A nurse is caring for a client who has multiple myeloma and is receiving thalidomide, an angiogenesis inhibitor, as part of targeted therapy. The nurse should instruct the client to report which of the following adverse effects of this drug? (Select all that apply.)
Numbness, tingling, or pain in the extremities
Drowsiness, dizziness, or confusion
Constipation, nausea, or vomiting
Swelling, redness, or warmth in the legs
Rash, itching, or hives
Correct Answer : A,B,C,E
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice D reason:
These are all interventions that can prevent nephrotoxicity from cisplatin, which is a potent and valuable chemotherapy drug that can cause kidney damage or failure. Nephrotoxicity is one of the most serious and doselimiting adverse effects of cisplatin, which can affect up to 30% of patients. Nephrotoxicity is caused by the accumulation of cisplatin in the renal tubular cells, leading to cell injury, inflammation, and ischemia³.
Choice A reason:
Administering mannitol as prescribed before cisplatin infusion can prevent nephrotoxicity by increasing urine output and reducing the concentration of cisplatin in the kidney. Mannitol is an osmotic diuretic that draws water from the extracellular space into the tubular lumen, thereby increasing urine volume and flow rate. Mannitol can also scavenge free radicals and reduce oxidative stress induced by cisplatin⁴.
Choice B reason:
Monitoring serum creatinine and blood urea nitrogen levels daily can prevent nephrotoxicity by detecting early signs of renal impairment and adjusting the dose of cisplatin accordingly. Serum creatinine and blood urea nitrogen 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 dose of cisplatin should be reduced or withheld if serum creatinine or blood urea nitrogen levels rise above a certain threshold⁴.
Choice C reason:
Encouraging fluid intake of at least 3 L per day during treatment can prevent nephrotoxicity by maintaining adequate hydration and preventing dehydration. Hydration is essential for preventing cisplatininduced renal toxicity, as it dilutes the concentration of cisplatin in the kidney and enhances its elimination. Dehydration can increase the risk of nephrotoxicity by reducing renal blood flow and causing tubular obstruction by uric acid crystals. Fluid intake can be oral or intravenous, depending on the patient's condition⁴.
Correct Answer is A
Explanation
Choice A reason:
Liver function tests should be monitored for adverse effects of imatinib, as this drug can cause hepatotoxicity and liver failure in some patients³⁴. These are serious side effects that can affect the liver's ability to metabolize drugs and toxins.
Choice B reason:
Serum electrolytes are not directly affected by imatinib, as this drug does not cause significant changes in sodium, potassium, calcium, or magnesium levels³. However, electrolyte imbalances may occur due to other factors such as dehydration, diarrhea, vomiting, or kidney problems.
Choice C reason:
Coagulation studies are not directly affected by imatinib, as this drug does not cause significant changes in prothrombin time, partial thromboplastin time, or international normalized ratio³. However, bleeding disorders may occur due to other factors such as thrombocytopenia, anemia, or vascular damage.
Choice D reason:
Liver function tests are the only laboratory tests that should be monitored for adverse effects of imatinib, as this drug can cause serious liver damage in some patients. The other tests are not directly affected by imatinib, but may be influenced by other factors or conditions. The nurse should also monitor for other signs and symptoms such as nausea, vomiting, diarrhea, rash, edema, fatigue, infection, etc. The nurse should report any abnormal findings to the doctor and intervene as needed.
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