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LILLEY Chapter 45: Antineoplastic Drugs Part 1: Cancer Overview and Cell Cycle-Specific Drugs
Terms in this set (13)
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. Which of these is the correct term for these tumors?
(Sarcomas are malignant tumors that arise from connective tissues. These tissues can be found in bone, cartilage, muscle, blood, lymphatic, and vascular tissues. The other options are incorrect.)
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?
a. "You can take aspirin to prevent stomatitis."
b. "Be sure to watch for and report black, tarry stools immediately."
c. "You need to increase your intake of foods containing fiber and citric acid."
d. "Be sure to examine your mouth daily for bleeding, painful areas, and ulcerations."
(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. Teach patients to 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 must 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 the first course of antineoplastic therapy. What is an appropriate outcome for this patient when dealing with this problem?
a. The patient will eat three balanced meals a day within 2 days.
b. The patient will return to normal eating pattern within 4 weeks.
c. The patient will maintain normal weight by consuming healthy snacks as tolerated.
d. The patient will maintain a diet of small, frequent feedings with nutrition supplements within 2 weeks.
(Consuming small, frequent meals with nutritional supplements, and maintaining a bland diet help to improve nutrition during antineoplastic therapy.)
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?
a. A transfusion of whole blood
b. Leucovorin rescue
c. Therapy with filgrastim (Neupogen)
d. Administration of allopurinol (Zyloprim)
(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. The other options are incorrect.)
A patient who has been on methotrexate therapy is experiencing mild pain. The patient is asking for aspirin for the pain. The nurse recognizes that which of these is true in this situation?
a. The aspirin will aggravate diarrhea.
b. The aspirin will masks signs of infection.
c. Aspirin can lead to methotrexate toxicity.
d. The aspirin will cause no problems for the patient on methotrexate.
(Methotrexate interacts with weak organic acids, such as aspirin, and can lead to toxicity by displacing the methotrexate from protein-binding sites.)
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?
a. "I will avoid those who have recently had a vaccination."
b. "I will eat only fresh fruits and vegetables."
c. "I will report a sore throat, cough, or low-grade temperature."
d. "It is important for both my family and me to practice good hand washing."
(Patients who are neutropenic and susceptible to infections need to adhere to a low-microbe diet by washing fresh fruits and vegetables and making sure foods are well cooked. The other options are correct.)
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?
a. There will be less nausea and vomiting.
b. Increased cancer-cell killing will occur.
c. The drugs will prevent metastasis.
d. Combination therapy reduces the need for radiation therapy.
(Because drug-resistant cells commonly develop, exposure to multiple drugs with multiple mechanisms and sites of action will destroy more subpopulations of cells. The other options are incorrect.)
The nurse is monitoring a patient who has severe bone marrow suppression following antineoplastic drug therapy. Which is considered a principal early sign of infection?
d. Elevated white blood cell count
(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. The other options are incorrect.)
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 treatment?
a. The physician will choose another drug to use.
b. The chemotherapy will be given along with supportive measures to treat a possible allergic reaction.
c. The patient will receive reduced doses of chemotherapy for a longer period of time.
d. The chemotherapy cannot be given because of the patient's allergy.
(Even if a patient has a known allergic reaction to a given antineoplastic medication, the urgency of treating the patient's cancer may still necessitate administering the medication and then treating any allergic symptoms with supportive medications, such as antihistamines, corticosteroids, and acetaminophen.)
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 which of these?
a. The lowest level of neutrophils reached during therapy.
b. The highest level of neutrophils reached during therapy.
c. The point at which the adverse effects of chemotherapy will stop.
d. The point at which the cytotoxic action against cancer cells is the highest.
(The lowest neutrophil count reached after a course of chemotherapy is known as the nadir. The other options are incorrect.)
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.)
a. Report unusual bleeding or bruising.
b. Hair loss is not expected with this drug.
c. Prepare for hair loss.
d. Avoid areas with large crowds or gatherings.
e. Avoid foods that are too hot or too cold or rough in texture.
f. Restrict fluid intake to reduce nausea and vomiting.
(Counsel patients who are taking methotrexate to expect hair loss and to report any unusual bleeding or bruising. Because of the possibility of infection, avoid areas with large crowds or gatherings. Foods that are too hot or too cold or rough in texture may be irritating to the oral mucosa. Fluid intake is to be encouraged to prevent dehydration.)
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.)
a. Bone marrow cells
b. Retinal cells
c. Hair follicle cells
d. Nerve myelin cells
e. Gastrointestinal (GI) mucous membrane cells
(Chemotherapy toxicities generally stem from the fact that chemotherapy drugs affect rapidly dividing cells—both harmful cancer cells and healthy, normal cells. Three types of rapidly dividing human cells are the cells of hair follicles, GI tract cells, and bone marrow cells. The other options are incorrect.)
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