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:

These are signs of cardiotoxicity from doxorubicin, which is a potent anthracycline chemotherapy drug that can cause damage to the heart muscle or valves. Cardiotoxicity is one of the most serious and doselimiting adverse effects of doxorubicin, which can affect up to 20% of patients. Cardiotoxicity can manifest as acute or chronic heart failure, arrhythmias, or myocardial infarction. The nurse should monitor the client for chest pain, dyspnea, palpitations, and edema, which indicate reduced cardiac function and fluid overload. The nurse should also measure the client's blood pressure, heart rate, oxygen saturation, and electrocardiogram (ECG) regularly³.

Choice B reason:

These are common side effects of chemotherapy, but they are not directly related to cardiotoxicity from doxorubicin. Nausea, vomiting, diarrhea, and abdominal pain can occur due to the effects of chemotherapy on the digestive system or the brain. They can also cause dehydration and electrolyte imbalance, which can affect the heart function. The nurse should assess the client for nausea, vomiting, diarrhea, and abdominal pain and provide antiemetics, fluids, and electrolytes as ordered.

Choice C reason:

These are not common signs of cardiotoxicity from doxorubicin, but rather of peripheral neuropathy from paclitaxel, which is another chemotherapy drug that is used in combination with doxorubicin and cyclophosphamide for breast cancer. Peripheral neuropathy is the damage to the nerves in the hands and feet, which can cause numbness, tingling, burning, or pain. Peripheral neuropathy can affect the client's quality of life and ability to perform daily activities. The nurse should assess the client for peripheral neuropathy and provide pain relief and supportive care as needed.

Choice D reason:

These are not common signs of cardiotoxicity from doxorubicin, but rather of infection from bone marrow suppression caused by chemotherapy. Bone marrow suppression is the decrease in the production of blood cells, such as red blood cells, white blood cells, and platelets. This can cause anemia, increased risk of infection, and bleeding problems. Infection can occur when the white blood cell count is low and the immune system is weakened. The nurse should monitor the client for fever, chills, sore throat, and mouth ulcers, which indicate infection and report them to the provider immediately.

Choice A reason:

Pallor and weakness are signs of anemia, as they indicate a low level of hemoglobin or red blood cells that carry oxygen to the tissues. Pallor is the loss of color in the skin, especially in the face, nails, and inside of the eyelids. Weakness is the feeling of having less energy or strength than usual.

Choice B reason:

Dizziness and headache are signs of anemia, as they indicate a low level of oxygen in the brain. Dizziness is the feeling of being lightheaded or unsteady. Headache is the pain or discomfort in the head, scalp, or neck.

Choice C reason:

Shortness of breath and tachycardia are signs of anemia, as they indicate a low level of oxygen in the lungs and heart. Shortness of breath is the feeling of not being able to breathe enough or catch your breath. Tachycardia is the abnormally fast or irregular heartbeat.

Choice D reason:

Constipation and abdominal pain are not directly related to anemia or fatigue, but may indicate other conditions such as dehydration, bowel obstruction, or infection. Constipation is the difficulty or infrequency in passing stools. Abdominal pain is the pain or discomfort in the stomach or belly area.

Choice E reason:

Difficulty sleeping and concentrating are not directly related to anemia or fatigue, but may indicate other conditions such as stress, depression, or anxiety. Difficulty sleeping is the trouble falling asleep or staying asleep. Difficulty concentrating is the trouble focusing on tasks or remembering things.