← Back

Chapter 8: Introduction to Cancer Therapy and Cancer Drugs

Every problem in the chapter beside the book’s answer, a chapter at a time as you scroll.

Chapter 8: Introduction to Cancer Therapy and Cancer Drugs

14 problems · 0 figures

Case Study 8.2.1 §8.2 source ↗

Read the following clinical scenario to answer the questions that follow. This case will evolve throughout the chapter.

Guadalupe Himenez is a 32-year-old female client who presents to the oncology clinic for her first visit after recently being diagnosed with breast cancer. She initially saw her gynecologist after detecting a lump in her left breast. Her provider ordered a mammogram and biopsy, which determined the mass was malignant, and a surgeon performed a lumpectomy to remove it. The surgeon has referred her to the oncologist to start chemotherapy. Prior to this, she has been in good health without any chronic medical conditions.

Social History
Tobacco use: None
Alcohol use: Occasionally drinks socially
Married with two children

Current Medications
None

While completing the initial assessment, which of the following is a priority to assess?
  1. a.
    Social support
  2. b.
    Family history of cancer
  3. c.
    Date of last menstrual period
  4. d.
    Food preferences
Table 8.14 in the book ↗
Vital Signs Physical Examination
Temperature: 98.2°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: S1, S2 noted

• Respiratory: Clear bilaterally

• GI: Abdomen soft, nontender, nondistended

• GU: Reports normal urine output

• Neurological: Within normal limits

• Integumentary: Skin appropriate; healing surgical incision noted on the left breast; no signs of infection

• GYN: History of two pregnancies with two living children
Blood pressure: 122/76 mm Hg
Heart rate: 73 beats/min
Height: 5'7"
Weight: 174 lb

Answer

C. Date of last menstrual period
Guadelupe is of childbearing age. It is important to confirm she is not pregnant prior to initiating chemotherapy, as these agents can have harmful effects on the fetus.

Case Study 8.2.2 §8.2 source ↗

Read the following clinical scenario to answer the questions that follow. This case will evolve throughout the chapter.

Guadalupe Himenez is a 32-year-old female client who presents to the oncology clinic for her first visit after recently being diagnosed with breast cancer. She initially saw her gynecologist after detecting a lump in her left breast. Her provider ordered a mammogram and biopsy, which determined the mass was malignant, and a surgeon performed a lumpectomy to remove it. The surgeon has referred her to the oncologist to start chemotherapy. Prior to this, she has been in good health without any chronic medical conditions.

Social History
Tobacco use: None
Alcohol use: Occasionally drinks socially
Married with two children

Current Medications
None

After discussing all the treatment options, Guadalupe consents to starting chemotherapy. What type of treatment is this?
  1. a.
    Adjuvant therapy
  2. b.
    Neoadjuvant therapy
  3. c.
    Biologic therapy
  4. d.
    Salvage therapy
Table 8.14 in the book ↗
Vital Signs Physical Examination
Temperature: 98.2°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: S1, S2 noted

• Respiratory: Clear bilaterally

• GI: Abdomen soft, nontender, nondistended

• GU: Reports normal urine output

• Neurological: Within normal limits

• Integumentary: Skin appropriate; healing surgical incision noted on the left breast; no signs of infection

• GYN: History of two pregnancies with two living children
Blood pressure: 122/76 mm Hg
Heart rate: 73 beats/min
Height: 5'7"
Weight: 174 lb

Answer

A. Adjuvant therapy
Adjuvant therapy is given after initial treatment with surgery or radiation.

Case Study 8.3.3 §8.3 source ↗

Read the following clinical scenario to answer the questions that follow. This case study is a follow-up to Case Study Part A.

Guadalupe Himenez has returned to the clinic for her first day of chemotherapy. Her treatment course will involve a combination of agents. Today she is receiving her first dose of paclitaxel (Taxol).

Prior to administering the Taxol, the nurse gives Guadalupe several medications including hydrocortisone and diphenhydramine. The client questions what these medications are for. What is the best response by the nurse?
  1. a.
    “To help stimulate your white blood count.”
  2. b.
    “To decrease the risk you will develop a hypersensitivity reaction to the Taxol.”
  3. c.
    “To decrease the risk of respiratory problems developing.”
  4. d.
    “To enhance the effectiveness of the medication.”

Answer

B. “To decrease the risk you will develop a hypersensitivity reaction to the Taxol.”
Taxol and other taxenes are likely to cause hypersensitivity reactions in clients receiving them. Premedicating the client with certain medications such as steroids, diphenhydramine, and histamine blockers will decrease the risk of these reactions.

Case Study 8.3.4 §8.3 source ↗

Read the following clinical scenario to answer the questions that follow. This case study is a follow-up to Case Study Part A.

Guadalupe Himenez has returned to the clinic for her first day of chemotherapy. Her treatment course will involve a combination of agents. Today she is receiving her first dose of paclitaxel (Taxol).

In addition to the parental chemotherapy regimen, Guadalupe will take tamoxifen orally at home. The nurse instructs the client on this new medication. Which of the following statements by Guadalupe indicates the need for additional instruction?
  1. a.
    “This medication will make my menstrual periods heavier.”
  2. b.
    “I will likely gain weight while taking this medication.”
  3. c.
    “I might start having hot flashes.”
  4. d.
    “This medication could cause nausea and vomiting.”

Answer

A. “This medication will make my menstrual periods heavier.”
Tamoxifen is an antiestrogen hormonal agent. Taking this medication will result in amenorrhea, or the absence of menstrual cycles.

8-1 §8.RQ source ↗

The nurse is providing instruction to a client who will be receiving chemotherapy that selectively kills cancer cells without harming normal cells. Which type of chemotherapy is the nurse describing to the client?
  1. a.
    Adjuvant therapy
  2. b.
    Neoadjuvant therapy
  3. c.
    Targeted therapy
  4. d.
    Biologic therapy

Answer

C. Targeted therapy
Targeted therapy is administered to selectively kill cancer cells without harming healthy cells.

8-2 §8.RQ source ↗

The nurse is reviewing the medical record for a client receiving doxorubicin for breast cancer. The record shows that the client has received a lifetime total of 360 mg/m2. Which action should the nurse take?
  1. a.
    Continue with treatment and routine monitoring because this is within safe lifetime dose limits
  2. b.
    Call the pharmacy to ask that the cumulative dose be reduced
  3. c.
    Notify the provider that the client needs a dose reduction
  4. d.
    Notify the client that the next chemotherapy appointment will be delayed

Answer

A. Continue with treatment and routine monitoring because this is within safe lifetime dose limits
The nurse should continue with the treatment because the client’s lifetime total of doxorubicin is within the maximum lifetime limit of 550 mg/m2.

8-3 §8.RQ source ↗

The nurse is checking the medication orders for a client receiving fluorouracil for the treatment of colon cancer. Which medication should the nurse anticipate will be ordered with fluorouracil?
  1. a.
    Leucovorin
  2. b.
    Phenytoin
  3. c.
    Acetaminophen
  4. d.
    Diphenhydramine

Answer

A. Leucovorin
Leucovorin is administered with fluorouracil to enhance the effectiveness of fluorouracil.

8-4 §8.RQ source ↗

Which statement made by a client indicates to the nurse that the client understands self-care during myelosuppressive chemotherapy?
  1. a.
    “I will include more salads in my diet.”
  2. b.
    “I am excited about visiting my granddaughter’s preschool class.”
  3. c.
    “I am going to increase my protein intake by eating venison my family prepared.”
  4. d.
    “My sister will be caring for my cat while I am undergoing treatment.”

Answer

D. “My sister will be caring for my cat while I am undergoing treatment.”
To avoid infection, the client with myelosuppression should avoid cat litter boxes.

8-5 §8.RQ source ↗

The nurse is caring for a client receiving pembrolizumab. What should the nurse should monitor the client for signs of?
  1. a.
    Vitamin D deficiency
  2. b.
    Pernicious anemia
  3. c.
    Immune-mediated destruction
  4. d.
    Severe neutropenia

Answer

C. Immune-mediated destruction
Pembrolizumab heightens T-lymphocyte activity, predisposing clients to the development of immune-mediated conditions.

8-6 §8.RQ source ↗

Which finding should the nurse expect in a client with acute myelogenous leukemia who has developed tumor lysis syndrome?
  1. a.
    Hypokalemia
  2. b.
    Hypophosphatemia
  3. c.
    Hypocalcemia
  4. d.
    Alkalosis

Answer

C. Hypocalcemia
Tumor lysis syndrome occurs when cancer cells are destroyed, releasing cellular debris and electrolytes into the blood, resulting in hypocalcemia, hyperkalemia, hyperphosphatemia, and acidosis.

8-7 §8.RQ source ↗

Which information would the nurse give to a 67-year-old female client receiving tamoxifen to treat breast cancer?
  1. a.
    Tamoxifen can cause muscle or joint pain.
  2. b.
    This medication is administered intramuscularly.
  3. c.
    Liver function tests need to be closely monitored.
  4. d.
    Tamoxifen is taken for 5 years.

Answer

D. Tamoxifen is taken for 5 years.
Tamoxifen, an antiestrogen administered to treat breast cancers that are hormone-receptor positive, is taken for 5 years.

8-8 §8.RQ source ↗

A client diagnosed with breast cancer is scheduled to begin initial treatment with doxorubicin. Prior to administering the first dose of doxorubicin, the nurse notes that the client’s left ventricular ejection fraction is 58%. Which action should the nurse take?
  1. a.
    Hold the medication and call the prescriber
  2. b.
    Administer the medication as prescribed
  3. c.
    Notify the prescriber and request a reduced dose
  4. d.
    Administer the medication, but at a reduced rate

Answer

B. Administer the medication as prescribed
Doxorubicin should not be administered to clients who have a left ventricular ejection fraction less than 55%. Since this client has an ejection fraction of 58%, the nurse would administer the medication as prescribed.

8-9 §8.RQ source ↗

The nurse is reviewing laboratory reports for a client receiving chemotherapy and notes an absolute neutrophil count of 1.4 cells/mcL. Which order should the nurse anticipate?
  1. a.
    Epoetin alfa
  2. b.
    Filgrastim
  3. c.
    Packed red blood cells
  4. d.
    Interferon A

Answer

B. Filgrastim
Because this client has a low absolute neutrophil count, the nurse anticipates an order for filgrastim to stimulate stem cell production of white blood cells.

8-10 §8.RQ source ↗

Which premedication order will the nurse anticipate being ordered to administer prior to administering rituximab?
  1. a.
    Diphenhydramine and acetaminophen
  2. b.
    Phenytoin and acetaminophen
  3. c.
    Corticosteroid
  4. d.
    Aspirin and ondansetron

Answer

A. Diphenhydramine and acetaminophen
Rituximab has a high risk for causing a sensitivity reaction, so the client must be premedicated with diphenhydramine and acetaminophen.

Loading chapter 9…

Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.