bevacizumab
A client receiving bevacizumab for metastatic colorectal cancer develops sudden severe abdominal pain and tenderness. Which potential adverse effect should the nurse suspect?
A. Hypertensive crisis
B. Gastrointestinal perforation
C. Tumor lysis syndrome
D. Pulmonary embolism
Correct Answer: B. Gastrointestinal perforation
Rationale: Bevacizumab can cause GI perforation or fistula formation, a life-threatening complication that presents with acute abdominal pain and tenderness.
A client with non–small cell lung cancer is prescribed erlotinib. The nurse understands that this drug works primarily by which mechanism?
A. Stimulating immune cells to destroy tumor tissue
B. Inhibiting the activation of epidermal growth factor receptor tyrosine kinase
C. Blocking androgen receptors in cancer cells
D. Preventing DNA cross-linking during cell replication
Correct Answer: B. Inhibiting the activation of epidermal growth factor receptor tyrosine kinase
Rationale: Erlotinib selectively inhibits EGFR tyrosine kinase, blocking signals that promote angiogenesis and cellular proliferation in cancer cells.
A client with chronic myelogenous leukemia (CML) is prescribed imatinib mesylate. The nurse understands that this drug works primarily by which mechanism?
A. Stimulating bone marrow to produce more leukocytes
B. Blocking DNA synthesis during the S phase of the cell cycle
C. Inhibiting the ATP binding site of the BCR-ABL tyrosine kinase
D. Enhancing immune cell recognition of tumor antigens
Correct Answer: C. Inhibiting the ATP binding site of the BCR-ABL tyrosine kinase
Rationale: Imatinib competitively inhibits the ATP binding site on the BCR-ABL kinase, halting proliferation and inducing apoptosis in Philadelphia chromosome–positive CML cells.
A client with multiple myeloma is prescribed bortezomib. The nurse understands that the primary mechanism of action of this medication is to:
A. Block DNA replication during the S phase of the cell cycle
B. Inhibit angiogenesis and tumor blood vessel formation
C. Reversibly inhibit the 26S proteasome, disrupting protein degradation in malignant cells
D. Prevent folic acid synthesis required for cancer cell proliferation
Correct Answer: C. Reversibly inhibit the 26S proteasome, disrupting protein degradation in malignant cells
Rationale: Bortezomib inhibits the 26S proteasome, which regulates protein degradation. This leads to the accumulation of abnormal proteins in cancer cells and triggers apoptosis, particularly in malignant plasma cells.
A client is receiving rituximab for the treatment of non-Hodgkin’s lymphoma. The nurse understands that the primary mechanism of action of this drug is to:
A. Stimulate bone marrow to produce new white blood cells
B. Bind to a specific antigen on cancer cells to inactivate or destroy them
C. Inhibit the enzyme tyrosine kinase to prevent cancer cell growth
D. Block DNA synthesis during cell division
Correct Answer: B. Bind to a specific antigen on cancer cells to inactivate or destroy them
Rationale: Rituximab is a monoclonal antibody that binds to a specific target antigen on malignant cells, marking them for destruction by the immune system.
A nurse is teaching a client about bevacizumab therapy. Which statement by the client indicates the need for further teaching?
A. “This medication works by blocking the growth of new blood vessels that feed the tumor.”
B. “It’s important that I monitor my blood pressure regularly during therapy.”
C. “I should avoid pregnancy while taking this drug.”
D. “It’s okay to have surgery right after my next infusion.”
Correct Answer: D. “It’s okay to have surgery right after my next infusion.”
Rationale: Bevacizumab delays wound healing and increases the risk of wound dehiscence, so it should be discontinued before elective surgery.
While assessing a client receiving erlotinib, the nurse should recognize which symptom as an adverse reaction requiring immediate provider notification?
A. Mild alopecia
B. Fatigue and anorexia
C. Shortness of breath with cough
D. Anxiety
Correct Answer: C. Shortness of breath with cough
Rationale: These may indicate interstitial pulmonary disease, a serious adverse effect of erlotinib that can lead to respiratory failure.
The nurse should monitor a client receiving imatinib for which serious adverse effect related to fluid balance?
A. Polyuria
B. Dehydration
C. Pleural effusion
D. Diarrhea
Correct Answer: C. Pleural effusion
Rationale: Pleural effusions and edema are serious adverse effects of imatinib and may lead to heart failure or pulmonary compromise if untreated.
The nurse caring for a client receiving bortezomib should monitor closely for which adverse effect associated with nerve damage?
A. Paresthesia and numbness in the extremities
B. Increased deep tendon reflexes
C. Visual changes
D. Hypertension
Correct Answer: A. Paresthesia and numbness in the extremities
Rationale: Peripheral neuropathy is a common and potentially dose-limiting side effect of bortezomib, presenting as numbness, tingling, or burning pain in the hands and feet.
During the first infusion of rituximab, the client suddenly develops shortness of breath, dizziness, and hypotension. Which action should the nurse take first?
A. Slow the infusion rate
B. Notify the healthcare provider
C. Stop the infusion immediately and assess the airway
D. Document the reaction in the client’s chart
Correct Answer: C. Stop the infusion immediately and assess the airway
Rationale: These are signs of a severe infusion reaction or anaphylaxis. The nurse must first stop the infusion and assess airway and breathing before notifying the provider.
The nurse reviews laboratory results for a client receiving bevacizumab. Which finding requires immediate intervention?
A. Mild leukopenia
B. Proteinuria
C. Hemoglobin of 12.8 g/dL
D. Sodium of 138 mEq/L
Correct Answer: B. Proteinuria
Rationale: Proteinuria indicates possible nephrotic syndrome, a known adverse effect of bevacizumab. The provider should be notified to prevent further renal damage.
A nurse is providing education to a client starting erlotinib therapy. Which statement by the client indicates a need for further teaching?
A. “I should avoid smoking while on this medication.”
B. “I may experience some diarrhea or skin changes.”
C. “It’s safe to continue taking this medication during pregnancy.”
D. “I need to report any sudden vision changes to my doctor.”
Correct Answer: C. “It’s safe to continue taking this medication during pregnancy.”
Rationale: Erlotinib is not safe during pregnancy or breastfeeding. It poses a risk for fetal harm, and contraception is recommended during therapy.
A client taking imatinib mesylate reports new-onset shortness of breath, weight gain, and swelling of the lower extremities. Which complication should the nurse suspect?
A. Cardiac tamponade
B. Heart failure
C. Tumor lysis syndrome
D. Renal failure
Correct Answer: B. Heart failure
Rationale: Fluid retention and edema from imatinib can progress to congestive heart failure, requiring immediate evaluation and possible discontinuation of the medication.
When reviewing the laboratory results of a client receiving bortezomib, which finding would be most concerning and require immediate follow-up?
A. Hemoglobin 12.9 g/dL
B. Platelet count 50,000/mm³
C. Sodium 138 mEq/L
D. Glucose 92 mg/dL
Correct Answer: B. Platelet count 50,000/mm³
Rationale: Bortezomib can cause pancytopenia, including thrombocytopenia, which increases the client’s risk for bleeding.
The nurse is reviewing the possible side effects of rituximab with a client. Which finding should the nurse tell the client to report immediately to the healthcare provider?
A. Mild fatigue
B. Headache after infusion
C. Fever, chills, and shortness of breath
D. Transient dizziness
Correct Answer: C. Fever, chills, and shortness of breath
Rationale: These may indicate a serious infusion reaction or cytokine release syndrome, which requires immediate medical evaluation and possible discontinuation of therapy.
A client receiving bevacizumab reports a severe headache and visual disturbances. The nurse should suspect which serious complication?
A. Posterior reversible encephalopathy syndrome (PRES)
B. Hyponatremia
C. Cerebral metastasis
D. Anxiety-related migraine
Correct Answer: A. Posterior reversible encephalopathy syndrome (PRES)
Rationale: Bevacizumab may cause PRES, characterized by headache, visual changes, seizures, and confusion due to severe hypertension and cerebral edem
The nurse is caring for a client taking erlotinib who reports severe abdominal pain. Which potential complication should the nurse suspect?
A. Peptic ulcer disease
B. Gastrointestinal perforation
C. Constipation
D. Liver metastasis
Correct Answer: B. Gastrointestinal perforation
Rationale: Erlotinib increases the risk of GI perforation, especially in clients with a history of peptic ulcer disease or diverticulitis. This is a medical emergency.
Which teaching point is most important for a woman of childbearing age who is starting imatinib therapy?
A. “You should stop taking all vitamins and supplements while on this drug.”
B. “This medication is safe during pregnancy after the first trimester.”
C. “Use reliable contraception; this drug is contraindicated during pregnancy.”
D. “You can resume breastfeeding once you’ve completed a few doses.”
Correct Answer: C. “Use reliable contraception; this drug is contraindicated during pregnancy.”
Rationale: Imatinib is teratogenic and contraindicated in patients who are pregnant or may become pregnant. Breastfeeding should also be avoided.
A client receiving bortezomib complains of dizziness and lightheadedness when standing. Which nursing intervention is most appropriate?
A. Administer an antiemetic
B. Encourage the client to increase physical activity
C. Teach the client to change positions slowly
D. Restrict fluid intake to prevent fluid overload
Correct Answer: C. Teach the client to change positions slowly
Rationale: Hypotension is a side effect of bortezomib. To reduce the risk of injury from orthostatic changes, clients should rise slowly from sitting or lying positions.
Which of the following laboratory findings would be most concerning in a client receiving rituximab?
A. WBC count 7,000/mm³
B. Blood glucose 110 mg/dL
C. Platelet count 40,000/mm³
D. Hemoglobin 13.5 g/dL
Correct Answer: C. Platelet count 40,000/mm³
Rationale: Rituximab can cause blood dyscrasias (such as thrombocytopenia), which increase the risk for bleeding. A platelet count this low warrants prompt intervention.
A nurse is assessing a client who recently began bevacizumab therapy. Which finding should the nurse prioritize reporting to the healthcare provider?
A. Blood pressure of 168/96 mm Hg
B. Mild back pain
C. Occasional nosebleeds
D. Dry skin and taste alteration
Correct Answer: A. Blood pressure of 168/96 mm Hg
Rationale: Hypertension and hypertensive crisis are common adverse effects of bevacizumab and must be monitored closely. Elevated BP increases the risk for stroke and encephalopathy.
A client on erlotinib reports new-onset blurred vision and eye pain. What should be the nurse’s priority action?
A. Reassure the client that this is a normal side effect
B. Encourage rest and recheck vision in a few days
C. Hold the medication and notify the healthcare provider immediately
D. Instruct the client to use artificial tears for dryness
Correct Answer: C. Hold the medication and notify the healthcare provider immediately
Rationale: Ocular changes such as vision loss or pain may signal serious corneal or retinal damage, an adverse reaction requiring immediate medical attention.
Which laboratory finding would be most concerning in a client receiving imatinib mesylate?
A. Hemoglobin 14 g/dL
B. ALT 125 U/L
C. Sodium 138 mEq/L
D. WBC 7,000/mm³
Correct Answer: B. ALT 125 U/L
Rationale: Hepatotoxicity is a known adverse effect of imatinib. Elevated liver enzymes, such as ALT, indicate potential liver damage and require prompt provider notification.
Which assessment finding in a client taking bortezomib should prompt the nurse to notify the healthcare provider immediately?
A. Mild rash on the upper arms
B. Injection site redness
C. Petechiae and unusual bruising
D. Fatigue after activity
Correct Answer: C. Petechiae and unusual bruising
Rationale: Pancytopenia caused by bortezomib can lead to thrombocytopenia, increasing the risk for bleeding. Petechiae and bruising indicate potential hematologic toxicity and warrant provider notification.
The nurse is teaching a client receiving rituximab about potential adverse effects. Which statement by the client indicates the need for further teaching?
A. “I might feel tired or have a mild headache after treatment.”
B. “If I get chills or trouble breathing, I should call 911 right away.”
C. “It’s normal to have mild itching and rash after every infusion, so I don’t need to report it.”
D. “I should check my blood sugar if I feel unusually thirsty or weak.”
Correct Answer: C. ‘It’s normal to have mild itching and rash after every infusion, so I don’t need to report it.’
Rationale: Even mild rash or itching can be an early sign of a hypersensitivity or anaphylactic reaction with rituximab and should always be reported to the provider