PHARM - Oncology

A client with cancer has received a course of chemotherapy with fluorouracil. The nurse should plan to reinforce which instructions?

"Do not get any immunizations without primary health care provider approval." Rationale:Because antineoplastic medications lower the body's resistance, the nurse teaches the client to avoid getting immunizations without primary health care provider approval. The client also should avoid contact with individuals who recently have received a live virus vaccine. Aspirin and aspirin-containing products should be avoided to minimize the risk of bleeding. Alcohol should be avoided to minimize the risk of toxicity.

A client with breast cancer has been given a prescription for cyclophosphamide. The nurse determines that the client understands the proper use of the medication if the client makes which statements? Select all that apply.

"I will increase fluid intake to 2 to 3 L/day." "I will observe my urine carefully for signs of bleeding." Rationale:A toxic effect of cyclophosphamide is hemorrhagic cystitis. The client should drink large amounts of fluid during the administration of this medication and observe the urine for bleeding. Clients also should observe for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be encouraged to increase potassium intake. The client would not be instructed to alter magnesium intake.

A client with benign prostatic hyperplasia is being administered finasteride. Which information should be included in the plan of care?

A pregnant caregiver should not be exposed to the crushed tablets of finasteride. Rationale:Finasteride can be harmful to the developing fetus. The fetus who has been exposed to crushed tablets of finasteride is at risk of developing birth defects. Breast enlargements, testicular changes, and testicular pain are symptoms that should be reported to the primary health care provider. The client should continue to have screening exams.

Exemestane 25 mg orally daily is prescribed for a client with advanced breast cancer. When reinforcing instructions to the client about the medication, which time does the nurse tell the client to take the medication?

After a meal Rationale:The best time for a client to take the daily dosage of exemestane is after a meal.

A client with advanced ovarian cancer is being treated with paclitaxel. The nurse monitors the client closely for which side effect of the medication?

Bradycardia Rationale:Side effects of paclitaxel include alopecia, pain in the joints and muscles, diarrhea, nausea, vomiting, peripheral neuropathy, hypotension, mucositis, pain and redness at the injection site, cardiac disturbances (bradycardia), and an abnormal electrocardiogram.

The client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? Select all that apply.

Chest c-ray, Pulmonary function studies Rationale:Bleomycin is an antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. During pulmonary fibrosis, the lung tissue becomes very scarred and hard. Pulmonary fibrosis is not reversible and the client is continuously short of breath. Pulmonary function studies and chest x-ray, along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and adventitious sounds, which could indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Cardiac studies such as an echocardiogram and electrocardiogram, and a cervical radiograph are unrelated to the specific use of this medication.

Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse assists in planning care, knowing that which is the primary action of this medication?

Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Rationale:Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. It is used in the treatment of metastatic breast carcinoma in women and men. It is also effective in delaying the recurrence of cancer following mastectomy. It reduces DNA synthesis and estrogen response.

Capecitabine is prescribed for a client with metastatic breast cancer. The nurse reinforces information to the client about the medication including what frequent side effect?

Diarrhea Rationale:Capecitabine is an antineoplastic medication. Diarrhea is a frequent side effect associated with the medication. Headache, myalgia, and dyspepsia can occur with the use of this medication, but these are not frequent side effects.

The nurse is caring for a child who is receiving chemotherapy for treatment of leukemia and prepares to address which expected needs of this client? Select all that apply.

Fatigue, Easy bruising, Possible infections Rationale:Expected findings with chemotherapy include bruising due to low platelet counts, possible infections from a low white blood cell and neutrophil counts, and fatigue from a low red blood cell count. All of these result from chemotherapy. Chemotherapy also causes alopecia, which is loss of all hair, and it commonly causes anorexia, nausea, and vomiting.

A client is scheduled to receive chemotherapy with a group of medications, one of which is asparaginase. The nurse anticipates that this medication should be removed from the regimen after noting which findings in the client's medical record? Select all that apply.

History of pancreatitis, Significantly elevated serum amylase Rationale:Asparaginase is contraindicated if the client has pancreatitis or a history of the same. A significantly elevated serum amylase is associated with acute pancreatitis. Because this medication impairs pancreatic function, tests to monitor pancreatic function should be performed before initiating therapy and when a week or more has elapsed between the administration of the doses. The client also is monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. History of heart failure and chronic obstructive lung disease and having had a thyroidectomy are not contraindications for the use of this medication.

The nurse tells a client with leukemia that allopurinol has been added to the medication list. The client is currently receiving busulfan. When the client asks the purpose of the new medication, the nurse responds that allopurinol is intended to prevent which complication?

Hyperuricemia Rationale:Busulfan is an antineoplastic agent used in the treatment of acute myelocytic leukemia and in the palliative treatment of chronic myelogenous leukemia. This therapy can cause blood dyscrasias, and with massive cell death the release of uric acid resulting in hyperuricemia. The client is then at risk of experiencing uric acid nephropathy, renal stones, and acute kidney injury. Allopurinol, an antigout medication, is used with chemotherapy to prevent or treat this complication of therapy. It also may be used in mouthwash following fluorouracil therapy to prevent stomatitis. Allopurinol is not used to prevent alopecia or diabetes. It is used to treat gouty arthritis, but this is the case with its use with chemotherapy.

The nurse is reinforcing medication instructions to a client with breast cancer who is receiving cyclophosphamide. Which instruction should the nurse provide to the client?

Increase fluid intake to 2000 to 3000 mL daily. Rationale:Hemorrhagic cystitis is a toxic effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal (GI) upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client should not be told to increase potassium intake. The client should not be instructed to alter sodium intake.

The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value should the nurse note as a result of the massive cell destruction that occurred from the chemotherapy?

Increased uric acid level Rationale:Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in a massive cell kill, releasing uric acid into the blood. Although anemia, decreased platelets, and decreased leukocytes also may be noted, an increased uric acid level is related specifically to cell destruction. Massive cell destruction may result in high levels of potassium, not hypokalemia.

The nurse is providing care for a client with a diagnosis of germ cell cancer of the testes who has been prescribed ifosfamide. The nurse anticipates that the client will also be prescribed which additional antineoplastic medication?

Mesna Rationale:Ifosfamide is administered for refractory germ cell cancer of the testes. Concurrent therapy with mesna and at least 2 L of oral or IV fluid daily limits the toxicity, seen as bone marrow depression and hemorrhagic cystitis. The remaining options are not used in conjunction with ifosfamide.

The nurse admitting a client to the hospital is reviewing the client's history and medications taken at home. Which condition in the client's history is being treated with tamoxifen citrate?

Metastatic breast cancer Rationale:Tamoxifen citrate is used to treat metastatic breast cancer Tamoxifen competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Diabetes mellitus, a positive tuberculin test, and a history of cholecystectomy are not treated with the medication.

A client with cancer is receiving daunorubicin intravenously. The nurse assigned to assist in caring for the client monitors for which commonly expected side effect?

Nausea and vomiting Rationale:Daunorubicin is an antineoplastic medication. The major gastrointestinal (GI) side effects include nausea, vomiting, stomatitis, and esophagitis. Cardiovascular side effects include heart failure and dysrhythmias. Other frequently occurring side effects are alopecia and bone marrow depression. Hypertension, polycythemia (increased red blood cells), and hypovolemia are not side effects of daunorubicin.

A client undergoing chemotherapy with intravenous vincristine sulfate has been given information about the treatment. The nurse determines that the client has adequate understanding if the client identifies which sign or symptom as a potential adverse/side effect of the medication?

Numbness in the feet Rationale:Vincristine is a mitosis inhibitor chemotherapeutic medication that has the adverse effect of damaging the peripheral nerves. This results in numbness in the extremities. Chest pain, weight gain, and bloody urine are not signs/symptoms associated with its use.

A client with lung cancer is receiving a high dose of methotrexate. Leucovorin is also prescribed. The nurse who is assisting in planning care for the client understands that administering the leucovorin with methotrexate is for which purpose?

Preserve normal cells Rationale:High concentrations of methotrexate damage normal cells. To save normal cells, leucovorin is given, which is known as "leucovorin rescue." Folate alone (leucovorin is the form given with chemotherapy) is given to treat megablastic anemia and promote healthy fetal development during pregnancy. In this application, it does promote DNA and nucleic acid synthesis. The medication in either form does not promote excretion.

A client diagnosed with acute lymphocytic leukemia has been prescribed asparaginase. Which finding represents possible medication toxicity?

Prolonged blood clotting times Rationale:Asparaginase can cause severe adverse effects; however, they are often different from those of other anticancer medications. By inhibiting protein synthesis, the medication can cause coagulation deficiencies and injury to the liver, pancreas, and kidneys. In contrast to most anticancer medications, asparaginase does not depress the bone marrow or cause alopecia, oral ulceration, or intestinal ulceration.

Docetaxel is prescribed for a client with metastatic breast cancer. In addition, dexamethasone is prescribed to be administered before initiation of the docetaxel. What is the rationale for the addition of dexamethasone to the treatment plan that the nurse should explain to the client?

Reduces the severity of fluid retention Rationale:Docetaxel is an antineoplastic medication. Frequent side effects include alopecia, hypersensitivity reaction, fluid retention, nausea, vomiting, diarrhea, fever, myalgia, and nail changes. Before receiving docetaxel, the client is premedicated with an oral corticosteroid to reduce the severity of fluid retention and prevent a hypersensitivity reaction. Dexamethasone may cause neutropenia, does not prevent thromboembolic disorders, and does not enhance the effects of docetaxel. In addition, dexamethasone is used with caution in the client with thromboembolic disorders.

Anastrozole is prescribed for a postmenopausal client with breast cancer. The nurse assists in developing a plan of care for the client and suggests monitoring the client closely for which adverse effect of this medication?

Thromboembolism Rationale:Anastrozole is an aromatase and blocks the formation of estrogen. The most serious adverse effect to anastrozole is thromboembolism. Common reactions include nausea, chest pain, edema, and shortness of breath. A variety of gastrointestinal tract or nervous system effects also may occur. Kidney failure, cardiac dysrhythmias, and hyperkalemia are not associated with the use of this medication.

A client diagnosed with testicular cancer is prescribed cisplatin. The nurse should monitor for which toxic effect of this medication?

Tinnitus Rationale:Cisplatin is a medication that can cause neurotoxicity, nephrotoxicity, bone marrow depression, and ototoxicity, which manifests as tinnitus and high-frequency hearing loss. Nausea and vomiting are expected adverse effects, and an elevated white blood cell count is not commonly experienced.

The client with acute myelocytic leukemia is being treated with busulfan. Which laboratory value should the nurse specifically monitor during treatment with this medication?

Uric acid level Rationale:Busulfan can cause an increase in the uric acid level because of massive cell death of malignant cells. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute kidney injury.

Cyclophosphamide is prescribed for a client with a diagnosis of breast cancer. The nurse has reinforced instructions to the client regarding the medication to prevent hemorrhagic cystitis. Which statement by the client indicates an understanding of this chemotherapeutic regimen?

"I need to increase my fluid intake to 2000 to 3000 mL daily." Rationale:Hemorrhagic cystitis is a toxic effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients should also monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal (GI) upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be encouraged to increase potassium intake (bananas and orange juice). Wiping from front to back or drinking cranberry juice would not prevent hemorrhagic cystitis.

Which information should the nurse provide to the client who will be receiving chemotherapy with doxorubicin? Select all that apply.

Alopecia can occur, Cardiotoxicity can occur, Urine and sweat may turn red, The medication is administered by the intravenous route, Promptly report any signs of bleeding to the primary health care provider Rationale:Doxorubicin causes cardiotoxicity, and the client should be monitored for this adverse effect. It also causes alopecia and the urine and sweat to turn red. It is administered by the intravenous route. Because of its vesicant properties, doxorubicin can cause severe local injury if extravasation occurs. Bone marrow suppression can occur, and the client should report signs of this adverse effect to the primary health care provider or caregiver Stool turns white in disorders that block bile secretion, such as cholelithiasis; this does not occur with chemotherapeutic agents.

The client with non-Hodgkin's lymphoma is receiving daunorubicin. Which sign/symptom should indicate to the nurse that the client is experiencing a toxic effect related to the medication?

Crackles on auscultation of the lungs Rationale:Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as heart failure is a toxic effect of daunorubicin. Bone marrow depression is also a toxic effect. Nausea and vomiting are frequent side effects associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. Fever is a frequent side effect, and diarrhea can occur occasionally. The other options, however, are not toxic effects.

Letrozole is prescribed for a postmenopausal client with advanced breast cancer. Which side effect of this medication should the nurse reinforce in the instructions to the client?

Leg pain Rationale:Letrozole is an aromatase inhibitor used to treat advanced breast cancer in postmenopausal women whose disease progressed after antiestrogen therapy. The most frequent side effects include skeletal, back, arm, and leg pain. Less frequent side effects include nausea, headache, fatigue, constipation, vomiting, and dyspnea.

The nurse is reviewing the laboratory results of a client receiving chemotherapy for cancer. The nurse reports which abnormal result to the primary health care provider?

Platelet count, 40,000 mm3 Rationale:Hematological toxicity from chemotherapy occurs when there is a decreased production of blood components (RBCs, WBCs, and platelets) owing to the effects of antineoplastic agents. Platelet counts normally are 150,000 to 400,000 mm3. The values of the hematocrit, WBC count, and RBC count are within normal limits. The nurse reports this finding because this value places the client at risk for bleeding.

A client with carcinoma of the breast is admitted to the hospital for treatment with intravenous vincristine. The client tells the nurse that she has been told by her friends that she is going to lose all her hair. After offering an open-ended question in reply, the client expresses how she feels. The nurse then gives the client information. The nurse makes which appropriate response to the client?

"Hair loss may occur, and it will grow back, but it may have a different color or texture." Rationale:Alopecia (hair loss) can occur following the administration of many antineoplastic medications. Alopecia is reversible, but new hair growth may have a different color and texture.

The nurse is caring for a client with a diagnosis of metastatic breast carcinoma. Tamoxifen citrate 10 mg orally twice daily is prescribed for the client, and the nurse is reinforcing instructions to the client regarding the medication. Which statement by the client would indicate an understanding of the medication?

"If I have difficulty seeing, I need to call the primary health care provider." Rationale:Tamoxifen citrate is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing a high concentration of receptors, such as the breasts, the uterus, and the vagina. Frequent side effects include hot flashes, nausea, vomiting, vaginal bleeding or discharge, pruritus vulvae, and skin rash. Adverse or toxic reactions include retinopathy, corneal opacity, and decreased visual acuity. The client needs to report menstrual irregularities, pelvic pain or pressure, and visual disturbances.

The client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication?

Calcium level Rationale:Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain. Tamoxifen does not increase glucose or potassium levels, or increase the prothrombin time.

Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that which is the primary action of this medication?

Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Rationale:Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen reduces DNA synthesis and estrogen response.

The client with ovarian cancer is being treated with vincristine. The nurse monitors the client, knowing that which adverse effect is specific to this medication?

Extreme numbness Rationale:Vincristine is a vinca alkaloid antineoplastic (miotic inhibitor) medication that has an adverse effect, specifically peripheral neuropathy. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation, rather than diarrhea, is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication.

The client with small cell lung cancer is being treated with etoposide and the nurse is assisting with caring for the client during administration. The client gets up to use the bathroom and is dizzy and very weak. The nurse understands these symptoms are likely as a result of which side/adverse effect that is specifically associated with this medication?

Orthostatic hypotension Rationale:A side effect specific to etoposide is orthostatic hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all antineoplastic medications.

The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase, an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which is documented in the client's history?

Pancreatitis Rationale:Asparaginase is a antineoplastic enzyme that is contraindicated if hypersensitivity exists in the case of pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function, and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between the administration of doses. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The medication may be used for clients with a history of diabetes mellitus, myocardial infarction, or chronic obstructive pulmonary disease.

The nurse is helping prepare instructions for a client who has developed stomatitis following the administration of a course of antineoplastic medications. Which instructions should the nurse suggest to include in the plan of care? Select all that apply.

Rinse the mouth with diluted baking soda or saline.; Nystatin should be prescribed if the client has areas of thrush.; Offer foods and liquids that are neutral in taste and are neither hot nor cold. Rationale:Stomatitis (ulceration in the mouth) can occur as a result of the administration of antineoplastic medications. The client should be instructed to examine the mouth daily and report any signs of ulceration. If stomatitis occurs, the client should be instructed to rinse the mouth with diluted baking soda or saline. If the client appear to have thrush, a fungal infection with Candida albicans, then nystatin, an antifungal medication, should be prescribed. Foods and fluids are important and should not be restricted. Neutral foods that are neither hot nor cold are often better tolerated. The client should avoid toothbrushing and flossing when stomatitis is severe.

Megestrol acetate, an antineoplastic medication, is prescribed for the client with metastatic endometrial carcinoma. The nurse reviews the client's history and contacts the registered nurse if which diagnosis is documented in the client's history?

Thrombophlebitis Rationale:Megestrol acetate suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of thrombophlebitis

A client with cancer is receiving cisplatin. Which findings indicate that the client is experiencing an adverse effect of the medication? Select all that apply.

Tinnitus, High-frequency hearing loss Rationale:An adverse effect related to the administration of cisplatin, an antineoplastic medication, is ototoxicity with hearing loss. Tinnitus or ringing in the ears is associated with this ototoxicity. The nurse should monitor for this adverse effect when administering this medication. Increased appetite, frequent urination, and seeing yellow halos around objects are not adverse effects of this medication.

The nurse is assisting with caring for a client with cancer who is receiving cisplatin. Which adverse effects are associated with this medication? Select all that apply.

Tinnitus, Ototoxicity, Nephrotoxicity, Hypomagnesemia Rationale:Cisplatin is an alkylating medication. Alkylating medications are cell cycle phase nonspecific and affect the synthesis of DNA by causing its cross-linking to inhibit cell reproduction. Cisplatin may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine may be administered before cisplatin to reduce the potential for renal toxicity.

A client with breast cancer is being treated with cyclophosphamide. The nurse plans care, knowing that this medication fits which classification?

Cell cycle phase nonspecific Rationale:Cyclophosphamide is an antineoplastic medication of the alkylating classification. Medications in this classification are cell cycle phase nonspecific and affect all phases of the reproductive cell cycle. Cell cycle phase-specific medications affect cells only during a certain phase of the reproductive cycle. An antimetabolite medication is one that blocks the metabolism or normal functioning of an organism. A hormonal medication is one that either supports or blocks the action of a hormone.

A client with bladder cancer is receiving cisplatin and vincristine. The nurse plans care, knowing that which is the purpose of administering both of these medications?

Decrease medication resistance and reduce medication toxicity Rationale:Cisplatin is an alkylating medication and vincristine is a vinca alkaloid. Alkylating medications are cell cycle phase nonspecific. Vinca alkaloids are cell cycle phase specific. Combinations of medications are used to enhance tumoricidal effects. Use of combination medications decreases medication resistance, increases destruction of cancer cells, and reduces medication toxicity. This combination does cause alopecia and gastrointestinal side effects.

The nurse is caring for a client receiving chemotherapy and determines that the client has developed myelosuppression. Which laboratory value would support the client's diagnosis of myelosuppression?

Hemoglobin 9.4 g/dL, hematocrit 26% Rationale:The client has been diagnosed with myelosuppression, which is bone marrow depression. The correct option is the hemoglobin and hematocrit, which is decreased. Hemoglobin is the main component of erythrocytes. Hematocrit represents red blood cell mass and is an important measurement in the identification of blood abnormalities. Red blood cells are produced in the bone marrow. BUN and creatinine address renal function. Protein levels address the amount of albumin in serum and low levels reflect decreased functioning by the liver and/or poor protein intake. These other laboratory values are within normal range.

The nurse is reinforcing information regarding chemotherapy with a client who has been diagnosed with cancer. The nurse tells the client that which is an advantage of continuous intravenous (IV) chemotherapy?

It uses smaller doses to kill cancer cells, so it is less toxic to normal tissues. Rationale:Continuous IV chemotherapy may be done over a period of hours, days, or weeks. A distinct advantage is that it exposes a tumor constantly to a small medication dose, which allows tumor cells to be killed while having fewer toxic effects to normal tissues. The cost and duration of therapy depend on the individual situation. The side effects depend on the agents used.

A client with carcinoma is admitted to the hospital for a chemotherapy treatment with intravenous bleomycin sulfate. The plan of care mentions observing for interstitial pneumonitis as the priority of care. Which finding most closely correlates to symptoms of interstitial pneumonitis and requires reporting?

Lung wheezing and shortness of breath Rationale:Bleomycin sulfate is an antineoplastic medication that can cause interstitial pneumonitis that can progress to pulmonary fibrosis. Pulmonary function studies along with hematologic, hepatic, and renal function tests need to be monitored. The nurse needs to monitor the respiratory status for dyspnea and wheezes that indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Productive cough is symptomatic of bacterial pneumonia. Distended neck veins and pink, frothy sputum are symptoms of heart failure. A barking cough is not a symptom of interstitial pneumonitis.

A client with acute nonlymphocytic anemia receives treatment with cytarabine. The nurse reinforces medication instructions to the client and tells the client that it is important to report which adverse effect to the primary health care provider?

Sore throat Rationale:The major adverse effect of cytarabine is bone marrow depression resulting in hematological toxicity. Signs of hematological toxicity include fever, sore throat, signs of local infection, easy bruising, or unusual bleeding from any site. If these signs occur, the primary health care provider (PHCP) is notified. Anorexia, nausea, and a transient headache can occur as side effects of the medication but do not necessarily warrant PHCP notification unless they are persistent.