A nurse is caring for a patient who has undergone a kidney transplant and is receiving cyclosporine as part of their immunosuppressive therapy.
Which of the following should the nurse include in the care plan? Select all that apply.

Choice A rationale

Extravasation of vesicant chemotherapy agents triggers immediate cellular damage and localized inflammatory responses. Stopping the infusion prevents further tissue exposure to toxic compounds that cause necrosis. Notification of the provider is essential to initiate specific antidote protocols or surgical consultation. Physical assessment determines the extent of the injury, which is critical for documentation and intervention planning. This priority action minimizes long term morbidity and functional loss at the peripheral or central venous access site.

Choice B rationale

Antiemetics are pharmacological agents used to manage chemotherapy induced nausea and vomiting by blocking neurotransmitters like serotonin or dopamine in the chemoreceptor trigger zone. While supportive care is important during oncological treatment, administering these medications does not address the acute mechanical or chemical injury occurring at the intravenous site. Continuing the infusion while the patient reports pain and swelling would exacerbate tissue destruction and potentially lead to compartment syndrome or permanent nerve damage.

Choice C rationale

Continuing a chemotherapy infusion when signs of infiltration or extravasation are present violates safety standards and increases the volume of vesicant in the interstitial space. Warm compresses are contraindicated for certain chemotherapeutic agents, such as vinca alkaloids, because heat can increase local blood flow and spread the toxic drug further into surrounding tissues. Initial management must prioritize cessation of the causative agent rather than symptom masking through thermal applications which might worsen the chemical burn.

Choice D rationale

Aspiration of residual drug from the cannula is a recognized component of extravasation management, but it must never be performed while the infusion is active. Attempting to aspirate without stopping the pump allows the machine to continue forcing fluid into the subcutaneous tissue under pressure. The sequence of nursing actions must always begin with stopping the flow of the hazardous substance to limit the radius of the injury before attempting to remove the fluid.

Choice A rationale

Metastasis is a defining characteristic of malignancy, not benignancy. Benign tumors remain localized to their site of origin and do not possess the genetic mutations or enzymatic capabilities, such as collagenase production, required to breach basement membranes and enter the lymphatic or circulatory systems. Scientifically, the absence of secondary tumor deposits in distant organs is a key diagnostic factor that clinicians use when reviewing pathology reports and imaging to determine the severity of a neoplasm.

Choice B rationale

Undifferentiated cells and high mitotic activity are classic markers of malignant transformation, known as anaplasia. Benign tumors generally consist of well-differentiated cells that closely resemble the parent tissue from which they arose. Their mitotic index is typically low, meaning cells divide at a rate similar to normal tissue. In contrast, malignant cells exhibit pleomorphism, large hyperchromatic nuclei, and frequent, often abnormal, mitotic figures, which signify a loss of cellular regulation and aggressive growth patterns.

Choice C rationale

Benign tumors are characterized by high levels of cellular differentiation and the presence of a fibrous capsule. This encapsulation prevents the tumor from infiltrating surrounding healthy tissues, creating a clear surgical plane that facilitates complete excision. Histologically, these cells maintain the functional and structural characteristics of the original tissue. This lack of invasiveness distinguishes them from malignant tumors, which grow by expansion and infiltration, often lacking a defined border and making surgical removal significantly more complex.

Choice D rationale

Benign tumors are typically slow-growing and do not usually lead to rapid clinical deterioration unless they are located in a critical area, such as the brain, where they might increase intracranial pressure. Aggressive growth and systemic wasting, or cachexia, are hallmarks of malignant processes. Malignant cells compete with healthy cells for nutrients and oxygen, often leading to significant metabolic shifts and the eventual failure of organ systems. Benign growths are generally considered non-threatening regarding immediate survival.