basic principles of cancer chemotherapy
Chapter 101: Basic Principles of Cancer Chemotherapy
Test Bank
MULTIPLE CHOICE
1. The nurse wants to evaluate a nursing student’s understanding of
chemotherapy. The nurse asks, “Which factor would be a major obstacle to
successful chemotherapy?” What is the student’s best response?
a.
“The patient’s reluctance about the doses administered.”
b.
“The patient’s degree of nausea.”
c.
“The toxicity of anticancer drugs to normal tissues.”
d.
“The difficulty attaining and maintaining venous access.”
ANS: C
The major obstacle to successful chemotherapy is the toxicity of anticancer drugs to
normal tissues. The patient’s reluctance regarding the dose is a vague response.
The patient’s degree of nausea should not be an issue, because many good
antiemetics may be given prophylactically. The question does not address whether
the chemotherapy is administered PO or IV; therefore, the response regarding
venous access would be an assumption.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1206
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
2. A nurse is teaching a group of nursing students about cancer
treatment. Which statement by a student indicates an understanding of the
characteristics of cancer cells?
a.
“Cancer cells are characterized by unrestrained growth and division.”
b.
“Division of cancer cells is characteristically rapid.”
c.
“Malignant cells of solid tumors do not invade other tissues.”
d.
“Telomerase is an enzyme produced by cancer cells that promotes metastases.”
ANS: A
Because malignant cells are unresponsive to the feedback mechanisms that
regulate cellular proliferation in healthy tissue, they are characterized by
unrestrained growth and division. Division of tumor cells is not necessarily rapid.
Malignant cells of all types can metastasize. Telomerase is an enzyme that permits
repeated division of cancer cells.
,PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 1207-1208
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
3. A patient is receiving chemotherapy. Seven days after a dose, the
patient’s neutrophil count is 1000 cells/mm3. The nurse will tell this patient:
a.
that hospitalization is necessary to provide infection prophylaxis.
b.
that the provider will probably repeat the lab work in 3 to 5 days.
c.
to ask the provider about skipping the next dose of chemotherapy.
d.
to report any symptoms such as pus, abscesses, or cough.
ANS: B
Normal neutrophil counts range from 2500 to 7000 cells/mm3. The lowest
neutrophil count, or nadir, usually occurs 10 to 14 days after dosing, so this
patient’s neutrophil count should be repeated at that time. Hospitalization is
controversial because of the risk of exposure to serious infections. The next dose
should not be skipped unless the neutrophil count is below 500/mm3. Patients with
neutropenia may not have symptoms of pus, abscess, or cough and should be
instructed to report any fever.
PTS: 1 DIF: Cognitive Level: Application REF: pp. 1214-1215
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
4. A patient with cancer has a tumor composed mostly of G0 cells. When
teaching this patient about the disease, the nurse will make which statement?
a.
“Cells in this patient’s type of tumor will proliferate rapidly.”
b.
“Chemotherapeutic agents that are not toxic to other tissues may be used.”
c.
“This type of tumor is especially sensitive to chemotherapy.”
d.
“This tumor will be managed primarily with surgery.”
ANS: D
Cells in the G0 phase are mitotically dormant; tumors composed mostly of G0 cells
have low growth fractions. Because cytotoxic agents are more active against tumors
with high growth fraction, this patient’s type of tumor will be managed primarily by
surgery and not chemotherapy. Cells in this type of tumor do not proliferate rapidly.
PTS: 1 DIF: Cognitive Level: Application REF: pp. 1208-1209
TOP: Nursing Process: Planning
,MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
5. A nurse is teaching a group of nursing students about how cytotoxic
anticancer drugs affect normal cells. Which statement by a student indicates an
understanding of this teaching?
a.
“Cytotoxic drugs lack tissue specificity.”
b.
“Cytotoxic drugs have a high degree of selective toxicity.”
c.
“Differences between cancer cells and normal cells are qualitative.”
d.
“Neoplastic cells and normal tissue cells are very different.”
ANS: A
Cytotoxic drugs kill target cells as well as normal cells, since they lack specificity for
cancer cells alone. Cytotoxic drugs therefore have a low degree of selective toxicity.
The differences between cancer cells and normal cells are quantitative and not
qualitative. Neoplastic cells and normal cells are very similar.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1209
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
6. A nurse explains to a patient with cancer why it is difficult to achieve
100% cell kill to cure cancer with chemotherapy. Which statement by the patient
indicates a need for further teaching?
a.
“It is necessary to continue giving the same dose of chemotherapeutic agents
throughout therapy, even if toxicity occurs.”
b.
“Symptoms of cancer often disappear before all malignant cells are eradicated.”
c.
“The immune system attacks chemotherapeutic agents and renders them
impotent.”
d.
“The immune system often fails to recognize cancer cells as foreign.”
ANS: C
The immune system does not attack chemotherapeutic agents, so this statement
would indicate a need for further teaching. The same dose of chemotherapeutic
agents must be given throughout therapy, which becomes difficult when patients
have severe toxic reactions. Because cancer symptoms often disappear before all
cells are killed, some therapies are stopped prematurely. The immune system does
not recognize cancer cells as foreign and thus does not assist in cell kill.
PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 1209-1210
TOP: Nursing Process: Implementation
, MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
7. These patients are receiving chemotherapy. Which patient should the
nurse see first?
a.
The patient with lightly bleeding gums
b.
The patient with nausea and vomiting
c.
The patient with a fever of 100.3°F
d.
The patient with diarrhea and stomatitis
ANS: C
Fever is the principal early sign of infection, which can have extremely serious
implications for an immunosuppressed patient. Because of a lack of neutrophils as a
result of chemotherapy, signs of infection may be masked. Lightly bleeding gums,
nausea, and vomiting are to be expected in patients receiving chemotherapy.
Diarrhea and stomatitis also are common in patients receiving chemotherapy.
PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 1214-1215
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk
Potential
8. A patient who has undergone surgical removal of a solid tumor has just
begun chemotherapy. The patient experiences severe nausea and vomiting as well
as alopecia. The nurse will expect the provider to:
a.
continue the chemotherapeutic agent at the same dose.
b.
decrease the dose of chemotherapy to minimize side effects.
c.
order lab tests to evaluate for the presence of residual cancer cells.
d.
stop the chemotherapy because the tumor has been removed.
ANS: A
Cure of cancer requires 100% cell kill. Solid tumors, which often respond poorly to
chemotherapeutic agents, can be “debulked” with surgery and then treated with
cytotoxic drugs, because the remaining cells often re-enter the cell cycle and
become sensitive to the drugs. Chemotherapeutic drugs must be given at the same
dose throughout therapy because of the kinetics of drug-induced cell kill. Because
chemotherapy has just begun, it is still necessary; moreover, cell counts of fewer
than 1 billion cells are no longer detectable and treatment must continue until all
cells are eradicated, so lab tests will not yield useful information. Stopping the
chemotherapy right after surgery is not indicated.
Chapter 101: Basic Principles of Cancer Chemotherapy
Test Bank
MULTIPLE CHOICE
1. The nurse wants to evaluate a nursing student’s understanding of
chemotherapy. The nurse asks, “Which factor would be a major obstacle to
successful chemotherapy?” What is the student’s best response?
a.
“The patient’s reluctance about the doses administered.”
b.
“The patient’s degree of nausea.”
c.
“The toxicity of anticancer drugs to normal tissues.”
d.
“The difficulty attaining and maintaining venous access.”
ANS: C
The major obstacle to successful chemotherapy is the toxicity of anticancer drugs to
normal tissues. The patient’s reluctance regarding the dose is a vague response.
The patient’s degree of nausea should not be an issue, because many good
antiemetics may be given prophylactically. The question does not address whether
the chemotherapy is administered PO or IV; therefore, the response regarding
venous access would be an assumption.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1206
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
2. A nurse is teaching a group of nursing students about cancer
treatment. Which statement by a student indicates an understanding of the
characteristics of cancer cells?
a.
“Cancer cells are characterized by unrestrained growth and division.”
b.
“Division of cancer cells is characteristically rapid.”
c.
“Malignant cells of solid tumors do not invade other tissues.”
d.
“Telomerase is an enzyme produced by cancer cells that promotes metastases.”
ANS: A
Because malignant cells are unresponsive to the feedback mechanisms that
regulate cellular proliferation in healthy tissue, they are characterized by
unrestrained growth and division. Division of tumor cells is not necessarily rapid.
Malignant cells of all types can metastasize. Telomerase is an enzyme that permits
repeated division of cancer cells.
,PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 1207-1208
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
3. A patient is receiving chemotherapy. Seven days after a dose, the
patient’s neutrophil count is 1000 cells/mm3. The nurse will tell this patient:
a.
that hospitalization is necessary to provide infection prophylaxis.
b.
that the provider will probably repeat the lab work in 3 to 5 days.
c.
to ask the provider about skipping the next dose of chemotherapy.
d.
to report any symptoms such as pus, abscesses, or cough.
ANS: B
Normal neutrophil counts range from 2500 to 7000 cells/mm3. The lowest
neutrophil count, or nadir, usually occurs 10 to 14 days after dosing, so this
patient’s neutrophil count should be repeated at that time. Hospitalization is
controversial because of the risk of exposure to serious infections. The next dose
should not be skipped unless the neutrophil count is below 500/mm3. Patients with
neutropenia may not have symptoms of pus, abscess, or cough and should be
instructed to report any fever.
PTS: 1 DIF: Cognitive Level: Application REF: pp. 1214-1215
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
4. A patient with cancer has a tumor composed mostly of G0 cells. When
teaching this patient about the disease, the nurse will make which statement?
a.
“Cells in this patient’s type of tumor will proliferate rapidly.”
b.
“Chemotherapeutic agents that are not toxic to other tissues may be used.”
c.
“This type of tumor is especially sensitive to chemotherapy.”
d.
“This tumor will be managed primarily with surgery.”
ANS: D
Cells in the G0 phase are mitotically dormant; tumors composed mostly of G0 cells
have low growth fractions. Because cytotoxic agents are more active against tumors
with high growth fraction, this patient’s type of tumor will be managed primarily by
surgery and not chemotherapy. Cells in this type of tumor do not proliferate rapidly.
PTS: 1 DIF: Cognitive Level: Application REF: pp. 1208-1209
TOP: Nursing Process: Planning
,MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
5. A nurse is teaching a group of nursing students about how cytotoxic
anticancer drugs affect normal cells. Which statement by a student indicates an
understanding of this teaching?
a.
“Cytotoxic drugs lack tissue specificity.”
b.
“Cytotoxic drugs have a high degree of selective toxicity.”
c.
“Differences between cancer cells and normal cells are qualitative.”
d.
“Neoplastic cells and normal tissue cells are very different.”
ANS: A
Cytotoxic drugs kill target cells as well as normal cells, since they lack specificity for
cancer cells alone. Cytotoxic drugs therefore have a low degree of selective toxicity.
The differences between cancer cells and normal cells are quantitative and not
qualitative. Neoplastic cells and normal cells are very similar.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1209
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
6. A nurse explains to a patient with cancer why it is difficult to achieve
100% cell kill to cure cancer with chemotherapy. Which statement by the patient
indicates a need for further teaching?
a.
“It is necessary to continue giving the same dose of chemotherapeutic agents
throughout therapy, even if toxicity occurs.”
b.
“Symptoms of cancer often disappear before all malignant cells are eradicated.”
c.
“The immune system attacks chemotherapeutic agents and renders them
impotent.”
d.
“The immune system often fails to recognize cancer cells as foreign.”
ANS: C
The immune system does not attack chemotherapeutic agents, so this statement
would indicate a need for further teaching. The same dose of chemotherapeutic
agents must be given throughout therapy, which becomes difficult when patients
have severe toxic reactions. Because cancer symptoms often disappear before all
cells are killed, some therapies are stopped prematurely. The immune system does
not recognize cancer cells as foreign and thus does not assist in cell kill.
PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 1209-1210
TOP: Nursing Process: Implementation
, MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
7. These patients are receiving chemotherapy. Which patient should the
nurse see first?
a.
The patient with lightly bleeding gums
b.
The patient with nausea and vomiting
c.
The patient with a fever of 100.3°F
d.
The patient with diarrhea and stomatitis
ANS: C
Fever is the principal early sign of infection, which can have extremely serious
implications for an immunosuppressed patient. Because of a lack of neutrophils as a
result of chemotherapy, signs of infection may be masked. Lightly bleeding gums,
nausea, and vomiting are to be expected in patients receiving chemotherapy.
Diarrhea and stomatitis also are common in patients receiving chemotherapy.
PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 1214-1215
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk
Potential
8. A patient who has undergone surgical removal of a solid tumor has just
begun chemotherapy. The patient experiences severe nausea and vomiting as well
as alopecia. The nurse will expect the provider to:
a.
continue the chemotherapeutic agent at the same dose.
b.
decrease the dose of chemotherapy to minimize side effects.
c.
order lab tests to evaluate for the presence of residual cancer cells.
d.
stop the chemotherapy because the tumor has been removed.
ANS: A
Cure of cancer requires 100% cell kill. Solid tumors, which often respond poorly to
chemotherapeutic agents, can be “debulked” with surgery and then treated with
cytotoxic drugs, because the remaining cells often re-enter the cell cycle and
become sensitive to the drugs. Chemotherapeutic drugs must be given at the same
dose throughout therapy because of the kinetics of drug-induced cell kill. Because
chemotherapy has just begun, it is still necessary; moreover, cell counts of fewer
than 1 billion cells are no longer detectable and treatment must continue until all
cells are eradicated, so lab tests will not yield useful information. Stopping the
chemotherapy right after surgery is not indicated.
