Exam 3: Chapters 45-47

Question 1

How does cancer metastasize?

Answer 1

Cancer METASTASIZES to other tissues or organs through the lymphatic system

Question 2

What is PRIMARY LESION?

Answer 2

Original site of growth

Question 3

What is METASTASIS?

Answer 3

Secondary lesion in new location caused by uncontrolled growth

Question 4

What is NEOPLASM?

Answer 4

Mass of new cells (tumor)

Question 5

What is a NONCANCEROUS tumor?

Answer 5

BENIGN

Question 6

What is a CANCEROUS tumor?

Answer 6

MALIGNANT

Question 7

Epithelial cells (GI mucosa, skin, etc.)

**Can be treated with Radiation & Chemo

Answer 7

CARCINOMAS

Question 8

Connective or supportive tissue (bone, cartilage, adipose)

**Can be treated with Radiation & Chemo

Answer 8

SARCOMA

Question 9

What tissue of origin are LYMPHOMAS?

Answer 9

LYMPHOCYTES (systemic)

Question 10

LEUKEMIAS (systematic)

TISSUE OF ORIGIN?

Answer 10

hematopoietic blood (RBC)

Question 11

MYELOMA (systematic)

TISSUE OF ORIGIN?

Answer 11

Plasma cells

Question 12

3 cancer types that can be treated with radiation

**HINT: They are all 3 systemic

Answer 12

1. Lymphomas
2. Leukemias
3. Myeloma

Question 13

How is localized cancer treated?

Answer 13

Radiation therapy and Chemotherapy

Question 14

How is systemic cancer treated?

Answer 14

Chemotherapy

Question 15

What is another name for these : Cancer drugs, anticancer drugs, cytotoxic chemotherapy, or just chemotherapy

Answer 15

Antineoplastic drugs

Question 16

2 divisions of chemotherapy treatment

Answer 16

1. Cell cycle-nonspecific (CCNS)-cytotoxic at any cell stage
2. Cell cycle-specific (CCS)

Question 17

Neutropenic precautions for nurse caring for chemo patient

Answer 17

Nurse “gowns up” to protect the patient (Bubble Boy)

**No fresh flowers, fresh veggies or fruits, or pets, and all visitors must be screened.

Avoid those who have had recent vaccinations

MUST wash hand frequently!!

Question 18

What is the most common side effect of Chemotherapy?

Answer 18

NAUSEA

Question 19

What does chemotherapy do to bone marrow?

Answer 19

• bone marrow suppression
• LOW RBC, WBC, Platelet count (lower coagulation time and higher risk of bleeding)

Question 20

What does chemotherapy do to hair follicles?

Answer 20

Alopecia (hair loss)

Question 21

What does chemotherapy do to the GI tract cells?

Answer 21

• ulcers
• decreased taste
• weight loss
• nausea

Question 22

Thrombocytopenia caused by bone marrow suppression

Answer 22

increased bleeding, bruising
*avoid high/squeezing blood pressure
cuff
* report nose bleeds
* brush teeth/hair lightly
*avoid IM/sub Q injections

Question 23

What is neutropenia

Answer 23

the presence of abnormally few neutrophils in the blood, leading to increased susceptibility to infection.
Undesirable side effect of bone marrow suppression

Question 24

Leukopenia

Answer 24

Abnormal reduction of circulating white blood cells, especially granulocytes.
Often interchangeable with neutropenia

Question 25

Digestive tract injury causing inflammation of the oral mucosa

Answer 25

STOMATITIS

Question 26

Common adverse effects of chemotherapy

Answer 26

Bone marrow suppression
*neutropenia & leukopenia
* Thrombocytopenia

Digestive tract injury
* stomatitis

Alopecia
* hair loss

Hyperuricemia
*excess of uric acid in the blood

Reproductive toxicity

Local injury from extravasation of vesicants

Question 27

Antimetabolite

Answer 27

Methotrexate

Question 28

What medication is used for cancer treatment and RA (rheumatoid arthritis)?

Answer 28

Methotrexate

**also used to treat severe cases of
psoriasis

Question 29

Mechanism of action - Methotrexate

Answer 29

• folic acid antagonism
• interferes with the use of folic acid
• as a result, DNA is not produced, and the
  cells die

Question 30

Methotrexate side effects

Answer 30

*nausea
*vomiting
*hair loss
*myelosuppression (decrease in bone
marrow activity that results in reduced
production of blood cells

Question 31

Methotrexate:

Nursing implications

Answer 31

Baseline blood counts

**TEST ?

Patient has acute Leukemia……… what to do? Baseline blood count

Question 32

Methotrexate:

Nursing implications

Answer 32

• GI mucous membranes: stomatitis,
  altered bowel function with high risk for
  poor appetite, nausea, vomiting, diarrhea,
  and inflammation and possible
  ulcerations of GI mucosa
• Hair follicles: loss of hair (alopecia)
• Bone marrow components: dangerously
  low (life-threatening) blood cell counts

Question 33

Antineoplastic medications:

ALKYLATING DRUGS - Adverse Effects

Answer 33

• Nephrotoxicity, peripheral neuropathy, ototoxicity

Question 34

Active in all stages of the cell cycle?

Answer 34

CCNS drugs (cell cycle-nonspecific)

Question 35

Both are harmful to the liver

Answer 35

Alkylating drugs and Cytotoxic antibiotics

Question 36

Adverse effects of Cytotoxic Antibiotics

Answer 36

Hair loss, nausea and vomiting, and myelosuppression

Question 37

Extravasation

Answer 37

Leaking of an antineoplastic drug into surrounding tissues during IV administration

Can result in permanent damage to nerves, tendons, muscles; loss of limb

If suspected STOP infusion IMMEDIATELY!

**Medical error (IV wasn’t working; leakage)

Question 38

Nursing implications before administering Antineoplastic drugs

Answer 38

Assess baseline blood counts prior to administration

Follow specific administration guidelines for each antineoplastic drug

Expect nausea, vomiting, diarrhea, and stomatitis (painful swelling and sores inside the mouth)

Question 39

What does DMARD stand for?

Answer 39

Disease Modifying and Antirheumatic Drugs

Question 40

What do DMARDS do?

Answer 40

More complex MOA:

 *Enhance or restore host's immune system defenses
 *Directly target the tumor cells causing a toxic effect
 *Modify the tumor's biology making it harder for it to survive

Question 41

Immunomodulating drugs….. what do they do?

Answer 41

immune system suppression so the body will no kill it (ex: organ transplant)

Question 42

Therapeutic effects of DMARDS

Answer 42

• enhancement of hematopoietic (the formation of blood cellular components) function
• regulation or enhancement of the immune response
• inhibition of metastases, prevention of cell division, or inhibition of cell maturation

Question 43

Hematopoietic Drugs

Answer 43

• promote synthesis of various types of major blood components

MOA:
* decrease the duration of anemia, neutropenia and thrombocytopenia

Question 44

Side effects of Hematopoietic drugs

Answer 44

Fever, muscle aches, bone pain, flushing

Question 45

Immunomodulating drugs

(mostly used for transplant patients)

Answer 45

• interferons: manufactured substances similar to natural interferon cytokines found in body (anti-viral & anti-tumor effects)
• Monoclonal Antibodies
• Interleukins: anti-tumor properties

Question 46

DMARDS

Answer 46

• modify the disease of rheumatoid arthritis

**Mechanism:
antiinflammatory
antiarthritic
immunomodulating

Question 47

Methotrexate

Answer 47

anticancer drug used to treat RA at lower doses

Question 48

Hydroxychloroquine

Answer 48

used to treat many autoimmune conditions such as lupus

Question 49

Adalimumab

Answer 49

Humira

Question 50

Nursing implications of DMARDS

Answer 50

*Monitor for signs of infection that can be caused by a weakened immune system
*therapeutic effects based on intended use
of the medication

***we know it is going to cause infection so we need to MONITOR!