A nurse is reviewing dietary recommendations for a client with cancer-related weight loss.
Which foods should be encouraged? (Select all that apply.)

Choice A rationale

Filgrastim (Neupogen) is a granulocyte colony-stimulating factor (G-CSF) that stimulates the production, maturation, and activation of neutrophils within the bone marrow. In patients undergoing chemotherapy with low white blood cell counts, particularly neutropenia, filgrastim is crucial for accelerating neutrophil recovery and reducing the incidence, severity, and duration of febrile neutropenia, thereby minimizing infection risk.

Choice B rationale

Epoetin alfa (Epogen) is an erythropoiesis-stimulating agent (ESA) that promotes red blood cell production. While chemotherapy can cause anemia, epoetin alfa specifically targets erythropoiesis and would not address a low white blood cell count. Its primary indication is for the treatment of chemotherapy-induced anemia, not neutropenia.

Choice C rationale

Vancomycin (Vancocin) is an antibiotic primarily used to treat serious bacterial infections, especially those caused by Gram-positive bacteria like methicillin-resistant Staphylococcus aureus (MRSA). It directly combats existing infections and does not stimulate the production of white blood cells. Administering an antibiotic would be appropriate for an infection, not to increase a low white blood cell count.

Choice D rationale

Vincristine (Oncovin) is a vinca alkaloid chemotherapy agent itself, commonly used in the treatment of various cancers. It works by inhibiting microtubule formation, leading to cell cycle arrest and apoptosis of rapidly dividing cells, including cancer cells. Administering another chemotherapy agent would further suppress bone marrow function, exacerbating a low white blood cell count, rather than improving it.

Choice A rationale

This response acknowledges the client's concern directly and validates their feelings about potential discomfort. It also provides reassurance by stating that measures will be taken to minimize pain, establishing trust and indicating a commitment to patient comfort. This therapeutic communication promotes a sense of control and prepares the client realistically for the procedure, promoting coping mechanisms.

Choice B rationale

This response is dismissive of the client's immediate concerns and shifts responsibility back to the provider, undermining the nurse's role in patient education and support. It does not address the client's anxiety about the procedure itself and can make the client feel unheard and unimportant. The nurse should be capable of addressing common procedure-related questions.

Choice C rationale

Bone marrow biopsies are typically performed under local anesthesia, not general anesthesia, meaning the client will be awake during the procedure, although discomfort will be managed. Providing inaccurate information can lead to a breach of trust and increased anxiety if the client realizes the information was incorrect during the procedure.

Choice D rationale

While the client might be worried about the biopsy results, the direct question was about the pain of the procedure. This response deflects from the immediate concern about physical discomfort and instead interprets the client's underlying emotional state, which is not what was asked. The nurse should directly answer the client's explicit question first.