Deck 102: Anticancer Drugs I: Cytotoxic Agents

Question 1

A patient will begin receiving vincristine [Oncovin] to treat Hodgkin's lymphoma. Which side effect(s) will the nurse tell the patient to report immediately?

A) Diarrhea, nausea, and vomiting
B) Hair loss
C) Headaches
D) Tingling of the extremities

Answer 1

Tingling of the extremities

Question 2

A nurse is discussing the care of a patient with cancer with a nursing student. The patient is about to begin chemotherapy with a bifunctional alkylating agent. Which statement by the student indicates an understanding of this chemotherapeutic agent?

A) "Alkylating agents are toxic to tissues that have rapidly dividing cells."
B) "Bifunctional alkylating agents cannot form cross-links in DNA."
C) "Resistance to alkylating agents is rare."
D) "This drug needs to be given as a prolonged infusion."

Answer 2

"Alkylating agents are toxic to tissues that have rapidly dividing cells."

Question 3

A patient is receiving intravenous vincristine [Oncovin]. The patient complains of pain at the IV insertion site. The nurse examines the site and notes an area of erythema and edema. What will the nurse do?

A) Change the IV site and notify the provider of the extravasation.
B) Contact the provider to suggest using a different chemotherapeutic agent.
C) Obtain an order for a topical anesthetic to minimize discomfort.
D) Slow the rate of infusion to reduce the patient's discomfort.

Answer 3

Change the IV site and notify the provider of the extravasation.

Question 4

The nurse is preparing to administer medication to a patient receiving cyclophosphamide [Cytoxan]. To protect against the side effect of hemorrhagic cystitis, the nurse would expect to administer which drug?

A) Decadron
B) Diphenhydramine [Benadryl]
C) Leucovorin
D) Mesna [Mesnex]

Question 5

A patient who has urinary bladder cancer will begin receiving the chemotherapeutic agent valrubicin [Valstar]. What will the nurse do when administering this drug?

A) Administer the drug intravenously using a large bore needle and tubing.
B) Ensure that the tubing used to administer the drug does not contain polyvinyl chloride.
C) Monitor the patient closely for a variety of systemic drug adverse effects.
D) Use a normal saline or sterile water diluent to dilute the medication.

Question 6

The nurse on an oncology unit prepares to administer the fourth cycle of docetaxel [Taxotere] to a patient with breast cancer. Which clinical finding would cause the nurse to withhold the dose and call the prescriber?

A) Alanine transaminase (ALT) 1.2 times the upper limit
B) Alkaline phosphatase 2 times the upper limit
C) Neutrophil count below 1500/mm³
D) Creatinine clearance of 130 mL/min/1.73 m²

Question 7

A patient will receive intrathecal liposomal cytarabine [DepoCyt] to treat acute myelogenous leukemia. The provider has ordered the concurrent administration of dexamethasone. The nurse understands that this is given to:

A) prevent bone marrow suppression.
B) prevent hair loss and stomatitis.
C) reduce the incidence of pulmonary edema.
D) reduce the severity of chemical arachnoiditis.

Question 8

A nurse is teaching a patient who will undergo chemotherapy with fluorouracil [Adrucil] to treat a solid tumor. Which statement by the patient indicates understanding of this chemotherapeutic agent's actions?

A) "Fluorouracil acts to deprive cancer cells of thymidylate needed to make DNA."
B) "Fluorouracil causes accumulation of adenosine, which inhibits DNA synthesis."
C) "Fluorouracil disrupts the biosynthesis of nucleic acids."
D) "Fluorouracil inhibits DNA polymerase in cancer cells."

Question 9

A patient on an oncology unit has been receiving ifosfamide [Ifex] for a few days. Before administering the next dose, the nurse reviews the patient's laboratory test results. Which finding would cause the nurse to hold the dose?

A) Elevated white blood cell count
B) Low hemoglobin and hematocrit levels
C) Low levels of ketones in the urine
D) Microscopic hematuria

Question 10

The nurse is caring for a patient who has been receiving vinorelbine [Navelbine] for about 5 days. Which assessment finding in this patient would cause the nurse to withhold the next dose and notify the prescriber?

A) Alopecia
B) Dyspnea and cough
C) Neutrophil count of 1200/mm³
D) Peripheral neuropathy

Question 11

A patient who has a brain tumor will receive a nitrosourea agent. A nursing student asks why this type of drug is used for this type of cancer. The nurse will tell the student that nitrosoureas are useful because they:

A) are lipophilic.
B) are bifunctional alkylating agents.
C) have a broad spectrum of antineoplastic characteristics.
D) have delayed bone marrow suppression.

Question 12

A patient will begin chemotherapy with cisplatin. Which medications will the nurse expect to administer to offset this agent's side effects?

A) Amifostine [Ethyol], diuretics, and antiemetics
B) Antiemetics, vitamin B₁₂, and glucocorticoids
C) Dexamethasone, antiemetics, and vistonuridine
D) Folic acid, gabapentin, and vitamin B₁₂

Question 13

A patient is receiving fluorouracil [Adrucil] as a continuous intravenous dose to treat a solid tumor. The patient reports soreness and blisters in the mouth, loose stools, and tingling of the hands and feet. What will the nurse do?

A) Contact the provider to discuss bolus dosing instead of continuous dosing.
B) Discontinue the medication and contact the provider to report these symptoms.
C) Reassure the patient that these are expected, uncomfortable side effects.
D) Request an order for dexamethasone to treat these side effects.

Question 14

A nursing student asks a nurse how cancer cells become resistant to methotrexate [Rheumatrex]. The nurse is correct to respond by saying that cancer cells acquire resistance to methotrexate by:

A) reduced production of transporter that pumps methotrexate out of cells.
B) reduced synthesis of dihydrofolate reductase.
C) reduced uptake of methotrexate into cells.
D) increased ability to convert the drug to a polyglutamated form.

Question 15

A nurse is discussing vesicant chemotherapeutic agents with a nursing student. Which statement by the student indicates a need for further teaching about this type of drug?

A) "Extravasation of this type of drug may result in the need for skin grafts."
B) "If an IV line used for a vesicant drug infiltrates, it must be discontinued immediately."
C) "These drugs may be administered orally as well as intravenously."
D) "This type of drug may not be infused at a site of previous irradiation."

Question 16

A nursing student asks about the differences between cell-cycle phase-specific chemotherapeutic agents and those that are cell-cycle phase nonspecific. What will the nurse explain?

A) Cell-cycle phase-nonspecific drugs are less toxic.
B) Cell-cycle phase-specific drugs do not harm "resting" cells.
C) Cell-cycle phase-specific drugs should be given at specific intervals.
D) Neither type is toxic to cells in the "resting" G0 phase.

Question 17

A patient with non-Hodgkin's lymphoma is about to begin chemotherapy with a massive dose of methotrexate [Rheumatrex]. The nurse will expect to administer which medication concurrently with this drug?

A) Dexamethasone
B) Folic acid
C) Leucovorin
D) Vitamin B₁₂

Question 18

A nurse provides teaching to a patient who will begin taking oral cyclophosphamide to treat non-Hodgkin's lymphoma. Which statement by the patient indicates an understanding about how to minimize side effects while taking this drug?

A) "I don't need to worry about bone marrow suppression with this drug."
B) "I should drink plenty of fluids while taking this drug."
C) "I should take this drug on an empty stomach."
D) "If I shampoo less often, I can prevent hair loss."