Chapter 45: Antineoplastic Drugs Part 1: Cancer Overview and Cell

Cycle–Specific Drugs

Multiple Choice

1. One patient has cancer of the bone; another has cancer in the connective tissues of the thigh muscles; a third patient has cancer in the vascular tissues. Which of these is the correct term for these tumors?

a. Sarcoma b. Leukemia c. Carcinoma d. Lymphoma

ANS: A

Sarcomas are malignant tumors that arise from connective tissues. These tissues can be found in bone, cartilage, muscle, blood, lymphatic, and vascular tissues. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation a. “You can take aspirin to prevent stomatitis.” b. “Be sure to watch for and report black, tarry stools immediately.” c. “You need to increase your intake of foods containing fiber and citric acid.” d. “Be sure to examine your mouth daily for bleeding, painful areas, and ulcerations.”

2. A patient is receiving her third course of 5-fluorouracil therapy and knows that stomatitis is a potential adverse effect of antineoplastic therapy. What will the nurse teach her about managing this problem?

ANS: D

The symptoms of stomatitis consist of pain or burning in the mouth, difficulty swallowing, taste changes, viscous saliva, dryness, cracking, and fissures, with or without bleeding mucosa. Teach patients to avoid consuming foods containing citric acid and foods that are hot or spicy or high in fiber. Assessing stools is important but is not related to stomatitis, and aspirin must not be used during this therapy.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential a. The patient will eat three balanced meals a day within 2 days. b. The patient will return to normal eating pattern within 4 weeks. c. The patient will maintain normal weight by consuming healthy snacks as tolerated. d. The patient will maintain a diet of small, frequent feedings with nutrition supplements within 2 weeks.

3. The nurse is developing a plan of care for a patient who is experiencing gastrointestinal adverse effects, including anorexia and nausea, after the first course of antineoplastic therapy. What is an appropriate outcome for this patient when dealing with this problem?

ANS: D

Consuming small, frequent meals with nutritional supplements, and maintaining a bland diet help to improve nutrition during antineoplastic therapy.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort a. A transfusion of whole blood b. Leucovorin rescue c. Therapy with filgrastim (Neupogen) d. Administration of allopurinol (Zyloprim)

4. A patient is receiving high doses of methotrexate and is experiencing severe bone marrow suppression. The nurse expects which intervention to be ordered with this drug to reduce this problem?

ANS: B

High-dose methotrexate is associated with bone marrow suppression, and it is always given in conjunction with the rescue drug leucovorin, which is an antidote for folic acid antagonists. Basically, leucovorin rescues the healthy cells from methotrexate. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential a. The aspirin will aggravate diarrhea. b. The aspirin will masks signs of infection. c. Aspirin can lead to methotrexate toxicity. d. The aspirin will cause no problems for the patient on methotrexate.

5. A patient who has been on methotrexate therapy is experiencing mild pain. The patient is asking for aspirin for the pain. The nurse recognizes that which of these is true in this situation?

ANS: C

Methotrexate interacts with weak organic acids, such as aspirin, and can lead to toxicity by displacing the methotrexate from protein-binding sites.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. “I will avoid those who have recently had a vaccination.” b. “I will eat only fresh fruits and vegetables.” c. “I will report a sore throat, cough, or low-grade temperature.” d. “It is important for both my family and me to practice good hand washing.”

6. The nurse is reviewing infection-prevention measures with a patient who is receiving antineoplastic drug therapy. Which statement by the patient indicates the need for further teaching?

ANS: B

Patients who are neutropenic and susceptible to infections need to adhere to a low-microbe diet by washing fresh fruits and vegetables and making sure foods are well cooked. The other options are correct.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control a. There will be less nausea and vomiting. b. Increased cancer-cell killing will occur. c. The drugs will prevent metastasis. d. Combination therapy reduces the need for radiation therapy.

7. The nurse is administering a combination of three different antineoplastic drugs to a patient who has metastatic breast cancer. Which statement best describes the rationale for combination therapy?

ANS: B

Because drug-resistant cells commonly develop, exposure to multiple drugs with multiple mechanisms and sites of action will destroy more subpopulations of cells. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Severe stomatitis b. Bone marrow suppression c. Delayed-onset cholinergic diarrhea d. Immediate and severe nausea and vomiting

8. A patient is receiving irinotecan (Camptosar), along with other antineoplastic drugs, as treatment for ovarian cancer. The nurse will monitor for which potentially life-threatening adverse effect that is associated with this drug?

ANS: C

In addition to producing hematologic adverse effects, irinotecan has been associated with severe diarrhea, known as cholinergic diarrhea, which may occur during infusions. Delayed diarrhea may occur 2 to 10 days after infusion of irinotecan. It is recommended that this condition be treated with atropine unless use of that drug is strongly contraindicated. This diarrhea can be severe and even life threatening.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Evaluation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Fever b. Diaphoresis c. Tachycardia d. Elevated white blood cell count

9. The nurse is monitoring a patient who has severe bone marrow suppression following antineoplastic drug therapy. Which is considered a principal early sign of infection?

ANS: A

Fever and/or chills may be the first sign of an oncoming infection. Elevated white blood cell count will not occur because of the bone marrow suppression. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential a. The physician will choose another drug to use. b. The chemotherapy will be given along with supportive measures to treat a possible allergic reaction. c. The patient will receive reduced doses of chemotherapy for a longer period of time. d. The chemotherapy cannot be given because of the patient’s allergy.

10. A patient, diagnosed with lymphoma, has an allergy to one of the proposed chemotherapy drugs. The tumor has not responded to other types of treatment. The nurse expects the oncologist to follow which course of treatment?

ANS: B

Even if a patient has a known allergic reaction to a given antineoplastic medication, the urgency of treating the patient’s cancer may still necessitate administering the medication and then treating any allergic symptoms with supportive medications, such as antihistamines, corticosteroids, and acetaminophen.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. The lowest level of neutrophils reached during therapy. b. The highest level of neutrophils reached during therapy. c. The point at which the adverse effects of chemotherapy will stop. d. The point at which the cytotoxic action against cancer cells is the highest.

11. During treatment of a patient who has brain cancer, the nurse hears the oncologist mention that the patient has reached the “nadir.” The nurse knows that this term means which of these?

ANS: A

The lowest neutrophil count reached after a course of chemotherapy is known as the nadir. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Multiple Response

1. Methotrexate is ordered for a patient with a malignant tumor, and the nurse is providing education about self-care after the chemotherapy is given. Which statements by the nurse are appropriate for the patient receiving methotrexate? (Select all that apply.)

a. Report unusual bleeding or bruising.

b. Hair loss is not expected with this drug.

c. Prepare for hair loss.

d. Avoid areas with large crowds or gatherings.

e. Avoid foods that are too hot or too cold or rough in texture.

f. Restrict fluid intake to reduce nausea and vomiting.

ANS: A, C, D, E

Counsel patients who are taking methotrexate to expect hair loss and to report any unusual bleeding or bruising. Because of the possibility of infection, avoid areas with large crowds or gatherings. Foods that are too hot or too cold or rough in texture may be irritating to the oral mucosa. Fluid intake is to be encouraged to prevent dehydration.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential a. Bone marrow cells b. Retinal cells c. Hair follicle cells d. Nerve myelin cells e. Gastrointestinal (GI) mucous membrane cells

2. When giving chemotherapy as cancer treatment, the nurse recognizes that toxicity to rapidly growing normal cells also occurs. Which rapidly growing normal cells are also harmed by chemotherapy? (Select all that apply.)

ANS: A, C, E

Chemotherapy toxicities generally stem from the fact that chemotherapy drugs affect rapidly dividing cells both harmful cancer cells and healthy, normal cells. Three types of rapidly dividing human cells are the cells of hair follicles, GI tract cells, and bone marrow cells. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

Completion

1. A patient is to receive a daily dose of fludarabine (Fludara), 25 mg/m2/day for 5 consecutive days. Each dose is diluted in a 125-mL bag of normal saline and is to infuse over 30 minutes. The nurse will set the infusion pump to what rate in milliliters per hour? _______

Chapter 45: Antineoplastic Drugs Part 1: Cancer Overview and Cell Cycle–Specific Drugs

ANS:

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Chapter 46: Antineoplastic Drugs Part 2: Cell Cycle–Nonspecific Drugs and Miscellaneous Drugs

Multiple Choice

1. A patient is receiving doxorubicin (Adriamycin) as part of treatment for ovarian cancer. Which nursing diagnosis is related to this antineoplastic drug?

a. Decreased cardiac output related to the adverse effect of cardiotoxicity b. Ineffective breathing pattern related to the adverse effect of pulmonary toxicity c. Risk for injury related to the effects of neurotoxicity (ataxia, numbness of hands and feet) d. Impaired urinary elimination pattern related to hyperuricemia

ANS: A

Decreased cardiac output related to the adverse effect of cardiotoxicity is a nursing diagnosis related to doxorubicin because adverse effects of doxorubicin include liver and cardiovascular toxicities. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Nursing Diagnosis

MSC: NCLEX: Physiological Integrity: Physiological Adaptation a. Alopecia b. Kidney damage c. Cardiotoxicity d. Stomatitis

2. When giving cisplatin (Platinol-AQ), the nurse is aware that the major dose-limiting effect of this drug is which condition?

ANS: B

Cisplatin may cause nephrotoxicity, and the patient’s renal function must be monitored closely while on this drug. Ensuring hydration will help to prevent nephrotoxicity.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. They are cytotoxic during a specific cell cycle. b. They are cytotoxic in any phase of the cell cycle. c. They are effective against several types of neoplasms. d. They are more highly differentiated than cell cycle–specific drugs.

3. The nurse is teaching a class about the various chemotherapy drugs. Which of these statements explains why alkylating drugs are also called “cell cycle–nonspecific drugs”?

ANS: B

Cell cycle–nonspecific drugs kill cancer cells during any phase of the growth cycle, whereas cell cycle–specific drugs kill cancer cells during specific phases of the cell growth cycle. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Evaluation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential a. Reduce the infusion rate. b. Discontinue the IV, and apply warm compresses. c. Stop the infusion immediately, but leave the IV catheter in place. d. Change the infusion to normal saline, and inject the area with hydrocortisone.

4. What is the nurse’s priority action if extravasation of an antineoplastic drug occurs during intravenous (IV) administration?

ANS: C

If extravasation is suspected, administration of the drug must be stopped immediately but the IV catheter left in place and the appropriate antidote instilled through the existing IV tube, after which the needle may be removed. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care a. Tinnitus and hearing loss b. Numbness and tingling in the fingers c. A weight gain of 2 pounds or more in 24 hours d. Decreased blood urea nitrogen and creatinine levels

5. A patient is receiving a third session of chemotherapy with daunorubicin (Cerubidine). The nurse will assess the patient for which signs of a potential severe toxic effect of this drug?

ANS: C

Cardiac toxicity may occur, so frequent checking of heart and breath sounds is necessary and daily weights need to be recorded (with reporting of an increase of 2 pounds or more in 24 hours or 5 pounds or more in 1 week).

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Let it dry, and then mop the floor. b. Wipe the area with a disposable paper towel. c. Use a spill kit to clean the area. d. Ask the housekeeping department to clean the floor.

6. When hanging a new infusion bag of a chemotherapy drug, the nurse accidentally spills a small amount of the solution onto the floor. Which action by the nurse is appropriate?

ANS: C

Special spill kits are employed to clean up even the smallest chemotherapy spills. These precautions are necessary to protect the health care provider from the cytotoxic effects of these drugs.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control a. Chemotherapy will continue as scheduled. b. Chemotherapy will resume with a lowered dosage. c. Chemotherapy will resume after a transfusion of neutrophils. d. Chemotherapy will be withheld until the neutrophil count returns toward normal levels.

7. Just before the second course of chemotherapy, the laboratory calls to report that the patient’s neutrophil count is 450 cells/mm3. The nurse expects that the oncologist will follow which course of treatment?

ANS: D

The normal range for neutrophils is above 1500 cells/mm3. If neutrophils are decreased to levels of less than 500 cells/mm3 (neutropenia), there is risk for severe infection. Chemotherapy will be held until the count returns toward normal levels.

DIF: COGNITIVE LEVEL: Analyzing (Analysis)

TOP: NURSING PROCESS: Evaluation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Hirsutism and acne b. Weight gain c. Flushing and hot flashes d. Alopecia and body odor

8. A female patient is receiving palliative therapy with androgen hormones as part of treatment for inoperable breast cancer. The nurse will discuss with the patient which potential body image changes that may occur as adverse effects?

ANS: A

Androgens used for cancer treatment, such as fluoxymesterone and testolactone, can cause menstrual irregularities, virilization of female, gynecomastia, hirsutism, acne, anxiety, headache, and nausea. The patient needs to be told of these effects before therapy begins. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Dexrazoxane (Zinecard) b. Allopurinol (Zyloprim) c. Octreotide (Sandostatin) d. Bismuth subsalicylate (Pepto-Bismol)

9. During chemotherapy, a patient develops severe diarrhea caused by a vasoactive intestinal peptide–secreting tumor (VIPoma). The nurse expects to administer which drug for this problem?

ANS: C

Octreotide (Sandostatin) is used for the management of a cancer-related condition called carcinoid crisis and treatment of the severe diarrhea caused by vasoactive intestinal peptide secreting tumors (VIPomas). The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Multiple Response

1. The nurse is assessing a patient who is receiving chemotherapy with an alkylating drug. Which assessment findings would be considered indications of an oncologic emergency? (Select all that apply.)

a. Dry, “scratchy,” or “swollen” throat b. Loss of hair c. Decreased red blood cell count d. White patches in the mouth or throat e. Temperature of 100.7° F (38.2° C) f. Decreased urine output

ANS: A, D, E, F

Indications of an oncologic emergency include fever and/or chills with a temperature higher than 100.5° F (38.1° C); new sores or white patches in the mouth or throat; changes in bladder function or patterns; dry, burning, “scratchy,” or “swollen” throat; and other signs and symptoms (see Box 46-4). The prescriber must be contacted immediately if any of the listed signs or symptoms occur. Loss of hair and decreased red blood cell count (a result of bone marrow suppression) are expected effects of chemotherapy.

DIF: COGNITIVE LEVEL: Analyzing (Analysis)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Tinnitus b. Heart failure c. Hearing loss d. Elevated blood urea nitrogen and creatinine levels e. Numbness or tingling in the extremities f. Elevated glucose and ketone levels

2. When a patient is receiving cisplatin (Platinol-AQ) chemotherapy, the nurse will monitor for which adverse effects? (Select all that apply.)

ANS: A, C, D, E

Cisplatin can cause nephrotoxicity, ototoxicity, and peripheral neuropathy. Nephrotoxicity is manifested by rising blood urea nitrogen and creatinine levels; ototoxicity is manifested by tinnitus, hearing loss, and dizziness; peripheral neuropathy is manifested by numbness or tingling of the extremities.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Evaluation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

COMPLETION

1. A patient will be receiving mitoxantrone (Novantrone), 12 mg/m2 every 3 weeks, as part of treatment for prostate cancer. Each dose is mixed into a 50-mL bag of D5W and needs to infuse over 15 minutes. The infusion pump delivers the dose at milliliters per hour. Identify the nurse will set the pump to infuse at what rate. _______

ANS:

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies