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?
Constipation, urinary retention, and abdominal distension
Hearing loss, tinnitus, and vertigo
Blurred vision, photophobia, and eye irritation
Numbness, tingling, and pain in the extremities
Headache, confusion, and altered mental status
The Correct Answer is D
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 .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","E"]
Explanation
Choice A reason:
Numbness, tingling, or pain in the extremities are signs of peripheral neuropathy, which is a common and serious side effect of thalidomide³. This condition can affect the nerves that control sensation and movement in the arms and legs, and can lead to permanent nerve damage if not treated.
Choice B reason:
Drowsiness, dizziness, or confusion are signs of central nervous system depression, which is a common and serious side effect of thalidomide³. This condition can affect the brain's ability to regulate alertness, cognition, and coordination, and can increase the risk of falls, accidents, and injuries.
Choice C reason:
Constipation, nausea, or vomiting are signs of gastrointestinal distress, which is a common and mild side effect of thalidomide. This condition can affect the digestive system's ability to process food and fluids, and can lead to dehydration, malnutrition, and electrolyte imbalance if not managed.
Choice D reason:
Swelling, redness, or warmth in the legs are not directly related to thalidomide use, but may indicate a deep vein thrombosis (DVT), which is a blood clot that forms in a vein deep in the body. Thalidomide can increase the risk of DVT by affecting the blood's ability to clot normally. A DVT can be lifethreatening if it breaks off and travels to the lungs, causing a pulmonary embolism.
Choice E reason:
Rash, itching, or hives are signs of allergic reaction, which is a rare but serious side effect of thalidomide³. This condition can affect the skin's immune response to the drug, and can lead to severe skin reactions such as StevensJohnson syndrome or toxic epidermal necrolysis if not treated.
Correct Answer is C
Explanation
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 .
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