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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.
Correct Answer: B
Rationale: 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.
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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. Ther9601Therapy with filgrastim
- D. Administration of allopurinol
Correct Answer: B
Rationale: 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.
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.
Correct Answer: D
Rationale: 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.
The nurse is evaluating the laboratory results of a patient who has received chemotherapy. The loss of which blood cell leads to lack of energy, fatigue, intolerance of activity and hypoxemia?
- A. White blood cells
- B. Red blood cells
- C. Platelets
- D. Albumin
Correct Answer: B
Rationale: Bone marrow suppression from antineoplastics affects RBC values, leading to severe anemia. RBCs carry oxygen-attached to the hemoglobin-from the lungs to the rest of the body. RBCs also help carry carbon dioxide back to the lungs for exhalation. Therefore, if RBC counts are low (e.g., with anemia), the body does not get the oxygen it needs, which leads to lack of energy, fatigue, intolerance of activity, shortness of breath, and hypoxemia.
The nurse is about to administer vincristine to a patient who has brain cancer. The patient has an intravenous port and an epidural line for pain medication. Which of these actions would the nurse question?
- A. Administer the vincristine via the intravenous line.
- B. Administer the vincristine via the intrathecal line (spinal route).
- C. Use an infusion pump for this medication.
- D. Give the vincristine with another chemotherapeutic agent.
Correct Answer: B
Rationale: Vincristine and other vinca alkaloids are not given intrathecally (via the spinal route) or by any other route except intravenously. Administering these drugs through the spinal route is almost always fatal, and the death is slow and excruciating. The error cannot be reversed once the medication is given. These drugs are often given in combination with other chemotherapeutic agents, and an infusion pump must be used for accurate delivery of medication.
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
Correct Answer: A
Rationale: 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.