ONCC Chemotherapy Administration and Safety 2 — Questions and Answers
Question 1: A patient receiving cisplatin should receive which intervention BEFORE chemotherapy administration to reduce the risk of nephrotoxicity?
- Restrict IV fluids to prevent fluid overload
- Administer IV hydration with normal saline and ensure adequate urine output (Correct answer)
- Administer furosemide to increase urine concentration
- Give oral hydration of 2 glasses of water only
Correct answer: Administer IV hydration with normal saline and ensure adequate urine output
Aggressive IV hydration with normal saline before and after cisplatin is standard practice to dilute the drug in the kidneys and protect against nephrotoxicity.
Question 2: Which lab value is the MOST important to assess before administering methotrexate at high doses?
- Serum glucose
- Renal function (BUN and creatinine) (Correct answer)
- Serum potassium
- Liver enzymes only
Correct answer: Renal function (BUN and creatinine)
High-dose methotrexate is renally excreted; impaired kidney function causes drug accumulation leading to severe mucositis, myelosuppression, and organ toxicity.
Question 3: Leucovorin (folinic acid) rescue is given after high-dose methotrexate to:
- Increase the antitumor effect of methotrexate
- Reduce methotrexate levels in the cerebrospinal fluid
- Rescue normal cells from methotrexate toxicity by bypassing dihydrofolate reductase inhibition (Correct answer)
- Reverse renal failure caused by methotrexate
Correct answer: Rescue normal cells from methotrexate toxicity by bypassing dihydrofolate reductase inhibition
Leucovorin provides a reduced folate that bypasses the methotrexate-blocked enzyme dihydrofolate reductase, protecting normal cells from folate depletion toxicity.
Question 4: A patient on vincristine reports difficulty walking and tingling in the hands and feet. The nurse should recognize this as:
- Bone marrow suppression
- Peripheral neuropathy, a dose-limiting toxicity of vincristine (Correct answer)
- A sign of extravasation at the infusion site
- Hypercalcemia related to the malignancy
Correct answer: Peripheral neuropathy, a dose-limiting toxicity of vincristine
Vincristine causes peripheral neuropathy as its primary dose-limiting toxicity due to its mechanism of inhibiting microtubule formation in nerve cells.
Question 5: Before administering bleomycin, the nurse should assess for which pre-existing condition that represents an absolute contraindication?
- Hypertension
- Severe pulmonary dysfunction (Correct answer)
- Mild renal insufficiency
- History of peptic ulcer disease
Correct answer: Severe pulmonary dysfunction
Bleomycin causes pulmonary fibrosis and is contraindicated in patients with severe pre-existing pulmonary dysfunction because it can cause fatal respiratory compromise.
Question 6: The nurse is preparing cyclophosphamide IV. Which measure is MOST important to prevent hemorrhagic cystitis?
- Premedicate with allopurinol
- Administer mesna and ensure vigorous IV hydration (Correct answer)
- Monitor serum creatinine hourly
- Administer furosemide before the infusion
Correct answer: Administer mesna and ensure vigorous IV hydration
Mesna binds the toxic metabolite acrolein in the bladder and, combined with vigorous IV hydration to dilute urine, is the primary prevention for cyclophosphamide-induced hemorrhagic cystitis.
Question 7: When a patient is receiving 5-fluorouracil (5-FU) by continuous infusion and develops severe mucositis and hand-foot syndrome, which action should the nurse take FIRST?
- Increase the infusion rate to complete the dose faster
- Hold the infusion and notify the oncologist immediately (Correct answer)
- Apply ice to the affected areas and continue the infusion
- Administer additional antiemetics
Correct answer: Hold the infusion and notify the oncologist immediately
Severe mucositis and hand-foot syndrome are signs of 5-FU toxicity that require holding the infusion and immediate physician notification to prevent life-threatening complications.
ONCC Chemotherapy Administration and Safety 2
A patient receiving cisplatin should receive which intervention BEFORE chemotherapy administration to reduce the risk of nephrotoxicity?