A nurse is administering leuprolide, a hormone, to a client who has prostate cancer. The nurse should explain to the client that leuprolide works by:

Choice A reason: Cyclophosphamide is an alkylating agent that can cause damage to the kidneys and bladder, leading to nephrotoxicity and hemorrhagic cystitis. Nephrotoxicity is the impairment of kidney function due to exposure to toxic substances, and hemorrhagic cystitis is the inflammation and bleeding of the bladder wall. The nurse should monitor the client's urine output, specific gravity, blood urea nitrogen, creatinine, and urinalysis for signs of renal impairment and hematuria. The nurse should also encourage the client to drink plenty of fluids, administer mesna (a protective agent), and alkalinize the urine to prevent these complications .

Choice B reason: Cardiotoxicity and extravasation injury are not common adverse effects of cyclophosphamide. Cardiotoxicity is the damage to the heart muscle caused by certain drugs, such as anthracyclines (e.g., doxorubicin) or trastuzumab. Extravasation injury is the leakage of a vesicant drug (a drug that causes tissue damage) into the surrounding tissues, causing pain, swelling, necrosis, and infection. Cyclophosphamide is not a vesicant drug, but vinca alkaloids (e.g., vincristine) or platinum compounds (e.g., cisplatin) are .

Choice C reason: Peripheral neuropathy and pulmonary fibrosis are not common adverse effects of cyclophosphamide. Peripheral neuropathy is the damage to the nerves of the peripheral nervous system, causing numbness, tingling, pain, or weakness in the hands or feet. Pulmonary fibrosis is the scarring of the lung tissue, causing shortness of breath, cough, and reduced oxygen levels. These complications are more likely to occur with drugs such as taxanes (e.g., paclitaxel) or bleomycin .

Choice D reason: Hepatotoxicity and gastrointestinal toxicity are not specific adverse effects of cyclophosphamide. Hepatotoxicity is the damage to the liver cells caused by certain drugs, such as methotrexate or acetaminophen. Gastrointestinal toxicity is the irritation of the mucous membranes of the digestive tract, causing nausea, vomiting, diarrhea, or mucositis. These side effects can occur with many chemotherapy drugs, but they are not unique to cyclophosphamide .

Choice A reason: Methotrexate is an antimetabolite that inhibits the synthesis of DNA and RNA, which are essential for cell division and growth. Methotrexate affects rapidly dividing cells, such as those in the bone marrow, where blood cells are produced. This can lead to bone marrow suppression, which is the reduction of the number and function of blood cells, causing anemia, leukopenia, thrombocytopenia, or pancytopenia. The nurse should monitor the client's complete blood count, signs of infection, bleeding, or fatigue, and administer leucovorin (a rescue agent) to prevent or treat this complication .

Choice B reason: Ototoxicity is not a common adverse effect of methotrexate. Ototoxicity is the damage to the inner ear or auditory nerve caused by certain drugs, such as aminoglycosides (e.g., gentamicin) or loop diuretics (e.g., furosemide). Ototoxicity can cause hearing loss, tinnitus, vertigo, or balance problems .

Choice C reason: Gastrointestinal toxicity is a common adverse effect of methotrexate. Gastrointestinal toxicity is the irritation of the mucous membranes of the digestive tract, causing nausea, vomiting, diarrhea, or mucositis. Methotrexate can also cause hepatotoxicity, which is the damage to the liver cells. The nurse should monitor the client's liver function tests, weight, fluid intake and output, and nutritional status. The nurse should also provide antiemetics, mouth care, hydration, and small frequent meals to prevent or manage this complication .

Choice D reason: Neurotoxicity is not a common adverse effect of methotrexate. Neurotoxicity is the damage to the brain or nervous system caused by certain drugs, such as platinum compounds (e.g., cisplatin) or vinca alkaloids (e.g., vincristine). Neurotoxicity can cause confusion, seizures, peripheral neuropathy, or encephalopathy .

Choice E reason: Skin reactions are a common adverse effect of methotrexate. Skin reactions include rash, pruritus, photosensitivity, alopecia, or erythema multiforme. The nurse should inspect the client's skin regularly, provide skin care, avoid exposure to sunlight or ultraviolet light, and apply sunscreen and moisturizer to prevent or treat this complication .