A nurse is caring for a client who is receiving cyclophosphamide, an alkylating agent, as part of chemotherapy for lymphoma. The nurse should monitor the client for which of the following adverse effects of this drug?

Choice A reason: Hearing loss is not a common side effect of paclitaxel, a natural product that interferes with the growth of cancer cells. Hearing loss may be caused by other factors, such as aging, exposure to loud noises, or ear infections.

Choice B reason: Chest pain and shortness of breath are not signs of peripheral neuropathy, but may indicate cardiac or pulmonary problems. Paclitaxel can cause hypersensitivity reactions, such as flushing, rash, and dyspnea, but these usually occur during or shortly after the infusion.

Choice C reason: Numbness and tingling in the hands and feet are symptoms of peripheral neuropathy, which is a common adverse effect of paclitaxel. Peripheral neuropathy is a condition that affects the nerves that carry messages to and from the brain and spinal cord. Paclitaxel can damage these nerves and cause sensory changes, such as numbness, tingling, burning, or pain. The client should report these symptoms to the provider, as they may require dose adjustment or discontinuation of the drug.

Choice D reason: Redness and swelling at the infusion site are not signs of peripheral neuropathy, but may indicate phlebitis or infiltration. Phlebitis is inflammation of the vein, which can cause pain, warmth, and redness along the vein. Infiltration is leakage of the drug into the surrounding tissue, which can cause swelling, pain, and skin damage. The nurse should monitor the infusion site for these complications and stop the infusion if they occur.

Choice A reason: Cyclophosphamide is an alkylating agent that can cause damage to the kidneys and bladder, leading to nephrotoxicity and hemorrhagic cystitis. Nephrotoxicity is the impairment of kidney function due to exposure to toxic substances, and hemorrhagic cystitis is the inflammation and bleeding of the bladder wall. The nurse should monitor the client's urine output, specific gravity, blood urea nitrogen, creatinine, and urinalysis for signs of renal impairment and hematuria. The nurse should also encourage the client to drink plenty of fluids, administer mesna (a protective agent), and alkalinize the urine to prevent these complications .

Choice B reason: Cardiotoxicity and extravasation injury are not common adverse effects of cyclophosphamide. Cardiotoxicity is the damage to the heart muscle caused by certain drugs, such as anthracyclines (e.g., doxorubicin) or trastuzumab. Extravasation injury is the leakage of a vesicant drug (a drug that causes tissue damage) into the surrounding tissues, causing pain, swelling, necrosis, and infection. Cyclophosphamide is not a vesicant drug, but vinca alkaloids (e.g., vincristine) or platinum compounds (e.g., cisplatin) are .

Choice C reason: Peripheral neuropathy and pulmonary fibrosis are not common adverse effects of cyclophosphamide. Peripheral neuropathy is the damage to the nerves of the peripheral nervous system, causing numbness, tingling, pain, or weakness in the hands or feet. Pulmonary fibrosis is the scarring of the lung tissue, causing shortness of breath, cough, and reduced oxygen levels. These complications are more likely to occur with drugs such as taxanes (e.g., paclitaxel) or bleomycin .

Choice D reason: Hepatotoxicity and gastrointestinal toxicity are not specific adverse effects of cyclophosphamide. Hepatotoxicity is the damage to the liver cells caused by certain drugs, such as methotrexate or acetaminophen. Gastrointestinal toxicity is the irritation of the mucous membranes of the digestive tract, causing nausea, vomiting, diarrhea, or mucositis. These side effects can occur with many chemotherapy drugs, but they are not unique to cyclophosphamide .