A patient receiving chemotherapy for leukemia is at risk for tumor lysis syndrome (TLS). Which laboratory value should the nurse anticipate in a patient developing TLS?

Choice A rationale

While an electrocardiogram (ECG) is crucial for monitoring cardiac function, Bleomycin is primarily known for its pulmonary toxicity, not direct cardiotoxicity requiring routine ECG monitoring in the absence of pre-existing cardiac conditions. Other chemotherapeutic agents like doxorubicin are more associated with cardiotoxicity, necessitating regular cardiac monitoring.

Choice B rationale

Bleomycin is well-known for its dose-dependent pulmonary toxicity, which can lead to interstitial pneumonitis and pulmonary fibrosis. This adverse effect is a significant concern and can be life-threatening. Daily pulmonary function testing allows for early detection of changes in lung capacity and function, enabling timely intervention and potentially preventing irreversible lung damage.

Choice C rationale

Measuring urinary output is a general nursing intervention for monitoring fluid balance and kidney function, which is important for many medications. However, Bleomycin is not primarily associated with significant nephrotoxicity that would necessitate specific, intensified urinary output monitoring beyond standard care compared to its prominent pulmonary effects.

Choice D rationale

Assessing hearing acuity is crucial for medications like cisplatin or aminoglycoside antibiotics, which are known to cause ototoxicity by damaging the hair cells in the cochlea. Bleomycin, however, does not have a primary adverse effect profile that includes ototoxicity, making this intervention less relevant specifically to Bleomycin administration.

Choice A rationale

CA125 is a biomarker primarily associated with ovarian cancer, not cervical cancer. A decreased level would generally be considered favorable, or within normal limits (normal range typically < 35 U/mL), and would not indicate an increased risk for cervical cancer, which is typically screened via cytology and HPV testing.

Choice B rationale

Regular Pap tests, also known as Papanicolaou tests, are the cornerstone of cervical cancer screening. These tests involve collecting cervical cells to detect precancerous or cancerous changes early, allowing for timely intervention and significantly reducing mortality rates by identifying dysplasia.

Choice C rationale

While pelvic exams are part of routine gynecological care, their primary purpose is to assess the overall health of the reproductive organs. They can detect some abnormalities but are not as effective as Pap tests for specific early detection of cellular changes indicative of cervical cancer.

Choice D rationale

The BRCA1 gene is a tumor suppressor gene primarily linked to an increased risk of hereditary breast and ovarian cancers. While genetic predispositions can influence cancer risk, BRCA1 is not directly associated with the development of cervical cancer. Cervical cancer is predominantly caused by persistent human papillomavirus (HPV) infection.