ONCC Chemotherapy Administration and Safety 1 — Questions and Answers
Question 1: When administering a vesicant chemotherapy agent via peripheral IV, how often should the nurse assess the site for signs of extravasation?
- Every 4 hours
- Every 1-2 hours
- Before and after each shift
- Every 30 minutes during infusion (Correct answer)
Correct answer: Every 30 minutes during infusion
Vesicants require assessment every 30 minutes during infusion because extravasation can cause severe tissue necrosis and must be caught immediately.
Question 2: A nurse is preparing to administer doxorubicin. Which piece of personal protective equipment (PPE) is MOST essential according to NIOSH hazardous drug handling guidelines?
- Surgical mask only
- Single nitrile gloves
- Double chemotherapy-rated gloves and a closed-front gown (Correct answer)
- Standard latex gloves and paper gown
Correct answer: Double chemotherapy-rated gloves and a closed-front gown
NIOSH guidelines for hazardous drug handling require double chemotherapy-rated gloves and a closed-front impermeable gown to minimize skin absorption and contamination.
Question 3: Which action is the FIRST priority when a chemotherapy extravasation is suspected?
- Apply a warm compress to the site
- Stop the infusion immediately and disconnect the IV tubing (Correct answer)
- Notify the physician
- Administer the antidote subcutaneously
Correct answer: Stop the infusion immediately and disconnect the IV tubing
Stopping the infusion immediately and disconnecting the IV tubing without removing the needle limits further tissue damage from the vesicant agent.
Question 4: A patient is ordered paclitaxel. Before administration, the nurse should premedicate with which combination to prevent hypersensitivity reactions?
- Ondansetron, lorazepam, and haloperidol
- Dexamethasone, diphenhydramine, and an H2 blocker (Correct answer)
- Prednisone, acetaminophen, and famotidine
- Methylprednisolone and epinephrine
Correct answer: Dexamethasone, diphenhydramine, and an H2 blocker
Paclitaxel requires premedication with a corticosteroid (dexamethasone), an antihistamine (diphenhydramine), and an H2 blocker to prevent the hypersensitivity reactions caused by the Cremophor EL vehicle.
Question 5: Which of the following is the correct approach for handling a chemotherapy spill on the floor?
- Use paper towels to absorb the spill, then dispose in regular trash
- Don PPE, use a spill kit, clean from the outside in, and dispose in a yellow hazardous waste container (Correct answer)
- Call environmental services immediately and leave the area
- Dilute with large amounts of water and mop up
Correct answer: Don PPE, use a spill kit, clean from the outside in, and dispose in a yellow hazardous waste container
Chemotherapy spills require PPE, a designated spill kit, cleaning from the outside inward to contain the spill, and disposal in an approved hazardous waste container.
Question 6: The nurse is administering rituximab and the patient develops chills, fever, hypotension, and bronchospasm 30 minutes into the infusion. What is the MOST likely cause?
- Extravasation
- Tumor lysis syndrome
- Cytokine release syndrome (Correct answer)
- Anaphylaxis from the IV fluid
Correct answer: Cytokine release syndrome
These symptoms occurring during a monoclonal antibody infusion are classic signs of cytokine release syndrome (infusion-related reaction), commonly seen with rituximab.
Question 7: When checking a chemotherapy order for safety, which verification is MOST critical before administration?
- Confirming the patient's room number
- Verifying dose per body surface area or weight against the prescribed protocol (Correct answer)
- Checking the IV line label only
- Confirming the infusion pump is the correct brand
Correct answer: Verifying dose per body surface area or weight against the prescribed protocol
Verifying the dose against the patient's body surface area or weight and the protocol is the most critical safety check because chemotherapy overdoses can be life-threatening.
ONCC Chemotherapy Administration and Safety 1
When administering a vesicant chemotherapy agent via peripheral IV, how often should the nurse assess the site for signs of extravasation?