CRNI Antineoplastic and Biologic Therapies 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?

Accepted Answer

Stop the infusion and notify the provider immediately.

Answer

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?

Accepted Answer

Two pairs of chemotherapy-tested gloves, a disposable, coated gown, and a face shield.

Answer

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?

Accepted Answer

Applying warm compresses and administering hyaluronidase.

Answer

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)?

Accepted Answer

Immune-mediated colitis.

Answer

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?

Accepted Answer

An echocardiogram or MUGA scan.

Answer

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.

CRNI Exam Practice Test

CRNI Exam Practice Test

CRNI Antineoplastic and Biologic Therapies Questions and Answers