A nurse is educating a client who has colon cancer and is receiving chemotherapy that causes anemia. The nurse should explain to the client that epoetin alfa, a bone marrow stimulant, works by:

Choice A reason:

The liver is not the organ that is protected by amifostine, a chemoprotective agent, from nephrotoxicity caused by cisplatin, a platinum compound that crosslinks DNA strands and prevents cell division. Cisplatin is used to treat lung cancer, a type of cancer that affects the respiratory system. The liver is not the primary target of cisplatin's toxicity, although it can cause hepatotoxicity in some cases. Amifostine does not prevent hepatotoxicity caused by cisplatin.

Choice B reason:

The kidneys are the organ that is protected by amifostine, a chemoprotective agent, from nephrotoxicity caused by cisplatin, a platinum compound that is used to treat lung cancer. Nephrotoxicity is a common and potentially serious adverse effect of cisplatin, which can cause acute or chronic renal failure, electrolyte imbalance, and metabolic acidosis. Nephrotoxicity is caused by the accumulation of cisplatin and its metabolites in the renal tubules, which leads to tubular damage and dysfunction. Amifostine can prevent or reduce nephrotoxicity caused by cisplatin. Amifostine is a prodrug that is converted to an active form by alkaline phosphatase in the normal tissues, but not in the tumor tissues. The active form of amifostine scavenges free radicals and protects the renal cells from oxidative stress.

Choice C reason:

The heart is not the organ that is protected by amifostine, a chemoprotective agent, from nephrotoxicity caused by cisplatin, a platinum compound that is used to treat lung cancer. The heart is not the primary target of cisplatin's toxicity, although it can cause cardiotoxicity in some cases. Amifostine does not prevent cardiotoxicity caused by cisplatin.

Choice D reason:

The lungs are not the organ that is protected by amifostine, a chemoprotective agent, from nephrotoxicity caused by cisplatin, a platinum compound that is used to treat lung cancer. The lungs are the primary site of action of cisplatin, as it kills the lung cancer cells. Amifostine does not protect the lung cancer cells from cisplatin's cytotoxic effect, as it does not reach them in its active form. Amifostine does not prevent pulmonary toxicity caused by cisplatin.

Choice A reason:

Bone marrow suppression is a common and potentially serious adverse effect of doxorubicin, an anthracycline that intercalates into DNA and inhibits the enzyme topoisomerase II, resulting in DNA damage and cell death. Doxorubicin is used to treat breast cancer, a type of cancer that affects the breast tissue. Bone marrow suppression can cause leukopenia, anemia, and thrombocytopenia, which can increase the risk of infection, bleeding, and fatigue. Dexrazoxane, a chemoprotective agent, does not prevent bone marrow suppression caused by doxorubicin. The nurse should monitor the client's blood counts regularly and provide supportive care as needed.

Choice B reason:

Cardiotoxicity is a rare but serious adverse effect of doxorubicin, an anthracycline that is used to treat breast cancer. Cardiotoxicity can cause acute or chronic heart failure, arrhythmias, and myocardial infarction. Cardiotoxicity is caused by the formation of free radicals that damage the cardiac muscle cells. Dexrazoxane, a chemoprotective agent, can reduce cardiotoxicity caused by doxorubicin. Dexrazoxane is an iron chelator that scavenges free radicals and protects the heart from oxidative stress. The nurse should monitor the client's cardiac function before and during treatment with doxorubicin and administer dexrazoxane as prescribed.

Choice C reason:

Extravasation injury is a rare but serious adverse effect of doxorubicin, an anthracycline that is used to treat breast cancer. Extravasation injury is leakage of the drug into the surrounding tissue, which can cause severe pain, swelling, blistering, necrosis, and ulceration. Extravasation injury is caused by the vesicant property of doxorubicin, which means that it can cause tissue damage if it escapes from the vein. Dexrazoxane, a chemoprotective agent, can reduce extravasation injury caused by doxorubicin. Dexrazoxane can prevent or limit tissue damage by inhibiting the enzyme topoisomerase II in the skin cells. The nurse should monitor the infusion site carefully and stop the infusion immediately if extravasation occurs. The nurse should also administer dexrazoxane as prescribed and follow the institutional protocol for extravasation management.

Choice D reason:

Alopecia is a common and usually mild adverse effect of doxorubicin, an anthracycline that is used to treat breast cancer. Alopecia is hair loss that can affect the scalp, eyebrows, eyelashes, and body hair. Alopecia is caused by the cytotoxic effect of doxorubicin on the hair follicles. Dexrazoxane, a chemoprotective agent, does not prevent alopecia caused by doxorubicin. The nurse should provide emotional support to the client and educate them on how to cope with hair loss, such as using wigs, hats, scarves, or makeup.

Choice E reason:

Mucositis is a common and potentially serious adverse effect of doxorubicin, an anthracycline that is used to treat breast cancer. Mucositis is inflammation and ulceration of the mucous membranes that line the mouth, throat, esophagus, stomach, and intestines. Mucositis can cause pain, difficulty swallowing, nausea, vomiting, diarrhea, and infection. Mucositis is caused by the cytotoxic effect of doxorubicin on the rapidly dividing cells of the mucous membranes. Dexrazoxane, a chemoprotective agent, does not prevent mucositis caused by doxorubicin. The nurse should assess the client's oral cavity regularly and provide oral hygiene as needed. The nurse should also advise the client to avoid spicy, acidic, or hot foods and drinks; use a soft toothbrush; rinse with saline or baking soda solution; and use topical analgesics or mouthwashes as prescribed.