Chemotherapy Competency Week 1

1.

A common Benzodiazepine used to treat nausea and vomiting in chemotherapy is
- A.
  
  Aloxi (palonosetron)
- B.
  
  Emend (aprepitant)
- C.
  
  Ativan (lorazepam)
- D.
  
  Compazine (prochlorperazine)
Correct Answer
C. Ativan (lorazepam)

Explanation
Although lorazapam is frequently given for acute and delayed nausea and vomiting for its sedating and amnesic effect, lorazepam is best used for anticipatory nausea and vomiting. (Polovich, White, & Kelleher, 2005; Wickham, 2004).

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2.

Your patient asks, "Why exactly does chemotherapy make you lose your hair?" How will you answer?
- A.
  
  "I'm not sure. Your should ask your provider during your next visit."
- B.
  
  "Cells responsible for hair growth are rapidly dividing and chemotherapy kills rapidly dividing cells."
- C.
  
  "Wearing an ice cap on your head will prevent hair loss."
- D.
  
  "Don't worry. It happens to everyone. It will grow back>"
Correct Answer
B. "Cells responsible for hair growth are rapidly dividing and chemotherapy kills rapidly dividing cells."

Explanation
At any given time, 85-90% of hair is in the growth phase. Alopecia is a misunderstood and feared side effect of therapy. By understanding the reason for hair loss, patients will be better able to cope with it. (Polovich, White, & Kelleher, 2005; Reeves, 2004).

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3.

You are making your rounds in the treatment room when you notice an IV rate that is inconsistent with the drug & volume being infused. Your next action should be
- A.
  
  Ignore it. It is not your patient.
- B.
  
  Pause the infusion. Find the patients nurse and clarify rate desired.
- C.
  
  Leave as is. Find the patients nurse and clarify rate desired.
- D.
  
  Change the rate and say nothing.
Correct Answer
B. Pause the infusion. Find the patients nurse and clarify rate desired.

Explanation
Infusion nurses work as a team and are expected to monitor all patients in room, not just those that have been assigned. Checking on IV rates is part of a safety system involving checks and double checks. Pausing the rate temporarily decreases the likelyhood of an undesireable outcome due to rapid or delayed infusion. Your co-worker will appreciate your attention to detail and would do the same in a similar situation.

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4.

What drug is given with fluorouracil (Adrucil/5FU) to potentiate its effects and with methotrexate to protect normal cells?
- A.
  
  Leucovorin
- B.
  
  Vitamin B12
- C.
  
  Folate
- D.
  
  Camptosar
Correct Answer
A. Leucovorin

Explanation
Leucovorin is similar to folic acid. Methotrexate works by competing with the folic acid in cancer cells, leading to a folic acid deficiency and cancer cell demise. Leucovorin is given to block the uptake of methotrexate into normal cells (after 24 hours to allow methotrexate to exert its anti-cancer effect) that also become folic acid deficient after methotrexate administration. Fluorouracil has a very short life span in blood and body tissues. Leucovorin enhances the binding of fluorouracil to an enzyme that prolong its life span in the blood and body tissues, which can lead to a greater anti-cancer effect. (Camp, Gullatte, Gilmore, & Hutcherson, 2001; Polovich, White, & Kelleher, 2005)

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5.

What teaching is necessary in the patient who is expected to experience mucositis?
- A.
  
  Oral assessment
- B.
  
  Mouth care
- C.
  
  Nutritional support
- D.
  
  All of the above
Correct Answer
D. All of the above

Explanation
Instruct the patient and family on the proper technique to use in assessing the oral cavity. Successful mouth care begins with chemotherapy administration to maintain mouth hygiene and moisture and ameliorate mucositis. Patients who will develop mucositis at home need to be provided with instructions and solutions for mouth care. If the patient develops mucositis, his or her ability to eat may be compromised. Provide eating hints for ways to maintain nutrition. (Beck, 2004; Polovich, White, & Kelleher, 2005)

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6.

When does the nadir most commonly occur?
- A.
  
  3-5 days post chemotherapy
- B.
  
  10-14 days post chemotherapy
- C.
  
  7-10 days post chemotherapy
- D.
  
  14-18 days post chemotherapy
Correct Answer
C. 7-10 days post chemotherapy

Explanation
Although 7-10 days is the most common time for nadir, the nadir varies with different drugs and drug classes. (Camp et al., 2001; Cleri and Haywood, 2002; Polovich, White, & Kelleher, 2005).

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7.

What is often the first symptom of oral mucositis?
- A.
  
  Pain and ulceration in the mouth and throat
- B.
  
  Mouth bleeding
- C.
  
  Visible ulcerations in the mouth
- D.
  
  Burning sensation in the mouth
Correct Answer
D. Burning sensation in the mouth

Explanation
The burning sensation in the mouth is generally followed by difficulty swallowing or a sensation of a lump in the throat. signs and symptoms of advanced mucositis are esophageal pain or burning, mouth swelling, excessive secretions, redness in the mouth and throat, mouth bleeding, ulcerated areas, and pain in the mouth and throat. ( Beck, 2004; Polovich, White, & Kelleher, 2005.

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8.

Advanced age causes an increased risk of neutropenia.
- A.
  
  True
- B.
  
  False
Correct Answer
A. True

Explanation
As people age, the bone marrow becomes fibrotic, and production of white blood cells is slowed. There is a smaller white blood cell reserve in the marrow of the elderly. (Camp-Sorrell, 2005; Polovich, White, & Kelleher, 2005; Wujcik, 2004.

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9.

Mrs Smith will be receiving T/C for her breast cancer. Taxotere iIV s ordered at 75 mg per m2 and Cytoxan IV is ordered at 600 mg per m2. Mrs. Smith is 5'7" and weighs 146 pounds. Her expected dose of each of these drugs would be
- A.
  
  Taxotere 133 mg, Cytoxan 700 mg.
- B.
  
  Taxotere 125 mg, Cytoxan 1000mg.
- C.
  
  Taxotere 133 mg., Cytoxan 1062 mg.
- D.
  
  Taxotere 120 mg., Cytoxan 1062 mg.
Correct Answer
C. Taxotere 133 mg., Cytoxan 1062 mg.

Explanation
BSA = 1.77 m2. (rounded from 1.769 m2)
Taxotere 75mg x 1.77m2 = 132.75 rounded to 133 mg
Cytoxan 600 mg x 1.77 =1062

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10.

What non-hematopoietic secondary malignancy is associated with cyclophosphamide (Cytoxan) administration?
- A.
  
  Bladder Cancer
- B.
  
  Uterine cancer
- C.
  
  Lung cancer
- D.
  
  Leukemia
Correct Answer
A. Bladder Cancer

Explanation
The metabolite from cyclophosphamide, acrolein is thought to cause bladder cancer as a secondary malignancy for some patients. (Camp et al. 2001; Cleri & Haywood, 2002;, Polovich, White, and Kelleher, 2005)

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Chemotherapy Competency Week 1

A common Benzodiazepine used to treat nausea and vomiting in chemotherapy is

Your patient asks, "Why exactly does chemotherapy make you lose your hair?" How will you answer?

You are making your rounds in the treatment room when you notice an IV rate that is inconsistent with the drug & volume being infused. Your next action should be

What drug is given with fluorouracil (Adrucil/5FU) to potentiate its effects and with methotrexate to protect normal cells?

What teaching is necessary in the patient who is expected to experience mucositis?

When does the nadir most commonly occur?

What is often the first symptom of oral mucositis?

Advanced age causes an increased risk of neutropenia.

Mrs Smith will be receiving T/C for her breast cancer. Taxotere iIV s ordered at 75 mg per m2 and Cytoxan IV is ordered at 600 mg per m2. Mrs. Smith is 5'7" and weighs 146 pounds. Her expected dose of each of these drugs would be

What non-hematopoietic secondary malignancy is associated with cyclophosphamide (Cytoxan) administration?