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 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 D reason:

These are manifestations of neurotoxicity from vincristine, which is a chemotherapy drug that belongs to the vinca alkaloids. Vinca alkaloids work by binding to tubulin and inhibiting the formation of microtubules, which are essential for cell division and function. Neurotoxicity is one of the most common and doselimiting adverse effects of vincristine, which can affect up to 80% of patients. Neurotoxicity can manifest as peripheral neuropathy, which is the damage to the nerves in the hands and feet, causing numbness, tingling, burning, or pain. The nurse should monitor the client for peripheral neuropathy and provide pain relief and supportive care as needed³.

Choice A reason:

These are not manifestations of neurotoxicity from vincristine, but rather of paralytic ileus from vincristine. Paralytic ileus is the loss of intestinal motility, causing constipation, urinary retention, and abdominal distension. Paralytic ileus is another common adverse effect of vincristine, which can affect up to 40% of patients. Paralytic ileus is caused by the inhibition of microtubules in the smooth muscle cells of the intestine and bladder, leading to reduced peristalsis and urine flow. The nurse should monitor the client for paralytic ileus and provide laxatives, catheterization, and fluids as ordered⁴.

Choice B reason:

These are not manifestations of neurotoxicity from vincristine, but rather of ototoxicity from cisplatin, which is another chemotherapy drug that is used in combination with vincristine and prednisone for lymphoma. Ototoxicity is the damage to the inner ear or hearing nerve, causing hearing loss, tinnitus, and vertigo. Ototoxicity is one of the most serious and doselimiting adverse effects of cisplatin, which can affect up to 50% of patients. Ototoxicity is caused by the accumulation of cisplatin in the cochlea and vestibular system, leading to oxidative stress and cell death. The nurse should monitor the client for ototoxicity and provide hearing tests and vestibular rehabilitation as needed .

Choice C reason:

These are not manifestations of neurotoxicity from vincristine, but rather of ocular toxicity from rituximab, which is another chemotherapy drug that is used in combination with vincristine and prednisone for lymphoma. Ocular toxicity is the damage to the eyes or vision, causing blurred vision, photophobia, and eye irritation. Ocular toxicity is a rare but serious adverse effect of rituximab, which can affect up to 1% of patients. Ocular toxicity is caused by the infusionrelated reactions or immunemediated reactions induced by rituximab, leading to inflammation and edema in the eyes. The nurse should monitor the client for ocular toxicity and provide eye drops and steroids as ordered .