Nokea
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 during therapy.
Correct Answer: D
Rationale: Consuming small, frequent meals with nutritional supplements and maintaining a bland diet help to improve nutrition during antineoplastic therapy.
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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.
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 mask signs of infection.
- C. Aspirin can lead to methotrexate toxicity.
- D. The aspirin will cause no problems for the patient on methotrexate.
Correct Answer: C
Rationale: Methotrexate interacts with weak organic acids, such as aspirin, and can lead to toxicity by displacing the methotrexate from protein-binding sites.
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.
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.