The nurse is teaching a group of new graduates about the safety needs of the client receiving chemotherapy. Before administering chemotherapy, the nurse should:

1. A

   Administer bolus of IV fluid

2. B

   Administer pain medication

3. C

   Administer an antiemetic

4. D

   Allow the patient a chance to eat

Appeared in: RAK Nursing Officer - 2019

Explanation

• Chemotherapy frequently causes severe nausea and vomiting (CINV), a major safety concern that can lead to dehydration, electrolyte imbalances, malnutrition, and treatment refusal.
• Prophylactic (preventive) administration of antiemetic medications is the standard of care to manage and prevent CINV effectively.
• Guidelines recommend giving antiemetics 30 to 60 minutes before the chemotherapy infusion starts. This timing allows the medication to reach peak effectiveness before the emetogenic agents are introduced.
• Controlling CINV from the first cycle is crucial for improving the patient's quality of life and ensuring they can continue with their prescribed treatment plan.

Why Other Options Were Wrong

• Option A: Administering a bolus of IV fluid is not a universal pre-chemotherapy requirement for all patients.
• Option B: Pain medication is not a routine prophylactic measure before chemotherapy.
• Option D: While dietary considerations are important, allowing a patient to eat is not the primary safety intervention to prevent nausea and vomiting.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Prophylactic care and safety measures in chemotherapy administration in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Effective management of CINV is a core nursing competency in oncology. Uncontrolled CINV can lead to serious complications like dehydration, electrolyte imbalance, and esophageal tears, potentially requiring hospitalization and causing delays in cancer treatment.
• Nurses play a vital role in assessing the patient's risk for CINV based on the specific chemotherapy regimen, patient history, and other risk factors, ensuring the correct antiemetic protocol is followed.
• What if the patient is receiving a highly emetogenic drug like cisplatin and also has a history of anticipatory nausea? The nursing priority expands. The nurse must ensure both the standard antiemetic regimen and pre-hydration with IV fluids are administered, while also addressing the psychological component with non-pharmacological techniques (e.g., guided imagery, relaxation) and potentially an anxiolytic like lorazepam if prescribed.

How to Approach the Question

• First, identify the core of the question: it asks for a priority safety action to be taken before administering chemotherapy to a general patient.
• Next, consider the most common, predictable, and potentially severe side effects of chemotherapy. Nausea and vomiting are almost universally associated with many chemotherapy drugs.
• Evaluate each option to determine if it is a universal precaution or a situational intervention.
• Option A (IV bolus) is situational (for nephrotoxic drugs).
• Option B (Pain meds) is situational (for patients in pain).
• Option D (Eating) is a comfort measure, not a primary safety intervention.

Concept Tested & Keywords

• Concept Tested: Prophylactic care and safety measures in chemotherapy administration.
• Stem keywords: chemotherapy, safety needs, before administering
• Lead-in keywords: should

Question ID

QLIXilDV1IfWvUPA1afXJb

Copy ID

Reference Book

E6 Pharmacology Nursing Lilley 11e Part 3 pp. 91-93, 97-99, 107-109