Ch 50
Your patient is taking ifosfamide as part of their cancer treatment. They are also taking Mesna to prevent cystitis induced by the ifosfamide. How does the Mesna work
By combining with metabolites of ifosfamide
During ongoing assessment of a patient receiving 5-FU therapy, the nurse finds the patient's platelet count to be 92,000 cells/mm3. The nurse should do which of the following?
Consult the prescriber for discontinuation of the drug Explanation: The drug should be discontinued if the patient's platelet count is less than 1,00,000 cells/mm3 because it indicates that the patient has developed thrombocytopenia. Increasing the dosage or continuing the therapy with a decreased dosage is not appropriate.
A client is experiencing intense nausea while being treated with chemotherapeutics. What actions should the nurse perform? Select all that apply.
Ensure that the client has had a dietician consult Administer antiemetics as prescribed Provide the client with small, frequent meals Explanation: A dietician should consult in the treatment of a client with nausea secondary to chemotherapy. Small, frequent meals and vigilant use of antiemetics are useful as well. There is no need for a low-residue diet and antacids do not normally prevent nausea.
The nurse is caring for a patient who has just been diagnosed with adenocarcinoma of the pancreas. What antineoplastic does the nurse suspect the patient will receive?
Mitomycin
A client has been started on vincristine as part of treatment for cancer. What factor will the nurse need to assess with regard to interactions with this medication?
Sensory, motor, and perceptual functions
A 54-year-old received a diagnosis of breast cancer several weeks ago and her current treatment regimen includes tamoxifen, a cell cycle-nonspecific antineoplastic drug. What is a characteristic of a cell cycle-nonspecific drug?
The drug is effective regardless of whether a cancerous cell is proliferating.
A client has just been diagnosed with liver cancer, and the care team is finalizing the extensive chemotherapy regimen that will begin imminently. Administration of chemotherapeutic drugs is best achieved through which route?
a central venous catheter (CVC) Explanation: Insertion of an indwelling central venous catheter is often appropriate for clients who have poor peripheral venous access, who require many doses of chemotherapy, or who require continuous infusions. The antecubital IV insertion site would be unlikely unstainable for this chemotherapy regimen. Overall, a CVC is preferable to peripheral access. IM administration is uncommon
The nurse should exercise caution when administering antimetabolites to a client with
bone marrow suppression.
What is the defining characteristic of a sarcoma?
originates from connective tissue
A client has returned to the outpatient treatment center for a regular IV chemotherapy session. The nurse understands that one of the goals of chemotherapy is to:
prevent or treat adverse drug effects. Explanation: Drugs used in oncologic disorders include those used to kill, damage, or slow the growth of cancer cells, and those used to prevent or treat adverse drug effects. Cancer cells demonstrate uncontrolled cell growth; normal cells grow in a controlled fashion. Biologic targeted therapies are a newer group of anticancer medications.
Which is an example of an antineoplastic drug that interferes with amino acid production in the S phase and the formation of microtubules in the M phase?
vinblastine
An oncology nurse is reviewing the pathophysiology of cancer and is discussing with a colleague the factors that contribute to the success or failure of a patient's chemotherapy. Which cancerous cell is most susceptible to the effects of chemotherapeutic drugs?
Cells that have a rapid mitotic rate
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
A client's chemotherapeutic regimen includes procarbazine. What is the client's most likely diagnosis?
Hodgkin lymphoma Explanation: Procarbazine (Matulane) is used in combination therapy for treatment of stages III and IV of Hodgkin disease.
The nurse is preparing to administer a client's prescribed chemotherapy. The client has developed bone marrow suppression during treatment. What should the nurse include in the client's plan of care? Select all that apply.
Implement falls prevention measures Place the client on protective isolation Monitor the client's laboratory values closely Allow sufficient time for rest between scheduled activities Explanation: Decreased platelets create a risk for bleeding if the client experiences an injury; anemia causes fatigue and activity intolerance; neutropenia creates a serious risk for infection. It is important for the nurse to monitor the client's laboratory values as closely as possible. Anticoagulants would be likely to exacerbate the risks associated with thrombocytopenia.
A nurse is preparing an antineoplastic agent for a 9-year-old cancer patient. Before administering an antineoplastic agent, the nurse's most important action should be to:
check indexes of bone marrow functioning.
The oncology nurse is administering a chemotherapy agent that arrests mitosis by promoting the formation of abnormal spindle fibers and mitotic asters. What classification of drug is the nurse administering?
Taxane Explanation: The taxanes arrest mitosis by promoting the formation of abnormal spindle fibers and mitotic asters. Paclitaxel (Taxol), the first drug in this category, was isolated from the bark of the Pacific yew, Taxus brevifolia.
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. Explanation: Thrombocytopenia, not thrombocytosis, is a common adverse effect of cytotoxic chemotherapy. Heparin is consequently contraindicated, and DVT is not a priority risk.
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. Explanation: Drugs that are effective through all phases of the cell cycle and not limited to a specific phase are classified as cell cycle-nonspecific
A young man asks the nurse about the goal of the cancer therapy his mother is receiving. What would be the nurse's best response?
The goal is to limit the cancer cells so the immune system can respond without causing too much toxicity to your mother."
Based on the nurse's understanding of antineoplastic drugs, the nurse would anticipate administering which in conjunction with doxorubicin as a cardioprotective agent?
dexrazoxane
A recent nursing graduate is receiving special training to become certified in handling and administering chemotherapy drugs. This special training is necessary because of what nursing diagnosis among clients receiving chemotherapy?
risk for injury related to chemotherapy Explanation: Because of the toxicity of chemotherapeutic agents, nurses who administer intravenous (IV) cytotoxic chemotherapy receive special training and are certified in handling and administering the chemotherapy drugs safely and accurately. Incorrect administration creates a serious risk for injury. Pain, contamination, and impaired health maintenance are not directly associated with incorrect administration.
A client has just started on an alkalating agent to treat their cancer. What is the most common side effect of most alkalating agents?
Myelosuppression
The nurse should encourage the client to implement which intervention in order to minimize the risk of developing chemotherapy-triggered mucositis?
thoroughly rinse the mouth often, especially before and after meals Explanation: 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
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. Explanation: Chemotherapeutic drugs that are most effective during a particular phase of the cycle are known as cell cycle-specific.
Which classes of antineoplastic drugs inhibit DNA synthesis during the S phase?
camptothecin analogs Explanation: Camptothecin analogs are the class of antineoplastic drugs that inhibit DNA synthesis during the S phase. Podophyllotoxins are the class of antineoplastic drugs that stop cells in the S and G2 phase, thereby causing cell division to cease. Taxanes also interfere in the M phase with microtubules. The vinca alkaloids, like vinblastine, are the class of antineoplastic drugs that interfere with amino acid production in the S phase and the formation of microtubules in the M phase.
Which herbal product has the benefits of overall well-being, cancer prevention, dental health, and maintenance of heart and liver health as a result of being loaded with antioxidants?
green tea Explanation: Green tea is the herbal product that has the benefits of overall well-being, cancer prevention, dental health, and maintenance of heart and liver health as a result of being loaded with antioxidants. Licorice is used to treat peptic ulcers, canker sores, and reflux (GERD). Also used for cough, asthma, and respiratory problems. Kava is used to treat anxiety, restlessness, stress, and insomnia. Ma huang is used to treat asthma, also used for weight loss.
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 Explanation: Severe neutropenia can be prevented or its extent and duration minimized by administering filgrastim or sargramostim to stimulate the bone marrow to produce leukocytes. Filgrastim does not address the risk of inflammation (mucositis), abnormal platelet production, or bleeding (hemorrhagic cystitis).
In which of these patients would cyclophosphamide not likely be effective?
A 60 year old with a brain tumor Explanation: Cyclophosphamide is the most widely used alkylating agent. It has a broad spectrum of antitumor activity and plays a major role in the treatment of hematologic malignancies such as Hodgkin's and non-Hodgkin's lymphoma and multiple myeloma. It is the only alkylating agent that is effective against acute as well as chronic leukemias. Cyclophosphamide is an important component of regimens used in stem cell transplantation. It is also effective against solid tumors, such as breast cancer, small cell lung cancer, endometrial cancer, and ovarian cancer. Cyclophosphamide is given intravenously or orally.
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. Explanation: 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.
A patient treated with a left breast lumpectomy and radiation therapy 2 weeks ago has developed redness, blistering, and hyperpigmentaion on the left breast. What does the nurse determine the patient is experiencing?
The patient is a having radiation recall reaction.
A client is undergoing treatment with chemotherapy. He calls the nurse and states that his mouth hurts and there are white patches on his tongue. The nurse suspects the white patches are a symptom
Candidiasis Explanation: White patches in the mouth are often caused by candidiasis infection related to the immunosuppressant effect of chemotherapy. Milk residue is not painful. Clients with HIV often have candidiasis, but HIV does not directly cause candidiasis. Good oral hygiene while undergoing chemotherapy is important; however, neglect of teeth brushing is not a symptom.
A client is receiving idarubicin. What is the nurse's priority assessment?
Cardiac function
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." Explanation: Extravasation is the escape of fluid from a blood vessel into surrounding tissues. Blood vessels are not cut for this to happen. Edema is when fluid is pooled in one area of the body. Extravasation is not a disease. In some types of shock, extravasation occurs.
The part of cell growth that entails RNA and protein synthesis preparing for division is known as which phase?
G2 phase Explanation: The part of cell growth that entails RNA and protein synthesis preparing for division is known as the G2 phase. During the G1 phase, RNA and proteins are built. During the S phase, DNA is made from the components of the G1 phase. Mitotic cell division occurs during the M phase.
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 client has been prescribed cabazitaxel 25 mg/m2 PO every three weeks for the treatment of prostate cancer. What is the nurse's priority response to this prescription?
Question the prescriber about the route Explanation: Cabazitaxel, like all mitotic inhibitors, is administer intravenously. Confirming the order with the prescriber would consequently be a priority.
In describing the action of alkylating agents, what would the nurse include?
React chemically with portions of RNA, DNA, and other cellular proteins
The nurse transfers from the adult oncology unit to the pediatric oncology unit. What will the nurse need to add to the client's plan of care that was not a part of the adult client's care plan?
Social, emotional, and intellectual stimulation Explanation: Children need to play and learn so meeting the child's social, emotional, and intellectual needs is a part of the care plan that was not as significant with adults. Administration of combination drugs, Double-checking dosage calculations and appropriateness of drug dosage, and Monitoring for hydration and nutritional status are all components of adult care as well as pediatric care.
A patient who will begin chemotherapy voices concern to the nurse about the accompanying nausea and vomitting. 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." Explanation: Reassure patients that nausea and vomiting can be relieved with antiemetic drug therapy and emphasize that they should request these agents when needed.
A client newly diagnosed with chronic myelocytic leukemia (CML) has been prescribed treatment with imatinib. What assessment question is most relevant to this client's care?
Will paying for this medication be a problem for you and your family?" Explanation: Imatinib is expensive. It is estimated that 1 year of treatment with the drug (which needs to be taken continually) costs the patient between $30,000 and $35,000. For nearly all clients, this is a very significant consideration. The drug is not associated with a risk for depression and it is not contraindicated in clients with a shellfish allergy. Social support is always important, but financial concerns are likely to be paramount.
A client with colorectal cancer is being treated with oxaliplatin. Which potential adverse effect should the nurse explain to the client?
cold-induced neurotoxicity Explanation: Cold-induced neurotoxicity is an adverse effect of oxaliplatin resulting from an effect on peripheral nerves, especially in the hands and feet. Dysuria, diarrhea, and insomnia are not closely associated with oxaliplatin as a result of its pharmacologic actions.
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 Explanation: Mutations of the p53 gene, a common genetic change in cancer, are associated with more than 90% of small cell lung cancers and more than 50% of breast and colon cancers. All other choices are incorrect.
An oncology nurse is reviewing the medication administration record of a client being treated for advanced prostate cancer. In addition to two chemotherapeutic agents, the nurse reads that the client has been ordered a cytoprotective agent. The goal of this agent is to:
reduce the incidence or severity of adverse drug effects.
An oncology nurse is reviewing the medication administration record of a client being treated for advanced prostate cancer. In addition to two chemotherapeutic agents, the nurse reads that the client has been ordered a cytoprotective agent. The goal of this agent is to
reduce the incidence or severity of adverse drug effects. Explanation: Cytoprotectant agents reduce the adverse effects of cytotoxic drugs, some of which can be severe, debilitating, or life threatening. Cytoprotectant drugs do not potentiate chemotherapy, protect the client from the effects of cancer, or buffer cytotoxins.
A nurse is providing client education to a 35-year-old woman who has been prescribed cyclophosphamide therapy. When discussing possible hair loss, the nurse will advise the cliient to:
see a wig specialist.
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 Explanation: Palliative chemotherapy is used in advanced cancer to prevent or treat pain and obstruction. Chemotherapy does not need to be stopped abruptly or replaced with CAM. Aggressive chemotherapy would not normally be administered in a palliative context.
A nurse is caring for a client who is to undergo chemotherapy for leukemia. Which should be part of the initial assessment performed by the nurse? Select all that apply.
type and location of the neoplastic lesion previous or concurrent treatments presence of nonmalignant disease Explanation: The initial assessment performed by the nurse for a client who is to receive chemotherapy includes the type and location of the neoplastic lesion, previous or concurrent treatments, and the presence of nonmalignant disease. Results of kidney function tests and radiographic scans are observed as part of ongoing chemotherapy administration.
A client is prescribed cyclophosphamide as part of her treatment for non-Hodgkin's lymphoma. Which symptoms should the client be instructed to report to her health care provider immediately?
Pain and burning with urination
A client is being treated for pancreatic cancer and has been prescribed streptozocin 500 mg/m2 IV 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 Explanation: The is calculated by multiplying the ordered dose by the client's body surface area: 500 mg x 1.78 m2 = 890 mg. Weight is not included in this calculation.
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 Explanation: The decrease in red cells that accompanies bone marrow suppression causes fatigue. Effects of bone marrow suppression on respiratory status, kidney function and electrolytes are not as common or direct, though many antineoplastics affect these domains.
The nurse is reviewing the lab values for a client who has myelosuppression post chemotherapy treatment. The nurse is likely to see which abnormal values for this client?
Decreased thrombocytes Explanation: Many antineoplastic drugs interfere with the bone marrow's ability to make new cells. This interference is called bone marrow suppression or myelosuppression and is a potentially dangerous adverse reaction. Bone marrow suppression is manifested by abnormal laboratory test results and clinical evidence of leukopenia, thrombocytopenia, or anemia. For example, there is a decrease in the white blood cells or leukocytes (leukopenia), a decrease in the thrombocytes (thrombocytopenia), and a decrease in the red blood cells, resulting in anemia.
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 Explanation: Nausea and vomiting are major threats to the client's nutrition. Failure to thrive is typically a chronic, rather than acute, health problem. Pain does not necessarily accompany nausea, and there is no indication that this client is not maintaining the necessary regimen
The nurse is providing care for an older adult client who has stomatitis secondary to the administration of methotrexate. The nurse should assess for indications of what nursing diagnoses? Select all that apply.
Impaired skin integrity Risk for infection Imbalanced nutrition Risk for bleeding Explanation: Because of the common adverse effects of severe bone marrow suppression, fatigue, malaise, rashes, alopecia, ulcerative stomatitis, hepatic toxicity, interstitial pneumonitis, chills, fever, and anaphylaxis, priority nursing diagnosis would include impaired skin integrity related to rash, risk for infection, and risk for bleeding related to severe bone marrow suppression. Because the client has stomatitis, there is a risk for imbalanced nutrition less than body requirements because eating is uncomfortable and not feeling well will also reduce her appetite. Autonomic dysreflexia is limited to clients who have spinal cord injuries.
A client with a diagnosis of non-small-cell lung cancer is currently undergoing chemotherapy. At the encouragement of a family member, the client has announced to the nurse the intention to complement this treatment with a regimen of herbal remedies. How should the nurse respond to this client's statement?
It's important to discuss what herbs you'll be taking with your health care provider or the pharmacist to make sure there aren't any interactions."