OCC Administration & Safety Protocols 3 — Questions and Answers
Question 1: A patient's chemotherapy cycle requires dose reduction due to a creatinine clearance of 35 mL/min. Which agent most commonly requires renal dose adjustment?
- Vincristine
- Carboplatin (Correct answer)
- Paclitaxel
- Doxorubicin
Correct answer: Carboplatin
Carboplatin dosing is calculated using the Calvert formula based on creatinine clearance (GFR), making renal function a direct determinant of the dose.
Question 2: Which practice best prevents catheter-related bloodstream infections (CRBSIs) during chemotherapy administration via a central line?
- Wearing non-sterile gloves only for line access
- Using maximal sterile barrier precautions during line access (Correct answer)
- Changing the central line dressing every 24 hours regardless of condition
- Flushing the line with sterile water instead of normal saline
Correct answer: Using maximal sterile barrier precautions during line access
Maximal sterile barrier precautions—sterile gloves, gown, mask, cap, and large drape—are the evidence-based standard for preventing CRBSIs during line access.
Question 3: A nurse discovers a chemotherapy spill on a countertop. After donning PPE, what is the correct order for spill cleanup?
- Wipe up liquid, contain area, dispose, decontaminate surface
- Contain the spill, absorb the liquid, clean the area, decontaminate, dispose in hazardous waste (Correct answer)
- Dispose of the item, wipe with alcohol, remove PPE
- Absorb immediately without containing, then notify pharmacy
Correct answer: Contain the spill, absorb the liquid, clean the area, decontaminate, dispose in hazardous waste
The correct spill response sequence is: contain > absorb > clean > decontaminate > dispose in chemotherapy waste containers while wearing full PPE throughout.
Question 4: Which vesicant chemotherapy agent requires an antidote (dexrazoxane) if extravasation occurs?
- Fluorouracil (5-FU)
- Doxorubicin (anthracycline) (Correct answer)
- Cyclophosphamide
- Bleomycin
Correct answer: Doxorubicin (anthracycline)
Dexrazoxane (Totect) is the FDA-approved antidote specifically for anthracycline extravasation to prevent severe tissue necrosis.
Question 5: What is the purpose of using a luer-lock connection rather than a slip-tip connection for chemotherapy administration sets?
- It allows faster infusion rates
- It prevents accidental disconnection and drug spillage (Correct answer)
- It is required only for cytarabine infusions
- It reduces the risk of phlebitis at the IV site
Correct answer: It prevents accidental disconnection and drug spillage
Luer-lock connections are mandatory for chemotherapy tubing because they screw securely into place, preventing accidental disconnection and potential drug exposure.
Question 6: According to ASCO/ONS chemotherapy administration standards, a two-nurse independent double-check is required before giving which type of drug?
- Any antiemetic given with chemotherapy
- High-alert chemotherapy agents, particularly those with a narrow therapeutic index (Correct answer)
- All oral medications dispensed in the oncology clinic
- Antifungal prophylaxis given concurrently with chemotherapy
Correct answer: High-alert chemotherapy agents, particularly those with a narrow therapeutic index
High-alert chemotherapy drugs with narrow therapeutic indices require an independent double-check by a second qualified nurse to verify the five rights before administration.
Question 7: What minimum vein assessment criterion should be documented before initiating peripheral chemotherapy infusion?
- Vein visibility only
- Vein patency, blood return confirmation, and absence of infiltration signs (Correct answer)
- Patient-reported pain score at the site
- Vein size as measured by ultrasound
Correct answer: Vein patency, blood return confirmation, and absence of infiltration signs
Confirming patency, blood return, and absence of infiltration or phlebitis are all required before infusing any vesicant or irritant chemotherapy peripherally.
OCC Administration & Safety Protocols 3
A patient's chemotherapy cycle requires dose reduction due to a creatinine clearance of 35 mL/min.
Which agent most commonly requires renal dose adjustment?