A nurse is caring for a client who has lung cancer and is receiving bleomycin, an antineoplastic antibiotic, as part of chemotherapy. The nurse should assess the client for which of the following signs and symptoms that indicate pulmonary fibrosis?

Choice A reason: Cough, dyspnea, and crackles are signs and symptoms of pulmonary fibrosis, which is a serious and potentially fatal adverse effect of bleomycin, an antineoplastic antibiotic that inhibits DNA synthesis in cancer cells. Pulmonary fibrosis is a condition that causes scarring and thickening of the lung tissue, which reduces the lung's ability to exchange oxygen and carbon dioxide. The client should be monitored for pulmonary function tests and chest xrays before and during treatment with bleomycin, and the drug should be discontinued if pulmonary fibrosis develops.

Choice B reason: Nausea, vomiting, and diarrhea are not signs of pulmonary fibrosis, but may occur as common side effects of bleomycin and other chemotherapy drugs. The nurse should provide antiemetic drugs, fluids, and electrolytes to prevent dehydration and electrolyte imbalance in the client.

Choice C reason: Fever, chills, and sore throat are not signs of pulmonary fibrosis, but may indicate infection, which is a risk factor for clients receiving chemotherapy. Chemotherapy drugs can suppress the immune system and make the client more susceptible to infections. The nurse should monitor the client's temperature, white blood cell count, and cultures, and administer antibiotics as prescribed.

Choice D reason: Jaundice, dark urine, and claycolored stools are not signs of pulmonary fibrosis, but may indicate liver damage, which is another possible adverse effect of bleomycin. Bleomycin can cause hepatotoxicity, which is toxicity to the liver cells that can impair the liver's function. The nurse should monitor the client's liver function tests, such as serum bilirubin, alkaline phosphatase, and transaminases, and report any abnormalities to the provider.

Choice A reason: Blocking the estrogen receptors on the cancer cells and inhibiting their growth is the mechanism of action of tamoxifen, a selective estrogen receptor modulator (SERM) that is used to treat breast cancer. Tamoxifen is not effective for prostate cancer, which is stimulated by testosterone, not estrogen.

Choice B reason: Stimulating the production of testosterone and increasing the sensitivity of the cancer cells to chemotherapy is not the mechanism of action of leuprolide, a hormone that is used to treat prostate cancer. Leuprolide does not increase testosterone, but decreases it. Increasing testosterone would worsen prostate cancer, not improve it.

Choice C reason: Suppressing the secretion of luteinizing hormone and reducing the level of testosterone is the mechanism of action of leuprolide, a gonadotropinreleasing hormone (GnRH) agonist that is used to treat prostate cancer. Leuprolide binds to the GnRH receptors in the pituitary gland and initially stimulates the release of luteinizing hormone (LH) and folliclestimulating hormone (FSH). However, with continuous administration, leuprolide desensitizes the receptors and inhibits the secretion of LH and FSH. This leads to a decrease in the production of testosterone by the testes, which reduces the growth of prostate cancer cells.

Choice D reason: Altering the metabolism of cortisol and inducing apoptosis of the cancer cells is not the mechanism of action of leuprolide, a hormone that is used to treat prostate cancer. Leuprolide does not affect cortisol, but testosterone. Cortisol is a glucocorticoid hormone that regulates stress response, inflammation, and metabolism. Apoptosis is a process of programmed cell death that can be triggered by some chemotherapy drugs, such as cisplatin and doxorubicin.