Which baseline assessment should the nurse verify before treatment begins?
1Pulmonary function testing to establish a baseline for doxorubicin-induced pulmonary fibrosis
2Bone mineral density testing to measure the client's risk for anthracycline-related osteoporosis
3Left ventricular ejection fraction measured by echocardiography or a MUGA scan✓ Correct answer
4Cervical cytology testing to identify the client's risk for doxorubicin-associated cardiomyopathy
Explanation
Doxorubicin can cause cumulative, dose-related cardiomyopathy. Left ventricular function should be assessed before treatment and regularly during and after therapy, using a consistent method such as echocardiography or multigated acquisition scanning. Pulmonary function, bone density, and cervical cytology do not establish the baseline measure needed to monitor anthracycline cardiac toxicity.
Clinical reasoning Anthracycline exposure can injure myocardium and reduce systolic function, with risk increasing as cumulative dose rises. A pretreatment LVEF provides the comparison point for later changes.
Decision rule Before doxorubicin, verify baseline LVEF by echocardiogram or MUGA and continue serial assessment with the same method during and after treatment.
Scenario A client with breast cancer is scheduled to begin a doxorubicin-containing regimen. The client has no prior anthracycline exposure.
Doxorubicin cardiomyopathy — Dose-related myocardial injury from an anthracycline that can reduce left ventricular systolic function.
Left ventricular ejection fraction — The percentage of left ventricular blood volume ejected with each contraction, measured by echocardiography or MUGA.
Dexrazoxane — Cardioprotectant given before high-dose anthracycline to reduce cardiotoxicity.