A client with Hodgkin’s disease is scheduled for a cyclophosphamide (Cytoxan) infusion. Which of the following manifestations causes the nurse the most concern? ? A. Blood in the urine ? B. Reports of a feeling of nausea ? C. White patches on the tongue ? D. Client weight gain

Cyclophosphamide is a chemotherapy drug used to treat different types of cancer, including Hodgkin's disease. It works by suppressing the immune system and stopping the growth of cancer cells. Common side effects of cyclophosphamide include nausea, vomiting, loss of appetite, and temporary hair loss. Serious side effects may include infections, bleeding, kidney problems, and severe allergic reactions.

A. Blood in the urine: Cyclophosphamide can cause kidney problems, and blood in the urine is a potential sign of kidney damage or a urinary tract problem. This manifestation is concerning and requires further evaluation. B. Reports of a feeling of nausea: Nausea is a common side effect of cyclophosphamide, but it is typically manageable with anti-nausea medications. While it's essential to address, it's generally not as concerning as some other side effects. C. White patches on the tongue: This manifestation could indicate an oral infection, such as oral thrush, which is a fungal infection. It is a concerning symptom, and the patient may need treatment for this condition, but it does not typically pose a severe risk compared to some other potential side effects of the drug. D. Client weight gain: Weight gain is not a common side effect of cyclophosphamide. It could be related to other factors, such as fluid retention or changes in appetite. Although unusual, it is not the most critical concern among the options provided.

Among the manifestations listed, blood in the urine (Option A) is the most concerning as it could indicate kidney damage or a urinary tract problem. Such conditions can have severe consequences and require prompt attention and evaluation. The correct answer is A. Blood in the urine.