Chapter 39-drugs used in cancer treatment

Question 1

Which of the following is an appropriate nursing intervention for a client receiving chemotherapy with a nursing diagnosis of “imbalanced nutrition: less than body requirements”?

Answer 1

Administer an antiemetic premedication prior to chemotherapy

Question 2

The client recently received a diagnosis of cancer. The client frequently asks the nurse about the disease and treatment even though the health care provider discussed the disease, its treatment, expected therapeutic effects, and adverse effects of therapy with the client. The most likely explanation for this repeated need for information is:

Answer 2

the client is under emotional stress due to the psychosocial impact of the diagnosis.

Question 3

The nurse understands that medications in this group of antineoplastics are cell-cycle nonspecific:

Answer 3

alkylating agents.

Question 4

A client with testicular carcinoma is prescribed to begin combination chemotherapy. The nurse anticipates the use of which preferred group for this type of cancer?

Answer 4

bleomycin, etoposide, platinol- Also referred to as BEP. This is a preferred regimen for testicular carcinoma.

Question 5

For the client experiencing xerostomia, the nurse should:

Answer 5

provide frequent lip lubrication with a water-soluble gel.

is a dry mouth that benefits from frequent lip lubrication.

Question 6

When caring for a client experiencing thrombocytopenia secondary to chemotherapy, the nurse should:

Answer 6

apply pressure for 3 to 5 minutes following injections.

Thrombocytopenia places the client at increased risk for bleeding.

Question 7

After administering cyclophosphamide to a client, the nurse should:

Answer 7

administer mesna to rescue the bladder.- Cyclophosphamide can cause hemorrhagic cystitis, so mesna is administered immediately after cyclophosphamide administration and at prescribed intervals for 24 hours.

Question 8

When caring for a client receiving a methotrexate infusion, the nurse should:

Answer 8

administer leucovorin immediately after the infusion of methotrexate.-This is the appropriate nursing action. Leucovorin competes with methotrexate at the cellular level to decrease uric acid levels.

Question 9

The nurse understands that which of the following actions best protects a client from infection?

Answer 9

appropriate handwashing

Question 10

To decrease systemic adverse effects of chemotherapy, the nurse should:

Answer 10

provide adequate hydration before and after chemotherapy administration.
This will maintain fluid and electrolyte balance and decrease the systemic adverse effects of chemotherapy.

Question 11

When caring for a client prescribed to receive methotrexate, the nurse should:

Answer 11

hydrate the client with IV fluids containing sodium bicarbonate before and after methotrexate administration.

Question 12

When caring for a client with chemotherapy-induced anemia, the nurse should:

Answer 12

monitor oxygen saturation- The client should receive continuous oxygen saturation monitoring via pulse oximetry.

Question 13

In treating cancer, the primary purpose of administering drugs according to a protocol or regimen of several drugs at a time is:

Answer 13

there is a more pronounced effect of the drugs on the cancer than if the drugs were used alone- This increases the effectiveness of therapy and decreases the risk of cancer cells becoming resistant to therapy.

Question 14

When monitoring a client prior to administration of methotrexate, the nurse should notify the health care provider regarding which value?

Answer 14

urine pH of 5.0-For a urine pH below 5.5, the methotrexate should be withheld and the health care provider notified.

Question 15

When precepting a nursing student on the oncology unit about nursing responsibilities related to client fluid and electrolyte balance, the nurse recognizes which response by the student indicates a need for further clarification?

Answer 15

“I should insert an indwelling catheter for accurate urine output readings.”

Question 16

Because antineoplastic agents affect all rapidly growing cells, the nurse observes for:

Answer 16

nausea and vomiting, bleeding, and alopecia.- These represent areas of rapidly growing cells.

Question 17

If the client develops anorexia, the nurse should encourage intake of:

Answer 17

protein and vitamin- These nutrients will encourage cellular growth and repair.

Question 18

When teaching the client and family how to prevent the development of stomatitis and ulceration, which client response indicates a need for further explanation?

Answer 18

“Commercial mouthwashes are best to use.”– Commercial mouthwashes (with alcohol) can be drying and irritating and should be avoided.

Question 19

The health care provider is preparing to administer an experimental drug intrathecally to a child with leukemia, the nurse should:

Answer 19

ensure information on the drug is available for reference on the nursing unit.

Question 20

When caring for a client with a uric acid level of 40 mg/100 mL, the nurse should:

Answer 20

encourage oral fluids and maintain IV fluids.- This is an elevated uric acid level, so fluids should be increased.

Question 21

When caring for a client receiving a corticosteroid as part of a chemotherapy regime, the nurse should:

Answer 21

report a glucose level of 125 mg/dL.- Corticosteroids can increase serum glucose levels, and levels above 100 mg/dL should be reported.

Question 22

The nurse is preparing to access an implanted vascular port. For this he needs a:

Answer 22

1-inch, right-angled Huber needle.-A right-angle Huber needle is needed to access an implanted vascular port.

Question 23

When handling cytotoxic agents the nurse should:

Answer 23

wear gloves at all times when handling these agents.- Gloves should be worn to protect the skin from contact with these agents that can be absorbed through the skin.

Question 24

When teaching clients receiving anticancer drugs by an implantable pump, the nurse would recognize the client understood the instructions when the client identified that she should avoid which activity?

Answer 24

hot baths and saunas-This activity, in addition to mountain climbing, deep sea diving, and contact sports, are contraindicated in clients with implantable pumps.

Question 25

When preparing nurse assignments, the charge nurse on the oncology unit should:

Answer 25

not assign pregnant nurses to care for persons receiving parenteral cytotoxic drugs.

Question 26

The nurse is aware that epoetin:

Answer 26

stimulates the bone marrow to produce red blood cells (RBCs).

Question 27

The nurse understands that pegfilgrastim:

Answer 27

is administered as one injection during the chemotherapy cycle.

Question 28

A client receiving chemotherapy asks the nurse if there is a drug that can prevent or treat oral mucositis. The nurse’s best response is:

Answer 28

“Yes, palifermin was developed for this purpose.”

Question 29

The nurse observes a reddened area on the forearm of a client receiving chemotherapy. The nurse should first:

Answer 29

notify the health care provider. This may indicate infection, so the health care provider should be notified.-

Question 30

Allopurinol is prescribed for a client, following her chemotherapy with methotrexate. The nurse understands that allopurinol for this client is to:

Answer 30

decrease client’s serum uric acid levels.-: Allopurinol is prescribed to lower the methotrexate-induced elevated uric acid levels.

Question 31

When administering cyclophosphamide to a client, the nurse should monitor:

Answer 31

urine for blood.- A complication of cyclophosphamide is hemorrhagic cystitis.

Question 32

When caring for a client experiencing breakthrough nausea and vomiting related to chemotherapy, assuming prescriptions are available if needed, the nurse should:

Answer 32

administer lorazepam IV.

–This is the drug and route of choice for this type of nausea and vomiting.

Question 33

When caring for clients receiving chemotherapy, the nurse monitors for adverse effects of this therapy, including the most common and potentially life-threatening adverse effects related to:

Answer 33

myelosuppression- This leads to risk of infection, bleeding, and decreased tissue perfusion.

Question 34

After receiving chemotherapy, a client is readmitted to the hospital with a platelet count of 40,000 cells/mm3. The nurse should monitor the client for:

Answer 34

nosebleeds.-A low platelet count causes an increased risk of bleeding.

Question 35

When teaching a client prescribed a corticosteroid, the nurse recognizes a need for further teaching when the client states,

Answer 35

“I should take my medication at bedtime.”-Corticosteroids can cause wakefulness, so they should be taken early in the day.

Question 36

When caring for a client receiving a vesicant chemotherapy agent, the nurse should:

Answer 36

monitor the IV site every 15 minutes.– Vesicant chemotherapy agents pose a high risk for extravasation and tissue necrosis

Question 37

When caring for a client with chemotherapy-induced thrombocytopenia, the nurse should:

Answer 37

avoid intramuscular injections.

These should be avoided because of the increased risk for bleeding.

Question 38

When caring for a client receiving intraperitoneal chemotherapy, the nurse should monitor the client for which of the following? Select all that apply.

Answer 38

a. abdominal discomfort.
c. respiratory distress.
d. gastrointestinal distress.
e. chills.
f. fluid and electrolye balance.

Question 39

Which of the following statements are true concerning temsirolimus? Select all that apply.

Answer 39

b. Antihistamine pretreatment is recommended due to the risk of hypersensitivity reactions.
c. Temsirolimus may cause anemia in some clients.
d. The use of temsirolimus can lead to bowel perforation.
e. The client should be monitored for elevated serum creatinine.
f. Asthenia may be an adverse effect.

Question 40

The client is receiving cladribine. The nurse should do which of the following? Select all that apply.

Answer 40

a. Obtain baseline CBC, serum electrolytes, and uric acid levels.
b. Anticipate severe bone marrow function suppression.
c. Monitor for neurologic toxicity.
d. Observe respiratory status.