# The oncology nurse reviews the record before the next infusion. Which findings require immediate follow-up? Highlight the findings associated with possible bleomycin pulmonary toxicity.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=556756&lang=en  
> language: en  
> subject: Medication Administration  
> category: PPT

## Question

The oncology nurse reviews the record before the next infusion. Which findings require immediate follow-up? Highlight the findings associated with possible bleomycin pulmonary toxicity.

Nurses' Notes
0810:
The client arrives for the fourth cycle of a chemotherapy regimen that includes bleomycin. Previous infusions were completed without an acute hypersensitivity reaction or respiratory complaint. The client reports a dry cough that began five days ago and now wakes the client at night. The client also reports shortness of breath while walking from the parking area to the clinic. Mild nausea occurs on the first day after treatment and improves with the prescribed antiemetic. The nurse notes fine crackles at both posterior lung bases that were not documented at the previous visit. The oral temperature is 37.2 °C, and the client denies fever, chills, or recent sick contacts. The client has stable darkening of the skin over the elbows since the second cycle. Hair thinning is unchanged from the prior assessment and the scalp remains intact. Pulse is 96/min and respirations are 22/min at rest. Room-air oxygen saturation has decreased from a baseline of 98% to 92% today. The client reports a small mouth sore that healed three days ago. Weight is unchanged, and there is no new lower-extremity swelling or calf tenderness. The client says fatigue improves after resting in the afternoon. The nurse delays releasing the infusion and contacts the oncology provider with the respiratory assessment.

## Explanation

New dry cough, exertional dyspnea, fine crackles, and declining oxygen saturation can indicate bleomycin lung injury. Hold routine progression and escalate the pulmonary changes for evaluation.

## In-depth explanation

Quick answer
The urgent cluster is a new dry cough, shortness of breath with light activity, fine bibasilar crackles, and a fall in oxygen saturation. These findings fit possible bleomycin-related pneumonitis and require evaluation before more drug is given.

Why this is correct
Bleomycin can inflame lung tissue and may progress to pulmonary fibrosis. Dyspnea is an early symptom and fine rales are an early sign; pulmonary changes warrant stopping treatment while the cause is evaluated.[1] The trend matters because the respiratory findings are new.

Easy analogy or mental picture
Imagine a soft sponge becoming stiff and harder to expand. The sponge is the lung and the increasing effort is the client's dyspnea. This picture explains the warning pattern but does not diagnose fibrosis without assessment.

Memory hook
Bleomycin plus breath change: pause and check the lungs.

NCLEX decision rule
When a client receiving bleomycin develops a new cough, dyspnea, crackles, or lower oxygen saturation, think pulmonary toxicity; assess respiratory status and notify the oncology team before the next dose.

Why the other choices are wrong
Mild nausea controlled by medication, stable skin darkening, hair thinning, a healed mouth sore, and unchanged weight may still need supportive care. They do not form the new respiratory cluster targeted by this item.References

- [1]DailyMed: Bleomycin Sulfate InjectionU.S. National Library of Medicine

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

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