Unit 2:Ch 14 (Kach 7th Ed) - Antineoplastic Agents

Question 1

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

Answer 1

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.

Question 2

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.

Answer 2

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.

Question 3

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.

Answer 3

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.

Question 4

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

Answer 4

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.

Question 5

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)

Answer 5

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.

Question 6

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)

Answer 6

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.

Question 7

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.

Answer 7

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.

Question 8

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.

Answer 8

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.

Question 9

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

Answer 9

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.

Question 10

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.

Answer 10

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.

Question 11

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.

Answer 11

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.

Question 12

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

Answer 12

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.

Question 13

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.

Answer 13

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.

Question 14

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.

Answer 14

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.

Question 15

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.

Answer 15

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.

Question 16

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

Answer 16

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.

Question 17

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

Answer 17

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.

Question 18

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

Answer 18

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.

Question 19

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

Answer 19

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.

Question 20

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

Answer 20

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.

Question 21

21. 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

Answer 21

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.

Question 22

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

Answer 22

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.

Question 23

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)

Answer 23

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.

Question 24

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

Answer 24

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.

Question 25

A female patient prescribed methotrexate for meningeal leukemia is asking the nurse about adverse
effects of the drug. What would the nurse tell this patient should be avoided while taking methotrexate?
A) Pregnancy
B) Aerobic exercise
C) Smoking
D) Alcohol

Answer 25

Ans: A
Feedback:
Antimetabolites are contraindicated for use during pregnancy and lactation because of the potential for
severe adverse effects on the fetus and neonate. The nurse would not caution the patient against aerobic
exercise, smoking, or alcohol use because of the medication she was taking.

Question 26

What is the nurse’s priority intervention to reduce the risk of cystitis caused by cyclophosphamide
(Cytoxan)?
A) Encourage the patient to drink cranberry juice.
B) Promote adequate rest and sleep.
c) Encourage fluids to maintain hydration.
D) Instruct the patient to wear only cotton underwear

Answer 26

Ans: C
Feedback:
Hemorrhagic cystitis is a potentially fatal adverse effect. Ensure that the patient is well hydrated.
Drinking cranberry juice or milk helps to hydrate the patient, but what he or she drinks is less important
than that he or she drinks adequate amounts of fluid. Wearing cotton underwear is not an intervention
the nurse would teach the patient.

Question 27

A young man asks the nurse about the goal of the cancer therapy his mother is receiving. What is the
nurse’s best response?
A) The goal is to limit the cancer cells so the immune system can respond without causing too much
toxicity to your mother.
B) The goal is to kill the cancer cells as quickly as possible before they can spread so your mother will
be well again.
C) The goal is to control the speed at which new cancer cells grow so the medication has a better
chance to work.
D) The goal is to keep the cancer cells from spreading all over your mother’s body and choose the
drug with the fewest adverse effects.

Answer 27

Ans: A
Feedback:
The goal of cancer therapy, much like that of anti-infective therapy, is to limit the offending cells to the
degree that the immune system can then respond without causing too much toxicity to the host.
Therefore, options B, C, and D are not correct.

Question 28

The nurse is acting as a mentor for a new graduate nurse who is delivering chemotherapy to a patient in
the short-stay unit. What action performed by the new graduate would the mentor teach is not
appropriate and requires correction?
A) Checking the IV line frequently
B) Using an infusion pump to administer the medication
C) Premedicating the patient as ordered
D) Starting the IV in a large, distal vein

Answer 28

Ans: B
Feedback:
If at all possible, do not use an infusion pump to administer one of these drugs because it will continue
to deliver the drug under pressure and can cause a severe extravasation. This would be the least
beneficial to the patient. Checking the line frequently, premedicating the patient as ordered, and using a
large, distal vein would be much more beneficial to the patient.

Question 29

A patient with rhabdomyosarcoma has been admitted for chemotherapy with vincristine. While preparing a plan of care for this patient, what would be an appropriate nursing diagnosis?
A) Altered body image due to severe fluid retention
B) Risk for bleeding due to possible hemorrhagic cystitis
C) Risk for injury related to muscle wasting and weight loss
D) Risk of infection related to possible nosocomial infection

Answer 29

Ans: C
Feedback:
Adverse effects of vincristine include ataxia, cranial nerve manifestations, neuritic pain, muscle
wasting, constipation, leukopenia, weight loss, loss of hair, and death. As a result, the risk for injury
due to weakness and falls is a significant concept. Risk for bleeding and severe fluid retention is
unlikely with this drug. The risk of infection is related to bone marrow suppression, not a possible
nosocomial infection. The patient is more at risk for a nosocomial infection because of the bone
marrow suppression.

Question 30

A patient newly diagnosed with chronic myelocytic leukemia (`) has been prescribed treatment with imatinib. The patient asks the nurse how imatinib works. What would be the nurse’s best response?
A) imatinib alkylates cellular DNA.
B) imatinib inhibits folic acid reductase, leading to inhibition of DNA synthesis and inhibition of
cellular replication.
C) imatinib binds to DNA and inhibits DNA synthesis in susceptible cells, causing cell death.
D) imatinib inhibits the enzyme created by the Philadelphia chromosome abnormality in CML.

Answer 30

Ans: D
Feedback:
Imatinib is a tyrosine kinase inhibitor that selectively inhibits the Bcr-Abl tyrosine kinase created by the
Philadelphia chromosome abnormality in CML and some tumor cells present in gastrointestinal stromal
tumor (GIST); blocking this enzyme inhibits proliferation and induces cell division. Alkylating agents
alkylate cellular DNA; antimetabolites inhibit folic acid reductase, leading to inhibition of
deoxyribonucleic acid (DNA) synthesis and inhibition of cellular replication; and antineoplastic
antibiotics bind to DNA and inhibit DNA synthesis in susceptible cells, causing cell death.

Question 31

The patient, diagnosed with chronic myelocytic leukemia (CML), has not been responding to
chemotherapy and the provider changes the patient to imatinib. The patient asks the nurse, What
adverse effects am I going to have to deal with from this drug? What is the nurse’s best response?
A) Adverse effects from this drug are more serious but this drug is stronger and more effective.
B) Adverse effects are similar to other drugs including bone marrow suppression, nausea, and hair
loss.
C) Adverse effects are much less likely or severe including GI upset, headache, and muscle pain.
D) Adverse effects vary from patient to patient and depend on your overall health as to what will
occur.

Answer 31

Ans: C
Feedback:
Patients who have CML and who have been switched to imatinib after traditional chemotherapy have
been amazed at how good they feel and how much they have recovered from the numerous adverse
effects of traditional chemotherapy. Administer with a meal and a full glass of water, arrange for small
frequent meals if GI upset is a problem, provide analgesics for headache and muscle pain, monitor
CBC, and examine for edema. Options A, B, and D are not correct.

Question 32

The nursing instructor teaches the students that antineoplastic drugs are often carcinogens. The students
are surprised to hear this and ask why. The instructor’s best response includes what information?
A) The drugs kill cells resulting in a need for more cellular growth with risk of a mutant cell.
B) These drugs do so much damage to so many human cells that the patient is debilitated.
C) If the patient remains cancer free for 2 years and then cancer is found, it is caused by the drugs.
D) Palliative therapy promotes the growth of new cancer cells because it is not strong enough.

Answer 32

Ans: A
Feedback:
Many neoplastic drugs result in the adverse effect of cancer because cell death caused by the agents
increase the need for cellular growth, placing the patient at increased risk for a mutant cell to develop.
Patients often recover completely from the adverse effects after chemotherapy is completed and do not
remain debilitated. Most cancer patients are not considered to be cured until they have remained cancer
free for 5 years because no cells have been identified that can remain dormant for 5 years. Palliative
therapy does not promote growth of new cancer cells.

Question 33

What classification of antineoplastic medication would the nurse administer that acts by inhibiting
microtubular reorganization?
A) Alkylating agents
B) Hormone modulators
C) Mitotic inhibitors
D) Antimetabolites

Answer 33

Ans: C
Feedback:
Mitotic inhibitors such as docetaxel and paclitaxel inhibit microtubular reorganization. Alkylating
agents interfere with ribonucleic acid (RNA), deoxyribonucleic acid (DNA), or other cellular proteins.
Hormone modulators react with specific receptor sites to block cell growth and activity. The
antimetabolite cladribine and miscellaneous agent hydroxyurea block DNA synthesis.

Question 34

The nurse transfers from the adult oncology unit to the pediatric oncology unit. What will the nurse
need to add to the patient’s plan of care that was not a part of the adult patient’s care plan?
A) Social, emotional, and intellectual stimulation
B) Concerns related to combination drug therapy
C) Double checking dosage calculations and appropriateness of drug dosage
D) Monitor for hydration and nutritional status

Answer 34

Ans: A
Feedback:
Children need to play and learn so meeting the child’s social, emotional, and intellectual needs is a part
of the care plan that was not as significant with adults. Administration of combination drugs, Double-checking dosage calculations and appropriateness of drug dosage, and Monitoring for hydration and
nutritional status are all components of adult care as well as pediatric care.

Question 35

The nurse is conducting a class for nurses hired to work on the oncology unit. What statement, if made
by the nurse, would be correct regarding chemotherapy for older adults? (Select all that apply.)
A) Older adults may be more susceptible to the central nervous system (CNS) and GI effects of these
drugs.
B) Older patients are at risk for dehydration and diminished nutritional status.
C) Safety precautions should be instituted as soon as any drug is initiated.
D) Dosage will need to be adjusted based on the age of the older adult.
E) Older adults are already somewhat immunosuppressed, so further suppression is a concern.

Answer 35

Ans: A, B, E
Feedback:
Older adults may be more susceptible to the CNS and GI effects of some of these drugs. Older patients
should be monitored for hydration and nutritional status regularly. Safety precautions should be
instituted if CNS effects occur but are not needed for every drug as soon as it is initiated. Dosage is
adjusted based on hepatic and renal function, not the patient’s age. Protecting these patients from
exposure to infection and injury is a very important aspect of their nursing care because older patients
are naturally somewhat immunosuppressed because of age.