Antineoplastic Drugs Questions

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Methotrexate (MTX)

Rheumatrex® or Trexall®
Routes of admin: Oral, IM, IV
One of the most versatile antineoplastic agents because it can be used for many malignancies.

Fludarabine

Fludara®
Routes of admin: IV
Antimetabolic and antineoplastic agent.
Used for chronic lymphocytic leukemia.
Adverse effects include weakness, headache, hearing loss, sleep disorders, and depression.
May also cause bone marrow toxicity, pneumonia, dyspnea, nosebleed (epistaxis) and edema

Mitomycin

Mutamycin®
Routes of admin: IV
Antibiotic, antineoplastic compound.
Effective in certain tumors that are nonresponsive to surgery, radiation or other chemotherapeutic agents.
Used in combination with other chemotherapeutic agents in palliative, adjunctive treatment of cancer of the breast, stomach, and pancreas.
Adverse effects include nausea, vomiting, bone marrow toxicity, asthma and pneumonia.

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

A. sarcoma.
B. leukemia.
C. carcinoma.
D. lymphoma.


ANS: A
Sarcomas are malignant tumors that arise from connective tissues. These tissues can be found in bone, cartilage, muscle, blood, lymphatic, and vascular tissues.

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 this problem?

A. Aspirin should be taken to prevent the development of stomatitis.
B. She should watch for and report black, tarry stools immediately.
C. She should increase her intake of foods containing fiber and citric acid.
D. She should examine her mouth daily for bleeding, painful areas and ulcerations.


ANS: D
The symptoms of stomatitis consist of pain or burning in the mouth, difficulty swallowing, taste changes, viscous saliva, dryness, cracking, and fissures, with or without bleeding mucosa. She should avoid consuming foods containing citric acid and foods that are hot or spicy or high in fiber. Assessing stools is important but is not related to stomatitis, and aspirin should not be used during this therapy.

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

A. eat 3 balanced meals a day within 4 days.
B. return to her normal eating pattern within 1 month.
C. maintain her normal weight by consuming healthful snacks as tolerated.
D. maintain a diet of frequent feedings with a nutrition supplement as a snack within 2 weeks.


ANS: D
Consuming small, frequent meals and eating slowly; consuming clear liquids; and maintaining a bland diet help to improve nutrition during antineoplastic therapy.

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

A. A transfusion of whole blood
B. leucovorin rescue
C. filgrastim (Neupogen) therapy
D. epoetin alfa (Epogen) therapy


ANS: B
High-dose methotrexate is associated with bone marrow suppression, and it is always given in conjunction with the rescue drug leucovorin, which is an antidote for folic acid antagonists. Basically, leucovorin rescues the healthy cells from methotrexate.

A patient who has been on methotrexate therapy has developed a fever. Her husband calls to see if he can give her some ibuprofen (a nonsteroidal antiinflammatory drug [NSAID]) for the fever. The nurse's response is based on the fact that ibuprofen

A. aggravates stomatitis.
B. masks signs of infection.
C. can lead to methotrexate toxicity.
D. will cause no problems for the patient on methotrexate.


ANS: C
Methotrexate interacts with protein-bound drugs, such as NSAIDs; the NSAIDs can lead to toxicity by displacing the methotrexate from plasma proteins.

The nurse is reviewing prevention-of-infection measures with a patient who is receiving antineoplastic drug therapy. Which statement by the patient, who is at risk for infection resulting from neutropenic effects of antineoplastic drug therapy, shows that he still needs further teaching about his care?

A. "I should avoid those who have recently had a vaccination."
B. "I will eat only fresh fruits and vegetables."
C. "I should report a sore throat, cough, or low-grade temperature."
D. "It is important for both my family and me to practice good hand washing."


ANS: B
Patients who are neutropenic and susceptible to infections should adhere to a low-microbe diet by washing fresh fruits and vegetables and making sure foods are well cooked. The other options are correct.

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

A. Telling the patient to avoid caffeine while on chemotherapy
B. Giving an antiemetic when the chemotherapy is started
C. Giving an antiemetic 30 to 60 minutes before the chemotherapy is started.
D. Increasing mobility before and during chemotherapy


ANS: C
Premedication with antiemetics 30 to 60 minutes before administration of the antineoplastics is the preferred treatment protocol to help reduce nausea and vomiting, prevent dehydration and malnutrition, and promote comfort.

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

A. There will be less nausea and vomiting.
B. Increased cancer-cell killing will occur.
C. Hair loss will be minimized.
D. Combination therapy reduces the need for radiation therapy.


ANS: B
Because drug-resistant cells commonly develop, exposure to multiple drugs with multiple mechanisms and sites of action will destroy more subpopulations of cells.

When monitoring a patient with severe bone marrow suppression, the nurse knows that which of the following is the principal early sign of infection?

A. Elevated white blood cell count
B. Diaphoresis
C. Tachycardia
D. Fever


ANS: D
Fever and/or chills may be the first sign of an oncoming infection. Elevated white blood cell count will not occur because of the bone marrow suppression.

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