Report extravasation signs immediately: pain, burning, swelling, or no blood return at the IV site.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse is preparing and administering chemotherapy. Which action indicates the nurse needs further teaching on safe handling of hazardous antineoplastic drugs?
Answer: C. Safe handling of hazardous chemotherapy includes wearing chemotherapy-rated gloves and a gown, preparing drugs in a biological safety cabinet, using a closed-system transfer device, and keeping a spill kit available. Chemotherapy materials and contaminated waste must go in designated cytotoxic (hazardous) containers; discarding them in the regular trash is unsafe and indicates a need for further teaching.
Question 2 of 5
A client receiving chemotherapy has an absolute neutrophil count (ANC) of 480/microliter. Which precaution is most important?
Answer: A. An ANC below 500 indicates severe neutropenia and a high infection risk. Neutropenic precautions, including meticulous hand hygiene and avoiding crowds and fresh flowers, protect the immunocompromised client.
Question 3 of 5
A nurse spills a cytotoxic (chemotherapy) drug. The first action is to:
Answer: B. Use the chemotherapy spill kit and appropriate PPE, contain the spill, and follow the cytotoxic spill protocol; restrict the area and report it. Cleaning it with bare hands and regular supplies risks exposure.
Question 4 of 5
Which medication is on the 'high-alert' list requiring extra safeguards?
Answer: B. High-alert medications (heparin, insulin, opioids, concentrated electrolytes like potassium chloride, chemotherapy) carry heightened risk of harm and need independent double-checks. Acetaminophen is generally not high-alert.
Question 5 of 5
A vesicant chemotherapy drug leaks into the tissue (extravasation). The nurse FIRST:
Answer: B. Stop the infusion immediately and follow the extravasation protocol (leave the catheter to aspirate, notify, antidote per drug) — extravasation of a vesicant causes severe tissue damage.
Keep the streak going with more questions like these, each with a full rationale.
What is chemotherapy precautions?
Precautions protect both the patient from toxic side effects and the nurse/family from hazardous drug exposure. It matters because chemo agents are hazardous, vesicants can cause severe tissue damage, and bone marrow suppression creates infection and bleeding risk.
Key points to remember
- Bone marrow suppression causes neutropenia, thrombocytopenia, and anemia (the three big toxicities).
- GI effects include nausea, vomiting, mucositis/stomatitis, and diarrhea.
- Vesicant drugs cause severe tissue necrosis if they extravasate (leak from the vein).
- Alopecia, fatigue, and altered taste are common and distressing but reversible.
- Cytotoxic drugs are hazardous and present in the patient's body fluids for about 48 hours after a dose.
- Tumor lysis syndrome can follow rapid cell kill, causing hyperkalemia, hyperphosphatemia, and hyperuricemia.
Nursing priorities
- Wear personal protective equipment (chemo gown, double gloves) when handling drugs, spills, or body fluids.
- Monitor the IV site continuously for vesicants; if extravasation occurs, stop the infusion immediately and follow the antidote protocol.
- Implement neutropenic and bleeding precautions based on blood counts.
- Administer antiemetics before chemotherapy and provide gentle oral care for mucositis.
- Ensure hydration and monitor labs for tumor lysis syndrome and organ toxicity.
Labs & values
Patient teaching
- For about 48 hours after chemo, flush the toilet twice with the lid closed and wash hands well; handle body fluids carefully.
- Avoid crowds and sick contacts, take temperature daily, and report fever or bleeding promptly.
- Expect hair loss (it regrows), use a soft toothbrush for mouth soreness, and take antinausea medicine as prescribed.
Red flags: report now
- Report extravasation signs immediately: pain, burning, swelling, or no blood return at the IV site.
- Report a fever of 100.4 F (38 C) or higher in a neutropenic patient; it is a medical emergency.
- Report signs of tumor lysis syndrome or anaphylaxis during infusion (wheezing, hypotension, urticaria).
References
Clinical references for this topic
