A nurse is caring for a client who has prostate cancer and is receiving chemotherapy that causes anemia and neutropenia. The nurse should identify that which of the following drugs can be used to treat both conditions by stimulating the production of red blood cells and neutrophils in the bone marrow? (Select all that apply.)

Choice A reason:

Bone marrow suppression is an adverse effect of dactinomycin, which is an antineoplastic antibiotic that works by binding to DNA and inhibiting RNA synthesis. 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. 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 B reason:

Skin reactions are an adverse effect of dactinomycin, which can cause inflammation, rash, acne, erythema multiforme, or increased pigmentation of previously irradiated skin. Skin reactions can occur due to the direct toxicity of dactinomycin on the skin cells or due to the hypersensitivity or allergic reactions induced by dactinomycin. The nurse should monitor the skin appearance and texture and report any changes to the provider. The nurse should also provide skin care and topical agents as ordered³.

Choice E reason:

Extravasation injury is an adverse effect of dactinomycin, which can occur when the drug leaks out of the vein into the surrounding tissue during intravenous infusion. Extravasation injury can cause severe pain, swelling, redness, blistering, ulceration, or necrosis of the affected tissue. The nurse should monitor the infusion site and stop the infusion immediately if extravasation occurs. The nurse should also elevate the affected limb and apply cold compresses as ordered. The nurse should consult with the provider for further management of extravasation injury³.

Choice C reason:

Cardiotoxicity is not an adverse effect of dactinomycin, but rather of doxorubicin, which is another antineoplastic antibiotic that can cause damage to the heart muscle or valves. Cardiotoxicity can manifest as acute or chronic heart failure, arrhythmias, or myocardial infarction. The nurse should monitor the blood pressure, heart rate, oxygen saturation, and electrocardiogram (ECG) regularly and report any abnormal findings to the provider .

Choice D reason:

Pulmonary fibrosis is not an adverse effect of dactinomycin, but rather of bleomycin, which is another antineoplastic antibiotic that can cause scarring of the lung tissue. Pulmonary fibrosis can manifest as shortness of breath, coughing, or reduced lung function. The nurse should monitor the respiratory rate, breath sounds, and chest xray regularly and report any abnormal findings to the provider .

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 .