Nursing study questions for NCLEX Anticancer Cytotoxic Agents

1. Review Questions
for the
NCLEX® EXAM
Anticancer Drugs I:
Cytotoxic Agents

2. Which scheduling approach for the administration of
phase-specific anticancer medications is used to
achieve maximum therapeutic effectiveness?
A. One day every 12 weeks
B. Short intervals over time
C. The first day of the month
D. At the end of treatment
Phase-specific agents are toxic to cells that are passing through a particular phase
of the cell cycle. To be effective, phase-specific agents must be present as cancer
cells cycle through the specific phase in which the drugs act. These agents must be
present for an extended time and often are administered by prolonged intravenous
infusion or in multiple doses at short intervals over an extended time. Correct
answer is B. Short intervals of time.
See Lehne Pharm text, Chap. 102, pg. 1271, Cell-Cycle Phase Specificity.

3. When planning care for a patient who is receiving
cyclophosphamide (Cytoxan), it is most important for the nurse
to include which intervention to prevent complications of
cyclophosphamide (Cytoxan) therapy?
A. Palpate for pedal pulses every 2 hours.
B. Monitor for laryngeal stridor and tetany.
C. Give an antidiarrheal medication.
D. Increase the IV and oral fluid intake.
Cyclophosphamide is an alkylating agent with adverse effects of dose-limiting
bone marrow suppression and hemorrhagic cystitis. Bladder injury can be
minimized by maintaining adequate hydration through increased fluid intake. It is
not necessary to monitor the patient for laryngeal stridor and tetany, palpate
pedal pulses, or give an antidiarrheal medication with cyclophosphamide.
Correct answer is D. Increase the IV and oral fluid intake.
See Lehne Pharm text, Chap. 102, pg. 1276, Cyclophosphamide.

4. Which statement is most important for a nurse to include in patient
teaching for a patient who is discharged after receiving high-dose
methotrexate (Rheumatrex)?
A. “Leucovorin (folinic acid) must be taken daily at the same time.”
B. “Consume extra fluids to minimize any injury to the kidneys.”
C. “Nausea and loss of appetite may last for several more days.”
D. “You may notice mouth soreness and ulcers in several weeks.”
It is most important that leucovorin (folinic acid) be taken as a
rescue medication 24 hours after high-dose methotrexate.
High-dose methotrexate exposes normal cells to significant
toxicity, and they can be saved by the administration of
leucovorin, which bypasses a metabolic block caused by
methotrexate. Failure to administer leucovorin in the right dose
at the right time can be fatal. Leucovorin rescue is more
important than informing the patient to increase fluid intake
and that nausea, loss of appetite, and mouth ulcers may occur
as adverse effects. Correct answer is A. Leucovorin must be
taken at the same time. See Lehne Pharm text, Chap. 102, pg.
1278, Methotrexate, Mechanism of Action.

5. A patient is receiving cisplatin (Platinol-AQ). Which
finding, if noted in the patient, would indicate a
complication requiring follow-up by a nurse?
A. Difficulty sleeping
B. Numbness in the fingers and toes
C. Breast fullness and tenderness
D. Heartburn and dyspepsia
Cisplatin is a platinum-containing anticancer medication
with adverse effects of peripheral sensory neuropathy.
Symptoms may be manifested as numbness and tingling in
the fingers and toes and difficulty with fine motor
activities, such as buttoning clothing and writing.
Difficulty sleeping, breast tenderness, and heartburn are
not associated with the adverse effects of cisplatin.Correct
answer is B. Numbness in the fingers and toes. See Lehne
Pharm text, Chap. 102, pg. 1277, Cisplatin, Toxicity.

6. A patient is given intravenous (IV) atropine for an
adverse effect caused by irinotecan (Camptosar).
Which assessment does the nurse use to evaluate
the effectiveness of this approach?
A. Skin flaking on the palms
B. Number of loose stools
C. Decrease in dyspnea
D. Increase in the heart rate
In addition to bone marrow suppression, irinotecan can
cause severe diarrhea. Early diarrhea occurs within 24 hours
of the start of the infusion because of cholinergic stimulation
of the gastrointestinal tract. This type of diarrhea can be
suppressed with IV atropine. Late diarrhea develops 24 hours
or longer after the infusion and is treated with loperamide.
Dyspnea, heart rate dysrhythmias, and skin flaking of the
palms are not adverse effects of irinotecan that require
treatment with IV atropine.Correct answer is B. Number of
loose stools.
See Lehne Pharm text, Chap. 102, pg. 1285, Irinotecan,
Adverse Effects.

7. Before an infusion of paclitaxel (Taxol), a nurse
should administer which medication to prevent a
complication?
A. Famotidine (Pepcid)
B. Diphenhydramine (Benadryl)
C. Furosemide (Lasix)
D. Acetaminophen (Tylenol)
Paclitaxel is a taxane anticancer agent that can cause severe
hypersensitivity reactions, manifested by hypotension,
dyspnea, and urticaria. Reactions can be minimized by
administration of a histamine1 receptor antagonist
(diphenhydramine), a histamine2 receptor antagonist
(cimetidine), and a glucocorticoid (dexamethasone). No
therapeutic effects are obtained with famotidine,
acetaminophen, or furosemide pretreatment. Correct
answer is B. Benadryl. See Lehne Pharm text, Chap. 102, pg.
1284, Paclitaxel, Toxicity.

8. The nurse identifies which cytotoxic anticancer
agent as most likely to cause pulmonary toxicity in
the patient?
A. Nitrogen mustards
B. Platinum compounds
C. Antimetabolites
D. Nonanthracyclines
Of the choices listed, the nonanthracyclines are most
likely to cause pulmonary fibrosis. Correct answer D.
Nonanthracyclines. See Lehne Pharm text, Chap 102, pg.
1278, Methotrexate, Toxicity.

9. A nurse is preparing to administer doxorubicin (Adriamycin)
intravenously (IV) to a patient who has breast cancer. Which actions
should the nurse take? (Select all that apply.)
A. Infuse normal saline for the preceding 24 hours.
B. Place the patient on a cardiac monitor.
C. Tell the patient the urine turns red.
D. Give a diuretic after the infusion.
E. Ensure the patency of the IV site.
Doxorubicin is an antitumor antibiotic with cardiotoxic adverse
effects. Cardiac activity may be assessed with a monitor, because
acute dysrhythmias and electrocardiographic (ECG) changes can
occur within minutes of administration. The medication imparts a
harmless red color to urine. IV patency is critical, because
doxorubicin is a vesicant and can cause significant local tissue
injury if extravasation occurs. It is not necessary to infuse normal
saline for 24 hours before administration or give a diuretic after
the infusion. Correct answers are B, C, E. See Lehne Pharm text,
Chap. 102, pg. 1281.

10. When working with a patient receiving pemetrexed (Alimta), the
nurse will do what? (Select all that apply.)
A. Administer the drug by mouth on an empty stomach.
B. Administer prophylactic doses of vitamin B12 1 week before
dosing.
C. Administer prophylactic doses of folic acid 1 week before
dosing.
D. Administer prophylactic glucocorticoids to reduce
skin rash.
A. Administer lidocaine to prevent cardiac toxicity.
Pemetrexed is administered intravenously. Lidocaine is not used
to prevent cardiotoxicity. The other three statements are
correct. Correct answers are: B. Administer prophylactic doses
of vitamin B12 one week before dosing, and C. Administer
prophylactic doses of folic acid one week before dosing, and D.
Administer prophylactic glucocorticoids to reduce skin rash.

11. The nurse assesses a patient receiving fluorouracil (Adrucil) for the
adverse effect of plantar erythrodysesthesia. What are the
characteristics of this syndrome? (Select all that apply.)
A. Hypoglycemia
B. Tingling of the palms and soles
C. Swelling of the palms and soles
D. Hypertension
E. Blistering of the palms and soles
The adverse effects of fluorouracil (Adrucil) therapy include
plantar erythrodysesthesia (hand-and-foot syndrome), which
is characterized by tingling, burning, redness, flaking, swelling,
and blistering of the palms and soles. Hypoglycemia and
hypertension are not characteristics of the syndrome. Correct
answers are B, C, E.