Question 1

A patient will receive intrathecal liposomal cytarabine (DepoCyt) to treat acute myelogenous leukemia. The provider has ordered the concurrent administration of dexamethasone. The nurse understands that this is given to:

Accepted Answer

Chemical arachnoiditis can occur with the liposomal formulation of cytarabine; dexamethasone is given to reduce the incidence and severity of this side effect. It is not used to prevent bone marrow suppression. It is not given to minimize hair loss or stomatitis. It does not reduce the incidence of pulmonary edema.

Question 2

A nurse is discussing vesicant chemotherapeutic agents with a nursing student. Which statement by the student indicates a need for further teaching about this type of drug?

Accepted Answer

Vesicants are given intravenously. Extravasation may cause severe local tissue injury, requiring skin grafts. Vesicants that infiltrate must be stopped immediately. Sites of previous irradiation should not be used.

Question 3

A patient is receiving intravenous vincristine (Oncovin). The patient complains of pain at the IV insertion site. The nurse examines the site and notes an area of erythema and edema. What will the nurse do?

Accepted Answer

Vincristine is a vesicant; extravasation of these agents can cause severe local injury that sometimes requires surgical debridement and skin grafting. The site should be changed, and the provider should be notified. Requesting a different drug is not indicated. Topical anesthetics will not prevent local tissue injury. Slowing the rate of infusion will not prevent local tissue injury.

Question 4

A nurse provides teaching to a patient who will begin taking oral cyclophosphamide to treat non-Hodgkin's lymphoma. Which statement by the patient indicates an understanding about how to minimize side effects while taking this drug?

Accepted Answer

Acute hemorrhagic cystitis can occur; this can be minimized by maintaining adequate hydration and taking mesna (Mesnex), a protective agent. Bone marrow suppression is a dose-limiting side effect. This drug should be taken with food. Hair loss cannot be prevented by shampooing less often.

Question 5

A patient will begin chemotherapy with cisplatin. Which medications will the nurse expect to administer to offset this agent's side effects?

Accepted Answer

Amifostine and diuretics are given to help minimize kidney damage with cisplatin. Antiemetics are given to minimize nausea and vomiting, which can be severe with this drug. Vitamin B₁₂ is used to reduce toxicity to the gastrointestinal (GI) tract caused by pralatrexate. Vistonuridine is used to treat fluorouracil overdose. Folic acid is not used to counter cisplatin side effects. Gabapentin is used to minimize neuropathy when oxaliplatin is used.

Question 6

The nurse is caring for a patient who has been receiving vinorelbine (Navelbine) for about 5 days. Which assessment finding in this patient would cause the nurse to withhold the next dose and notify the prescriber?

Accepted Answer

The nurse should withhold the dose if the patient has new-onset cough and dyspnea, because these may indicate the development of interstitial pulmonary changes and acute respiratory distress syndrome. Alopecia would not cause the nurse to withhold the dose. Neutropenia is expected and is not at a critical level. Although this count is low, it would not prevent administration of the medication. Peripheral neuropathy is expected with vinorelbine.

Question 7

A nurse is discussing the care of a patient with cancer with a nursing student. The patient is about to begin chemotherapy with a bifunctional alkylating agent. Which statement by the student indicates an understanding of this chemotherapeutic agent?

Accepted Answer

Alkylating agents are toxic to rapidly dividing cells. Bifunctional agents form cross-links in cell DNA. Resistance to alkylating agents is common. These drugs may be given by bolus dosing.

Question 8

A patient with non-Hodgkin's lymphoma is about to begin chemotherapy with methotrexate (Rheumatrex). The nurse will expect to administer which medication concurrently with this drug?

Accepted Answer

Leucovorin is used to protect normal cells when large doses of methotrexate are given. Dexamethasone, folic acid, and vitamin B₁₂ are not given concurrently with methotrexate.

Question 9

The nurse is preparing to administer medication to a patient receiving cyclophosphamide (Cytoxan). To protect against the side effect of hemorrhagic cystitis, the nurse would expect to administer which drug?

Accepted Answer

Cyclophosphamide can cause acute hemorrhagic cystitis; to prevent this, the nurse should expect to administer mesna, which is a protective agent. Decadron, diphenhydramine, and leucovorin are indicated for the prevention of side effects associated with different anticancer agents.

Question 10

A patient who has a brain tumor will receive a nitrosourea agent. A nursing student asks why this type of drug is used for this type of cancer. The nurse will tell the student that nitrosoureas are because they:

Accepted Answer

Nitrosoureas are lipophilic and thus are able to cross the blood-brain barrier, making them more effective against solid tumors in the brain. They are alkylating agents with a broad spectrum of antineoplastic activity, but these are not the deciding factors in their use for brain tumors. Delayed bone marrow suppression is their major dose-limiting toxicity.

Question 11

A patient is receiving fluorouracil (Adrucil) as a continuous intravenous dose to treat a solid tumor. The patient reports soreness and blisters in the mouth, loose stools, and tingling of the hands and feet. What will the nurse do?

Accepted Answer

Stomatitis, GI symptoms, and palmar-plantar erythrodysesthesias are dose-limiting side effects of fluorouracil, characterized by the symptoms described. When these occur, the provider should be notified. Continuous dosing is generally less toxic than bolus dosing. Reassurance without discontinuing the medication and contacting the provider is not correct. Dexamethasone is not given to counter these effects.

Question 12

The nurse on an oncology unit prepares to administer the fourth cycle of docetaxel (Taxotere) to a patient with breast cancer. Which clinical finding would cause the nurse to withhold the dose and call the prescriber?

Accepted Answer

If the neutrophil count drops below 1500/mm³, the nurse should withhold the dose and notify the prescriber. The other values do not indicate a need to withhold the dose.

Question 13

A nursing student asks a nurse how cancer cells become resistant to methotrexate (Rheumatrex). The nurse is correct to respond by saying that cancer cells acquire resistance to methotrexate by:

Accepted Answer

Resistance to methotrexate occurs through five mechanisms, including reduced uptake of methotrexate into cells. Resistance also occurs through increased production of the transporter pump, increased synthesis of dihydrofolate reductase, and a decreased ability to convert the drug.

Question 14

A nurse is teaching a patient who will undergo chemotherapy with fluorouracil (Adrucil) to treat a solid tumor. Which statement by the patient indicates understanding of this chemotherapeutic agent's actions?

Accepted Answer

Fluorouracil acts by depriving cancer cells of thymidylate, which is necessary to make DNA. It does not cause the accumulation of adenosine, disrupt the biosynthesis of nucleic acids, or inhibit DNA polymerase.

Question 15

A patient will begin receiving vincristine (Oncovin) to treat Hodgkin's lymphoma. Which side effect(s) will the nurse tell the patient to report immediately?

Accepted Answer

Peripheral neuropathy is the major dose-limiting toxicity of vincristine. Patients should be counseled to report tingling of the extremities. Diarrhea, nausea, vomiting, and hair loss may occur but are expected. Headaches are not likely.

Question 16

A nursing student asks about the differences between cell-cycle phase-specific chemotherapeutic agents and those that are cell-cycle phase nonspecific. What will the nurse explain?

Accepted Answer

Cell-cycle phase-specific drugs do not harm "resting" cells, because these drugs are toxic only to cells that are active participants in the cell cycle. Cell-cycle phase-nonspecific drugs are not less toxic than cell-cycle phase-specific agents. Cell-cycle phase-specific drugs are usually given by prolonged infusion. Cell-cycle phase-nonspecific drugs are toxic to "resting" cells.

Question 17

A patient on an oncology unit has been receiving ifosfamide (Ifex) for a few days. Before administering the next dose, the nurse reviews the patient's laboratory test results. Which finding would cause the nurse to hold the dose?

Accepted Answer

The nurse should hold the dose for microscopic hematuria, because this may indicate hemorrhagic cystitis. An elevated white blood cell count is not an indication to hold the dose. Low hemoglobin and hematocrit levels are expected for a patient undergoing chemotherapy. Ketones may reveal some other problem, but they are not associated with ifosfamide.

Quiz 102: Anticancer Drugs I: Cytotoxic Agents