Chapter 14: Antineoplastic Agents

A person is said to be cured of cancer when he or she has been cancer free for a period of __________ years.

5 (Rationale: When a person has been cancer free for 5 years, that person is said to be cured of cancer.)

True or False: Cancer cells can rapidly develop a resistance to alkylating agents.

False (Rationale: Neoplastic cells can rapidly develop resistance to antimetabolites.)

True or False: No cancer cells have been identified that can remain dormant for more than 2 years.

False (Rationale: No cells have been identified that can remain dormant for more than 5 years.)

True or False: Cancer is considered the second leading cause of death in the United States.

True (Rationale: Cancer is the second leading cause of death. Coronary disease is the leading cause of death.)

A nurse is administering an antineoplastic that can cause necrosis and cellulitis if extravasation occurs. Which intervention would be most appropriate to prevent this from occurring? a. Using an infusion pump b. Administering through a hand vein c. Inspecting site frequently for redness or swelling d. Using proximal veins

c. Inspecting site frequently for redness or swelling (Rationale: Site inspection is a major intervention for preventing extravasation. Distal veins should be used. Small veins in the hand or wrist should be avoided. An infusion pump should be avoided because it can continue to administer under pressure, leading to severe extravasation.)

True or False: A patient with alopecia should cover his or her head if he or she will be exposed to extremes of temperature.

True (Rationale: Some patients may choose to get a wig as soon as their hair begins to fall out while others may prefer to remain bald. Whichever choice the patient makes, it is important to teach the patient to cover his or her head in extremes of temperature or when out in the sun for extended periods of time, because a great deal of heat is lost through the head in cold weather and the skin is very subject to sunburn in warm, sunny weather.)

True or False: An adverse effect of tamoxifen therapy involves menopausal symptoms.

True (Rationale: Tamoxifen is a hormone modulator and is antiestrogen, blocking estradiol production without effects on adrenal hormones. As a result, menopausal symptoms like hot flashes, mood swings, edema, and vaginal dryness and itching can occur.)

What classification of antineoplastic agents would be considered cancer non-cell cycle specific agents? a. Antimetabolites b. Protein tyrosine kinase inhibitors c. Alkylating agents d. Mitotic inhibitors

c. Alkylating agents (Rationale: Alkylating agents affect cells in all phases of the cell cycle and are considered non-cell cycle specific. Antimetabolites are considered to be S phase specific agents. Mitotic inhibitors are cell cycle-specific agents working in the M phase of the cell cycle. Protein tyrosine kinase inhibitors target specific enzymes needed for protein building by specific tumor cells. They do not affect health human cells.)

A patient is experiencing antineoplastic-induced nausea and vomiting. The health care provider prescribes ondansetron. The nurse understands that this agent acts in what way? a. Blocking human substance P/neurokinin 1 receptors b. Calming the activity of the gastrointestinal tract c. Blocking serotonin receptors in the CTZ d. Directly blocking the chemoreceptor trigger zone (CTZ)

c. Blocking serotonin receptors in the CTZ (Rationale: Ondansetron blocks serotonin receptors in the CTZ. Aprepitant blocks human substance P/neurokinin 1 receptors in the central nervous system. Benzodiazepines directly block the CTZ. Metoclopramide calms the activity of the GI tract.)

When describing alkylating agents, the nurse identifies what drug as a prototype? a. Fluorouracil b. Vincristine c. Chlorambucil d. Methotrexate

c. Chlorambucil (Rationale: Chlorambucil is the prototype alkylating agent. Fluorouracil is an antimetabolite. Methotrexate is the prototype antimetabolite. Vincristine is the prototype mitotic inhibitor.)

A patient is receiving a toremifene. What signs and symptoms will the nurse be especially alert for that are specific to this drug? a. CNS changes b. Infection c. Hypercalcemia d. Renal dysfunction

c. Hypercalcemia (Rationale: Toremifene is a hormone/hormone modulator that often produces hypercalcemia. Many antineoplastic drugs produce bone marrow suppression placing the patient at high risk for infection, so that is not specific to this drug. Many antineoplastics have CNS changes as a common side effect. Renal dysfunction is important to dosage management of almost all antineoplastic drugs and is not specific to toremifene.)

A patient is receiving carboplatin. The nurse would expect to administer this drug by which route? a. Oral b. Intramuscular c. Intravenous d. Subcutaneous

c. Intravenous (Rationale: Carboplatin is administered IV on day 1 every 4 weeks.)

The nurse is preparing to administer ondansetron to treat a patient experiencing nausea and vomiting as a result of antineoplastic therapy. The nurse looks up the medication and learns that this agent will block what chemical? a. Norepinephrine b. Dopamine c. Serotonin d. GABA

c. Serotonin (Rationale: Ondansetron blocks serotonin receptors in the chemoreceptor trigger zone. It has no effect on blocking dopamine, norepinephrine, or GABA.)

When describing the various effects of antineoplastic agents, the nurse explains that antineoplastic drugs primarily affect human cells that are rapidly multiplying, going through the cell cycle quickly. The nurse would identify what cells as an example? a. Breast b. Ovaries c. Skin d. Testicles

c. Skin (Rationale: Skin cells proceed very rapidly through the cell cycle. Breast cells, cells of the testicles, and cells of the ovaries proceed very slowly through the cell cycle.)

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? a. Methotrexate b. Imatinib c. Vincristine d. Doxorubicin

d. Doxorubicin (Rationale: Doxorubicin is the prototype antineoplastic antibiotic. Vincristine is the prototype mitotic inhibitor. Imatinib is the prototype protein tyrosine kinase inhibitor. Methotrexate is the prototype antimetabolite.)

A patient is to receive doxorubicin as treatment for leukemia. The nurse would instruct the patient that the typical cycle would be repeated at which frequency? a. Every 4 weeks b. Every other week c. Every week d. Every 3 weeks

d. Every 3 weeks (Rationale: Doxorubicin is administered as a single IV dose and repeated every 21 days [3 weeks]).

During which phase of the cell cycle would a nurse expect a mitotic inhibitor to act? a. G1 b. G0 c. S d. M

d. M (Rationale: Mitotic inhibitors act only during the M phase of the cell cycle.)

An antineoplastic extravasates and the antidote is administered. The nurse would apply warmth to the site of extravasation if what drug was involved? a. Dactinomycin b. Doxorubicin c. Mechlorethamine d. Teniposide

d. Teniposide (Rationale: Heat/warm compresses are applied if teniposide extravasates. Ice compresses are applied if mechlorethamine extravasates. Cold compresses are applied if doxorubicin extravasates. Cold compresses are applied if dactinomycin extravasates.)

After teaching a group of students about antineoplastic agents and their effect on cancer and healthy cells, the instructor determines that the teaching was successful when the students identify which drug as having the least effect on healthy cells? a. Vinblastine b. Gefitinib c. Docetaxel d. Paclitaxel

b. Gefitinib (Rationale: Gefitinib belongs to the group of drugs called protein tyrosine kinase inhibitors, which do not affect healthy human cells. Docetaxel is a mitotic inhibitor that affects both healthy and cancer cells. Vinblastine is a mitotic inhibitor that affects both healthy and cancer cells. Paclitaxel is a mitotic inhibitor that affects both healthy and cancer cells.)

While receiving etoposide IV, extravasation occurs. What agent would the nurse expect to have ordered to reduce tissue damage? a. Sodium bicarbonate b. Hyaluronidase c. Isotonic sodium thiosulfate d. Ascorbic acid

b. Hyaluronidase (Rationale: Hyaluronidase is used to extravasations of etoposide, teniposide, vinblastine, or vincristine. Sodium bicarbonate is used for extravasations of daunorubicin, doxorubicin, vinblastine, or vincristine. Ascorbic acid is used for extravasations of dactinomycin. Isotonic sodium thiosulfate is used for extravasation of mechlorethamine.)

The nurse reviews the plan of care for a patient receiving antineoplastic therapy and sees a nursing diagnosis of risk for infection. What assessment finding would support this diagnosis? a. Alopecia b. Pancytopenia c. Dehydration d. Gastrointestinal toxicity

b. Pancytopenia (Rationale: Pancytopenia indicates bone marrow suppression, which would reduce the immune response and place the patient at increased risk for infection. Gastrointestinal toxicity might suggest a nursing diagnosis of imbalanced nutrition, diarrhea, or risk for dysfunctional gastrointestinal motility. Dehydration might suggest a nursing diagnosis of deficient fluid volume. Alopecia may suggest a nursing diagnosis of disturbed body image.)

The nurse recognizes that nitrogen mustards belong to what classification of antineoplastic? a. Alkylating agent b. Hormone modulator c. Mitotic inhibitor d. Antimetabolite

a. Alkylating agent (Rationale: Nitrogen mustard is among the oldest drugs in the classification of alkylating agents, and modification of the structure of this and other older drugs has led to the development of nitrosoureas. Therefore, the other options are incorrect.)

The nurse would classify what types of cancer as solid tumors? (Select all that apply.) a. Carcinomas b. Lymphoma c. Hematologic malignancies d. Sarcomas e. Leukemia

a. Carcinomas d. Sarcomas (Rationale: Cancers can be divided into two groups: solid tumors and hematological malignancies. Solid tumors may originate in any body organ and may be further divided into carcinomas, or tumors that originate in epithelial cells, and sarcomas, or tumors that originate in the mesenchyme and are made up of embryonic connective tissue cells. Hematological malignancies, such as the leukemias and lymphomas, occur in the blood-forming organs.)

A patient is to receive goserelin as treatment for advanced prostatic cancer. The nurse would expect this drug to be ordered for administration by which route? a. Implant b. Oral c. Intramuscular d. Intravenous

a. Implant (Rationale: Goserelin is administered by implant or subcutaneous injection.)

A patient who is receiving methotrexate is also receiving leucovorin. The nurse understands that leucovorin is given for what reason? a. Synergistic effect on the cancer cells b. Counteract effects of methotrexate c. Reduction of alopecia d. Relief of nausea and vomiting

b. Counteract effects of methotrexate (Rationale: Leucovorin is administered with methotrexate to counteract the toxic effects of methotrexate treatment. Leucovorin does not have a synergistic effect on cancer cells. Leucovorin will not relieve nausea and vomiting or alopecia.)

How would the nurse describe the action of alkylating agents? a. React chemically with portions of RNA, DNA, and other cellular proteins b. Block DNA synthesis to interfere with the cell's ability to divide c. Inhibit DNA production by replacing the natural substances for cell function d. Insert itself between base pairs in the DNA chain to disrupt DNA synthesis

a. React chemically with portions of RNA, DNA, and other cellular proteins (Rationale: Alkylating agents react chemically with portions of the RNA, DNA, or other cellular proteins. Antimetabolites inhibit DNA production in cells that depend on certain natural metabolites to produce DNA, replacing the needed metabolites, which prevents normal cellular function. Mitotic inhibitors interfere with the ability of a cell to divide, blocking or altering DNA synthesis. Antineoplastic antibiotics interfere with cellular DNA synthesis by inserting themselves between base pairs in the DNA chain.)

When a cell loses its differentiation and organization, the nurse recognizes that what has occurred? a. Autonomy b. Anaplasia c. Neoplasm d. Metastasis

b. Anaplasia (Rationale: Anaplasia is the loss of organization and structure. Anaplasia is a property held by all cancer cells. Autonomy is the loss of the normal controls and reactions that inhibit growth and spreading, which is another property of cancer cells. Metastasis is the ability of a cancer cell to enter the circulatory or lymphatic system and travel to other areas of the body that are conductive to growth and survival, which is another property of some cancer cells. A neoplasm is a new or cancerous growth that occurs when abnormal cells have the opportunity to multiply and grow.)

The creation of blood vessels to supply oxygen and nutrients to the abnormal cells is known as what? a. Anaplasia b. Angiogenesis c. Carcinoma d. Autonomy

b. Angiogenesis (Rationale: Angiogenesis is the creation of new blood vessels that occurs when cancer cells release an enzyme that promotes new vessels to feed the cancer cells. Anaplasia is the loss of organization and structure. Anaplasia is a property held by all cancer cells. Autonomy is the loss of the normal controls and reactions that inhibit growth and spreading, which is another property of cancer cells. Carcinoma is a term used to define a tumor that originates from epithelial cells.)

What is the nurse's priority teaching point for a patient who is receiving temsirolimus? a. Drink adequate fluids b. Avoid grapefruit juice c. Promote frequent rest periods d. Maintain adequate nutrition

b. Avoid grapefruit juice (Rationale: Although rest, fluids, and nutrition are important for any patient receiving an antineoplastic, a patient receiving temsirolimus needs to avoid grapefruit juice because of possible drug-food interaction, and this is the priority teaching point.)

A patient is receiving idarubicin. What is the nurse's priority assessment? a. Blood studies b. Cardiac function c. Electrolyte levels d. Respiratory function

b. Cardiac function (Rationale: The patient's cardiac function needs to be monitored closely because idarubicin is specifically toxic to the heart. The response of "blood studies" is nonspecific and could involve virtually any lab test. Respiratory function is not commonly impacted by idarubicin. Electrolyte levels should be monitored in patients receiving any antineoplastic study due to adverse effects impacting nutrition and kidney function, but are not specific to idarubicin.)