PrepU Chapter 14: Drug therapy for the treatment of cancer

A young client 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."

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

Which of the following patients has the greatest potential to benefit from treatment with rituximab?

A woman who has chronic lymphocytic leukemia

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."

A client asks the nurse why the chemotherapy is often administered in cycles. Which response by the nurse would be most appropriate?

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

When describing alkylating agents, the nurse would explain that this medication is seen as the prototype:

Chlorambucil

Which drug would have the least effect on healthy human cells?

Imatinib

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 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 food and a large glass of water

A nurse in an outpatient treatment center is caring for a client who receives regular IV chemotherapy sessions. The nurse understands that one important goal of chemotherapy is what?

Prevention or treatment of adverse drug effects

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 client who is taking chemotherapeutic medications has developed stomatitis. What intervention should the nurse include in the client's plan of care?

Provide mouth care frequently.

Mr. Melika is treated with high-dose chemotherapy after a radical prostatectomy. What term would best describe this type of therapy?

Adjuvant therapy

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?

Mytomycin

A patient will be having chemotherapy to reduce a colon tumor prior to having a colon resection. To what is this type of therapy referred?

Neoadjuvant therapy

The nurse is assessing a client for adverse effects related to methotrexate therapy. What diagnostic finding should the nurse prioritize?

creatinine clearance

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

The nurse will assess the client receiving chemotherapy for which symptoms related to tumor lysis syndrome? (Select all that apply.)

Numbness and tingling of the extremities Nausea Confusion

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

Oral

A patient with a diagnosis of chronic myeloid leukemia has met with the oncologist, who has recommended treatment with the kinase inhibitor imatinib. What route of administration will the client receive?

Oral administration of imatinib in a home setting

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 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 patient newly diagnosed with CML has been prescribed treatment with imatinib. The patient asks the nurse how imatinib works. What would be the nurse's best response?

"Imatinib inhibits the enzyme created by the Philadelphia chromosome abnormality in CML."

A patient is receiving a short course of high-dose therapy after radiation and a lumpectomy for the treatment of breast cancer. What type of therapy is this considered?

Adjuvant therapy

A patient with chronic lymphocytic leukemia (CLL) will imminently begin a course of treatment with rituximab. In order to minimize the risk of adverse effects, what strategy for administration will be adopted?

Administering the initial doses by slow infusion while observing for adverse reactions

A nurse is caring for a client who has received chemotherapy treatment. The client has developed inflammation of the oral mucous membrane, which is affecting the nutritional aspects of care. What suggestions should the nurse provide to the client for relief?

Provide mouth care with normal saline every 4 hours

Many times a combination of antineoplastic medications are used to:

decrease the development of cell resistance.

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 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:

drink a lot of water.

A 63-year-old male patient has just begun treatment with IV paclitaxel. About 10 minutes into the infusion, the nurse becomes concerned about a possible anaphylactic reaction to the drug because the patient is experiencing:

dyspnea.

A nurse educator is discussing the role of protooncogenes in the pathophysiology of cancer. What typically triggers protooncogenes to differentiate into oncogenes?

exposure to carcinogens

The client is taking ifosfamide as a component of cancer treatment, and the client's oncologist has just added mesna to the client's medication regimen. How should the nurse best assess for the therapeutic effect of mesna?

monitoring the client's urine output for signs of hematuria

In caring for clients undergoing chemotherapy, the nurse should monitor for what adverse effective triggered by the cytotoxic effect of the antineoplastic medication therapy? Select all that apply.

mucositis nausea diarrhea

What is the defining characteristic of a sarcoma?

originates from connective tissue

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

A female client prescribed methotrexate for meningeal leukemia is asking the nurse about adverse effects of the drug. What would the nurse tell this client should be avoided while taking methotrexate?

pregnancy

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

proliferation

The nurse is caring for a client whose current antineoplastic regimen includes bicalutamide. The nurse should anticipate what additional aspect of this client's cancer treatment?

prostatectomy

A 46-year-old woman is undergoing treatment for breast cancer, and her current course of chemotherapy will be supplemented with trastuzumab (Herceptin). The nurse should anticipate which of the following routes of administration?

Intravenous administration with a dosage based on the patient's body weight

A male client is prescribed cytotoxic antineoplastic drugs as part of his cancer treatment regimen. His wife is 2 months pregnant. The nurse teaches both the client and his wife that she should avoid contact with the drug, for which reasons? (Select all that apply.)

It is carcinogenic. It is mutagenic. It is teratogenic.

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

M

A nurse is caring for a client who is undergoing chemotherapy. The client has experienced several episodes of vomiting. Which would be appropriate for the nurse to do for this client as part of the ongoing assessment?

Measure all fluid intake and output

Which agent would the nurse expect to be administered orally?

Methotrexate

Which would the nurse identify as an antineoplastic antibiotic?

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?

Monitor the client closely and repeat LFTs routinely.

The nurse is caring for a client receiving cyclophosphamide. What is the priority nursing action for this client?

Monitor urinalysis results.

The client asks the nurse why many chemotherapy drugs must be given IV. What is the nurse's best response?

Most chemotherapy drugs are inactivated by enzymes in the stomach.

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

Mike, a lymphoma client, is administered bleomycin drug therapy according to the health care provider's instructions. Following the drug administration, he reports fever, chills, nausea, and general weakness. What preventive measure would be helpful in his case?

Providing premedication with acetaminophen and diphenhydramine

A client is prescribed doxorubicin drug therapy for carcinoma of the breast. On the second day of drug therapy, she calls in to report reddish urine. What should the nurse do?

Reassure the client that it is a harmless and expected response to the drug.

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

The nurse is administering a client's chemotherapeutic drug through a peripheral IV site, and the nurse observes that extravasation has occurred. What is the nurse's best action?

Stop the infusion and inform the health care provider immediately.

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?

Suggest the use of a wig or cap.

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.

Your new admission is a 53-year-old black woman, presenting after bilateral mastectomies. Earlier biopsy results indicated multiple malignancies in each breast. How long does it usually take for malignant cells to produce a clinically detectable neoplasm?

Years

The nurse is caring for a client whose current chemotherapy regimen includes mitomycin. What is the client's most likely diagnosis?

adenocarcinoma of the pancreas

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.

Which agents would be considered cancer non-cell cycle specific agents?

alkylating agents

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

The mitotic inhibitors interfere with the ability of a cell to divide, and they block or alter DNA synthesis, thus causing cell death. For clients taking these drugs, the nurse should:

avoid any skin, eye, or mucous membrane contact with the drug.

The nurse is caring for a client who has leukemia. What aspect of this client's health status should the nurse prioritize when confirming the appropriateness and dosing of antimetabolites?

bone marrow suppression

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

The nurse is providing medication education to a client with breast cancer who has been prescribed tamoxifen. How should the nurse explain the action of the drug?

slows the growth of cancer cells

A patient has been scheduled to begin treatment with rituximab for non-Hodgkin's lymphoma. The nurse who will administer this drug should understand that it targets

specific antigens on the surface of malignant B cells.

A client with a diagnosis of cancer is experiencing pain and the early signs of organ dysfunction. How should the nurse explain these signs and symptoms originate?

tumor cells invading healthy tissue

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 of what?

Candidiasis

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

Cardiotoxicity

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 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 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 the new hair may be a different color or texture."

The client is instructed to return to the clinic after calling and reporting various concerns. The nurse alerts the primary health care provider after noting which sign(s) on the assessment? Select all that apply.

Bleeding gums Petechiae Hematuria

Nitrosoureas are alkylating agents that interfere with cell division and structuring of DNA during all phases of the malignant cell cycle. They are most effective in hematologic malignancies but are also used for others. After dosing, what needs monitoring and for what time period?

CBC weekly for at least 6 weeks

A patient has been prescribed melphalan, an alkylating agent, for the treatment of an ovarian tumor. The patient wants to know the action of the drug in treating the tumor. Which of the following should the nurse inform the patient?

Changes the cell to a more alkaline environment.

A client is receiving bleomycin as part of a chemotherapy regimen. Which would be most important for the nurse to monitor?

Chest x-ray

A 71-year-old male client is receiving chemotherapy as part of the treatment regimen for his cancer. To monitor renal function, what laboratory measurements would the nurse expect the health care provider to order?

Creatinine clearance

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 client has been diagnosed with cancer. The health care provider prescribes antineoplastic drug therapy to the client. How should the nurse explain the use of antineoplastic drugs?

Delays spread of cancer to other sites

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

What is the nurse's priority intervention to reduce the risk of renal damage caused by cyclophosphamide?

Encourage fluids to maintain hydration.

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.

A male patient is receiving rituximab therapy for non-Hodgkin's lymphoma. Which of the following would be a priority nursing intervention to reduce the risk for cytotoxicity and tumor lysis syndrome?

Ensure that the patient maintains a normal fluid and electrolyte balance.

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 3 weeks

A 26-year-old man with testicular cancer is prescribed combination chemotherapy that involves using two drugs that are effective against testicular tumors. Combination drug therapy is superior to single-drug therapy because of:

Higher tumor response rates

A client's chemotherapeutic regimen includes procarbazine. What is the client's most likely diagnosis?

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

A 39-year-old client has begun taking tamoxifen to reduce the risk of contralateral breast cancer. The client is now reporting hot flashes and dysmenorrhea. What is the nurse's best action?

Inform the client that these are likely adverse effects of drug therapy.

What best reflects the action of antimetabolites?

Inhibits DNA production via replacing the natural substances needed for it

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

Intravenous

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.

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

Tamoxifen

The client has just been started on an alkylating agent to treat testicular cancer. What assessment finding would suggest that the client is experiencing a common adverse effect of this medication?

The client's most recent laboratory results indicate pancytopenia.

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.

A client with Hodgkin disease has been prescribed vincristine. What nursing consideration should the nurse prioritize when administering this drug?

The nurse should avoid any skin, eye, or mucous membrane contact with the drug.

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 has chronic heart failure resulting in significant peripheral edema.

A patient who has been taking high doses of cyclophosphamide for the treatment of acute leukemia states that he is having pain and burning on urination and has noticed blood in the urine. What does the nurse identify has occurred?

The patient has developed sterile hemorrhagic cystitis.

A patient with a recent diagnosis of chronic myelogenous leukemia (CML) is discussing treatment options with his care team. What aspect of the patient's condition would contraindicate the use of cyclophosphamide for the treatment of leukemia?

The patient's bone marrow function is significantly depressed.

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 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.

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 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

A female client is prescribed methotrexate for meningeal leukemia. What health education should the nurse prioritize?

Use reliable forms of barrier contraception.

The nurse is caring for a client who is receiving a combination of antineoplastic agents. The client has been told that alopecia is likely to occur, and the client is tearful and distraught about this. What is the nurse's best response?

Validate the client's sense of impending loss and offer guidance for getting a wig.