# A client develops severe diarrhea, mucositis, neutropenia, and neurotoxicity during the first treatment cycle of capecitabine. Which action is the priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522890&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client develops severe diarrhea, mucositis, neutropenia, and neurotoxicity during the first treatment cycle of capecitabine. Which action is the priority?

## Option

1. Reassure the client that first-cycle toxicity is expected.
2. Give the next dose with an antidiarrheal drug.
3. Hold capecitabine and notify the oncology team urgently about possible severe fluoropyrimidine toxicity or DPD deficiency. **✔ Correct answer**
4. Wait until the next scheduled cycle review.

**Correct answer: 3**

## Explanation

Acute early-onset or unusually severe toxicity can indicate complete or near-complete dihydropyrimidine dehydrogenase deficiency. Further exposure can be fatal and requires immediate interruption and evaluation.

## In-depth explanation

Quick answer
Treat early multisystem capecitabine toxicity as a stop signal.

Why this is correct
Supportive treatment does not make continued fluoropyrimidine exposure safe while severe toxicity is being evaluated.

Easy analogy or mental picture
Build a medication-safety chain: identify the new cue, connect it to the drug mechanism or labeled limitation, stop preventable exposure, stabilize the client, and verify a measurable response.

Memory hook
Drug, urgent cue, protective action, and reassessment endpoint.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving indicated treatment and required monitoring.

Why the other choices are wrong
Options that continue a suspect exposure, normalize a labeled danger cue, substitute an unauthorized dose, or delay escalation leave the client at risk.References
1DailyMed: Capecitabine TabletsDPD deficiency and early severe or fatal fluoropyrimidine toxicity

## Clinical scenario

Medication-safety review
Verify indication, current assessment, dose and route, organ function, interactions, urgent toxicity cues, authorized action, and measurable follow-up.

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