Hormonal Therapy

Every question here, with the answer

1. A client with hormone-receptor positive breast cancer is prescribed tamoxifen. Which item in the client's history should the nurse report to the health care provider before the first dose?

   1. Seasonal allergies
   2. Two previous pregnancies
   3. Deep-vein thrombosis two years ago
   4. Appendectomy as a teenager

   Answer: Deep-vein thrombosis two years ago

   Tamoxifen is contraindicated in clients with a history of deep-vein thrombosis or pulmonary embolus and in those who need coumarin-type anticoagulants. The other history items are not contraindications named in the section.

2. A nurse is teaching a client who is starting tamoxifen at home. Which symptoms should the client be told to report to the health care provider? Select all that apply.

   1. Bone pain
   2. Swelling in the extremities
   3. Chest pain or shortness of breath
   4. Mild hot flashes that come and go
   5. Pain in the calf

   Answer: Bone pain, Swelling in the extremities, Chest pain or shortness of breath, Pain in the calf

   The client on a hormonal agent should report fever, chills, productive cough, bone pain, swelling in extremities, calf pain, chest pain, or shortness of breath, which can signal clots or other serious effects. Hot flashes are an expected side effect.

3. A client is starting flutamide for prostate cancer. Which laboratory test should the nurse expect to be checked periodically during therapy?

   1. Serum amylase
   2. Liver enzymes
   3. Serum glucose
   4. Thyroid-stimulating hormone

   Answer: Liver enzymes

   Antiandrogens such as flutamide are hepatotoxic, so liver enzymes must be evaluated periodically, and flutamide carries a boxed warning for life-threatening liver failure. The other tests are not linked to antiandrogens in the section.

4. A postmenopausal client taking anastrozole reports aching joints and hot flashes. How should the nurse interpret these symptoms?

   1. They are caused by a drug interaction with food.
   2. They are known side effects of aromatase inhibitors and may limit use if the client cannot tolerate them.
   3. They suggest a hypersensitivity reaction and the drug must be stopped.
   4. They mean the cancer has spread to the bones.

   Answer: They are known side effects of aromatase inhibitors and may limit use if the client cannot tolerate them.

   Aromatase inhibitors may cause menopausal symptoms and muscle and joint pain, which may limit use if the client cannot tolerate them. The section does not link these symptoms to hypersensitivity, metastasis, or food interactions.

5. A client with breast cancer asks why her oncologist says tamoxifen will not help her. Her tumor is hormone-receptor negative. Which response by the nurse is accurate?

   1. Tamoxifen is only used for prostate cancer.
   2. Tamoxifen is only given by intramuscular injection.
   3. Tamoxifen only works in premenopausal clients.
   4. Antiestrogens are effective only in breast cancers that are hormone-receptor positive.

   Answer: Antiestrogens are effective only in breast cancers that are hormone-receptor positive.

   Antiestrogens work by blocking estrogen receptors, so they are only effective in hormone-receptor positive breast cancers. Tamoxifen is an oral drug used for breast cancer; the other statements are not supported by the section.

6. A male client receiving bicalutamide for prostate cancer asks what changes he might notice. Which effects should the nurse include? Select all that apply.

   1. Increased muscle mass
   2. Hot flashes
   3. Erectile dysfunction
   4. Breast development and tenderness
   5. Reduced hair growth

   Answer: Hot flashes, Erectile dysfunction, Breast development and tenderness, Reduced hair growth

   Antiandrogens may reduce masculine characteristics such as hair growth and cause erectile dysfunction; male clients on hormonal treatment may develop breast tenderness, and hot flashes are a listed effect of hormonal therapies. Increased muscle mass is not an effect described.