A nurse is caring for a client who has colon cancer and is receiving dactinomycin, an antineoplastic antibiotic, as part of chemotherapy. The nurse should identify that dactinomycin can cause which of the following adverse effects? (Select all that apply.)

Choice A reason:

Administering dexrazoxane as prescribed before doxorubicin infusion can help prevent cardiotoxicity by inhibiting the formation of DNA doublestrand breaks mediated by topoisomerase II beta, which is a key mechanism of doxorubicininduced cardiac damage³. Dexrazoxane is a chelating agent that binds to iron and prevents the generation of reactive oxygen species that can cause oxidative stress and DNA damage⁴. Dexrazoxane is the only drug approved by the Food and Drug Administration (FDA) for the prevention of doxorubicin cardiotoxicity in patients with metastatic breast cancer who have received a cumulative dose of 300 mg/m2 or more⁵.

Choice B reason:

Monitoring electrocardiogram (ECG) and cardiac enzymes during treatment can help detect cardiotoxicity from doxorubicin, but not prevent it. ECG can show changes such as ST segment depression, T wave inversion, arrhythmias, or conduction abnormalities that indicate cardiac ischemia or injury. Cardiac enzymes such as troponin and creatine kinaseMB (CKMB) can show elevation that indicates myocardial damage or necrosis.

Choice C reason:

Assessing for signs and symptoms of heart failure such as dyspnea, edema, and crackles can help diagnose cardiotoxicity from doxorubicin, but not prevent it. Dyspnea is the difficulty or discomfort in breathing that indicates reduced cardiac output or pulmonary congestion. Edema is the swelling of the lower extremities or abdomen that indicates fluid retention or rightsided heart failure. Crackles are the abnormal lung sounds that indicate pulmonary edema or leftsided heart failure.

Choice D reason:

Administering dexrazoxane as prescribed before doxorubicin infusion is the only intervention that can prevent cardiotoxicity from doxorubicin. Monitoring ECG and cardiac enzymes during treatment and assessing for signs and symptoms of heart failure can help detect and treat cardiotoxicity, but not prevent it. Other strategies that may help prevent doxorubicin cardiotoxicity include limiting the cumulative dose of doxorubicin to less than 450 to 550 mg/m2, administering the drug as an infusion rather than an injection, using a liposomal formulation of doxorubicin, and using other agents with antioxidant or antiinflammatory properties⁴.

Choice A reason:

Blood pressure and pulse should be monitored before and during the infusion of trastuzumab, as this drug can cause cardiomyopathy and heart failure in some patients. These are serious side effects that can affect the heart's ability to pump blood effectively.

Choice B reason:

Respiratory rate and oxygen saturation should be monitored before and during the infusion of trastuzumab, as this drug can cause infusion reactions and pulmonary toxicity in some patients³. These are serious side effects that can affect the lungs' ability to exchange oxygen and carbon dioxide.

Choice C reason:

Temperature and skin condition should be monitored before and during the infusion of trastuzumab, as this drug can cause fever, chills, rash, and infection in some patients. These are common side effects that can indicate an allergic reaction or an infection.

Choice D reason:

All of the above assessments should be performed before and during the infusion of trastuzumab, as this drug can cause various side effects that can affect the heart, lungs, skin, and immune system of the patient. The nurse should also monitor for other signs and symptoms such as nausea, vomiting, diarrhea, headache, cough, sore throat, etc. The nurse should report any abnormal findings to the doctor and intervene as needed.