# A nurse is preparing to administer cyclophosphamide (Cytoxan) to a patient with breast cancer. Which safety precaution is the highest priority when handling this antineoplastic medication? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543519 > language: ko > subject: Pharmacology ## 문제 A nurse is preparing to administer cyclophosphamide (Cytoxan) to a patient with breast cancer. Which safety precaution is the highest priority when handling this antineoplastic medication? ## 보기 1. Wear double gloves, protective gown, and face shield when preparing and administering the medication **✔ 정답** 2. Monitor the patient's complete blood count before administration 3. Ensure adequate hydration by administering normal saline before the infusion 4. Verify the patient's identity using two identifiers before administration **정답: 1** ## 해설 Personal protective equipment (double gloves, gown, face shield) is the highest priority when handling cytotoxic medications like cyclophosphamide to prevent occupational exposure and health risks to healthcare workers. Other measures like CBC monitoring, hydration, and patient verification are important but secondary to staff safety. ## 심화 해설 Correct Answer: 1 Analysis of the Priority Safety Precaution When administering cyclophosphamide, an alkylating agent classified as an antineoplastic medication, the nurse's highest priority safety precaution is to wear double gloves, a protective gown, and a face shield during preparation and administration. This action directly addresses the principle of occupational safety and is the cornerstone of safe handling. The rationale for this priority is rooted in the inherent toxicity of these drugs. Antineoplastic agents like cyclophosphamide are designed to be cytotoxic; they are not selective and pose significant risks to healthcare workers through occupational exposure. The primary route of exposure is through direct skin contact and aerosol inhalation during drug preparation and administration. [1, 3] Research consistently identifies that the use of personal protective equipment (PPE) is the fundamental and most critical step in preventing both the acute and long-term health consequences of exposure, which include mutagenic, teratogenic, and carcinogenic effects. [2] Without this physical barrier, the nurse is directly vulnerable to the drug's hazardous properties. Therefore, donning appropriate PPE is the immediate, nurse-centric action that must be performed before any other step in the medication administration process to ensure a safe practice environment. Why Other Options Are Not the Highest Priority While the other options represent essential components of safe medication administration, they are secondary to the immediate physical protection of the healthcare provider from a known hazardous substance. - Option 2: Monitor the patient's complete blood count (CBC) before administration. Monitoring the CBC is a critical patient safety measure because cyclophosphamide causes myelosuppression, leading to neutropenia, thrombocytopenia, and anemia. A low absolute neutrophil count (ANC) or platelet count may necessitate holding the dose to protect the patient from infection or bleeding. However, this is a patient assessment parameter that is verified before physically handling the drug. The nurse's personal safety from the drug's cytotoxic effects is an even more fundamental and immediate concern that must be addressed first by donning PPE. [1, 2] - Option 3: Ensure adequate hydration by administering normal saline before the infusion. Ensuring adequate hydration is a key intervention to prevent hemorrhagic cystitis, a severe adverse effect caused by the acrolein metabolite of cyclophosphamide irritating the bladder mucosa. This is a crucial patient safety intervention, but it is a therapeutic action taken after the nurse has already prepared and is ready to administer the drug. The nurse's own protection from exposure must be established before initiating this step. - Option 4: Verify the patient's identity using two identifiers before administration. Verifying patient identity is a universal, non-negotiable patient safety protocol to prevent medication errors. It is a prerequisite for administering any medication. However, it does not address the unique and severe occupational hazard posed by antineoplastic drugs. The specific, high-priority safety precaution inherent to handling a hazardous drug like cyclophosphamide is the use of full-barrier PPE. [1, 4] The hierarchy of controls dictates that elimination of the hazard is ideal, but when that is not possible, as with essential chemotherapy, the use of PPE is the most direct personal control measure. In-Depth Clinical Reasoning and Evidence The consistent finding across global studies is that despite clear evidence of risk, adherence to safe handling precautions, particularly the consistent use of full PPE, remains suboptimal. Barriers frequently cited include a lack of training, a weak institutional safety culture, and inconsistent policies. [1, 2, 3] This underscores why the nurse's deliberate action to don PPE is the highest priority—it is the single most effective behavior to break the chain of exposure. An educational intervention study demonstrated that targeted training significantly improves nurses' knowledge, attitudes, and performance related to safe handling, directly linking knowledge of risk to the correct practice of using protective measures. [1, 3] Furthermore, a study on predictors of safe handling precautions found that factors like perceived risk and workplace safety climate directly influence a nurse's adherence to using PPE. [4] This confirms that the act of wearing double gloves and a gown is not just a task but a conscious clinical judgment that reflects an understanding of the drug's hazardous nature and the nurse's professional responsibility for self-protection. The hierarchy of safety for hazardous drugs starts with engineering controls (like a biological safety cabinet), but the final and most direct personal defense for the nurse at the point of care is the consistent and correct use of PPE. [2]References (research sources) - [2]Nurse compliance with personal protective equipment when handling chemotherapy: a multicenter cross-sectional study in Palestine.Research articleLama N, Saca-Hazboun H. (2026) · DOI: 10.1186/s12913-026-14132-x - [4]Predictor Factors Associated With Hazardous Drug Safe Handling Precautions Across a UK Oncology Nurse Sample and Implications for Novel Treatments.Research articleCampbell K, Dicksit D, Polovich M. (2025) · DOI: 10.1016/j.soncn.2025.151817 ## 임상 시나리오 Safe Handling of Antineoplastic AgentsProtecting the Nurse from Cytotoxic Exposure The highest priority when handling cyclophosphamide is personal protective equipment (PPE). Don double gloves, a protective gown, and a face shield before any drug preparation or administration. This creates a physical barrier against the primary routes of occupational exposure: direct skin contact and aerosol inhalation. These drugs are non-selective and cytotoxic. CautionExposure carries mutagenic, teratogenic, and carcinogenic risks. PPE must be worn from the moment the drug vial is handled until disposal is complete. ## 핵심 개념 - **Cyclophosphamide** — An alkylating agent antineoplastic medication that is cytotoxic and poses carcinogenic, mutagenic, and teratogenic risks to healthcare workers upon exposure. - **Personal Protective Equipment (PPE)** — Barriers such as double gloves, a protective gown, and a face shield used to prevent direct skin contact and aerosol inhalation of hazardous drugs. - **Occupational Exposure** — Contact with a hazardous substance in the workplace, which for antineoplastic drugs can occur via skin absorption or inhalation during preparation and administration. ## 같은 주제 문제 - [A nurse is caring for a patient receiving chemotherapy with vincristine. Which assessment …](https://mymerci.kr/pages/nclex_q.php?qn_id=543517) - [A nurse is caring for a patient receiving chemotherapy with cisplatin. 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