CRNI Antineoplastic and Biologic Therapies 2 — Questions and Answers
Question 1: Which vesicant chemotherapy agent requires immediate intervention if extravasation occurs during IV infusion?
- Cyclophosphamide
- Doxorubicin (Correct answer)
- Methotrexate
- Bleomycin
Correct answer: Doxorubicin
Doxorubicin is a vesicant that can cause severe tissue necrosis if extravasation occurs, requiring immediate intervention including stopping the infusion and applying cold compresses.
Vesicant agents like doxorubicin (an anthracycline) cause significant tissue damage upon extravasation. Unlike irritants that cause local inflammation, vesicants can lead to tissue necrosis, blistering, and permanent damage. The nurse must stop the infusion immediately, aspirate residual drug, administer the antidote dexrazoxane if available, and apply cold compresses. Cyclophosphamide is classified as an irritant, while methotrexate and bleomycin are generally non-vesicants.
Question 2: When administering biologic response modifiers, which nursing assessment is MOST critical during the first 30 minutes?
- Blood pressure monitoring every 15 minutes
- Monitoring for anaphylactic reactions (Correct answer)
- Assessing urine output
- Checking blood glucose levels
Correct answer: Monitoring for anaphylactic reactions
Biologic agents such as monoclonal antibodies carry the highest risk of infusion reactions and anaphylaxis during the first 30 minutes of administration.
Biologic response modifiers, particularly monoclonal antibodies like rituximab and trastuzumab, carry a significant risk of infusion-related reactions including anaphylaxis. These reactions most commonly occur during the first infusion and within the first 30 minutes. The CRNI nurse must remain at the bedside during this critical window, monitoring for signs of hypotension, bronchospasm, urticaria, and angioedema. Emergency equipment and medications including epinephrine must be readily available.
Question 3: What is the recommended action when a patient receiving a cytotoxic infusion reports burning at the IV site?
- Slow the infusion rate and continue monitoring
- Stop the infusion immediately and assess the site (Correct answer)
- Apply a warm compress and continue the infusion
- Flush the line with normal saline and resume
Correct answer: Stop the infusion immediately and assess the site
Burning at the IV site during cytotoxic infusion suggests possible extravasation, requiring immediate cessation of the infusion and thorough site assessment.
Any complaint of burning, stinging, or pain at the IV insertion site during cytotoxic drug administration must be treated as a potential extravasation until proven otherwise. The INS Standards of Practice require the nurse to immediately stop the infusion, leave the needle in place, aspirate any residual drug, and notify the physician. Continuing the infusion or merely slowing the rate risks severe tissue damage, particularly with vesicant agents. Documentation should include the time symptoms began, the amount of drug infused, and all interventions performed.
Question 4: Which personal protective equipment (PPE) is required when handling antineoplastic agents according to current INS standards?
- Sterile gloves only
- Double chemotherapy-tested gloves, gown, and face shield (Correct answer)
- Standard exam gloves and mask
- Sterile gown and single pair of gloves
Correct answer: Double chemotherapy-tested gloves, gown, and face shield
Current standards require double gloving with chemotherapy-tested gloves, a protective gown, and face/eye protection when handling antineoplastic agents to prevent occupational exposure.
The INS Standards of Practice and NIOSH guidelines mandate comprehensive PPE when handling antineoplastic agents: double gloving with ASTM-tested chemotherapy gloves, a lint-free disposable gown with closed front and tight-fitting cuffs, and face/eye protection when there is risk of splashing. Standard exam gloves are insufficient as they may not provide adequate protection against hazardous drug permeation. PPE must be donned before handling and removed carefully to prevent self-contamination, with immediate handwashing afterward.
Question 5: A patient is prescribed a targeted therapy infusion. Which laboratory value should be monitored MOST closely during treatment?
- Serum calcium levels
- Complete blood count with differential (Correct answer)
- Serum albumin
- Prothrombin time
Correct answer: Complete blood count with differential
Targeted therapies frequently cause myelosuppression, making CBC with differential essential for monitoring neutropenia, thrombocytopenia, and anemia.
While targeted therapies are designed to be more specific than traditional chemotherapy, many still cause significant myelosuppression. The CBC with differential is the most critical monitoring parameter because it detects neutropenia (infection risk), thrombocytopenia (bleeding risk), and anemia. Treatment may need to be held or doses adjusted based on absolute neutrophil count. While other lab values are important in certain contexts, the CBC with differential directly impacts patient safety and treatment continuation decisions for most antineoplastic regimens.
Question 6: What is the maximum recommended time frame for use of a closed-system transfer device (CSTD) when preparing hazardous drugs?
- Use once and discard
- Within the beyond-use date specified by the manufacturer (Correct answer)
- Up to 24 hours after initial use
- Until the device shows visible damage
Correct answer: Within the beyond-use date specified by the manufacturer
CSTDs must be used within the manufacturer-specified beyond-use date to ensure containment integrity and prevent hazardous drug exposure.
Closed-system transfer devices (CSTDs) are engineered to prevent the release of hazardous drug vapor and aerosols during preparation and administration. Each manufacturer specifies a beyond-use date that accounts for the device's ability to maintain a sealed system. Using a CSTD beyond this date compromises containment and increases risk of occupational exposure. The CRNI must verify the device integrity before each use and follow manufacturer instructions precisely. Single-use devices must be discarded after one use, while multi-use devices follow the specified beyond-use timeframe.
CRNI Antineoplastic and Biologic Therapies 2
Which vesicant chemotherapy agent requires immediate intervention if extravasation occurs during IV infusion?