Term
| A client with acute myelocytic leukemia is being treated with busulfan (Myleran, Busulfex). What lab value can you expect to be elevated? |
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Definition
| Busulfan (Myleran, Busulfex) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute kidney injury. |
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Term
| A client with small cell lung cancer is being treated with etoposide (Toposar). The nurse monitors the client during administration, knowing that which adverse effect is specifically associated with this medication? |
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Definition
| An adverse effect specific to etoposide is orthostatic hypotension. Etoposide should be administered slowly over 30 to 60 minutes to avoid hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all the antineoplastic medications |
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Term
| A client with ovarian cancer is being treated with vincristine (Vincasar). The nurse monitors the client, knowing that which manifestation indicates an adverse effect specific to this medication? |
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Definition
Peripheral neuropathy
An adverse effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy |
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Term
| The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse contacts the health care provider before administering the medication if which disorder is documented in the client's history? |
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Definition
Pancreatitis
Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between dose administrations. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. |
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Term
| Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The nurse administering the medication understands that which is the primary action of this medication? |
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Definition
Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNA synthesis and estrogen response.
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Term
| A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? |
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Definition
Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium level should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.
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Term
| Megestrol acetate (Megace), an antineoplastic medication, is prescribed for a client with metastatic endometrial carcinoma. The nurse reviews the client's history and should contact the health care provider if which diagnosis is documented in the client's history? |
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Definition
Megestrol acetate (Megace) suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of thrombophlebitis
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Term
| The nurse is monitoring the intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. On inspection of the site, the nurse notes redness and swelling and that the infusion of the medication has slowed in rate. The nurse suspects extravasation and should take which actions? |
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Definition
Stop the infusion.
Notify the health care provider (HCP)
Prepare to apply ice or heat to the site
Prepare to administer a prescribed antidote into the site |
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Term
| The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? |
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Definition
Increased uric acid level
Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in massive cell kill. |
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Term
| The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action? |
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Definition
Hemorrhagic cystitis is an adverse effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase potassium intake
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Term
| A client with non–Hodgkin's lymphoma is receiving daunorubicin (DaunoXome). Which finding would indicate to the nurse that the client is experiencing an adverse effect related to the medication? |
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Definition
Crackles on auscultation of the lungs
Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as heart failure (lung crackles) is an adverse effect of daunorubicin. Bone marrow depression is also an adverse effect. Fever is a frequent side effect and sores in the mouth and throat can occur occasionally. Nausea and vomiting is a frequent side effect associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. |
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Term
| The nurse is reviewing the record of a client who arrives at the health care clinic. The nurse notes that the client is taking letrozole (Femara). The nurse should suspect that the client has which disorder? |
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Definition
| Letrozole is used in the palliative treatment for advanced breast cancer in the postmenopausal woman with disease progression after treatment with antiestrogen therapy |
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Term
| A nurse is monitoring a client with acute lymphocytic leukemia for toxic effects of asparaginase (Elspar). The nurse should notify the health care provider if monitoring reveals which finding? |
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Definition
Prolonged blood clotting times
Asparaginase can cause severe adverse effects; however, they often are different from those of other antineoplastic medications. By inhibiting protein synthesis, the medication can cause coagulation deficiencies and injury to the liver, pancreas, and kidneys. Signs and symptoms of central nervous system depression ranging from confusion to coma can occur. Nausea and vomiting can be intense and may limit the dose that can be tolerated. In contrast with most antineoplastic medications, asparaginase does not depress the bone marrow, nor does it cause alopecia, oral ulceration, or intestinal ulceration. |
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Term
| A client with testicular cancer is receiving cisplatin. The nurse assesses for which finding as a toxic effect of this medication? |
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Definition
Tinnitus
Cisplatin is a medication that kills cells primarily by forming cross-links between and within strands of deoxyribonucleic acid. Its principal use is in the treatment of testicular cancer, although it also can be used to treat carcinomas of the ovary, bladder, head, and neck. It can cause neurotoxicity, nephrotoxicity, bone marrow depression, and ototoxicity, which manifests as tinnitus and high-frequency hearing loss. Nausea and vomiting are expected side effects, which can be severe and begin 1 hour after administration, persisting for 1 to 2 days |
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Term
| The nurse transcribes a medication prescription for ifosfamide (Ifex) for a client with a diagnosis of germ cell cancer of the testes. The nurse reviews the client's history and looks for another prescription for which medication, which usually is administered with the antineoplastic medication? |
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Definition
Mesna (Mesnex)
Ifosfamide is used to treat refractory germ cell cancer of the testes. Concurrent therapy with mesna and at least 2 L of oral or intravenous fluid daily will limit the toxicity of this medication, evidenced by bone marrow depression and hemorrhagic cystitis. Mesna is a detoxifying agent used to inhibit the hemorrhagic cystitis induced by ifosfamide. |
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Term
| A client with squamous cell carcinoma is receiving bleomycin. To determine whether adverse effects of this medication are occurring, the nurse should carefully assess which item? |
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Definition
Lung sounds
The major form of dose-limiting toxicity with bleomycin is injury to the lungs. It manifests initially as pneumonitis but can progress to severe pulmonary fibrosis and death. In addition to auscultation of lung sounds, pulmonary function studies should be monitored. Bleomycin is discontinued at the first sign of these adverse changes. Nausea and vomiting usually are mild with the use of this medication, and unlike most other anticancer agents, bleomycin exerts minimal toxicity to bone marrow. |
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Term
| The nurse caring for a client receiving vincristine (Oncovin) is monitoring the client for toxicity. The nurse interprets that the client is experiencing a toxic effect of this medication on the basis of which assessment finding? |
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Definition
Weakness and sensory loss in the legs
Peripheral neuropathy is the major dose-limiting toxicity associated with vincristine. Nearly all clients exhibit signs and symptoms of sensory or motor nerve injury such as decreased reflexes, weakness, paresthesia, and sensory loss. Nausea and vomiting are rare with the use of this medication. In contrast with most anticancer medications, vincristine causes little toxicity to bone marrow. |
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Term
| A client is receiving intravesical chemotherapy for cancer of the bladder. The nurse should plan to take which action after the completion of each treatment? |
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Definition
After intravesical chemotherapy, the nurse increases fluids to help flush the medication out of the bladder after the period of retention.
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Term
| A female client with a diagnosis of breast cancer is taking cyclophosphamide. The client calls the health care clinic and tells the nurse that the medication is upsetting her stomach. What instruction should the nurse provide to the client? |
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Definition
| Hemorrhagic cystitis is a toxic effect that can occur with the use of this medication. The medication should be taken on an empty stomach, but if the client complains of gastrointestinal (GI) upset, it can be taken with food. The client who is taking cyclophosphamide needs to be instructed to drink copious amounts of fluids during the administration of this medication. Orange juice probably would cause and increase the GI upset. |
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Term
| The nurse is preparing a plan of care for a client who will be receiving intravenous bleomycin sulfate for the treatment of cancer. In developing the plan of care, the nurse includes monitoring of which option as the priority? |
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Definition
Lung sounds
Bleomycin is an antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. The priority is to monitor lung sounds for the presence of crackles, which may indicate pulmonary toxicity. Pulmonary function studies along with hematological, hepatic, and renal function tests are required in monitoring for toxic effects of this agent. If pulmonary toxicity develops, the medication would be discontinued. |
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Term
| The nurse is monitoring a client with leukemia who is receiving doxorubicin (Adriamycin PFS) by intravenous infusion. The nurse should monitor for which assessment finding that would indicate toxicity to the medication? |
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Definition
Electrocardiogram (ECG) changes
Cardiotoxicity can occur with the use of doxorubicin. The medication can produce irreversible toxicity to the heart, including ECG changes and heart failure. |
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Term
| The nurse is collecting subjective and objective data from a client and notes that the client is taking capecitabine (Xeloda). The nurse determines that this medication has been prescribed to treat which condition? |
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Definition
Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. It also is used to treat colon cancer.
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Term
| Capecitabine (Xeloda) has been prescribed for a client, and the client asks the nurse about the action of the medication. The nurse responds that this medication has which mechanism of action? |
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Definition
Capecitabine is an antimetabolite that inhibits enzymes necessary for the synthesis of essential cellular components. It interferes with DNA synthesis, RNA processing, and protein synthesis.
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Term
| The health care provider (HCP) writes a prescription for capecitabine (Xeloda) for a client who was admitted to the hospital. The nurse should contact the HCP to verify the prescription if which condition is noted in the assessment data? |
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Definition
Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. A contraindication to the use of this medication is severe renal impairment such as that which occurs in chronic kidney disease.
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Term
| Capecitabine (Xeloda) has been prescribed for a client. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication? |
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Definition
Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Bone marrow depression can occur from the use of this medication, and a CBC and blood chemistry studies should be done periodically. Liver function tests, bilirubin level assay, and triglyceride levels are unnecessary.
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Term
| Capecitabine (Xeloda) has been prescribed for a client, and the client asks the nurse about the side effects of the medication. The nurse responds that a frequent side effect of this medication is which finding? |
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Definition
Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Frequent side effects include diarrhea, nausea, vomiting, stomatitis, hand and foot syndrome (painful palmar-plantar erythema and swelling with paresthesias, tingling, and blistering), fatigue, anorexia, and dermatitis.
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Term
| A client admitted to the hospital is taking capecitabine (Xeloda). The nurse should monitor the client for which symptom that is an adverse effect of the medication? |
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Definition
Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Adverse effects include bone marrow depression, cardiovascular toxicity, and respiratory toxicity. Headache, constipation, and dizziness are not adverse effects of this medication.
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Term
| A female client with carcinoma of the breast is admitted to the hospital for treatment with intravenously administered doxorubicin (Adriamycin). The client tells the nurse she has been told by her friends that she is going to lose all her hair. What is the appropriate nursing response? |
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Definition
Alopecia (hair loss) can occur after the administration of many antineoplastic medications. Alopecia is reversible, but the new hair growth may have a different color and texture.
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Term
| The clinic nurse prepares instructions for a client who developed stomatitis after the administration of a course of antineoplastic medications. The nurse should provide the client with which instruction? |
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Definition
| Stomatitis (ulceration in the mouth) can result from the administration of antineoplastic medications. The client should be instructed to examine the mouth daily and report any signs of ulceration. If stomatitis occurs, the client should be instructed to rinse the mouth with baking soda or saline. |
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Term
| The client with bladder cancer is receiving cisplatin and vincristine (Vincasar PFS). The nurse preparing to give the medication understands that which is the purpose of administering both of these medications? |
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Definition
Combinations of medications are used to enhance tumoricidal effects and increase the therapeutic response.
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Term
| A client with lung cancer is receiving a high dose of methotrexate (Trexall). Leucovorin (citrovorum factor, folic acid) is also prescribed. The nurse planning care for the client should understand that the purpose of administering the leucovorin is to promote which action? |
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Definition
High concentrations of methotrexate harm and damage normal cells. To save normal cells, leucovorin is given; this is known as leucovorin rescue. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting normal cells to synthesize. Note that leucovorin rescue is potentially hazardous. Failure to administer leucovorin in the right dose at the right time can be fatal.
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Term
| The nurse administering a combination chemotherapy regimen understands that it is important to implement which action? |
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Definition
Avoid giving agents with the same nadirs and toxicities at the same time.
The goal of administering combination chemotherapy in cycles or specific sequences is to produce additive or synergistic therapeutic effects. Administering several medications with different mechanisms of action and different onsets of nadirs and toxicities enhances tumor cell destruction while minimizing medication resistance and overlapping toxicities. |
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Term
| A client with cancer has received a course of chemotherapy and received fluorouracil (Adrucil). The nurse should tell the client to report which finding immediately? |
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Definition
Fluorouracil (Adrucil) should be discontinued as soon as reactions (stomatitis, diarrhea) occur. Dosage can also be limited by palmar-plantar erythrodysesthesia syndrome (also called hand-foot syndrome), characterized by tingling, burning, redness, flaking, swelling, and blistering of the palms and soles.
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Term
| The nurse reviewing a medical record notes that high concentrations of methotrexate followed by leucovorin (citrovorum factor, folic acid) are being given to the client with cancer. The nurse correctly interprets that which is the reason for therapy with leucovorin? |
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Definition
Preserve normal cells.
The administration of leucovorin with methotrexate is known as leucovorin rescue. High concentrations of methotrexate cause harm and damage to normal cells. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting normal cells to synthesize. Leucovorin rescue is potentially hazardous, because failure to administer leucovorin in the right dose at the right time can be fatal. |
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Term
| The nurse understands that which condition is an indication for the use of asparaginase (Elspar)? |
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Definition
Asparaginase is indicated for the treatment of acute lymphocytic leukemia. Lung cancer, breast cancer, and metastatic prostate cancer are treated with other antineoplastic agents.
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Term
| The nurse tells a client with leukemia who is receiving chemotherapy that allopurinol (Zyloprim) has been added to the medication list. When the client asks the purpose of the new medication, the nurse responds that the allopurinol is intended to prevent which problem? |
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Definition
Chemotherapy destroys cells leading to the release of uric acid into the bloodstream. The client is then at risk of experiencing uric acid nephropathy, renal stones, and acute kidney injury. Allopurinol (Zyloprim), an antigout medication, is used with chemotherapy to prevent or treat this complication of therapy. It also may be used in mouthwash following fluorouracil (Adrucil) therapy to prevent stomatitis.
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Term
| A nurse is assigned to care for a client with metastatic breast cancer who is taking tamoxifen citrate. The nurse plans to monitor for which changes in laboratory values for this client? |
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Definition
Tamoxifen citrate is an antiestrogen and antineoplastic medication. It may increase the calcium level and lower the low-density lipoprotein levels. Before the initiation of therapy, the complete blood count (CBC), platelet count, and serum calcium levels should be determined. These blood levels should continue to be monitored periodically during therapy. The nurse should monitor for signs of hypercalcemia while the client is taking this medication. These signs include increased urine volume, excessive thirst, nausea, vomiting, constipation, decreased muscle tone, and deep bone or flank pain.
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