Chapter 37: Anticancer Drugs Nursing School Test Banks

Chapter 37: Anticancer Drugs
Test Bank

MULTIPLE CHOICE

1. A patient who has cancer is about to begin chemotherapy. The patient asks the nurse why two chemotherapeutic agents are being used instead of just one. Which response by the nurse is correct?
a. The drugs may be given in less toxic doses if two drugs are used.
b. Two agents used together can have synergistic effects.
c. Use of two drugs will increase tumorcidal activity in the G0 phase of the cell.
d. Using two agents will shorten the length of time chemotherapy is needed.
ANS: B
Using two or more chemotherapeutic agents can have a synergistic effect. Combination therapy typically uses two drugs with different dose-limiting toxicities, but the use of more than one drug does not allow for using less toxic doses. Combination therapy allows cell kill in all phases of the cell cycle. Combination therapy does not shorten the length of time chemotherapy is needed.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 505
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A patient who is about to begin chemotherapy asks the nurse when the risk of infection is highest. The nurse will tell the patient that infection risk is greatest at which point?
a. A week to 10 days after each chemotherapy dose
b. During the week immediately after chemotherapy
c. Immediately prior to each dose of chemotherapy
d. When the patients temperature is elevated by 1 F
ANS: A
Following chemotherapy administration, the time at which the blood count, including white blood cells, is lowest is typically 7 to 10 days after treatment.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 508
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The nurse is caring for a patient who is receiving a third dose of high-dose cyclophosphamide (Cytoxan). The nurse notes hematuria. The nurse will notify the provider and will perform which action?
a. Ask whether the patient takes allopurinol (Lopurin).
b. Assess the patients skin and fingernails for darkening.
c. Question the patient about fluid intake.
d. Reassure the patient that this is an expected side effect.
ANS: C
Hemorrhagic cystitis is a common adverse effect of high-dose cyclophosphamide and can be mitigated by increasing fluid intake. Allopurinol is given to treat gout, which is characterized by uric acid crystalluria. Darkening of the fingernails and skin is a common adverse effect of cyclophosphamide but is unrelated to hemorrhagic cystitis.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 520
TOP: NURSING PROCESS: Evaluation/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. The nurse is caring for a patient who is receiving intravenous mechlorethamine (Mustargen). The patient reports pain at the IV site, and the nurse assesses swelling and pallor at the site. What action will the nurse take?
a. Administer an analgesic medication.
b. Apply a warm compress to the site.
c. Slow the infusion and notify the provider.
d. Stop the infusion immediately.
ANS: D
Methchlorethamine is a severe vesicant and can cause tissue necrosis if it infiltrates into the tissues. The nurse should stop the infusion.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 510
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. An oncology home care nurse is preparing to administer a chemotherapeutic agent to a patient at the patients home. What precautions will the nurse take while administering the IV chemotherapeutic agent?
a. Clear a counter space for preparation of the solution.
b. Don a surgical mask while administering the drug.
c. Take surgical scrubs to wear during the infusion.
d. Wear an impermeable, disposable gown when hanging the drug.
ANS: D
Nurses should take precautions when handling cytotoxic drugs if inhalation, ingestion, or contact with skin and mucous membranes is possible. When hanging an IV solution, it is possible to splash solution onto the skin, so the nurse should wear a disposable, impermeable gown. If the nurse has to prepare a solution at home, a plastic-backed pad should be used as a surface. When there is a risk of aerosol exposure, a National Institute for Occupational Safety and Healthapproved respirator is necessary. Surgical masks do not provide adequate respiratory protection. Surgical scrubs are permeable.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 507
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse is teaching a patient who will take oral cyclophosphamide (Cytoxan). Which statement by the patient indicates understanding of the teaching?
a. I should follow a diet high in organ meats and beans while taking this drug.
b. I should brush my teeth and gums vigorously twice daily.
c. I should report any low-grade temperature elevation immediately.
d. I should take the drug at bedtime to minimize side effects.
ANS: C
Even a low-grade temperature should be reported because it can indicate significant infection in immunocompromised patients. Patients should eat a low-purine diet while taking this medication. Patients should brush teeth and gums with a soft bristle toothbrush. Patients should take the medication early in the day to avoid accumulation in the bladder.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 510
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. A patient is receiving bleomycin (Blenoxane) as part of a chemotherapeutic regimen to treat leukemia. During intravenous administration of this drug, what will the nurse observe the patient closely for?
a. Hypotension and visual disturbances
b. Pain and blistering at the IV site
c. Pink to red urine
d. Shortness of breath and wheezing
ANS: D
Bleomycin can cause anaphylaxis, so patients should be monitored for respiratory distress. Pain and blistering at the IV site is common to antitumor antibiotics except for bleomycin. Urine color changes occur with doxorubicin. Vincristine causes hypotension and visual disturbances.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 519
TOP: NURSING PROCESS: Assessment/Evaluation/Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. A patient is receiving the antitumor antibiotic doxorubicin (Adriamycin) to treat lung cancer. The patient is experiencing shortness of breath and palpitations. The nurse is concerned that the patient has developed which condition?
a. Anemia
b. Cardiotoxicity
c. Hypersensitivity
d. Pulmonary infection
ANS: B
Cardiotoxicity is a known adverse effect of this drug and is manifested in shortness of breath, edema, and palpitations.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 519
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. The nurse is caring for a patient who is receiving vincristine (Oncovin), a plant alkaloid chemotherapeutic agent, to treat non-Hodgkins lymphoma. The nurse observes that the patient has difficulty walking. What action will the nurse take?
a. Ask about numbness or tingling in the fingers and toes.
b. Assess heart rate and blood pressure to evaluate for orthostatic hypotension.
c. Assess the temperature to evaluate for infection.
d. Request an order for a complete blood count and electrolytes.
ANS: A
Peripheral neuropathy can occur with this drug and is manifested by difficulty walking and numbness and tingling in the fingers and toes. Orthostatic hypotension is not a side effect. Infection is always a concern, and regular evaluation of complete blood count and electrolytes is performed but not related to signs of peripheral neuropathy.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 523
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A woman who has advanced breast cancer will begin receiving androgen therapy. The nurse will explain to the patient that androgen therapy is used to
a. enhance her own estrogen production.
b. give her a sense of well-being.
c. minimize hot flashes.
d. promote regression of her tumor.
ANS: D
Androgen is used to treat breast cancer to promote regression of tumors. Other hormonal therapies are used in other circumstances to promote well-being.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 525
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The nurse is teaching a patient who is receiving vincristine (Oncovin) about long-term management of the treatment regimen. Which information will the nurse provide in teaching the patient?
a. If you experience numbness of your hands, it will eventually resolve.
b. If your IV starts to hurt, you should pull the IV out immediately.
c. You should ask for antinausea medication at the first sign of nausea.
d. You should report difficulty buttoning your clothes to your provider.
ANS: D
Difficulty buttoning clothing is a sign of peripheral neuropathy and should be reported. Numbness of hands may resolve after chemotherapy is stopped, but it may never resolve. If the IV infiltrates, the infusion should be stopped and the needle left in until attempts to aspirate residual vesicant are performed. Antinausea medication should be given prior to beginning the infusion.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 524
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. The nurse is caring for a patient who is receiving fluorouracil (5-FU) to treat pancreatic cancer. Which interventions are included in the nurses plan of care for this patient? (Select all that apply.)
a. Apply ice to the IV site if the patient reports pain.
b. Administer antiemetics when the patient reports nausea.
c. Counsel the patient to use waxed dental floss.
d. Discourage visits with people who have respiratory infections.
e. Offer ice chips frequently.
f. Restrict to nothing by mouth during intravenous drug administration.
ANS: A, C, E
If the patient reports pain at the IV site, the nurse should apply ice and notify the provider. Patients should use waxed dental floss to avoid bleeding of the gums. Ice chips help with oral pain. Antiemetics should be given prior to administration of the drug. Visitors with active infections should be restricted. Patients do not need to be NPO during the IV infusion.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 515
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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