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.)
Bone marrow suppression
Skin reactions
Cardiotoxicity
Pulmonary fibrosis
Extravasation injury
Correct Answer : A,B,E
Choice A reason:
Bone marrow suppression is an adverse effect of dactinomycin, which is an antineoplastic antibiotic that works by binding to DNA and inhibiting RNA synthesis. 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. The nurse should monitor the complete blood count and differential, which measure the number and type of blood cells in a sample of blood. The nurse should report any abnormal results to the provider and provide supportive care as ordered³.
Choice B reason:
Skin reactions are an adverse effect of dactinomycin, which can cause inflammation, rash, acne, erythema multiforme, or increased pigmentation of previously irradiated skin. Skin reactions can occur due to the direct toxicity of dactinomycin on the skin cells or due to the hypersensitivity or allergic reactions induced by dactinomycin. The nurse should monitor the skin appearance and texture and report any changes to the provider. The nurse should also provide skin care and topical agents as ordered³.
Choice E reason:
Extravasation injury is an adverse effect of dactinomycin, which can occur when the drug leaks out of the vein into the surrounding tissue during intravenous infusion. Extravasation injury can cause severe pain, swelling, redness, blistering, ulceration, or necrosis of the affected tissue. The nurse should monitor the infusion site and stop the infusion immediately if extravasation occurs. The nurse should also elevate the affected limb and apply cold compresses as ordered. The nurse should consult with the provider for further management of extravasation injury³.
Choice C reason:
Cardiotoxicity is not an adverse effect of dactinomycin, but rather of doxorubicin, which is another antineoplastic antibiotic that can cause damage to the heart muscle or valves. Cardiotoxicity can manifest as acute or chronic heart failure, arrhythmias, or myocardial infarction. The nurse should monitor the blood pressure, heart rate, oxygen saturation, and electrocardiogram (ECG) regularly and report any abnormal findings to the provider .
Choice D reason:
Pulmonary fibrosis is not an adverse effect of dactinomycin, but rather of bleomycin, which is another antineoplastic antibiotic that can cause scarring of the lung tissue. Pulmonary fibrosis can manifest as shortness of breath, coughing, or reduced lung function. The nurse should monitor the respiratory rate, breath sounds, and chest xray regularly and report any abnormal findings to the provider .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice D reason:
These are all interventions that can prevent nephrotoxicity from cisplatin, which is a potent and valuable chemotherapy drug that can cause kidney damage or failure. Nephrotoxicity is one of the most serious and doselimiting adverse effects of cisplatin, which can affect up to 30% of patients. Nephrotoxicity is caused by the accumulation of cisplatin in the renal tubular cells, leading to cell injury, inflammation, and ischemia³.
Choice A reason:
Administering mannitol as prescribed before cisplatin infusion can prevent nephrotoxicity by increasing urine output and reducing the concentration of cisplatin in the kidney. Mannitol is an osmotic diuretic that draws water from the extracellular space into the tubular lumen, thereby increasing urine volume and flow rate. Mannitol can also scavenge free radicals and reduce oxidative stress induced by cisplatin⁴.
Choice B reason:
Monitoring serum creatinine and blood urea nitrogen levels daily can prevent nephrotoxicity by detecting early signs of renal impairment and adjusting the dose of cisplatin accordingly. Serum creatinine and blood urea nitrogen are markers of kidney function that reflect the glomerular filtration rate (GFR). An increase in these levels indicates a decrease in GFR and a loss of kidney function. The dose of cisplatin should be reduced or withheld if serum creatinine or blood urea nitrogen levels rise above a certain threshold⁴.
Choice C reason:
Encouraging fluid intake of at least 3 L per day during treatment can prevent nephrotoxicity by maintaining adequate hydration and preventing dehydration. Hydration is essential for preventing cisplatininduced renal toxicity, as it dilutes the concentration of cisplatin in the kidney and enhances its elimination. Dehydration can increase the risk of nephrotoxicity by reducing renal blood flow and causing tubular obstruction by uric acid crystals. Fluid intake can be oral or intravenous, depending on the patient's condition⁴.
Correct Answer is ["C","D"]
Explanation
Choice A reason:
Epoetin alfa (Epogen) is a drug that stimulates the production of red blood cells in the bone marrow, but not neutrophils. It is used to treat anemia caused by chemotherapy, chronic kidney disease, or other conditions.
Choice B reason:
Filgrastim (Neupogen) is a drug that stimulates the production of neutrophils in the bone marrow, but not red blood cells. It is used to prevent or treat neutropenia caused by chemotherapy, bone marrow transplant, or other conditions.
Choice C reason:
Sargramostim (Leukine) is a drug that stimulates the production of both red blood cells and neutrophils in the bone marrow. It is used to prevent or treat anemia and neutropenia caused by chemotherapy, bone marrow transplant, or other conditions.
Choice D reason:
Pegfilgrastim (Neulasta) is a drug that stimulates the production of both red blood cells and neutrophils in the bone marrow⁴. It is a longacting form of filgrastim that works in the same way but can be given less often. It is used to prevent or treat anemia and neutropenia caused by chemotherapy.
Choice E reason:
Darbepoetin alfa (Aranesp) is a drug that stimulates the production of red blood cells in the bone marrow, but not neutrophils. It is a longacting form of epoetin alfa that works in the same way but can be given less often. It is used to treat anemia caused by chemotherapy, chronic kidney disease, or other conditions.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today