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:

Cardiotoxicity is not a common adverse effect of cyclophosphamide, an alkylating agent that crosslinks DNA strands and prevents cell division. Cyclophosphamide is used to treat ovarian cancer, a type of cancer that affects the female reproductive organs. Cardiotoxicity may be caused by other drugs, such as anthracyclines and trastuzumab, which are used to treat other types of cancer.

Choice B reason:

Hemorrhagic cystitis is a common and potentially serious adverse effect of cyclophosphamide, an alkylating agent that is used to treat ovarian cancer. Hemorrhagic cystitis is inflammation and bleeding of the bladder, which can lead to infection, obstruction, and renal failure. Hemorrhagic cystitis is caused by the metabolite of cyclophosphamide, acrolein, which irritates the bladder lining. The nurse should administer mesna, a chemoprotective agent, to the client to prevent hemorrhagic cystitis. Mesna binds to acrolein and inactivates it, preventing it from damaging the bladder. The nurse should also encourage the client to drink plenty of fluids and void frequently to flush out the drug and its metabolites.

Choice C reason:

Nephrotoxicity is not a common adverse effect of cyclophosphamide, an alkylating agent that is used to treat ovarian cancer. Nephrotoxicity may be caused by other drugs, such as cisplatin and methotrexate, which are used to treat other types of cancer.

Choice D reason:

Neurotoxicity is not a common adverse effect of cyclophosphamide, an alkylating agent that is used to treat ovarian cancer. Neurotoxicity may be caused by other drugs, such as vincristine and paclitaxel, which are used to treat other types of cancer.

Choice A reason:

Hypertension and headache are not common adverse effects of filgrastim, a bone marrow stimulant that is used to treat neutropenia caused by chemotherapy. Filgrastim is a synthetic form of granulocyte colonystimulating factor (GCSF), a hormone that stimulates the production of neutrophils, a type of white blood cell that fights infection, in the bone marrow. Hypertension and headache may be caused by other factors, such as stress, pain, or dehydration.

Choice B reason:

Diarrhea and abdominal pain are not common adverse effects of filgrastim, a bone marrow stimulant that is used to treat neutropenia caused by chemotherapy. Diarrhea and abdominal pain may be caused by other drugs, such as antibiotics or antineoplastic agents, that affect the gastrointestinal tract.

Choice C reason:

Fever and flulike symptoms are common and usually mild adverse effects of filgrastim, a bone marrow stimulant that is used to treat neutropenia caused by chemotherapy. Fever and flulike symptoms can occur because filgrastim stimulates the immune system and causes the release of cytokines, which are substances that mediate inflammation and immune response. The client should report these symptoms to the provider and receive appropriate treatment, such as acetaminophen, fluids, and rest.

Choice D reason:

Bleeding and bruising are not common adverse effects of filgrastim, a bone marrow stimulant that is used to treat neutropenia caused by chemotherapy. Bleeding and bruising may be caused by thrombocytopenia, a condition that causes low platelet count and increases the risk of bleeding. Thrombocytopenia can be caused by chemotherapy, but it is not treated by filgrastim. Filgrastim does not increase the number of platelets in the blood, but it may increase the risk of splenic rupture, as more white blood cells can enlarge the spleen. The client should have their platelet count and spleen size monitored regularly and report any signs of bleeding or abdominal pain.