A child diagnosed with Wilms tumor is receiving dactinomycin as part of their treatment. To which drug classification does dactinomycin belong?

A Mitotic inhibitor.

Corticosteroid.

Antitumor antibiotic.

Alkylating agent.

Answer and Explanation

The Correct Answer is C

A. Mitotic inhibitors, such as vincristine and paclitaxel, work by inhibiting microtubule formation during cell division. Dactinomycin does not function through this mechanism, so it does not belong to this class.

B. Corticosteroids, like prednisone or dexamethasone, are anti-inflammatory and immunosuppressive agents. Dactinomycin is not a corticosteroid and does not have these effects.

C. Antitumor antibiotics, such as dactinomycin, act by binding to DNA and inhibiting RNA synthesis, thereby preventing cancer cell replication. Dactinomycin is specifically used in pediatric cancers, including Wilms tumor and rhabdomyosarcoma, as part of combination chemotherapy protocols.

D. Alkylating agents, such as cyclophosphamide or ifosfamide, work by adding alkyl groups to DNA, causing cross-linking and DNA damage. Dactinomycin does not exert its effects through alkylation and is not classified as an alkylating agent.

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Correct Answer is A

Explanation

A. The neutrophil count is the most relevant laboratory value in this situation. Neutrophils are white blood cells that play a key role in the immune system's response to bacterial infections. An elevated neutrophil count, or neutrophilia, often indicates an active infection. Additionally, a shift to immature neutrophils (“left shift”) may suggest a significant or acute bacterial infection. Including this information when reporting purulent drainage allows the healthcare provider to evaluate the severity of infection and determine whether interventions such as antibiotics or wound cultures are necessary.

B. Hematocrit measures the proportion of red blood cells in the blood and is primarily used to assess anemia, blood loss, or hydration status. While important for overall postoperative assessment, hematocrit does not provide information about infection and is not directly relevant to purulent drainage.

C. Platelet count evaluates the body's ability to clot and the risk of bleeding. Although thrombocytopenia may affect surgical site healing or bleeding risk, it does not indicate infection and is secondary to assessing purulent drainage.

D. Serum sodium level reflects electrolyte balance and is important in fluid management and overall metabolic status. However, sodium levels do not provide information about infection or immune response.

A. Encourage intake of high potassium foods. B. Initiate toileting schedule. C. Monitor for signs of anemia. D. Provide perineal skin barrier cream.

Correct Answer is C

Explanation

A. Encouraging intake of high potassium foods is contraindicated. Anuric clients cannot excrete potassium effectively, which puts them at risk for hyperkalemia, a potentially life-threatening condition that can cause cardiac arrhythmias or cardiac arrest. Dietary potassium must be restricted, and blood potassium levels closely monitored, particularly in the days between dialysis sessions.

B. Initiating a toileting schedule is unnecessary for an anuric client. Since the client does not produce urine, interventions related to bladder management, such as scheduled voiding, are irrelevant. Nursing care should focus on other physiological and systemic needs.

C. Monitoring for signs of anemia is a priority. CKD leads to reduced production of erythropoietin by the kidneys, which decreases red blood cell production. Signs of anemia include fatigue, pallor, shortness of breath, tachycardia, and decreased activity tolerance. Early identification allows timely interventions such as erythropoiesis-stimulating agents (ESAs), iron supplementation, or blood transfusions. Anemia also affects quality of life and overall functional status in long-term care residents.

D. Providing perineal skin barrier cream is generally for clients who are incontinent. While maintaining skin integrity is important, this intervention is not a priority for an anuric client with no urine output. Resources and interventions should focus on more relevant complications of CKD, such as anemia, electrolyte imbalances, and cardiovascular issues.

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A child diagnosed with Wilms tumor is receiving dactinomycin as part of their treatment. To which drug classification does dactinomycin belong?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While changing a client's postoperative dressing, the nurse observes purulent drainage at the site. Before reporting this finding to the healthcare provider, the nurse should note which of the client's laboratory values?

Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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