CANCER TREATMENTS COMPREHENSIVE EXAMINATION
ANSWERS AND RATIONALES
1. 1. It is not fine for the client not to be able
to eat. The client needs a positive nitrogen
balance if the client is to respond well to the
treatment.
2. This is a suggestion to alleviate the pain
caused by mouth ulcerations resulting
from chemotherapy. The antacid coats
the tender mucosal lining. If this does
not work, then there are numbing medi-
cations that the HCP can prescribe.
3. This will cause pain and result in the client
dreading mealtime. There are interventions
that can help the client with the problem.
4. This may be expected as a result of the che-
motherapy and it will go away when the cli-
ent’s immune system has a chance to recover
from the insult caused by the chemotherapy,
but it is not the best response. The nurse
should try to help the client deal with the
mouth ulcers.
2. 1. Ondansetron (Zofran), a 5-HT3 receptor
agonist, will help the nausea, but it will not
have any effect on the client’s nervousness.
2. Morphine, an opioid analgesic, is capable
of producing analgesia and has bronchodi-
lating effects, but it will not treat nausea or
nervousness.
3. Lorazepam (Ativan), a benzodiazepine,
is a sedative hypnotic that has antiemetic
and antianxiety properties. The nurse
should administer this medication to treat
both of the client’s reported symptoms.
4. Prochlorperazine (Compazine) is an anti-
emetic that will treat the nausea but not the
nervousness. This is not the best medication
for the nurse to administer.
MEDICATION MEMORY JOGGER: The test
taker should know the medications by the
specific classifications. Medications in the
same classification usually share the same
side effects and adverse effects, and the
same interventions are needed to adminis-
ter the medications safely.
3. 1. Determining optimum dosing, scheduling,
and toxicity of a medication is the purpose
of a Phase I clinical trial. Clients participat-
ing in Phase I and II trials are not placed in
the trials unless their cancers have failed to
respond to standard treatment procedures.
2. Determining the effectiveness of a medi-
cation against specific tumor types is the
purpose of a Phase II clinical trial.
328
6924_Ch12_301-332.indd 328
3. Comparing a new medication with the
standard treatment procedures is the
purpose of a Phase III clinical trial.
4. Further investigation to determine if a med-
ication may have other uses is the purpose
of a Phase IV clinical trial.
4. 1. To prevent nausea the client should
take an antiemetic 30 minutes before
attempting to eat. Maintaining the
client’s nutritional status is the most
important information for the nurse to
discuss.
2. There is no reason for the client to keep
a record of the nausea. If the nausea is not
controlled, the client should report it to the
HCP.
3. Reporting to the HCP that a client has
become dehydrated is important, but if the
nurse is able to assist with interventions to
maintain the client’s nutritional status, the
client will also be able to maintain his or her
hydration status.
4. The client should not try to eat favorite
foods when nauseated. Doing so may create
an aversion to the foods, and then the favor-
ite foods will not be useful if dealing with
anorexia.
5. 1. Erythropoietin (Procrit) is a biologic
response modifier that is administered
to increase the production of RBCs. The
client’s levels are below normal. The nurse
would not question administering this
medication.
2. Oprelvekin (Neumega) is a biologic mod-
ifier that is administered to increase the
production of platelets. The client’s levels
are below normal. The nurse would not
question administering this medication.
3. Interferon (Intron A) is a biologic modifier
that would not be questioned on the basis of
information provided by a CBC.
4. Filgrastim (Neupogen), a biologic
response modifier, is administered to
increase the production of WBCs. It is
discontinued when the WBC is 10,200
or 10.2 × 103. The nurse should hold this
medication and notify the HCP of the
client’s laboratory values.
6. 1. The client is neutropenic despite the
number of WBCs. The absolute neutro-
phil count is only 708 (5,900 × 0.12 = 708);
normal is greater than 2,500. This client is
7/11/18 4:07 PM

at great risk of developing an infection. The
nurse would hold the chemotherapy and
discuss the absolute neutrophil count with
the HCP.
2. This client’s laboratory data indicates
a great risk for infection. The nurse
should assess the client for any sign of an
infection.
3. This is an intervention for thrombocytope-
nia, not neutropenia.
4. The client may need to be prescribed anti-
biotic therapy, but aminoglycoside antibiot-
10. 1. Ketoconazole (Nizoral) is an
ics are used mainly for methicillin-resistant
Staphylococcus aureus infections (MRSA).
7. 1. The medication is usually mixed in small
volumes of fluid because the nurse should
not leave the client during the administra-
tion of a vesicant.
2. The nurse should not leave the client. The
nurse can observe this complication directly.
3. Infusion pumps are controversial because
the pump could force the vesicant medica-
tion into the client’s tissue and cause more
extensive damage.
4. When administering a vesicant med-
ication into a peripheral IV line, the
nurse must know that the vein is patent
and that there is little likelihood of a
leak-back phenomenon occurring; that
is, a leaking of minute amounts of the
medication into the tissue because the
catheter has been in the vein too long
and an enlarging of the insertion site has
occurred. The nurse should start a new
11. 1. Clients are not transfused unless the Hgb
IV site.
8. 1. Steroid medications are particularly
useful in the treatment of lymphomas
because they exert direct toxicity on
lymphoid tissue by suppressing mitosis
of the cancer cells and dissolution of
lymphocytes.
2. Steroids do suppress inflammation, but
this is not the reason to administer these
medications to clients diagnosed with a
lymphoma.
3. This is a belittling statement and does not
address the client’s concerns.
4. Other medications that are prescribed have
side effects also. The nurse should not
undermine the HCP by suggesting this.
9. 1. Doxorubicin (Adriamycin) is an antineoplas-
tic agent. Shaving the entire head would not
create comfort. Hair keeps heat in the body
and is aesthetic.
6924_Ch12_301-332.indd 329
CHAPTER 12 CANCER TREATMENTS 329
2. Doxorubicin (Adriamycin) is an anti-
neoplastic agent that can cause alopecia.
Wearing a wig that matches the client’s
hair color and style will allow the client
to appear in public without having com-
ments made about her loss of hair.
3. This is assuming that the client wants to
discuss feelings about her body image.
4. The nurse should warn the client about
being in the sun without covering her head,
but it is not the most helpful information.
anti-infective medication that treats
yeast infections. White, patchy areas in
the mouth indicate oral candidiasis, a
yeast infection. The correct adminis-
tration procedure is to have the client
swish the medication around in the
mouth and then swallow the medication
to treat areas in the esophagus as well.
2. Metronidazole (Flagyl) is a gastrointestinal
anti-infective that treats intestinal amoe-
bae, vaginal trichomonas, and anaerobic
bacteria, not yeast infections.
3. Miconazole (Monistat) is an antifungal
used to treat yeast infections, but applying
a topical cream to the oral mucosa would
cause pain and would not adhere to the
mucosal lining.
4. Doxycycline (Vibramycin) is an antibiotic
that would further destroy the good bacte-
ria needed to keep the yeast in check. This
would increase the client’s problem.
is less than 8 and the Hct is less than 24.
There is no reason to type and cross-
match the client.
2. The client’s absolute neutrophil count
(3,456) is higher than 2,500, indicating
that the client has adequate circulating
neutrophils to protect against infection.
3. Thrombocytopenia is defined as a
platelet count of less than 100,000. If it
is less than 50,000 the client is at risk
for bleeding; if it is less than 20,000,
the client is at great risk for hemor-
rhage. This client’s platelet count is
13,000. The nurse should prepare to
infuse platelets to prevent hemorrhage.
4. The client’s absolute neutrophil count
is higher than 2,500, so the client has
adequate circulating neutrophils to protect
against infection. The client does not need
to be placed in reverse isolation (neutrope-
nic precautions).
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 330 PHARMACOLOGY SUCCESS
12. 1. This may be an important question for the
business manager to ask, but this is not the
nurse’s responsibility. The nurse should be
concerned with administering the medica-
tions safely.
2. How the client deals with fatigue is not
important when deciding if it is safe to
administer the chemotherapy.
3. Using up a prescription is not the most
important question when assessing the
client for side effects or adverse effects of
chemotherapy.
4. The medications’ full effect will not
occur until between the treatments.
Nadir counts of WBCs and other
clinical manifestations relating to the
chemotherapy should be assessed.
The nurse should assess for stomati-
tis, infections, and nutritional status.
A fever would indicate an infection,
and difficulty swallowing could indicate
mouth inflammation (stomatitis) or
ulcerations.
13. 1. The nurse should address the client’s
concern with information. The client did
say, “I am afraid,” but accurate information
can alleviate the fear. This is not the best
response.
2. The nurse should inform the client
about pain control options. After the
client has accurate information, the
nurse can address the fear, if it still
exists.
3. This does not give the client the informa-
tion the client is seeking.
4. Addiction should not be a concern of the
client. Although it is a remote possibility,
usually the client will taper the dose of the
medication if it is too high. This client is
worried about dying in pain, and addiction
need not be a concern for a client who is
terminally ill.
14. 1. Leucovorin (folinic acid), a rescue fac-
tor, is used as a rescue medication for
certain drugs. Rescue medications are
specifically timed to prevent life-
threatening complications. The nurse
should administer this medication first.
2. Pain is a priority, but it is not life-
threatening if the client has to wait
for a few minutes to receive the pain
medication.
3. An antiemetic medication is a priority, but
it is not life-threatening if the client has
to wait for a few minutes to receive the
antiemetic medication.
6924_Ch12_301-332.indd 330
4. The client has already had two doses of
the medication. This is not the priority
medication to administer.
MEDICATION MEMORY JOGGER: The clas-
sification of “rescue factor” should provide
the test taker with a clue about priority.
15. 2, 5, 3, 1, 4
2. The first step should be to assess the
client for signs of fluid volume over-
load. Crackles in the lungs would indi-
cate to the nurse to infuse the PRBCs
as slowly as possible.
5. Blood products require two nurses to
verify that the correct product is being
administered. This is the second step.
3. Administering infusions is safer when
the nurse uses a pump. Infusion devices
prevent inadvertent rapid administra-
tion of fluids, and pumps also prevent
the transfusion from slowing down
(blood is very thick) and not infusing
within the time period.
1. Blood should initially be transfused at a
very slow rate. The most common time
for a life-threatening complication to
occur is within the first 15 minutes of
the transfusion. The nurse should not
leave the client being given the transfu-
sion for 15 minutes and should perform
vital signs every 5 minutes. If at the
end of the 15 minutes the client has
not experienced any difficulty with the
blood product, then the nurse should
adjust the infusion rate to transfuse the
PRBCs within 4 hours.
4. Setting the transfusion to infuse within
the time period is the final step before
the nurse leaves the client’s room.
16. 1. Darbepoetin (Aranesp) is a hematopoi-
etic growth factor that stimulates RBC
production. Monitoring the WBC count
would be appropriate for clients receiving
Neupogen and Neulasta, both of which
stimulate WBC production.
2. Darbepoetin (Aranesp) is a hematopoietic
growth factor that stimulates RBC pro-
duction. Darbepoetin will not affect the
client’s lung capacity.
3. Darbepoetin (Aranesp) is a hematopoi-
etic growth factor that stimulates RBC
production. When the Hct level rises,
it can result in an increase in blood
pressure. The nurse should monitor the
client’s blood pressure.
4. Darbepoetin (Aranesp) is a hematopoi-
etic growth factor that stimulates RBC
7/11/18 4:07 PM

production. Monitoring platelet counts
would be appropriate for a client receiving
oprelvekin (Neumega), which stimulates
platelet production.
17. 1. Many clients take digoxin and do fine
during surgery. The HCP should be aware
of the client’s cardiac status when he or she
performed the history and physical. The
nurse does not have to notify the surgeon
about this medication.
2. The client stopped taking the aspirin last
week. The nurse does not have to notify
the surgeon about this medication.
3. Clopidogrel (Plavix) is an antiplatelet
medication the client has been taking.
It should be discontinued at least 7 days
before surgery. The nurse should notify
the surgeon because the surgery will
need to be rescheduled.
4. Many clients become nauseated following
anesthesia. The nurse would not have to
notify the surgeon.
18. 1. Because this client will be monitoring
the IV injection site, the nurse should
teach the client about signs of phlebitis
(for a peripheral IV) or an infection and
what to do if they occur.
2. The client will not receive the medication
from the hospital pharmacy, the client will
obtain the medication from a neighbor-
hood pharmacy or from a home health-
care agency pharmacy.
3. There is no need for the client to self-
document the pain.
4. Arrangements for follow-up care
should be made with a home care
agency.
5. The medications will be administered
using a pump designed for this pur-
pose. The nurse should make sure the
client is able to operate the pump.
19. 1. The nurse cannot delegate administration
of medications in this setting and cannot
delegate this particular type of medication
in any setting.
2. The nurse cannot delegate teaching to a
UAP.
3. The nurse must document what he or she
does. This cannot be delegated.
4. The UAP could apply a topical OTC
preparation.
6924_Ch12_301-332.indd 331
CHAPTER 12 CANCER TREATMENTS 331
20. 1. Stomatitis is an inflammation of the buccal
mucosa. A social worker would not be able
to help with this client.
2. Stomatitis is an inflammation of the
buccal mucosa. A dietitian can help
the client by providing foods the client
can swallow without too much chewing
and at the same time receive adequate
nutrition. The nurse should refer the
client to the dietitian.
3. Stomatitis is not a terminal process. Hos-
pice nurses care for the terminally ill.
4. Stomatitis is an inflammation of the buccal
mucosa. A physical therapist would not be
able to help with this client.
MEDICATION MEMORY JOGGER: The test
taker must know medical terminology.
21. 1. Capecitabine (Xeloda) is an oral anti-
neoplastic agent used in the treatment
of advanced breast cancer and colon
and rectum cancer. It is not a first line
medication. Because it is an oral medi-
cation the nurse on a medical unit may
be required to administer the medi-
cation, depending on the policy of the
facility. Regardless, the nurse must be
fully aware of the actions, side effects,
and adverse reactions these medications
can produce. The medication should be
administered 30 minutes after a meal,
whole, and with a full glass of water.
2. The pill must be swallowed whole.
3. An adverse reaction can be pain,
tenderness, swelling, or blistering of
the soles of the feet and palms of the
hands with peeling. The client should
immediately notify the HCP if noticing
problems in these areas.
4. The medication can lower the client’s
white blood count and increase the risk
of infections.
5. The medication is taken orally.
22. 1. Use of the oral antineoplastic medica-
tion everolimus (Afinitor) can result in
serious lung issues for the client. Any
sign of breathing difficulties must be
immediately reported to the HCP.
2. The medication should be taken at the
same time daily.
3. The medication should be taken after a
meal with a full glass of water.
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 332 PHARMACOLOGY SUCCESS

4. There is no reason to take the pulse prevent nutritional imbalances, but it is

and blood pressure prior to taking this not administered to increase the appetite.
medication. 3. Megesterol acetate (Megace, Appetrol)
is an antineoplastic agent found to have
23. 1. Folinic acid is a vitamin that can assist the
appetite-increasing properties in some
nurse when working with cancer clients to
clients. It is given in an oral suspension.
improve nutritional status or act as a res-
4. Pantoprazole (Protonix) is a proton pump
cue factor to prevent permanent damage
inhibitor used to decrease stomach acid
from some antineoplastic agents, but it is
production and helpful in prevention and
not administered to increase appetite.
treatment of gastric ulcers, but it does not
2. Cyanocobalamin (Vitamin B12) is needed
increase the appetite.
by the body to produce red blood cells and

6924_Ch12_301-332.indd 332 7/11/18 4:07 PM