A nurse is caring for a client who has lung cancer and is receiving bleomycin, an antineoplastic antibiotic, as part of chemotherapy. The nurse should assess the client for which of the following signs and symptoms that indicate pulmonary fibrosis?

Choice A reason: Cough, dyspnea, and crackles are signs and symptoms of pulmonary fibrosis, which is a serious and potentially fatal adverse effect of bleomycin, an antineoplastic antibiotic that inhibits DNA synthesis in cancer cells. Pulmonary fibrosis is a condition that causes scarring and thickening of the lung tissue, which reduces the lung's ability to exchange oxygen and carbon dioxide. The client should be monitored for pulmonary function tests and chest xrays before and during treatment with bleomycin, and the drug should be discontinued if pulmonary fibrosis develops.

Choice B reason: Nausea, vomiting, and diarrhea are not signs of pulmonary fibrosis, but may occur as common side effects of bleomycin and other chemotherapy drugs. The nurse should provide antiemetic drugs, fluids, and electrolytes to prevent dehydration and electrolyte imbalance in the client.

Choice C reason: Fever, chills, and sore throat are not signs of pulmonary fibrosis, but may indicate infection, which is a risk factor for clients receiving chemotherapy. Chemotherapy drugs can suppress the immune system and make the client more susceptible to infections. The nurse should monitor the client's temperature, white blood cell count, and cultures, and administer antibiotics as prescribed.

Choice D reason: Jaundice, dark urine, and claycolored stools are not signs of pulmonary fibrosis, but may indicate liver damage, which is another possible adverse effect of bleomycin. Bleomycin can cause hepatotoxicity, which is toxicity to the liver cells that can impair the liver's function. The nurse should monitor the client's liver function tests, such as serum bilirubin, alkaline phosphatase, and transaminases, and report any abnormalities to the provider.

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 .