# During peripheral doxorubicin infusion, a client develops new burning and stinging, localized erythema, a 3 cm area of swelling, and a high-pressure pump alarm at the IV site. Blood return remains present on gentle aspiration; temperature is 36.9 C and the client has no dyspnea. Classify each finding by what it supports in this clinical situation. More than one column may apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=513943&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

During peripheral doxorubicin infusion, a client develops new burning and stinging, localized erythema, a 3 cm area of swelling, and a high-pressure pump alarm at the IV site. Blood return remains present on gentle aspiration; temperature is 36.9 C and the client has no dyspnea. Classify each finding by what it supports in this clinical situation. More than one column may apply.

|  | Supports suspected extravasation | Does not exclude extravasation | Does not explain the local event |
| --- | --- | --- | --- |
| New burning with erythema and swelling at the infusion site |  |  |  |
| New high-pressure alarm during the infusion |  |  |  |
| Blood return remains present on gentle aspiration |  |  |  |
| Temperature 36.9 C and no dyspnea |  |  |  |

## Explanation

Local burning, erythema, swelling, and pressure resistance support extravasation. Blood return does not exclude it, while stable systemic findings do not determine local tissue safety.

## In-depth explanation

Quick answer
Separate cues that support extravasation from cues that merely fail to exclude it.

Why this is correct
The doxorubicin label warns that extravasation may be present with blood return. Local symptoms and infusion resistance therefore carry more weight than a reassuring aspiration finding.

Easy analogy or mental picture
Sort the clues into signal, non-exclusion, and unrelated background instead of averaging them together.

Memory hook
Local vesicant cues outweigh one reassuring line check.

NCLEX decision rule
Analyze what each finding can prove. A cue that does not rule out harm is not evidence that the site is safe.

Why the other choices are wrong
Normal oxygenation and temperature do not explain the local change, and blood return cannot be used as a veto against the other findings.References
1DailyMed: Doxorubicin Hydrochloride InjectionExtravasation recognition and immediate discontinuation
2ONS/ASCO Antineoplastic Extravasation GuidelineEvidence-based antidote, thermal care, and escalation framework

## Clinical scenario

Doxorubicin extravasation cue weighting
Distinguish local evidence of vesicant escape from findings that do not exclude extravasation or do not explain the local event.

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