# The oncology nurse reviews a follow-up note for a client receiving cyclophosphamide. Which findings require immediate follow-up? Highlight the findings associated with possible hemorrhagic cystitis.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=495000&lang=en  
> language: en  
> subject: Medication Administration  
> category: PPT

## Question

The oncology nurse reviews a follow-up note for a client receiving cyclophosphamide. Which findings require immediate follow-up? Highlight the findings associated with possible hemorrhagic cystitis.

Nurses' Notes
1410: The client received the third outpatient cyclophosphamide treatment two days ago. The morning weight is unchanged from the previous treatment visit. The client reports mild fatigue after walking to the kitchen. The oral mucosa is moist, and the small mouth ulcer from last week has healed. At 1330, the client noticed red urine with two small clots in the toilet. Appetite improved after the prescribed antiemetic was taken. The client says that urine was clear yellow earlier this week. During the call, the client describes suprapubic burning that becomes worse during urination. The temperature is 37.1 °C. The home pulse reading is similar to the usual resting value. The client reports drinking the fluids listed in the treatment plan. A routine blood count is scheduled for tomorrow morning at the infusion center. Since noon, the client has voided small amounts six times with a strong urge. The client denies flank trauma or a recent urinary procedure. The bowel movement today was soft and brown. The client can state when the next oncology appointment is scheduled. No nosebleed or gum bleeding is reported. The nurse reviews the medication list and confirms no new anticoagulant was started.

## Explanation

Visible blood in urine, painful suprapubic burning with urination, and frequent small voids require immediate follow-up. Cyclophosphamide metabolites can injure the bladder lining and cause hemorrhagic cystitis.

## In-depth explanation

Quick answer
Highlight red urine with clots, suprapubic burning during urination, and frequent small-volume voids. Together they indicate possible cyclophosphamide-related bladder injury.

Why this is correct
Cyclophosphamide is broken down into metabolites that leave the body in urine. Prolonged contact can irritate and damage the bladder lining, causing dysuria, urgency, and bleeding. Visible hematuria or a new cluster of urinary symptoms needs prompt evaluation before more medication is given.[2]

Easy analogy or mental picture
Think of an irritating chemical sitting in a sink. Flowing water and regular drainage reduce contact time, but red water and painful drainage suggest the surface is already injured. The sink image explains contact, not the full biology of cystitis.

Memory hook
Cyclophosphamide plus blood, burn, or frequent small voids means bladder alarm.

NCLEX decision rule
When a client receiving cyclophosphamide develops hematuria or new painful, frequent urination, think hemorrhagic cystitis and escalate before the next dose. Do not dismiss urinary bleeding as an expected treatment effect.

Why the other choices are wrong
Stable weight, a healed mouth, improving appetite, clear urine earlier in the week, an unchanged pulse, a scheduled laboratory visit, and mild fatigue without urinary symptoms do not establish the displayed bladder-toxicity pattern.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]DailyMed: Cyclophosphamide Tablets Prescribing InformationU.S. National Library of Medicine

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