NCLEX Practice Exam for Pharmacology: Antineoplastic Medications

EXPLANATION

✔ Correct answer:

Increase fluid intake to 2-3 liters daily. Cyclophosphamide (Cytoxan) is an alkylating agent used in the treatment of various cancers. One of the significant side effects of cyclophosphamide is hemorrhagic cystitis, which is inflammation and bleeding of the bladder lining. Increasing fluid intake to 2-3 liters daily helps to dilute the urine and ensure frequent urination, which helps to flush out the metabolites of cyclophosphamide that can irritate the bladder, thereby reducing the risk of hemorrhagic cystitis.

Cyclophosphamide is metabolized in the liver to produce active metabolites, including acrolein, which can concentrate in the bladder and cause direct irritation to the bladder lining. Adequate hydration promotes frequent urination, which helps to dilute and eliminate these irritating metabolites, minimizing bladder exposure and the risk of hemorrhagic cystitis.

Think of the bladder as a water balloon that can get damaged if filled with a harmful substance. Drinking plenty of fluids is like continuously flushing the balloon with clean water, reducing the concentration of the harmful substance and protecting the balloon from damage.

Nurse Clara should provide comprehensive education to the client, including:

• Encouraging the client to drink at least 2-3 liters of fluid daily, unless contraindicated by other medical conditions.
• Advising the client to void frequently, especially before bedtime, to minimize bladder exposure to irritants.
• Monitoring the client for signs and symptoms of hemorrhagic cystitis, such as blood in the urine, pain during urination, and increased frequency of urination.
• Educating the client about the importance of reporting any urinary symptoms immediately.
• Considering the use of protective agents such as Mesna, if prescribed, which binds to and inactivates acrolein in the urine.

✘ Incorrect answer options:

Take the medication alongside meals. While taking some medications with food can help reduce gastrointestinal upset, it is not a specific recommendation for cyclophosphamide to prevent its significant adverse effects like hemorrhagic cystitis.

Consume foods high in purine. Foods high in purine can increase uric acid levels and are typically recommended to be avoided in conditions like gout. They do not have a direct impact on preventing the side effects of cyclophosphamide.

Include foods rich in potassium in the diet. While maintaining adequate potassium levels is important for overall health, this is not specifically related to the administration of cyclophosphamide or its side effects. Increasing fluid intake to prevent hemorrhagic cystitis is more critical.

EXPLANATION

✔ Correct answer:

A history of pulmonary embolism. Megestrol acetate (Megace) is a progestational agent commonly used in the treatment of advanced breast cancer, as well as for appetite stimulation in patients with significant weight loss. One of the significant risks associated with Megestrol acetate is the increased risk of thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolism (PE). Therefore, if the client has a history of pulmonary embolism, it is crucial to inform the healthcare provider, as Megestrol acetate could increase the risk of recurrence or exacerbate thromboembolic conditions.

Megestrol acetate can affect the coagulation pathway, leading to an increased tendency for blood clot formation. This prothrombotic effect poses a higher risk for patients with a history of thromboembolic events such as pulmonary embolism. Monitoring and potentially choosing alternative treatments is essential for patients with such a history to prevent life-threatening complications.

Imagine a person who has previously experienced a blocked water pipe (pulmonary embolism). If you introduce a substance that promotes blockages (Megestrol acetate), there's a high risk the pipe could get blocked again, causing severe problems. Similarly, using Megestrol acetate in someone with a history of pulmonary embolism can increase the risk of another clot forming.

Nurse Laura should carefully review the client's medical history and communicate any history of pulmonary embolism to the healthcare provider. Key interventions include:

• Contacting the physician immediately if a history of pulmonary embolism is noted in the client's medical history.
• Monitoring the client closely for signs and symptoms of thromboembolic events, such as sudden shortness of breath, chest pain, swelling, or redness in the extremities.
• Educating the client about the symptoms of thromboembolic events and the importance of seeking immediate medical attention if they occur.
• Considering alternative therapies or additional prophylactic measures (e.g., anticoagulants) in collaboration with the healthcare provider.
• Ensuring regular follow-up and monitoring if Megestrol acetate is deemed necessary despite the history of thromboembolic events.

✘ Incorrect answer options:

A case of gouty arthritis. While Megestrol acetate may impact weight and appetite, it does not specifically exacerbate gouty arthritis. Gout management typically involves other medications and lifestyle modifications.

A background of ischemic heart disease. Ischemic heart disease requires careful management during cancer treatment, but it is not specifically contraindicated for Megestrol acetate. However, cardiovascular status should be monitored during treatment.

A history of bronchial asthma. Asthma is not a direct contraindication for Megestrol acetate. While all medications should be used cautiously in patients with complex medical histories, asthma does not pose a specific increased risk with this medication.

EXPLANATION

✔ Correct answer:

Oral. Mitomycin (Mutamycin) is an antineoplastic antibiotic used in chemotherapy to treat various cancers, including colorectal cancer. It is not administered orally due to its poor absorption and instability in the gastrointestinal tract. Instead, Mitomycin is typically administered through intravenous, intravesical, or intraarterial routes to ensure proper absorption and efficacy in targeting cancer cells.

Mitomycin works by inhibiting DNA synthesis and causing cross-linking of DNA strands, leading to cell death. For effective action, it needs to be delivered directly into the bloodstream or the specific area of treatment. The intravenous route allows systemic distribution, the intravesical route targets bladder cancer directly, and the intraarterial route delivers high concentrations to specific regions, such as hepatic tumors, while minimizing systemic toxicity.

Imagine trying to deliver a package to a specific person in a large building. If you leave the package at the front desk (oral route), it might get lost or delayed before reaching the person. Instead, if you use a direct delivery service (intravenous, intravesical, or intraarterial routes), the package is handed directly to the intended recipient, ensuring it gets there quickly and safely.

Nurse Emily should be well-informed about the appropriate administration routes for Mitomycin and monitor the patient for potential side effects and complications. Key interventions include:

• Ensuring proper preparation and handling of the medication to maintain its stability and effectiveness.
• Using appropriate intravenous techniques to prevent extravasation, which can cause severe tissue damage.
• Monitoring the patient for signs of toxicity, such as myelosuppression, nephrotoxicity, and pulmonary toxicity.
• Educating the patient about the treatment plan, potential side effects, and the importance of reporting any adverse reactions promptly.

✘ Incorrect answer options:

Intravenous. Mitomycin is commonly administered intravenously to treat systemic cancers, including colorectal cancer. This route ensures that the drug is distributed throughout the body to target cancer cells effectively.

Intravesical. Mitomycin can be administered intravesically, particularly for treating superficial bladder cancer. This route delivers the drug directly into the bladder, allowing high local concentrations while minimizing systemic absorption.

Intraarterial. Intraarterial administration of Mitomycin is used in certain cases to deliver the drug directly to specific regions, such as the liver, for targeted treatment of localized tumors.

EXPLANATION

✔ Correct answer:

Triglyceride levels. Tamoxifen (Nolvadex) is a selective estrogen receptor modulator (SERM) used in the treatment of hormone receptor-positive breast cancer in both men and women. One of the potential side effects of Tamoxifen is hypertriglyceridemia, or elevated triglyceride levels. Therefore, it is essential for Nurse Alex to monitor the client's triglyceride levels regularly to manage and mitigate this risk.

Tamoxifen can affect lipid metabolism, leading to an increase in serum triglyceride levels. Elevated triglycerides can increase the risk of pancreatitis and cardiovascular disease, making it important to monitor and manage lipid profiles in patients receiving this medication.

Think of triglycerides as fat particles in the blood. If the body produces or retains too many of these particles due to medication effects, it’s like having excess grease in the engine of a car, which can cause the engine to malfunction over time. Regular checks help ensure the engine (body) runs smoothly.

Nurse Alex should monitor triglyceride levels as part of the client's routine blood tests and implement strategies to manage elevated levels, including:

• Scheduling regular blood tests to monitor lipid profiles, including triglycerides.
• Educating the client on a heart-healthy diet low in saturated fats and sugars to help manage lipid levels.
• Encouraging regular physical activity to help maintain healthy triglyceride levels.
• Collaborating with the healthcare provider to adjust the treatment plan if significant hypertriglyceridemia occurs.
• Assessing for signs and symptoms of pancreatitis or cardiovascular issues, and reporting any findings promptly.

✘ Incorrect answer options:

Fasting blood sugar. While some medications, particularly corticosteroids, can affect blood sugar levels, Tamoxifen is not specifically associated with significant alterations in fasting blood glucose.

Activated partial thromboplastin time. The activated partial thromboplastin time (aPTT) is a measure of blood coagulation. Tamoxifen does not typically affect this parameter directly. It is more relevant for patients on anticoagulant therapy.

Serum sodium and potassium levels. While electrolyte levels are important to monitor in many conditions and treatments, Tamoxifen is not known to cause significant disturbances in sodium or potassium levels.

EXPLANATION

✔ Correct answer:

Developing a dysrhythmia. Idarubicin (Idamycin) is an anthracycline antibiotic used in the treatment of various cancers, including non-Hodgkin's lymphoma. One of the serious adverse effects associated with Idarubicin is cardiotoxicity, which can manifest as dysrhythmias (abnormal heart rhythms). This can occur due to the medication's effect on cardiac myocytes, leading to both acute and chronic cardiac issues, including heart failure and arrhythmias.

Idarubicin works by intercalating into DNA, thereby inhibiting the synthesis of DNA and RNA, and generating free radicals that cause DNA strand breaks. While this is effective in killing cancer cells, it also causes damage to cardiac cells. The cardiac myocytes are particularly susceptible to the oxidative stress and free radical damage induced by Idarubicin, leading to dysfunction and dysrhythmias.

Imagine your heart as a metronome that keeps a steady rhythm. Idarubicin can act like a disruptive force that interferes with the metronome's regular beat, causing it to skip or change rhythm unexpectedly, which is what happens during a dysrhythmia.

Nurse Emily should monitor the patient's cardiac status closely while they are receiving Idarubicin. Key interventions include:

• Regularly monitoring the patient's heart rate and rhythm through ECGs to detect any dysrhythmias early.
• Assessing for signs and symptoms of cardiac distress, such as chest pain, palpitations, shortness of breath, and fatigue.
• Collaborating with the healthcare team to evaluate the patient's cardiac function before and during treatment, including echocardiograms and measuring biomarkers like troponin and BNP.
• Educating the patient about the importance of reporting any new or unusual cardiac symptoms immediately.
• Considering dose adjustments or alternative treatments if significant cardiotoxicity is detected.

✘ Incorrect answer options:

Experiencing nausea and vomiting. Nausea and vomiting are common side effects of many chemotherapy drugs, including Idarubicin, but they are not specific indicators of a severe adverse reaction like cardiotoxicity.

Observing weight loss. Weight loss can occur in cancer patients due to the disease itself and the effects of chemotherapy. While important to monitor, it is not specific to the adverse effects of Idarubicin.

Suffering from peripheral neuropathy. Peripheral neuropathy is more commonly associated with other chemotherapeutic agents, such as vinca alkaloids and taxanes. It is not a primary adverse effect of Idarubicin.

EXPLANATION

✔ Correct answer:

Uric acid level. Busulfan (Myleran) is an alkylating agent used in the treatment of chronic myelocytic leukemia (CML) and sometimes acute myelocytic leukemia (AML). One of the side effects of Busulfan is hyperuricemia, which is an elevated level of uric acid in the blood. This occurs due to the rapid destruction of leukemia cells, leading to the release of purines that are metabolized into uric acid, potentially causing hyperuricemia and subsequent gout or kidney damage if not properly managed.

When leukemia cells are destroyed by Busulfan, their intracellular contents, including nucleic acids, are released into the bloodstream. The breakdown of these nucleic acids produces purines, which are then metabolized into uric acid. The kidneys excrete uric acid, but excessive levels can lead to the formation of uric acid crystals, which can deposit in joints (causing gout) or the kidneys (causing nephropathy).

Imagine your body is like a factory that produces waste products that need to be taken out by garbage trucks (kidneys). If the factory suddenly produces a huge amount of waste (uric acid) because it's breaking down a lot of materials (leukemia cells), the garbage trucks might get overwhelmed, leading to a pile-up of waste (hyperuricemia) that can cause problems.

Nurse Rachel should closely monitor the client's uric acid levels and implement interventions to prevent complications from hyperuricemia, including:

• Regularly checking the client's uric acid levels through blood tests.
• Encouraging adequate hydration to help flush out uric acid through the kidneys.
• Administering medications such as allopurinol or febuxostat to prevent the formation of uric acid crystals.
• Monitoring for signs and symptoms of gout, such as joint pain and swelling.
• Assessing kidney function to detect early signs of nephropathy.

✘ Incorrect answer options:

Platelet count. While monitoring the platelet count is important in patients undergoing chemotherapy, especially for those at risk of myelosuppression, it is not the most specific lab value to monitor for clients on Busulfan. Myelosuppression can affect platelets, but it is a broader issue compared to the specific risk of hyperuricemia.

Prothrombin time. Prothrombin time (PT) measures blood clotting and is used to monitor anticoagulation therapy. It is not specifically affected by Busulfan.

Serum calcium. Serum calcium levels are important to monitor in various conditions, including bone metastases and parathyroid disorders, but they are not specifically affected by Busulfan therapy.

EXPLANATION

✔ Correct answer:

Myelosuppression. Etoposide (Etopophos) is an antineoplastic agent used in the treatment of various cancers, including testicular cancer. One of the most significant side effects associated with Etoposide is myelosuppression, which involves the decreased production of blood cells by the bone marrow. This can lead to neutropenia (low white blood cell count), thrombocytopenia (low platelet count), and anemia (low red blood cell count).

Etoposide works by inhibiting the enzyme topoisomerase II, which is essential for DNA replication and cell division. While effective against rapidly dividing cancer cells, it also affects normal rapidly dividing cells in the bone marrow. This suppression of bone marrow activity results in reduced blood cell production, making patients more susceptible to infections, bleeding, and fatigue.

Think of the bone marrow as a factory that produces essential workers (blood cells) for the body's maintenance. Etoposide, like a powerful strike, disrupts the factory's operation, reducing the number of workers produced, which in turn impacts the overall functioning and efficiency of the body.

Nurse Lisa should monitor the patient's complete blood count (CBC) regularly to detect early signs of myelosuppression. Interventions may include:

• Implementing infection control measures and educating the patient on avoiding exposure to infectious agents.
• Monitoring for signs of bleeding and providing platelet transfusions if necessary.
• Administering growth factors such as G-CSF (granulocyte colony-stimulating factor) to stimulate white blood cell production if neutropenia occurs.
• Assessing for symptoms of anemia and considering red blood cell transfusions if needed.

✘ Incorrect answer options:

Nephrotoxicity. While some chemotherapeutic agents can cause nephrotoxicity (kidney damage), Etoposide is not commonly associated with significant nephrotoxicity.

Ototoxicity. Ototoxicity (hearing damage) is a side effect typically linked to medications such as cisplatin and aminoglycosides, not Etoposide.

Cardiotoxicity. Cardiotoxicity (heart damage) is associated with certain chemotherapeutic agents like anthracyclines (e.g., doxorubicin) but is not a common side effect of Etoposide.

EXPLANATION

✔ Correct answer:

Hyperuricemia. Chemotherapy often causes rapid destruction of cancer cells, leading to the release of their contents into the bloodstream. One of the byproducts of this cell breakdown is uric acid, which results from the metabolism of purines released from the destroyed cells. This can lead to an elevated level of uric acid in the blood, a condition known as hyperuricemia.

When cells are destroyed, they release intracellular components, including nucleic acids. The breakdown of these nucleic acids produces purines, which are then metabolized into uric acid. Normally, uric acid is excreted by the kidneys, but the massive increase in cell turnover during chemotherapy can overwhelm the body's ability to clear uric acid, leading to hyperuricemia. If untreated, hyperuricemia can lead to complications such as gout or acute renal failure due to uric acid crystal deposition in the kidneys.

Imagine a large factory producing goods (cells). If the factory suddenly has to shut down and dispose of all its goods rapidly (cell destruction), the waste disposal system (kidneys) might get overwhelmed by the sudden influx of waste (uric acid), leading to a backlog (hyperuricemia).

Nurses should monitor patients for signs of hyperuricemia and ensure appropriate management, which may include:

• Regularly checking uric acid levels through blood tests.
• Hydration to help flush uric acid through the kidneys.
• Administering medications such as allopurinol or rasburicase to reduce uric acid levels.
• Monitoring renal function and urine output to detect early signs of renal impairment.

✘ Incorrect answer options:

Thrombocytopenia. Thrombocytopenia, or a low platelet count, is a common side effect of chemotherapy but is not a direct result of cell breakdown. It occurs due to the bone marrow's reduced ability to produce platelets.

Leukopenia. Leukopenia, or a low white blood cell count, is another common side effect of chemotherapy, resulting from bone marrow suppression. It is not caused by the release of cellular components into the bloodstream.

Anemia. Anemia, or a low red blood cell count, can also result from chemotherapy due to bone marrow suppression. It is not directly related to the cell breakdown process but rather the bone marrow's reduced capacity to produce red blood cells.

EXPLANATION

✔ Correct answer:

Onset of ataxia. Ataxia, a neurological symptom characterized by lack of voluntary coordination of muscle movements, can indicate severe neurotoxicity, a rare but serious side effect of Fluorouracil (Adrucil). The onset of ataxia is a significant concern because it can signal central nervous system toxicity, which may lead to severe and irreversible damage. Therefore, Nurse Laura should immediately discontinue the medication and notify the healthcare provider.

Fluorouracil is an antimetabolite that inhibits DNA synthesis, which is effective against rapidly dividing cancer cells but can also affect normal cells, including those in the central nervous system. Neurotoxicity from Fluorouracil can manifest as cerebellar dysfunction, leading to symptoms such as ataxia, confusion, and dizziness. Immediate discontinuation of the drug is essential to prevent further damage.

Imagine a person suddenly losing their balance and coordination while walking on a straight path. This unexpected change signals an underlying issue that needs immediate attention to prevent a fall. Similarly, the onset of ataxia during Fluorouracil treatment signals a severe problem that requires immediate action.

Nurse Laura should take the following steps:

• Immediately discontinue the Fluorouracil infusion to prevent further neurotoxicity.
• Notify the healthcare provider promptly about the onset of ataxia.
• Monitor the client’s neurological status closely, including assessments of coordination, balance, and mental status.
• Document the symptoms, actions taken, and the client's response to the intervention.
• Provide supportive care and ensure safety measures are in place to prevent falls and injuries.
• Prepare for potential further diagnostic testing or interventions as ordered by the healthcare provider.

✘ Incorrect answer options:

Development of palmar-plantar erythrodysesthesia. Also known as hand-foot syndrome, this is a common side effect of Fluorouracil, characterized by redness, swelling, and pain on the palms and soles. While it requires management, it is not typically an indication to immediately discontinue the medication.

Occurrence of constipation. Constipation can occur due to various reasons, including chemotherapy, but it is not a specific or severe enough side effect of Fluorouracil that would necessitate immediate discontinuation.

Experiencing insomnia. Insomnia is not a typical side effect of Fluorouracil and does not require immediate discontinuation of the medication. It may be managed with supportive measures and does not pose an immediate threat to the client's health.

EXPLANATION

✔ Correct answer:

Onset of tinnitus. Cisplatin (Platinol-AQ) is a platinum-based chemotherapeutic agent used in the treatment of various cancers, including testicular, ovarian, bladder, and lung cancers. One of the notable and specific side effects of Cisplatin is ototoxicity, which can manifest as tinnitus (ringing in the ears) and hearing loss. This ototoxicity is dose-dependent and can be permanent.

Cisplatin induces ototoxicity by damaging the hair cells in the cochlea of the inner ear. The drug generates reactive oxygen species (ROS) that lead to oxidative stress and apoptosis (cell death) in these sensory cells. This damage impairs auditory function, resulting in symptoms such as tinnitus and hearing loss.

Think of the cochlea as a delicate musical instrument, like a piano. Cisplatin acts like a corrosive substance that damages the piano strings (hair cells), causing the instrument to produce distorted or continuous sounds (tinnitus) instead of clear music.

Nurse Olivia should closely monitor the client for signs of ototoxicity and implement strategies to manage and mitigate this side effect, including:

• Regularly assessing the client’s hearing before, during, and after treatment using audiometric tests.
• Educating the client about the symptoms of ototoxicity, such as tinnitus, hearing loss, and a feeling of fullness in the ears, and encouraging them to report any changes promptly.
• Administering the lowest effective dose of Cisplatin and considering alternative therapies if ototoxicity occurs.
• Implementing protective measures such as antioxidant supplementation, which may help reduce oxidative stress.
• Collaborating with the healthcare team to evaluate the need for dose adjustments or additional protective agents.

✘ Incorrect answer options:

Development of ptosis. Ptosis (drooping of the upper eyelid) is not a side effect typically associated with Cisplatin. Ptosis is more commonly related to neurological conditions or other medications.

Presence of depressed tendon reflexes. Depressed tendon reflexes can occur with certain chemotherapeutic agents that cause neuropathy, such as vincristine, but they are not specifically linked to Cisplatin.

Increased photosensitivity. Increased photosensitivity is a side effect of certain medications, such as some antibiotics and chemotherapy agents like 5-fluorouracil, but it is not commonly associated with Cisplatin.

EXPLANATION

✔ Correct answer:

Reinsert the IV at a more distal part of the same vein. When a patient receiving an IV infusion of an antineoplastic medication complains of pain and redness at the insertion site, it could indicate extravasation, which is the leakage of the medication into the surrounding tissue. Reinserting the IV at a more distal part of the same vein should be avoided because the same vein might have been damaged or compromised, increasing the risk of further extravasation and tissue injury.

Extravasation of antineoplastic agents, especially vesicants, can cause severe tissue damage, leading to necrosis, ulceration, and long-term complications. Continuing to use the same vein, even at a distal site, increases the risk of exacerbating the injury, as the damaged vein may not adequately contain the IV fluid.

Imagine a garden hose with a small leak. If you move the nozzle further down the hose without addressing the leak, water will continue to escape and potentially cause more damage. Similarly, using the same compromised vein can lead to more medication leaking into the tissue.

Nurse Kevin should take the following actions to manage the situation effectively:

• Stop the infusion immediately to prevent further extravasation.
• Notify the physician promptly to get further instructions and appropriate interventions.
• Apply either a heat or ice compress to the site based on the specific medication's guidelines to reduce pain and inflammation. Some medications may require a heat compress, while others may benefit from ice.
• Administer an antidote as prescribed if one is available for the specific antineoplastic agent to neutralize the effects and limit tissue damage.
• Document the incident thoroughly, including the patient's symptoms, actions taken, and any communications with the healthcare team.
• Monitor the site closely for signs of worsening injury, such as increased pain, swelling, or blistering, and provide ongoing care as needed.

✘ Incorrect answer options:

Notify the physician. This is a critical step in managing extravasation and should be done promptly to ensure appropriate treatment and interventions.

Apply either a heat or ice compress to the site. Depending on the type of antineoplastic agent, applying a heat or ice compress can help reduce tissue damage and alleviate pain. It is important to follow specific guidelines for the medication being administered.

Administer an antidote as prescribed. Administering an antidote, if available, is an essential step in mitigating the effects of extravasation and preventing further tissue damage.

EXPLANATION

✔ Correct answer:

Measure and weigh the patient on the day of administration. Administering chemotherapy accurately requires precise dosing based on the patient's current body surface area (BSA). BSA calculations depend on accurate and up-to-date height and weight measurements. Fluctuations in weight can significantly impact the calculated dose, so it is essential to measure and weigh the patient on the day of administration to ensure safe and effective treatment.

Chemotherapy dosing based on BSA is designed to optimize therapeutic efficacy while minimizing toxicity. BSA is calculated using the patient's height and weight, providing a more accurate representation of the body's metabolic mass than weight alone. This method helps in adjusting the dose according to the patient's ability to metabolize and clear the drugs.

Imagine you are baking a cake, and the recipe requires precise measurements of ingredients. If you use outdated measurements (e.g., from last week), the balance of ingredients might be off, affecting the quality of the cake. Similarly, using current weight and height ensures the chemotherapy dose is just right for the patient's current body condition.

Prior to chemotherapy administration, Nurse Smith should:

• Measure the patient’s height if it has not been measured recently.
• Weigh the patient on the day of chemotherapy administration to obtain the most current weight.
• Calculate the BSA using the updated height and weight.
• Verify the calculated dose with another nurse or pharmacist for accuracy.
• Review any changes in the patient's condition that may affect chemotherapy administration, such as renal or liver function.

✘ Incorrect answer options:

Inquire about the patient's intake and output. While monitoring intake and output is important for assessing hydration status and kidney function, it is not directly relevant for calculating chemotherapy dosage based on BSA. This information is more pertinent to ongoing assessment during and after chemotherapy administration.

Calculate the body mass index (BMI). BMI is a measure of body fat based on height and weight, but it does not provide the detailed information needed to determine chemotherapy dosage. BSA is preferred over BMI because it accounts for the patient's metabolic mass more accurately.

Ask the patient for their height and weight. Self-reported height and weight may not be accurate. Direct measurement ensures precision, which is critical for safe and effective chemotherapy dosing.

EXPLANATION

✔ Correct answer:

Platelet count of 45,000 cells/mm³. A platelet count of 45,000 cells/mm³ is significantly below the normal range (150,000 to 450,000 cells/mm³) and indicates thrombocytopenia. This condition places the client at a high risk for bleeding because platelets are crucial for proper blood clotting. Therefore, Nurse Megan should initiate bleeding precautions to prevent and manage potential bleeding complications in the client.

Thrombocytopenia can occur as a side effect of antineoplastic medications, which often cause bone marrow suppression. This suppression leads to a reduced production of platelets, making the patient more susceptible to spontaneous bleeding and hemorrhage. Bleeding precautions are necessary to minimize the risk of bleeding and to ensure prompt intervention if bleeding occurs.

Imagine your blood vessels as pipes in a plumbing system and platelets as the sealants that plug any leaks. If the sealants are significantly reduced (low platelet count), even small leaks can become big problems, making it essential to take extra precautions to prevent and manage leaks.

Nurse Megan should take several steps to ensure the safety of the client with thrombocytopenia, including:

• Implementing bleeding precautions such as avoiding invasive procedures, using a soft toothbrush, and avoiding activities that can cause injury.
• Monitoring for signs of bleeding, such as petechiae, ecchymoses, bleeding gums, and hematuria.
• Educating the client and their family about the importance of bleeding precautions and how to recognize signs of bleeding.
• Ensuring that the client receives platelet transfusions if necessary, based on the severity of the thrombocytopenia and clinical symptoms.
• Collaborating with the healthcare team to adjust the treatment plan if severe thrombocytopenia occurs, including possible dose adjustments of the antineoplastic medications.

✘ Incorrect answer options:

Hemoglobin count of 15 g/dl. A hemoglobin count of 15 g/dl is within the normal range (13.8 to 17.2 g/dl for men) and does not indicate a need for bleeding precautions. Hemoglobin levels reflect the oxygen-carrying capacity of the blood, not bleeding risk.

Clotting time of 8 minutes. A clotting time of 8 minutes can be within the normal range depending on the specific test used and lab standards. While it is essential to monitor clotting time, this value alone does not indicate a need for bleeding precautions without other abnormal findings.

White blood cell count of 6,000/mm³. A white blood cell (WBC) count of 6,000/mm³ is within the normal range (4,500 to 11,000/mm³) and does not indicate a need for bleeding precautions. WBC counts are used to assess immune function and infection risk, not bleeding risk.

EXPLANATION

✔ Correct answer:

A history of pancreatitis. Asparaginase (Elspar) is an enzyme used in the treatment of acute lymphoblastic leukemia (ALL) by depleting asparagine, an amino acid necessary for the survival of leukemia cells. One of the significant and potentially severe side effects of Asparaginase is pancreatitis. Therefore, if the client has a history of pancreatitis, it is crucial to inform the healthcare provider because administering Asparaginase could exacerbate this condition or lead to a recurrence of pancreatitis.

Asparaginase works by hydrolyzing asparagine into aspartic acid and ammonia, depriving leukemia cells of the asparagine required for protein synthesis and cell survival. However, this can also affect normal cells, including pancreatic cells, leading to inflammation of the pancreas (pancreatitis). The risk of pancreatitis with Asparaginase is significant enough that a history of pancreatitis is a relative contraindication for its use.

Imagine a person with a previously injured ankle. If they are given a task that involves a lot of running (akin to receiving Asparaginase), it could worsen the injury. Similarly, administering Asparaginase to someone with a history of pancreatitis could aggravate their pancreatic condition.

Nurse Mark should review the client's medical history carefully and ensure any history of pancreatitis is communicated to the healthcare provider. Key interventions include:

• Contacting the healthcare provider immediately if a history of pancreatitis is noted.
• Monitoring the client closely for signs and symptoms of pancreatitis, such as abdominal pain, nausea, vomiting, and elevated pancreatic enzymes.
• Educating the client about the potential risks and symptoms of pancreatitis to ensure prompt reporting and management.
• Ensuring regular monitoring of pancreatic enzyme levels (amylase and lipase) during Asparaginase treatment.

✘ Incorrect answer options:

A diagnosis of Type II Diabetes Mellitus. While Asparaginase can affect glucose metabolism and might require closer monitoring of blood glucose levels, Type II Diabetes Mellitus is not an absolute contraindication. Management strategies can be adjusted for diabetic clients receiving Asparaginase.

A background of ischemic heart disease. Ischemic heart disease requires careful monitoring during chemotherapy, but it is not specifically a contraindication for Asparaginase. Other chemotherapy agents may pose more significant cardiovascular risks.

A history of asthma. Asthma is not a specific contraindication for Asparaginase, although clients with a history of severe allergies or anaphylaxis should be monitored closely due to the risk of hypersensitivity reactions.

EXPLANATION

✔ Correct answer:

Stop the medication. In the event of an anaphylactic reaction during chemotherapy, the first and most crucial action Nurse Jenna should take is to stop the administration of the medication immediately. This prevents further exposure to the allergen, which is critical in managing the acute reaction and preventing it from worsening.

An anaphylactic reaction is a severe, life-threatening allergic reaction that occurs rapidly after exposure to an allergen. It involves the release of histamines and other chemicals from mast cells and basophils, leading to vasodilation, increased capillary permeability, bronchoconstriction, and potentially shock. Immediate cessation of the offending agent is essential to prevent further exacerbation of these symptoms.

Imagine someone is having an allergic reaction to a specific food. The first step would be to stop eating the food immediately to prevent further exposure and worsening of the reaction. Similarly, stopping the infusion of the medication is the critical first step in managing anaphylaxis.

Nurse Jenna should take the following actions in the case of an anaphylactic reaction:

• Stop the medication infusion immediately to prevent further exposure to the allergen.
• Maintain the IV line but do not remove it. This allows for the administration of emergency medications such as epinephrine, antihistamines, and corticosteroids through the same line.
• Administer emergency medications as prescribed, including epinephrine, which is the first-line treatment for anaphylaxis.
• Monitor the client’s vital signs closely, including heart rate, blood pressure, and respiratory status.
• Position the client appropriately to ensure an open airway and improve breathing. Typically, the client is positioned in a supine position with legs elevated if they are experiencing hypotension.
• Call for emergency assistance and be prepared to initiate advanced life support measures if necessary.
• Document the incident thoroughly, including the time of onset, the actions taken, and the client's response to treatment.

✘ Incorrect answer options:

Remove the IV line. Removing the IV line is not advisable, as it is crucial to maintain access for administering emergency medications and fluids during an anaphylactic reaction.

Administer nitroglycerin. Nitroglycerin is used to treat chest pain (angina) by dilating blood vessels but is not appropriate for managing anaphylactic reactions.

Position the client in a reverse Trendelenburg position. The reverse Trendelenburg position, where the head is higher than the feet, is not appropriate during anaphylaxis. The correct positioning typically involves laying the client flat with their legs elevated to help improve blood flow if they are experiencing hypotension.

EXPLANATION

✔ Correct answer:

Consult with healthcare providers prior to getting immunizations. Clients undergoing treatment with antineoplastic medications should be cautious about receiving immunizations. Chemotherapy and other antineoplastic treatments can suppress the immune system, reducing the body’s ability to mount an effective immune response to vaccines and increasing the risk of adverse reactions. Live vaccines, in particular, can pose significant risks to immunocompromised individuals because they can potentially cause infections.

Antineoplastic medications target rapidly dividing cells, including cancer cells, but also affect normal cells such as those in the bone marrow, gastrointestinal tract, and hair follicles. This can lead to myelosuppression, increasing susceptibility to infections and reducing the efficacy and safety of immunizations.

Think of the immune system as an army protecting the body. Antineoplastic medications can temporarily weaken this army, making it less effective at defending against invaders, including those introduced by vaccines. Consulting with healthcare providers ensures that any new "training" (vaccines) is safe and appropriate given the current strength of the army.

Nurse Kelly should provide comprehensive education to the client, including:

• Advising the client to consult with their oncologist or primary healthcare provider before receiving any immunizations.
• Informing the client about the potential risks associated with live vaccines during immunosuppressive treatment.
• Encouraging the client to keep a record of all vaccinations and communicate their treatment status to healthcare providers.
• Providing information on alternative preventive measures to reduce the risk of infections, such as practicing good hygiene and avoiding contact with sick individuals.

✘ Incorrect answer options:

Take acetylsalicylic acid if a headache occurs. Acetylsalicylic acid (aspirin) can increase the risk of bleeding, especially in clients with thrombocytopenia due to antineoplastic therapy. Alternatives like acetaminophen are generally preferred for headache management in these patients.

Avoid consuming hot foods and those high in fiber. While some dietary adjustments may be necessary during chemotherapy, there is no general recommendation to avoid hot foods or high-fiber foods unless specific gastrointestinal side effects dictate otherwise.

Drink alcoholic beverages in moderation during the evening. Alcohol consumption can interact with antineoplastic medications, exacerbate side effects, and impair liver function, which is crucial for metabolizing these drugs. Therefore, clients are usually advised to avoid alcohol during treatment.

EXPLANATION

✔ Correct answer:

Experiencing numbness in the toes. Vincristine (Vincasar) is a chemotherapeutic agent used in the treatment of various cancers, including non-Hodgkin’s lymphoma. One of the primary side effects specifically associated with vincristine is peripheral neuropathy, which manifests as numbness, tingling, or pain in the extremities, particularly the toes and fingers. This occurs because vincristine disrupts microtubule formation, affecting nerve function.

Vincristine works by inhibiting the formation of microtubules, essential components of the cellular skeleton and intracellular transport system. While this mechanism effectively prevents cancer cells from dividing, it also impacts normal nerve cells, leading to peripheral neuropathy. The longest nerves, such as those to the toes and fingers, are often affected first.

Imagine a railway system where the tracks (microtubules) are damaged, causing trains (nerve signals) to slow down or stop. This disruption in the railway system leads to delays and problems in delivering goods (sensations) to distant stations (extremities), resulting in numbness or tingling in the toes.

Nurse Kim should monitor the client for signs of peripheral neuropathy and provide appropriate interventions, which may include:

• Regularly assessing the client's sensory and motor functions, especially in the extremities.
• Educating the client on reporting any new or worsening symptoms of numbness, tingling, or pain.
• Implementing safety measures to prevent falls or injuries due to decreased sensation.
• Collaborating with the healthcare team to adjust the vincristine dose if neuropathy becomes severe.
• Providing supportive care measures, such as pain management and physical therapy, to alleviate symptoms.

✘ Incorrect answer options:

Feeling a heaviness in the chest. Heaviness in the chest could indicate cardiotoxicity or other cardiovascular issues, but it is not a primary side effect of vincristine. Other chemotherapeutic agents, such as anthracyclines, are more commonly associated with cardiotoxicity.

Developing alopecia. While alopecia (hair loss) is a common side effect of many chemotherapeutic agents, it is not specific to vincristine. Hair loss is more generalized and not uniquely indicative of vincristine treatment.

Observing weight gain. Weight gain is not typically associated with vincristine. It could be related to other factors such as fluid retention from corticosteroids or other supportive medications, but it is not a direct side effect of vincristine.

EXPLANATION

✔ Correct answer:

Leucovorin (Folinic acid). Methotrexate (Rheumatrex) is an antineoplastic and immunosuppressive agent used in the treatment of various cancers and autoimmune diseases. It works by inhibiting dihydrofolate reductase, which is essential for DNA synthesis and cell replication. High doses of Methotrexate can lead to severe toxicity, including myelosuppression, mucositis, and renal damage. Leucovorin (Folinic acid) is used as a rescue medication to prevent or mitigate Methotrexate toxicity. It works by providing a source of reduced folate, which bypasses the block created by Methotrexate and allows normal cells to continue DNA synthesis and repair.

Methotrexate inhibits the enzyme dihydrofolate reductase, preventing the conversion of dihydrofolate to tetrahydrofolate, a necessary component for thymidylate and purine synthesis. Without these components, DNA synthesis and cell replication are halted, which is particularly harmful to rapidly dividing cells, including both cancerous and normal cells. Leucovorin rescues normal cells by supplying reduced folates, thus allowing these cells to bypass the metabolic block and continue normal DNA synthesis.

Imagine Methotrexate as a roadblock on a highway preventing cars (cells) from reaching their destination (DNA synthesis). Leucovorin acts as a detour route, allowing the cars to bypass the roadblock and continue on their journey, thus preventing traffic jams (toxicity).

Nurse Alicia should ensure Leucovorin is readily available when administering Methotrexate, especially at high doses. Key interventions include:

• Administering Leucovorin at the appropriate time after Methotrexate infusion to ensure maximum protective effect.
• Monitoring the client’s blood levels of Methotrexate to determine the duration and dosing of Leucovorin rescue therapy.
• Educating the client about the importance of taking Leucovorin exactly as prescribed to mitigate the risk of Methotrexate toxicity.
• Monitoring for signs of Methotrexate toxicity, including mucositis, myelosuppression, and renal dysfunction.
• Ensuring adequate hydration and urinary alkalinization to enhance Methotrexate excretion and reduce the risk of nephrotoxicity.

✘ Incorrect answer options:

Vigabatrin (Sabril). Vigabatrin is an antiepileptic medication used to treat seizures, particularly infantile spasms and refractory complex partial seizures. It is not related to the prevention or treatment of Methotrexate toxicity.

Mesna (Mesnex). Mesna is used to prevent hemorrhagic cystitis caused by certain chemotherapeutic agents like ifosfamide and cyclophosphamide. It works by detoxifying harmful metabolites in the urinary tract. It is not used for Methotrexate toxicity.

Oseltamivir (Tamiflu). Oseltamivir is an antiviral medication used to treat and prevent influenza. It has no role in the prevention or treatment of Methotrexate toxicity.

EXPLANATION

✔ Correct answer:

Suffering from constipation. Tamoxifen (Nolvadex) is a selective estrogen receptor modulator (SERM) used primarily in the treatment of hormone receptor-positive breast cancer and sometimes ovarian cancer. One of the side effects specifically associated with Tamoxifen is gastrointestinal disturbances, including constipation. This occurs due to the medication's impact on the gastrointestinal motility.

Tamoxifen works by binding to estrogen receptors, thereby inhibiting the proliferative action of estrogen on hormone-sensitive tumors. However, this effect on estrogen receptors can also influence other bodily systems, including the gastrointestinal tract, leading to reduced motility and constipation.

Imagine the gastrointestinal tract as a conveyor belt that moves food through the digestive system. Tamoxifen can slow down the conveyor belt, causing a backlog (constipation) because the belt isn't moving the food along as efficiently as it should.

Nurse Sarah should monitor the client for symptoms of constipation and implement strategies to manage this side effect, including:

• Encouraging the client to maintain a high-fiber diet to promote bowel regularity.
• Ensuring adequate fluid intake to help soften stools.
• Promoting regular physical activity, which can help stimulate bowel movements.
• Advising the use of stool softeners or laxatives if necessary, as recommended by the healthcare provider.
• Monitoring for signs of severe constipation or bowel obstruction and reporting any concerns promptly.

✘ Incorrect answer options:

Experiencing convulsions. Convulsions are not commonly associated with Tamoxifen. These symptoms would prompt evaluation for other causes, such as electrolyte imbalances, neurological conditions, or other medications.

Noticing facial twitching. Facial twitching is not a typical side effect of Tamoxifen. This symptom might indicate a neurological issue or a reaction to another medication but is not specifically linked to Tamoxifen use.

Having weak and brittle nails. While changes in hair and nail texture can occur with some chemotherapeutic agents, weak and brittle nails are not a primary side effect associated with Tamoxifen. This effect is more common with other types of cancer treatments, such as taxanes.

EXPLANATION

✔ Correct answer:

Pulmonary function tests (PFTs). Bleomycin (Blenoxane) is a chemotherapeutic agent used to treat various cancers, including sarcomas. One of the significant and potentially severe side effects of Bleomycin is pulmonary toxicity, which can lead to pulmonary fibrosis and impaired lung function. Therefore, it is crucial to monitor the client’s lung function regularly through pulmonary function tests (PFTs) before and during treatment.

Bleomycin can cause damage to lung tissue, leading to inflammation, scarring (fibrosis), and decreased lung capacity. Pulmonary toxicity is dose-dependent and can manifest as dyspnea, cough, and reduced exercise tolerance. PFTs help assess the lung's capacity to move air in and out and measure how effectively the lungs transfer oxygen into the blood.

Imagine the lungs as a set of balloons. Over time, if the balloons develop stiff spots and can't expand or contract properly, they won't hold or move as much air. PFTs are like checking how well the balloons can inflate and deflate to ensure they're still working correctly.

Nurse Jenna should ensure that pulmonary function is closely monitored and take steps to mitigate the risk of pulmonary toxicity, including:

• Scheduling regular pulmonary function tests as recommended by the physician.
• Educating the client on recognizing early symptoms of pulmonary toxicity, such as shortness of breath and persistent cough.
• Assessing the client's respiratory status regularly and reporting any changes to the healthcare provider promptly.
• Encouraging the client to avoid smoking and exposure to respiratory irritants.
• Collaborating with the healthcare team to adjust the Bleomycin dose or discontinue it if significant pulmonary toxicity is detected.

✘ Incorrect answer options:

A cranial x-ray. A cranial x-ray is used to assess conditions related to the head and brain, such as fractures or tumors, but is not relevant for monitoring the side effects of Bleomycin.

An electrocardiogram (ECG). An ECG is used to evaluate heart function and detect cardiac abnormalities. While important for monitoring cardiotoxicity from other chemotherapeutic agents, it is not specific for Bleomycin's primary risk of pulmonary toxicity.

A stress test. A stress test assesses cardiovascular function under physical exertion and is used to diagnose conditions like coronary artery disease. It is not indicated for monitoring pulmonary toxicity from Bleomycin.