A nurse is caring for a client who has lymphoma and is receiving vincristine, prednisone, and rituximab as induction chemotherapy. The nurse should identify that vincristine can cause neurotoxicity and instruct the client to report which of the following manifestations?

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.

Choice A reason:

Administering dexrazoxane as prescribed before doxorubicin infusion can help prevent cardiotoxicity by inhibiting the formation of DNA doublestrand breaks mediated by topoisomerase II beta, which is a key mechanism of doxorubicininduced cardiac damage³. Dexrazoxane is a chelating agent that binds to iron and prevents the generation of reactive oxygen species that can cause oxidative stress and DNA damage⁴. Dexrazoxane is the only drug approved by the Food and Drug Administration (FDA) for the prevention of doxorubicin cardiotoxicity in patients with metastatic breast cancer who have received a cumulative dose of 300 mg/m2 or more⁵.

Choice B reason:

Monitoring electrocardiogram (ECG) and cardiac enzymes during treatment can help detect cardiotoxicity from doxorubicin, but not prevent it. ECG can show changes such as ST segment depression, T wave inversion, arrhythmias, or conduction abnormalities that indicate cardiac ischemia or injury. Cardiac enzymes such as troponin and creatine kinaseMB (CKMB) can show elevation that indicates myocardial damage or necrosis.

Choice C reason:

Assessing for signs and symptoms of heart failure such as dyspnea, edema, and crackles can help diagnose cardiotoxicity from doxorubicin, but not prevent it. Dyspnea is the difficulty or discomfort in breathing that indicates reduced cardiac output or pulmonary congestion. Edema is the swelling of the lower extremities or abdomen that indicates fluid retention or rightsided heart failure. Crackles are the abnormal lung sounds that indicate pulmonary edema or leftsided heart failure.

Choice D reason:

Administering dexrazoxane as prescribed before doxorubicin infusion is the only intervention that can prevent cardiotoxicity from doxorubicin. Monitoring ECG and cardiac enzymes during treatment and assessing for signs and symptoms of heart failure can help detect and treat cardiotoxicity, but not prevent it. Other strategies that may help prevent doxorubicin cardiotoxicity include limiting the cumulative dose of doxorubicin to less than 450 to 550 mg/m2, administering the drug as an infusion rather than an injection, using a liposomal formulation of doxorubicin, and using other agents with antioxidant or antiinflammatory properties⁴.