Page 1364 - Saunders Comprehensive Review For NCLEX-RN

473. Answer: 4

Rationale: Bleomycin is an antineoplastic medication that can cause interstitial
pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies
along with hematological, hepatic, and renal function tests need to be monitored.
The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate
pulmonary toxicity. The medication needs to be discontinued immediately if
pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this
medication.
Test-Taking Strategy: Eliminate options 1 and 2 first because they are cardiac
related and are therefore comparable or alike. From the remaining options, use the
ABCs—airway, breathing, and circulation—to direct you to the correct option.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Analysis
Content Area: Pharmacology: Oncology Medications: Antitumor Antibiotics
Health Problem: Adult Health: Cancer: Laryngeal and Lung
Priority Concepts: Cellular Regulation; Clinical Judgment
Reference: Gahart, Nazareno, Ortega (2017), p. 183.

474. Answer: 2

Rationale: Busulfan can cause an increase in the uric acid level. Hyperuricemia
can produce uric acid nephropathy, renal stones, and acute kidney injury. Options 1,
3, and 4 are not specifically related to this medication.
Test-Taking Strategy: Focus on the subject, a specific laboratory value. It is
necessary to know the adverse effects associated with this medication. Recalling that
busulfan increases the uric acid level will direct you to the correct option.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Pharmacology: Oncology Medications: Alkylating
Health Problem: Adult Health: Cancer: Leukemia
Priority Concepts: Cellular Regulation; Clinical Judgment
Reference: Skidmore-Roth (2017), p. 178.

475. Answer: 4

Rationale: An adverse effect specific to etoposide is orthostatic hypotension.
Etoposide should be administered slowly over 30 to 60 minutes to avoid
hypotension. The client’s blood pressure is monitored during the infusion. Hair loss
occurs with nearly all antineoplastic medications. Chest pain and pulmonary fibrosis
are unrelated to this medication.
Test-Taking Strategy: Eliminate option 1 first, because this adverse effect is
associated with many of the antineoplastic agents. Eliminate options 2 and 3 next
because they are comparable or alike and are unrelated to etoposide. Note that the
question asks for the adverse effect specific to this medication. Correlate hypotension

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