CRNI Antineoplastic and Biologic Therapies Questions and Answers 1 — Questions and Answers
Question 1: A patient receiving a first-time infusion of rituximab develops facial flushing, chills, and rigors 30 minutes into the infusion. What is the CRNI's PRIORITY action?
- Increase the infusion rate to complete the therapy faster.
- Obtain a full set of vital signs and continue to monitor.
- Stop the infusion and notify the provider immediately. (Correct answer)
- Administer acetaminophen and diphenhydramine as per protocol.
Correct answer: Stop the infusion and notify the provider immediately.
Infusion-related reactions are common with monoclonal antibodies like rituximab, especially during the first dose. The priority nursing action is to immediately stop the infusion to prevent the reaction from worsening. After stopping the infusion, the nurse should assess the patient, including vital signs, and then notify the provider for further orders, which may include administering medications and restarting the infusion at a slower rate once symptoms resolve.
Question 2: According to OSHA and Oncology Nursing Society (ONS) guidelines, which of the following represents the minimum required personal protective equipment (PPE) for a nurse administering an intravenous push (IVP) of a hazardous antineoplastic drug?
- One pair of gloves and a disposable gown.
- A fluid-resistant gown and a surgical mask.
- Two pairs of chemotherapy-tested gloves, a disposable, coated gown, and a face shield. (Correct answer)
- A fit-tested N95 respirator and safety goggles.
Correct answer: Two pairs of chemotherapy-tested gloves, a disposable, coated gown, and a face shield.
Administering IV push chemotherapy carries a high risk of splashing and exposure. Guidelines from OSHA, USP <800>, and ONS mandate comprehensive PPE. This includes two pairs of gloves tested for use with chemotherapy, a disposable gown made of a low-permeability fabric (e.g., polyethylene-coated), and eye and face protection, such as a face shield or goggles with a mask.
Question 3: A patient receiving a peripheral infusion of vincristine complains of burning at the IV site. The CRNI suspects extravasation. Which of the following interventions is critical for managing this specific type of extravasation?
- Applying a cold compress to promote vasoconstriction.
- Administering dexrazoxane as the indicated antidote.
- Vigorously massaging the area to disperse the drug.
- Applying warm compresses and administering hyaluronidase. (Correct answer)
Correct answer: Applying warm compresses and administering hyaluronidase.
The management of vesicant extravasation is drug-class specific. For vinca alkaloids, such as vincristine, the standard of care is to apply warm compresses to cause vasodilation and help disperse the drug. The specific antidote is the enzyme hyaluronidase, which is injected subcutaneously around the site to break down connective tissue and further aid in drug dispersal. Cold compresses are contraindicated as they can worsen tissue damage from vinca alkaloids.
Question 4: A patient receiving the immune checkpoint inhibitor pembrolizumab reports a new onset of profuse, watery diarrhea two weeks after their third infusion. The CRNI should recognize this as a potential sign of which common immune-related adverse event (irAE)?
- Cytokine release syndrome.
- Immune-mediated colitis. (Correct answer)
- A Type 1 hypersensitivity reaction.
- Drug-induced pancreatitis.
Correct answer: Immune-mediated colitis.
Immune checkpoint inhibitors work by enhancing the body's immune response against cancer, but this can also lead to the immune system attacking healthy organs, causing immune-related adverse events (irAEs). Colitis, or inflammation of the colon, is one of the most common irAEs and typically presents with diarrhea, which can be severe. This adverse event often has a delayed onset, occurring weeks to months after starting therapy.
Question 5: A CRNI is preparing to administer doxorubicin. Which of the following baseline assessments is MOST critical to review before initiating therapy due to this agent's primary dose-limiting toxicity?
- Pulmonary function tests.
- An echocardiogram or MUGA scan. (Correct answer)
- A peripheral nerve conduction study.
- Serum creatinine and BUN.
Correct answer: An echocardiogram or MUGA scan.
Doxorubicin, an anthracycline, is well known for its significant risk of causing cumulative, dose-related cardiotoxicity, which can lead to irreversible congestive heart failure. Therefore, it is a standard of care to assess the patient's baseline cardiac function, specifically the left ventricular ejection fraction (LVEF), using an echocardiogram or a MUGA scan before starting treatment and to monitor it periodically.
Question 6: A patient is scheduled to receive both paclitaxel and trastuzumab on the same day for HER2-positive breast cancer. To ensure patient safety and therapeutic efficacy, what is the standard administration sequence for these agents?
- Administer paclitaxel first, followed by trastuzumab. (Correct answer)
- Administer both drugs concurrently using a Y-site connection.
- Administer trastuzumab first, followed by paclitaxel.
- The order of administration does not impact safety or efficacy.
Correct answer: Administer paclitaxel first, followed by trastuzumab.
When paclitaxel and trastuzumab are administered in the same session, the standard practice is to infuse paclitaxel first. This sequencing allows the nurse to monitor for and manage a potential hypersensitivity reaction to paclitaxel before administering trastuzumab, which also carries a risk of infusion reaction. Confusing the symptoms of two potential reactions is avoided with this sequence.
CRNI Antineoplastic and Biologic Therapies Questions and Answers 1
A patient receiving a first-time infusion of rituximab develops facial flushing, chills, and rigors 30 minutes into the infusion.
What is the CRNI's PRIORITY action?