A client received high-dose methotrexate 24 hours ago. The nurse notes urine pH 6.5 and methotrexate level still elevated. Which is the priority nursing intervention?

• 1 Stop the leucovorin rescue and immediately administer activated charcoal to enhance methotrexate elimination.
• 2 Decrease the IV hydration rate to avoid fluid volume excess because the methotrexate level is still elevated.
• 3 Prepare the client for urgent hemodialysis to rapidly decrease the elevated methotrexate level and prevent toxicity.
• 4 Continue scheduled leucovorin rescue and ensure aggressive IV hydration with sodium bicarbonate to maintain urine pH >7.0 ✓ Correct answer

For study reference only. Always follow current clinical guidelines and your institution’s protocols.