Which of the following is true regarding intravenous infusion of a vesicant Quizlet

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Encapsulated

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Benign: grows slowly, localized, encapsulated, well differentiated cells, no metastasis, not harmful to host. Malignant: Grows rapidly, infiltrates surrounding tissues, not encapsulated, poorly differentiated, metastasis present, always harmful

Acetaminophen

Rationale:
Common side effects of rituximab include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, anorexia, and nausea. The patient is commonly premedicated with acetaminophen in an attempt to prevent or decrease the intensity of these symptoms, and large amounts of fluids help decrease symptoms.

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1. Science
2. Medicine
3. Oncology

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Terms in this set (33)

Which biologic 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

Which term means a substance that can cause cancer development?

a.
Malignant transformation
b.
Thrombocytopenia
c.
Carcinogen
d.
Emetogenic

ANS: C
A carcinogen is any substance or event that can damage the DNA of a cell and cause cancer development. Malignant transformation is the process of a normal cell changing into a cancer cell as a result of exposure to a carcinogen. Thrombocytopenia is a reduction of the normal level of platelets in the blood. Emetogenic is a substance or condition that induces vomiting.

Which class of chemotherapy drugs works by interfering with the formation of tubules so that new cells cannot separate during cell division?

a.
Antimetabolites
b.
Antitumor antibiotics
c.
Antimitotics
d.
Alkylating agents

ANS: C
Antimitotics work by disrupting the formation of spindles, which are needed to fully separate a cell that has undergone cell division into two new cells. Antimetabolites work by placing counterfeit bases into DNA so that those genes do not work properly and cell division does not occur. Antitumor antibiotics also damage the DNA and interrupt both DNA synthesis and RNA synthesis. Alkylating agents cross-link DNA so that it cannot separate.

Which type of chemotherapy drug causes tissue damage on direct contact?

a.
Cyclins
b.
Vesicants
c.
Biologics
d.
Emetogenics

ANS: B
Vesicants are tissue damaging drugs and chemicals. Cyclins are biologic agents that promote cell division. Biologics are substances made by the body and are now manufactured that stimulate or modify cell responses. Emetogenics are drugs or other substances that induce vomiting.

Which side effect of chemotherapy puts patients at increased risk for infection?

a.
Anemia
b.
Hypoxemia
c.
Neutropenia
d.
Thrombocytopenia

ANS: C
Neutropenia is a reduction in the normal amount of circulating neutrophils that are responsible for protection against infection. Hypoxemia is a reduced blood oxygen level. Anemia is a reduction in the number of circulating red blood cells. Thrombocytopenia is a reduction of circulating platelets that can result in impaired blood clotting.

Which statement regarding "dose dense" chemotherapy is true?

a.
It requires large volumes of intravenous fluids because it is very thick.
b.
It can be given only to patients whose cancers have a specific target.
c.
The dosage is based on the type of cancer and not on patient size.
d.
The side effects are more severe and harder to control.

ANS: D
Dose dense chemotherapy is a regimen in which higher doses of the drugs are given more frequently. Although this delivery schedule can increase the cure rate, it also makes the side effects, such as vomiting, more intense, which then are harder to control.

To what cancer therapy drug class does anastrozole (Arimidex) belong?

a.
Alkylating agent
b.
Biological response modifier
c.
Hormone inhibitor
d.
Miscellaneous agent

ANS: C
Anastrozole prevents the production of estrogen in the adrenal gland and reduces blood estrogen levels. Thus it is a hormone inhibitor.

Which normal tissue often shows side effects of therapy with any of the epidermal growth factor receptor inhibitor (EGFRI) drugs?

a.
Skin
b.
Kidney
c.
Heart
d.
Lungs

ANS: A
The skin contains a fairly high number of epidermal growth factor receptors. Thus drugs that work by inhibiting this receptor not only affect the cancer cells with these receptors, they also cause side effects in the skin and mucous membranes. The kidney, heart, and lungs have few, if any, of these receptors and do not experience side effects from EGFRIs.

How does oncogene activation cause normal cells to transform into cancer cells?

a.
By inhibiting the ability of suppressor gene products to regulate the cell cycle
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.

Why is it necessary to wear personal protective equipment (PPE) when preparing or administering chemotherapy?

a.
To allow maximum potency to be maintained
b.
To keep the drugs from becoming contaminated
c.
To prevent absorption through skin and mucous membranes
d.
To ensure the patient's blood does not come into direct contact with another person

ANS: C
Chemotherapy drugs are highly toxic to living cells and can be absorbed through skin and mucous membranes. Wearing PPE protects the person who is mixing or administering the drugs from coming into direct contact with them.

Why is chemotherapy considered "systemic" treatment for cancer?

a.
The dosage of chemotherapy is based on weight or square meters.
b.
The drugs are all cytotoxic and can cause serious harm if given at the wrong dose.
c.
It attacks rapidly dividing cells rather than cells that are either slowly dividing or not dividing.
d.
It circulates throughout the body and exerts its effects wherever the cells are located.

ANS: D
Surgery and radiation are considered local therapy because they affect only the tumor and the tissues very close by. Chemotherapy is considered systemic therapy because its effects are not confined to the local areas near the tissues only. Whether they are given intravenously or orally, they circulate through the entire body. This is why the side effects are so widespread.

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.
Pharmacy technician 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 pharmacy technicians may mix chemotherapy drugs under the direction of a pharmacist, they are not approved to administer them.

A patient with breast cancer asks why her hair is falling out while receiving chemotherapy when the cancer is in her breast. What is your 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.

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 system's 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.

Which action is most important to perform the first time a patient receives intravenous chemotherapy?

a.
Close the door to the room and do not let children visit.
b.
Wear a gown, mask, and gloves while taking vital signs.
c.
Stay with the patient during the first 15 minutes of the infusion.
d.
Be sure that two units of blood for the patient are on the unit before starting the infusion.

ANS: C
Chemotherapy drugs are high alert drugs that can have many adverse reactions. Most adverse reactions occur within the first 5 to 10 minutes of the infusion. Staying with the patient for the first 15 minutes allows you to observe the patient closely for signs of an adverse reaction and to intervene quickly if one should occur.

A patient who is receiving intravenous (IV) chemotherapy asks why you are wearing a mask, gloves, and gown when giving the drugs. What is your 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 person 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, pharmacists, and pharmacy technician) 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.

When it is time for a patient's third round of chemotherapy for colon cancer, the patient's white blood cell count is low and the treatment is delayed. The patient is upset at this delay. What is your 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 week's additional growth time for colon cancer is not significant.

What is the most important intervention for extravasation of an IV chemotherapy drug?

a.
Ensure that the drug given is the exact drug and dosage ordered.
b.
Administer the chemotherapy through an 18-gauge IV catheter.
c.
Instruct the patient to keep his or her arm below heart level.
d.
Prevent extravasation from ever occurring.

ANS: D
The most important intervention for extravasation is prevention. Monitor the access site of any infusing vesicant at least every 30 minutes to prevent extravasation or limit damage by preventing leakage of larger volumes. Assessing flow rate, checking for blood return, and asking about burning at the IV site are all parts of the process of prevention.

A patient arrives to receive a second round of combination chemotherapy. What is the most important patient assessment finding 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 patient's meter square (m2) of total body surface area. This measurement is calculated from the patient's height in centimeters and weight in kilograms. The patient's weight can change drastically from one round of chemotherapy to the next. Height does not change. Because this is the patient's second round, an accurate weight is needed to calculate the correct drug dosages.

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 your best action?

a.
Hold today's dose of chemotherapy and notify the prescriber immediately.
b.
Ask the patient whether sores were also 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 today's 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.

Which physical change indicates the patient receiving interferon therapy for melanoma may have peripheral neuropathy?

a.
Alopecia
b.
Numb toes
c.
Frequent urination
d.
Diarrhea

ANS: B
Peripheral neuropathy is a problem in which nerve function is impaired or gone. It is a common side effect with interferon therapy and some other types of cancer therapy. Sensory function is lost before motor function. Numb toes, as a new onset problem, is an indication of peripheral neuropathy.

A patient is receiving intravenous (IV) chemotherapy through a peripheral line. Which IV site assessment finding indicates 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.

Which chemotherapy problem, experienced by a patient after the first round of chemotherapy, do you 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/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 patient's 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.

Which intervention is most important to teach a patient receiving chemotherapy with a drug that causes thrombocytopenia?

a.
"Eat a low bacteria diet."
b.
"Take your temperature daily."
c.
"Use a soft-bristled toothbrush and do not floss."
d.
"Avoid using mouthwashes that contain alcohol."

ANS: C
Thrombocytopenia is a low blood platelet count that can interfere with blood clotting and makes the patient at high risk for bleeding. Using a soft-bristled toothbrush and not flossing prevent injury to the gums that could result in excessive bleeding.

How does flutamide (Eulexin) control prostate cancer?

a.
It prevents the adrenal gland from producing testosterone and lowers blood testosterone levels.
b.
It stimulates the lymphocytes of the immune system to attack and destroy prostate cancer cells as if they were foreign tissues.
c.
It is an antiandrogen that binds to testosterone receptors and prevents or slows prostate cancer cell growth.
d.
It is a synthetic estrogen (an estrogen agonist) that binds testosterone receptors and prevents or slows prostate cancer cell growth.

ANS: C
Flutamide is an antiandrogen drug, not a synthetic estrogen, that binds to testosterone receptors on prostate cancer cells and prevents naturally occurring testosterone from binding to them. Most prostate cancer cells require testosterone to grow. By blocking the receptors with an antiandrogen, prostate cancer cell growth is prevented or at least slowed.

How is therapy with biological response modifiers (BRMs) different from targeted therapy?

a.
There is no difference; the terms mean the same thing.
b.
Targeted therapy only works on cancers that are inherited and BRMs work on all cancers.
c.
BRMs are administered as oral agents whereas targeted therapies must be injected directly into the tumor to be effective.
d.
BRMs affect the general immune response of anyone who takes the drug and targeted therapies only work in cancer cells that have a specific target.

ANS: D
Targeted therapies are effective only against cancer cells that actually express the target and BRMs induce immune system changes in anyone taking the drug. Some targeted therapies are oral agents and others must be administered intravenously, not injected into the tumor.

Which side effects are most common among patients receiving therapy with biological response modifiers (BRMs)?

a.
Alopecia and bad breath
b.
Abdominal cramps and constipation
c.
Productive cough and wheezing
d.
Fever, chills, and flulike symptoms

ANS: D
BRMs stimulate the immune system, especially inflammation. The side effects produced from the stimulation include fever, chills, rigors, and flulike symptoms.

A patient receiving hormone manipulation as cancer therapy has all of the following side effects. For which one should you notify the prescriber immediately?

a.
Redness, pain, and swelling of the calf
b.
Fluid retention with weight gain
c.
Acne and darkening of the skin
d.
Breast swelling and tenderness

ANS: A
The redness, pain, and swelling of the calf indicate a possible deep vein thrombosis, which can be life-threatening. Immediate intervention is needed. Although skin changes and breast tenderness may be distressing, they do not warrant immediate intervention. The fluid retention and weight gain are expected and should be monitored but do not require immediate intervention.

A male patient is prescribed estrogen as hormone treatment for cancer. Which assessment is most important 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 patient's abdominal girth.

ANS: C
Using estrogen as hormone therapy for cancer increases the risk for developing blood clots and deep vein thrombosis. The patient should be assessed for this problem at every clinic visit and instructed to perform daily assessment of the lower extremities for swelling, hard, cordlike veins, redness along the vein tract, and extremity pain.

Which chemotherapy agents in this list have a high emetogenic potential? (select all that apply)

a.
Busulfan (Myleran)
b.
Capecitabine (Xeloda)
c.
Dactinomycin (Cosmegen)
d.
Floxuridine (FUDR)
e.
Melphalan (Alkeran)
f.
Mitoxantrone (Novantrone)
g.
Thiotepa (Thioplex)
h.
Vincristine (Oncovin)

ANS: A, C, D, E
As described in Table 12-2, busulfan, dactinomycin, floxuridine, and melphalal all have a high potential for causing nausea/vomiting. Capecitabine, mitoxantrone, thiotepa, and vincristine all have a low potential for causing nausea/vomiting.

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/vomiting
d.
Neutropenia
e.
Peripheral neuropathy
f.
Stomach and intestinal changes

ANS: C, D, E
Nausea/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.

An infant with cancer is to receive vincristine (Oncovin) 0.05 mg/kg intravenously. The infant weighs 18 lb. What is the appropriate dose, in mg?

ANS:
0.409

1 kg = 2.2 lb.
18 lb/2.2 = 8.18 kg.
0.05 mg × 8.18 kg = 0.409 mg.

Calculate the meter square body surface area for a man who is 5 feet 9 inches tall and weighs 157 lb.

ANS:
1.25

The formula for meter square body surface area is to multiply the person's weight in kg by his or her height in centimeters (cm) and dividing the product by 10,000 (because there are 10,000 centimeters square cm2 in 1 m2 square).
1 kg = 2.2 lb.
1 inch = 2.54 cm.
157 lb/2.2 = 71.36 kg.
5 feet 9 inches = 69 inches × 2.54 = 175.26 cm.
175.26 cm × 71.36 kg = 12,506.55, round up to 12,507 cm2.
12,507 cm2/10,000 = 1.25 m2.

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Which is the safest way to administer vesicant therapy?

Which adverse effect is observed when a vesicant agent extravasation during chemotherapy?

Which type of chemotherapy drug causes tissue damage on direct contact?

Which of the following is a concern when using oral chemotherapy agents?