Basic Principles of Cancer Chemotherapy Test Bank (newest)

Basic Principles of Cancer Chemotherapy Test Bank MULTIPLE CHOICE 1. The nurse wants to evaluate a nursing student’s understanding of chemotherapy. The nurse asks, “Which factor would be a major obstacle to successful chemotherapy?” What is the student’s best response? a. “The patient’s reluctance about the doses administered.” b. “The patient’s degree of nausea.” c. “The toxicity of anticancer drugs to normal tissues.” d. “The difficulty attaining and maintaining venous access.” ANS: C The major obstacle to successful chemotherapy is the toxicity of anticancer drugs to normal tissues. The patient’s reluctance regarding the dose is a vague response. The patient’s degree of nausea should not be an issue, because many good antiemetics may be given prophylactically. The question does not address whether the chemotherapy is administered PO or IV; therefore, the response regarding venous access would be an assumption. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1206 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. A nurse is teaching a group of nursing students about cancer treatment. Which statement by a student indicates an understanding of the characteristics of cancer cells? a. “Cancer cells are characterized by unrestrained growth and division.” b. “Division of cancer cells is characteristically rapid.” c. “Malignant cells of solid tumors do not invade other tissues.” d. “Telomerase is an enzyme produced by cancer cells that promotes metastases.” ANS: A Because malignant cells are unresponsive to the feedback mechanisms that regulate cellular proliferation in healthy tissue, they are characterized by unrestrained growth and division. Division of tumor cells is not necessarily rapid. Malignant cells of all types can metastasize. Telomerase is an enzyme that permits repeated division of cancer cells. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation 3. A patient is receiving chemotherapy. Seven days after a dose, the patient’s neutrophil count is 1000 cells/mm3. The nurse will tell this patient: a. that hospitalization is necessary to provide infection prophylaxis. b. that the provider will probably repeat the lab work in 3 to 5 days. c. to ask the provider about skipping the next dose of chemotherapy. d. to report any symptoms such as pus, abscesses, or cough. ANS: B Normal neutrophil counts range from 2500 to 7000 cells/mm3. The lowest neutrophil count, or nadir, usually occurs 10 to 14 days after dosing, so this patient’s neutrophil count should be repeated at that time. Hospitalization is controversial because of the risk of exposure to serious infections. The next dose should not be skipped unless the neutrophil count is below 500/mm3. Patients with neutropenia may not have symptoms of pus, abscess, or cough and should be instructed to report any fever. PTS: 1 DIF: Cognitive Level: Application REF: pp. TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation 4. A patient with cancer has a tumor composed mostly of G0 cells. When teaching this patient about the disease, the nurse will make which statement? a. “Cells in this patient’s type of tumor will proliferate rapidly.” b. “Chemotherapeutic agents that are not toxic to other tissues may be used.” c. “This type of tumor is especially sensitive to chemotherapy.” d. “This tumor will be managed primarily with surgery.” ANS: D Cells in the G0 phase are mitotically dormant; tumors composed mostly of G0 cells have low growth fractions. Because cytotoxic agents are more active against tumors with high growth fraction, this patient’s type of tumor will be managed primarily by surgery and not chemotherapy. Cells in this type of tumor do not proliferate rapidly. PTS: 1 DIF: Cognitive Level: Application REF: pp. TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation 5. A nurse is teaching a group of nursing students about how cytotoxic anticancer drugs affect normal cells. Which statement by a student indicates an understanding of this teaching? a. “Cytotoxic drugs lack tissue specificity.” b. “Cytotoxic drugs have a high degree of selective toxicity.” c. “Differences between cancer cells and normal cells are qualitative.” d. “Neoplastic cells and normal tissue cells are very different.” ANS: A Cytotoxic drugs kill target cells as well as normal cells, since they lack specificity for cancer cells alone. Cytotoxic drugs therefore have a low degree of selective toxicity. The differences between cancer cells and normal cells are quantitative and not qualitative. Neoplastic cells and normal cells are very similar. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1209 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation 6. A nurse explains to a patient with cancer why it is difficult to achieve 100% cell kill to cure cancer with chemotherapy. Which statement by the patient indicates a need for further teaching? a. “It is necessary to continue giving the same dose of chemotherapeutic agents throughout therapy, even if toxicity occurs.” b. “Symptoms of cancer often disappear before all malignant cells are eradicated.” c. “The immune system attacks chemotherapeutic agents and renders them impotent.” d. “The immune system often fails to recognize cancer cells as foreign.” ANS: C The immune system does not attack chemotherapeutic agents, so this statement would indicate a need for further teaching. The same dose of chemotherapeutic agents must be given throughout therapy, which becomes difficult when patients have severe toxic reactions. Because cancer symptoms often disappear before all cells are killed, some therapies are stopped prematurely. The immune system does not recognize cancer cells as foreign and thus does not assist in cell kill. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 7. These patients are receiving chemotherapy. Which patient should the nurse see first? a. The patient with lightly bleeding gums b. The patient with nausea and vomiting c. The patient with a fever of 100.3°F d. The patient with diarrhea and stomatitis ANS: C Fever is the principal early sign of infection, which can have extremely serious implications for an immunosuppressed patient. Because of a lack of neutrophils as a result of chemotherapy, signs of infection may be masked. Lightly bleeding gums, nausea, and vomiting are to be expected in patients receiving chemotherapy. Diarrhea and stomatitis also are common in patients receiving chemotherapy. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 8. A patient who has undergone surgical removal of a solid tumor has just begun chemotherapy. The patient experiences severe nausea and vomiting as well as alopecia. The nurse will expect the provider to: a. continue the chemotherapeutic agent at the same dose. b. decrease the dose of chemotherapy to minimize side effects. c. order lab tests to evaluate for the presence of residual cancer cells. d. stop the chemotherapy because the tumor has been removed. ANS: A Cure of cancer requires 100% cell kill. Solid tumors, which often respond poorly to chemotherapeutic agents, can be “debulked” with surgery and then treated with cytotoxic drugs, because the remaining cells often re-enter the cell cycle and become sensitive to the drugs. Chemotherapeutic drugs must be given at the same dose throughout therapy because of the kinetics of drug-induced cell kill. Because chemotherapy has just begun, it is still necessary; moreover, cell counts of fewer than 1 billion cells are no longer detectable and treatment must continue until all cells are eradicated, so lab tests will not yield useful information. Stopping the chemotherapy right after surgery is not indicated. PTS: 1 DIF: Cognitive Level: Application REF: pp. TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation 9. A patient with cancer who is receiving chemotherapy develops a fever. The patient’s chest radiograph is normal. The patient’s neutrophil count is 750/mm3. The nurse expects the provider to: a. begin empiric therapy with intravenous antibiotics. b. obtain cultures and wait for results before prescribing antibiotics. c. order colony-stimulating factor to minimize neutrophilia. d. reassure the patient that serious infection is unlikely. ANS: A In the absence of neutrophils, as occurs with bone marrow suppression in chemotherapy, fever is the principle sign of infection. Pus, abscesses, and infiltrates on a chest x-ray may all be absent. When a neutropenic patient develops an infection, immediate and vigorous intervention is required. Empiric IV antibiotic therapy should begin while waiting for laboratory results and cultures. It is not correct to wait for culture results before initiating antibiotic therapy. Colony- stimulating factor can minimize neutropenia but does not eliminate the need for IV antibiotics. It is not correct to reassure the patient that a serious infection is unlikely. PTS: 1 DIF: Cognitive Level: Application REF: pp. TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 10. A nursing student asks a nurse why chemotherapeutic agents are given intermittently instead of continuously. The nurse will tell the student that intermittent dosing: a. allows normal cells to recover and repopulate. b. catches malignant cells in latent phases. c. increases cancer cell kill and speeds up treatment. d. suppresses drug resistance in tumor cells. ANS: A Intermittent chemotherapy allows normal cells to repopulate between rounds of therapy. Cells in latent phases do not generally respond to chemotherapy. Intermittent therapy does not speed up treatment or increase tumor cell kill. Intermittent therapy does not suppress drug resistance in tumor cells. PTS: 1 DIF: Cognitive Level: Application REF: p. 1212 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 11. A patient asks a nurse about ways to minimize side effects of chemotherapy. Which response is correct? a. “Avoid contact with people who are ill.” b. “Take antiemetics immediately after receiving chemotherapy.” c. “Treat fevers immediately with ibuprofen.” d. “Use a firm-bristled toothbrush to stimulate gums.” ANS: A Patients receiving chemotherapy should be taught to avoid contact with people who are ill in order to minimize their chances of contracting an illness, which could be devastating if they are neutropenic. Antiemetics are useful when given before chemotherapy. Fevers need to be investigated; taking antipyretics can mask fever, which is often the only indication of an infection. A firm-bristled toothbrush can further irritate gums; good oral hygiene is necessary, but with a soft-bristled brush. PTS: 1 DIF: Cognitive Level: Application REF: pp. TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 12. A hospitalized patient with cancer is receiving chemotherapy and reports oral pain. Inspection of this patient’s oral mucosa reveals erythema and inflammation without denudation or ulceration. The nurse understands that: a. chemotherapy will have to be stopped until healing of the oral mucosa occurs. b. the patient can use a mouthwash with a topical anesthetic to control pain. c. the patient will need an antifungal agent to treat Candida albicans. d. the patient will need systemic opioids to control discomfort. ANS: B Patients with mild stomatitis can use a mouthwash with a local anesthetic to control pain. Chemotherapy does not have to be stopped until the pain or ulceration is severe. Antifungal agents may be used to treat Candida albicans; this patient does not exhibit signs of that infection. Systemic opioids may be used when pain becomes severe. PTS: 1 DIF: Cognitive Level: Application REF: pp. TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 13. A patient has just been diagnosed with cancer and will begin chemotherapy. The patient asks the nurse about the possibility of nausea and vomiting. The nurse will tell the patient that: a. nausea and vomiting can be avoided by having a snack before chemotherapy. b. nausea and vomiting are common side effects and will abate over time. c. nausea and vomiting are common and will be treated with antiemetics when they occur. d. the provider will order drugs to help prevent nausea and vomiting before each dose. ANS: D Nausea and vomiting are common but can be reduced by premedication with antiemetics. Having a snack before dosing is not effective. This side effect will not abate over time. Antiemetics are most effective when given before dosing, not as needed. PTS: 1 DIF: Cognitive Level: Application REF: p. 1210 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 14. A patient who has leukemia is receiving chemotherapy and develops severe anemia. The provider has ordered hospitalization and blood transfusions. The patient asks the nurse about using erythropoietin (epoetin alfa) instead. What will the nurse tell this patient? a. “Ask your provider about ordering erythropoietin instead of a transfusion.” b. “Erythropoietin (epoetin alfa) can make your leukemia worse.” c. “Erythropoietin is used to prolong life in patients with myeloid malignancies.” d. “You will probably receive erythropoietin along with the transfusion.” ANS: B Erythropoietin is used to stimulate erythrocyte production but can also stimulate proliferation of cancers in patients with leukemia and other myeloid malignancies. It is used when the goal is palliation, not to cure or to prolong life. PTS: 1 DIF: Cognitive Level: Application REF: p. 1210 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential MULTIPLE RESPONSE 1. What contributes to drug resistance to chemotherapeutic agents? (Select all that apply.) a. Cellular production of P-glycoprotein b. Creation of selection pressure by drugs c. Drug-induced cellular mutation d. Increased drug uptake by tumor cells e. Reduced target molecule sensitivity ANS: A, B, E Drug resistance can occur by cellular production of a drug transport molecule, known as P-glycoprotein, that can transport the drug out of the cell; creation of selection pressure by favoring drug-resistant mutant cells; and reduction of target molecule sensitivity. Drug resistance does not occur by drug-induced mutation or increased drug uptake by tumor cells. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. Which are guidelines for selecting chemotherapeutic agents to use in combination therapy? (Select all that apply.) a. Drugs used should have different mechanisms. b. Each drug should be delivered by different routes. c. Each drug should be effective. d. Each drug should have different dosing schedules. e. Toxicities should be minimally overlapping. ANS: A, C, E When selecting drugs for combination therapy, each drug should be effective by itself and should have a different mechanism of action. The drugs should have minimally overlapping toxicities. The routes and the dosing schedules are not considerations. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies Chapter 102: Anticancer Drugs I: Cytotoxic Agents Test Bank MULTIPLE CHOICE 1. A nursing student asks about the differences between cell-cycle phase– specific chemotherapeutic agents and those that are cell-cycle phase nonspecific. What will the nurse explain? a. Cell-cycle phase–nonspecific drugs are less toxic. b. Cell-cycle phase–specific drugs do not harm “resting” cells. c. Cell-cycle phase–specific drugs should be given at specific intervals. d. Neither type is toxic to cells in the “resting” G0 phase. ANS: B Cell-cycle phase–specific drugs do not harm “resting” cells, because these drugs are toxic only to cells that are active participants in the cell cycle. Cell-cycle phase– nonspecific drugs are not less toxic than cell-cycle phase–specific agents. Cell-cycle phase–specific drugs are usually given by prolonged infusion. Cell-cycle phase– nonspecific drugs are toxic to “resting” cells. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. A patient on an oncology unit has been receiving ifosfamide [Ifex] for a few days. Before administering the next dose, the nurse reviews the patient’s laboratory test results. Which finding would cause the nurse to hold the dose? a. Elevated white blood cell count b. Low hemoglobin and hematocrit levels c. Low levels of ketones in the urine d. Microscopic hematuria ANS: D The nurse should hold the dose for microscopic hematuria, because this may indicate hemorrhagic cystitis. An elevated white blood cell count is not an indication to hold the dose. Low hemoglobin and hematocrit levels are expected for a patient undergoing chemotherapy. Ketones may reveal some other problem, but they are not associated with ifosfamide. PTS: 1 DIF: Cognitive Level: Application REF: p. 1225 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. A patient is receiving intravenous vincristine [Oncovin]. The patient complains of pain at the IV insertion site. The nurse examines the site and notes an area of erythema and edema. What will the nurse do? a. Change the IV site and notify the provider of the extravasation. b. Contact the provider to suggest using a different chemotherapeutic agent. c. Obtain an order for a topical anesthetic to minimize discomfort. d. Slow the rate of infusion to reduce the patient’s discomfort. ANS: A Vincristine is a vesicant; extravasation of these agents can cause severe local injury that sometimes requires surgical debridement and skin grafting. The site should be changed, and the provider should be notified. Requesting a different drug is not indicated. Topical anesthetics will not prevent local tissue injury. Slowing the rate of infusion will not prevent local tissue injury. PTS: 1 DIF: Cognitive Level: Application REF: p. 1223 TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 4. A nurse is discussing the care of a patient with cancer with a nursing student. The patient is about to begin chemotherapy with a bifunctional alkylating agent. Which statement by the student indicates an understanding of this chemotherapeutic agent? a. “Alkylating agents are toxic to tissues that have rapidly dividing cells.” b. “Bifunctional alkylating agents cannot form cross-links in DNA.” c. “Resistance to alkylating agents is rare.” d. “This drug needs to be given as a prolonged infusion.” ANS: A Alkylating agents are toxic to rapidly dividing cells. Bifunctional agents form cross- links in cell DNA. Resistance to alkylating agents is common. These drugs may be given by bolus dosing. PTS: 1 DIF: Cognitive Level: Application REF: pp. TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. A nurse provides teaching to a patient who will begin taking oral cyclophosphamide to treat non-Hodgkin’s lymphoma. Which statement by the patient indicates an understanding about how to minimize side effects while taking this drug? a. “I don’t need to worry about bone marrow suppression with this drug.” b. “I should drink plenty of fluids while taking this drug.” c. “I should take this drug on an empty stomach.” d. “If I shampoo less often, I can prevent hair loss.” ANS: B Acute hemorrhagic cystitis can occur; this can be minimized by maintaining adequate hydration and taking mesna [Mesnex], a protective agent. Bone marrow suppression is a dose-limiting side effect. This drug should be taken with food. Hair loss cannot be prevented by shampooing less often. PTS: 1 DIF: Cognitive Level: Application REF: p. 1225 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 6. A nurse is discussing vesicant chemotherapeutic agents with a nursing student. Which statement by the student indicates a need for further teaching about this type of drug? a. “Extravasation of this type of drug may result in the need for skin grafts.” b. “If an IV line used for a vesicant drug infiltrates, it must be discontinued immediately.” c. “These drugs may be administered orally as well as intravenously.” d. “This type of drug may not be infused at a site of previous irradiation.” ANS: C Vesicants are given intravenously. Extravasation may cause severe local tissue injury, requiring skin grafts. Vesicants that infiltrate must be stopped immediately. Sites of previous irradiation should not be used. PTS: 1 DIF: Cognitive Level: Application REF: p. 1223 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 7. A patient who has a brain tumor will receive a nitrosourea agent. A nursing student asks why this type of drug is used for this type of cancer. The nurse will tell the student that nitrosoureas are useful because they: a. are lipophilic. b. are bifunctional alkylating agents. c. have a broad spectrum of antineoplastic characteristics. d. have delayed bone marrow suppression. ANS: A Nitrosoureas are lipophilic and thus are able to cross the blood-brain barrier, making them more effective against solid tumors in the brain. They are alkylating agents with a broad spectrum of antineoplastic activity, but these are not the deciding factors in their use for brain tumors. Delayed bone marrow suppression is their major dose-limiting toxicity. PTS: 1 DIF: Cognitive Level: Application REF: pp. TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 8. A patient will begin chemotherapy with cisplatin. Which medications will the nurse expect to administer to offset this agent’s side effects? a. Amifostine [Ethyol], diuretics, and antiemetics b. Antiemetics, vitamin B12, and glucocorticoids c. Dexamethasone, antiemetics, and vistonuridine d. Folic acid, gabapentin, and vitamin B12 ANS: A Amifostine and diuretics are given to help minimize kidney damage with cisplatin. Antiemetics are given to minimize nausea and vomiting, which can be severe with this drug. Vitamin B12 is used to reduce toxicity to the gastrointestinal (GI) tract caused by pralatrexate. Vistonuridine is used to treat fluorouracil overdose. Folic acid is not used to counter cisplatin side effects. Gabapentin is used to minimize neuropathy when oxaliplatin is used. PTS: 1 DIF: Cognitive Level: Application REF: p. 1226 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 9. A patient with non-Hodgkin’s lymphoma is about to begin chemotherapy with a massive dose of methotrexate [Rheumatrex]. The nurse will expect to administer which medication concurrently with this drug? a. Dexamethasone b. Folic acid c. Leucovorin d. Vitamin B12 ANS: C Leucovorin is used to protect normal cells when massive doses of methotrexate are given. Dexamethasone, folic acid, and vitamin B12 are not given concurrently with methotrexate. PTS: 1 DIF: Cognitive Level: Application REF: pp. TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 10. The nurse is preparing to administer medication to a patient receiving cyclophosphamide [Cytoxan]. To protect against the side effect of hemorrhagic cystitis, the nurse would expect to administer which drug? a. Decadron b. Diphenhydramine [Benadryl] c. Leucovorin d. Mesna [Mesnex] ANS: D Cyclophosphamide can cause acute hemorrhagic cystitis; to prevent this, the nurse should expect to administer mesna, which is a protective agent. Decadron, diphenhydramine, and leucovorin are indicated for the prevention of side effects associated with different anticancer agents. PTS: 1 DIF: Cognitive Level: Application REF: p. 1225 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 11. A nursing student asks a nurse how cancer cells become resistant to methotrexate [Rheumatrex]. The nurse is correct to respond by saying that cancer cells acquire resistance to methotrexate by: a. reduced production of transporter that pumps methotrexate out of cells. b. reduced synthesis of dihydrofolate reductase. c. reduced uptake of methotrexate into cells. d. increased ability to convert the drug to a polyglutamated form. ANS: C Resistance to methotrexate occurs through five mechanisms, including reduced uptake of methotrexate into cells. Resistance also occurs through increased production of the transporter pump, increased synthesis of dihydrofolate reductase, and a decreased ability to convert the drug. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1228 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 12. A patient will receive intrathecal liposomal cytarabine [DepoCyt] to treat acute myelogenous leukemia. The provider has ordered the concurrent administration of dexamethasone. The nurse understands that this is given to: a. prevent bone marrow suppression. b. prevent hair loss and stomatitis. c. reduce the incidence of pulmonary edema. d. reduce the severity of chemical arachnoiditis. ANS: D Chemical arachnoiditis can occur with the liposomal formulation of cytarabine; dexamethasone is given to reduce the incidence and severity of this side effect. It is not used to prevent bone marrow suppression. It is not given to minimize hair loss or stomatitis. It does not reduce the incidence of pulmonary edema. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1229 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 13. The nurse is caring for a patient who has been receiving vinorelbine [Navelbine] for about 5 days. Which assessment finding in this patient would cause the nurse to withhold the next dose and notify the prescriber? a. Alopecia b. Dyspnea and cough c. Neutrophil count of 1200/mm3 d. Peripheral neuropathy ANS: B The nurse should withhold the dose if the patient has new-onset cough and dyspnea, because these may indicate the development of interstitial pulmonary changes and acute respiratory distress syndrome. Alopecia would not cause the nurse to withhold the dose. Neutropenia is expected and is not at a critical level. Although this count is low, it would not prevent administration of the medication. Peripheral neuropathy is expected with vinorelbine. PTS: 1 DIF: Cognitive Level: Application REF: p. 1233 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 14. The nurse on an oncology unit prepares to administer the fourth cycle of docetaxel [Taxotere] to a patient with breast cancer. Which clinical finding would cause the nurse to withhold the dose and call the prescriber? a. Alanine transaminase (ALT) 1.2 times the upper limit b. Alkaline phosphatase 2 times the upper limit c. Neutrophil count below 1500/mm3 d. Creatinine clearance of 130 mL/min/1.73 m2 ANS: C If the neutrophil count drops below 1500/mm3, the nurse should withhold the dose and notify the prescriber. An ALT 1.5 times the upper limit and an alkaline phosphatase 2.5 times the upper limit are concerning. The creatinine clearance is not a concern. PTS: 1 DIF: Cognitive Level: Application REF: p. 1234 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 15. A nurse is teaching a patient who will undergo chemotherapy with fluorouracil [Adrucil] to treat a solid tumor. Which statement by the patient indicates understanding of this chemotherapeutic agent’s actions? a. “Fluorouracil acts to deprive cancer cells of thymidylate needed to make DNA.” b. “Fluorouracil causes accumulation of adenosine, which inhibits DNA synthesis.” c. “Fluorouracil disrupts the biosynthesis of nucleic acids.” d. “Fluorouracil inhibits DNA polymerase in cancer cells.” ANS: A Fluorouracil acts by depriving cancer cells of thymidylate, which is necessary to make DNA. It does not cause the accumulation of adenosine, disrupt the biosynthesis of nucleic acids, or inhibit DNA polymerase. PTS: 1 DIF: Cognitive Level: Application REF: p. 1229 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 16. A patient will begin receiving vincristine [Oncovin] to treat Hodgkin’s lymphoma. Which side effect(s) will the nurse tell the patient to report immediately? a. Diarrhea, nausea, and vomiting b. Hair loss c. Headaches d. Tingling of the extremities ANS: D Peripheral neuropathy is the major dose-limiting toxicity of vincristine. Patients should be counseled to report tingling of the extremities. Diarrhea, nausea, vomiting, and hair loss may occur but are expected. Headaches are not likely. PTS: 1 DIF: Cognitive Level: Application REF: p. 1233 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 17. A patient is receiving fluorouracil [Adrucil] as a continuous intravenous dose to treat a solid tumor. The patient reports soreness and blisters in the mouth, loose stools, and tingling of the hands and feet. What will the nurse do? a. Contact the provider to discuss bolus dosing instead of continuous dosing. b. Discontinue the medication and contact the provider to report these symptoms. c. Reassure the patient that these are expected, uncomfortable side effects. d. Request an order for dexamethasone to treat these side effects. ANS: B Stomatitis, GI symptoms, and palmar-plantar erythrodysesthesias are dose-limiting side effects of fluorouracil, characterized by the symptoms described. When these occur, the provider should be notified. Continuous dosing is generally less toxic than bolus dosing. Reassurance without discontinuing the medication and contacting the provider is not correct. Dexamethasone is not given to counter these effects. PTS: 1 DIF: Cognitive Level: Application REF: p. 1229 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 18. A patient who has urinary bladder cancer will begin receiving the chemotherapeutic agent valrubicin [Valstar]. What will the nurse do when administering this drug? a. Administer the drug intravenously using a large bore needle and tubing. b. Ensure that the tubing used to administer the drug does not contain polyvinyl chloride. c. Monitor the patient closely for a variety of systemic drug adverse effects. d. Use a normal saline or sterile water diluent to dilute the medication. ANS: B Valrubicin is given to treat urinary bladder cancer and, because the diluent used contains castor oil, it should not be given in tubing that contains PVC. It is given as an intravesical irrigation directly into the bladder and does not usually cause systemic side effects. The diluent contains castor oil. PTS: 1 DIF: Cognitive Level: Application REF: p. 1232 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Chapter 103: Anticancer Drugs II: Hormonal Agents, Targeted Drugs, and Other Noncytotoxic Anticancer Drugs Test Bank MULTIPLE CHOICE 1. A nursing student asks the nurse what differentiates antiestrogen drugs from aromatase inhibitors in the treatment of breast cancer. What is the correct response by the nurse? a. Antiestrogen drugs decrease the risk for thromboembolic events. b. Antiestrogen drugs increase the risk for endometrial cancer. c. Aromatase inhibitors block the production of estrogen by the ovaries. d. Aromatase inhibitors can be used for tumor cells that lack estrogen receptors. ANS: B Antiestrogen drugs cause proliferation of endometrial tissue by acting as receptor agonists at receptors in the uterus. Antiestrogen drugs increase the risk of thromboembolic events. Aromatase inhibitors block the production of estrogen from androgenic precursors, not by the ovaries. Aromatase inhibitors are used to treat ER-positive breast cancer. PTS: 1 DIF: Cognitive Level: Application REF: p. 1239 | p. 1242 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. A 43-year-old patient with a strong family history of breast cancer considers taking tamoxifen [Nolvadex] for cancer prevention. Which assessment finding is a possible contraindication? a. History of deep vein thrombosis (DVT) b. History of osteoporosis c. Hyperlipidemia d. Prior hysterectomy ANS: A The patient’s age and DVT history place her at risk for thrombosis. Tamoxifen would not be indicated for this patient. A prior hysterectomy, osteoporosis, and hyperlipidemia are not contraindications to tamoxifen. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1229 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. A 45-year-old patient with a family history of breast cancer is considering using tamoxifen [Nolvadex] for cancer prevention. The nurse performs a health history and learns that the woman had a child when she was 35 years old, that she has not had a hysterectomy, and that she experienced DVT when she was pregnant. What will the nurse tell the patient? a. Because of her family risk and late childbearing, this drug is a good choice for her. b. Her history of DVT outweighs any possible benefits she may have with this drug. c. Since she has not had a hysterectomy, the risk of endometrial cancer is too great. d. When she turns 50 years old, this drug will carry fewer risks for her. ANS: B Tamoxifen is a good choice for women between the ages of 40 and 49 years as a cancer preventive, except for women at risk for DVT. Family risk and late childbearing age are indications for using tamoxifen, but only in women without increased risk of DVT. The risk of endometrial cancer increases with age and, without the risk of DVT, would not be a contraindication in a woman of the patient’s age. The patient’s risks of DVT do not change with age. PTS: 1 DIF: Cognitive Level: Application REF: p. 1229 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. A premenopausal woman has ER-positive breast cancer, and her prescriber has ordered tamoxifen [Nolvadex]. She asks the nurse if anastrozole [Arimidex] would work better for her. What will the nurse tell her? a. Anastrozole is more likely to cause hot flushes than tamoxifen. b. Anastrozole is more likely to promote endometrial carcinoma. c. Cancer recurrence is higher with anastrozole. d. Until she is postmenopausal, anastrozole will not be effective. ANS: D Anastrozole is used to treat ER-positive breast cancer in postmenopausal women. Because it does not block estrogen production in the ovaries, it is not effective in premenopausal women. It may cause hot flushes but is less likely to do so than tamoxifen. It is devoid of all estrogenic activity and does not promote endometrial cancer PTS: 1 DIF: Cognitive Level: Application REF: p. 1242 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. The nurse is caring for a patient in the oncology unit who was recently diagnosed with advanced renal carcinoma. The nurse prepares to administer aldesleukin [Proleukin] as part of the treatment regimen. What is the primary adverse effect of this drug? a. Hypertension b. Capillary leakage syndrome c. Hyperglycemia d. Hyperuricemia ANS: B Capillary leakage syndrome, an adverse effect of aldesleukin, is a particular concern, because it is a potentially fatal reaction characterized by hypotension and reduced organ perfusion. Proleukin is not associated with hypertension, hyperglycemia, or hyperuricemia. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1262 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 6. A patient will begin taking tamoxifen [Nolvadex] to treat breast cancer. The nurse performs a medication history and learns that the patient is taking sertraline [Zoloft] for depression. The nurse will tell the patient to contact her provider to ask about: a. increasing her dose of sertraline. b. changing from sertraline to escitalopram [Lexapro]. c. switching from sertraline to fluoxetine [Prozac]. d. decreasing her dose of tamoxifen. ANS: B Inhibitors of CYP2D6, such as sertraline, can negate the benefits of treatment with tamoxifen. Patients taking sertraline should request switching to another antidepressant, such as escitalopram. Increasing the dose of sertraline would only exacerbate the problem. Fluoxetine is similar to sertraline so changing to this drug would be incorrect. It is not correct to decrease the dose of tamoxifen. PTS: 1 DIF: Cognitive Level: Application REF: p. 1241 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 7. A nurse is preparing to administer a second infusion of trastuzumab [Herceptin] to a patient who has breast cancer. The patient tells the nurse that she experienced chills, fever, pain, and nausea after her first infusion. What will the nurse do? a. Contact the provider to request a CBC to assess for neutropenia. b. Ensure that oxygen and respiratory support measures are readily available. c. Reassure the patient that these symptoms will diminish with each infusion. d. Request an order for an electrocardiogram. ANS: C Patients taking trastuzumab may experience a flu-like syndrome with their first infusion that will diminish with subsequent infusions. Neutropenia is not a concern with this drug. Hypersensitivity reactions may occur, but the patient’s symptoms are not characteristic of this. Cardiotoxicity may occur, but the symptoms are not characteristic of this. PTS: 1 DIF: Cognitive Level: Application REF: pp. TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 8. A patient with advanced cancer of the prostate begins treatment with leuprolide [Lupron Depot] injections and will receive 7.5 mg IM once per month. After the first injection, the patient experiences an increase in cancer symptoms. What will the nurse tell the patient? a. Desensitization to the drug over time will result in a decrease in these symptoms. b. The dose of leuprolide may have to be increased to 22.5 mg per month. c. These symptoms indicate a need for surgical castration to treat the cancer. d. This is a sign that the patient’s cancer is getting worse. ANS: A Patients taking leuprolide may initially experience an increase in cancer symptoms until GnRH receptors in the pituitary become desensitized. Increasing the dose is not indicated, and these symptoms do not warrant surgical castration. They do not reflect a worsening of this patient’s cancer symptoms. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1246 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 9. A patient with advanced prostate cancer will begin treatment with leuprolide [Lupron]. The provider has ordered flutamide to be given as adjunct therapy. The patient asks the nurse why both drugs are necessary. The nurse will tell the patient that: a. flutamide reduces the side effects, such as hot flushes, caused by leuprolide. b. flutamide suppresses initial tumor flare caused by leuprolide. c. leuprolide helps to reduce the toxicity of flutamide. d. the combination of both drugs increases cancer survival. ANS: B Flutamide is given with GnRH agonists, such as leuprolide, to prevent tumor flare when GnRH therapy is begun. Flutamide increases hot flushes. Leuprolide does not decrease flutamide toxicity. There is no increase in cancer survival with this combination. PTS: 1 DIF: Cognitive Level: Application REF: p. 1248 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 10. The nurse would be correct to state that the purpose of angiogenesis inhibitors is to: a. kill existing cancer cells directly. b. suppress the formation of new blood vessels in tumors. c. enhance the size of collateral vessels. d. enhance red cell development in the bone marrow. ANS: B Angiogenesis inhibitors suppress the formation of new blood vessels, thereby depriving solid tumors of the expanding blood supply they need for continued growth. Angiogenesis inhibitors cannot kill tumor cells that already exist. Angiogenesis inhibitors do not enhance collateral vessel or red cell development. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1260 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 11. A patient with colorectal cancer is admitted to the hospital oncology unit to receive cetuximab [Erbitux]. The nurse notes that the prescriber has not ordered any other medications. The nurse will contact the prescriber to request an order for which medication in order to minimize cetuximab’s side effects? a. Diphenhydramine [Benadryl] b. Epinephrine c. Ondansetron [Zofran] d. Magnesium supplements ANS: A Cetuximab can cause severe infusion reactions. Premedication with diphenhydramine can help reduce this risk. Epinephrine is used for medical management of an infusion reaction and not to minimize the risk. Ondansetron is not indicated because nausea and vomiting are not a concern. Magnesium supplements are given when hypomagnesemia is documented, not as a preventive. PTS: 1 DIF: Cognitive Level: Application REF: p. 1250 | p. 1253 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 12. A patient with chronic myeloid leukemia (CML) begins treatment with imatinib [Gleevec]. Which statement by the patient indicates understanding of this medication?