# A nurse on an oncology unit prepares to administer an IV vesicant antineoplastic medication to an adult client. Which actions are appropriate? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=368577&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A nurse on an oncology unit prepares to administer an IV vesicant antineoplastic medication to an adult client. Which actions are appropriate? Select all that apply.

1

Complete the policy-required independent verification with qualified personnel, checking the client, drug, dose, route, rate, and treatment order

2

Use the prescribed vascular access; if a peripheral catheter is permitted, select a new catheter in a large, intact forearm vein and confirm patency and blood return

3

Wear double chemotherapy gloves and a chemotherapy-tested impermeable gown, adding eye, face, or respiratory protection for splash or inhalation risk

4

For suspected extravasation, stop the drug, leave the catheter for aspiration, and follow the agent-specific notification, antidote, and compress protocol

5

For the vesicant medication, choose a small distal hand or wrist vein because it is easy to inspect, and continue unless severe pain, swelling, or tissue discoloration develops

6

Place all antineoplastic medication tubing, syringes, personal protective equipment, and spill-cleanup materials in ordinary medical waste once administration is complete

## Explanation

Hazardous antineoplastic medications require trained personnel, a policy-defined independent verification, suitable vascular access, and exposure controls (Choices 1, 2, and 3). For a peripheral vesicant, avoid joints and small distal hand or wrist veins, use a recently placed catheter in a large intact vein when permitted, and check patency and blood return according to the medication and policy. Suspected extravasation requires stopping the drug while leaving the catheter available to aspirate residual medication and deliver an antidote when indicated; then follow the medication-specific compress and escalation protocol (Choice 4). Do not wait for severe injury before responding (Choice 5). Drug-contaminated supplies require designated hazardous-drug waste handling rather than ordinary medical waste (Choice 6).

## In-depth explanation

Hazardous Drug Handling (USP <800>/NIOSH)
1. PPE: chemotherapy-tested gown, double chemotherapy gloves, eye protection, respiratory protection (NIOSH-approved) per agent and route
2. Closed-system transfer device (CSTD) for compounding and administration
3. Chemotherapy spill kit immediately available; staff trained on cleanup
4. Yellow chemotherapy waste containers for ALL waste, PPE, tubing
5. Pregnant or breastfeeding staff: alternative assignment per policy

Vesicant Access
- Central line preferred for continuous/repeated vesicants
- Peripheral: large vein, proximal forearm, fresh IV site
- AVOID hand, wrist, antecubital fossa (limited tissue, tendons, joints)
- Confirm blood return before and during; monitor q30-60 min

Two-RN Verification (bedside)
- Order, drug name, dose (with calculation), route, rate, BSA
- Client identity (two identifiers)
- Informed consent for chemotherapy
- Recent labs (CBC, BMP, kidney/liver function per protocol)
- Anti-emetic premedication given

Extravasation Response
1. STOP infusion
2. LEAVE the catheter in place
3. Aspirate residual drug through the catheter
4. Notify provider; follow facility extravasation protocol
5. Antidote per agent (e.g., dexrazoxane for anthracyclines; hyaluronidase for vinca alkaloids; sodium thiosulfate for nitrogen mustards)
6. Cold compress for most vesicants; WARM for vinca alkaloids and oxaliplatin
7. Photograph site; mark border; reassess regularly
8. Document; report; refer to plastics if severe

Memory Tip
"PPE + Two-RN + Big-vein + Blood return; STOP-LEAVE-ASPIRATE-Antidote"

## Clinical scenario

Scenario
Oncology unit; IV vesicant chemotherapy for an adult client; nurse preparing safe administration.

Safety Bundle
1. Chemotherapy PPE + spill kit available
2. Two chemotherapy-trained RN bedside verification
3. Vesicant-appropriate access (central preferred; peripheral large proximal forearm)
4. Confirm blood return before and during
5. Extravasation response: STOP-LEAVE-ASPIRATE-NOTIFY-ANTIDOTE-COLD/WARM
6. Yellow chemotherapy waste container for all waste

Avoid
- Hand or wrist IV for vesicants
- Single-RN verification
- Discarding chemotherapy waste in regular bins
- Removing the catheter on extravasation (used to aspirate)

## Key concepts

- **Hazardous Drug Handling (USP <800> and NIOSH)** — Standards governing the safe handling of hazardous drugs (chemotherapy, hormone agents, monoclonal antibodies, immunosuppressants, etc.) to protect healthcare workers, clients, and the environment. Requirements include chemotherapy-rated PPE (gown, double gloves, eye and respiratory protection), closed-system transfer devices for compounding and administration, designated yellow chemotherapy waste containers, immediately available spill kits, trained staff, and alternative-duty options for pregnant or breastfeeding staff per facility policy.
- **Chemotherapy Extravasation Management** — Vesicant chemotherapy escape into surrounding tissue can cause severe tissue necrosis, tendon/nerve damage, and long-term disability. Recognition: pain, burning, swelling, redness, loss of blood return. Immediate response: STOP infusion, LEAVE the catheter in place, aspirate residual drug through the catheter, notify provider, follow agent-specific antidote (dexrazoxane for anthracyclines; hyaluronidase for vinca alkaloids; sodium thiosulfate for nitrogen mustards) and temperature (cold compress for most; WARM for vinca alkaloids and oxaliplatin), photograph and mark the site, and refer to plastics for significant injury.
- **Two-RN Chemotherapy Verification** — Chemotherapy is on the ISMP high-alert medication list. Standard practice requires verification by two chemotherapy-trained RNs at the bedside before initiation: the prescriber order; the drug name; the dose and the dose calculation (BSA, weight, kidney/liver adjustment); route; rate; client identity (two identifiers); informed consent; recent relevant labs (CBC, BMP, organ function); and pre-medications administered (anti-emetic, hydration, etc.). Documentation of this verification is mandatory.

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