Oncology Test #2 Nursing

Front 1

Common side effects of chemotherapy drugs include:

Back 1

Neutropenia, Anemia, Thrombocytopenia, Nausea/Vomiting, Mucositis/Stomatitis, Alopecia, Diarrhea

Front 2

When administering Chemotherapy through IV the nurse should ensure that ....

Back 2

make sure that the IV is in the vein because chemotherapy is a vesicant and can cause tissue necrosis if it infiltrates the tissue.

Front 3

Filgrastim (Neupogen)
Epoetin alfa (Epogen)

Back 3

Colony-stimulating factors

Front 4

Anticholinergics/Belladonna alkaloid:

Scopolamine, TransdermScop

Back 4

Indication: Motion sickness, secretion reduction preoperatively, N/V

Adverse affects: Dry mouth, drowsiness, blurred vision, urinary retention, constipation

Front 5

Antihistamines (H1 receptor blockers):

Promethazine (Phenergan)
Diphenhydramine (Benadryl)

Back 5

Indications:
Motion sickness, non-productive cough; sedation, rhinitis, allergy sx, N/V

Adverse effects:
Dizziness, drowsiness, dry mouth, urinary retention.

Front 6

Neuroleptics/Phenothiazine:

Prochlorperazine (Compazine)
Chlorpropmazine (Thorazine)

Back 6

Indications:
N/V intractable hiccups, Psychotic disorders

Adverse effects:
Extrapyramidal sx, anticholinergic effects.

Front 7

Prokinetics/Dopamine antagonist:

Metaclopramide
Reglan

Back 7

Indications:
Delayed gastric emptying, gastroesophageal reflux, N/V

Adverse effects:
Extrapyramidal sx, fatigue, restlessness, sedation, dry mouth

Front 8

Serotonin blockers/antiseritonergic:

Ondansetron (Zofran)
Granisetron (Kytril)

Back 8

Indications:
N/V associated with cancer postoperative N/V

Adverse effects:
Headache, dizziness, diarrhea, constipation, rash.

Front 9

Tetrahydrocannabinoids:
(THC):
Dronabinol (Marinol)

Back 9

Indications:
N/V assoc with cancer chemotx; improve appetite in AIDS pt; control glaucoma sx.

Adverse effects:
Sedation, euphoria, anxiety, perceptual changes, dry mouth.

Front 10

Misc. Antinausea Drugs:
Phosphorated carbohydrate solution (Emetrol)

Back 10

Indications:
Mild N/V

Adverse effects:
Abdominal pain, diarrhea

Front 11

Aprepitant (Emend)

give with corticosteroid and 5-HT3 blocker

Back 11

Indications:
Prevention of N/V in highly emetogenic drugs such as Cisplatin

Adverse effects:
headache, insomnia, anorexia, constipation.

Front 12

A 60-year-old male with a history of angina pectoris complains of chest pain radiating to the neck and left arm. The nurse's best initial response is which of the following?

Back 12

Administer sublingual nitroglycerin
Sublingual nitroglycerin is the drug of choice to treat acute angina. Acting within 1 to 2 minutes, it decreases myocardial work and oxygen demand through venous and arterial dilation, which in turn reduces preload and afterload. It may also improve myocardial oxygen supply by dilating collateral blood vessels and reducing stenosis. Oxygen should be administered during angina, and low-dose aspirin therapy is often prescribed routinely for clients with angina.
Implementation; Physiological Integrity; Application

Front 13

A female client with acute myocardial infarction complains of severe chest pain. The nurse administers an initial intravenous dose of 6 mg morphine. 2 to 4 mg of morphine may be administered every 5 minutes until the pain is relieved. 5 minutes later, the client rates the chest pain as the same as before the administration of the first dose of morphine. The client's vital signs are stable. The nurse's next appropriate action is which of the following?

Back 13

Administer 4 mg of morphine
The client, experiencing a myocardial infarction, experiences severe pain. Morphine has both vasodilator and arterial dilator effects, decreasing myocardial oxygen use by reducing preload and afterload. Though morphine causes respiratory depression, the client's vital signs are stable, and 4 mg of morphine may be administered to reduce client's pain and increase cardiac perfusion.
Implementation; Physiological Integrity; Application

Front 14

A client is prescribed propranolol (Inderal) to help prevent angina. The nurse evaluating the client's understanding of the instructions knows further teaching is required when the client states

Back 14

"I will take the Inderal if I have an acute attack of angina."
Beta-blockers such as Inderal help prevent angina but will not relieve an acute attack. The client is instructed to keep a supply of fast-acting nitrates on hand for acute anginal attacks. The other responses indicate appropriate understanding of the medication.
Evaluation; Physiological Integrity; Analysis

Front 15

A nurse, monitoring a client's cardiac rhythm, notes an atrial rate of 70, and ventricular rate of 40, both with regular rhythms. There is no relationship between P waves and QRS complexes. The nurse recognizes this rhythm as which of the following?

Back 15

Third-degree AV block
A rhythm with no relationship between P waves and QRS complexes (independent rhythms), and an atrial rate 60 to 100 bpm, ventricular rate 15 to 60 bpm, both regular in rhythm, indicates third-degree AV block. The dysrhythmia is life threatening and immediate pacemaker therapy is required.
Assessment; Physiological Integrity; Analysis

Front 16

Digoxin is ordered for a client with congestive heart failure. The client is also receiving intravenous Lasix. Which of the following laboratory values is essential for the nurse to assess before administering the digoxin?

Sodium level
Potassium level
BUN
pH

Back 16

Potassium level

Low potassium levels are a risk for digoxin toxicity.

Front 17

A nurse is assessing a pt with severe stomatitis. What might some of the nursing interventions be?

Back 17

-Collect cultures
-Use toothette or gauze soaked with solution for cleaning.
-Rinse mouth out with Mycostatin
-remove dentures
-Use lip lubricant
-Provide liquid or purred diet
-Monitor dehydration

Front 18

CHANGE in bowel/bladder habit
A sore that does not heal
UNUSUAL bleeding discharge
THICKENING or lump under skin
INDIGESTION (persistent)
OBVIOUS changes in wart or mole
NAGGING cough or hoarseness

Back 18

ACS (American Cancer Society)
Seven warning signs

PAIN is a late sign of cancer.

Front 19

1. Loss of topoininhibition

2. Anaplasia

Back 19

1. abnormal cell will not stop growing...loose control.

2. lack of differentiation.

Front 20

Diagnostic Tests for cancer Depends on the suspected Cancer source.

Back 20

Biopsy
Radiologic imaging
CXR
CT scan
MRI
Bone Scan

Front 21

Goals of Cancer Tx include:
CURE
CONTROl
PALLIATION

Back 21

-5 year survival does not equal cure.
-Can't make it all go away
-to maintain quality of life

Front 22

Tx modalities
Surgery
Radiation
Chemotherapy
Biologic therapy

Back 22

-oldest method of Tx cut tumor out, local Tx, establish Dx, Cure or control
-Cure control palliation, external beam; brachytherapy(implantation)
-use of chemicals as systemic therapy
-

Front 23

* IL-2 or Interleukin-2 Aldesleukin treats certain types of cancer.
Inteferons:
* Interferon alpha and beta treats certain types of cancer.
*Monoclonal Antibodies:
* Rituxan or Rituximab treats non-Hodgkin's lymphoma.
* Herceptin or Trastuzumab treats breast cancer.

Treatments for controlling side effects:
Colony stimulating factors
*Filgrastim (Neuopen)
increases white blood cell counts and helps prevent infection in people who are getting chemotherapy.
* Procrit, Epogen, or Erythropoietin helps make red blood cells in people who have anemia.

Back 23

Types of Biological Cancer Tx
Common side effects:

Front 24

Chemotherapy drugs:
Drug / Class
Methotrexate/Antimetabolite
Cisplatin/Alkylating
Paclitaxel/Mitotic spindle Poisons
Fluorouracil/antimetabolite
Vincristine/Mitotic spindle Poisons
Doxyrubicin/Antitumor antibiotic

Back 24

Common Side effects:
Neutropenia
Anemia
Thrombocytopenia
N/V
Anorexia
Mucositis/Stomatitis
Alopecia
Diarrhea

Front 25

You are a nurse on an oncology ward. A pt was given a drug to releive sx of N/V. You observe a pt developing a new symptom of akathisia, dystonia. More than likely this patient is experiencing SE from which of the following drugs?
a.Scopolamine
b.Diphenhydramine(benadryl)
c.Chlorpromazine(Thorazine)
d.Aprepitant(Emend)

Back 25

c.Chlorpromazine(Thorazine)

Extrapyramidal sx are a SE of antiphychotic drugs.
This drug is also used for intractlable hiccups.
Other drugs that have this effect are Reglan and Metaclopramide.

Front 26

Your pt is complaining about having a dry mouth after taking a drug to control N/V. Which of the following drugs does cause this effect?
a. Promethazine(Phenergan)
b. Scololamine, TransdermScop
c. Metaclopramide, Reglan
d. Dronabinol (Marinol)
e. all of the above

Back 26

e. all of the above

a. Promethazine(Phenergan)
b. Scololamine, TransdermScop
c. Metaclopramide, Reglan
d. Dronabinol (Marinol)

Front 27

Your pt is being given a drug to stimulate his appetite because he has anorexia after chemotherapy. Which drug will he more than likely be given?
a. Lasix
b.Metoprolol
c.Dronabinol (Marinol)
d.Cisplatin

Back 27

X a. Lasix - (this is a diuretic)
X b.Metoprolol - (this drug is a beta blocker used for heart pts)
c.Dronabinol (Marinol) - This is the correct answer.
X d.Cisplatin (this is a chemo drug)

Front 28

Your pt just had chemotherapy. What drug may the pt been given before chemotherapy?
a. Midol
b. Filgrastim (Neupogen)
c. clopidogrel (Plavix)
d. Aprepitant (Emend)

Back 28

d. Aprepitant (Emend)

Prevention of N/V in highly emetogenic drugs such as anticancer agents.

Front 29

One of your pts just had chemotherapy and is at risk for developing neutropenia. What drug might the doctor order?
a. Vincristine
b. Doxyrubicin
c. Flourouracil
d. Epetin alfa (Epogen)
e. Paclitaxel

Back 29

d. Epoetin alfa (Epogen)

All other drugs given are chemotherapy drugs. Epoetin is given to decrease the duration of neutropenia, therfore decreasing the risk for infection in cancer pts.

Front 30

An antiemetic regimen administered before chemotherapy is recommended to prevent acute nausea and vomiting. This three-drug combination is recommended by ASCO (American Society of Clinical Oncology) for highly emetogenic chemotherapy medications:
Which one is not part of this regimen?
1. Serotonin 5-HT3 receptor antagonist (Ondansetron, dolasetron, granisetron, palonosetron)
2. Dexamethasone (corticosteroid)
3. Aprepitant (NK1 receptor antagonist)
4. Ciplatin

Back 30

4. Cisplatin is a cancer drug.

5-HT3 antagonists are most effective in the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV), especially that caused by highly emetogenic drugs such as cisplatin; when used for this purpose, they may be given alone or, more frequently, with glucocorticoid, usually dexamethasone. They are usually given intravenously, shortly before administration of the chemotherapeutic agent. The concomitant administration of a NK1 receptor antagonist, such as aprepitant, increases the efficacy of 5-HT3 antagonists in preventing both acute and delayed CINV.
The 5-HT3 antagonists are also indicated in the prevention and treatment of radiation-induced nausea and vomiting (RINV) and post-op nausea and vomiting (PONV).

Front 31

A pt who has just had chemotherapy will more than likely experience delayed nausea & vomiting which combination of drugs are helpful in preventing this?

Back 31

The combination of dexamethasone and aprepitant

Front 32

Suggestions for managing anticipatory nausea & vomiting:

Back 32

Physchological techniques and/or the use of benzodiazepines such as lorzepam (Ativan®)

Front 33

Nutrition Tips for Managing Nausea & Vomiting:

Back 33

*Eat small, frequent meals and snacks
*Eat toast, crackers, dry cereal, bread sticks, pretzels
*Try yogurt, sherbet, rice, noodles, baked chicken
*Serve foods cold or at room temperature
*Avoid hot, spicy foods
*Avoid fatty, greasy and fried foods- potato chips, french fries, fried meat and sausage
*Avoid sweet, fatty foods such as candy, cookies or cake
*Avoid caffeine and alcohol
*Suck on hard candies, peppermints or lemon drops
*Slowly drink or sip liquids throughout the day including sports drinks, ginger ale, apple juice and flat pop
*Try Ensure® Enlive! (apple or mixed berry) supplement or Nestle Nutritional juice beverage

Front 34

If a pt develops pneumonitis or fibrosis and develops a cough, what might be a good drug to prescribe?

Back 34

Antihistamine for the Tx of the dry cough.

Front 35

What teaching tips might you give a pt to help manage fatigue after chemotherapy?

Back 35

- increase intake of carbohydrates and protein
- participate in planned exercise programs