A nurse is caring for a client who has lung cancer and is receiving combination chemotherapy with cisplatin and etoposide. Which of the following interventions should the nurse implement to prevent nephrotoxicity from cisplatin?

Choice C reason:

This is the laboratory test that the nurse should monitor for adverse effects of cytarabine, which is an antimetabolite chemotherapy drug that works by slowing or stopping the growth of cancer cells. The main adverse effect of cytarabine is bone marrow suppression, which 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 A reason:

These are not the laboratory tests that the nurse should monitor for adverse effects of cytarabine, but rather of cisplatin, which is another chemotherapy drug that can cause kidney damage or failure. Cisplatin can accumulate in the kidney cells and cause oxidative stress and cell death. The nurse should monitor the serum creatinine and blood urea nitrogen levels, which 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 nurse should report any abnormal results to the provider and provide fluids and electrolytes as ordered⁴.

Choice B reason:

These are not the laboratory tests that the nurse should monitor for adverse effects of cytarabine, but rather of amphotericin B, which is an antifungal drug that can cause electrolyte imbalance. Amphotericin B can affect the transport of sodium and potassium across cell membranes and cause renal tubular acidosis. The nurse should monitor the serum potassium and magnesium levels, which are important electrolytes for nerve and muscle function. A decrease in these levels can cause muscle weakness, cramps, arrhythmias, and seizures. The nurse should report any abnormal results to the provider and provide supplements as ordered .

Choice D reason:

These are not the laboratory tests that the nurse should monitor for adverse effects of cytarabine, but rather of methotrexate, which is another antimetabolite chemotherapy drug that can cause liver damage or failure. Methotrexate can interfere with the metabolism of folate and cause accumulation of toxic metabolites in the liver cells. The nurse should monitor the serum bilirubin and liver enzyme levels, which are markers of liver function that reflect the liver's ability to process bilirubin and other substances. An increase in these levels indicates liver injury or inflammation. The nurse should report any abnormal results to the provider and provide folinic acid as ordered .

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.