Antineoplastics pt. 1
The nurse is reviewing a patient's chemotherapy regimen. Which medication is classified as an M-phase-specific antineoplastic?
Choices:
A. Etoposide
B. Topotecan
C. Methotrexate
D. Vincristine
D. Vincristine
A nurse is preparing to administer topotecan. Which finding requires the nurse to withhold the medication and notify the prescriber?
Choices:
A. Baseline neutrophil count of 1,200 cells/mm3
B. Baseline neutrophil count of 1,700 cells/mm3
C. Platelet count of 180,000 cells/mm3
D. Mild nausea after the previous treatment
A. Baseline neutrophil count of 1,200 cells/mm3
A patient is prescribed doxorubicin for breast cancer. The nurse recognizes that a critical nursing concern with this drug is:
A) Ototoxicity and hearing loss
B) Cardiotoxicity and heart failure
C) Hepatotoxicity requiring liver transplant
D) Nephrotoxicity and acute kidney injury
B) Cardiotoxicity and heart failure
Question 1: A nurse is preparing to administer an intravenous vesicant antineoplastic drug. Which action is the priority before starting the infusion?
Choices:
A. Apply a warm pack to the infusion site
B. Verify the intravenous device and its patency
C. Mix the antineoplastic drug with other intravenous infusions
D. Administer the drug through an infiltrated intravenous site
B. Verify the intravenous device and its patency
The nurse reviews a prescription for methotrexate for a patient with rheumatoid arthritis. Which action is most important to promote medication safety?
Choices:
A. Administer the medication every day until joint pain improves.
B. Verify that the medication is prescribed and administered once weekly.
C. Hold the medication whenever the patient reports mild joint discomfort.
D. Give the medication only when the patient has an active infection.
B. Verify that the medication is prescribed and administered once weekly.
The nurse is preparing to administer a biologic response-modifying drug by infusion. Which action is most appropriate before and during administration?
Choices:
A. Give every biologic response-modifying drug by the subcutaneous route.
B. Administer the drug without reviewing the manufacturer’s dilution directions.
C. Administer prescribed premedications and closely monitor vital signs, especially temperature.
D. Withhold all premedications because infusion reactions are uncommon.
E. Avoid assessing temperature unless the patient reports chills.
C. Administer prescribed premedications and closely monitor vital signs, especially temperature.
A nurse is preparing to administer topotecan. Which laboratory result requires the nurse to hold the medication and notify the prescriber?
Choices:
A. Baseline neutrophil count of 1,800 cells/mm3
B. Baseline neutrophil count of 1,200 cells/mm3
C. Baseline neutrophil count of 2,400 cells/mm3
D. Baseline neutrophil count of 3,100 cells/mm3
B. Baseline neutrophil count of 1,200 cells/mm3
A patient develops sudden bronchospasm and facial flushing several minutes after a docetaxel infusion begins. What is the nurse's priority action?
Choices:
A. Document the findings as an expected effect of chemotherapy
B. Contact the prescriber immediately and prepare for treatment of a hypersensitivity response
C. Continue the infusion and reassess the patient at the end of therapy
D. Administer the next scheduled dose of chemotherapy early
B. Contact the prescriber immediately and prepare for treatment of a hypersensitivity response
Which nursing intervention is most important when administering IV antineoplastic medications?
A) Administer rapidly to minimize tissue exposure
B) Use central venous access and verify correct placement
C) Mix all chemotherapy agents in one IV bag
D) Apply warm compresses to the IV site during infusion
B) Use central venous access and verify correct placement
: A patient receiving doxorubicin has gained 2.5 lb in 24 hours. Which action should the nurse take?
Choices:
A. Notify the prescriber about the weight increase
B. Document the weight and reassess it at the next monthly visit
C. Encourage the patient to increase fluid intake
D. Administer the next dose without further assessment
A. Notify the prescriber about the weight increase
The nurse is preparing a patient for infliximab therapy. Which findings should the nurse identify as requiring further evaluation before administration? Select all that apply.
Choices:
A. Positive or suspected latent tuberculosis
B. Active infection
C. Severe heart failure
D. A need for routine baseline weight measurement
E. A history of mild gastrointestinal upset after taking medication with food
A. Positive or suspected latent tuberculosis
B. Active infection
C. Severe heart failure
A patient is scheduled to receive myelosuppressive chemotherapy and filgrastim. Which nursing action is appropriate?
Choices:
A. Administer filgrastim only after the patient develops an infection.
B. Dilute filgrastim with sterile water for injection.
C. Administer filgrastim during the chemotherapy infusion.
D. Administer filgrastim before infection develops, but not within 24 hours before or after myelosuppressive chemotherapy.
E. Continue filgrastim after the ANC reaches 10,000/mm3 without notifying the prescriber.
D. Administer filgrastim before infection develops, but not within 24 hours before or after myelosuppressive chemotherapy.
The nurse is administering vincristine. Which action is essential to prevent a potentially fatal medication error?
Choices:
A. Administer vincristine intrathecally when treating leukemia
B. Give vincristine subcutaneously if the intravenous site is difficult to access
C. Administer vincristine by the intravenous route only
D. Dispense vincristine in a syringe for rapid administration
C. Administer vincristine by the intravenous route only
The nurse is monitoring a patient receiving doxorubicin. Which findings require prompt follow-up? Select all that apply.
Choices:
A. New dyspnea
B. A stable weight with clear breath sounds
C. A preference for a different meal
D. A weight gain of 2 lb (0.9 kg) in 24 hours
E. A newly irregular pulse
F. An abnormal heart sound
A. New dyspnea
D. A weight gain of 2 lb (0.9 kg) in 24 hours
E. A newly irregular pulse
F. An abnormal heart sound
A patient receiving methotrexate asks why she must have frequent laboratory tests. The best nursing response is:
A) "It's routine hospital policy for all patients."
B) "Methotrexate can suppress bone marrow and affect liver and kidney function, requiring close monitoring."
C) "Your insurance company requires it."
D) "The tests help us determine if you can stop the medication early."
B) "Methotrexate can suppress bone marrow and affect liver and kidney function, requiring close monitoring."
The nurse is teaching a family caregiver about oral chemotherapy administered at home. Which instructions should the nurse include? Select all that apply.
Choices:
A. Recognize that chemotherapy may be excreted in urine, stool, vomit, sweat, and saliva
B. Follow evidence-based precautions for hazardous medications
C. Handle the tablets with bare hands if the dose is small
D. Allow family members to handle the medication because it is taken orally
E. Use protective techniques when handling the tablets
A. Recognize that chemotherapy may be excreted in urine, stool, vomit, sweat, and saliva
B. Follow evidence-based precautions for hazardous medications
E. Use protective techniques when handling the tablets
A patient is receiving trastuzumab. Which assessment finding requires the nurse to notify the prescriber promptly?
Choices:
A. A documented history of rheumatoid arthritis
B. New signs of ventricular dysfunction or heart failure
C. Improved ability to perform activities of daily living
D. A need for premedication before the infusion
B. New signs of ventricular dysfunction or heart failure
The nurse is preparing to initiate abatacept therapy. Which actions are appropriate? Select all that apply.
Choices:
A. Use a fixed dose without considering the patient’s weight.
B. Complete a baseline head-to-toe assessment.
C. Obtain an accurate patient weight.
D. Review the patient’s immunization record.
E. Skip the baseline physical assessment because abatacept is not an antirheumatic drug.
F. Begin therapy before confirming that immunizations are current.
B. Complete a baseline head-to-toe assessment.
C. Obtain an accurate patient weight.
D. Review the patient’s immunization record.
A patient is receiving an M-phase taxane infusion. Which findings require immediate nursing action? Select all that apply.
Choices:
A. Crackles in the lungs
B. A preference for a different meal
C. Sudden bronchospasm
D. Mild fatigue after treatment
E. Flushing of the face
F. Dependent edema
A. Crackles in the lungs
C. Sudden bronchospasm
E. Flushing of the face
F. Dependent edema
: A patient receiving intravenous antineoplastic therapy reports burning and pain at the infusion site. Which action should the nurse take first?
Choices:
A. Increase the infusion rate to complete the medication promptly
B. Stop the infusion, leave the cannula in place, and follow the facility extravasation protocol
C. Remove the cannula immediately and apply firm pressure
D. Flush the line rapidly with additional intravenous solution
B. Stop the infusion, leave the cannula in place, and follow the facility extravasation protocol
A nurse is teaching a patient about alopecia related to antineoplastic therapy. Which statement by the patient indicates need for further education?
A) "Hair loss may be temporary and regrow after treatment ends."
B) "I should wear a wig or head covering if I choose."
C) "Hair loss is permanent and will never grow back."
D) "Scalp cooling may reduce hair loss during some treatments."
C) "Hair loss is permanent and will never grow back."
Which nursing interventions are appropriate for a patient receiving antineoplastic therapy with a risk for myelosuppression? Select all that apply.
Choices:
A. Take the patient's temperature rectally every 4 hours
B. Encourage the patient to report a temperature of 100.5°F (38.1°C) or higher
C. Use oral or axillary temperature measurements during periods of infection risk
D. Monitor blood cell counts as ordered
E. Perform careful hand hygiene and follow Standard Precautions
F. Delay reporting fever until the patient develops chills
B. Encourage the patient to report a temperature of 100.5°F (38.1°C) or higher
C. Use oral or axillary temperature measurements during periods of infection risk
D. Monitor blood cell counts as ordered
E. Perform careful hand hygiene and follow Standard Precautions
The nurse is completing baseline assessments before interferon therapy. Which actions are appropriate? Select all that apply.
Choices:
A. Assess BUN, creatinine, alkaline phosphatase, and AST levels.
B. Confirm that methotrexate is prescribed daily for rheumatoid arthritis.
C. Plan to administer filgrastim within 24 hours of myelosuppressive chemotherapy.
D. Review the medication profile for other bone marrow-suppressive drugs.
E. Obtain baseline white blood cell and platelet counts.
F. Review the patient's history for autoimmune disorders, hepatitis, liver failure, and AIDS.
A. Assess BUN, creatinine, alkaline phosphatase, and AST levels.
D. Review the medication profile for other bone marrow-suppressive drugs.
E. Obtain baseline white blood cell and platelet counts.
F. Review the patient's history for autoimmune disorders, hepatitis, liver failure, and AIDS.
Before initiating interferon therapy, which assessment is the nurse's priority?
Choices:
A. Restrict oral fluids before the first dose
B. Confirm that the patient is taking an immunosuppressant medication
C. Review the patient's history for autoimmune disorders, liver disease, hepatitis, AIDS, and drug allergies
D. Administer the first dose before obtaining baseline laboratory results
C. Review the patient's history for autoimmune disorders, liver disease, hepatitis, AIDS, and drug allergies
The nurse is reviewing cell-cycle-specific chemotherapy medications with a student. Which medication-phase associations are accurate? Select all that apply.
Choices:
A. Paclitaxel—M phase
B. Methotrexate—M phase
C. Vincristine—M phase
D. Irinotecan—G0 phase
E. Topotecan—S phase
F. Etoposide—G1 phase
A. Paclitaxel—M phase
C. Vincristine—M phase
E. Topotecan—S phase
F. Etoposide—G1 phase
The nurse is teaching a patient receiving cell-cycle-specific antineoplastic therapy about reducing infection and bleeding risks. Which instructions should the nurse include? Select all that apply.
Choices:
A. Eat raw foods to preserve their nutritional value
B. Receive intramuscular injections routinely to reduce venipunctures
C. Report a temperature of 100.5°F (38.1°C) or higher immediately
D. Use a soft toothbrush and report bleeding from the mouth or gums
E. Avoid people who have a cold, flu symptoms, or other signs of infection
F. Avoid rectal temperatures
C. Report a temperature of 100.5°F (38.1°C) or higher immediately
D. Use a soft toothbrush and report bleeding from the mouth or gums
E. Avoid people who have a cold, flu symptoms, or other signs of infection
F. Avoid rectal temperatures
Which patient statement demonstrates understanding of safe handling of a cytotoxic antineoplastic medication at home?
A) "I'll dispose of the medication in the toilet after treatment."
B) "I'll wear gloves when handling the medication and place used materials in a designated sealed container."
C) "Since it's a small dose, I don't need special precautions."
D) "I'll share leftover medication with a family member if they develop cancer."
B) "I'll wear gloves when handling the medication and place used materials in a designated sealed container."
: The nurse is caring for a patient receiving antineoplastic therapy. Which findings require immediate attention? Select all that apply.
Choices:
A. Dyspnea during therapy
B. Temperature of 100.4°F (38.1°C) or higher
C. Crackles in the lungs
D. Mild fatigue after treatment
E. Temporary decrease in appetite without vomiting
F. Severe diarrhea after irinotecan infusion
A. Dyspnea during therapy
B. Temperature of 100.4°F (38.1°C) or higher
C. Crackles in the lungs
F. Severe diarrhea after irinotecan infusion
Which nursing actions are appropriate when caring for a patient beginning disease-modifying antirheumatic drug therapy? Select all that apply.
Choices:
A. Assess hepatic function and baseline blood cell counts before leflunomide therapy.
B. Verify the patient's weight before abatacept therapy.
C. Obtain baseline blood cell and platelet counts.
D. Administer methotrexate daily to maintain continuous disease suppression.
E. Begin abatacept before confirming that immunizations are current.
F. Assess for active bacterial infection, active herpes, tuberculosis, and hepatitis B or C.
A. Assess hepatic function and baseline blood cell counts before leflunomide therapy.
B. Verify the patient's weight before abatacept therapy.
C. Obtain baseline blood cell and platelet counts.
F. Assess for active bacterial infection, active herpes, tuberculosis, and hepatitis B or C.
The nurse is preparing a patient for interferon therapy. Which baseline assessments should be completed? Select all that apply.
Choices:
A. No laboratory assessment unless symptoms develop
B. Only the patient's temperature and oxygen saturation
C. BUN and serum creatinine levels
D. WBC and platelet counts
E. Baseline neurologic functioning and blood pressure, including postural readings
F. ALP and AST levels
C. BUN and serum creatinine levels
D. WBC and platelet counts
E. Baseline neurologic functioning and blood pressure, including postural readings
F. ALP and AST levels