Nokea
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.
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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 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.
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, 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.
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.