Chapter 27: Drugs for Cancer Therapy Nursing School Test Banks

Workman: Understanding Pharmacology

Chapter 27: Drugs for Cancer Therapy

Test Bank

MULTIPLE CHOICE

1. Which biological feature is specific to normal differentiated cells but not to cancer cells?
a. Anaplasia
b. Hypertrophy
c. Aneuploidy
d. Loose adherence
ANS: B
Some normal tissues increase in size by having individual cells get larger, a process called hypertrophy. Cancer cells are usually small and always grow by hyperplasia, not hypertrophy. The other features listed are characteristics that are associated with cancer cells and not normal differentiated cells.

PTS: 0 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 483 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

2. How is apoptosis related to cancer development?
a. Cancer only occurs in cells capable of apoptosis.
b. Apoptosis increases the risk for DNA mutations.
c. The process of carcinogenesis suppresses or inhibits apoptosis.
d. Cancer cells with large amounts of apoptosis are more resistant to chemotherapy.
ANS: C
Normal cells have a finite life span. When a normal cell reaches the end of this life span the cell responds to signals for programmed cell death (apoptosis). The purpose of apoptosis is to ensure each organ has an adequate number of cells at their functional peak. Most cancer cells have an enzyme that prevents apoptosis, allowing these cells to have an unlimited life span (are immortal).

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 485 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

3. Which factor is the most common contributor to cancer development?
a. Advancing age
b. Eating a high-fat diet
c. Having parents with cancer
d. Living in a geographic area with poor sanitation
ANS: A
Advancing age is the most important risk factor for cancer. Exposure to carcinogens adds up over a lifetime, and immune protection decreases with age.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 488 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

4. How does oncogene activation cause normal cells to transform into cancer cells?
a. By inhibiting the ability of suppressor gene products to regulate apoptosis
b. By increasing the amount of cyclins present so that cells keep entering the cell cycle and dividing
c. By preventing the immune system from recognizing and eliminating cells that are no longer totally normal
d. By reducing the amount of glucose and other nutrients that reach normal cells, resulting in the starvation and death of normal cells
ANS: B
Oncogene activation is the main mechanism of carcinogenesis regardless of the specific cause. These genes, when activated, produce proteins (cyclins) that promote cell division. This excessive cell growth causes cells to change from normal cells to cancer cells.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 487 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

5. Which health care worker is the most appropriate person to administer intravenous (IV) chemotherapy?
a. Licensed practical/vocational nurse who has worked on an oncology unit for 10 years
b. Registered nurse who has completed menopause 5 years ago and can no longer get pregnant
c. Registered nurse who has completed an approved chemotherapy course
d. Pharmacist with 5 years experience in mixing chemotherapy
ANS: C
Safe administration of IV chemotherapy drugs requires special education and competency according to the standard of care designated by the Oncology Nursing Society (ONS) and supported by the American Society of Clinical Oncologists (ASCO). This does not mean that only an advanced practice nurse can perform this function; however, it does mean that the individual must be a registered nurse who has completed an approved chemotherapy course. LPNs/LVNs are not certified for IV chemotherapy. Although pharmacists may mix chemotherapy drugs, they are not approved to administer them.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 490 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Safe and Effective Care Environment

6. A patient with breast cancer asks why her hair is falling out while receiving chemotherapy when the cancer is in her breast. What is the nurses best response?
a. Breast cells and hair cells are similar. Any drug that affects one can be expected to affect the other.
b. The chemotherapy is interfering with your nutritional status. Eating more protein will help stop the hair loss.
c. It is possible that some cancer cells have escaped from your breast. Chemotherapy will kill cancer cells wherever they are.
d. Chemotherapy is delivered to all tissues and exerts the same damaging effects on some normal cells as well as on cancer cells.
ANS: D
Chemotherapy is a systemic treatment and exerts its effects on normal cells as well as cancer cells. Normal cells that undergo cell division frequently, such as skin, hair, and bone marrow cells, are most commonly affected.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

7. How do most chemotherapy drugs help rid the body of cancer cells?
a. They interfere with cancer cell division.
b. They prevent cancer cells from receiving oxygen.
c. They enhance the immune systems ability to recognize and kill cancer cells.
d. They force cancer cells to undergo reverse transformation to become normal cells.
ANS: A
The six major chemotherapy drug categories are antimetabolites, antitumor antibiotics, antimitotics, alkylating agents, topoisomerase inhibitors, and miscellaneous drugs. Although each of these drug categories has different specific actions, the result of all actions is to impair the ability of the cell to divide.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 488 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

8. A patient who is receiving intravenous (IV) chemotherapy asks why the nurse is wearing a mask, gloves, and gown when giving the drugs. What is the nurses best response?
a. These drugs will reduce your immune response, and with these coverings I am protecting you from getting an infection from me.
b. Because your immunity is reduced by this therapy, I am preventing the spread of infection from you to me or any other patient here.
c. The drugs are powerful and I handle them every day. The clothing protects me from accidentally absorbing these strong drugs.
d. The hospital policy is for any nurse giving these drugs to wear gowns, gloves, and masks to prevent other people from getting cancer.
ANS: C
Most chemotherapy drugs are absorbed through the skin and mucous membranes. As a result, health care workers who prepare or give these drugs (especially nurses and pharmacists) are at risk for absorbing them. Even at low doses, chronic exposure to chemotherapy drugs can affect health. The Oncology Nursing Society and OSHA have specific guidelines for using caution and wearing protective clothing whenever preparing, giving, or disposing of chemotherapy drugs.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

9. When it is time for a patients third round of chemotherapy for colon cancer, the patients white blood cell count is low and the treatment is delayed. The patient is upset at this delay. What is the nurses best response?
a. This extra time will give your hair a chance to grow back in.
b. This is for the best. You are too weak to receive chemotherapy now.
c. I will call the physician and request a prescription for something to calm your nerves.
d. Try not to worry. Your counts will probably be high enough next week and the chemotherapy will work just as well then.
ANS: D
Many patients are concerned that a delay of chemotherapy will mean that they are missing a treatment and that cancer cells will overgrow. Delayed treatments are not missed treatments, and 1 weeks additional growth time for colon cancer is not significant.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

10. A patient who is to receive combination chemotherapy today has an absolute neutrophil count (ANC) of 6200 cells/mm3. What is the certified chemotherapy nurses best action?
a. Administer the chemotherapy as prescribed.
b. Assess the patient for signs and symptoms of infection.
c. Hold the chemotherapy doses and notify the prescriber.
d. Explain to the patient that the treatment must be delayed until the ANC is acceptable.
ANS: A
Although there are exceptions, most agencies permit therapy only if the patients total WBC is above 2000 cells/mm3 or if the ANC, which includes the segmented neutrophils (segs, polys, PMNs) and band neutrophils (bands) together, are at least 1500 cells/mm3. This patients ANC is well above the minimum needed to receive chemotherapy.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Safe and Effective Care Environment

11. A patient arrives to receive a second round of combination chemotherapy. What is the most important patient assessment finding for the nurse to report to the prescriber?
a. Height
b. Weight
c. Blood pressure
d. Pulse rate and rhythm
ANS: B
Many intravenous chemotherapy drugs are dosed based on the patients meter square (m2) of total body surface area. This measurement is calculated from the patients height in centimeters and weight in kilograms. The patients weight can change drastically from one round of chemotherapy to the next. Height does not change. Because this is the patients second round, an accurate weight is needed to calculate the correct drug dosages.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe and Effective Care Environment

12. Which drug does the nurse prepare to administer to a patient receiving combination chemotherapy who has a red blood cell (RBC) count of 120 million/mm3?
a. Bleomycin (Blenoxane)
b. Oprelvekin (Neumega)
c. Epoetin alfa (Procrit)
d. Megestrol (Megace)
ANS: C
The RBC count is low and the patient is anemic. Epoetin alfa is a biological response modifier that increases bone marrow production of RBCs and reduces the severity of anemia. The other drugs are chemotherapy agents (bleomycin), hormones (megestrol), and a biological response modifier that affects platelets rather than RBCs (oprelvekin [Neumega]).

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Planning MSC: Client Needs Category: Physiological Integrity

13. A patient who is to receive a third round of combination chemotherapy today reports that mouth sores were present for 4 days within a week of receiving the last round of chemotherapy. What is the nurses best action?
a. Hold todays dose of chemotherapy and notify the prescriber immediately.
b. Ask the patient whether sores were present after the first round of chemotherapy.
c. Reassure the patient that this is an expected chemotherapy side effect and no action is needed.
d. Administer the chemotherapy as prescribed and call the prescriber to determine whether preventive drugs are needed.
ANS: D
Mouth sores (mucositis) occur when patients become immunosuppressed with chemotherapy. The fact that they healed before this round means that the patient can receive todays doses of chemotherapy. It is not a reason to withhold this dose. However, the prescriber should be notified to determine whether the patient should have prophylactic (preventive) drugs or should start anti-infective drugs at the first sign of a new outbreak of mouth sores.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

14. A patient is receiving intravenous (IV) chemotherapy through a peripheral line. Which IV site assessment finding indicates to the nurse that the IV access needs to be discontinued?
a. Bruising at the insertion site
b. Coolness of the skin below the site
c. Tissue swelling above and below the site
d. Wetness of the dressing over the access site
ANS: C
Swelling of the tissue above and below the site is an indication of fluid leakage from the vein into the tissues (infiltration). Even if the infusion did not contain any chemotherapy drugs, the infusion needs to be discontinued. Bruising is an indication of tissue trauma but not infiltration or extravasation. Coolness of the skin below the site is not specific to infiltration or extravasation. Dressing wetness indicates an external leak.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Safe and Effective Care Environment

15. Which chemotherapy problem, experienced by a patient after the first round of chemotherapy, does the nurse report to the prescriber to reduce the chemotherapy dose or delay the next treatment?
a. Productive cough and fever
b. Loss of scalp and body hair
c. Moderate nausea and vomiting
d. Fatigue and increased sleep time
ANS: A
A productive cough and fever are indicators of infection. The chemotherapy reduces the white blood cell count and greatly reduces the patients ability to recover from the infection. This is a life-threatening complication of chemotherapy that requires either a reduced drug dose or delay of treatment.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

16. A patient who has just been diagnosed with breast cancer asks why her treatment plan does not include the new drug Herceptin that she has read about. What is the nurses best response?
a. Your immune system is too weak to tolerate Herceptin.
b. This drug is experimental and dangerous for you to take before trying other therapies.
c. Your breast cancer does not have the protein that this drug works on, so you would not benefit from this therapy.
d. You are young and can better tolerate the standard therapies for breast cancer that have been proven effective but have strong side effects.
ANS: C
Trastuzumab (Herceptin) is a type of targeted therapy that is an antibody directed against a specific protein that some breast cancers make. When Herceptin binds to this protein, cancer cell growth is inhibited and the cell dies. Only about 5% of all breast cancers have the protein that Herceptin binds to. If the cancer does not overexpress that protein, Herceptin will not have any therapeutic effect.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

17. Which action is most important for the nurse to implement to prevent nausea and vomiting in a patient who is prescribed intravenous (IV) chemotherapy?
a. Keep the patient NPO during the time chemotherapy is infusing.
b. Administer antiemetic drugs before administering chemotherapy.
c. Ensure that the chemotherapy is infused over a 4- to 6-hour period.
d. Assess the patients responses every hour during the infusion period.
ANS: B
When emetogenic chemotherapy drugs are prescribed, the patient should receive antiemetic drugs as premedication before the chemotherapy drugs are administered. This allows time for prevention of chemotherapy-associated nausea and vomiting; however, the antiemetic therapy cannot stop until all risk for nausea and vomiting is passed. Patients become nauseated and vomit even when they are NPO.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

18. A male patient is prescribed estrogen as hormone treatment for cancer. Which assessment is most important for the nurse to perform for this patient?
a. Ask whether there has been a change in the level of sexual activity.
b. Compare breast size after therapy to that from before therapy.
c. Check for swelling and hard, cordlike veins in the legs.
d. Measure the patients abdominal girth.
ANS: C
Using estrogen as hormone therapy for cancer increases the risk for developing blood clots and deep vein thrombosis. The nurse assesses the patient for this problem at every clinic visit and instructs him (or her) to perform daily assessment of the lower extremities for swelling, hard, cord-like veins, redness along the vein tract, and extremity pain.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

1. Which complications or responses to chemotherapy have a greater impact among older adults who receive intravenous chemotherapy? (Select all that apply.)
a. Alopecia
b. Headache
c. Nausea and vomiting
d. Neutropenia
e. Peripheral neuropathy
f. Stomach and intestinal changes
ANS: C, D, E
Nausea and vomiting do not occur more frequently in older adults compared with younger adults, but they are more likely to lead to dehydration in older adults. Older adults have age-related reduced activity of the bone marrow, including production of white blood cells. This reduced activity is intensified with chemotherapy, greatly increasing their risk for life-threatening infection. Peripheral nerve function decreases with aging; chemotherapy-induced peripheral neuropathy occurs at lower dosages in older adults, increasing these patients risk for injury. Chemotherapy-induced alopecia, headache, and stomach/intestinal alterations do not appear to occur more frequently in older adults than younger adults.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 496 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

ESSAY

1. A patient who has been prescribed combination chemotherapy today has a total white blood cell (WBC) count of 5 cells/mm3, a lymphocyte count of 2.2 cells/mm3, a segmented neutrophil count of 1.8 cells/mm3, a basophil count of 0.15 cells/mm3, an eosinophil count of 250 cells/mm3, and a band neutrophil count of 0.6 cells/mm3. What does the nurse calculate as the absolute neutrophil count (ANC)?
_____ cells/mm3

ANS:
2400
Calculate the ANC by adding the number of segmented neutrophils and band neutrophils together, then multiplying the total by 1000. In this case, the WBC differential shows 1.8 segmented neutrophils and 0.6 band neutrophils; the total is 2.4 multiplied by 1000, or 2400 cells/mm3.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

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