Question 1

A nurse is preparing to administer a second infusion of trastuzumab [Herceptin] to a patient who has breast cancer. The patient tells the nurse that she experienced chills, fever, pain, and nausea after her first infusion. What will the nurse do?

Accepted Answer

Patients taking trastuzumab may experience a flu-like syndrome with their first infusion that will diminish with subsequent infusions. Neutropenia is not a concern with this drug. Hypersensitivity reactions may occur, but the patient's symptoms are not characteristic of this. Cardiotoxicity may occur, but the symptoms are not characteristic of this.

Question 2

The nurse is caring for a patient in the oncology unit who was recently diagnosed with advanced renal carcinoma. The nurse prepares to administer aldesleukin [Proleukin] as part of the treatment regimen. What is the primary adverse effect of this drug?

Accepted Answer

Capillary leakage syndrome, an adverse effect of aldesleukin, is a particular concern, because it is a potentially fatal reaction characterized by hypotension and reduced organ perfusion. Proleukin is not associated with hypertension, hyperglycemia, or hyperuricemia.

Question 3

A patient with colorectal cancer is admitted to the hospital oncology unit to receive cetuximab [Erbitux]. The nurse notes that the prescriber has not ordered any other medications. The nurse will contact the prescriber to request an order for which medication in order to minimize cetuximab's side effects?

Accepted Answer

Cetuximab can cause severe infusion reactions. Premedication with diphenhydramine can help reduce this risk. Epinephrine is used for medical management of an infusion reaction and not to minimize the risk. Ondansetron is not indicated because nausea and vomiting are not a concern. Magnesium supplements are given when hypomagnesemia is documented, not as a preventive.

Question 4

A 43-year-old patient with a strong family history of breast cancer considers taking tamoxifen [Nolvadex] for cancer prevention. Which assessment finding is a possible contraindication?

Accepted Answer

The patient's age and DVT history place her at risk for thrombosis. Tamoxifen would not be indicated for this patient. A prior hysterectomy, osteoporosis, and hyperlipidemia are not contraindications to tamoxifen.

Question 5

A patient with chronic myeloid leukemia (CML) begins treatment with imatinib [Gleevec]. Which statement by the patient indicates understanding of this medication?

Accepted Answer

Over time, resistance to imatinib may develop because the genes that code for BCR-ABL can mutate. Side effects of imatinib are not dose-dependent. Imatinib has significant drug interactions with several drugs. Imatinib is given orally.

Question 6

The nurse would be correct to state that the purpose of angiogenesis inhibitors is to:

Accepted Answer

Angiogenesis inhibitors suppress the formation of new blood vessels, thereby depriving solid tumors of the expanding blood supply they need for continued growth. Angiogenesis inhibitors cannot kill tumor cells that already exist. Angiogenesis inhibitors do not enhance collateral vessel or red cell development.

Question 7

A nursing student asks the nurse what differentiates antiestrogen drugs from aromatase inhibitors in the treatment of breast cancer. What is the correct response by the nurse?

Accepted Answer

Antiestrogen drugs cause proliferation of endometrial tissues by acting as receptor agonists at receptors in the uterus. Antiestrogen drugs increase the risk of thromboembolic events. Aromatase inhibitors block the production of estrogen from androgenic precursors, not by the ovaries. Aromatase inhibitors are used to treat ER-positive breast cancer.

Question 8

A patient with advanced prostate cancer will begin treatment with leuprolide [Lupron]. The provider has ordered flutamide to be given as adjunct therapy. The patient asks the nurse why both drugs are necessary. The nurse will tell the patient that:

Accepted Answer

Flutamide is given with GnRH agonists, such as leuprolide, to prevent tumor flare when GnRH therapy is begun. Flutamide increases hot flushes. Leuprolide does not decrease flutamide toxicity. There is no increase in cancer survival with this combination.

Question 9

A patient with advanced cancer of the prostate begins treatment with leuprolide [Lupron Depot] injections and will receive 7.5 mg IM once per month. After the first injection, the patient experiences an increase in cancer symptoms. What will the nurse tell the patient?

Accepted Answer

Patients taking leuprolide may initially experience an increase in cancer symptoms until GnRH receptors in the pituitary become desensitized. Increasing the dose is not indicated, and these symptoms do not warrant surgical castration. They do not reflect a worsening of this patient's cancer symptoms.

Question 10

The nurse is preparing to administer a first dose of ado-trastuzumab emtansine [Kadcyla] to a patient who has metastatic breast cancer. Which nursing action is correct?

Accepted Answer

Ado-trastuzumab emtansine is used for patients with HER2-positive disease. Although severe hypersensitivity reactions may occur, it is not recommended that a test dose along with an antihistamine be given. The initial dose should be given over 90 minutes, with subsequent doses given over 30 minutes if tolerated. Liver damage is common, so liver function needs to be monitored.

Question 11

A 45-year-old patient with a family history of breast cancer is considering using tamoxifen [Nolvadex] for cancer prevention. The nurse performs a health history and learns that the woman had a child when she was 35 years old, that she has not had a hysterectomy, and that she experienced DVT when she was pregnant. What will the nurse tell the patient?

Accepted Answer

Tamoxifen is a good choice for women between the ages of 40 and 49 years as a cancer preventive, except for women at risk for DVT. Family risk and late childbearing age are indications for using tamoxifen, but only in women without increased risk of DVT. The risk of endometrial cancer increases with age and, without the risk of DVT, would not be a contraindication in a woman of the patient's age. The patient's risks of DVT do not change with age.

Question 12

A premenopausal woman has ER-positive breast cancer, and her prescriber has ordered tamoxifen [Nolvadex]. She asks the nurse if anastrozole [Arimidex] would work better for her. What will the nurse tell her?

Accepted Answer

Anastrozole is used to treat ER-positive breast cancer in postmenopausal women. Because it does not block estrogen production in the ovaries, it is not effective in premenopausal women. It may cause hot flushes but is less likely to do so than tamoxifen. It is devoid of all estrogenic activity and does not promote endometrial cancer.

Question 13

A patient will begin taking tamoxifen [Nolvadex] to treat breast cancer. The nurse performs a medication history and learns that the patient is taking sertraline [Zoloft] for depression. The nurse will tell the patient to contact her provider to ask about:

Accepted Answer

Inhibitors of CYP2D6, such as sertraline, can negate the benefits of treatment with tamoxifen. Patients taking sertraline should request switching to another antidepressant, such as escitalopram. Increasing the dose of sertraline would only exacerbate the problem. Fluoxetine is similar to sertraline so changing to this drug would be incorrect. It is not correct to decrease the dose of tamoxifen.

Quiz 103: Anticancer Drugs II: Hormonal Agents, Targeted Drugs, and Other Noncytotoxic Anticancer Drugs