Chapter 14: Drug Therapy for the Treatment of Cancer

Which agent would the nurse expect to be administered orally?

Methotrexate

The nurse on an oncology unit is providing care for several clients with cancer, most of whom are receiving chemotherapy. What client should the nurse prioritize?

A client with hairy cell leukemia receiving pentostatin whose urine output is 35 mL over the past 12 hours

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

Which nonpharmacological intervention may prevent cystitis caused by cyclophosphamide (Cytoxan)?

Keeping well hydrated

What can the oncology nurse do to minimize the exposure risk to chemotherapeutic agents?

Review institutional policies and procedures related to chemotherapy

A female client develops hepatotoxicity from the antineoplastic drugs that she is receiving. She has abnormal levels of AST, ALT, and bilirubin. The health care provider may not decrease the drugs for what reason?

These findings do not indicate decreased ability to metabolize drugs.

A client, diagnosed with chronic myelocytic leukemia (CML), has not been responding to chemotherapy and the provider changes the client to imatinib. The client asks the nurse, "Compared with my previous meds, what adverse effects am I going to have to deal with from this drug?" What is the nurse's best response?

"Adverse effects are much less likely or severe including GI upset, headache, and muscle pain."

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 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

A patient taking tamoxifen to reduce the risk of contralateral breast cancer asks the nurse about adverse effects of the drug. What is an adverse effect of tamoxifen?

Cerebrovascular accidents

Biologic targeted antineoplastics are being used more frequently to increase anticancer efficacy and decrease the adverse effects of traditional cytotoxic chemotherapy. They address which mechanisms of action in cancer development? Select all that apply.

Failure of the immune system to eliminate mutant, premalignant, and malignant cells. Failure of the growth-regulating mechanisms to control the proliferation of mutant, premalignant, and malignant cells.

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?

Increased risk of nephrotoxicity

A nurse is caring for a patient undergoing treatment with plant alkaloids for cancer. The patient is also administered warfarin for a history of atrial fibrillation. Which of the following is an interactive effect of the two drugs which the nurse should monitor the patient for?

Increased risk of prolonged bleeding

Which would the nurse identify as an antineoplastic antibiotic?

Mitomycin

A nurse is preparing to administer imatinib to a client. The nurse expects to administer this drug by which route?

Oral

A client is prescribed cyclophosphamide as part of her treatment for non-Hodgkin's lymphoma. Which symptoms should the client be instructted to report to her health care provider immediately?

Pain and burning with urination

An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease?

Prostate cancer

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 patient with rhabdomyosarcoma has been admitted for chemotherapy with Vincristine. While preparing a plan of care for this patient, what would be an appropriate nursing diagnosis to use?

Risk for injury

A nurse on an oncology unit is aware of the need to assess for adverse effects in patients who are being treated with rituximab. The risks of adverse effects are highest at what point during the course of treatment?

Shortly after the initiation of the first infusion of rituximab

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

The nurse should monitor a client receiving doxorubicin (Doxil) for signs of extravasation that include which of the following? Select all that apply:

Swelling Lack of blood return Redness

A patient taking high doses of cyclophosphamide is exhibiting muscle cramps and confusion and reports headaches. The nurse assesses the laboratory tests and notices the sodium level is low. What does the nurse determine may be occurring with this patient?

The patient is exhibiting signs of syndrome of inappropriate antidiuretic hormone caused by the high dose of cyclophosphamide.

In recent years, there have been rapid advances in cancer care for children and high cure rates for many pediatric malignancies. What is the reason behind many of these advances?

The systematic enrollment of children in well-designed clinical trials

Anemia from chemotherapy treatment is the result of bone marrow suppression.

True

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.

Malignant cells seem to be more susceptible than normal cells to the effects of which class of antineoplastic drugs?

alkylating agents

The pathophysiology instructor is discussing neoplasms with the pre-nursing students. The instructor explains that the effects of neoplasms are caused by:

invading healthy tissue.

What health education topic should the community health nurse emphasize when planning care for a client who will be prescribed an oral chemotherapy drug for the next several months while recovering at home?

techniques for safely handling the drug

The nurse may be asked to administer which medications to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis?

allopurinol

Many times a combination of antineoplastic medications are used to:

decrease the development of cell resistance.

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?

"Liver impairment usually subsides when chemotherapy is complete."

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."

The nurse is conducting an ongoing assessment on a client who has received an antineoplastic agent. Which signs should the nurse prioritize and alert the health care provider concerning? Select all that apply.

Cough Sore throat White blood cell count of less than 3500/mm3

A client has been diagnosed with leukemia. Which alkylating agent is the only one that can be used for both acute and chronic leukemia?

Cyclophosphamide

A patient is receiving carboplatin. The nurse would expect to administer this drug by which route?

Intravenous

Mr. Mass has been diagnosed with lung cancer. The health care provider orders chemotherapy prior to the surgery to reduce the tumor burden. What strategy relates to chemotherapy administered to reduce the tumor burden before surgery or radiation to improve the outcomes of these methods?

Neoadjuvant therapy

A client with a pancreatic tumor will be starting on chemotherapy to decrease the size of the tumor, give the client a better quality of life, and reduce discomfort. What is this form of therapy called?

Palliative therapy

A nurse is providing client education to a 50-year-old woman who is taking methotrexate (MTX) for breast cancer. The nurse will instruct the client to avoid which drug?

Salicylates

A nurse is caring for a client being treated with antineoplastic drugs. The client reports recently experiencing bloody urine. What complication might this client be experiencing?

Thrombocytopenia

The nurse is preparing to administer doxorubicin for a client who has a diagnosis of neuroblastoma. What action should the nurse perform?

Wear personal protective equipment

A client asks the nurse what cancer cell growth is called. What would the nurse tell the client?

proliferation

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

What rationale should the nurse provide to the client when describing the necessity of recovery periods between treatment cycles of chemotherapy?

Time is needed to replace many of the healthy body cells killed by chemotherapy.

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.