth is slowed. Alkylating agents change the shape of the DNA double helix and prevent the nucleic acid from completing normal cell division. Biological response modifiers are drugs that enhance the ability of body defenses to destroy cancer cells. They may produce their effects directly, by binding to cancer cells and destroying them, or indirectly, by activating general aspects of the immune response.
13) A client asks the nurse why he is receiving several chemotherapeutic agents as treatment for cancer. Which response should the nurse provide the client? "Using multiple drugs means a shorter treatment time." "Using multiple drugs decreases the incidence of side effects." "Using multiple drugs will help kill more of the cancer." "Using multiple drugs is more cost effective in treating cancer."
Answer: 3 Explanation: Using multiple drugs does not shorten the time required for treatment. Using multiple drugs does not decrease the incidence of side effects, but will reduce the chance of toxicity and slow the development of resistance. In most cases, multiple drugs from different antineoplastic classes are given during a course of chemotherapy. The use of multiple drugs affects different stages of the cancer cell's lifecycle and attacks the various clones within the tumor via several mechanisms of action, thus increasing the percentage of cell kill. Using multiple drugs is not more cost effective.
17) For which adverse effect should the nurse monitor the client prescribed tamoxifen? Fatigue Cough Vaginal discharge Signs of dehydration
Answer: 3 Explanation: Fatigue may occur with many types of chemotherapy but is not a particular adverse effect with tamoxifen. Cough is not an expected adverse effect of tamoxifen. Vaginal discharge is an expected adverse effect of tamoxifen and should be reported to the healthcare team. Rather than dehydration, the client should be monitored for water retention and concentrated urine.
15) Which describes the growth fraction ratio? The number of replicating cells to the number of active cells. The number of nonreplicating cells to the number of active cells. The number of replicating cells to the number of resting cells. The number of nonreplicating cells to the number of resting cells.
Answer: 3 Explanation: The number of replicating cells to the number of active cells is not the ratio as it relates to the growth fraction. The number of nonreplicating cells to the number of active cells is not the ratio as it relates to the growth fraction. The growth fraction is a measure of the number of cells undergoing mitosis in a tissue. It is a ratio of the number of replicating cells to the number of resting cells. The number of nonreplicating cells to the number of resting cells is not the ratio as it relates to the growth fraction.
16) Which is the most important nursing consideration for clients receiving alkylating agents? Nausea and vomiting Nutritional intake Skin integrity CBC with differential
Answer: 4 Explanation: Epithelial cells lining the GI tract are damaged as a result of alkylating agents, resulting in nausea, vomiting, and diarrhea, but this is not dose limiting. Nutritional intake is affected when the epithelial cells lining the GI tract are damaged as a result of alkylating agents, resulting in nausea, vomiting, and diarrhea, but this is not dose limiting. Alkylating agents are not associated with skin integrity issues in a client; however, the client should be monitored for adverse effects such as a rash and Stevens-Johnson syndrome. Because blood cells are particularly sensitive to the actions of alkylating agents, bone marrow suppression is the primary dose-limiting toxicity of drugs in this class. Within days after administration, the numbers of erythrocytes, leukocytes, and platelets begin to decline, reaching a nadir at 9 to 14 days.
20) Which action should the nurse take after discontinuing an intravenous infusion of doxorubicin (Adriamycin) that has extravasated? Inspect the area for irritation. A warm, wet compress should be placed on the site. Wash the area thoroughly with soap and water. Apply ice packs to the area immediately.
Answer: 4 Explanation: Special actions are indicated beyond inspecting the area. A warm wet compress is not the recommended treatment. Washing the surface will not treat the extravasation. Ice packs will help to reduce absorption of the drug.
8) The nurse has provided education about cancer prevention to a community group. Which statements made by the participants indicate an understanding of the information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "I've been thinking about trying a vegetarian diet. Now may be a good time." "I am going to call my doctor and schedule a pap smear." "I think I will start taking vitamin A and selenium." "I've never been a drinker, but I am going to start drinking a glass of wine with dinner." "I am going to read the label on that new bottle of sunscreen I bought."
Explanation: It is not necessary to become a vegetarian, but following a plant-based diet may help to reduce risk of cancer. Regular screenings will help catch changes that may become malignant, but is not a primary preventative measure. Taking vitamin and mineral supplements is not shown to reduce cancer risk. The client who does not already drink alcohol should not start drinking. Those who do drink alcohol should limit or eliminate its use. Sunscreen use is recommended to help prevent skin cancer.
6) Which client should the nurse recognize has the highest risk for developing cancer? The client who consumes excessive alcohol The client who is 25 pounds overweight but exercises regularly The client who usually applies sunscreen when going outdoors The client who frequently forgets self-breast exams but has routine mammograms
The client who frequently forgets self-breast exams but has routine mammograms Answer: 1 Explanation: Excessive use of alcohol increases the risk of developing cancer. Being 25 pounds overweight is not a big risk and regular exercise is protective against cancer. Application of sunscreen prior to going outdoors will help prevent skin cancer. A monthly self-breast exam is ideal, but routine mammograms will help detect cancer.