Unit 2:Ch 14 (Kach 7th Ed) - Antineoplastic Agents Flashcards
The process of cancerous cells exhibiting a loss of cellular differentiation and organization leading to a
loss of their ability to function normally is called what?
A) Anaplasia
B) Angiogenesis
C) Autonomy
D) Metastasis
Ans: A
Feedback:
Cancerous cells exhibit anaplasia, which is a loss of cellular differentiation and organization that leads
to a loss of their ability to function normally. Angiogenesis refers to the abnormal cells releasing
enzymes that generate blood vessels in the area to supply both oxygen and nutrients to the cells.
Cancerous cells exhibit autonomy, which is the ability to grow without the usual homeostatic
restrictions that regulate cell growth and control. Metastasis is the process of the cancerous cells
traveling from the place of origin to develop new tumors.
The mitotic inhibitors interfere with the ability of a cell to divide and they block or alter
deoxyribonucleic acid (DNA) synthesis, thus causing cell death. What is important for the nurse to
remember when administering these drugs?
A) The nurse should encourage the patient to eat six small meals a day.
B) The nurse should avoid any skin, eye, or mucous membrane contact with the drug.
C) The nurse should avoid using a distal vein.
D) The nurse should check for extravasation when the infusion is over.
Ans: B
Feedback:
Special care needs to be taken when administering these drugs. The nurse should avoid any skin, eye,
or mucous membrane contact with the drug. This type of contact can cause serious reactions and
toxicity for the nurse. The nurse should check for extravasation frequently during the infusion and not
wait until the infusion is completed, a distal vein should be used, nausea and vomiting are commonly experienced adverse effects of these drugs, and small meals may help the patient to maintain adequate
nutrition but this is not the important concern when administering the drug.
A nurse is preparing an antineoplastic agent for a 9-year-old cancer patient. Before administering an
antineoplastic agent, what is the nurse’s priority action?
A) Wash his or her hands.
B) Identify the child by checking the arm band and asking him or her to state his or her name.
C) Ensure a quiet environment so the patient can sleep during administration of the drug.
D) Check laboratory studies to determine most recent measures of bone marrow function.
Ans: D
Feedback:
The most important action of the nurse before administering the drug would be to check indexes of
bone marrow functioning because these results will help to determine the proper dosage. Smaller
dosages are administered if bone marrow function declines, whereas larger dosages can be given if
bone marrow function is good. Only after this is checked will the nurse begin the process of actually
administering the medication by performing hand hygiene, identifying the patient, and creating a quiet
environment.
A patient with leukemia receives rasburicase (Elitek) before administering chemotherapy. What is the
nurse’s priority assessment after administration of this medication?
A) Blood glucose levels
B) Serum potassium levels
C) Serum calcium levels
D) Uric acid levels
Ans: D
Feedback:
Rasburicase is approved for the management of plasma uric acid levels in patients with leukemia,
lymphoma, and solid malignancies who are receiving antineoplastic therapy associated with tumor lysis
and elevated serum uric acid levels. Uric acid levels should be analyzed within 4 hours of each dose of
rasburicase. Blood glucose, potassium, and calcium levels should not be affected by administration of
the drug.
The nurse is caring for a patient at risk of severe-to-fatal interstitial lung disease. What antineoplastic
agent is the nurse administering that carries this risk?
A) Valrubicin (Valstar)
B) Erlotinib (Tarceva)
C) Histrelin acetate (Vantas)
D) Triptorelin pamoate (Trelstar Depot)
Ans: B
Feedback:
Erlotinib inhibits tyrosine kinase associated with epidermal growth factor found on surfaces of normal
and cancer cells and causes serious-to-fatal interstitial lung disease. Histrelin inhibits gonadotropic
secretion and decreases follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and
testosterone levels and suppresses testosterone production. Hot flashes are very common with this drug.
Triptorelin pamoate decreases FSH and LH levels and also suppresses testosterone production. It has
also been associated with sexual dysfunction, urinary tract symptoms, bone pain, and hot flashes.
Valrubicin is used in intravesical therapy for carcinoma in situ of the bladder. It is also associated with
severe bladder spasms.
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?
A) Bleomycin (Blenoxane)
B) Daunorubicin (DaunoXome)
C) Idarubicin (Idamycin)
D) Mitomycin (Mutamycin)
Ans: D
Feedback:
Mitomycin is used in before the treatment of disseminated adenocarcinoma of the stomach and
pancreas. Bleomycin is used for palliative treatment of squamous cell carcinomas, testicular cancers,
and lymphomas. Daunorubicin is the first-line treatment of advanced HIV infection and associated
Kaposi’s sarcoma. Idarubicin is used in combination therapy for treatment of acute myeloid leukemia in
adults.
The nurse is caring for a patient receiving cyclophosphamide (Cytoxan). What is the priority nursing action for this patient? A) Monitor urinalysis results. B) Provide small, frequent meals. C) Administer an antiemetic when needed. D) Provide oral care.
Ans: A
Feedback:
The priority nursing action would be to monitor the patient’s urinalysis results because hemorrhagic
cystitis is a potentially fatal adverse effect of cyclophosphamide. Providing small frequent meals, and
oral care and administering an antiemetic are necessary to maintain nutrition when GI effects are severe
but, assessments come before interventions and these interventions are of lower priority than
monitoring for hemorrhagic cystitis.
A 42-year-old woman 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 her teaching plan concerning the drug
therapy?
A) Stay on a low-fat diet during the course of the drug therapy.
B) Take special care when shaving or when brushing her teeth.
C) Continue to go to church or to the mall just as she did before the diagnosis of cancer.
D) Stay in bed 2 days after each administration.
Ans: B
Feedback:
Special care should be taken when shaving or when brushing her teeth because she may bruise more
easily than normal and gums may bleed. A cancer patient should not be on a diet during chemotherapy
unless prescribed. Care should be taken to avoid crowds and public places where risk of infection is
greater. Cancer patients should remain as active as tolerated, but they should be careful not to
overextend themselves physically to promote optimal health.
The nurse should exercise caution when administering antimetabolites to a patient diagnosed with what? A) Bone marrow suppression b) Diabetes mellitus C) Hypertension D) Seizure activity
Ans: A
Feedback:
Bone marrow is often the index for dosing and redosing levels. Caution should be used and strict
monitoring done for patients with suppressed bone marrow who are receiving an antimetabolite.
Diabetes mellitus, hypertension, and seizure activity have not been identified as interfering with this
drug therapy.
The nurse is caring for a patient who is receiving a combination of antineoplastic agents. The patient
will most likely lose his or her hair. Why would the nurse suggest that he or she get a wig or use
appropriate head cover?
A) People may be uncomfortable seeing his or her bald head.
B) The hair will likely grow back if the head is covered at all times.
C) His or her self-esteem will be better if the head is covered.
D) Heat is lost through the head and it is important to cover it during extremes in temperature.
Ans: D
Feedback:
Most of the heat is lost through the head and it is important to cover the head to prevent extreme
changes in core temperature, which could affect all biochemical processes in the body. Other people’s
feelings should not be an issue in whether she wears a wig or not. Even though loss of hair could
decrease self-esteem, patients are usually more concerned about their prognosis. Whether the head is
covered or not has nothing to do with hair growing back.
A patient diagnosed with a malignancy is receiving an antimetabolite as part of his or her medication
therapy. What would the nurse be sure to teach this patient about his or her antimetabolite medication?
(Select all that apply.)
A) Report all other drugs and alternative therapies he or she is taking.
B) Use safety measures due to possible dizziness, headache, and drowsiness.
C) Cover the head at extremes of temperature.
D) Plan for appropriate exercise regimens.
E) Avoid being alone as much as possible.
Ans: A, B, C
Feedback:
Provide the following patient teaching: Follow the appropriate dosage regimen, including dates to
return for further doses. Patients need to be reminded to report all other drugs and alternative therapies
that they might be using; maintain nutrition if GI effects are severe; cover the head at extremes of
temperature if alopecia is anticipated; plan for appropriate rest periods because fatigue and weakness
are common adverse effects of the drugs; avoid infection including avoiding crowded places, sick
people, and working in soil; and use safety measures such as not driving or using dangerous equipment
due to possible dizziness, headache, and drowsiness. The nurse would not tell the patient to plan for
appropriate exercise regimens because patients are more likely to need encouragement to rest; there is
no reason he cannot be alone.
The nurse explains that the signs and symptoms caused by cancer are a result of what? A) Overgrowth of tumor cells B) Enzymes that generate blood vessels C) Tumor cells invading healthy tissue D) Metastasis
Ans: C
Feedback:
As cancer cells grow, they invade and damage healthy host tissues and this is what causes signs and
symptoms of cancer. When cancer metastasizes, the tumor cells invade new tissue and other signs and
symptoms occur. Cancer cells do overgrow and the abnormal cells do release enzymes that generate
blood vessels, but this is not what causes the signs and symptoms of cancer. The effects of neoplasms
are not caused by overgrowth of tumor cells, enzymes that generate blood vessels, or metastasis.
The nurse is caring for a patient newly diagnosed with a primary brain tumor. The patient asks the
nurse where his or her tumor came from. What is the nurse’s best response?
A) Your tumor originated from somewhere outside the CNS from a cell just like other cells.
B) Your tumor is from the pituitary gland in origin.
c) Your tumor originated from a single cell that is genetically different from nearby cells.
D) Your tumor is from nerve tissue somewhere in your body.
Ans: C
Feedback:
All cancers start with a single cell that is genetically different from the other cells in the surrounding
tissue. Determining the site of the first cell to genetically mutate in this patient would require more
information so it is impossible to say if the originating cell was in the CNS, the pituitary gland, or
peripheral nerve tissue.
A nurse on the oncology unit is caring for a patient with an astrocytoma. The patient has just been told
that the tumor is growing very fast. The patient asks the nurse how these tumors grow. What is the
nurse’s best response?
A) Brain tumors infiltrate the surrounding tissue.
B) Brain tumors grow by invading the surrounding grey matter.
C) Brain tumors grow by invading the surrounding white matter.
D) Brain tumors spread down the spinal cord.
Ans: A
Feedback:
Over time, these neoplastic cells grow uncontrollably, invading and damaging healthy tissue in the area
and even undergoing metastasis (traveling from the place of origin to develop new tumors in other
areas of the body where conditions are favorable for cell growth). The abnormal cells release enzymes
that generate blood vessels. Brain tumors can invade either grey or white matter or they can spread
down the spinal cord. These responses do not answer the patient’s question.
A patient asks the nurse what a cancer cell’s growth rate is called. What is the nurse’s best response?
A) Cancer cell’s growth rate is called proliferation.
B) Cancer cell’s growth rate is called anaplasia.
C) Cancer cell’s growth rate is called pleomorphism.
D) Cancer cell’s growth rate is called neoplasm.
Ans: A
Feedback:
A cancer cell growth rate is called proliferation. Anaplasia is the loss of organization and structure,
pleomorphism is the occurrence of more than one shape of the cell, and a neoplasm is the term for a
new or cancerous growth occurring when abnormal cells have the opportunity to multiply and grow.
The nurse is caring for a patient receiving a combination of different antineoplastic medications. The
patient asks why they use so many different medications instead of just one drug. The nurse explains
that a combination does what? (Select all that apply.)
A) Decreases the development of cell resistance
B) Increases the length of treatment
C) Increases the quantity of each medication used
D) Decreases the side effects of each medication
E) Targets different phases of the cell cycle
Ans: A, E
Feedback:
Malignant cells that remain in a dormant phase for long periods are difficult to destroy. These cells can
emerge long after cancer treatment has finished after weeks, months, or years to begin their division and
growth cycle all over again. For this reason, antineoplastic agents are often given in sequence over
periods of time, in the hope that the drugs will affect the cancer cells as they emerge from dormancy or
move into a new phase of the cell cycle. A combination of antineoplastic agents targeting different
phases of the cell cycle is frequently most effective in treating many cancers. Combinations of drugs do
not increase the length of treatment, increase the quantity of medication used, or decrease the adverse
effects of the medications used.
The nurse is caring for a patient who is taking bicalutamide (Casodex). For what type of cancer would the nurse administer this drug? A) Bladder B) Colon C) Breast D) Prostate
Ans: D
Feedback:
Bicalutamide (Casodex) is administered in combination with a luteinizing hormone for the treatment of
advanced prostate cancer. This medication would not be effective for treating bladder, colon, or breast
cancer because it is a hormone modulator and works only on hormone-requiring cancers.
What nursing diagnosis is a priority for the 87-year-old woman, who has stomatitis secondary to the
administration of methotrexate? (Select all that apply.)
A) Impaired skin integrity
B) Risk for infection
C) Imbalanced nutrition
D) Risk for bleeding
E) Hopelessness
Ans: A, B, C, D
Feedback:
Because of the common adverse effects of severe bone marrow suppression, fatigue, malaise, rashes,
alopecia, ulcerative stomatitis, hepatic toxicity, interstitial pneumonitis, chills, fever, and anaphylaxis,
priority nursing diagnosis would include impaired skin integrity related to rash, risk for infection, and
risk for bleeding related to severe bone marrow suppression. Because the patient has stomatitis, there is
a risk for imbalanced nutrition less than body requirements because eating is uncomfortable and not
feeling well will also reduce her appetite. Although fear and anxiety are common with any cancer
diagnosis, hopelessness is usually not as common unless the patient receives a terminal diagnosis and,
even then, many patients are able to remain hopeful.
What measure protects the nurse when preparing cytotoxic drugs?
A) Wearing protective equipment such as gloves, mask, and gown
B) Washing hands before preparation
C) Mixing medication in a 1-L bag
D) Administering medication IM
Ans: A
Feedback:
Cytotoxic drugs are toxic chemicals and the nurse who administers them must take adequate
precautions to avoid self-exposure. These precautions include protective equipment. Hand hygiene
should be performed before administering any medication but this measure does not protect the nurse.
Whether mixing the medication in a 1-L bag or administering it IM, the nurse must wear protective
equipment.
The patient has just been started on an alkylating agent to treat cancer. What is the most common
adverse effect of most alkylating agents that the nurse will monitor for?
A) Bone marrow suppression
B) Nephrotoxicity
C) Confusion
D) Depression
Ans: A
Feedback:
Hematological effects include bone marrow suppression, with leukopenia, thrombocytopenia, anemia,
and pancytopenia, secondary to the effects of the drugs on the rapidly multiplying cells of the bone
marrow. Therefore, options B, C, and D are not correct.
- The patient is taking ifosfamide as part of his or her cancer treatment. Mesna (Mesnex) is added to the
treatment regimen to prevent cystitis induced by the ifosfamide. The nurse explains that mesna works
by what action?
A) By increasing urine output
B) By shielding the kidney from ifosfamide
C) By increasing white blood cell production
D) By combining with a metabolite of ifosfamide
Ans: D
Feedback:
Mesna combines with a urotoxic metabolite of ifosfamide to reduce the damaging effects of ifosfamide.
It has no effect on urine output, does not provide a shield for the kidney, and has no impact on white
blood cell production.
Chlorambucil has been ordered for a patient with Hodgkin’s disease. The patient’s son asks the nurse what adverse effects this drug has. What will the nurse include when responding to this question? (Select all that apply.) A) Tremors B) Muscle twitching C) Confusion D) Gynecomastia E) Alopecia
Ans: A, B, C
Feedback:
Chlorambucil is a palliative treatment for chronic lymphocytic leukemia, malignant lymphomas, and
Hodgkin’s disease. Adverse effects include tremors, muscle twitching, confusion, nausea,
hepatotoxicity, bone marrow suppression, sterility, and cancer.
A patient with acute myeloblastic leukemia is taking doxorubicin. What medication, if ordered, would
the nurse recognize as a cardioprotective drug used in combination with doxorubicin?
A) Dexrazoxane (Zinecard)
B) Ixabepilone (Ixempra)
C) Teniposide (Vumon)
D) Vinblastine (Velban)
Ans: A
Feedback:
Dexrazoxane is a powerful chelating agent that is a cardioprotective drug that interferes with the
cardiotoxic effects of doxorubicin. Ixabepilone (Ixempra) is given in combination with capecitabine for
the treatment of patients with metastatic or locally advanced breast cancer. Teniposide is given in
combination with other drugs for induction therapy in childhood acute lymphoblastic leukemia.
Vinblastine is given in combination with other medications as part of the treatment for advanced
testicular germ cell cancer.
A patient taking tamoxifen to reduce the risk of contralateral breast cancer asks the nurse about adverse
effects of the drug. What is an adverse effect of tamoxifen?
A) Stomatitis
B) Mucositis
C) Thrombocytopenia
D) Cerebrovascular accidents
Ans: D
Feedback:
Adverse effects of tamoxifen include hot flashes, rash, nausea, vomiting, vaginal bleeding, menstrual
irregularities, edema, pain, cerebrovascular accident, and pulmonary emboli. They do not include
stomatitis, mucositis, or thrombocytopenia.
