Nokea
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.
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A patient is receiving irinotecan, 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
Correct Answer: C
Rationale: 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. It is recommended that this condition can be treated with atropine unless use of that drug is strongly contraindicated. This diarrhea can be severe and even life-threatening.
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.
The nurse is teaching about infection-prevention measures with a patient who is receiving antineoplastic drug therapy. During a Teach-Back session, which statement by the patient indicates the need for further education?
- A. I will avoid those who have recently had a vaccination.
- B. I will eat only fresh fruits and raw 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 handwashing.
Correct Answer: B
Rationale: 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 infection-prevention measures.
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.
During treatment of a patient who has breast 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.
Correct Answer: A
Rationale: The lowest neutrophil count reached after a course of chemotherapy is known as the nadir. The other options are incorrect.