CRNI Antineoplastic and Biologic Therapies 4 — Questions and Answers
Question 1: A patient receiving intrathecal methotrexate develops arachnoiditis. Which symptom cluster is most consistent with this complication?
- Fever, rash, and eosinophilia
- Headache, nuchal rigidity, and back pain (Correct answer)
- Peripheral neuropathy and foot drop
- Nausea, vomiting, and diarrhea
Correct answer: Headache, nuchal rigidity, and back pain
Intrathecal methotrexate-induced arachnoiditis presents with meningeal irritation signs including headache, nuchal rigidity, and back pain.
Question 2: When preparing to administer rituximab, the CRNI knows to premedicate with which combination to reduce infusion-related reactions?
- Ondansetron and dexamethasone
- Acetaminophen and diphenhydramine (Correct answer)
- Lorazepam and haloperidol
- Ranitidine and metoclopramide
Correct answer: Acetaminophen and diphenhydramine
Standard premedication before rituximab includes acetaminophen and diphenhydramine to blunt cytokine-mediated infusion reactions.
Question 3: A patient on capecitabine (Xeloda) reports painful redness and swelling of the palms and soles. The nurse identifies this as:
- Stevens-Johnson syndrome
- Hand-foot syndrome (palmar-plantar erythrodysesthesia) (Correct answer)
- Raynaud phenomenon
- Contact dermatitis
Correct answer: Hand-foot syndrome (palmar-plantar erythrodysesthesia)
Hand-foot syndrome (palmar-plantar erythrodysesthesia) is a hallmark toxicity of capecitabine characterized by painful erythema and swelling of palms and soles.
Question 4: Which laboratory value is the most critical to assess before administering a dose of methotrexate?
- Serum calcium
- Serum creatinine (Correct answer)
- Serum potassium
- Serum albumin
Correct answer: Serum creatinine
Renal function (serum creatinine) must be assessed before methotrexate because the drug is renally eliminated and impaired clearance leads to severe toxicity.
Question 5: A nurse is caring for a patient who received high-dose cisplatin 48 hours ago. Which electrolyte imbalance requires the most vigilant monitoring?
- Hypercalcemia
- Hypernatremia
- Hypomagnesemia (Correct answer)
- Hyperkalemia
Correct answer: Hypomagnesemia
Cisplatin causes renal tubular damage leading to significant magnesium wasting; hypomagnesemia is the most common and clinically significant electrolyte disturbance.
Question 6: Bevacizumab (Avastin) is contraindicated within how many weeks of major surgery due to impaired wound healing?
- 2 weeks
- 4 weeks (Correct answer)
- 8 weeks
- 12 weeks
Correct answer: 4 weeks
Bevacizumab should not be administered within 4 weeks of major surgery because its anti-VEGF mechanism impairs wound healing and increases bleeding risk.
Question 7: A patient receiving blinatumomab develops confusion, tremors, and difficulty speaking on day 3 of infusion. The nurse's priority action is:
- Administer diphenhydramine IV and slow the infusion
- Stop the infusion and notify the physician immediately (Correct answer)
- Obtain a STAT blood glucose level
- Place the patient in Trendelenburg position
Correct answer: Stop the infusion and notify the physician immediately
Neurologic toxicity (cytokine release syndrome-related CNS effects) from blinatumomab requires immediate infusion cessation and physician notification.
CRNI Antineoplastic and Biologic Therapies 4
A patient receiving intrathecal methotrexate develops arachnoiditis.
Which symptom cluster is most consistent with this complication?