Chapter 45: Antineoplastic Drugs Part 1: Cancer Overview and Cell Cycle–Specific
Drugs
Lilley: Pharmacology and the Nursing Process, 8th Edition
MULTIPLE CHOICE
1. One patient has cancer of the bone; another has cancer in the connective tissues of the thigh
muscles; a third patient has cancer in the vascular tissues. Which of these is the correct term
for these tumors?
a. Sarcoma
b. Leukemia
c. Carcinoma
d. Lymphoma
ANS: A
Sarcomas are malignant tumors that arise from connective tissues. These tissues can be found
in bone, cartilage, muscle, blood, lymphatic, and vascular tissues. The other options are
incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 711
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
2. A patient is receiving her third course of 5-fluorouracil therapy and knows that stomatitis is a
potential adverse effect of antineoplastic therapy. What will the nurse teach her about
managing this problem?
a. “You can take aspirin to prevent stomatitis.”
b. “Be sure to watch for and report black, tarry stools immediately.”
c. “You need to increase your intake of foods containing fiber and citric acid.”
d. “Be sure to examine your mouth daily for bleeding, painful areas, and ulcerations.”
ANS: D
The symptoms of stomatitis consist of pain or burning in the mouth, difficulty swallowing,
taste changes, viscous saliva, dryness, cracking, and fissures, with or without bleeding
mucosa. Teach patients to avoid consuming foods containing citric acid and foods that are hot
or spicy or high in fiber. Assessing stools is important but is not related to stomatitis, and
aspirin must not be used during this therapy.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 731
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
3. The nurse is developing a plan of care for a patient who is experiencing gastrointestinal
adverse effects, including anorexia and nausea, after the first course of antineoplastic therapy.
What is an appropriate outcome for this patient when dealing with this problem?
a. The patient will eat three balanced meals a day within 2 days.
b. The patient will return to normal eating pattern within 4 weeks.
c. The patient will maintain normal weight by consuming healthy snacks as tolerated.
d. The patient will maintain a diet of small, frequent feedings with nutrition
supplements within 2 weeks.
ANS: D
Consuming small, frequent meals with nutritional supplements, and maintaining a bland diet
help to improve nutrition during antineoplastic therapy.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 729
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
4. A patient is receiving high doses of methotrexate and is experiencing severe bone marrow
suppression. The nurse expects which intervention to be ordered with this drug to reduce this
problem?
a. A transfusion of whole blood
b. Leucovorin rescue
c. Therapy with filgrastim (Neupogen)
d. Administration of allopurinol (Zyloprim)
ANS: B
High-dose methotrexate is associated with bone marrow suppression, and it is always given in
conjunction with the rescue drug leucovorin, which is an antidote for folic acid antagonists.
Basically, leucovorin rescues the healthy cells from methotrexate. The other options are
incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 719
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
5. A patient who has been on methotrexate therapy is experiencing mild pain. The patient is
asking for aspirin for the pain. The nurse recognizes that which of these is true in this
situation?
a. The aspirin will aggravate diarrhea.
b. The aspirin will masks signs of infection.
c. Aspirin can lead to methotrexate toxicity.
d. The aspirin will cause no problems for the patient on methotrexate.
ANS: C
Methotrexate interacts with weak organic acids, such as aspirin, and can lead to toxicity by
displacing the methotrexate from protein-binding sites.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 720
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. The nurse is reviewing infection-prevention measures with a patient who is receiving
antineoplastic drug therapy. Which statement by the patient indicates the need for further
teaching?
a. “I will avoid those who have recently had a vaccination.”
b. “I will eat only fresh fruits and vegetables.”
c. “I will report a sore throat, cough, or low-grade temperature.”
d. “It is important for both my family and me to practice good hand washing.”
ANS: B
Patients who are neutropenic and susceptible to infections need to adhere to a low-microbe
diet by washing fresh fruits and vegetables and making sure foods are well cooked. The other
options are correct.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 729
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control
7. The nurse is administering a combination of three different antineoplastic drugs to a patient
who has metastatic breast cancer. Which statement best describes the rationale for
combination therapy?
a. There will be less nausea and vomiting.
b. Increased cancer-cell killing will occur.
c. The drugs will prevent metastasis.
d. Combination therapy reduces the need for radiation therapy.
ANS: B
Because drug-resistant cells commonly develop, exposure to multiple drugs with multiple
mechanisms and sites of action will destroy more subpopulations of cells. The other options
are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 715
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
8. A patient is receiving irinotecan (Camptosar), along with other antineoplastic drugs, as
treatment for ovarian cancer. The nurse will monitor for which potentially life-threatening
adverse effect that is associated with this drug?
a. Severe stomatitis
b. Bone marrow suppression
c. Delayed-onset cholinergic diarrhea
d. Immediate and severe nausea and vomiting
ANS: C
In addition to producing hematologic adverse effects, irinotecan has been associated with
severe diarrhea, known as cholinergic diarrhea, which may occur during infusions. Delayed
diarrhea may occur 2 to 10 days after infusion of irinotecan. It is recommended that this
condition be treated with atropine unless use of that drug is strongly contraindicated. This
diarrhea can be severe and even life threatening.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 723
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
9. The nurse is monitoring a patient who has severe bone marrow suppression following
antineoplastic drug therapy. Which is considered a principal early sign of infection?
a. Fever
b. Diaphoresis
c. Tachycardia
d. Elevated white blood cell count
ANS: A
Fever and/or chills may be the first sign of an oncoming infection. Elevated white blood cell
count will not occur because of the bone marrow suppression. The other options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 729
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
10. A patient, diagnosed with lymphoma, has an allergy to one of the proposed chemotherapy
drugs. The tumor has not responded to other types of treatment. The nurse expects the
oncologist to follow which course of treatment?
a. The physician will choose another drug to use.
b. The chemotherapy will be given along with supportive measures to treat a possible
allergic reaction.
c. The patient will receive reduced doses of chemotherapy for a longer period of
time.
d. The chemotherapy cannot be given because of the patient’s allergy.
ANS: B
Even if a patient has a known allergic reaction to a given antineoplastic medication, the
urgency of treating the patient’s cancer may still necessitate administering the medication and
then treating any allergic symptoms with supportive medications, such as antihistamines,
corticosteroids, and acetaminophen.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 717
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
11. During treatment of a patient who has brain cancer, the nurse hears the oncologist mention
that the patient has reached the “nadir.” The nurse knows that this term means which of these?
a. The lowest level of neutrophils reached during therapy.
b. The highest level of neutrophils reached during therapy.
c. The point at which the adverse effects of chemotherapy will stop.
d. The point at which the cytotoxic action against cancer cells is the highest.
ANS: A
The lowest neutrophil count reached after a course of chemotherapy is known as the nadir.
The other options are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 717
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
MULTIPLE RESPONSE
1. Methotrexate is ordered for a patient with a malignant tumor, and the nurse is providing
education about self-care after the chemotherapy is given. Which statements by the nurse are
appropriate for the patient receiving methotrexate? (Select all that apply.)
a. Report unusual bleeding or bruising.
b. Hair loss is not expected with this drug.
c. Prepare for hair loss.
d. Avoid areas with large crowds or gatherings.
e. Avoid foods that are too hot or too cold or rough in texture.
f. Restrict fluid intake to reduce nausea and vomiting.
ANS: A, C, D, E
Counsel patients who are taking methotrexate to expect hair loss and to report any unusual
bleeding or bruising. Because of the possibility of infection, avoid areas with large crowds or
gatherings. Foods that are too hot or too cold or rough in texture may be irritating to the oral
mucosa. Fluid intake is to be encouraged to prevent dehydration.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: pp. 731-732
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
2. When giving chemotherapy as cancer treatment, the nurse recognizes that toxicity to rapidly
growing normal cells also occurs. Which rapidly growing normal cells are also harmed by
chemotherapy? (Select all that apply.)
a. Bone marrow cells
b. Retinal cells
c. Hair follicle cells
d. Nerve myelin cells
e. Gastrointestinal (GI) mucous membrane cells
ANS: A, C, E
Chemotherapy toxicities generally stem from the fact that chemotherapy drugs affect rapidly
dividing cells—both harmful cancer cells and healthy, normal cells. Three types of rapidly
dividing human cells are the cells of hair follicles, GI tract cells, and bone marrow cells. The
other options are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 725
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
COMPLETION
1. A patient is to receive a daily dose of fludarabine (Fludara), 25 mg/m2/day for 5 consecutive
days. Each dose is diluted in a 125-mL bag of normal saline and is to infuse over 30 minutes.
The nurse will set the infusion pump to what rate in milliliters per hour? _______
ANS:
DIF: COGNITIVE LEVEL: Applying (Application)
REF: N/A
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies