Week 2 part 2

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1

One patient has cancer of the bone; another has cancer in the connective tissues of the thigh muscles; a third patient has cancer in the vascular tissues. These patients have a type of tumor referred to as a

sarcoma

2

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

“Be sure to examine your mouth daily for bleeding, painful areas, and ulcerations.”

3

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

maintain a diet of small, frequent feedings with nutrition supplements within 2 weeks.

4

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

Leucovorin rescue

5

A patient who has been on methotrexate therapy is experiencing mild pain. Her husband calls to see if he can give her aspirin for the pain. The nurse’s response is based on the fact that aspirin

can lead to methotrexate toxicity.

6

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

“I will eat only fresh fruits and vegetables.”

7

When administering chemotherapy for treatment of cancer, the nurse implements which intervention that treats or even prevents chemotherapy-induced nausea and vomiting?

Giving an antiemetic 30 to 60 minutes before the chemotherapy is started.

8

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

Increased cancer-cell killing will occur.

9

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

Delayed-onset cholinergic diarrhea

10

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

Fever

11

The nurse is providing education regarding chemotherapy to a patient who is about to receive the first course of treatment. Which statement by the nurse is appropriate?

“Report black, tarry stools if they occur.”

12

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

The chemotherapy will be given along with supportive measures to treat a possible allergic reaction

13

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

lowest level of neutrophils reached during therapy.

14

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

Report unusual bleeding or bruising.

Prepare for hair loss.

Avoid straight-edged razors.

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

15

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

Hair follicle cells

Gastrointestinal (GI) mucous membrane cells

Bone marrow cells

16

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

250 mL/hr

30 minutes = 0.5 hours

125 mL : 0.5 hr :: x mL : 1 hr

(125 ´ 1) = (0.5 ´ x); 125 = 0.5x; x = 250; set the pump to infuse at 250 mL/hr

17

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

Decreased cardiac output related to the adverse effect of cardiotoxicity

18

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

Kidney damage

19

The nurse is teaching a class about the various chemotherapy drugs and explains that alkylating drugs are also called “cell cycle–nonspecific drugs” because they are

cytotoxic in any phase of the cell cycle

20

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

Stop the infusion immediately, but leave the IV catheter in place

21

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

A weight gain of 2 pounds or more in 24 hours

22

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

Use a spill kit to clean the area.

23

During therapy with the cytotoxic antibiotic bleomycin, the nurse will assess for a potentially serious adverse effect by monitoring which assessment finding?

Respiratory function

24

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

Chemotherapy will be withheld until the neutrophil count returns toward normal levels.

25

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

Hirsutism and acne

26

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

octreotide (Sandostatin)

27

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

Dry, “scratchy,” or “swollen” throat

White patches in the mouth or throat

Temperature of 100.7° F (38.2° C)

Decreased urine output

28

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

Tinnitus

Hearing loss

Elevated blood urea nitrogen and creatinine levels

Numbness or tingling in the extremities

29

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

200 mL/hr

15 minutes = 0.25 hours

50 mL : 0.25 hr :: x mL : 1 hr

(50 ´ 1) = (0.25 ´ x); 50 = 0.25x; x = 200 mL/hr

30

When monitoring a patient’s response to interferon therapy, the nurse notes that the major dose-limiting factor for interferon therapy is which condition?

Fatigue

31

A patient asks about his cancer treatment with monoclonal antibodies. The nurse tells him that which is the major advantage of treating certain cancers with monoclonal antibodies?

Monoclonal antibodies target certain tumor cells and bypass normal cells.

32

During a patient’s therapy with interleukins, the nurse monitors the patient for capillary leak syndrome. Which assessment finding, if present, would indicate this problem?

A sudden, 15-pound weight gain

33

A patient who has received chemotherapy has a critically low platelet count. The nurse expects which drug or drug class to be used to stimulate platelet cell production?

oprelvekin (Neumega)

34

A patient who has received chemotherapy has a steadily decreasing white blood cell count. The chemotherapy will end on Tuesday afternoon. The oncologist has mentioned that a colony-stimulating factor will be started soon. The nurse knows that the appropriate time to start this medication is when?

Wednesday afternoon, 24 hours after the chemotherapy ends

35

A patient has an order for the monoclonal antibody adalimumab (Humira). The nurse notes that the patient does not have a history of cancer. What is another possible reason for administering this drug?

Rheumatoid arthritis

36

During interleukin drug therapy, a patient is showing signs of severe fluid retention, with increasing dyspnea and severe peripheral edema. The next dose of the interleukin is due now. Which action will the nurse take next?

Hold the drug, and notify the prescriber.

37

The nurse is administering an interferon and will implement which intervention?

Rotating sites if administered subcutaneously

38

Abatacept (Orencia) is prescribed for a patient with severe rheumatoid arthritis. The nurse checks the patient’s medical history, knowing that this medication would need to be used cautiously if which condition is present?

Chronic obstructive pulmonary disease

39

Aldesleukin [IL-2] (Proleukin) is prescribed for a patient. The nurse reviews the patient’s medication list and would note a potential drug interaction if which drug class is also ordered?

Antihypertensive drugs

40

During therapy with hematopoietic drugs, the nurse will monitor the patient for which adverse effects? (Select all that apply.)

Edema

Diarrhea

Nausea and vomiting

Headache

41

A patient is to receive filgrastim (Neupogen) 5 mcg/kg/day. The patient weighs 198 pounds. How many micrograms of medication will this patient receive each day?

450 mcg

Convert pounds to kilograms: 198 ¸ 2.2 = 90 kg

Calculate mcg/day for this patient: 5 mcg/kg/day ´ 90 kg = 450 mcg/day

42

A patient will be receiving aldesleukin [IL-2] (Proleukin), 600,000 IU/kg every 8 hours for 14 doses. The patient weighs 220 pounds. How many IU of medication will this patient receive per dose?

60 million (60,000,000) IU

Convert pounds to kilograms: 220 ¸ 2.2 = 100 kg

Calculate IU/kg for this patient: 600,000 IU/kg ´ 100 kg = 60,000,000 IU per dose

43

A patient must be treated immediately for acute organ transplant rejection. The nurse anticipates that muromonab-CD3 (Orthoclone OKT3) will be ordered. What is the priority assessment before beginning drug therapy with muromonab-CD3?

Fluid volume status

44

A patient is about to undergo a kidney transplant. She will be given an immunosuppressant drug before, during, and after surgery to minimize organ rejection. During the preoperative teaching session, which information will the nurse include about the medication therapy?

Several days before the surgery, the medication will be administered orally

45

A patient has an order for cyclosporine (Sandimmune). The nurse finds that cyclosporine-modified (Neoral) is available in the automated medication cabinet. Which action by the nurse is correct?

Notify the pharmacy to obtain the Sandimmune form of the drug.

46

The nurse is preparing to administer an injection of monoclonal antibodies. Which additional drug will the nurse administer to minimize adverse reactions to the monoclonal antibodies?

A corticosteroid

47

When administering cyclosporine, the nurse notes that allopurinol is also ordered for the patient. What is a potential result of this drug interaction?

Increased levels of cyclosporine and toxicity

48

The nurse is monitoring a patient who is receiving muromonab-CD3 (Orthoclone OKT3) after an organ transplant. Which effect is possible with muromonab-CD3 therapy?

Chest pain

49

When monitoring a patient who is on immunosuppressant therapy with azathioprine (Imuran), the nurse will monitor which laboratory results?

White blood cell (leukocyte) count

50

A patient with multiple sclerosis will be starting therapy with an immunosuppressant drug. The nurse expects that which drug will be used?

glatiramer acetate (Copaxone)

51

Cyclosporine is prescribed for a patient who had an organ transplant. The nurse will monitor the patient for which common adverse effect?

Hypertension

52

The nurse follows which procedures when giving intravenous (IV) cyclosporine? (Select all that apply.)

Using an infusion pump to administer this medication

Monitoring the patient closely for the first 30 minutes for severe adverse effects

Checking blood levels periodically during cyclosporine therapy

Performing frequent oral care during therapy

53

A patient has started azathioprine (Imuran) therapy as part of renal transplant surgery. The nurse will monitor for which expected adverse effect of azathioprine therapy? (Select all that apply.)

Leukopenia

Thrombocytopenia

Hepatotoxicity

54

A patient will be on a tacrolimus (Prograf) infusion after receiving a liver transplant. The order reads, “Give 0.03 mg/kg/day as a continuous IV infusion.” The patient weighs 159 pounds, and the medication injection solution is available in a 5-mg/mL strength. How many milliliters will the nurse draw up for this infusion? (Record answer using two decimal places.)

0.43 mL

Convert pounds to kilograms: 159 ¸ 2.2 = 72.27 kg

Calculate the mg/kg/day dosage in milligrams:

0.03 mg/kg/day ´ 72.27 kg = 2.1681, rounded to 2.17 mg

Calculate the mL to administer:

5 mg : 1 mL :: 2.17 mg : x mL

(5 ´ x) = (1 ´ 2.17); 5x = 2.17; x = 0.434 rounded to 0.43 mL