chapter 14 pharm

A client with advanced prostatic cancer has opted for palliative care. At a care conference, the decision is made to pursue histrelin treatment. What should the nurse teach the client about this medication? "These pills will likely give you a much higher quality of life." "We'll work with your family so that you can receive your IV infusions at home." "This will involve giving you an implant of the drug" "The advantage of this drug is that it involves just one intramuscular injection every six weeks."

"This will involve giving you an implant of the drug"

A patient who will begin chemotherapy voices concern to the nurse about the accompanying nausea and vomiting. What is the best response by the nurse? "We can relieve your nausea and vomiting with drugs but you can have them only before and after the chemotherapy." "Not everyone has nausea and vomiting. Just wait to see how you will react to the chemotherapy." "We can relieve your nausea and vomiting with antiemetic drug therapy. You should ask for these medications whenever you need them." "Nausea and vomiting are an unfortunate side effect of the chemotherapy. We will do what we can but you may have it anyway."

"We can relieve your nausea and vomiting with antiemetic drug therapy. You should ask for these medications whenever you need them."

A patient having chemotherapy is losing her hair. She asks the nurse if her hair will come back as it originally was. What is the best response by the nurse? "Your hair will grow back, but it will be very thin and straight." "Your hair may not grow back, but we can refer you to a wig specialist." "I think you have more to worry about than if you have hair. You can buy a wig." "Your hair will grow back, but the new hair may be a different color or texture."

"Your hair will grow back, but the new hair may be a different color or texture."

Which antineoplastic drugs are classified as antineoplastic antibiotics? (Select all that apply.) Bleomycin (Blenoxane) Carboplatin (Paraplatin) Dactinomycin (Cosmegen) Busulfan (Busulfex) Daunorubicin (DaunoXome)

Bleomycin (Blenoxane) Dactinomycin (Cosmegen) Daunorubicin (DaunoXome)

A 49-year-old client is diagnosed with ovarian cancer. What is a characteristic of malignant cells that differentiates them from normal body cells? Cancerous cells grow in an uncontrollable fashion. Cancerous cells are not responsive to the presence of drugs. Cancerous cells have a theoretically infinite life span. Cancerous cells do not require an energy source in order to proliferate.

Cancerous cells grow in an uncontrollable fashion.

A nurse is administering an antineoplastic extravasation occurs. How can the nurse best prevent tissue damage caused by extravasation? Infuse into proximal veins whenever possible Administer through a hand vein, if possible Inspect the site frequently for redness or swelling Use an infusion pump

Inspect the site frequently for redness or swelling

A male patient has been on long-term bicalutamide therapy. In order to assess adverse effects of the drug therapy, the nurse will closely monitor: Liver function Blood counts Pap test results Visual function

Liver function

The nurse is caring for a patient who is receiving a combination of antineoplastic agents. The patient will most likely lose her hair. Why would the nurse suggest that she get a wig or use appropriate head cover? Her self-esteem will be better if the head is covered The hair will likely grow back if the head is covered at all times Most of the heat is lost through the head and it is important to cover it during extremes in temperature People may be uncomfortable seeing her bald head

Most of the heat is lost through the head and it is important to cover it during extremes in temperature

A nurse educator who coordinates the staff education on an oncology unit is conducting an inservice on targeted therapies. What potential benefit of targeted therapies should the nurse highlight in this education session? Targeted therapies have the potential to damage cancerous cells while leaving normal body cells less affected. Targeted therapies are significantly more cost-effective than traditional chemotherapeutic drugs. Targeted therapies have the potential to provide prophylactic protection against neoplasia in high-risk individuals. Targeted therapies achieve the therapeutic benefits of traditional chemotherapy with no risk of adverse effects.

Targeted therapies have the potential to damage cancerous cells while leaving normal body cells less affected.

Common causes of primary hypothyroidism include all of the following EXCEPT: Treatment of hyperthyroidism with antithyroid drugs. Treatment with steroid medications. Radiation to the neck. Hashimoto's thyroiditis.

Treatment with steroid medications.

What measure protects the nurse when preparing cytotoxic drugs? Wearing protective equipment such as gloves, mask, and gown Mixing medication in a 1-L bag Washing hands before preparation Administering medication IM

Wearing protective equipment such as gloves, mask, and gown

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

With food and a large glass of water

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. encourage the client to request antiemetics if the nausea becomes unbearable. ensure that the client is NPO from midnight prior to receiving the drug. place the client on a low-residue diet.

administer a combination of antiemetics prior to the administration of the drug.

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-nonspecific. growth fraction. cell targeting. cell cycle-specific.

cell cycle-specific.

The purpose of antineoplastic drugs is to affect cells that rapidly divide and reproduce; however, the adverse effects produced by antineoplastic drugs result from their systemic use, which exposes nonmalignant cells in the body that are rapidly dividing and reproducing. Which is not an example of a rapidly dividing and reproducing cell in the body? hair follicle cell nerve cell oral mucosal cell bone marrow cell

nerve cell

What drug type is most likely to cause respiratory depression and myxedema coma in clients with thyroid disorders? opioid analgesics beta-adrenergic blockers calcium channel blockers thioamide antithyroids

opioid analgesics

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

oral

What is the defining characteristic of a sarcoma? originates from connective tissue attributable to endogenous carcinogens sequestered within bone or muscle tissue congenital in nature

originates from connective tissue

The nurse reviews the plan of care for a patient receiving antineoplastic therapy. The nurse notes a nursing diagnosis of risk for infection. Which adverse effect would the nurse expect the patient to exhibit? dehydration gastrointestinal toxicity alopecia pancytopenia

pancytopenia

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 follow a specific sequence of cytotoxic events in order to achieve cell death. They affect cancerous cells and normal body cells in a similar manner. They achieve a synergistic effect when administered in combination with cell cycle-nonspecific drugs. They affect cancerous cells during a particular phase of cellular reproduction.

They affect cancerous cells during a particular phase of cellular reproduction.

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? amifostine leucovorin mesna allopurinol

allopurinol

Dosage of cytotoxic drugs for children is based on: height. body surface area. weight. disease process.

body surface area.

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 lack contact inhibition Cells with a long generation time Cells that have a rapid mitotic rate Cells that lack a blood supply

Cells that have a rapid mitotic rate

A postmenopausal woman with breast cancer will most likely be treated with which anti-estrogen drug? Cyclophosphamide Bleomycin Tamoxifen Cisplatin

Tamoxifen

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: encourage the client to request antiemetics if the nausea becomes unbearable. administer a combination of antiemetics prior to the administration of the drug. ensure that the client is NPO from midnight prior to receiving the drug. place the client on a low-residue diet.

administer a combination of antiemetics prior to the administration of the drug.

A client is receiving tamoxifen. Which adverse effect would be most specific to the action of this drug? hepatic dysfunction menopausal effects gastrointestinal toxicity bone marrow suppression

menopausal effects

Tamoxifen achieves a therapeutic effect by which means? slowing the growth of cancer cells inducing apoptosis of cancer cells causing mutations of cancer cells increasing the viability of healthy cells that are adjacent to cancerous cells

slowing the growth of cancer cells

An adult client has recently begun cancer treatment with methotrexate (MTX). When reviewing this client's laboratory work, the nurse should consequently prioritize assessment of what? Calcium and magnesium Arterial blood gases BUN and creatinine Sodium and potassium

BUN and creatinine

A client has just started on an alkylating agent to treat their cancer. What is the most common side effect of most alkylating agents? Nephrotoxicity Depression Confusion Myelosuppression

Myelosuppression

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

Take special care when shaving or brushing her teeth.

When assessing a client for adverse effects related to methotrexate (MTX) therapy, the nurse should prioritize what diagnostic findings? calcium and magnesium levels electrocardiogram (ECG) serum osmolality creatinine clearance

creatinine clearance

The nurse should encourage the client to implement which intervention in order to minimize the risk of developing chemotherapy-triggered mucositis? self-administer 650 mg of acetaminophen 4 times daily limit fluid intake to prevent overhydration of mucous membranes thoroughly rinse the mouth often, especially before and after meals gargle with a commercial mouthwash 3 to 4 times daily

thoroughly rinse the mouth often, especially before and after meals

The dosages of the chemotherapy agents that will be administered are based primarily on what client variable? comorbidities body surface area (BSA) percentage of body water weight

weight

An older adult client has been using levothyroxine for several years on an outpatient basis. Which client statement should the nurse attribute to the decreased effect of levothyroxine? "I've been using a lot of antacids lately because of my indigestion." "Overall, I'd say that I'm under a lot of stress lately." "My daughter and I have started the Atkins diet to try to lose some weight." "I've stopped taking aspirin for my arthritis and started using acetaminophen."

"I've been using a lot of antacids lately because of my indigestion."

A client is diagnosed with a brain tumor. The client is told that the cancer cells proliferate. The client asks the nurse what this means. What is the nurse's best response? "The proliferation of cancer cells is the metastasis of the tumor." "The proliferation is the growth of cancer cells and the rate of growth." "The proliferation of the cancer cells is the suppression of growth." "The proliferation of the cancer cells is the treatment with chemotherapy."

"The proliferation is the growth of cancer cells and the rate of growth."

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

"The reddish urine is an expected response to the drug."

A client is being treated for cancer and dronabinol has been added to the client's current medication regimen. What assessment finding would indicate a therapeutic effect of this medication? Stable white blood cell levels Decreased pain Increased energy Absence of nausea

Absence of nausea

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

Cardiotoxicity

A client has been diagnosed with a brain tumor and is dealing with this diagnosis by seeking detailed information about cancer. The nurse would explain to the client that cancer is essentially a result of the disruption of what? Lymphatic system Immune system Cell cycle Cell wall

Cell cycle

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

Ensure that all staff and visitors adhere to infection control precautions.

A male client is receiving parenteral cytotoxic medications in the home. Adjunct therapy may include what substance? Antidiuretic hormone Heparin Normal saline 0.9% intravenously Erythropoietin

Erythropoietin

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? Every 4 weeks Every 3 weeks Every other week Every week

Every 3 weeks

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

False

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? Docetaxel Gefitinib Vinblastine Paclitaxel

Gefitinib

Fewer adverse effects are associated with monoclonal antibody therapy than those of cytotoxic drugs. However, some of the potential adverse effects of monoclonal antibodies can be life threatening, including which effect? Bronchoconstriction and pulmonary edema Heart failure and bleeding problems Ischemic heart disease Changes in cognition and personality changes

Heart failure and bleeding problems

A client's chemotherapeutic regimen includes procarbazine. What is the client's most likely diagnosis? Astrocytoma Hodgkin lymphoma Pancreatic cancer Neuroblastoma

Hodgkin lymphoma

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

Hormonal therapies

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. Administer anticoagulants as prescribed Place the client on protective isolation Monitor the client's laboratory values closely Allow sufficient time for rest between scheduled activities Implement falls prevention measures

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

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? Prevention of hemorrhagic cystitis Increased leukocytes Resolution of mucositis Increased platelet levels

Increased leukocytes

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? Resolution of mucositis Prevention of hemorrhagic cystitis Increased platelet levels Increased leukocytes

Increased leukocytes

A female client is ending an extensive chemotherapeutic regimen that included cytotoxic antineoplastic drugs. What does the nurse understand about bone marrow toxicity in this client? It is a common adverse effect of her treatment. It will cause the health care provider to increase the dose of chemotherapeutic medications. It will ultimately lead to death. It is a rare side effect of the chemotherapy.

It is a common adverse effect of her treatment.

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

M

Which agent would the nurse expect to be administered orally? Fluorouracil Gemcitabine Methotrexate Cytarabine

Methotrexate

Which would the nurse identify as an antineoplastic antibiotic? Vinblastine Mitomycin Docetaxel Teniposide

Mitomycin

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? Increase the dose of capecitabine. Add routine blood transfusions to the client's treatment regimen. Discontinue the capecitabine. Monitor the client closely and repeat LFTs routinely.

Monitor the client closely and repeat LFTs routinely.

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. What is the goal of treatment with this agent? Reduce the incidence or severity of adverse drug effects. Buffer the cytotoxins that result from the metabolism of chemotherapeutic agents. Protect the client from pathophysiologic effects of malignancy. Potentiate the beneficial effects of chemotherapy.

Reduce the incidence or severity of adverse drug effects.

A patient has just received the first dose of imatinib and the nurse on the oncology unit is amending the patient's care plan accordingly. What nursing diagnosis is most appropriate in light of this addition to the patient's drug regimen? Risk for Acute Confusion related to adverse neurological effects of imatinib Risk for Impaired Skin Integrity related to exaggerated inflammatory response Risk for Infection related to bone marrow suppression Risk for Deficient Fluid Volume related to changes in osmotic pressure

Risk for Infection related to bone marrow suppression

A patient is to start with chemotherapy. The patient is worried about going bald in the course of the treatment. How can the nurse assist the patient in being comfortable with his or her body image? Explain that hair preserves body heat. Forewarn about hair loss. Explain it is not life-threatening. Suggest the use of a wig or cap.

Suggest the use of a wig or cap.

An older adult woman has been diagnosed with acute lymphoblastic leukemia (ALL) and her care team has identified potential benefits of imatinib. Which characteristic of this patient's current health status may preclude the use of imatinib? The patient had a total knee arthroplasty several months earlier. The patient experienced a mild ischemic stroke several years ago and had transient ischemic attacks last year. The patient has type 2 diabetes mellitus that is controlled using diet and oral antihyperglycemics. The patient has chronic heart failure resulting in significant peripheral edema.

The patient has chronic heart failure resulting in significant peripheral edema.

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. The restoration of fluid balance and nutrition is needed before continuing with chemotherapy. There is a need to restore a physiologic reserve of energy before further chemotherapy. Time is required for the successful application of radiotherapy between cycles of chemotherapy.

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

Many times a combination of antineoplastic medications are used to: increase the quantity of each medication used. decrease the side effects of each medication. decrease the development of cell resistance. increase the length of treatment.

decrease the development of cell resistance.

A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to: increase the protein in her diet. drink a lot of water. limit fluid intake. take the medication at bedtime.

drink a lot of water.

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

The process of creating new blood vessels to supply oxygen and nutrients to the cells

A middle-aged patient has received a diagnosis of GI stromal tumor following an extensive diagnostic workup. Imatinib has been recommended as a component of the patient's drug regimen. What patient education should the nurse provide to this patient? "If you experience significant nausea after taking a dose, stop taking the drug and schedule an appointment at the clinic." "Try to keep your PICC line dressing as dry as possible at all times." "It's important that you let us know if you develop any significant swelling or puffiness." "You'll likely experience a lot of dry mouth while you're taking this drug, so it's helpful to chew ice chips."

"It's important that you let us know if you develop any significant swelling or puffiness."

A client asks the nurse why the chemotherapy is often administered in cycles. Which response by the nurse would be most appropriate? "The cycles are the only way to guarantee a cure for the cancer." "The drugs are highly toxic, so the body needs time to recover." "The cycles help to prevent the drugs from destroying the healthy cells." "We want to attack the cells that might be dormant or moving into a new phase."

"We want to attack the cells that might be dormant or moving into a new phase."

A 25-year-old female client is prescribed methotrexate to treat rheumatoid arthritis (RA). The nurse should teach the client to: drink milk with the medication. expect a mild rash and itching. take a pain reliever for sore throat. use an effective contraceptive.

use an effective contraceptive.